Clinical Characteristics and Neonatal Outcomes of Pregnant Patients With COVID-19: A Systematic Review

Abstract

Background and Objective: Coronavirus disease 2019 (COVID-19) characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created serious concerns about its potential adverse effects. There are limited data on clinical, radiological, and neonatal outcomes of pregnant women with COVID-19 pneumonia. This study aimed to assess clinical manifestations and neonatal outcomes of pregnant women with COVID-19.Methods: We conducted a systematic article search of PubMed, EMBASE, Scopus, Google Scholar, and Web of Science for studies that discussed pregnant patients with confirmed COVID-19 between January 1, 2020, and April 20, 2020, with no restriction on language. Articles were independently evaluated by two expert authors. We included all retrospective studies that reported the clinical features and outcomes of pregnant patients with COVID-19.Results: Forty-seven articles were assessed for eligibility; 13 articles met the inclusion criteria for the systematic review. Data is reported for 235 pregnant women with COVID-19. The age range of patients was 25–40 years, and the gestational age ranged from 8 to 40 weeks plus 6 days. Clinical characteristics were fever [138/235 (58.72%)], cough [111/235 (47.23%)], and sore throat [21/235 (8.93%)]. One hundred fifty six out of 235 (66.38%) pregnant women had cesarean section, and 79 (33.62%) had a vaginal delivery. All the patients showed lung abnormalities in CT scan images, and none of the patients died. Neutrophil cell count, C-reactive protein (CRP) concentration, ALT, and AST were increased but lymphocyte count and albumin levels were decreased. Amniotic fluid, neonatal throat swab, and breastmilk samples were taken to test for SARS-CoV-2 but all found negativ results. Recent published evidence showed the possibility of vertical transmission up to 30%, and neonatal death up to 2.5%. Pre-eclampsia, fetal distress, PROM, pre-mature delivery were the major complications of pregnant women with COVID-19.Conclusions: Our study findings show that the clinical, laboratory and radiological characteristics of pregnant women with COVID-19 were similar to those of the general populations. The possibility of vertical transmission cannot be ignored but C-section should not be routinely recommended anymore according to latest evidences and, in any case, decisions should be taken after proper discussion with the family. Future studies are needed to confirm or refute these findings with a larger number of sample sizes and a long-term follow-up period.

Excretion of SARS-CoV-2 in breast milk: a single-centre observational study

“… 17 Islam et al did not find any evidence of vertical transmission from mother to her fetus. 18 The findings of our study support the WHO, UNICEF and CDC policy of advocating breast feeding by SARS-CoV-2-infected mothers. Our findings resemble a meta-analysis conducted by Islam et al .…”

“…Our findings resemble a meta-analysis conducted by Islam et al . 18 Chambers et al detected 1 of 18 samples of breast milk positive for SARS-CoV-2 by RT-PCR. 19 Martins-Filho analysed the presence of SARS-CoV-2 in the breast milk of pregnant woman with COVID-19 during the third trimester of pregnancy.…”

COVID-19 and the neonatal microbiome: will the pandemic cost infants their microbes?

“…16 C-sections are also higher in COVID-19 positive mothers who deliver prematurely and the relationship between COVID-19 infection and preterm birth remains unknown. 17,18 C-section delivery is a known risk factor for early life intestinal dysbiosis due to colonization of the newborn with a mixture of potentially pathogenic organisms found on skin and in the hospital, compared with colonization by Lactobacillus after a vaginal delivery. 19 Prior to the pandemic, a global rise in C-sections from 3% in 1990 to 6% in 2018 was a concern.…”

Covid-19 imaging: A narrative review

“… November 2020 European journal of radiology Systematic review and meta-analysis Brain CT and MRI Cerebral microhemorrhages Spontaneous acute ICH Acute/subacute infarct Encephalitis/encephalopathy 21 2125 >58 years 0.069 (0.049–0.089) 0.054 (0.031–0.076) 0.240 (0.160–0.318) 0.330 (0.019–0.047) <0.001 < 0.001<0.001 < 0.001 94 87 97 92 <0.001 <0.001 0.014 <0.001 Garg et al [ 65 ]. November 2020 Clinical Imaging Systematic review and meta-analysis Chest x-ray Chest CT Imaging findings GGO Consolidation Imaging findings GGO GGO + Consolidations Consolidation Crazy-paving Halo sign Nodule Pleural effusion Lymphadenopathy Diagnostic accuracy estimates GGO sensitivity/specificity GGO + Consolidation sensitivity/specificity Consolidation only sensitivity/specificity 56 5 6007 396 5762 2.1–70 0.387 (0.222–0.583) 0.469–0.297-0.649) 0.669 (0.608–0.724) 0.449 (0.387–0.513) 0.321 (0.236–0.419) 0.291 (0.196–0.408) 0.236 (0.117–0.418) 0.089 (0.057–0.138) 0.056 (0.042–0.074) 0.027 (0.013–0.055) 0.73(0.71–0.80)/0.61(0.41–0.78) 0.58(0.48–0.68)/0.58(0.41–0.73) 0.49(0.20–0.78)/0.56(0.30–0.78) 83 84 92 83 96 93 94 65 51 84 96/94 31/77 96/91 Islam et al [ 66 ]. December 2020 Frontiers in medicine.…”