Impact of COVID-19 Severity on Obstetric and Neonatal Outcomes: A Study of Pregnant Women in Albania

Background: SARS-CoV-2 infection during pregnancy has been associated with adverse maternal and neonatal outcomes, particularly in severe disease. However, evidence stratified by disease severity from Southeastern Europe remains limited. The aim of this study was to compare obstetric and neonatal outcomes between mild and severe COVID-19 among pregnant women managed in tertiary maternity hospitals in Tirana, Albania. Methods: A retrospective multicenter observational study was conducted between January 2020 and December 2022 in the two main tertiary maternity hospitals in Tirana. Pregnant or postpartum women with RT-PCR-confirmed SARS-CoV-2 infection were included. COVID-19 cases were classified as mild or severe according to clinical presentation and oxygen saturation. Maternal, obstetric, and neonatal outcomes were analyzed and multivariable logistic regression was used to evaluate associations between disease severity and selected outcomes. Results: A total of 270 pregnant women were included, of whom 212 (78.5%) had mild COVID-19 and 58 (21.5%) severe disease. The mean maternal age was 29.4 years and most infections occurred during the third trimester (80.8%). Severe COVID-19 was associated with significantly higher odds of NICU admission (aOR 2.87, 95% CI 1.36–6.05), Apgar score < 7 at 5 min (aOR 8.39, 95% CI 1.49–47.35), low birth weight (aOR 2.53, 95% CI 1.06–6.03), and emergency cesarean section (aOR 8.10, 95% CI 2.64–24.86). Maternal age, obesity, parity, and comorbidities were not significantly associated with the examined outcomes. Conclusions: Severe COVID-19 during pregnancy was associated with poorer neonatal condition at birth and increased obstetric intervention, highlighting the importance of close monitoring and coordinated obstetric–neonatal management in pregnancies complicated by severe SARS-CoV-2 infection.