Update on clinical outcomes of women with COVID‐19 during pregnancy

Zeng, Yingchun; Lin, Lin; Yan, Qiaoyuan; Wei, Wei; Yang, Bing Xiang; Huang, Run; He, Fang; Chen, Dunjin

doi:10.1002/ijgo.13236

Cited by 27 publications

(27 citation statements)

References 6 publications

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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

1,870

153

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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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

1,870

153

2,305

View full text Add to dashboard Cite

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“…In addition, 2 studies were excluded due to duplicity of data reporting. Out of 27 studies [ [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] ], 16 studies were from China (14 were from Hubei province and 2 from Guangzhou) and 4 studies was from USA [ [44] , [45] , [46] , [47] ], 2 from France [ 48 , 49 ], 2 from Italy [ 50 , 51 ], 1 from UK [ 52 ], 1 from Spain [ 53 ], and 1 from Iran [ 54 ]. Of 27 studies, 4 studies (n = 233) also included a control group [ [38] , [39] , [40] , [41] ].…”

Section: Resultsmentioning

confidence: 99%

“…However, a substantial reduction in the heterogeneity measure was observed for adverse pregnancy outcomes when the analysis was restricted to studies ascertaining pregnancy outcomes with a sample size greater than 10 ( Table 3 ). In the sensitivity analysis after restricting the analysis to relatively large Chinese studies [ 28 , 32 , [35] , [36] , [37] , [38] , [39] , [40] , 43 ], removing a US study due to relatively a low sample size [ 45 ] and two European studies due to relatively a small sample size [ 52 ] and a large number of women without pregnancy status [ 49 ], the heterogeneity was eliminated for all pregnancy outcomes. After removing heterogeneity, the rate of C-section was substantially higher in Chinese studies (91 %, I 2 = 9.2 %) compared to the US (40 %, I 2 = 0 %) or European (38 %, I 2 = 9.3 %) studies.…”

Section: Resultsmentioning

confidence: 99%

Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

Dubey

Reddy

Manuel

et al. 2020

European Journal of Obstetrics & Gynecology and Reproductiv

157

135

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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.

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“…Moreover, viral antigens are engulfed by dendritic cells, which migrate to lymph nodes and initiate acquired responses by resident CD4 and CD8 T cells ( Littauer and Skountzou, 2018 ). Consequently, pregnant women are potentially more susceptible to severe viral infections due to a shift from cellular to humoral immunity, with a decrease in cellular immunity and an increase in humoral immunity during pregnancy and puerperium ( Kourtis et al, 2014 ; Zeng et al, 2020 ). Indeed, published articles on influenza A virus subtype H1N1 or circulating rhinovirus strains in healthy pregnant women indicated significantly reduced IFN responses, suggesting that there is an increased vulnerability to severe viral infection outcomes during pregnancy ( Littauer and Skountzou, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Can immunity during pregnancy influence SARS-CoV-2 infection? – A systematic review

Areia

Mota-Pinto

2020

Journal of Reproductive Immunology

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Background: During pregnancy, the maternal immune system must create and sustain tolerance to the allogeneic fetus while maintaining the ability to protect against microbial assaults. Objectives: Ascertain the immunological differences in immune cells of pregnant women that may influence SARS-CoV-2 infection. Study design: Systematic review conducted in accordance with PRISMA guidelines and registered within PRO-SPERO CRD42020189735. A systematic search was undertaken across ISI, PubMed, Scopus, Embase, Cochrane Library and clinical trials.gov from January 2019 up until June 2020. Eligibility criteria included COVID-19 infection, pregnancy, and availability of immune characteristics for the pregnant women. Two authors independently screened for the suitability of inclusion. Main outcome measures: Information was manually extracted from full-text articles and efforts were made to identify overlapping data. Variables extracted and analysed included the quantification of white blood cells (WBC), lymphocytes, and C-reactive protein (CRP). Results: The literature search yielded 162 studies, of which 11 were considered appropriate for selection. Only four were used in this systematic review. Our research showed that pregnant women with COVID-19 only differ from other pregnant women in their lower WBC count. The proportion of reduced lymphocyte cases is similar in both groups, as is the case of Creactive protein levels. Conclusions: In line with previous coronavirus infections, severe maternal morbidity and perinatal death with COVID-19 infection were more likely to be expected in pregnancy. Our research showed that pregnant women with COVID-19 in terms of immunity only differ from other pregnant women in their lower WBC count.

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Update on clinical outcomes of women with COVID‐19 during pregnancy

Abstract: Most women with COVID‐19 delivered at or beyond the late preterm period. Some who delivered prematurely had other medical indications for preterm birth.

Cited by 27 publications

References 6 publications

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

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

Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

Can immunity during pregnancy influence SARS-CoV-2 infection? – A systematic review

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