Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19)

Savasi, Valeria; Parisi, Francesca; Patanè, Luisa; Ferrazzi, E.; Frigerio, Luigi; Pellegrino, A.; Spinillo, Arsenio; Tateo, Saverio; Ottoboni, Mariacristina; Veronese, Paola; Petraglia, Felice; Vergani, Patrizia; Facchinetti, Fabio; Spazzini, Donata; Cetin, Irene

doi:10.1097/aog.0000000000003979

Cited by 167 publications

(199 citation statements)

References 13 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

1,918

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

1,918

153

2,305

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“…Notably, subject n. 17 was the only one to deliver prematurely at week 34. Prematurity was indeed reported to be more frequent in SARS-CoV-2 infected patients 8 . We hypothesize that this might be related to the in ammatory status, as a consequence of the viral infection; alternatively, this could have been the result of a pre-existing condition that triggered the premature delivery and facilitated viral entry through the placenta.…”

Section: Discussionmentioning

confidence: 96%

“…Maternal physiological adaptations to pregnancy are known to increase the risk of developing severe illness in response to viral infections, such as in uenza; preliminary data suggest that the prognosis of SARS-CoV-2 infection could be more severe as well in pregnant women 8 . Vertical transmission of SARS-CoV and MERS, the two other animal coronaviruses known to infect humans, was never documented to occur.…”

Section: Introductionmentioning

confidence: 99%

In-Utero Mother-to-Child SARS-CoV-2 Transmission: Viral Detection and Fetal Immune Response

Fenizia

Biasin

Cetin

et al. 2020

Preprint

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Pregnancy is known to increase the risk of severe illnesses in response to viral infections. Therefore, the impact of SARS-CoV-2 infection during gestational ages might be detrimental and the potential vertical transmission should be thoroughly studied.Herein, we investigated whether SARS-CoV-2 vertical transmission is possible and, in case, whether this results in a fetal involvement. Additionally, we analyzed the role of the antibody and the inflammatory responses in placenta and plasma from SARS-CoV-2-positive pregnant women and fetuses.31 SARS-CoV-2 pregnant women were enrolled. Real-time PCR was performed to detect the virus on maternal and newborns’ nasopharyngeal swabs, vaginal swabs, maternal and umbilical cord plasma, placenta and umbilical cord biopsies, amniotic fluids and milk. Maternal and umbilical cord plasma, and milk were tested for specific anti-SARS-CoV-2 antibodies. RNA expression quantification of genes involved in the inflammatory response was performed on four selected placentas. On maternal and umbilical cord plasma of the same subjects, secreted cytokines/chemokines were quantified.SARS-CoV-2 is found in at-term placentae and in the umbilical cord blood, in the vaginal mucosa of pregnant women and in milk. Furthermore, we report the presence of specific anti-SARS-CoV-2 IgM and IgG antibodies in the umbilical cord blood of pregnant women, as well as in milk specimens. Finally, a specific inflammatory response is triggered by SARS-CoV-2 infection in pregnant women at both systemic and placental level, and in umbilical cord blood plasma.Our data strongly support the hypothesis that in-utero vertical transmission is possible in SARS-CoV-2 positive pregnant women. This is essential for defining proper obstetric management of COVID-19 pregnant women, or putative indications for mode and timing of delivery.

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“…Albeit still limited, there is evidence that SARS-Cov-2 can cause life-threatening situations also in pregnancy, even if fatal cases seem rare [5][6][7][8][9] . Severe pneumonia occurs in 5-16% of women 5,8,9 and may require prompt pregnancy termination for improving respiratory assistance. However, this evidence was drawn from case series, a study design that could overestimate the detrimental effects of SARS-Cov-2.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, our reassuring clinical ndings are somehow in disagreement with recent evidence from large case series of affected pregnant women. Savasi et al reported on an Italian multicenter case series of 77 women hospitalized for Covid-19 and highlighted that one in ve delivered urgently for respiratory compromise or were admitted to an intensive care unit9 . Based on a retrospective case series in the USA, 7 out of 46 pregnant…”

mentioning

confidence: 99%

Covid-19 in the second half of pregnancy: prevalence and clinical relevance

Ruggiero

Somigliana

Tassis

et al. 2020

Preprint

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Evidence on the prevalence and outcome of Covid-19 in pregnancy is yet inconclusive. To draw more information on this issue, we prospectively recruited 315 consecutive women delivering in a referral hospital located in Lombardy, Italy and evaluated the proportion of women who had Covid-19 in pregnancy. All recruited subjects underwent a nasopharyngeal swab to assess the presence of Sars-Cov-2 using Real-time PCR. In addition, two different type of antibodies for the virus were evaluated in peripheral blood, those against the spike proteins S1 and S2 of the envelope and those against the nucleoprotein of the nucleocapsid. Women were considered to have had Covid-19 in pregnancy if at least one of the assessment was positive. Overall, 28 women had a diagnosis of Covid-19 in pregnancy (8.9%, 95%CI: 6.2-12.5%), in line with the local general population. Women diagnosed with the infection were more likely to report one or more episodes of symptoms suggestive for Covid-19 (n=11, 39.3%) compared to unaffected women (n=39, 13.6%). The corresponding OR was 4.11 (95%CI: 1.79-9.44). Symptoms significantly associated with Covid-19 in pregnancy included fever, cough, dyspnea and anosmia. Only one woman necessitated intensive care. No maternal deaths occurred. Pregnancy outcome in women with and without Covid-19 did not also differ. In conclusion, women in the second half of pregnancy do not appear to be more susceptible to Covid-19 and its complications. In addition, the study suggests that pregnancy outcome may not be significantly affected.

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Clinical Findings and Disease Severity in Hospitalized Pregnant Women With Coronavirus Disease 2019 (COVID-19)

Cited by 167 publications

References 13 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

In-Utero Mother-to-Child SARS-CoV-2 Transmission: Viral Detection and Fetal Immune Response

Covid-19 in the second half of pregnancy: prevalence and clinical relevance

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