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Meta-Analysis
. 2021 Jun 30:11:05018.
doi: 10.7189/jogh.11.05018.

A systematic review and meta-analysis of data on pregnant women with confirmed COVID-19: Clinical presentation, and pregnancy and perinatal outcomes based on COVID-19 severity

Zohra S Lassi  1   2 , Ali Ana  1   2 , Jai K Das  3 , Rehana A Salam  3 , Zahra A Padhani  3 , Omer Irfan  4 , Zulfiqar A Bhutta  4   5
Affiliations
Meta-Analysis

A systematic review and meta-analysis of data on pregnant women with confirmed COVID-19: Clinical presentation, and pregnancy and perinatal outcomes based on COVID-19 severity

Zohra S Lassi et al. J Glob Health. .

Abstract

Background: We determined the clinical presentation, risk factors, and pregnancy and perinatal outcomes in pregnant women with confirmed COVID-19 and identified if these are different based on COVID-19 severity.

Methods: We included all observational studies on pregnant women with confirmed COVID-19 reporting clinical presentation, risk factors, and pregnancy and perinatal outcomes. We included all studies published between Dec/2019-Feb/2021 in Medline, Embase, the WHO COVID-19 databases, and clinicaltrials.gov. The methodological quality of cohort and case-series was assessed using NHLBI criteria.

Results: 31 016 pregnant women from 62 studies were included. Women were an average of 30.9 years of age, most (77.7%) were in the third trimester, and 16.4% developed severe COVID-19. Nearly half were asymptomatic, while the most commonly reported symptoms were cough, fever, fatigue, and anosmia/ageusia. About 7% were admitted to the intensive care unit (ICU), 8% required mechanical ventilation, and 2% of the women died. Almost 80% of women delivered; 48.4% had cesarean births. Among newborns, 23.4% were preterm (<37 weeks), 16.6% were low birth weight, and 23.7% were admitted to neonatal ICU. A total of 21 stillbirths (1.6%) and 24 neonatal deaths (1.6%) were recorded, while 50 babies (3.5%) were COVID-19 positive. Studies comparing pregnant women with severe and non-severe COVID-19 showed that women with severe COVID-19 were 3.7 years older and the risk of severe COVID-19 was 1.5 times higher among women >35 years. The risk of severe COVID-19 was significantly higher among women who were obese, had smoked, diabetic, and had pre-eclampsia. The risk of preterm birth was almost 2.4 folds among women with severe COVID-19.

Conclusions: Our review suggests a heightened risk of COVID-19 severity and adverse pregnancy and perinatal outcomes among women with certain demographic and health profiles. These findings can inform the formation of current guidelines; however, these should be constantly updated as the global COVID-19 scenario unfolds.

Registration: PROSPERO: CRD42020182048.

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Conflict of interest statement

Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection process.
Figure 2
Figure 2
Distribution of included studies on global map.
Figure 3
Figure 3
Clinical presentations on pregnant women with COVID-19. The figure presents pooled proportion with 95% confidence intervals using random-effect model.
Figure 4
Figure 4
Clinical presentation, risk factors, and pregnancy and perinatal outcomes: pregnant with severe and non-severe COVID-19. The figure presents pooled proportion with 95% confidence intervals using random-effect model.
See this image and copyright information in PMC

References

    1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at John Hopkins University Available: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd4029942.... Accessed: 2 June 2020.
    1. WHO. Naming the coronavirus disease (COVID-2019) and the virus that causes it. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technica... (accessed 20 April 2020). World Health Organization.
    1. Dorn AV, Cooney RE, Sabin ML.COVID-19 exacerbating inequalities in the US. Lancet. 2020;395:1243-4. 10.1016/S0140-6736(20)30893-X - DOI - PMC - PubMed
    1. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Pena R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623. 10.1016/j.tmaid.2020.101623 - DOI - PMC - PubMed
    1. Liu H, Wang L-L, Zhao S-J, Kwak-Kim J, Mor G, Liao A-H.Why are pregnant women susceptible to viral infection: an immunological viewpoint? J Reprod Immunol. 2020;139:103122. 10.1016/j.jri.2020.103122 - DOI - PMC - PubMed