Ebola virus disease in pregnancy: a systematic review and meta-analysis

Abstract

This review synthesises and appraises evidence on the effects of Ebola virus disease (EVD) in pregnancy. We searched bibliographic databases from dates of inception to November 2020, yielding 28 included studies. The absolute risk of maternal death associated with EVD was estimated at 67.8% (95% confidence interval [CI] 49.8 to 83.7, I2=85%, p<0.01) and the relative risk of death in pregnant women compared with non-pregnant women was estimated at 1.18 (95% CI 0.59 to 2.35, I2=31.0%, p=0.230). The absolute risk for foetal losses was estimated at 76.9% (95% CI 45.0 to 98.3, I2=96%, p<0.01) and neonatal death was 98.5% (95% CI 84.9 to 100, I2=0.0%, p=0.40). The gap analysis suggests limited or no data on the clinical course, non-fatal perinatal outcomes and EVD management in pregnant women. The review suggests that EVD has a high maternal and perinatal mortality, underscoring the urgent need for preventative and therapeutic solutions and improved screening and follow-up of pregnant women and newborns during outbreaks. There is not enough evidence to conclusively rule out pregnancy as a risk factor for mortality and there is limited evidence on the disease course, outcomes and management of EVD in pregnancy, and this supports the need for robust clinical trials and prospective studies that include pregnant women.

Maternal, fetal, and perinatal outcomes among pregnant women admitted to an Ebola treatment center in the Democratic Republic of Congo, 2018–2020

“…Our finding that pregnant women were not at increased risk of death compared to propensity score matched non-pregnant women is consistent with reports from the West Africa outbreak as well as a recent systematic review and meta-analysis [12,26]. While evidence remains limited, the historical assumption that pregnancy is a risk factor for death from EVD is not supported by current evidence.…”

Collateral Damage in the Placenta during Viral Infection in Pregnancy: A Possible Mechanism for Vertical Transmission and an Adverse Pregnancy Outcome

“…Similarly, during outbreaks of Ebola infection, higher percentages of maternal mortality were reported and increases in preterm births and abortions were documented [ 44 , 45 , 46 ]. The Ebola virus also negatively regulates the innate immune response and viral proteins, such as VP34 and V24, which mediate the detection of viral RNA by blocking the activation of STAT pathways, culminating in a failure of the antiviral response to interferons [ 47 , 48 ].…”