Abstract Background Pregnant women are considered people at risk in the context of COVID-19 due to physiological changes in immunity, cardiopulmonary function, and metabolic status. These changes may increase susceptibility to infection and lead to progression to severe diseases. In particular, maternal comorbidities and pregnancy-related complications have been identified as potential risk factors for worsened clinical outcomes. However, data from low- and middle-income countries remain scarce, limiting the generalizability of global evidence to these findings. Indonesia, one of the most populous countries in Asia, had high maternal morbidity during the pandemic, yet few studies have focused on determinants of COVID-19 severity among pregnant women. Objective This study aimed to assess the association between maternal co-morbidities, pregnancy-related complications, and the severity of COVID-19 in a national maternal referral hospital. Materials and methods A retrospective observational study was conducted, involving 252 pregnant women with confirmed COVID-19 admitted to Harapan Kita Women and Children Hospital, Jakarta, between 2020 and 2022. COVID-19 severity was categorized as moderate or severe based on the World Health Organization (WHO) classification. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for associations between clinical variables and disease severity. Results Maternal comorbidities were significantly associated with severe COVID-19 (OR 3.2; 95% CI 1.08-9.26). Diabetes mellitus (DM) was the strongest independent predictor of severe disease (OR 5.0; 95% CI 1.28-19.88). Hypertension (OR 2.8; 95% CI 0.59-13.60) and preeclampsia (OR 1.2; 95% CI 0.40-3.75) were not statistically significant. These findings align with global reports that metabolic dysfunction exacerbates inflammation and immune dysregulation. Conclusions Comorbidities, particularly diabetes mellitus, significantly increase the risk of severe COVID-19 in pregnancy. Targeted screening and early intervention are essential, especially in resource-limited countries, in order to improve maternal outcomes.
Bur et al. (Sun,) studied this question.