Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

Abstract

Objective: Coronavirus disease 2019 (COVID-19) has become a global pandemic and may adversely affect pregnancy outcomes. We estimated the adverse maternal and neonatal characteristics and outcomes among COVID-19 infected women and determined heterogeneity in the estimates and associated factors.

Study designs: PubMed search was performed of confirmed COVID-19 pregnant cases and related outcomes were ascertained prior to July 8, 2020, in this systematic review and meta-analysis. Studies reporting premature birth, low birth weight, COVID-19 infection in neonates, or mode of delivery status were included in the study. Two investigators independently performed searches, assessed quality of eligible studies as per the Cochrane handbook recommendations, extracted and reported data according to PRISMA guidelines. Pooled proportions of maternal and neonatal outcomes were estimated using meta-analyses for studies with varying sample sizes while a systematic review with descriptive data analysis was performed for case report studies. Maternal and neonatal outcomes included C-section, premature birth, low birth weight, adverse pregnancy events and COVID transmission in neonates.

Results: A total of 790 COVID-19 positive females and 548 neonates from 61 studies were analyzed. The rates of C-section, premature birth, low birth weight, and adverse pregnancy events were estimated as 72 %, 23 %, 7 %, and 27 % respectively. In the heterogeneity analysis, the rate of C-section was substantially higher in Chinese studies (91 %) compared to the US (40 %) or European (38 %) studies. The rates of preterm birth and adverse pregnancy events were also lowest in the US studies (12 %, 15 %) compared to Chinese (17 %, 21 %), and European studies (19 %, 19 %). In case reports, the rates of C-section, preterm birth, and low birth weight were estimated as 69 %, 56 %, and 35 %, respectively. Adverse pregnancy outcomes were associated with infection acquired at early gestational ages, more symptomatic presentation, myalgia symptom at presentation, and use of oxygen support therapy.

Conclusions: Adverse pregnancy outcomes were prevalent in COVID-19 infected females and varied by location, type, and size of the studies. Regular screening and early detection of COVID-19 in pregnant women may provide more favorable outcomes.

Keywords: Adverse pregnancy outcomes; COVID-19; Cesarean section; Low birth weight; Meta-analysis; Preterm birth.

Fig. 1

Study flowchart. Inclusion of studies at different stages for this systematic review and meta-analysis.

Fig. 2

(A) Funnel plot for preterm birth outcome; (B) Funnel plot for adverse pregnancy events.

Fig. 3

(A) Rates of cesarean section, adverse pregnancy events, preterm birth, and low birth weight estimated from case series studies. The meta-analysis findings of case series studies reported separately for Chinese studies with a sample size>10, the USA studies after excluding a study with low sample size, and European studies after excluding one study with small sample size and another study with a large number of women without pregnancy status. N denotes the number of datasets or cases, I² denotes the measure of heterogeneity across studies. The adverse pregnancy events include preterm birth, death, stillbirth, and early terminated pregnancies; (B) Rates of cesarean section, preterm birth, and low birth weight estimated from case report studies by location of the study. European studies included studies from Ireland, Italy, Netherlands, Spain, Sweden, Turkey, and UK; others included studies from countries (Jordan, Iran, Korea, India, Peru, Canada, and Australia).