“…The references included in publications, websites of national reports and academic non-government organizations yielded 22 new articles fitting our criteria. We excluded 106 articles and, ultimately, included 37 articles in this review ( Figure 1 ): four case-control studies( 13 , 14 , 15 , 16 ), nine cases series( 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ), 23 case reports( 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ), and one national report( 10 ). Figure 1 Selection of studies …”
Section: Resultsmentioning
confidence: 99%
“…A descriptive analysis based on 33 articles and a meta-analysis based on 4 case-control studies was performed. For the descriptive analysis, we included a total of 322 pregnant women, 111 (34.5%) patients from Netherlands( 10 ), 80(24.8%) from USA( 17 , 19 , 21 , 40 , 42 , 46 ), 76(23.6%) from China ( 22 , 23 , 26 , 27 , 30 , 32 , 33 , 37 , 39 , 47 ), 43(13.3%) from Italy ( 18 , 29 ), 2(0.6%) from Canada( 20 ), and one each from Honduras( 28 ), South Korea( 31 ), Sweden( 34 ), Germany( 35 ), Turkey( 36 ), Iran( 38 ), Australia( 41 ), Spain( 43 ), Peru( 44 ), and India( 45 ). ( Supplemental Table 2 ) One case series(24) and one case report(48) from China were considered for analysis of vertical transmission.…”
Section: Resultsmentioning
confidence: 99%
“…Most studies had the same rate of non-response for both groups ( Supplemental Table 3a ). The quality of case series and case reports evaluated using the modified NOS were: three studies were deemed to be good( 20 , 26 , 46 ), 23 were moderate( 17 , 19 , 22 , 23 , 24 , 27 , 28 , 29 , 30 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 , 48 ), and six were poor in methodological quality ( Supplemental Table 3b )( 18 , 21 , 25 , 32 , 33 , 45 ). The Dutch Association for Obstetrics and Gynecology’s official report was no assessed for quality( 10 ).…”
Section: Resultsmentioning
confidence: 99%
“…Twenty articles including 88 patients reported the laboratory characteristics ( 19 , 20 , 22 , 28 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 42 , 43 , 44 , 46 , 47 ). Table 2 describes lymphopenia (n=52,59.1%), elevated concentrations of C-reactive protein (n=46, 52.3%) and leukopenia (n=23,26.1%) as the most common findings.…”
Section: Resultsmentioning
confidence: 99%
“…Data from 15 patients showed bilateral lesions in 13 (86.7%). Albeit other modalities were rarely reported, it is noteworthy that seven cases were reported with pneumonia by x-chest ray (77.8%)( 19 , 20 , 37 , 38 , 40 , 42 , 43 ), and 2 reports found signs of pneumonia on ultrasound lung examination( 36 , 40 ). (Detailed description in Supplemental Table 6 ).…”
“…The references included in publications, websites of national reports and academic non-government organizations yielded 22 new articles fitting our criteria. We excluded 106 articles and, ultimately, included 37 articles in this review ( Figure 1 ): four case-control studies( 13 , 14 , 15 , 16 ), nine cases series( 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ), 23 case reports( 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ), and one national report( 10 ). Figure 1 Selection of studies …”
Section: Resultsmentioning
confidence: 99%
“…A descriptive analysis based on 33 articles and a meta-analysis based on 4 case-control studies was performed. For the descriptive analysis, we included a total of 322 pregnant women, 111 (34.5%) patients from Netherlands( 10 ), 80(24.8%) from USA( 17 , 19 , 21 , 40 , 42 , 46 ), 76(23.6%) from China ( 22 , 23 , 26 , 27 , 30 , 32 , 33 , 37 , 39 , 47 ), 43(13.3%) from Italy ( 18 , 29 ), 2(0.6%) from Canada( 20 ), and one each from Honduras( 28 ), South Korea( 31 ), Sweden( 34 ), Germany( 35 ), Turkey( 36 ), Iran( 38 ), Australia( 41 ), Spain( 43 ), Peru( 44 ), and India( 45 ). ( Supplemental Table 2 ) One case series(24) and one case report(48) from China were considered for analysis of vertical transmission.…”
Section: Resultsmentioning
confidence: 99%
“…Most studies had the same rate of non-response for both groups ( Supplemental Table 3a ). The quality of case series and case reports evaluated using the modified NOS were: three studies were deemed to be good( 20 , 26 , 46 ), 23 were moderate( 17 , 19 , 22 , 23 , 24 , 27 , 28 , 29 , 30 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 , 48 ), and six were poor in methodological quality ( Supplemental Table 3b )( 18 , 21 , 25 , 32 , 33 , 45 ). The Dutch Association for Obstetrics and Gynecology’s official report was no assessed for quality( 10 ).…”
Section: Resultsmentioning
confidence: 99%
“…Twenty articles including 88 patients reported the laboratory characteristics ( 19 , 20 , 22 , 28 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 42 , 43 , 44 , 46 , 47 ). Table 2 describes lymphopenia (n=52,59.1%), elevated concentrations of C-reactive protein (n=46, 52.3%) and leukopenia (n=23,26.1%) as the most common findings.…”
Section: Resultsmentioning
confidence: 99%
“…Data from 15 patients showed bilateral lesions in 13 (86.7%). Albeit other modalities were rarely reported, it is noteworthy that seven cases were reported with pneumonia by x-chest ray (77.8%)( 19 , 20 , 37 , 38 , 40 , 42 , 43 ), and 2 reports found signs of pneumonia on ultrasound lung examination( 36 , 40 ). (Detailed description in Supplemental Table 6 ).…”
Objective
Coronavirus disease 2019 (COVID-19) has become a global pandemic and may adversely affect pregnancy outcomes. We estimated the adverse maternal and neonatal characteristics and outcomes among COVID-19 infected women and determined heterogeneity in the estimates and associated factors.
