Adverse Perinatal Outcomes in COVID-19 Infected Pregnant Women: A Systematic Review and Meta-Analysis

Abstract

The impact of COVID-19 virus infection during pregnancy is still unclear. This systematic review and meta-analysis aimed to quantitatively pool the evidence on impact of COVID-19 infection on perinatal outcomes. Databases of Medline, Embase, and Cochrane library were searched using the keywords related to COVID-19 and perinatal outcomes from December 2019 to 30 June 2021. Observational studies comparing the perinatal outcomes of COVID-19 infection in pregnancy with a non-infected comparator were included. The screening process and quality assessment of the included studies were performed independently by two reviewers. Meta-analyses were used to pool the comparative dichotomous data on perinatal outcomes. The database search yielded 4049 results, 1254 of which were duplicates. We included a total of 21 observational studies that assessed the adverse perinatal outcomes with COVID-19 infection. The odds of maternal death (pooled OR: 7.05 [2.41−20.65]), preeclampsia (pooled OR: 1.39 [1.29−1.50]), cesarean delivery (pooled OR: 1.67 [1.29−2.15]), fetal distress (pooled OR: 1.66 [1.35−2.05]), preterm birth (pooled OR: 1.86 [1.34−2.58]), low birth weight (pooled OR: 1.69 [1.35−2.11]), stillbirth (pooled OR: 1.46 [1.16−1.85]), 5th minute Apgar score of less than 7 (pooled OR: 1.44 [1.11−1.86]) and admissions to neonatal intensive care unit (pooled OR: 2.12 [1.36−3.32]) were higher among COVID-19 infected pregnant women compared to non-infected pregnant women.

Perinatal mental health during the COVID‐19 pandemic

“…However, a recent systematic review found a significant increase in maternal deaths, pre-eclampsia, caesarean deliveries, pre-term birth, low birth weight, stillbirth and admissions to a neonatal intensive care unit in COVID-19 infected pregnant women compared with non-infected. 22 There is little evidence to support vertical transmission of the virus or transmission via breastmilk. 23 The longer-term impact of in utero exposure to COVID-19 on the developing infant remains to be seen, providing a useful focus for future research.…”

“…Data on obstetric and neonatal outcomes of COVID‐19 infection are more conflicting. However, a recent systematic review found a significant increase in maternal deaths, pre‐eclampsia, caesarean deliveries, pre‐term birth, low birth weight, stillbirth and admissions to a neonatal intensive care unit in COVID‐19 infected pregnant women compared with non‐infected 22 . There is little evidence to support vertical transmission of the virus or transmission via breastmilk 23 .…”

COVID‐19 vaccine and pregnancy outcomes: A systematic review and meta‐analysis

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Pregnancy is considered an independent risk factor for adverse outcome in women with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, with increased rates of maternal mortality and intensive care unit admissions compared with non‐pregnant women, and also with increased rates of preterm deliveries (both spontaneous and iatrogenic), stillbirth, cesarean sections, and other pregnancy‐related diseases. 10 , 11 , 12 , 13 , 14 , 15 , 16 Recently, the American College of Obstetricians and Gynecologists, the Society for Maternal‐Fetal Medicine, and the Centers for Disease Control and Prevention declared that all pregnant women should be vaccinated to reduce maternal and fetal‐neonatal morbidity and mortality. 17 , 18 However, although it is growingly recognized that COVID‐19 vaccination programs, including booster doses, are safe and open to pregnant women, 19 , 20 Zavala et al 21 observed that, by September 2021, 17% of national policies still continued to recommend against the use of any COVID‐19 vaccine during pregnancy, of which 25% were low‐ and middle‐income countries, taking into consideration the lack of clinical trials, and developmental and reproductive toxicology data involving pregnant women.…”

The Impact of the COVID-19 Pandemic on Perinatal Loss Experienced by the Parental Couple: Protocol for a Mixed Methods Study

“…During the pandemic health emergency, maternal and fetal outcomes worsened globally, although there are limited data indicating that SARS-CoV-2 infection caused higher levels of adverse perinatal outcomes [ 51 , 52 ], measured in infected pregnant women compared to noninfected pregnant women [ 53 ]. Adverse outcomes include increased risks of perinatal loss [ 54 , 55 ].…”