COVID-19 and pregnancy: A comparison of case reports, case series and registry studies

Abstract

Background Selection, outcome and publication biases are well described in case reports and case series but may be less of a problem early in the appearance of a new disease when all cases might appear to be worth publishing. Objective To use a prospectively collected database of primary sources to compare the reporting of COVID-19 in pregnancy in case reports, case series and in registries over the first 8 months of the pandemic. Study Design : MEDLINE, Embase and Maternity and Infant Care databases were searched from 22 March to 5 November 2020, to create a curated list of primary sources. Duplicate reports were excluded. Case reports, case series and registry studies of pregnant women with confirmed COVID-19, where neonatal outcomes were reported, were selected and data extracted on neonatal infection status, neonatal death, neonatal intensive care unit admission, preterm birth, stillbirth, maternal critical care unit admission and maternal death. Results 149 studies comprising 41,658 mothers and 8,854 neonates were included. All complications were more common in case reports, and in retrospective series compared with presumably prospective registry studies. Extensive overlap is likely in registry studies, with cases from seven countries reported by multiple registries. The UK Obstetric Surveillance System was the only registry to explicitly report identification and removal of duplicate cases, although five other registries reported collection of patient identifiable data which would facilitate identification of duplicates. Conclusions Since it is likely that registries provide the least biased estimates, the higher rates seen in the other two study designs are probably due to selection or publication bias. However even some registry studies include self- or doctor-reported cases, so might be biased, and we could not completely exclude overlap of cases in some registries.

Cardiovascular Complications of Pregnancy-Associated COVID-19 Infections

“…A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) analysis of 149 studies found adverse outcomes to be more common in case reports and series suggesting reporting bias and raised concerns of patient overlap in registry studies. 4 The most recent update of a live global systematic review of COVID-19 infections in pregnancy included over 60,000 pregnant or recently pregnant women from 192 studies. Reported prevalence of pregnancy-associated infections ranging from 7% with universal sampling to 28% in symptomatic women.…”

Possible vertical transmission and pregnancy complications during pregnancy due to COVID-19

“…The World Health Organization announced that the outbreak of (COVID-19) can be considered a "pandemic" where the virus spreads progressively around the world. Thirty-nine million people and more suffered from the virus worldwide till Oct 16, 2020, with a death toll exceeding 1,099,000 [1][2][3][4][5]. The severe acute respiratory syndrome coronavirus-19 pandemic has uncovered vulnerable populations across international health crises [1,2,[6][7][8].…”

“…Thirty-nine million people and more suffered from the virus worldwide till Oct 16, 2020, with a death toll exceeding 1,099,000 [1][2][3][4][5]. The severe acute respiratory syndrome coronavirus-19 pandemic has uncovered vulnerable populations across international health crises [1,2,[6][7][8]. The knowledge obtained from prior human coronavirus epidemics revealed that pregnant women and neonates are from the most vulnerable populations and at high risk of COVID-19 infection, according to their body immunity and are mainly at risk for bad findings [8][9][10][11].…”

“…The knowledge obtained from prior human coronavirus epidemics revealed that pregnant women and neonates are from the most vulnerable populations and at high risk of COVID-19 infection, according to their body immunity and are mainly at risk for bad findings [8][9][10][11]. Several case reports about pregnancy during covid-19 showed different results and effects on mothers and babies [1,7,8]. This doubt affected obstetricians to depend on certain procedures such as cesarean birth, mother-baby isolation, and formula or expressed milk feeding [1,11].…”

“…Several case reports about pregnancy during covid-19 showed different results and effects on mothers and babies [1,7,8]. This doubt affected obstetricians to depend on certain procedures such as cesarean birth, mother-baby isolation, and formula or expressed milk feeding [1,11]. The clinical decisions that can be taken will be better and based on solid knowledge after reviewing and evaluating the outcomes stated by databases and registry studies.…”