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The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis.
Eur J Med Res. 2020 Sep 04; 25(1):39.EJ

Abstract

BACKGROUND

Coronavirus is challenging the global health care system from time to time. The pregnant state, with alterations in hormone levels and decreased lung volumes due to a gravid uterus and slightly immunocompromised state may predispose patients to a more rapidly deteriorating clinical course and can get a greater risk of harm for both the mother and fetus. Therefore, this systematic review was aimed to assess the effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and its possibility of vertical maternal-fetal transmission.

METHODS

A systematic search was conducted on PubMed, Web of Science, Embase, Google Scholar and the Cochrane Library until the end of April. All authors independently extracted all necessary data using excel spreadsheet form. Only published articles with fully accessible data on pregnant women infected with SARS-CoV, MARS-CoV, and SARS-CoV-2 were included. Data on clinical manifestations, maternal and perinatal outcomes were extracted and analyzed.

RESULT

Out of 879 articles reviewed, 39 studies involving 1316 pregnant women were included. The most common clinical features were fever, cough, and myalgia with prevalence ranging from 30 to 97%, while lymphocytopenia and C-reactive protein were the most common abnormal laboratory findings (55-100%). Pneumonia was the most diagnosed clinical symptom of COVID-19 and non-COVID-19 infection with prevalence ranged from 71 to 89%. Bilateral pneumonia (57.9%) and ground-glass opacity (65.8%) were the most common CT imaging reported. The most common treatment options used were hydroxychloroquine (79.7%), ribavirin (65.2%), and oxygen therapy (78.8%). Regarding maternal outcome, the rate of preterm birth < 37 weeks of gestation was 14.3%, preeclampsia (5.9%), miscarriage (14.5%, preterm premature rupture of membranes (9.2%) and fetal growth restriction (2.8%). From the total coronavirus infected pregnant women, 56.9% delivered by cesarean, 31.3% admitted to ICU, while 2.7% were died. Among the perinatal outcomes, fetal distress rated (26.5%), neonatal asphyxia rated (1.4%). Only, 1.2% of neonates had apgar score < 7 at 5 min. Neonate admitted to ICU was rated 11.3%, while the rate of perinatal death was 2.2%. In the current review, none of the studies reported transmission of CoV from the mother to the fetus in utero during the study period.

CONCLUSION

Coronavirus infection is more likely to affect pregnant women. Respiratory infectious diseases have demonstrated an increased risk of adverse maternal obstetrical complications than the general population due to physiological changes occurred during pregnancy. None of the studies reported transmission of CoV from the mother to the fetus in utero, which may be due to a very low expression of angiotensin-converting enzyme-2 in early maternal-fetal interface cells.

Authors+Show Affiliations

Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia. kumadiriba47@gmail.com.Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia.Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32887660

Citation

Diriba, Kuma, et al. "The Effect of Coronavirus Infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) During Pregnancy and the Possibility of Vertical Maternal-fetal Transmission: a Systematic Review and Meta-analysis." European Journal of Medical Research, vol. 25, no. 1, 2020, p. 39.
Diriba K, Awulachew E, Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. Eur J Med Res. 2020;25(1):39.
Diriba, K., Awulachew, E., & Getu, E. (2020). The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. European Journal of Medical Research, 25(1), 39. https://doi.org/10.1186/s40001-020-00439-w
Diriba K, Awulachew E, Getu E. The Effect of Coronavirus Infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) During Pregnancy and the Possibility of Vertical Maternal-fetal Transmission: a Systematic Review and Meta-analysis. Eur J Med Res. 2020 Sep 4;25(1):39. PubMed PMID: 32887660.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. AU - Diriba,Kuma, AU - Awulachew,Ephrem, AU - Getu,Eyob, Y1 - 2020/09/04/ PY - 2020/06/03/received PY - 2020/08/19/accepted PY - 2020/9/5/entrez PY - 2020/9/6/pubmed PY - 2020/9/17/medline KW - Coronavirus KW - Infection KW - Middle East respiratory syndrome KW - Novel coronavirus-2019 KW - Pregnancy KW - Severe acute respiratory syndrome KW - Severe acute respiratory syndrome coronavirus-2 KW - Vertical transmission SP - 39 EP - 39 JF - European journal of medical research JO - Eur J Med Res VL - 25 IS - 1 N2 - BACKGROUND: Coronavirus is challenging the global health care system from time to time. The pregnant state, with alterations in hormone levels and decreased lung volumes due to a gravid uterus and slightly immunocompromised state may predispose patients to a more rapidly deteriorating clinical course and can get a greater risk of harm for both the mother and fetus. Therefore, this systematic review was aimed to assess the effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and its possibility of vertical maternal-fetal transmission. METHODS: A systematic search was conducted on PubMed, Web of Science, Embase, Google Scholar and the Cochrane Library until the end of April. All authors independently extracted all necessary data using excel spreadsheet form. Only published articles with fully accessible data on pregnant women infected with SARS-CoV, MARS-CoV, and SARS-CoV-2 were included. Data on clinical manifestations, maternal and perinatal outcomes were extracted and analyzed. RESULT: Out of 879 articles reviewed, 39 studies involving 1316 pregnant women were included. The most common clinical features were fever, cough, and myalgia with prevalence ranging from 30 to 97%, while lymphocytopenia and C-reactive protein were the most common abnormal laboratory findings (55-100%). Pneumonia was the most diagnosed clinical symptom of COVID-19 and non-COVID-19 infection with prevalence ranged from 71 to 89%. Bilateral pneumonia (57.9%) and ground-glass opacity (65.8%) were the most common CT imaging reported. The most common treatment options used were hydroxychloroquine (79.7%), ribavirin (65.2%), and oxygen therapy (78.8%). Regarding maternal outcome, the rate of preterm birth < 37 weeks of gestation was 14.3%, preeclampsia (5.9%), miscarriage (14.5%, preterm premature rupture of membranes (9.2%) and fetal growth restriction (2.8%). From the total coronavirus infected pregnant women, 56.9% delivered by cesarean, 31.3% admitted to ICU, while 2.7% were died. Among the perinatal outcomes, fetal distress rated (26.5%), neonatal asphyxia rated (1.4%). Only, 1.2% of neonates had apgar score < 7 at 5 min. Neonate admitted to ICU was rated 11.3%, while the rate of perinatal death was 2.2%. In the current review, none of the studies reported transmission of CoV from the mother to the fetus in utero during the study period. CONCLUSION: Coronavirus infection is more likely to affect pregnant women. Respiratory infectious diseases have demonstrated an increased risk of adverse maternal obstetrical complications than the general population due to physiological changes occurred during pregnancy. None of the studies reported transmission of CoV from the mother to the fetus in utero, which may be due to a very low expression of angiotensin-converting enzyme-2 in early maternal-fetal interface cells. SN - 2047-783X UR - https://www.unboundmedicine.com/medline/citation/32887660/The_effect_of_coronavirus_infection__SARS_CoV_2_MERS_CoV_and_SARS_CoV__during_pregnancy_and_the_possibility_of_vertical_maternal_fetal_transmission:_a_systematic_review_and_meta_analysis_ L2 - https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-020-00439-w DB - PRIME DP - Unbound Medicine ER -