Study Designs
PubMed search was performed of confirmed COVID-19 pregnant cases and related outcomes were ascertained prior to July 8, 2020, in this systematic review and meta-analysis. Studies reporting premature birth, low birth weight, COVID-19 infection in neonates, or mode of delivery status were included in the study. Two investigators independently performed searches, assessed quality of eligible studies as per the Cochrane handbook recommendations, extracted and reported data according to PRISMA guidelines. Pooled proportions of maternal and neonatal outcomes were estimated using meta-analyses for studies with varying sample sizes while a systematic review with descriptive data analysis was performed for case report studies. Maternal and neonatal outcomes included C-section, premature birth, low birth weight, adverse pregnancy events and COVID transmission in neonates.
Results
A total of 790 COVID-19 positive females and 548 neonates from 61 studies were analyzed. The rates of C-section, premature birth, low birth weight, and adverse pregnancy events were estimated as 72 %, 23 %, 7 %, and 27 % respectively. In the heterogeneity analysis, the rate of C-section was substantially higher in Chinese studies (91 %) compared to the US (40 %) or European (38 %) studies. The rates of preterm birth and adverse pregnancy events were also lowest in the US studies (12 %, 15 %) compared to Chinese (17 %, 21 %), and European studies (19 %, 19 %). In case reports, the rates of C-section, preterm birth, and low birth weight were estimated as 69 %, 56 %, and 35 %, respectively. Adverse pregnancy outcomes were associated with infection acquired at early gestational ages, more symptomatic presentation, myalgia symptom at presentation, and use of oxygen support therapy.
Conclusions
Adverse pregnancy outcomes were prevalent in COVID-19 infected females and varied by location, type, and size of the studies. Regular screening and early detection of COVID-19 in pregnant women may provide more favorable outcomes.
Objective: Delivery management interventions (DMI) were recommended to prevent delivery-associated transmission of maternal SARS-CoV-2 to infants without evidence of effect on early neonatal SARS-CoV-2 infection (ENI) and neonatal death <28 days of life (ND). This systematic review describes different DMI combinations and the frequency of ENI and ND.
Study Design: Individual patient data were collected from articles published 1 January 2020 - 31 December 2021 from Cochrane review databases, Medline and Google Scholar. Article inclusion criteria were: Documented maternal SARS-CoV-2 PCR positive status 10 days before delivery or symptomatic at delivery with a positive test within 48 hours, known delivery method and known infant SARS-CoV-2 PCR result. Primary outcomes were ENI (positive PCR at 12 hours-10 days) and ND. All characteristics were pooled using DerSimonian-Laird inverse variance method. Primary outcome analyses were carried out using logit transformation and random effect. Pooled results were expressed as percentages (95% confidence intervals). Continuity correction was applied for all pooled results if any included study has 0 event.
Results: 11,075 publications were screened. 117 publications representing 244 infants and 230 mothers were included. All publications were case reports. ENI and ND were reported in 23.4% (18.2, 29.18) and 2.1% (0.67, 4.72) of cases respectively. Among cases with available information, DMIs were reported for physical environment (85-100%), delivery specific interventions (47-100%), and infant care practices (80-100%). No significant comparisons could be performed between different DMI combinations due to small sample size.
Conclusion: The evidence supporting any DMI in SARS-CoV-2 infected mothers to prevent ENI nor ND is extremely limited. Limitations of this meta-analysis include high risk of bias, small sample size and large confidence intervals. This identifies the need for multinational database generation and specific studies designed to provide evidence of DMI guidelines best suited to prevent transmission from mother to neonate.
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