BACKGROUND AND PURPOSE:

• A ‘living’ systematic review was started in April 2020 to keep up with the latest literature on clinical manifestations of covid-19 in pregnancy and is updated regularly as new data becomes available
• Allotey et al. (BMJ, 2020) provides the latest update on clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed COVID-19

METHODS:

• Systematic review and meta-analysis
• Data sources
  • Medline | Embase | Cochrane database | WHO COVID-19 database | China National Knowledge Infrastructure (CNKI) | Wanfang databases from December 1, 2019 to October 6, 2020
  • Preprint servers | Social media | Reference lists
• Inclusion criteria
  • Cohort studies
  • Studies that reported the rates clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed COVID-19
• Study design
  • At least two researchers independently extracted the data and assessed study quality
  • Random effects meta-analysis was performed, with estimates pooled as odds ratios (OR) and proportions with 95% confidence intervals

RESULTS:

• 192 studies
• 10% of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed COVID-19 (73 studies; 67,271 women)
• Most common clinical manifestations of COVID-19 in pregnancy
  • Fever: 40%
  • Cough: 41%
• Pregnant and recently pregnant women vs nonpregnant women were overall
  • Less likely to have symptoms OR 0.28 (95% CI, 0.13 to 0.62)
  • Were less likely to report these specific symptoms
    • Fever: OR 0.49 (95% CI, 0.38 to 0.63)
    • Dyspnea: OR 0.76 (95% CI, 0.67 to 0.85)
    • Myalgia: OR 0.53 (95% CI, 0.36 to 0.78)
• Pregnant and recently pregnant women vs nonpregnant women had higher odds of
  • ICU admission: OR 2.13 (95% CI, 1.53 to 2.95)
  • Invasive ventilation: OR 2.59 (95% CI, 2.28 to 2.94)
  • ECMO: OR 2.02 (95% CI, 1.22 to 3.34)
• Overall mortality
  • Pregnant women with confirmed COVID-19: 0.02% died from any cause
• The following maternal characteristics were associated with severe COVID-19 in pregnancy
  • Increased maternal age
    • OR 1.83 (95% CI, 1.27 to 2.63)
  • High BMI
    • OR 2.37 (95% CI, 1.83 to 3.07)
  • Pre-existing maternal comorbidity
    • OR 1.81 (95% CI, 1.49 to 2.20)
  • Chronic hypertension
    • OR 2.0 (95% CI, 1.14 to 3.48)
  • Pre-existing diabetes
    • OR 2.12 (95% CI, 1.62 to 2.78)
  • Preeclampsia
    • OR 4.21 (95% CI, 1.27 to 14.0)
• The following were associated with serious complications such as ICU admission, invasive ventilation and maternal death
  • Increased maternal age
  • High BMI
  • Non-white ethnicity
  • Pre-existing maternal comorbidity including chronic hypertension and diabetes
  • Preeclampsia
• Compared to pregnant women without COVID-19, those with the disease had increased odds of
  • Maternal death: OR 2.85 (95% CI, 1.08 to 7.52)
  • ICU: OR 18.58 (95% CI 7.53 to 45.82); I2=0%
  • Preterm birth: OR 1.47 (95% CI 1.14 to 1.91); I2=18.6%
• The odds of NICU admission were higher in babies born to mothers with COVID-19
  • OR 4.89 (95% CI, 1.87 to 12.81)

CONCLUSION:

• While pregnant and recently pregnant women vs nonpregnant women with COVID-19 who attended or were admitted to a hospital were less likely to have symptoms such as fever, dyspnea or myalgias, they were more likely to be admitted to the ICU or need invasive ventilation
  • There may be a higher risk of maternal death
• Pregnant women with COVID-19 were more likely to deliver preterm, and their infants were more likely to be admitted to the NICU
• Non-white ethnicity, chronic hypertension, preexisting diabetes, high maternal age, and high BMI were risk factors for severe COVID-19 in pregnancy
• The authors due temper their results based on the quality of the data

Our review update also identified an increased risk for maternal death, need for maternal admission to the intensive care unit, and stillbirth in pregnant women with covid-19 compared to pregnant women without the disease

However, our confidence in these estimates is not high, owing to the small numbers of events in both groups

Further data are still needed to robustly assess these outcomes, along with the emerging data on increased risk of severe outcomes such as the need for ECMO

Learn More – Primary Sources:

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

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