Background: Coronavirus disease 2019 (COVID-19) infection is associated with increased perinatal morbidity and mortality. Despite this, vaccination hesitancy among pregnant women remains to be a huge problem. In this study we aimed to evaluate COVID-19 vaccination safety and uptake in pregnancy, and to evaluate adverse perinatal outcomes associated with COVID-19 in pregnancy, compared with non-infected pregnant women. Methods: This is a retrospective single-institution cohort study of women who gave birth in 2021. The primary outcomes of the study were the safety of COVID-19 vaccination during pregnancy, and the comparison of perinatal outcomes in COVID-19 infected women during pregnancy group vs non-infected. The secondary outcomes included vaccine uptake rate, trimester evaluation of vaccination safety, and side effects. Results: Among 3620 deliveries, 1943 individuals who were vaccine eligible before delivery were included in the vaccine safety and uptake analysis. Out of 1943 pregnant women, 212 (10.9%) women received at least one dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine during pregnancy. 189 (89.2%) of them received BNT162b2 (Pfizer/BioNTech) and 23 (10.8%) CoronaVac (Sinovac). Following propensity score matching, no significant increase in emergency cesarean section (C-section) rates, intrapartum complications, stillbirth, congenital anomalies, maternal or neonatal intensive care unit (NICU) admissions were found in COVID-19 vaccinated group compared to the non-vaccinated (p > 0.05, for all). 436 women with a history of COVID-19 polymerase chain reaction (PCR) positivity during pregnancy were compared with 2972 women who tested negative. No overall significant adverse effects were identified due to COVID-19 infection during pregnancy. Perinatal outcomes were similar in both groups (p > 0.05, for all). In the subgroup analysis of 212 pregnant women vaccinated during pregnancy, NICU admission was lowest in the third trimester group (p 0.001). Antenatal vaccine uptake was higher among women with pregestational diabetes, hypothyroidism and autoimmune diseases compared to the overall vaccination rate (23%, 14%, 20.8% and 10.9% respectively). Conclusions: In this study, COVID-19 vaccination in pregnancy was not associated with significant adverse perinatal outcomes. Overall, COVID-19 infection was not associated with increased adverse perinatal outcomes. Our results should be confirmed in a bigger cohort in order to draw more definite conclusions.