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SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of
clinical features and pregnancy outcomes
#MMPMID32838230
Khalil A
; Kalafat E
; Benlioglu C
; O'Brien P
; Morris E
; Draycott T
; Thangaratinam S
; Le Doare K
; Heath P
; Ladhani S
; von Dadelszen P
; Magee LA
EClinicalMedicine
2020[Aug]; 25
(?): 100446
PMID32838230
show ga
BACKGROUND: Perform a systematic review and meta-analysis of SARS-CoV-2 infection
and pregnancy. METHODS: Databases (Medline, Embase, Clinicaltrials.gov, Cochrane
Library) were searched electronically on 6th April and updated regularly until
8th June 2020. Reports of pregnant women with reverse transcription PCR (RT-PCR)
confirmed COVID-19 were included. Meta-analytical proportion summaries and
meta-regression analyses for key clinical outcomes are provided. FINDINGS: 86
studies were included, 17 studies (2567 pregnancies) in the quantitative
synthesis; other small case series and case reports were used to extract
rarely-reported events and outcome. Most women (73.9%) were in the third
trimester; 52.4% have delivered, half by caesarean section (48.3%). The
proportion of Black, Asian or minority ethnic group membership (50.8%); obesity
(38.2%), and chronic co-morbidities (32.5%) were high. The most commonly reported
clinical symptoms were fever (63.3%), cough (71.4%) and dyspnoea (34.4%). The
commonest laboratory abnormalities were raised CRP or procalcitonin (54.0%),
lymphopenia (34.2%) and elevated transaminases (16.0%). Preterm birth before 37
weeks' gestation was common (21.8%), usually medically-indicated (18.4%).
Maternal intensive care unit admission was required in 7.0%, with intubation in
3.4%. Maternal mortality was uncommon (~1%). Maternal intensive care admission
was higher in cohorts with higher rates of co-morbidities (beta=0.007, p<0.05)
and maternal age over 35 years (beta=0.007, p<0.01). Maternal mortality was
higher in cohorts with higher rates of antiviral drug use (beta=0.03, p<0.001),
likely due to residual confounding. Neonatal nasopharyngeal swab RT-PCR was
positive in 1.4%. INTERPRETATION: The risk of iatrogenic preterm birth and
caesarean delivery was increased. The available evidence is reassuring,
suggesting that maternal morbidity is similar to that of women of reproductive
age. Vertical transmission of the virus probably occurs, albeit in a small
proportion of cases. FUNDING: N/A.
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