COVID-19 in Pregnant Women: Case Series from One Large New York City Obstetrical Practice

Fox, Nathan S.; Melka, Stephanie

doi:10.1055/s-0040-1712529

Cited by 33 publications

(25 citation statements)

References 3 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

1,914

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

1,914

153

2,305

View full text Add to dashboard Cite

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“…In the past, SARS infection was found to increase the risk of fetal distress, and gestational diabetes and pre‐eclampsia are known to be higher in MERS infection, but no such correlation can be established for SARS‐CoV‐2 31 . 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 …”

Section: Maternal Outcomes In Covid‐19mentioning

confidence: 99%

“…A case series from the USA reported adverse outcomes in 28.5% pregnant patients with COVID‐19 including shortness of breath, dyspnea, cardiomyopathy, and moderately reduced left ventricular ejection fractions and hypokinesis, leading to admission to the ICU 39 . However, another case series of pregnant women with confirmed COVID‐19 from the U.S.A reported no pregnancy complications or maternal deaths but reported one fetal demise at 14 weeks of gestation 33 . Recently, the U.S. Centers for Disease Control and Prevention (CDC) presented a surveillance report of women (pregnant and non‐pregnant) with laboratory‐confirmed COVID‐19.…”

Section: Maternal Outcomes In Covid‐19mentioning

confidence: 99%

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

Salem

Katranji

Bakdash

2020

Intl J Gynecology & Obste

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Pregnant women, their fetuses, and newborns are likely to represent a high‐risk population during the current coronavirus disease 2019 (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). Literature on the outcomes of COVID‐19 infections during pregnancy is slowly building up. The aim of the present review was to gather evidence from relevant articles published in English from January to August 2020 in Medline and Google Scholar. The review revealed that pregnant women who become COVID‐19‐positive are usually either asymptomatic or mild‐to‐moderately symptomatic, similar to non‐pregnant women. Pneumonia is one of the most common outcomes in pregnant women with COVID‐19. However, it cannot be conclusively said that SARS‐CoV‐2 infection increases the risk of maternal, fetal, and neonatal complications. Pregnant women with COVID‐19 with co‐morbidities have increased risks of complications: there are regional variations in the rates of adverse outcomes reported. Though uncommon, the review shows that vertical transmission is possible. Additionally, the third trimester seems to be the most vulnerable period of infection. This aspect needs to be researched further to activate surveillance programs at the end of second trimester. Overall, it is necessary to monitor pregnant women before and after delivery, and their infants, during this pandemic.

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“…No entanto, uma das pacientes teve morte fetal inexplicada na 14ª semana gestacional, enquanto apresentava sintomas da doença. 9 Ainda em Nova Iorque, ao analisar 3 casos de COVID-19 em gestantes, as mães evoluíram bem, apesar da intubação e da necessidade de ventilação mecânica. A idade gestacional na intubação foi entre 23 e 29 semanas e a duração da ventilação mecânica foi de 3 a 8 dias.…”

Section: Discussionunclassified