COVID-19 and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes

  1. Agustín Ciapponi
  2. Ariel Bardach
  3. Daniel Comandé
  4. Mabel Berrueta
  5. Fernando J. Argento
  6. Federico Rodriguez Cairoli
  7. Natalia Zamora
  8. Victoria Santa María
  9. Xu Xiong
  10. Sabra Zaraa
  11. Agustina Mazzoni
  12. Pierre Buekens

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Abstract

We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783).

Methods

We searched literature databases and COVID-19 research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR’s results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables.

Results

We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had "critically low" overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 clinical findings during pregnancy were fever (28–100%), mild respiratory symptoms (20–79%), raised C-reactive protein (28–96%), lymphopenia (34–80%), and pneumonia signs in diagnostic imaging (7–99%). The most frequent maternal outcomes were C-section (23–96%) and preterm delivery (14–64%). Most of their babies were asymptomatic (16–93%) or presented fever (0–50%), low birth weight (5–43%) or preterm delivery (2–69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 versus non-COVID-19 pregnant women was 1.88 (95% Confidence Interval [CI] 1.36–2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05–4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks.

Conclusion

This comprehensive overview supports that pregnant women with COVID-19 may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.

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  1. Version published to 10.1371/journal.pone.0253974
  2. ScreenIT

    SciScore for 10.1101/2021.04.29.21256327: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablePregnant women without interventions or exposures under study, including active or inactive comparators, usual care, or placebo, were defined as comparison groups.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We performed an overview of SRs or umbrella review (PROSPERO Registration number CRD42020208783) following Cochrane methods[5] and the Preferred Reporting Items for systematic Reviews and Meta-Analyses (PRISMA) statement[6] and a specific guideline for overviews[7] (S1.
    Cochrane
    suggested: (Cochrane Library, RRID:SCR_013000)
    Search strategy: From January to October 2020 an experienced librarian searched the Cochrane Library, MEDLINE, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Science Citation Index Expanded (SCI-EXPANDED), China Network Knowledge Information (CNKI), WHO Database of publications on SARS-CoV-2, EPPI-Centre map of the current evidence on COVID-19, guidelines published by national and international professional societies (e.g., ACOG, RCOG, FIGO), pre-print servers (ArXiv, BiorXiv, medRxiv, search.bioPreprint), and COVID-19 research websites (PregCOV-19LSR, Maternal and Child Health, Nutrition: John Hopkins Centre for Humanitarian health, the LOVE database) We also searched the reference lists of included SRs.
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    ArXiv
    suggested: (arXiv, RRID:SCR_006500)
    BiorXiv
    suggested: (bioRxiv, RRID:SCR_003933)
    This process was performed using the web-based software COVIDENCE [9].
    COVIDENCE
    suggested: (Covidence, RRID:SCR_016484)

    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: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: This overview has several strengths. First, we followed sound methodology to conduct the present overview of systematic reviews. Second, we included systematic reviews without language restrictions. Third, we adhered to rigorous quality appraisal for the conduction of systematic reviews (AMSTAR-2 tool), which was independently assessed by two reviewers and discrepancies solved by consensus. We summarized and critically appraised an important amount of evidence that is relevant to health decision-making (See examples of policy briefs in supporting information S9 and S10) and highlighted evidence gaps that could guide future research. Finally, we conducted a sensitive and comprehensive search strategy to reduce the risk of missing relevant studies. We synthesized the results of all relevant SRs, highlighting their overlap through a matrix of primary studies by SR, and we also selected the best SR that answered a specific question according to pre-defined criteria of relevance, comprehensiveness, data update, and quality. We presented these SRs through a summary of the findings tables with the certainty of evidence according to the GRADE approach. Our review integrated the evidence generated by different independent groups, which could improve the robustness of our findings. Our study is not exempt from limitations. A main limitation is that the last search was run in October 2020. This is due to the time needed to perform a through SR. The general con...

    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.

    Results from scite Reference Check: We found no unreliable references.

    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.

  3. Version published to 10.1101/2021.04.29.21256327v1 on medRxiv