COVID-19 and maternal, fetal and neonatal mortality: a systematic review

Abstract

Objective: This is the first comprehensive review to focus on currently available evidence regarding maternal, fetal and neonatal mortality cases associated with Coronavirus Disease 2019 (COVID-19) infection, up to July 2020. Methods: We systematically searched PubMed, Scopus, Google Scholar and Web of Science databases to identify any reported cases of maternal, fetal or neonatal mortality associated with COVID-19 infection. The references of relevant studies were also hand-searched. Results: Of 2815 studies screened, 10 studies reporting 37 maternal and 12 perinatal mortality cases (7 fetal demise and 5 neonatal death) were finally eligible for inclusion to this review. All maternal deaths were seen in women with previous co-morbidities, of which the most common were obesity, diabetes, asthma and advanced maternal age. Acute respiratory distress syndrome (ARDS) and severity of pneumonia were considered as the leading causes of all maternal mortalities, except for one case who died of thromboembolism during postpartum period. Fetal and neonatal mortalities were suggested to be a result of the severity of maternal infection or the prematurity, respectively. Interestingly, there was no evidence of vertical transmission or positive COVID-19 test result among expired neonates. Conclusion: Current available evidence suggested that maternal mortality mostly happened among women with previous co-morbidities and neonatal mortality seems to be a result of prematurity rather than infection. However, further reports are needed so that the magnitude of the maternal and perinatal mortality could be determined more precisely.

Updated experience of a tertiary pandemic center on 533 pregnant women with COVID‐19 infection: A prospective cohort study from Turkey

“…Other cases were isolated at home for at least 14 days under the supervision of expert community teams. On the other hand, the rate of severe cases and maternal mortality were lower than the reported rates in the current literature 16,17 …”

COVID‐19 infection in pregnant women: Review of maternal and fetal outcomes

“…However, morbidity and mortality were found to be quite low in pregnant patients with COVID‐19 11,12,21,24,28,30,32,33 . In general, a systematic review of the literature shows that pregnant women positive for COVID‐19 with co‐morbidities are more likely to develop complications than those without 34 …”

Problems with Early Systematic Reviews: The Case of Coronavirus Disease 2019 (COVID-19) in Pregnancy

“…All the systematic reviews included in our analysis acknowledge the limitation that their review is limited to largely case series and case reports. Apart from the innate bias of case series and case reports, the current literature is complicated by inconsistent reporting and small sample size which further impede efforts to apply the findings to the larger population (Ashraf et al 2020;Capobianco et al 2020;Della Gatta et al 2020;Di Mascio et al 2020;Dubey et al 2020;Hessami et al 2020;Kotlyar et al 2020;Lopes de Sousa et al 2020;Matar et al 2020;Sayre et al 2017;Smith et al 2020;Thomas et al 2020a, b;Trippella et al 2020;Trocado et al 2020;Turan et al 2020;Walker et al 2020;Yang et al 2020;Yoon et al 2020;Zaigham et al 2020). Duplicate reporting overemphasizes findings.…”

“…Since December 2019 when the infection was first identified, more than 41,000 MEDLINEindexed papers have been published on COVID-19. Up to 31st July 2020, at least 29 systematic reviews on COVID-19 and pregnancy with varying conclusions have been published (Abdollahpour and Khadivzadeh 2020;Akhtar et al 2020;Ashraf et al 2020;Capobianco et al 2020;Della Gatta et al 2020;Deniz and Tezer 2020;Di Mascio et al 2020;Dubey et al 2020;Elshafeey et al 2020;Hessami et al 2020;Juan et al 2020;Kasraeian et al 2020;Kotlyar et al 2020;Lopes de Sousa et al 2020;Matar et al 2020;Melo and Araújo 2020;Muhidin et al 2020;Segars et al 2020;Silva et al 2020;Smith et al 2020;Thomas et al 2020a, b;Trippella et al 2020;Trocado et al 2020;Turan et al 2020;Walker et al 2020;Yang et al 2020;Yoon et al 2020;Zaigham and Andersson 2020). Factors which are likely to cause bias and thus, inaccuracy in subsequent analysis in systematic reviews were then identified and compiled.…”