Pregnancy Outcomes According to Gestational Timing of Maternal SARS-CoV-2 Infection: A Narrative Review

Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with heterogeneous pregnancy outcomes. This narrative review examines associations between the gestational timing of maternal SARS-CoV-2 infection and maternal, obstetric, fetal, and neonatal outcomes, including maternal well-being. The evidence base comprised English-language publications identified through PubMed/MEDLINE and relevant reference lists between January 2020 and September 2026. Timing-specific observational studies were prioritised, and findings were synthesised qualitatively because of methodological and clinical heterogeneity. Mild first-trimester infection is not consistently associated with pregnancy loss or impaired fetal growth. Large registry data do not show increased major congenital anomalies among live births, although a smaller prospective study reports a conflicting signal. Selected cohorts associate broader early- or midpregnancy exposure windows with stillbirth, but these windows do not isolate the first trimester. Evidence does not establish a trimester-specific preeclampsia gradient. Third-trimester and peripartum infection show the most consistent associations with preterm birth and acute maternal and neonatal morbidity, partly reflecting provider-initiated delivery and prematurity. Placental injury can contribute to fetal compromise without confirmed congenital infection; selected pathology series cannot estimate population risk. Congenital infection remains uncommon, and neonatal positivity alone does not establish intrauterine transmission. A small early-pregnancy cohort documents anxiety symptoms but cannot establish infection-attributable psychological risk. Different gestational exposure periods are associated with distinct outcome profiles, without demonstrating an independent timing effect or universal trimester-based gradient. Interpretation requires attention to severity, vaccination, variant period, healthcare access, and the interval between infection and delivery.