Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV-2 in women with COVID-19: A systematic review of 441 cases

  1. Rahul K Gajbhiye
  2. Deepak N Modi
  3. Smita D Mahale

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Abstract

Objective

The aim of this systematic review was to examine the maternal and fetal outcomes in pregnant women with COVID-19 and also assess the incidence of maternal-fetal transmission of SARS CO-V-2 infection.

Data sources

We searched PUMBED. Medline, Embase, MedRxiv and bioRxiv databases upto 3 rd May 2020 utilizing combinations of word variants for “coronavirus” or “COVID-19” or “severe acute respiratory syndrome” or “SARS-COV-2” and “pregnancy”. We also included data from preprint articles.

Study eligibility criteria

Original case reports and case series on pregnant women with diagnosis of SARS-CoV-2 infection.

Study appraisal and synthesis methods

We included 50 studies reporting the information on 441 pregnant women and 391 neonates. The primary outcome measures were maternal health characteristics and adverse pregnancy outcomes, neonatal outcomes and SARS-CoV-2 infection in neonates was extracted. Treatments given to pregnant women with COVID-19 were also recorded.

Results

Out of 441 women affected by COVID-19 in pregnancy, 387 women have delivered. There are nine maternal deaths reported. In pregnant women with COVID-19, the most common symptoms were fever (56%), cough (43%), myalgia (19%), dyspnea (18%) and diarrhea (6%). Pneumonia was diagnosed by CT scan imaging in 96 % of COVID-19 pregnant women. Pregnancy complications included delivery by cesarean section (80%), preterm labor (26%), fetal distress (8%) and premature rupture of membranes (9%). Six still births (2%) are reported. The most common co-morbidities associated with pregnant women with COVID-19 were hypertensive disorders (10%), diabetes (9%), placental disorders (2%), co-infections (3%), scarred uterus (3%) and hypothyroidism (3%). Amongst the neonates of COVID-19 mothers, preterm birth (25%), respiratory distress syndrome (8%), pneumonia (8%) were reported. There were four neonatal deaths reported. Vertical transmission rate of SARS-CoV-2 is estimated to be 8%.

Conclusion

In pregnant women with COVID-19, hypertensive disorders and diabetes are common comorbidities and there is a risk of preterm delivery and maternal death. Amongst the neonates born to mothers with COVID-19, respiratory distress syndrome and pneumonia are common occurrence. There are reports of still births and neonatal deaths. There is an evidence of vertical transmission of SARS-CoV-2 infection in women with COVID-19.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.11.20062356: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationThird author (SM) coordinated the discussion for agreement of the shortlisted articles and looked for inconsistencies by randomly selecting a subset of articles (20%).
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableSince the publication of our preprint in April 20209, two studies from China were published that described clinical characteristics and outcomes of 116 and 118 pregnant women with COVID-1910,11.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Eligibility criteria, information sources, search strategy: We performed a systematic search in PUBMED, Medline, Google Scholar, preprint servers medRxiv, bioRxiv and arXiv databases utilizing combinations of word variants for “coronavirus”, 2019 n-COV. or “COVID-19” and “pregnancy”.
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)
    arXiv
    suggested: (arXiv, RRID:SCR_006500)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.11.20062356v2 on medRxiv
  3. Version published to 10.1101/2020.04.11.20062356v1 on medRxiv