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COVID-19 in pregnant women: A systematic review and meta-analysis.
Eur J Obstet Gynecol Reprod Biol. 2020 Sep; 252:543-558.EJ

Abstract

OBJECTIVE

Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several reports highlighted the risk of infection and disease in pregnant women and neonates. To assess the risk of clinical complications in pregnant women and neonates infected with SARS-CoV-2 carrying out a systematic review and meta-analysis of observational studies.

DATA SOURCES

Search of the scientific evidence was performed using the engines PubMed and Scopus, including articles published from December 2019 to 15 April 2020.

STUDY ELIGIBILITY CRITERIA

Only observational studies focused on the assessment of clinical outcomes associated with pregnancy in COVID-19 women were selected.

STUDY APPRAISAL AND SYNTHESIS METHODS

The first screening was based on the assessment of titles and abstracts, followed by the evaluation of full-texts. Qualitative variables were summarized with frequencies, whereas quantitative variables with central and variability indicators depending on their parametric distribution. Forest plots were used to describe point estimates and in-between studies variability. Study quality assessment was performed.

RESULTS

Thirteen studies were selected. All of them were carried out in China. The mean (SD) age and gestational age of pregnant women were 30.3 (1.5) years and 35.9 (2.9) weeks, respectively. The mean (SD) duration from the first symptoms to the hospital admission and to labour were 5.5 (2.0) and 9.5 (8.7) days, respectively. Patients mainly complained of fever and cough (pooled (95 % CI) proportions were 76.0 % (57.0 %-90.0 %) and 38.0 (28.0 %-47.0 %), respectively). Several antibiotics, antivirals, and corticosteroids were prescribed in different combinations. The pooled prevalence of maternal complications and of caesarean section were 45.0 % (95 % CI: 24.0 %-67.0 %) and 88.0 % (95 %CI: 82.0 %-94.0 %). A proportion of pregnant women less than 20 % were admitted to ICU. The pooled proportion of preterm infants was 23.0 % (95 %CI: 11.0 %-39.0 %). The most frequent neonatal complications were pneumonia and respiratory distress syndrome. The pooled percentage of infected neonates was 6.0 % (95 %CI: 2.0 %-12.0 %).

CONCLUSIONS

The present study suggests a high rate of maternal and neonatal complications in infected individuals. However, the current scientific evidence highlights a low risk of neonatal infection. Multicentre, cohort studies are needed to better elucidate the role of SARS-CoV-2 during pregnancy.

Authors+Show Affiliations

Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.Gynecologic and Obstetric Clinic, University of Cagliari, Cagliari, Italy.Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. Electronic address: gsotgiu@uniss.it.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32713730

Citation

Capobianco, Giampiero, et al. "COVID-19 in Pregnant Women: a Systematic Review and Meta-analysis." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 252, 2020, pp. 543-558.
Capobianco G, Saderi L, Aliberti S, et al. COVID-19 in pregnant women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;252:543-558.
Capobianco, G., Saderi, L., Aliberti, S., Mondoni, M., Piana, A., Dessole, F., Dessole, M., Cherchi, P. L., Dessole, S., & Sotgiu, G. (2020). COVID-19 in pregnant women: A systematic review and meta-analysis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 252, 543-558. https://doi.org/10.1016/j.ejogrb.2020.07.006
Capobianco G, et al. COVID-19 in Pregnant Women: a Systematic Review and Meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;252:543-558. PubMed PMID: 32713730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 in pregnant women: A systematic review and meta-analysis. AU - Capobianco,Giampiero, AU - Saderi,Laura, AU - Aliberti,Stefano, AU - Mondoni,Michele, AU - Piana,Andrea, AU - Dessole,Francesco, AU - Dessole,Margherita, AU - Cherchi,Pier Luigi, AU - Dessole,Salvatore, AU - Sotgiu,Giovanni, Y1 - 2020/07/16/ PY - 2020/06/12/received PY - 2020/06/29/revised PY - 2020/07/02/accepted PY - 2020/7/28/pubmed PY - 2020/9/12/medline PY - 2020/7/28/entrez KW - COVID-19 KW - Neonate KW - Pregnancy KW - SARS-CoV-2 KW - Vertical transmission SP - 543 EP - 558 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur J Obstet Gynecol Reprod Biol VL - 252 N2 - OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several reports highlighted the risk of infection and disease in pregnant women and neonates. To assess the risk of clinical complications in pregnant women and neonates infected with SARS-CoV-2 carrying out a systematic review and meta-analysis of observational studies. DATA SOURCES: Search of the scientific evidence was performed using the engines PubMed and Scopus, including articles published from December 2019 to 15 April 2020. STUDY ELIGIBILITY CRITERIA: Only observational studies focused on the assessment of clinical outcomes associated with pregnancy in COVID-19 women were selected. STUDY APPRAISAL AND SYNTHESIS METHODS: The first screening was based on the assessment of titles and abstracts, followed by the evaluation of full-texts. Qualitative variables were summarized with frequencies, whereas quantitative variables with central and variability indicators depending on their parametric distribution. Forest plots were used to describe point estimates and in-between studies variability. Study quality assessment was performed. RESULTS: Thirteen studies were selected. All of them were carried out in China. The mean (SD) age and gestational age of pregnant women were 30.3 (1.5) years and 35.9 (2.9) weeks, respectively. The mean (SD) duration from the first symptoms to the hospital admission and to labour were 5.5 (2.0) and 9.5 (8.7) days, respectively. Patients mainly complained of fever and cough (pooled (95 % CI) proportions were 76.0 % (57.0 %-90.0 %) and 38.0 (28.0 %-47.0 %), respectively). Several antibiotics, antivirals, and corticosteroids were prescribed in different combinations. The pooled prevalence of maternal complications and of caesarean section were 45.0 % (95 % CI: 24.0 %-67.0 %) and 88.0 % (95 %CI: 82.0 %-94.0 %). A proportion of pregnant women less than 20 % were admitted to ICU. The pooled proportion of preterm infants was 23.0 % (95 %CI: 11.0 %-39.0 %). The most frequent neonatal complications were pneumonia and respiratory distress syndrome. The pooled percentage of infected neonates was 6.0 % (95 %CI: 2.0 %-12.0 %). CONCLUSIONS: The present study suggests a high rate of maternal and neonatal complications in infected individuals. However, the current scientific evidence highlights a low risk of neonatal infection. Multicentre, cohort studies are needed to better elucidate the role of SARS-CoV-2 during pregnancy. SN - 1872-7654 UR - https://www.unboundmedicine.com/medline/citation/32713730/COVID_19_in_pregnant_women:_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0301-2115(20)30446-2 DB - PRIME DP - Unbound Medicine ER -