COVID‐19 pandemic and population‐level pregnancy and neonatal outcomes: a living systematic review and meta‐analysis

Yang, Jie; D’Souza, Rohan; Kharrat, Ashraf; Fell, Deshayne B.; Snelgrove, John; Murphy, Kellie; Shah, Prakeshkumar S

doi:10.1111/aogs.14206

Cited by 47 publications

(76 citation statements)

References 55 publications

(111 reference statements)

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“…Recent meta‐analyses on population stillbirth rates during the pandemic and historical cohorts from the pre‐pandemic era show that, in high‐income countries, stillbirth rates, unrelated to maternal SARS‐CoV‐2 infection, remained stable, as shown in the synthesis of 21 studies from 18 countries (OR 1.08, 95% CI 0.94–1.23; P = 1.23; adjusted OR 1.06, 95% CI 0.81–1.38); in a further 14 studies from nine countries (OR 1.38, 95% CI 0.94–2.02; P = 0.099; I 2 = 52%) 18 ; or another analysis including 12 studies (OR 1.113, 95% CI 0.834–1.485) 19 . In accordance with our findings, an increase in birth weight was reported by six studies (mean difference 17 g, 95% CI 7–28 g) during the pandemic period 17 …”

Section: Discussionsupporting

confidence: 89%

“…19 In accordance with our findings, an increase in birth weight was reported by six studies (mean difference 17 g, 95% CI 7-28 g) during the pandemic period. 17 However, we agree that the incidence of antepartum stillbirth is still alarmingly high, and that "there has never been a more urgent time" to conceal the direct and indirect drivers of increased stillbirth rates during the pandemic. 20 The major strength of our study is the high quality of its validated data derived from a nationwide birth registry.…”

Section: Risk Factors For Experiencing Antepartum Stillbirth In Austriamentioning

confidence: 88%

“… 19 In accordance with our findings, an increase in birth weight was reported by six studies (mean difference 17 g, 95% CI 7–28 g) during the pandemic period. 17 …”

Section: Discussionmentioning

confidence: 99%

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Antepartum stillbirth rates during the COVID‐19 pandemic in Austria: A population‐based study

Muin

Neururer

Falcone

et al. 2021

Intl J Gynecology & Obste

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Background The coronavirus disease 2019 (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has had dramatic effects on the pregnant population worldwide, increasing the risk of adverse perinatal outcomes. Objective To assess the incidence of antepartum stillbirth (aSB) during the COVID‐19 pandemic in Austria. Methods We collected epidemiological data from the Austrian Birth Registry and compared the rate of aSB (i.e., fetal death at or after 24+0 gestational weeks) during the pandemic period (March–December 2020) and in the respective pre‐pandemic months (2015–2019). Results In total, 65 660 pregnancies were included, of which 171 resulted in aSB at 33.7 ± 4.8 gestational weeks. During the pandemic, the aSB rate increased from 2.49‰ to 2.60‰ (P = 0.601), in contrast to the significant decline in preterm deliveries at or before 37 gestational weeks from 0.61‰ to 0.56‰ (relative risk [RR] 0.93; 95% confidence interval [CI] 0.91–0.96; P < 0.001). During the first lockdown, the aSB rate significantly increased from 2.38‰ to 3.52‰ (P = 0.021), yielding an adjusted odds ratio of 1.57 (95% CI 1.08–2.27; P = 0.018). The event of aSB during the COVID‐19 pandemic was strongly related with increased fetal weight and maternal obesity. Conclusion In Austria, there has been an overall increase in the incidence of aSB during the pandemic with a significant peak during the first lockdown.

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Section: Discussionsupporting

confidence: 89%

Section: Risk Factors For Experiencing Antepartum Stillbirth In Austriamentioning

confidence: 88%

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Antepartum stillbirth rates during the COVID‐19 pandemic in Austria: A population‐based study

Muin

Neururer

Falcone

et al. 2021

Intl J Gynecology & Obste

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“…Although stillbirth, prematurity (ranging from 18.9% to 66%), asphyxia, respiratory distress (4.9%), large for gestational age, low birth weight, small for gestational age, multiple organ dysfunction syndrome, disseminated intravascular coagulation, and congenital abnormalities (3.3%) have been reported in babies delivered from COVID-19-infected mothers, experts' opinions on this issue are not unanimous (97,(105)(106)(107)(108)(109)(110). Also, the rate of NICU hospitalization varied significantly, ranging from 0% to 8% of newborns from mothers with COVID-19 (97,(105)(106)(107)(108)(109)(110), and it should be emphasized that admission to the NICU did not occur necessarily because of clinical indication, but also to provide isolation from other newborns and maternal contact despite the patient appeared asymptomatic and clinically stable (105)(106)(107)(108)(109)(110). The prevalence of neonatal death in the offspring of women diagnosed with COVID-19 during pregnancy has been estimated ranging from 0% to 7%.…”

Section: Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-cov-2)...mentioning

confidence: 99%

Effects of Vertical Transmission of Respiratory Viruses to the Offspring

et al. 2022

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Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.

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“…Centres should have contingency plans if case numbers increase (Supplementary data 6 ). Decisions regarding the presence of partners/ support persons during antepartum appointments should be based on the patient volume at each centre, the ability to follow physical distancing protocols, while safely providing in-person care to the birthing parent and emerging evidence on the impact of restrictions on maternal physical and mental health, preterm birth and stillbirths [ 58 – 61 ]. Pregnancy and parenting education classes could be conducted online, if possible.…”

Section: Results and Interpretationmentioning

confidence: 99%

Adapting obstetric and neonatal services during the COVID-19 pandemic: a scoping review

Gold

Clarfield

Johnstone

et al. 2022

BMC Pregnancy Childbirth

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Background The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction. Method Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations. Results We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options. Interpretation There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability.

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COVID‐19 pandemic and population‐level pregnancy and neonatal outcomes: a living systematic review and meta‐analysis

Cited by 47 publications

References 55 publications

Antepartum stillbirth rates during the COVID‐19 pandemic in Austria: A population‐based study

Antepartum stillbirth rates during the COVID‐19 pandemic in Austria: A population‐based study

Effects of Vertical Transmission of Respiratory Viruses to the Offspring

Adapting obstetric and neonatal services during the COVID-19 pandemic: a scoping review

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