Pregnancy and Breastfeeding During COVID-19 Pandemic: A Systematic Review of Published Pregnancy Cases

  1. Carina Rodrigues
  2. Inês Baía
  3. Rosa Domingues
  4. Henrique Barros

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Abstract

Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19.

Methods: Searches were conducted in PubMed®, Scopus®, Web of Science®, and MedRxiv® up to 26th June 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality.

Results: We identified 161 original studies reporting 3,985 cases of pregnant women with COVID-19 (1,007 discharged while pregnant). The 2,059 published cases with pregnancy outcomes resulted in 42 abortions, 21 stillbirths, and 2,015 live births. Preterm birth occurred in 23% of cases. Around 6% of pregnant women required admission to an intensive care unit and 28 died. There were 10 neonatal deaths. From the 163 cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus, 10 were positive. Sixty-one newborns were positive for SARS-CoV-2. Four breast milk samples from 92 cases showed evidence of SARS-CoV-2.

Conclusion: Emerging evidence suggests that vertical transmission is possible, however, there is still a limited number of reported cases with intrapartum samples. Information, counseling and adequate monitoring are essential to prevent and manage adverse effects of SARS-CoV-2 infection during pregnancy.

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  1. Version published to 10.3389/fpubh.2020.558144
  2. ScreenIT

    SciScore for 10.1101/2020.04.25.20079509: (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 variableThe review follows the Preferred Reporting of Systematic Reviews and Meta-Analysis (PRISMA) guidelines.9, 10 We searched PubMed® up to 8 April 2020 to identify original published studies describing pregnant women at any gestational age diagnosed with COVID-19 (confirmed by clinical/radiological evidence of pneumonia compatible with SARS-CoV-2 and/or by quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR of SARS-CoV-2 infection).

    Table 2: Resources

    No key resources detected.

    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:
    Limitations of this systematic review should be acknowledged. Considerable heterogeneity was observed across the studies, which did not allow us to conduct a meta-analysis. On the other hand, we cannot guarantee that we were able to identify all the cases of pregnant women described in the literature. Possibly there are additional cases currently presented in other types of publications, such as reports. Also, considering the importance of summarizing all existing cases, we did not assess the quality of the studies included in this review. Several studies had missing outcome data and selective reporting bias could not be excluded. Additionally, there may be some cases which could be duplicated, namely the studies which did not describe clinical characteristics case by case.30, 33, 34, 36

    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 10.1101/2020.04.25.20079509v2 on medRxiv
  4. Version published to 10.1101/2020.04.25.20079509v1 on medRxiv