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Objective To evaluate the relationship between the severity of coronavirus disease 2019 (COVID‐19) during pregnancy and the risk of adverse maternal outcomes. Methods A descriptive‐analytical cross‐sectional study conducted on 258 pregnant women who were hospitalized due to confirmed COVID‐19 from March 2020 to January 2021 at the Forghani Hospital in Qom, Iran. Demographic and obstetric characteristics, laboratory findings, and adverse maternal outcomes were recorded from the patients’ medical records. The Fisher exact test, one‐way analysis of variance, and regression logistics were used to assess the relationship between variables. Results Of the total study population, 206 (79.8%) pregnant women had mild to moderate disease, 43 (16.7%) had severe disease, and 9 (3.5%) were in the critical stage of the disease. Eight women (3.1%) died and 33 (12.8%) were admitted to the intensive care unit (ICU). The most important demographic factors associated with the severity of the disease were ethnicity, underlying conditions, maternal age, and parity. The severity of the disease was significantly associated with increased cesarean delivery and admission to the ICU. Conclusion Pregnant women with severe and critical disease had a high rate of cesarean delivery and admission to the ICU. There were eight cases of maternal mortality.

Our results showed that socioeconomic status and marital quality are the most important risk factors for disturbing mental health among Iranian pregnant women.