SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes

Abstract

Background: Perform a systematic review and meta-analysis of SARS-CoV-2 infection and pregnancy. Methods: Databases (Medline, Embase, Clinicaltrials.gov, Cochrane Library) were searched electronically on 6th April and updated regularly until 8th June 2020. Reports of pregnant women with reverse transcription PCR (RT-PCR) confirmed COVID-19 were included. Meta-analytical proportion summaries and meta-regression analyses for key clinical outcomes are provided. Findings: 86 studies were included, 17 studies (2567 pregnancies) in the quantitative synthesis; other small case series and case reports were used to extract rarely-reported events and outcome. Most women (73.9%) were in the third trimester; 52.4% have delivered, half by caesarean section (48.3%). The proportion of Black, Asian or minority ethnic group membership (50.8%); obesity (38.2%), and chronic co-morbidities (32.5%) were high. The most commonly reported clinical symptoms were fever (63.3%), cough (71.4%) and dyspnoea (34.4%). The commonest laboratory abnormalities were raised CRP or procalcitonin (54.0%), lymphopenia (34.2%) and elevated transaminases (16.0%). Preterm birth before 37 weeks' gestation was common (21.8%), usually medically-indicated (18.4%). Maternal intensive care unit admission was required in 7.0%, with intubation in 3.4%. Maternal mortality was uncommon (~1%). Maternal intensive care admission was higher in cohorts with higher rates of co-morbidities (beta=0.007, p<0.05) and maternal age over 35 years (beta=0.007, p<0.01). Maternal mortality was higher in cohorts with higher rates of antiviral drug use (beta=0.03, p<0.001), likely due to residual confounding. Neonatal nasopharyngeal swab RT-PCR was positive in 1.4%. Interpretation: The risk of iatrogenic preterm birth and caesarean delivery was increased. The available evidence is reassuring, suggesting that maternal morbidity is similar to that of women of reproductive age. Vertical transmission of the virus probably occurs, albeit in a small proportion of cases.

Attitude and perceptions towards&nbsp;COVID-19 among pregnant women in Singapore: A cross-sectional survey

“…The effects of SARS-CoV-2 in pregnancy had been based upon previous experience with SARS-CoV-1 and Middle East Respiratory Syndrome-related coronavirus (MERS) initially [5][6]. However, SARS-CoV-2 turns out to be far more infectious, albeit with lower mortality and similar morbidity to women of reproductive age [7]. The rapidly evolving pandemic over the past six months has given rise to multiple livingguidelines for the management of COVID-19 in pregnancy from a range of professional bodies such as the Royal College of Obstetricians & Gynaecologists (RCOG), American College of Obstetricians and Gynaecologists (ACOG) and the Academy of Medicine in Singapore [8][9][10].…”

Attitude and perceptions towards&nbsp;COVID-19 among pregnant women in Singapore: A cross-sectional survey

“…Di Mascio et al showed that 41.1% of pregnant women with COVID-19 had preterm birth before 37 weeks gestation , however that study did not distinguish between spontaneous and iatrogenic preterm birth [22]. A systemic review by A. Khalil et al also showed an 18.4% increase in iatrogenic preterm births before 37 weeks as these women were ill enough to require early caesarean deliveries [7]. This emphasizes the importance of imparting knowledge and educating women to to avoid unnecessary anxieties from non-evidenced based perceptions.…”

“…In our study, 53% of women would choose to have a caesarean section over a vaginal delivery if they were diagnosed with COVID-19. A. Khalil et al showed that nearly half of pregnant women infected with COVID-19 had caesarean deliveries [7]. As there is no convincing evidence of vertical transmission, vaginal delivery is not contraindicated in patients with COVID-19 [8,9].…”

“…The effects of SARS-CoV-2 in pregnancy had been based upon previous experience with SARS-CoV-1 and Middle East Respiratory Syndrome-related coronavirus (MERS) initially [5][6]. However, SARS-CoV-2 turns out to be far more infectious, albeit with lower mortality and similar morbidity to women of reproductive age [7]. The rapidly evolving pandemic over the past six months has given rise to multiple living-guidelines for the management of COVID-19 in pregnancy from a range of professional bodies such as the Royal College of Obstetricians & Gynaecologists (RCOG), American College of Obstetricians and Gynaecologists (ACOG) and the Academy of Medicine in Singapore [8][9][10].…”

Pregnancy hypertension diagnosis and care in COVID‐19 era and beyond

“…The coronavirus disease 2019 (COVID-19) pandemic has led to an abrupt transition to virtual healthcare in pregnancy in order to reduce dependence on hospital-based care and minimize the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which appears to carry a similar risk in pregnancy compared with that in non-pregnant adults 1 . This is true for all women, including the approximately 10% who have pregnancy hypertension and receive specialist hypertension care 2 .…”