Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

Abstract

Objective Coronavirus disease 2019 (COVID-19) has become a global pandemic and may adversely affect pregnancy outcomes. We estimated the adverse maternal and neonatal characteristics and outcomes among COVID-19 infected women and determined heterogeneity in the estimates and associated factors. Study Designs PubMed search was performed of confirmed COVID-19 pregnant cases and related outcomes were ascertained prior to July 8, 2020, in this systematic review and meta-analysis. Studies reporting premature birth, low birth weight, COVID-19 infection in neonates, or mode of delivery status were included in the study. Two investigators independently performed searches, assessed quality of eligible studies as per the Cochrane handbook recommendations, extracted and reported data according to PRISMA guidelines. Pooled proportions of maternal and neonatal outcomes were estimated using meta-analyses for studies with varying sample sizes while a systematic review with descriptive data analysis was performed for case report studies. Maternal and neonatal outcomes included C-section, premature birth, low birth weight, adverse pregnancy events and COVID transmission in neonates. Results A total of 790 COVID-19 positive females and 548 neonates from 61 studies were analyzed. The rates of C-section, premature birth, low birth weight, and adverse pregnancy events were estimated as 72 %, 23 %, 7 %, and 27 % respectively. In the heterogeneity analysis, the rate of C-section was substantially higher in Chinese studies (91 %) compared to the US (40 %) or European (38 %) studies. The rates of preterm birth and adverse pregnancy events were also lowest in the US studies (12 %, 15 %) compared to Chinese (17 %, 21 %), and European studies (19 %, 19 %). In case reports, the rates of C-section, preterm birth, and low birth weight were estimated as 69 %, 56 %, and 35 %, respectively. Adverse pregnancy outcomes were associated with infection acquired at early gestational ages, more symptomatic presentation, myalgia symptom at presentation, and use of oxygen support therapy. Conclusions Adverse pregnancy outcomes were prevalent in COVID-19 infected females and varied by location, type, and size of the studies. Regular screening and early detection of COVID-19 in pregnant women may provide more favorable outcomes.

Maternal and Neonatal Characteristics and Outcomes of COVID-19 in Pregnancy: An Overview of Systematic Reviews

“…After the application of the eligibility criteria, 39 studies were finally included [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], one (2.6%) of which was described as “rapid” [ 42 ] and two (5.1%) as “scoping” systematic reviews [ 30 , 50 ]. Thirteen (33%) of them also undertook a meta-analysis [ 14 , 16 , 18 , 19 , 24 , 25 , 27 , 36 , 38 , 40 , 48 ,…”

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.…”

“…Additionally, variations in management and healthcare resources exists between countries (Turan et al 2020). Genetic and environmental factors can also influence the natural history of disease (Capobianco et al 2020) and thus, these factors limit generalizability of the findings of systematic reviews (Dubey et al 2020). Exclusion of studies not published in the English language may further cause bias (Matar et al 2020;Muhidin et al 2020;Thomas et al 2020a, b).…”

“…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.…”

Perinatal mortality and morbidity of SARS-COV-2 infection during pregnancy in European countries: Findings from an international study

“…Evidence has been accumulating rapidly in the last months to provide early information to help with counseling and care of pregnant women with SARS CoV-2 infection, and despite the relatively short time from the pandemic outbreak, a multitude of systematic reviews have been published on the topic of SARS-COV-2 infection and COVID-19 disease during pregnancy. However, these studies often share important limitations that might affect the robustness of the results [1,[3][4][5][6].…”