SARS-CoV-2, the novel coronavirus responsible for the global COVID-19 pandemic, affects individuals across all demographics. Pregnant women have been recognized as a vulnerable population for SARS-CoV-2 infection; however, data on the precise impact of COVID-19 in this group remain limited. To address this, we performed a systematic review summarizing maternal and fetal outcomes in pregnant women with SARS-CoV-2 infection, aiming to characterize obstetric patients based on the country of publication. Thirty-eight studies were included, encompassing 2,670 patients from seven countries, with China contributing 20 studies (52.6%). Significant differences were observed across countries in median maternal age, with Spain reporting the highest average age (34.6 years); smoking prevalence; proportion of symptomatic patients at triage; imaging modalities (with China and France performing CT scans universally, compared to chest X-rays in other countries); rates of cesarean delivery (83.9% in China versus 35.9% in Spain, p < 0.001); maternal mortality; proportion of patients requiring treatment; and the use of antivirals, antibiotics, and anticoagulants, as well as neonatal measurements. Overall, perinatal outcomes were favorable in most countries, with vertical transmission rates remaining very low. The reviewed studies demonstrated moderate to high quality. Most data reflect the first pandemic wave, indicating that SARS-CoV-2 infection in pregnant women generally presents with symptoms in the third trimester, often accompanied by risk factors such as advanced maternal age, elevated body mass index, and additional comorbidities developing during pregnancy. Cesarean delivery rates and prematurity were high, contributing to increased maternal and perinatal morbidity and mortality. Observed differences between countries may reflect regional patient profiles, the timing of pandemic waves influencing management strategies, and variations in local medical practices.
