COVID-19 Severity Among Non-Vaccinated Pregnant Women During the Delta Wave in Tunisia: A Retrospective Monocentric Study

Introduction: Pregnant women are vulnerable to SARS-CoV2 infection, particularly with the Delta variant. The aim of our study is to describe the COVID-19 syndrome among non-vaccinated pregnant women during the delta wave and to investigate risk factors for severe forms. Methods: In this study, we included all non-vaccinated pregnant women who tested positive for COVID-19 and who required hospital admission at any stage of gestation during the Delta wave in the maternity of Sfax, Tunisia. Patients were divided into 2 groups according to the mode of delivery in case of completed pregnancies and according to the severity of the disease. Severe COVID-19 is considered when the pregnant woman requires advanced oxygen support or intensive care unit referral. We performed univariate and multivariate logistic regression models to investigate the predictors of severe maternal outcomes among infected pregnant women. The significance level was set top ≤ 0.05. Results: one hundred patients were included. Severe adverse outcomes were observed in 23 patients (group1). The mortality rate during the Delta wave was 6%. The mode of delivery had not influenced the maternal and perinatal outcomes. Age >35 years old [OR 3.16, 95% CI 1.13- 8.84], BMI>30 kg/m2 [OR 2.63, 95% CI 1.0 -6.95], preeclampsia [OR 4.0, CI 95% 1.04- 15.32], dyspnea [OR 7.55, 95% CI 2.62- 21.7], cytolysis [ OR 4.6, 95% CI 1.48- 14.2], and lung injury in CT Scan > 50% [OR9.6, 95%CI 1.48-62.1] were significantly associated with an increased risk of severe maternal outcomes. Conclusions: During the delta wave in Tunisia, non-vaccinated pregnant women seem to be at higher risk of severe maternal outcomes and maternal deaths. The main risk factors for severe outcomes were age 35, obesity, preeclampsia, cytolysis, and severe lung damage in the CT scan.