A systematic review and meta-analysis of pregnancy and COVID-19: Signs and symptoms, laboratory tests, and perinatal outcomes

  1. Soheil Hassanipour
  2. Saeed Bagheri Faradonbeh
  3. Khalil Momeni
  4. Zahra Heidarifard
  5. Mohammad-Javad Khosousi
  6. Leila Khosousi
  7. Hosein Ameri
  8. Morteza Arab-Zozani

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Abstract

Background: Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 appeared in December 2019 in Wuhan, China. Objective: To investigate the clinical manifestations including signs and symptoms, laboratory results, and perinatal outcomes in pregnant women with COVID-19. Materials and Methods: Scholarly databases such as PubMed via LitCovid hub, Embase, Scopus, Web of sciences, and Google scholar were searched on April 7, 2020. Meta-analysis was performed via comprehensive meta-analysis software using the Mantel-Haenszel method. The event rate with 95% CI was calculated for each variable. Results: Ten studies were selected. The pooled prevalence for fever, post-partum fever, cough, myalgia, fatigue, dyspnea, sore throat, and diarrhea were 66.8%, 37.1%, 35%, 24.6 %, 14.9%, 14.6%, 11.5%, and 7.6%, respectively. Laboratory test results were 49.8% for lymphopenia, 47.7% for leukocytosis, 83.7% for elevated neutrophil ratio, 57% for elevated C-reactive protein, and 71.4% for decreased lymphocyte ratio. The rate of cesarean section for delivery in all cases was 84%. Of the newborns of the corona positive mothers, only one had a positive test result. Also, there was only one death due to a decreased lymphocyte ratio. Conclusion: Fever was the most common sign and symptom in pregnant women with COVID-19. Among the laboratory tests, the highest amount was related to elevated neutrophil ratio. It seems that due to the differences between pregnant women and the general population, special measures should be considered to treat these patients. Key words: COVID-19, Pregnancy, Diagnosis, Signs and symptoms, Meta-analysis.

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  1. Version published to 10.18502/ijrm.v18i12.8022
  2. ScreenIT

    SciScore for 10.1101/2020.09.28.20202945: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableEligibility criteria: All studies were included based on the following criteria: they investigated COVID-19 in pregnant women or during pregnancy and were in the English language.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Information sources and search: We searched PubMed via LitCovid hub, Embase, Scopus, Web of sciences and Google scholar using a specific search strategy (“2019 nCoV” OR 2019nCoV OR “2019 novel coronavirus” OR “COVID 19” OR COVID19 OR “new coronavirus” OR “novel coronavirus” OR “SARS CoV-2” OR (Wuhan AND coronavirus) OR “COVID 19” OR “SARS-CoV” OR “2019-nCoV” OR “SARS-CoV-2” AND pregnancy OR “pregnant women”) on 07 April 2020.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    Google scholar
    suggested: (Google Scholar, RRID:SCR_008878)

    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:
    Our study has some limitations. First, all patients registered in these included articles were in the third trimester of pregnancy, and the effect of the virus infection on the fetus in the first or second trimester was unknown. Second, due to the short duration of the outbreak, the long-term consequences of the disease on infants have not been possible and more studies are needed. Third, the low number of samples of articles included is another limitation of the work. Fourth, all included studies were from china. In conclusion, pregnant women with COVID-19 pneumonia had diverse symptoms; however, fever and cough are the main clinical symptoms of these women. Although one infant was born with COVID-19 in the included studies, there was little evidence that COVID-19 was transmitted from mother to infant in late pregnancy. Therefore, the study of long-term outcomes on mother and child, as well as the vertical transfer of mother to child in second-trimester pregnancies and the first months after delivery, requires further studies.

    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.

  3. Version published to 10.1101/2020.09.28.20202945v1 on medRxiv