Background:The aim of this study was to evaluate maternal and perinatal outcomes of pregnant women affected by COVID-19 during the first pandemic wave in a third level university hospital of southern Italy. Methods:This was a single-center, cohort study on SARS-CoV-2 in pregnancy. Pregnant women with laboratory-confirmed SARS-COV-2 from August 1, 2020 to January 1, 2021 from University of Naples Federico II were included in the study. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was the incidence preterm birth.Results: 249 singleton pregnancies, positive to SARS-COV-2 at RT-PCR nasal and pharyngeal swab, were included in the study. Mean gestational age at diagnosis was 31.0 ± 6.7 weeks, with 2.4% of women being diagnosed in the first, 14.1% in the second and 83.5% in the third trimester of pregnancy. The vast majority of the women received therapy with low molecular weight heparin (88.8%). 47 women (18.9%) required oxygen therapy. The rate of admission to the maternal intensive care unit was 2.8%. There was one case of maternal death, accounting for a maternal mortality rate of 0.4%. Out of the 249 ended pregnancies, we reported two spontaneous abortions and two stillbirths. Among the 245 live-born babies, no neonatal deaths were recorded. All babies were tested negative at RT-PCR nasal and pharyngeal swab. The incidence of preterm delivery before 37 weeks was 10%.Conclusion: SARS-COV-2 infection in pregnant women during the first pandemic wave in the South of Italy was associated with relative low rates of maternal and perinatal adverse outcome.