The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a major public health issue worldwide since Dec 2019. With the rising number of infected cases daily, concerns have been raised to generate comprehensive and extensive evidence about the effects of COVID-19 infection during pregnancy on maternal obstetric outcomes; this would provide guidance in obstetrician clinical management to reduce maternal mortality and morbidity. The aim is to evaluate the effects of COVID-19 on pregnancy and its maternal obstetrical outcomes. We searched four databases (PubMed, Embase, Scopus and Web of Science) by using medical subject heading and keywords under the PECO concept (P = Pregnant woman, E = COVID-19 infection, O = Obstetric outcome). The search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to identify relevant articles based on inclusion and exclusion criteria published from January 1st 2020 to June 20th 2021. The risk of bias of the selected articles was also assessed. We found that though most pregnant women experienced mild to moderate COVID-19 symptoms, the severity development was considered multifactorial, which included issues like maternal pre-gestational comorbidity and health status. The severe form of COVID-19 was linked to an increased BMI in women. Caesarean rates were higher in the COVID-19 positive cohort, especially if the women are experiencing severe COVID-19. An increased miscarriage rate was found in women infected with COVID-19 in the first trimester of pregnancy as compared to the second trimester. The rate of preterm delivery was also elevated among pregnant women who were suffering from severe-to-critical COVID- 19 disease. There were reports on maternal death secondary to acute respiratory distress syndrome from COVID-19 disease, but the percentage was low. We did not find any significant link between COVID-19 and intrauterine death and infection, hypertension in pregnancy, stillbirth and post- partum haemorrhage. COVID-19 positive pregnant women are at enhanced risk of preterm birth, obstetric complications and caesarean section delivery. This systematic review provided a comprehensive guide to obstetricians when managing a COVID-19 positive pregnancy.
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