Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during
pregnancy: a systematic review and meta-analysis
#MMPMID32292902
Di Mascio D
; Khalil A
; Saccone G
; Rizzo G
; Buca D
; Liberati M
; Vecchiet J
; Nappi L
; Scambia G
; Berghella V
; D'Antonio F
Am J Obstet Gynecol MFM
2020[May]; 2
(2
): 100107
PMID32292902
show ga
OBJECTIVE: The aim of this systematic review was to report pregnancy and
perinatal outcomes of coronavirus spectrum infections, and particularly
coronavirus 2019 (COVID-19) disease because of severe acute respiratory
syndrome-coronavirus-2 infection during pregnancy. DATA SOURCES: Medline, Embase,
Cinahl, and Clinicaltrials.gov databases were searched electronically utilizing
combinations of word variants for coronavirus or severe acute respiratory
syndrome or SARS or Middle East respiratory syndrome or MERS or COVID-19 and
pregnancy. The search and selection criteria were restricted to English language.
STUDY ELIGIBILITY CRITERIA: Inclusion criteria were hospitalized pregnant women
with a confirmed coronavirus related-illness, defined as severe acute respiratory
syndrome (SARS), Middle East respiratory syndrome (MERS), or COVID-19. STUDY
APPRAISAL AND SYNTHESIS METHODS: We used meta-analyses of proportions to combine
data and reported pooled proportions, so that a pooled proportion may not
coincide with the actual raw proportion in the results. The pregnancy outcomes
observed included miscarriage, preterm birth, preeclampsia, preterm prelabor
rupture of membranes, fetal growth restriction, and mode of delivery. The
perinatal outcomes observed were fetal distress, Apgar score <7 at 5 minutes,
neonatal asphyxia, admission to a neonatal intensive care unit, perinatal death,
and evidence of vertical transmission. RESULTS: Nineteen studies including 79
hospitalized women were eligible for this systematic review: 41 pregnancies
(51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An
overt diagnosis of pneumonia was made in 91.8%, and the most common symptoms were
fever (82.6%), cough (57.1%), and dyspnea (27.0%). For all coronavirus
infections, the pooled proportion of miscarriage was 64.7% (8/12; 95% confidence
interval, 37.9-87.3), although reported only for women affected by SARS in two
studies with no control group; the pooled proportion of preterm birth <37 weeks
was 24.3% (14/56; 95% confidence interval, 12.5-38.6); premature prelabor rupture
of membranes occurred in 20.7% (6/34; 95% confidence interval, 9.5-34.9),
preeclampsia in 16.2% (2/19; 95% confidence interval, 4.2-34.1), and fetal growth
restriction in 11.7% (2/29; 95% confidence interval, 3.2-24.4), although reported
only for women affected by SARS; 84% (50/58) were delivered by cesarean; the
pooled proportion of perinatal death was 11.1% (5/60; 95% confidence interval,
84.8-19.6), and 57.2% of newborns (3/12; 95% confidence interval, 3.6-99.8) were
admitted to the neonatal intensive care unit. When focusing on COVID-19, the most
common adverse pregnancy outcome was preterm birth <37 weeks, occurring in 41.1%
of cases (14/32; 95% confidence interval, 25.6-57.6), while the pooled proportion
of perinatal death was 7.0% (2/41; 95% confidence interval, 1.4-16.3). None of
the 41 newborns assessed showed clinical signs of vertical transmission.
CONCLUSION: In hospitalized mothers infected with coronavirus infections,
including COVID-19, >90% of whom also had pneumonia, preterm birth is the most
common adverse pregnancy outcome. COVID-19 infection was associated with higher
rate (and pooled proportions) of preterm birth, preeclampsia, cesarean, and
perinatal death. There have been no published cases of clinical evidence of
vertical transmission. Evidence is accumulating rapidly, so these data may need
to be updated soon. The findings from this study can guide and enhance prenatal
counseling of women with COVID-19 infection occurring during pregnancy, although
they should be interpreted with caution in view of the very small number of
included cases.
|Abortion, Spontaneous/*epidemiology
[MESH]
|COVID-19/*epidemiology
[MESH]
|Cesarean Section/statistics & numerical data
[MESH]
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