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. 2020 Jun 4;15(6):e0234187.
doi: 10.1371/journal.pone.0234187. eCollection 2020.

Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review

Vinayak Smith  1 , Densearn Seo  2 , Ritesh Warty  1 , Olivia Payne  3 , Mohamed Salih  3 , Ken Lee Chin  2   4 , Richard Ofori-Asenso  5 , Sathya Krishnan  6 , Fabricio da Silva Costa  1   7 , Beverley Vollenhoven  1 , Euan Wallace  1
Affiliations

Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review

Vinayak Smith et al. PLoS One. .

Abstract

Background: COVID-19 has created an extraordinary global health crisis. However, with limited understanding of the effects of COVID-19 during pregnancy, clinicians and patients are forced to make uninformed decisions.

Objectives: To systematically evaluate the literature and report the maternal and neonatal outcomes associated with COVID-19.

Search strategy: PubMed, MEDLINE, and EMBASE were searched from November 1st, 2019 and March 28th, 2020.

Selection criteria: Primary studies, reported in English, investigating COVID-19-positive pregnant women and reporting their pregnancy and neonatal outcomes.

Data collection and analysis: Data in relation to clinical presentation, investigation were maternal and neonatal outcomes were extracted and analysed using summary statistics. Hypothesis testing was performed to examine differences in time-to-delivery. Study quality was assessed using the ICROMS tool.

Main results: Of 73 identified articles, nine were eligible for inclusion (n = 92). 67.4% (62/92) of women were symptomatic at presentation. RT-PCR was inferior to CT-based diagnosis in 31.7% (26/79) of cases. Maternal mortality rate was 0% and only one patient required intensive care and ventilation. 63.8% (30/47) had preterm births, 61.1% (11/18) fetal distress and 80% (40/50) a Caesarean section. 76.92% (11/13) of neonates required NICU admission and 42.8% (40/50) had a low birth weight. There was one indeterminate case of potential vertical transmission. Mean time-to-delivery was 4.3±3.08 days (n = 12) with no difference in outcomes (p>0.05).

Conclusions: COVID-19-positive pregnant women present with fewer symptoms than the general population and may be RT-PCR negative despite having signs of viral pneumonia. The incidence of preterm births, low birth weight, C-section, NICU admission appear higher than the general population.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
Fig 2
Fig 2. Quality assessment results using ICROMS tool.
Minimum required score for NCBA is 18 and CBA is 17. Studies which do not meet this score fail the assessment.
Fig 3
Fig 3. Relationship between maternal and neonatal outcomes, and time to delivery (TTD).
DNO—did not occur; NRA—No result available.
See this image and copyright information in PMC

References

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