Problems with Early Systematic Reviews: The Case of Coronavirus Disease 2019 (COVID-19) in Pregnancy

Abstract

Introduction Rapid dissemination of findings regarding the Coronavirus Disease 2019 (COVID-19) and its potential effects on pregnancy is crucial to support understanding and development of recommendations for optimization of obstetrics care. However, much of the current studies published are in the form of case reports or case series which can be prone to biases. Other factors also further complicate attempts to analyze data accurately. Hence, this evaluation hopes to highlight some of these problems and provide suggestions to help clinicians mitigate and make reasonable conclusions when reading the abundant yet limited body of evidence when furthering their research efforts. Methods Studies regarding COVID-19 and pregnancy were searched on databases such as PubMed, EMBASE, Scopus, the Cochrane Library. Manual search of references of select articles were also undertaken. Apart from summarizing study limitations identified by authors, the characteristics of current literature and systematic reviews were also evaluated to identify potential factors affecting accuracy of subsequent analysis. Results Factors such as innate biasness in study design of current literature, duplicate reporting, differing inclusion criteria of systematic reviews, scarce data, inadequate follow-up period and limitations of systematic reviews have been shown to hinder the ability for accurate data extrapolation. Discussion Unless additional studies are conducted in identified areas of data scarcity and a common list of factors affecting accuracy of data analysis are taken into account when developing recommendations, discrepancies will continue to arise and accurate data analysis and valid systematic reviews will be precluded.

Assessment of fetal growth and anomalies in the era of COVID-19 pandemic: an Egyptian pilot study

“…We included only patients with the laboratory-confirmed positive qRT-PCR assay. However, the viral nucleic acid test has a false-negative rate of up to 30% [ 29 ].…”

Worse outcomes of pregnancy in COVID-19 infection during parturition may be due to referral bias: analysis in a prospective cohort of 963 pregnancies

“…4 This was compounded by duplicate reporting of the same patients in different cohorts, variable inclusion criteria of systematic reviews, and scarce and missing data. 5 More recent systematic reviews have shown that maternal deaths and neonatal outcomes were similar in deliveries conducted in COVID-19 mothers compared with noneCOVID-19 mothers. 6 The limitations of our study include the fact that we do not have the indications for cesarean deliveries in the cohort and that it was carried out in a tertiary center that would receive more complicated cases.…”

Exploring the Gantt chart as a tool to highlight double report in case series published during the first wave of the COVID-19 pandemic

“…Author details 1 Unidade de Bioestatística, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 2 Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 3 Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.…”

“…The novelty of the COVID-19 illness and the search for rapid answers to questions on its characteristics, treatment, and prognosis unleashed a flood of papers being rapidly produced, some with no strict adherence to methodological directives [ 1 ]. Several systematic reviews on pregnancy and COVID-19 were available by the end of 2020, and concern about case duplications and other methodological issues was raised at that time [ 2 ]. An editorial called attention to the report of different aspects of the disease in the same participant, in papers published in different journals, with no clear citation of a prior publication [ 3 ].…”