Abstract
BackgroundPregnant women represent a potentially high‐risk population in the COVID‐19 pandemic.ObjectiveTo summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID‐19.Search strategyRelevant databases were searched up until May 29, 2020.Selection criteriaCase series/reports of hospitalized pregnant women with laboratory‐confirmed COVID‐19.Data collection and analysisPRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools.Main resultsOverall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory‐confirmed SARS‐CoV‐2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D‐dimer and interleukin‐6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID‐19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours.ConclusionsAdvanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D‐dimer and interleukin‐6 levels are predictive of poor pregnancy outcomes in COVID‐19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.
Highlights
Coronavirus disease 2019 (COVID‐19) is caused by severe acute respi‐ ratory syndrome coronavirus 2 (SARS‐CoV‐2) and was first reported in Wuhan, Hubei Province, China, in December 2019
The present review is one of the largest interna‐ tional systematic reviews of published studies on COVID‐19 infec‐ tion in pregnancy, stratified by risk according to severity of COVID‐19 disease and timing in pregnancy
The review pro‐ vides sufficient data to support previous findings that pregnancy is not associated with a more severe course of infection overall. Women in their third trimester and those with co‐morbidities are at particular risk of developing critical infection
Summary
Coronavirus disease 2019 (COVID‐19) is caused by severe acute respi‐ ratory syndrome coronavirus 2 (SARS‐CoV‐2) and was first reported in Wuhan, Hubei Province, China, in December 2019. The initial data on COVID‐19 outcomes in pregnancy were derived from small numbers of patients, first from China and from Italy, with uncertainty regarding the extent to which these findings might be extrapolated to inform obstetric practice elsewhere in the world. The objective of the present review was to evaluate clinical charac‐ teristics and maternal, fetal, and neonatal outcomes among pregnant women admitted to hospital with laboratory‐confirmed SARS‐CoV‐2 infection by conducting a large global comprehensive review of data from various epicenters. Objective: To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID‐19. Selection criteria: Case series/reports of hospitalized pregnant women with laboratory‐confirmed COVID‐19. Conclusions: Advanced gestation, maternal age, obesity, diabetes mellitus, and a com‐ bination of elevated D‐dimer and interleukin‐6 levels are predictive of poor pregnancy outcomes in COVID‐19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved
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