A meta-analysis for the risk and prevalence of preeclampsia among pregnant women with COVID-19

Abstract

Preeclampsia and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are both life-threatening disorders when they occur during pregnancy. They are similarly characterized by systemic immune activation and have a deleterious effect on maternal endothelial cells. During the coronavirus disease-2019 (COVID-19) pandemic, there were reports of preeclampsia or a preeclampsia-like syndrome occurring in pregnant women with SARS-CoV-2 infection. We performed a meta-analysis to estimate the risk and prevalence of preeclampsia and SARS-CoV-2 infection in pregnant women. A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and China National Knowledge Infrastructure to identify all relevant studies published up to February 29, 2020. All studies that reported the prevalence of preeclampsia in pregnant women with SARS-CoV-2 infection were selected. A total of 10 case-control studies and 15 case series met our inclusion criteria. Pooled data revealed no significant difference between infected pregnant women and uninfected pregnant women for the risk of preeclampsia [odds ratio (OR)=1.676, 95% confidence interval (CI) 0.679-4.139, p=0.236]. The stratified analysis revealed significant risk in the infected Asian pregnant women (OR=2.637, 95% CI 1.030-6.747, p=0.043), but not Caucasian. The prevalence of preeclampsia was 8.2% (95% CI 0.057-0.117) in infected pregnant women with COVID-19 in the overall population. Its prevalence was highest in North America (10.7%), followed by Asian (7.9%), Caucasian (6.7%), European (4.9%), and West Asian (2.6%) infected pregnant women. Our pooled data showed that the prevalence of preeclampsia in pregnant women with SARS-CoV-2 infection was 8.2%. However, there was no increased risk of occurrence of preeclampsia among pregnant women with SARS-CoV-2 infection.

Keywords: COVID-19; SARS-CoV-2; hypertensive disease of pregnancy; meta-analysis; preeclampsia; pregnancy.

Figure 1

The study selection and inclusion process

Figure 2

Forest plots for the risk of preeclampsia in pregnant women with SARS-CoV-2 infection. A: overall population; B: Caucasians; and C: Asians

Figure 3

Forest plots for the prevalence of preeclampsia in pregnant women with SARS-CoV-2 infection. A: overall population; B: Caucasians; and C: Asians

Figure 4

Begg’s funnel plot for publication bias test for the risk and prevalence of preeclampsia in pregnant women with SARS-CoV-2. A: Risk; B: Prevalence