COVID-19 in pregnancy: the foetal perspective—a systematic review

Abstract

ObjectiveWe aimed to conduct a systematic review of the available literature to determine the effects of confirmed cases of COVID-19 in pregnant women from the foetal perspective by estimation of mother to child transmission, perinatal outcome and possible teratogenicity.MethodsData sources: eligible studies between 1 November 2019 and 10 August 2020 were retrieved from PubMed, Embase, LitCovid, Google Scholar, EBSCO MEDLINE, CENTRAL, CINAHL, MedRXiv, BioRXiv and Scopus collection databases. English language case reports, case series and cohort studies of SARS-CoV-2 confirmed pregnant women with data on perinatal outcome, congenital anomalies and mother to child transmission were analysed.Results38 case reports, 34 cohort and case series describing 1408 neonates were included for evidence acquisition of mother to child transmission. 29 case reports and 31 case series and cohort studies describing 1318 foetuses were included for the evaluation of perinatal outcome and congenital anomalies. A pooled proportion of 3.67% neonates had positive SARS-CoV-2 viral RNA nasopharyngeal swab results and 7.1% had positive cord blood samples. 11.7% of the placenta, 6.8% of amniotic fluid, 9.6% of faecal and rectal swabs and none of the urine samples were positive. The rate of preterm labour was 26.4% (OR=1.45, 95% CI 1.03 to 2.03 with p=0.03) and caesarean delivery (CS) was 59.9% (OR=1.54, 95% CI 1.17 to 2.03 with p=0.002). The most common neonatal symptom was breathing difficulty (1.79%). Stillbirth rate was 9.9 per 1000 total births in babies born to COVID-19 mothers.ConclusionChances of mother to child transmission of the SARS-CoV-2 virus is low. The perinatal outcome for the foetus is favourable. There is increased chances of CS but not preterm delivery.The stillbirth and neonatal death rates are low. There are no reported congenital anomalies in babies born to SARS CoV-2 positive mothers.

The Effect of COVID-19 Infection During Pregnancy; Evaluating Neonatal Outcomes and the Impact of the B.1.1.7. Variant

“…The effect, if any, of COVID-19 exposure during pregnancy on congenital malformations is not yet known. 46 The European Surveillance of Congenital Anomalies network describe a prevalence of major congenital anomalies of 2.4% in the general population. 47 In this study, 9% of infants had a congenital anomaly diagnosed.…”

Vertical Transmission of SARS-CoV-2 during Pregnancy: A Prospective Italian Cohort Study

“…Considerable uncertainty remains about the extent of the vertical transmission (VT), intended as congenital (transplacental) or intrapartum transmission, and which occurs in the first 48 hours of life. Our knowledge derives either from retrospective cohort analyses [1][2][3] or systematic reviews of case series of pregnant women with COVID-19 [4][5][6][7][8][9][10][11][12][13] , which mainly included small studies from single centers; thus, limiting the generalizability of results,…”

Gestantes com COVID-19 e as suas consequências nos recém-nascidos

“…A transmissão vertical intrauterina é algo que não está claro nos estudos analisados (Yang et al, 2020). Contudo, estudos pioneiros demonstram que não houve transmissão intrauterina em gestantes (Karimi-Zarchi et al, 2020;Dube et al, 2020;. Já outros artigos defendem que essa infecção não acontece com os fetos de gestantes que foram diagnosticadas com o vírus durante o terceiro trimestre de gravidez Khan et al, 2020).…”

“…A transmissão vertical extrauterina no parto vaginal não foi identificada em uma pequena amostragem de gestantes infectadas no terceiro trimestre (Khan et al, 2020). Cabe citar, que gestantes com COVID-19 não possuem indicação ao parto cesárea (Dube et al, 2020;Boaventura et al, 2021), apenas após uma avaliação obstétrica essa opção pode ser aconselhada . Novamente, o Czeresnia (2020) acrescenta a discussão evidenciando o aumento de partos prematuros e as indicações de parto cesárea em gestantes contaminadas com o Sars-CoV-2.…”