SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study

Importance Georgia experienced an increase in maternal mortality (MM) during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation. Objective: This study aimed to assess associations between SARS-CoV-2 infection during pregnancy and MM, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery. Methods: We performed a national birth registry-based cohort study including pregnant women who delivered between February 28, 2020 and August 31, 2022. Data was linked with Coronavirus disease (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery, confirmed infection in the 30 days before or at delivery, and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs). Results: Among 111,278 pregnant women, 16,661 had confirmed infection during pregnancy; 7,304 were fully vaccinated against COVID-19. Compared to the reference group, those with confirmed infection in the 30 days before or at delivery experienced increased odds of MM (aOR: 45.5, 95% CI, 23.1–89.3), post-delivery ICU admission (aOR: 5.62, 95% CI, 4.37–7.22), and CS delivery (aOR: 1.12, 95% CI, 1.03–1.21). Conclusions: Hence, pregnant women in Georgia with confirmed SARS-CoV-2 infection in the 30 days before or at delivery conferred an alarmingly higher risk of MM and post-delivery ICU admission. Additionally, results highlight that most women were not vaccinated against COVID-19. These findings should signal to stakeholders that adherence to public health preventive measures needs to be improved.