Severe acute respiratory syndrome coronavirus 2 in pregnancy: symptomatic pregnant women are only the tip of the iceberg

Khalil, Asma; Hill, Robert A.; Ladhani, Shamez; Pattisson, Katherine; O’Brien, Pat

doi:10.1016/j.ajog.2020.05.005

Cited by 81 publications

(97 citation statements)

References 5 publications

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“…This percentage is substantially lower than the seroprevalence of 3-6% measured in the general population in Belgium in April 2020 [16]. Importantly, the estimates observed in our sample are undoubtedly underestimations of the actual prevalence due to the potential of an asymptomatic course of COVID-19 in pregnancy and to the lack of systematic testing in Belgium at the time of the survey completion [17,18]. However, even in the most extreme scenario when up to 85% of the infected pregnant respondents were asymptomatic [17,18], and were thus not tested and diagnosed, the seroprevalence of COVID-19 in our sample would not exceed the percentage observed in the general population [16].…”

Section: Main Findingscontrasting

confidence: 70%

SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium

Ceulemans

Verbakel

Calsteren

et al. 2020

IJERPH

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COVID-19 also affects pregnant and breastfeeding women. Hence, clinicians and policymakers require reliable evidence on COVID-19 epidemiology and consequences in this population. We aimed to assess the susceptibility of pregnant women to SARS-CoV-2 and women’s perceived impact of the pandemic on their breastfeeding practices, medical counseling and social support. We performed a cross-sectional study using an online survey in primary care in Belgium. Pregnant and breastfeeding women and women who breastfed in the preceding four weeks were eligible to participate. The survey was distributed through social media in April 2020. In total, 6470 women participated (i.e., 2647 pregnant and 3823 breastfeeding women). Overall, 0.3% of all respondents reported to have tested positive for SARS-CoV-2, not indicating a higher susceptibility of pregnant women to contracting COVID-19. More than 90% refuted that the pandemic affected their breastfeeding practices, nor indicated that the coronavirus was responsible for breastfeeding cessation. Half of the women even considered giving longer breastmilk because of the coronavirus. In contrast, women’s medical counseling and social support were negatively affected by the lockdown. Women without previous breastfeeding experience and in the early postpartum period experienced a higher burden in terms of reduced medical counseling and support. In the future, more consideration and alternative supportive measures such as tele-visits by midwives or perinatal organizations are required for these women.

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Section: Main Findingscontrasting

confidence: 70%

SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium

Ceulemans

Verbakel

Calsteren

et al. 2020

IJERPH

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“…Eight studies (95 247 women) compared pregnant populations with non-pregnant populations,2526272829303132 and four studies (2230 women) compared pregnant women with covid-19 versus pregnant women without covid-19 33343536. Forty cohort studies reported on clinical manifestations (13 018 pregnant, 85 084 non-pregnant women),25262728293031323536373839404142434445464748495051525354555657585960616263646566 45 studies reported on covid-19 related maternal outcomes (14 094 pregnant, 85 169 non-pregnant women),2526272829303132353637383940414243454647484950515354555657585961626364656667…”

