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. 2020 Aug 13;7(9):ofaa350.
doi: 10.1093/ofid/ofaa350. eCollection 2020 Sep.

A Systematic Review of Treatment and Outcomes of Pregnant Women With COVID-19-A Call for Clinical Trials

Katelyn A Pastick  1 , Melanie R Nicol  2 , Elizabeth Smyth  3 , Rebecca Zash  4 , David R Boulware  1 , Radha Rajasingham  1 , Emily G McDonald  3   5
Affiliations

A Systematic Review of Treatment and Outcomes of Pregnant Women With COVID-19-A Call for Clinical Trials

Katelyn A Pastick et al. Open Forum Infect Dis. .

Abstract

Background: Data pertaining to COVID-19 in pregnancy are limited; to better inform clinicians, we collated data from COVID-19 cases during pregnancy and summarized clinical trials enrolling this population.

Methods: We performed a systematic literature review of PubMed/MEDLINE to identify cases of COVID-19 in pregnancy or the postpartum period and associated outcomes. We then evaluated the proportion of COVID-19 clinical trials (from ClinicalTrials.gov) excluding pregnant or breastfeeding persons (both through June 29, 2020).

Results: We identified 11 308 published cases of COVID-19 during pregnancy. Of those reporting disease severity, 21% (416/1999) were severe/critical. Maternal and neonatal survival were reassuring (98% [10 437/10 597] and 99% [1155/1163], respectively). Neonatal disease was rare, with only 41 possible cases of infection reported in the literature. Of 2351 ongoing COVID-19 therapeutic clinical trials, 1282 were enrolling persons of reproductive age and 65% (829/1282) excluded pregnant persons. Pregnancy was an exclusion criterion for 69% (75/109) of chloroquine/hydroxychloroquine, 80% (28/35) of lopinavir/ritonavir, and 48% (44/91) of convalescent plasma studies. We identified 48 actively recruiting or completed drug trials reporting inclusion of this population.

Conclusions: There are limited published reports of COVID-19 in pregnancy despite more than 14 million cases worldwide. To date, clinical outcomes appear reassuring, but data related to important long-term outcomes are missing or not yet reported. The large number of clinical trials excluding pregnant persons, despite interventions with safety data in pregnancy, is concerning. In addition to observational cohort studies, pregnancy-specific adaptive clinical trials could be designed to identify safe and effective treatments.

Keywords: COVID-19; SARS-CoV-2; breastfeeding; coronavirus; pregnancy.

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Figures

Figure 1.
Figure 1.
Search strategy of reported cases of COVID-19 in pregnancy in the literature.
Figure 2.
Figure 2.
Search strategy of ongoing COVID-19-related clinical trials permitting the inclusion of pregnant or breastfeeding persons.
See this image and copyright information in PMC

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