Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol

Abstract

BackgroundOver 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population, however, there is scarcity of information related to pharmacological management, maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected, therefore managing pregnant population presents a unique challenge. Research Question(s)This systematic review seeks to answer the following questions in relation to COVID-19,What are the different clinical characteristics presented in maternal and perinatal population?What are the different maternal and perinatal outcome measures reported?What are the distinct therapeutic interventions reported to treat Covid-19?Is it safe to use ‘medications’ used in the treatment of COVID-19 during antenatal, perinatal, postnatal and breastfeeding?Method The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, LitCovid etc. will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to Refworks and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle–Ottawa Quality Assessment Scale for non-randomized studies and for case reports Murad et al tool will be used. Decision to conduct metanalysis will be based on several factors including homogeneity and outcome measures reported, otherwise a narrative synthesis will be deemed appropriate. Discussion This systematic review will summarise the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding.Systematic review registrationProspero (CRD42020181163)

Knowledge about Care of Pregnant Mothers during the Covid-19 Pandemic

“…Questionnaire questions about whether mothers who are confirmed to have COVID-19 can breastfeed their babies, 27 respondents answered incorrectly, mothers who were confirmed to have COVID-19 were allowed to touch and hold their babies, and 32 respondents answered incorrectly. Mothers who breastfeed confirmed COVID-19 in the Parazzini study (2020) in 10 cases breastfeeding was allowed, with women wearing surgical masks and 2 women having a new diagnosis of COVID-19 infection in the postpartum period and being breastfed without a surgical mask, the two newborns tested positive for Covid-19 on the 1 st and 3 rd days [21]. This is similar to the Indonesian Ministry of Health (2020) breastfeeding during the COVID-19 pandemic, and it is not transmitted through breast milk because the transmission of this virus comes from droplets, so mothers must avoid using eating utensils at the same time as the fetus [22].…”

“…The rate of premature birth in pregnant women with COVID-19 is higher than pregnant women without the disease [24]. Parazzini (2020) said elective cesarean section was performed in 18 cases, in 8 cases the indications were not related to Covid-19 infection, but in 10 cases the indications were worsening shortness of breath or other Covid-19-related symptoms in women who tried vaginal delivery [21].…”

365 Dias de pandemia de COVID-19 e a realidade brasileira: pesquisas e reflexões

“…Várias opções de tratamento incluem, fármacos antivirais e combinações, antimaláricos, anti-histamínicos, esteroides e antipiréticos. Enquanto as estratégias de tratamento para COVID-19 diferem entre os países, a OMS e os Centros de Controle de Doenças (CDC) e as diretrizes de prevenção são muito gerais, e ambos aconselham o manejo de pacientes grávidas e pediátricas com cuidado (THOMAS et al, 2020). Nesse sentido, o uso de agentes terapêuticos deve ser feito após uma análise individual de risco-benefício e uma cuidadosa consideração dos potenciais benefícios para a mãe e segurança fetal (TRAPANI JÚNIOR et al, 2020).…”

Recommendations for prenatal, intrapartum, and postpartum care during COVID‐19 pandemic in India

“…24,36,37 Some case reports and small studies observed increased complications and adverse maternal and fetal outcome with COVID-19 severe disease. [46][47][48] Royal College of Obstetricians and Gynecologists Guideline has reported some adverse outcome with COVID-19 in pregnancy in the form of slight increased risk of preterm delivery, premature rupture of membranes, maternal sepsis, preeclampsia, and postpartum hemorrhage. 12 In their systematic review and meta-analysis on COVID-19 in pregnancy, Capobianco et al 49 observed increased maternal and neonatal complications.…”