Abstract
SARS-CoV-2 is the novel member of coronavirus responsible for the worldwide pandemic COVID-19, affecting all types of people. In this context, established research identified pregnant women as a susceptible group of SARS-CoV-2 infection, although there is still limited data regarding the real impact of COVID-19 in this group. With that purpose, we conducted a systematic review describing the maternal-fetal results of pregnant women infected by SARS-CoV-2, in aim to analyze the profile of the obstetric patients according to the country of origin of the publication. A total of 38 articles were included in this systematic review with 2670 patients from 7 countries, with 20 works published from China (52.6%). We reported significative differences according to the median maternal age, with Spain as the country with the highest age (34.6 years); The percentage of tabaquism; proportion of symptomatic patients in the triage; type of radiological exam (China and France conduct CT scans on all their patients in comparison to the use of chest X-Ray in the rest of the countries studied); percentages of C-sections (83.9% in China; 35.9% Spain, p < 0.001); maternal mortality rate, proportion of patients who need treatments, the use of antivirals, antibiotics, and anticoagulants as well as measurements of the newborns. Perinatal results are favorable in the majority of countries, with very low rates of vertical transmission in the majority of works. The studies collected in this review showed moderate to high index of quality. The different works describe the affectation during the first wave of the pandemic, where the pregnant woman with SARS-CoV-2 infection is generally symptomatic during the third trimester of gestation along with other factors associated with worse prognosis of the disease, such as higher age, body mass index, and further comorbidities developed during pregnancy. In the obstetric patient, proportion of C-sections are elevated together with prematurity, increasing maternal perinatal morbimortality. Differences found between countries could be based on the proper profile of the patient in each region, the period of the pandemic directly affecting how it was managed, and the variations regarding in situ medical attention.
Highlights
COVID-19 is the accepted term used for the infection performed by the novel coronavirus SARS-CoV-2 suddenly discovered in Wuhan, China [1]
Of the articles identified in the 2 databases, a total of 38 articles [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58] were included in this systematic review with 2670 patients proceeding from 7 countries (China, United States of America (USA), France, United Kingdom (UK), Spain, Italy, and Portugal)
As a particular overview of the published works based on the country of origin and considering the results described in Supplementary Tables S1 and S2 as well as Figures 2 and 3, it could be summarized that patients included in the works from China (52.6% of our study) were the first women recruited according to the evolution of this global pandemic, with the first case reported on 8 December 2019 [21]
Summary
COVID-19 is the accepted term used for the infection performed by the novel coronavirus SARS-CoV-2 suddenly discovered in Wuhan, China [1]. SARS-CoV-2 infects human cells through its binding via spike protein to the angiotensin-converting enzyme 2 [ACE-2] receptor [3]. This receptor is widely expressed in various tissues and organs and sex, age, race, or pathological conditions may regulate the expression of ACE-2 [4]. Despite elder people [7] and patients with baseline comorbidities or receiving different therapies [8] being the most vulnerable population, this condition affects all range of ages, including children and obstetric patients
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