Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review

Abstract

Purpose This systematic review summarizes the clinical features and maternal–infant outcomes of 230 pregnant women (154 patients gave birth) infected with COVID-19 and their 156 infants, including the possibility and evidence of vertical transmission. Methods An electronic search of PubMed, Embase, Medline, MedRxiv, CNKI, and the Chinese Medical Journal Full Text Database following PRISMA guidelines was performed through April 18, 2020. Search terms included COVID-19, SARS-CoV-2, pregnant women, infants, and vertical transmission. Results A total of 230 women with COVID-19 (154 deliveries, 66 ongoing pregnancies, and 10 abortions) and 156 newborns from 20 eligible studies were included in this systematic review. A total of 34.62% of the pregnant patients had obstetric complications, and 59.05% of patients displayed fever. Lymphopenia was observed in 40.71% of patients. A total of 5.19% of women received mechanical ventilation. Seven women were critically ill. One mother and two newborns died. A total of 24.74% of newborns were premature. Five newborns’ throat swab tests of SARS-CoV-2 were positive, all of which were delivered by cesarean section. For eight newborns with negative throat swab tests, three had both elevated IgM and IgG against SARS-CoV-2. Nucleic acid tests of vaginal secretions, breast milk, amniotic fluid, placental blood, and placental tissues were negative. Conclusion Most pregnant patients were mildly ill. The mortality of pregnant women with COVID-19 was lower than that of overall COVID-19 patients. Cesarean section was more common than vaginal delivery for pregnant women with COVID-19. Premature delivery was the main adverse event for newborns. The vertical transmission rate calculated by SARS-CoV-2 nucleic acid tests was 3.91%. Serum antibodies against SARS-CoV-2 should be tested more frequently, and multiple samples should be included in pathogenic testing.

Placental pathology in COVID-19 affected pregnant women: A prospective case-control study

“…Several authors suggest that COVID-19 may trigger a severe systemic inflammatory response, with consequent MVM caused by the SARS-CoV-2 infection derived-hypoxia [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. We also recently reported [ 32 ] evidence of an increased immune activation profile in SARS-CoV-2 positive subjects, with higher levels of cytokines and chemokines in placental tissue, maternal and funicular plasma.…”

“…The infection with SARS-CoV-2 has the potential to increase inflammatory and oxidative stress in the placenta, thus compromising both pregnancy evolution and fetal development [ 1 ]. Indeed, pregnancies complicated by SARS-CoV-2 infection have an increased risk of miscarriage, preterm birth, pre-eclampsia and stillbirth [ 2 , 3 , 4 ]. These pregnancy-related pathologies have long been known to be associated with an abnormal placental development.…”

Infants infected with SARS-CoV-2 and newborns born to mother diagnosed with COVID-19: clinical experience

“…A study states that delivery management should be determined according to medical indications and recommends vaginal delivery if there are no indications [ 11 ]. Furthermore, another study indicated that vertical SARS-CoV-2 transmission is all seen after cesarean delivery [ 12 ]. None of the babies delivered by cesarean were infected with SARS-COV-2.…”

Clinical Relevance of Covid-19 in the Second Half of Pregnancy

“…Albeit still limited, there is evidence that SARS-Cov-2 can cause life-threatening situations also in pregnancy, even if fatal cases seem rare [5][6][7][8][9]. However, this evidence was mainly drawn from case series or selected referral centers, a study design that could overestimate the detrimental effects of SARS-Cov-2.…”

“…The fatality rate varies widely in the literature (1-22%) and depends on the clinical phase of the disease, gender, age and predisposing conditions such as diabetes, hypertensive disorders and obesity [3,4]. Albeit still limited, there is evidence that SARS-Cov-2 can cause life-threatening situations also in pregnancy, even if fatal cases seem rare [5][6][7][8][9]. However, this evidence was mainly drawn from case series or selected referral centers, a study design that could overestimate the detrimental effects of SARS-Cov-2.…”