Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021

Abstract

Objectives COVID-19 is a rapidly changing and developing emergency that requires constant re-evaluation of available data. We report a systematic review and meta analysis based on all published high quality data up to and including June 3rd 2021 on the maternal and neonatal outcomes in pregnant women infected with the Coronavirus Disease 2019 (COVID-19). Data Sources PubMed, SCOPUS, MEDLINE, ClinicalTrials.gov, and Web of Science databases were queried from inception up to June 3rd 2021. Study Eligibility Criteria We included all clinical studies (prospective and retrospective cohort studies, case-control studies, case series, and rapid communications) that reported data on any maternal and neonatal outcomes of pregnant women with COVID-19. Study Appraisal and Synthesis Methods Data were analyzed as pooled proportions or odds ratios (OR) and 95% confidence intervals (95% CI) in meta-analysis models. Results We included 111 studies enrolling 42754 COVID-19-positive pregnant women. From COVID-19-positive pregnant women, the incidence rate of cesarean section was 53.2% (95% CI: 48%–58.4%), 41.5% (95% CI: 36.3%–46.8%) for spontaneous vaginal delivery and 6.4% (95% CI: 4.5%–9.2%) for operative delivery. The rate of some adverse neonatal events was relatively high in mothers infected with COVID-19 including premature delivery (16.7%, 95% CI: 12.8%–21.5%), and low birthweight (16.7%, 95% CI: 12.8%–21.5%). Vertical transmission (3.5%, 95% CI: 2.7%–4.7%), neonatal death (3%, 95% CI: 2%–4%), stillbirth (1.9%, 95% CI: 1.5–2.4%) and maternal mortality (0.012% 95% CI: 0.010-0.014%) were rare adverse events. Mean birth weight was 3069.7g, 95% CI: 3009.7g–3129.8g). In the comparative analysis, COVID-19 significantly increased the risk of premature delivery (OR= 1. 48, [95% CI; 1 .22, 1.8]), preeclampsia (OR= 1. 6, [95% CI; 1.2, 2.1]), stillbirth (OR= 2.36, [95% CI 1.24, 4.462]), neonatal mortality (OR= 3.35, [95% CI; 1.07, 10.5]), and maternal mortality (OR= 3.08, [95% CI; 1.5, 6.3]). Pooled analyses were homogenous, with mild heterogeneity in premature delivery and preeclampsia outcomes. Conclusion Data must be interpreted with caution as limited data is available and no complete assessment of bias is possible at this time. Our data suggests that pregnant women who test positive for COVID-19 seem to be at higher risk for lower birth weights and premature delivery. There is no evidence at this time of the sharply increased maternal mortality that was seen with both the previous 2002 Middle East Respiratory Syndrome (MERS) and 2003 Severe Acute Respiratory Syndrome (SARS) pandemics.

Protecting Breastfeeding during the COVID-19 Pandemic: A Scoping Review of Perinatal Care Recommendations in the Context of Maternal and Child Well-Being

“…It seems that the timing of delivery of patients with a positive SARS-CoV-2 test result can be rescheduled considering the severity of COVID-19 infection and obstetric indications such as gestational age and fetal well-being, maternal cardiac disease, diabetes, preeclampsia, and existing comorbidities. Clinical data including over 42,000 pregnant women indicated that the ratio of cesarean to VD was higher (53.2% CS vs. 41.5% VD) in those populations and that pregnant women who were exposed to a heavier course of COVID-19 were more likely to have a risk of preterm delivery [ 114 ].…”

“…The current state of knowledge regarding SARS-CoV-2 infection in the first few days of life indicates that sharing the room of a COVID-19-affected mother and infant and taking precautions minimizes the risk of infection and provides more health and emotional benefits than potential harm [ 76 , 114 ].…”

The Impact of the Covid-19 Pandemic on Maternal Mortality Attributes

“…Pregnant women with comorbidities are considered at a greater risk of experiencing severe diseases, morbidity, and mortality (POGI, 2020). COVID-19 likely increases the risk of premature birth, preeclampsia, stillbirth, neonatal death, and maternal death (Marchand et al, 2022). It is more threatening that 1.30% of 11,758 pregnant women infected with COVID-19 died, and and 20% of the postpartum women, had comorbidities (Karimi et al, 2021).The Indonesian Ministry of Health has changed health guidelines for checking pregnancy, childbirth, and postpartum during the COVID-19 pandemic, for example, delay in pregnancy programs and routine pregnancy examinations for suspect and positive confirmed mothers, and change in mode of second-trimester pregnancy examination (Ministry of health Republic of Indonesia, 2020b).…”

The impact of COVID-19 on pregnant and recently pregnant women in Malawi: A national facility-based cohort

“…It was though suggested in this multi-country cohort that no systematic pattern of differences in maternal outcomes were measured between participating countries (7). Therefore, the direct impact of COVID-19 on pregnant and recently pregnant women in Africa, and thus the true global impact, is still not well described (8).…”