Section: Resultsmentioning

confidence: 99%

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

Allotey

Fernández

Bonet

et al. 2020

BMJ

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1,870

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2,305

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Objective To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). Design Living systematic review and meta-analysis. Data sources Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 26 June 2020, along with preprint servers, social media, and reference lists. Study selection Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. Data extraction At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. Results 77 studies were included. Overall, 10% (95% confidence interval 7% to14%; 28 studies, 11 432 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (39%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% confidence interval 0.22 to 0.85; I 2 =74%; 5 studies; 80 521 women) and myalgia (0.48, 0.45 to 0.51; I 2 =0%; 3 studies; 80 409 women) and were more likely to need admission to an intensive care unit (1.62, 1.33 to 1.96; I 2 =0%) and invasive ventilation (1.88, 1.36 to 2.60; I 2 =0%; 4 studies, 91 606 women). 73 pregnant women (0.1%, 26 studies, 11 580 women) with confirmed covid-19 died from any cause. Increased maternal age (1.78, 1.25 to 2.55; I 2 =9%; 4 studies; 1058 women), high body mass index (2.38, 1.67 to 3.39; I 2 =0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14 to 3.48; I 2 =0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31 to 4.80; I 2 =12%; 2 studies; 858 women) were associated with severe covid-19 in pregnancy. Pre-existing maternal comorbidity was a risk factor for admission to an intensive care unit (4.21, 1.06 to 16.72; I 2 =0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40 to 14.37; I 2 =0%; 2 studies; 313 women). Spontaneous preterm birth rate was 6% (95% confidence interval 3% to 9%; I 2 =55%; 10 studies; 870 women) in women with covid-19. The odds of any preterm birth (3.01, 95% confidence interval 1.16 to 7.85; I 2 =1%; 2 studies; 339 women) was high in pregnant women with covid-19 compared with those without the disease. A quarter of all neonates born to mothers with covid-19 were admitted to the neonatal unit (25%) and were at increased risk of admission (odds ratio 3.13, 95% confidence interval 2.05 to 4.78, I 2 =not estimable; 1 study, 1121 neonates) than those born to mothers without covid-19. Conclusion Pregnant and recently pregnant women are less likely to manifest covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are high in pregnant women with covid-19 than in pregnant women without the disease. Systematic review registration PROSPERO CRD42020178076. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

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“…Die klinische Manifestation der Infektion mit SARS-CoV-2 stellt sich variabel mit z. T. auch asymptomatischen Verläufen dar 5 . Aktuelle Screening-Untersuchungen schwangerer Frauen bei Hospitalisation in Regionen mit hohen Infektionsraten konnten einen relevanten Anteil SARS-CoV-2-positiver asymptomatischer Patientinnen von 6,2% (London) bis 32,6% (New York) nachweisen 6 7 8 .…”

Section: Diskussionunclassified

Periodenprävalenz von SARS-CoV-2 in einer unselektierten Stichprobe schwangerer Frauen in Jena, Thüringen

Zöllkau

Baier

Scherag

et al. 2020

Z Geburtshilfe Neonatol

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Zusammenfassung Einleitung Die Stadt Jena, Thüringen, führte nach exponentiellem Anstieg der SARS-CoV-2 Infektionen bundesweit erstmalig eine Pflicht zur Bedeckung von Mund und Nase ein. Durch Screening einer unselektierten Kohorte von Schwangeren sollte eine Schätzung der SARS-CoV-2 Periodenprävalenz erfolgen. Von Interesse war die Frage nach der Dunkelziffer. Methoden Bei stationärer Aufnahme erfolgte ein Screening sowie eine Antikörperbestimmungen auf SARS-CoV-2, mittels spezifischer Real-Time-PCR und Bestimmung spezifischer SARS-CoV-2 IgG im Serum mittels ELISA. Die Schätzung der SARS-CoV2 Periodenprävalenz erfolgte nach der exakten Methode von Clopper und Pearson, der Gruppenvergleich mit Fischers exaktem Test. Ergebnisse Vom 06.04. bis 13.05.2020 wurden 234 Schwangere stationär aufgenommen. 225 (96,2%) durchgeführte SARS-CoV2 PCR verblieben negativ. Bei einer (0,6%) von 180 (76,9%) erfolgten Antikörperbestimmungen wurden spezifische IgG-Antikörper detektiert. Die Intervallschätzung der Periodenprävalenz ergibt damit ein 95%-Konfidenzintervall zwischen 0–1,7%. Für 96 Haushalten mit Kindern ergibt sich eine Periodenprävalenz von 0–3,8%, die sich nicht von der für 76 Haushalte ohne Kinder von 0–4,8% unterscheidet (p=1,00). Diskussion Erstmalig wird die SARS-CoV-2 Periodenprävalenz einer unselektierten Stichprobe Schwangerer in Deutschland erfasst. Es ergab sich kein Hinweis für eine befürchtet hohe Dunkelziffer asymptomatischer Schwangerer für unbemerkte SARS-CoV-2 Infektionen mittels Antikörpernachweis. Die messbare Serokonversionsrate lag bei unter 1% (0,6%).

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Severe acute respiratory syndrome coronavirus 2 in pregnancy: symptomatic pregnant women are only the tip of the iceberg

Cited by 81 publications

References 5 publications

SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium

SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

Periodenprävalenz von SARS-CoV-2 in einer unselektierten Stichprobe schwangerer Frauen in Jena, Thüringen

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