SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis

Abstract

Objectives To assess the rates of SARS-CoV-2 positivity in babies born to mothers with SARS-CoV-2 infection, the timing of mother-to-child transmission and perinatal outcomes, and factors associated with SARS-CoV-2 status in offspring. Design Living systematic review and meta-analysis. Data sources Major databases between 1 December 2019 and 3 August 2021. Study selection Cohort studies of pregnant and recently pregnant women (including after abortion or miscarriage) who sought hospital care for any reason and had a diagnosis of SARS-CoV-2 infection, and also provided data on offspring SARS-CoV-2 status and risk factors for positivity. Case series and case reports were also included to assess the timing and likelihood of mother-to-child transmission in SARS-CoV-2 positive babies. Data extraction Two reviewers independently extracted data and assessed study quality. A random effects model was used to synthesise data for rates, with associations reported using odds ratios and 95% confidence intervals. Narrative syntheses were performed when meta-analysis was inappropriate. The World Health Organization classification was used to categorise the timing of mother-to-child transmission (in utero, intrapartum, early postnatal). Results 472 studies (206 cohort studies, 266 case series and case reports; 28 952 mothers, 18 237 babies) were included. Overall, 1.8% (95% confidence interval 1.2% to 2.5%; 140 studies) of the 14 271 babies born to mothers with SARS-CoV-2 infection tested positive for the virus with reverse transcriptase polymerase chain reaction (RT-PCR). Of the 592 SARS-CoV-2 positive babies with data on the timing of exposure and type and timing of tests, 14 had confirmed mother-to-child transmission: seven in utero (448 assessed), two intrapartum (18 assessed), and five during the early postnatal period (70 assessed). Of the 800 SARS-CoV-2 positive babies with outcome data, 20 were stillbirths, 23 were neonatal deaths, and eight were early pregnancy losses; 749 babies were alive at the end of follow-up. Severe maternal covid-19 (odds ratio 2.4, 95% confidence interval 1.3 to 4.4), maternal death (14.1, 4.1 to 48.0), maternal admission to an intensive care unit (3.5, 1.7 to 6.9), and maternal postnatal infection (5.0, 1.2 to 20.1) were associated with SARS-CoV-2 positivity in offspring. Positivity rates using RT-PCR varied between regions, ranging from 0.1% (95% confidence interval 0.0% to 0.3%) in studies from North America to 5.7% (3.2% to 8.7%) in studies from Latin America and the Caribbean. Conclusion SARS-CoV-2 positivity rates were found to be low in babies born to mothers with SARS-CoV-2 infection. Evidence suggests confirmed vertical transmission of SARS-CoV-2, although this is likely to be rare. Severity of maternal covid-19 appears to be associated with SARS-CoV-2 positivity in offspring. Systematic review registration PROSPERO CRD42020178076. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

Obstetric–Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study

“…It is reported in a living systematic review that SARS-CoV-2 infection was associated with increased risk of preterm birth [24,28], in line with our results that shown a nine-fold increased risk in symptomatic women.…”

“…Even though the percentage of complications was low, as per other studies (5.5-8.4%) [8,24], the risk of an adverse outcome in the prepartum and/or postpartum period increased in symptomatic patients, especially those with severe disease. In addition, as other studies have shown [21,28,34,37], the maternal mortality rate attributed to COVID-19 was higher than our study (~1.6% vs. 0.8%). Our study identified no association between maternal background disease and the manifestation of COVID-19 symptoms.…”

Can SARS-CoV-2 positive pregnant women affect the hearing of their newborns: A systematic review

“…Since the COVID-19 outbreak, the impact of SARS-CoV-2 on the placenta and its potential for vertical transmission has been raised concerns [19] . A recent meta-analysis published in BMJ confirmed vertical transmission of SARS-CoV-2, and the severity of maternal COVID-19 appears to correlate with infant SARS-CoV-2 positive [20] . Several previous studies have examined the hearing screening outcomes of newborns whose mothers tested positive for SARS-CoV-2 during pregnancy, revealing an increased risk of HL in these newborns [7] , [21] .…”

Hearing Outcomes of Infants Born to Mothers With Active COVID-19 Infection

“…Although intrauterine transmission is possible from a pathophysiological standpoint, actual in-utero infections appear to be rare, estimated at 2% [6]. Infection outcomes during pregnancy were divided according to the trimester in which the mother was infected: first, second and third trimester.…”