Differential impact of COVID‐19 in pregnant women from high‐income countries and low‐ to middle‐income countries: A systematic review and meta‐analysis

Gajbhiye, Rahul; Sawant, Mamta S.; Kuppusamy, Periyasamy; Surve, Suchitra; Pasi, Achhelal; Prusty, Ranjan Kumar; Mahale, Smita D.; Modi, Deepak

doi:10.1002/ijgo.13793

Cited by 61 publications

(70 citation statements)

References 41 publications

(88 reference statements)

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“…There is limited information on PTB rates in women with COVID‐19 in low‐ and middle‐income countries. A recent meta‐analysis reported the disproportionate impact of COVID‐19 on pregnant women residing in low‐ and middle‐income countries 7 . Earlier, we reported higher rates of intensive care unit admission and maternal mortality among pregnant women during the second wave of the COVID‐19 pandemic in India 8 .…”

Section: Introductionmentioning

confidence: 51%

Increased spontaneous preterm births during the second wave of the coronavirus disease 2019 pandemic in India

Mahajan

Pednekar

Gaikwad

et al. 2021

Intl J Gynecology & Obste

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Objective To compare spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB) rates during both waves of the coronavirus disease 2019 (COVID‐19) pandemic. Methods Retrospective analysis of the PregCovid registry of pregnant women with COVID‐19 was performed at a dedicated COVID‐19 hospital in Mumbai, India. The data of 1630 women were analyzed for this study between April 4, 2020 and July 4, 2021. Prepandemic data were analyzed and compared with pandemic data. Main outcome measure was spontaneous preterm birth rate. Results Preterm deliveries were higher during the second wave (46/329; 14%) compared with the first wave (82/807; 10.2%) of the COVID‐19 pandemic (P = 0.065). Higher SPTBs were reported during the second wave than the first wave (12.5% versus 8.3%) (P = 0.03) as well as the prepandemic period (12.5% versus 10.5%) (P = 0.286). IPTBs were significantly lower in the pandemic period than in the prepandemic period (1.8 versus 3.3) (P = 0.012). Conclusion In Mumbai, India, we found an unusual change in SPTBs during the 6 months of the second wave of COVID‐19 compared with the previous 10 months of the first wave of pandemic and 1 year of prepandemic.

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Section: Introductionmentioning

confidence: 51%

Increased spontaneous preterm births during the second wave of the coronavirus disease 2019 pandemic in India

Mahajan

Pednekar

Gaikwad

et al. 2021

Intl J Gynecology & Obste

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“…The most common symptoms reported were fatigue, fever, cough, and anosmia with ageusia (74,77,78). Moreover, living in low-to middle-income countries and having a history of smoking, overweight or obesity, hypertension, diabetes, cardiovascular diseases, or chronic pulmonary diseases were risk factors for developing severe COVID-19 in pregnancy (74,(79)(80)(81). Comorbidities increased the risk of intensive care admission and mortality significantly (80).…”

Section: Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-cov-2)...mentioning

confidence: 99%

“…Moreover, living in low-to middle-income countries and having a history of smoking, overweight or obesity, hypertension, diabetes, cardiovascular diseases, or chronic pulmonary diseases were risk factors for developing severe COVID-19 in pregnancy (74,(79)(80)(81). Comorbidities increased the risk of intensive care admission and mortality significantly (80). In retrospective studies of pregnant women with confirmed or suspected COVID-19, the risk for pneumonia increased with maternal age above 35 years and lymphopenia, whereas it decreased with gestational age (76,81).…”

Section: Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-cov-2)...mentioning

confidence: 99%

Effects of Vertical Transmission of Respiratory Viruses to the Offspring

et al. 2022

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Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.

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“…Nevertheless, the growing evidence demonstrates an increased risk of severe adverse outcomes from SARS-CoV-2 infection in pregnant compared with non- pregnant women, particularly when infection occurs during late-second and early-third trimesters ( 11 , 12 ). This increased burden of COVID-19 appears to be disproportionately affecting mother-neonate dyads from low- and middle- income countries ( 13 ). An increased risk of severe COVID-19 outcomes in pregnant women is likely attributable to several factors associated with pregnancy including immunological changes leading to dampening of cellular immunity ( 14 ), physiological changes such as reduced lung capacity and increased risk of thromboembolic disease in late pregnancy ( 1 ).…”

Section: Incidence and Burden Of Covid-19 In Pregnant Womenmentioning

confidence: 99%

Global Perspectives on Immunization Against SARS-CoV-2 During Pregnancy and Priorities for Future Research: An International Consensus Paper From the World Association of Infectious Diseases and Immunological Disorders

et al. 2021

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with a higher risk for severe morbidity and mortality when compared with infection in non-pregnant women of childbearing age. An increasing number of countries recommend immunization against SARS-CoV-2 in pregnant women. Recent studies provide preliminary and supportive evidence on safety, immunogenicity and effectiveness of coronavirus disease 2019 (COVID-19) vaccines in pregnant women; however, important knowledge gaps remain which warrant further studies. This collaborative consensus paper provides a review of the current literature on COVID-19 vaccines in pregnant women, identifies knowledge gaps and outlines priorities for future research to optimize protection against SARS-CoV-2 in the pregnant women and their infants.

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Differential impact of COVID‐19 in pregnant women from high‐income countries and low‐ to middle‐income countries: A systematic review and meta‐analysis

Cited by 61 publications

References 41 publications

Increased spontaneous preterm births during the second wave of the coronavirus disease 2019 pandemic in India

Increased spontaneous preterm births during the second wave of the coronavirus disease 2019 pandemic in India

Effects of Vertical Transmission of Respiratory Viruses to the Offspring

Global Perspectives on Immunization Against SARS-CoV-2 During Pregnancy and Priorities for Future Research: An International Consensus Paper From the World Association of Infectious Diseases and Immunological Disorders

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