Laboratory Effects of COVID-19 Infection in Pregnant Women and Their Newborns: A Systematic Review and Meta-Analysis

Abstract

Amidst the COVID-19 pandemic, there is a need for further research on its manifestation in pregnant women, since they are particularly prone to respiratory pathogens, like severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), due to physiological changes during pregnancy. Its effects on infants born to mothers with COVID-19 are also not well-studied, and more evidence is needed on vertical transmission of the disease from mother to infant and on the transmission of IgG/IgM antibodies between mother and infant. We aim to systematically review and evaluate the effects of COVID-19 among SARS-CoV-2-positive pregnant women in late pregnancy and neonates with SARS-CoV-2-positive pregnant mothers using blood assays to find indicators of maternal and neonatal complications. We searched for original published articles in Google Scholar, Medline (PubMed), and Embase databases to identify articles in the English language from December 2019 to July 20, 2020. Duplicate entries were searched by their titles, authors, date of publication, and Digital Object Identifier. The selected studies were included based on patient pregnancy on admission, pregnant mothers with laboratory-confirmed COVID-19 virus, maternal/neonatal complications, and blood test results. We excluded duplicate studies, articles where full text was not available, other languages than English, opinions, and perspectives. The meta-analysis using the Generalized Linear Mixed model was conducted using the “meta” and “metaprop” packages in R code. Of the 1,642 studies assessed for eligibility, 29 studies (375 mothers and neonates) were included. Preterm birth rate was 34.2%, and cesarean section rate was 82.7%. Maternal laboratory findings found elevated neutrophils (71.4%; 95% CI: 38.5–90.9), elevated CRP (67.7%; 95%: 50.6–81.1), and low hemoglobin (57.3%; 95% CI: 26.0–87.8). We found platelet count, lactate dehydrogenase, and procalcitonin to be less strongly correlated with preterm birth than between high neutrophil counts (P = 0.0007), low hemoglobin (P = 0.0188), and risk of preterm birth. There is little evidence for vertical transmission. Elevated procalcitonin levels (23.2%; 95% CI: 8.4–49.8) are observed in infants born to mothers with COVID-19, which could indicate risk for neonatal sepsis. These infants may gain passive immunity to COVID-19 through antibody transfer via placenta. These results can guide current obstetrical care during the current SARS-CoV-2 pandemic.

Comparative Evaluation of Systemic Immune Indexes in Infants Born to COVID-19 PCR Positive and Negative Mothers - Can Neonatal Effects Be Predicted?

“…In the meta-analysis of babies born to COVID-19 PCR-positive mothers, neutrophil levels were found to be higher than the control group, as in our study 12 . It has been shown that high neutrophil count, increased CRP values, PLR and NLR ratios in adult patient groups are very informative in determining the severity of the disease and in the follow-up of treatment [13][14][15][16]18 .…”

“…Although it is said that the severity of the disease may be higher in newborns compared to older children as a result of inadequate immune response, mortality and morbidity rates were found to be lower 11 . In the meta-analyses, the immunoglobulin G (IgG) levels in babies born to COVID-19 PCR positive mothers were found to be higher than the normal population, and it was hypothesized that COVID-19 antibodies transmitted from the mother via the placental route protect the baby from active disease 12 .…”

Evaluation of the Obstetric Patient: Pregnancy Outcomes during COVID-19 Pandemic—A Single-Center Retrospective Study in Romania

“…The anatomical and physiological changes seen during pregnancy placed pregnant women in the "high-risk population" for SARS-CoV-2 [1]; however, for the younger patients in our study, the risk of severe complications decreased. We also considered the possible repercussions associated with the vertical transmission of the virus, but RT-PCR detection of the virus in newborns was absent [1,3,5,[22][23][24][25][26][27][28][29]. The manifestations of SARS-CoV-2 infection in the pregnant population were similar to those described in the literature for the general population and from other studies on pregnant women [8,24,30].…”

The explorat ion of inflammat ory and coagulation biomarkers between pregnantwomen with andwithout COVID-19

“…A hospital-based prospective casecontrol study was performed to assess the comparison of inflammation and coagulation biomarkers (such as NLR, PLR, and D-dimer) The New ArmeNiAN medicAl JourNAl, Vol. 16 (2022), No 2, p. 25 1. Our analysis shows no statistically significant differences in maternal age and gestational age characteristics between groups (p>0.05).…”

“…16 (2022), No 2, p. Wardhana M.P. et al, [25][26][27][28][29][30][31][32] among the third trimester of expectant with a confirmed diagnosis of COVID-19. This study was carried out from January until June 2021 at the labor room of Obstetrics and Gynaecology, Dr Soetomo General Academic Hospital Surabaya, Indonesia.…”