COVID-19 in pregnant women: A systematic review and meta-analysis

Abstract

Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several reports highlighted the risk of infection and disease in pregnant women and neonates. To assess the risk of clinical complications in pregnant women and neonates infected with SARS-CoV-2 carrying out a systematic review and meta-analysis of observational studies. Data sources: Search of the scientific evidence was performed using the engines PubMed and Scopus, including articles published from December 2019 to 15 April 2020. Study eligibility criteria: Only observational studies focused on the assessment of clinical outcomes associated with pregnancy in COVID-19 women were selected. Study appraisal and synthesis methods: The first screening was based on the assessment of titles and abstracts, followed by the evaluation of full-texts. Qualitative variables were summarized with frequencies, whereas quantitative variables with central and variability indicators depending on their parametric distribution. Forest plots were used to describe point estimates and in-between studies variability. Study quality assessment was performed. Results: Thirteen studies were selected. All of them were carried out in China. The mean (SD) age and gestational age of pregnant women were 30.3 (1.5) years and 35.9 (2.9) weeks, respectively. The mean (SD) duration from the first symptoms to the hospital admission and to labour were 5.5 (2.0) and 9.5 (8.7) days, respectively. Patients mainly complained of fever and cough (pooled (95 % CI) proportions were 76.0 % (57.0 %-90.0 %) and 38.0 (28.0 %-47.0 %), respectively). Several antibiotics, antivirals, and corticosteroids were prescribed in different combinations. The pooled prevalence of maternal complications and of caesarean section were 45.0 % (95 % CI: 24.0 %-67.0 %) and 88.0 % (95 %CI: 82.0 %-94.0 %). A proportion of pregnant women less than 20 % were admitted to ICU. The pooled proportion of preterm infants was 23.0 % (95 %CI: 11.0 %-39.0 %). The most frequent neonatal complications were pneumonia and respiratory distress syndrome. The pooled percentage of infected neonates was 6.0 % (95 %CI: 2.0 %-12.0 %). Conclusions: The present study suggests a high rate of maternal and neonatal complications in infected individuals. However, the current scientific evidence highlights a low risk of neonatal infection. Multicentre, cohort studies are needed to better elucidate the role of SARS-CoV-2 during pregnancy.

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.…”

“…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). Exclusion of studies not published in the English language may further cause bias (Matar et al 2020;Muhidin et al 2020;Thomas et al 2020a, b).…”

“…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.…”

Perinatal mortality and morbidity of SARS-COV-2 infection during pregnancy in European countries: Findings from an international study

“…After being epidemic in China, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) infection has rapidly spread in many countries as a global pandemic, with the number of affected cases dramatically increasing worldwide on a daily basis. Although the median age of hospitalized patients with confirmed infection is usually more advanced [1], with older age reported to be associated to higher mortality rate [2], physiological adaptations occurring during pregnancy have been claimed to be potentially responsible for a more severe respiratory disease, thus leading to higher rates of maternal and fetal complications [3,4].…”

“…Evidence has been accumulating rapidly in the last months to provide early information to help with counseling and care of pregnant women with SARS CoV-2 infection, and despite the relatively short time from the pandemic outbreak, a multitude of systematic reviews have been published on the topic of SARS-COV-2 infection and COVID-19 disease during pregnancy. However, these studies often share important limitations that might affect the robustness of the results [1,[3][4][5][6].…”