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Review
. 2022 Jan 20;10(2):203.
doi: 10.3390/healthcare10020203.

Adverse Perinatal Outcomes in COVID-19 Infected Pregnant Women: A Systematic Review and Meta-Analysis

Malshani L Pathirathna  1 , Buddhini P P Samarasekara  1 , Thakshila S Dasanayake  1 , Padmapriya Saravanakumar  2 , Ishanka Weerasekara  3   4
Affiliations
Review

Adverse Perinatal Outcomes in COVID-19 Infected Pregnant Women: A Systematic Review and Meta-Analysis

Malshani L Pathirathna et al. Healthcare (Basel). .

Abstract

The impact of COVID-19 virus infection during pregnancy is still unclear. This systematic review and meta-analysis aimed to quantitatively pool the evidence on impact of COVID-19 infection on perinatal outcomes. Databases of Medline, Embase, and Cochrane library were searched using the keywords related to COVID-19 and perinatal outcomes from December 2019 to 30 June 2021. Observational studies comparing the perinatal outcomes of COVID-19 infection in pregnancy with a non-infected comparator were included. The screening process and quality assessment of the included studies were performed independently by two reviewers. Meta-analyses were used to pool the comparative dichotomous data on perinatal outcomes. The database search yielded 4049 results, 1254 of which were duplicates. We included a total of 21 observational studies that assessed the adverse perinatal outcomes with COVID-19 infection. The odds of maternal death (pooled OR: 7.05 [2.41-20.65]), preeclampsia (pooled OR: 1.39 [1.29-1.50]), cesarean delivery (pooled OR: 1.67 [1.29-2.15]), fetal distress (pooled OR: 1.66 [1.35-2.05]), preterm birth (pooled OR: 1.86 [1.34-2.58]), low birth weight (pooled OR: 1.69 [1.35-2.11]), stillbirth (pooled OR: 1.46 [1.16-1.85]), 5th minute Apgar score of less than 7 (pooled OR: 1.44 [1.11-1.86]) and admissions to neonatal intensive care unit (pooled OR: 2.12 [1.36-3.32]) were higher among COVID-19 infected pregnant women compared to non-infected pregnant women.

Keywords: COVID-19; perinatal outcomes; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart of included studies.
Figure 2
Figure 2
(A) Quality assessment of included cohort studies; (B) Quality assessment of included case–control studies.
Figure 3
Figure 3
Incidence of COVID-19 among pregnant women.
Figure 4
Figure 4
(A) Forest plots of adverse maternal outcomes. (a) Maternal death. (b) Preeclampsia. (c) Cesarean delivery. (d) Miscarriage/abortion. (e) PROM/PPROM. (f) Operative vaginal birth. PROM, Pre-labor rupture of membrane. PPROM, Preterm pre-labor rupture of membrane. (B) Forest plots of adverse fetal outcomes. (a) Fetal distress. (b) Intrauterine death. (C) Forest plots of adverse neonatal outcomes. (a) Preterm birth. (b) Low Birth weight. (c) Fifth minute Apgar score <7. (d) Neonatal death. (e) Admissions to NICU. (f) Stillbirth. NICU, Neonatal intensive care unit.
Figure 4
Figure 4
(A) Forest plots of adverse maternal outcomes. (a) Maternal death. (b) Preeclampsia. (c) Cesarean delivery. (d) Miscarriage/abortion. (e) PROM/PPROM. (f) Operative vaginal birth. PROM, Pre-labor rupture of membrane. PPROM, Preterm pre-labor rupture of membrane. (B) Forest plots of adverse fetal outcomes. (a) Fetal distress. (b) Intrauterine death. (C) Forest plots of adverse neonatal outcomes. (a) Preterm birth. (b) Low Birth weight. (c) Fifth minute Apgar score <7. (d) Neonatal death. (e) Admissions to NICU. (f) Stillbirth. NICU, Neonatal intensive care unit.
Figure 4
Figure 4
(A) Forest plots of adverse maternal outcomes. (a) Maternal death. (b) Preeclampsia. (c) Cesarean delivery. (d) Miscarriage/abortion. (e) PROM/PPROM. (f) Operative vaginal birth. PROM, Pre-labor rupture of membrane. PPROM, Preterm pre-labor rupture of membrane. (B) Forest plots of adverse fetal outcomes. (a) Fetal distress. (b) Intrauterine death. (C) Forest plots of adverse neonatal outcomes. (a) Preterm birth. (b) Low Birth weight. (c) Fifth minute Apgar score <7. (d) Neonatal death. (e) Admissions to NICU. (f) Stillbirth. NICU, Neonatal intensive care unit.
Figure 4
Figure 4
(A) Forest plots of adverse maternal outcomes. (a) Maternal death. (b) Preeclampsia. (c) Cesarean delivery. (d) Miscarriage/abortion. (e) PROM/PPROM. (f) Operative vaginal birth. PROM, Pre-labor rupture of membrane. PPROM, Preterm pre-labor rupture of membrane. (B) Forest plots of adverse fetal outcomes. (a) Fetal distress. (b) Intrauterine death. (C) Forest plots of adverse neonatal outcomes. (a) Preterm birth. (b) Low Birth weight. (c) Fifth minute Apgar score <7. (d) Neonatal death. (e) Admissions to NICU. (f) Stillbirth. NICU, Neonatal intensive care unit.
Figure 4
Figure 4
(A) Forest plots of adverse maternal outcomes. (a) Maternal death. (b) Preeclampsia. (c) Cesarean delivery. (d) Miscarriage/abortion. (e) PROM/PPROM. (f) Operative vaginal birth. PROM, Pre-labor rupture of membrane. PPROM, Preterm pre-labor rupture of membrane. (B) Forest plots of adverse fetal outcomes. (a) Fetal distress. (b) Intrauterine death. (C) Forest plots of adverse neonatal outcomes. (a) Preterm birth. (b) Low Birth weight. (c) Fifth minute Apgar score <7. (d) Neonatal death. (e) Admissions to NICU. (f) Stillbirth. NICU, Neonatal intensive care unit.
Figure 5
Figure 5
Forest plots of comorbidities among COVID-19 infected women. (a) Pre-gestational diabetes. (b) Gestational diabetes. (c) Chronic hypertension. (d) Anemia. (e) Cardiac diseases. (f) Chronic kidney disease. (g) Asthma. (h) Chronic lung diseases (other than asthma). (i) Hypothyroidism. (j) Immunosuppression. (k) Thrombophilia.
Figure 5
Figure 5
Forest plots of comorbidities among COVID-19 infected women. (a) Pre-gestational diabetes. (b) Gestational diabetes. (c) Chronic hypertension. (d) Anemia. (e) Cardiac diseases. (f) Chronic kidney disease. (g) Asthma. (h) Chronic lung diseases (other than asthma). (i) Hypothyroidism. (j) Immunosuppression. (k) Thrombophilia.
Figure 5
Figure 5
Forest plots of comorbidities among COVID-19 infected women. (a) Pre-gestational diabetes. (b) Gestational diabetes. (c) Chronic hypertension. (d) Anemia. (e) Cardiac diseases. (f) Chronic kidney disease. (g) Asthma. (h) Chronic lung diseases (other than asthma). (i) Hypothyroidism. (j) Immunosuppression. (k) Thrombophilia.
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