COVID-19 in Pregnancy: A Current Review of Global Cases

Abstract

Importance: There is great concern about the impact of COVID-19 in pregnancy due to the high morbidity and mortality associated with prior coronavirus infections.Objective: The objective of this review is to summarize the current literature on the impact of COVID-19 on pregnant women and their newborns.Evidence Acquisition: The search terms COVID-19 and pregnancy were used in Medline and Clinical Key databases. Only articles written in English with outcome data on both mothers and their newborns were incorporated.Results: Pregnant women generally experience COVID-19 as a mild-moderate illness. However, approximately 5% become critically ill. Women with underlying comorbidities seem more likely to experience severe morbidity. Newborns also generally have a favorable course.Vertical transmission in the intrauterine period is possible but rare. Infection control measures need to be taken to prevent transmission during the peripartum period. There is a paucity of data on infections in the first and second trimesters, but research from those infected in the third trimester indicates a possible link with preterm birth. There is a significant percentage of asymptomatic cases. Racial disparities are also being noted with disproportionate numbers of racial/ethnic minorities being affected.Conclusions: COVID-19 is generally experienced by pregnant women and their newborns as a mild to moderate illness, although a minority become critically ill and mortality does occur. This is more likely among those with underlying comorbidities, as in the general population. Asymptomatic cases heighten the need for increased testing and infection control measures. Racial disparities highlight underlying vulnerabilities and the need for increased research and policy changes.Target Audience: Obstetricians and gynecologist, family physicians Learning Objectives: After completing this activity, the reader should be better able to describe clinical presentations of pregnant women who contract COVID-19; explain the risks associated with maternal morbidity and mortality with COVID-19 infections; outline the risks of vertical transmission and neonatal outcomes of pregnant women with COVID-19 infections; and identify racial/ethnic disparities among pregnant women with COVID-19.Since the novel coronavirus (2019-nCov now known as SARS-CoV-2) came to light in December 2019 in Wuhan, China, it has spread throughout the world causing the COVID-19 pandemic. As of October 14, 2020, there were more than 38 million confirmed cases documented worldwide with approximately 8 million of those in the United States, and over 1 million deaths globally. Given the grave complications that other severe coronavirus infections (severe acute respiratory coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV]) have caused in pregnant women, 1,2 there was heightened concern about how COVID-19 would significantly impact maternal child

COVID-19 and pregnancy: clinical outcomes; mechanisms, and vaccine efficacy

“…97 An increasing incidence of preterm deliveries has also been reported in SARS-CoV-2 infected pregnancies. 98 And in line with these reports, a systematic review shows that reported rates of preterm births in COVID-19 patients varies greatly between studies, from 14.3 to 61.2%. 99 Despite the variety of available clinical reports, there is some consensus among them that there is a strong link between premature birth and symptomatic COVID-19 during pregnancy.…”

“…Limited data is available on neonatal outcomes of maternal COVID-19. Several studies report neonates that tested positive for SARS-CoV-2 RNA had no observed adverse outcomes, 98,112 and others report that the majority of newborns and infants with SARS-CoV-2 infection appear to have mild disease. 113,98 However, a review gathered and reported data for 629 neonates that were tested for the virus after birth with 35 positive cases an reported that some adverse effects were observed.…”

Is the Immunization of Pregnant Women against COVID-19 Justified?

“…Preterm delivery and stillbirth were the most frequently detected complications. Common, even if less frequent, were preeclampsia and caesarean section [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. In a systematic review and meta-analysis of studies published until 29 January 2021, globally involving 7569 and 416,775 pregnant women with and without COVID-19, it was calculated that, compared with noninfected women, the odds ratios (OR) for preeclampsia, preterm birth and stillbirth were 1.33 (95% CI, 1.03-1.73), 1.82 (95% CI, 1.38-2.39), and 2.11 (95% CI, 1.14-3.90), respectively, in infected women [17].…”

“…In a systematic review and meta-analysis of studies published until 29 January 2021, globally involving 7569 and 416,775 pregnant women with and without COVID-19, it was calculated that, compared with noninfected women, the odds ratios (OR) for preeclampsia, preterm birth and stillbirth were 1.33 (95% CI, 1.03-1.73), 1.82 (95% CI, 1.38-2.39), and 2.11 (95% CI, 1.14-3.90), respectively, in infected women [17]. The preterm birth incidence rate varied from 12.2% to 37% [58][59][60][61][62], compared to historical rates of 8.9-10.2% [30,59,60]. Finally, the risk of stillbirth was found to be more than five times higher in pregnant women with COVID-19 than in the general population (3.2% vs. 0.6%) [61].…”