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Meta-Analysis
. 2022 Nov;7(11):e010060.
doi: 10.1136/bmjgh-2022-010060.

Global variations in the burden of SARS-CoV-2 infection and its outcomes in pregnant women by geographical region and country's income status: a meta-analysis

Jameela Sheikh  1 , Heidi Lawson  1 , John Allotey  2 , Magnus Yap  1 , Rishab Balaji  1 , Tania Kew  1 , Elena Stallings  3   4 , Dyuti Coomar  2 , Andrea Gaetano-Gil  3   4 , Javier Zamora  2   3 , Shakila Thangaratinam  5   6 ; PregCOV-19 Living Systematic Review Consortium
Collaborators, Affiliations
Meta-Analysis

Global variations in the burden of SARS-CoV-2 infection and its outcomes in pregnant women by geographical region and country's income status: a meta-analysis

Jameela Sheikh et al. BMJ Glob Health. 2022 Nov.

Abstract

Introduction: The prevalence of COVID-19 and its impact varied between countries and regions. Pregnant women are at high risk of COVID-19 complications compared with non-pregnant women. The magnitude of variations, if any, in SARS-CoV-2 infection rates and its health outcomes among pregnant women by geographical regions and country's income level is not known.

Methods: We performed a random-effects meta-analysis as part of the ongoing PregCOV-19 living systematic review (December 2019 to April 2021). We included cohort studies on pregnant women with COVID-19 reporting maternal (mortality, intensive care admission and preterm birth) and offspring (mortality, stillbirth, neonatal intensive care admission) outcomes and grouped them by World Bank geographical region and income level. We reported results as proportions with 95% confidence intervals (CI).

Results: We included 311 studies (2 003 724 pregnant women, 57 countries). The rates of SARS-CoV-2 infection in pregnant women varied significantly by region (p<0.001) and income level (p<0.001), with the highest rates observed in Latin America and the Caribbean (19%, 95% CI 12% to 27%; 13 studies, 38 748 women) and lower-middle-income countries (13%, 95% CI 6% to 23%; 25 studies, 100 080 women). We found significant differences in maternal and offspring outcomes by region and income level. Lower-middle-income countries reported significantly higher rates of maternal mortality (0.68%, 95% CI 0.24% to 1.27%; 3 studies, 31 136 women), intensive care admission (4.53%, 95% CI 2.57% to 6.91%; 54 studies, 23 420 women) and stillbirths (1.09%, 95% CI 0.48% to 1.88%; 41 studies, 4724 women) than high-income countries. COVID-19 complications disproportionately affected South Asia, which had the highest maternal mortality rate (0.88%, 95% CI 0.16% to 1.95%; 17 studies, 2023 women); Latin America and the Caribbean had the highest stillbirth rates (1.97%, 95% CI 0.9% to 3.33%; 10 studies, 1750 women).

Conclusion: The rates of SARS-CoV-2 infection in pregnant women vary globally, and its health outcomes mirror the COVID-19 burden and global maternal and offspring inequalities.

Prospero registration number: CRD42020178076.

Keywords: COVID-19; Maternal health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study selection. Shaded boxes reproduced from published work: Allotey et al (In Press) Clinical Manifestations, risk factors, and maternal and perinatal outcomes of COVID-19 in pregnancy: living systematic review and meta-analysis.
Figure 2
Figure 2
Quality assessment of studies included in the systematic review of global variations of SARS-CoV-2 infection and its complications in pregnant women.
Figure 3
Figure 3
Forest plots showing SARS-CoV-2 infection rates in pregnant women by (A) geographical region and (B) country income level.
See this image and copyright information in PMC

References

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