Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

Abstract

Background Pregnant women represent a potentially high‐risk population in the COVID‐19 pandemic. Objective To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID‐19. Search strategy Relevant databases were searched up until May 29, 2020. Selection criteria Case series/reports of hospitalized pregnant women with laboratory‐confirmed COVID‐19. Data collection and analysis PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools. Main results Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory‐confirmed SARS‐CoV‐2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D‐dimer and interleukin‐6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID‐19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. Conclusions Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D‐dimer and interleukin‐6 levels are predictive of poor pregnancy outcomes in COVID‐19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.

Maternal and Neonatal Characteristics and Outcomes of COVID-19 in Pregnancy: An Overview of Systematic Reviews

“…After the application of the eligibility criteria, 39 studies were finally included [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], one (2.6%) of which was described as “rapid” [ 42 ] and two (5.1%) as “scoping” systematic reviews [ 30 , 50 ]. Thirteen (33%) of them also undertook a meta-analysis [ 14 , 16 , 18 , 19 , 24 , 25 , 27 , 36 , 38 , 40 , 48 ,…”

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

“…Since, several articles have reported that the possibilities of vertical transmission (37,38), highlighting the importance of long-follow up of newborns (39). To clarify the vertical transmission and neonatal outcomes due to SARS-CoV-2 infection; we further compared our findings with other recently published systematic review and meta-analyses (38,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Raschetti et al (38) evaluated neonatal outcomes from 74 published articles in where 30% of neonates were reported in the possible vertical transmission and 70% were from environmental sources ( Table 4).…”

Problems with Early Systematic Reviews: The Case of Coronavirus Disease 2019 (COVID-19) in Pregnancy

“…All the systematic reviews included in our analysis acknowledge the limitation that their review is limited to largely case series and case reports. Apart from the innate bias of case series and case reports, the current literature is complicated by inconsistent reporting and small sample size which further impede efforts to apply the findings to the larger population (Ashraf et al 2020;Capobianco et al 2020;Della Gatta et al 2020;Di Mascio et al 2020;Dubey et al 2020;Hessami et al 2020;Kotlyar et al 2020;Lopes de Sousa et al 2020;Matar et al 2020;Sayre et al 2017;Smith et al 2020;Thomas et al 2020a, b;Trippella et al 2020;Trocado et al 2020;Turan et al 2020;Walker et al 2020;Yang et al 2020;Yoon et al 2020;Zaigham et al 2020). Duplicate reporting overemphasizes findings.…”

“…They can occur when overlaps in patient series are not clearly stated, when the same case is reported by both the admitting and receiving hospitals or when different aspects of the same case are reported, making it difficult for screening by direct comparison of the clinical findings (Di Mascio et al 2020;Elshafeey et al 2020;Juan et al 2020). Additionally, variations in management and healthcare resources exists between countries (Turan et al 2020). Genetic and environmental factors can also influence the natural history of disease (Capobianco et al 2020) and thus, these factors limit generalizability of the findings of systematic reviews (Dubey et al 2020).…”

“…Since December 2019 when the infection was first identified, more than 41,000 MEDLINEindexed papers have been published on COVID-19. Up to 31st July 2020, at least 29 systematic reviews on COVID-19 and pregnancy with varying conclusions have been published (Abdollahpour and Khadivzadeh 2020;Akhtar et al 2020;Ashraf et al 2020;Capobianco et al 2020;Della Gatta et al 2020;Deniz and Tezer 2020;Di Mascio et al 2020;Dubey et al 2020;Elshafeey et al 2020;Hessami et al 2020;Juan et al 2020;Kasraeian et al 2020;Kotlyar et al 2020;Lopes de Sousa et al 2020;Matar et al 2020;Melo and Araújo 2020;Muhidin et al 2020;Segars et al 2020;Silva et al 2020;Smith et al 2020;Thomas et al 2020a, b;Trippella et al 2020;Trocado et al 2020;Turan et al 2020;Walker et al 2020;Yang et al 2020;Yoon et al 2020;Zaigham and Andersson 2020). Factors which are likely to cause bias and thus, inaccuracy in subsequent analysis in systematic reviews were then identified and compiled.…”