Abstract
In less than four months, the total of confirmed cases of COVID-19 was 1,684,833 worldwide. Outcomes among the public of pregnant women with COVID-19 are still unclear. We performed a systematic review and meta-analysis to analyze whether COVID-19 in pregnant women is related to premature birth and birth weight, and to summarize the diagnostic results of neonates born to mothers with COVID-19 for investigating the possibility of vertical transmission. Searches were performed in PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv, and medRxiv. We used the odds ratio (OR) and mean difference (MD) as measure of analysis. Summary estimates were calculated using random effects models. 38 studies were included; data from 279 women were analyzed; 60 patients were diagnosed with COVID-19. The meta-analysis showed no significant association between COVID-19 and preterm delivery (OR = 2.25; 95%CI: 0.96, 5.31; p = 0.06; I² = 0%). No significant relationship was found between birth weight and COVID-19 (MD = -124.16; 95%CI: -260.54, 12.22; p = 0.07; I² = 0%). Among 432 newborns, 10 were reported with positive results for early SARS-CoV-2. Due to the characteristics of the studies, the level of evidence of this meta-analysis was considered very low. COVID-19 in pregnant women may not be associated with the occurrence of preterm deliveries or the birth weight of the newborn children, however the evidence to date is very uncertain. A few reports suggest vertical transmission of SARS-CoV-2 to newborn is possible, but evidence is still uncertain.
Highlights
In December 2019, cases of pneumonia related to coronavirus disease 2019 (COVID-19) infection were reported in the city of Wuhan and soon spread to other locations in China and other countries 1
The first phase of this study focused on the following question: Is there a relationship between COVID-19 in pregnant women, preterm delivery and birth weight? Studies were considered eligible if they satisfied the following criteria: (i) they were a case-control or cohort study, or nested design and considered pregnant women without COVID-19 as a control group; (ii) they provided data on COVID-19 diagnoses in pregnant women, delivery, and birth weight of the newborn; (iii) COVID-19 was ascertained by laboratory analyses positive in reverse transcription polymerase chain reaction (RT-PCR) tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or by radiological findings compatible with the disease; (iv) preterm delivery was
The second phase of this study focused on the following question: what are the postpartum diagnostic results for SARS-CoV-2 of neonates born to women with COVID-19? Studies were considered eligible if they satisfied the following criteria: (i) they were a cross-sectional study, case-control, cohort, nested design, case report, or case series and (ii) they provided data on diagnostic results of neonates born to women with COVID-19
Summary
In December 2019, cases of pneumonia related to coronavirus disease 2019 (COVID-19) infection were reported in the city of Wuhan and soon spread to other locations in China and other countries 1. As of April 24, 2020, the total number of confirmed cases of COVID-19 infection was 2,790,986 worldwide, with 195,920 deaths in 185 regions. Efforts to prevent the transmission of the etiological agent, which occurs mainly through aspiration or contact with respiratory secretions of infected patients, are being adopted worldwide, with an emphasis on the social isolation of the population through the blocking of services considered non-essential 4, including the restriction or closing of elective clinical services, bars, hotels, shopping malls, shows, restaurants, schools, universities, ports, airports, and highways. An official information from China demonstrated that 8% of pregnant women with COVID-19 were severe cases and may be vulnerable to infection 8. Results among the public of pregnant women and newborns require more detailed analysis
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