Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Yee, Jeong; Kim, Woorim; Han, Ji Min; Yoon, Hee; Lee, Nari; Lee, Jun Young; Gwak, Hye Sun

doi:10.21203/rs.3.rs-29550/v1

Cited by 20 publications

(32 citation statements)

References 24 publications

(31 reference statements)

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“…Interestingly, case fatality was 0%, 18% and 25% respectively. In addition, clinical manifestations reported in pregnant women were mild and similar to those reported in non-pregnant women infected by SARS-CoV-2, with predominant features including fever, cough, dyspnea and lymphopenia 6 . Vertical transmission has been reported in SARS as ACE2 receptor is widely expressed in the placenta.…”

Section: Introductionsupporting

confidence: 71%

Endogenous control of inflammation characterizes pregnant women with asymptomatic or paucisymptomatic SARS-CoV-2 infection

Biasi

Tartaro

Gibellini

et al. 2021

Preprint

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In 14 pregnant women who had asymptomatic or paucisymptomatic SARS-CoV-2 infection, we performed a detailed 38-parameter analysis of peripheral blood mononuclear cells by mass cytometry, studied the expression of T-cell master regular genes, investigated cell proliferation and cytokine production, and measured plasma levels of 62 cytokines. No patient showed lymphopenia or gross alterations of white blood cells. Unsupervised analyses revealed that most immune parameters were similar in patients and uninfected controls, apart from an increase in low density neutrophils in SARS-CoV-2 positive women. Also, patients did not show altered plasma levels of interleukin-6 or other main inflammatory molecules, but displayed significant increases of anti-inflammatory cytokines such as IL-1RA, IL-10 and IL-19, and decreased levels of IL-17, PD-L1 and D-dimer. The endogenous control of inflammation, as evidenced by plasma levels of soluble molecules, could be a strategy used during pregnancy to avoid virus-induced damages and maintain a normal immune response.

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Section: Introductionsupporting

confidence: 71%

Endogenous control of inflammation characterizes pregnant women with asymptomatic or paucisymptomatic SARS-CoV-2 infection

Biasi

Tartaro

Gibellini

et al. 2021

Preprint

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“…Overall, 48 SRs had a high risk of bias 7 11 21 22 24-52 54-65 [67][68][69] . One SR had a low risk of bias 23 and three SRs had an unclear risk of bias 9 53 66 .…”

Section: Resultsmentioning

confidence: 99%

Maternal and perinatal outcomes related to COVID‐19 and pregnancy: An overview of systematic reviews

Vergara-Merino

Meza

Couve‐Pérez

et al. 2021

Acta Obstet Gynecol Scand

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Introduction: Evidence about COVID-19 and pregnancy has rapidly increased since December 2019, making it difficult to make rigorous evidence-based decisions. The objective of this overview of systematic reviews is to conduct a comprehensive analysis of the current evidence on prognosis of COVID-19 in pregnant women. Material and methods: We used Living OVerview of Evidence (L•OVE) platform for COVID-19, which continually retrieves studies from 46 data sources (including Pubmed/MEDLINE, Embase, other electronic databases, clinical trials registries, preprint repositories, among other sources relevant to COVID-19), mapping them into PICO questions. The search covered the period from the inception date of each database to September 13, 2020. We included systematic reviews assessing outcomes of pregnant women with COVID-19 and/or their newborns. Two authors independently screened the titles and abstracts, assessed full-texts to select the studies that met the inclusion criteria, extracted data, and appraised the risk of bias of each included systematic review. We measured the overlap of primary studies included among the selected systematic reviews by building a matrix of evidence, calculating the corrected covered area, and assessing the level of overlapping for every pair of systematic reviews. Results: Our search yielded 1132 references. 52 systematic reviews met inclusion criteria and were included in this overview. Only one review had a low risk of bias, three had an unclear risk of bias, and 48 had a high risk of bias. Most of the included reviews were highly overlapped among each other. In the included reviews, rates of maternal death varied from 0% to 11.1%, admission to intensive care from 2.1% to 28.5%, preterm deliveries before 37 weeks from 14.3% to 61.2%, and cesarean delivery from 48.3% to 100%. Regarding neonatal outcomes, neonatal death varied from 0% to 11.7% while the estimated infection status of the newborn varied between 0% and 11.5%. Conclusions: Only one of 52 systematic reviews had a low risk of bias. Results were heterogenous and the overlap of primary studies was frequently very high between pairs of systematic reviews. High quality evidence syntheses of comparative studies are needed to guide future clinical decisions.

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“…Adverse maternal and infant outcomes associated with COVID-19 infection include higher risk of preterm birth, caesarean birth, and some cases of fetal and maternal death. [30][31][32][33][34][35][36] A recent US Centers for Disease Control surveillance report of 24 434 pregnant individuals with COVID-19 infection identified higher risk of admission to intensive care, invasive ventilation and death compared with non-pregnant individuals of reproductive age. 37 A systematic review of maternal mental health during COVID-19 found significant increases in risk of anxiety and higher scores on the Edinburgh Postnatal Depression Survey (EPDS) among pregnant and postpartum individuals during COVID-19 compared with pre-COVID-19.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

COVID-19 and perinatal intimate partner violence: a cross-sectional survey of pregnant and postpartum individuals in the early stages of the COVID-19 pandemic

et al. 2021

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ObjectiveThe objectives of this study were to: (1) document violent and controlling behaviours within intimate partnerships during the perinatal period; and (2) determine individual, interpersonal and household-level factors influencing the risk of perinatal intimate partner violence (IPV).DesignCross-sectional survey.SettingThe Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada.ParticipantsPatients who gave birth at The Ottawa Hospital and were >20 days post partum between 17 March and 16 June 2020.Main outcomes and measuresPerinatal IPV was defined as regular controlling behaviours or act-based forms of emotional/physical/sexual abuse in the 12 months before pregnancy, during pregnancy and/or post partum. Log-binomial multivariable regression models were used to compute adjusted risk ratios (aRRs) and 95% CIs to identify potential risk factors for IPV: maternal age, postpartum depression, parity, increase in partner substance use and household income.ResultsAmong 216 participants, the median maternal age was 33 years (IQR: 30–36). In total, 52 (24.07%) reported some form of perinatal IPV, 37 (17.13%) reported regular controlling behaviour and 9 (4.17%) reported both. Household income below the municipal median was the strongest risk factor for perinatal IPV (aRR: 3.24, 95% CI: 1.87 to 5.59). There was no apparent association between maternal age (aRR: 0.99, 95% CI: 0.94 to 1.04), postpartum depression (aRR: 1.03, 95% CI: 1.00 to 1.07), nulliparity (aRR: 1.18, 95% CI: 0.71 to 1.97) or increases in partner substance use (aRR: 0.73, 95% CI: 0.42 to 1.25) with IPV.ConclusionOne in four individuals in this study experienced perinatal IPV. Household income was the strongest risk factor, and surprisingly, many hypothesised risk factors (eg, mental health, partner substance use, etc) were not significantly associated with perinatal IPV in this sample. This highlights the challenges in both measuring IPV and identifying individuals exposed to perinatal IPV during the high stress of the COVID-19 pandemic.

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Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Cited by 20 publications

References 24 publications

Endogenous control of inflammation characterizes pregnant women with asymptomatic or paucisymptomatic SARS-CoV-2 infection

Endogenous control of inflammation characterizes pregnant women with asymptomatic or paucisymptomatic SARS-CoV-2 infection

Maternal and perinatal outcomes related to COVID‐19 and pregnancy: An overview of systematic reviews

COVID-19 and perinatal intimate partner violence: a cross-sectional survey of pregnant and postpartum individuals in the early stages of the COVID-19 pandemic

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