COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Prognosis Zaigham M, Andersson O Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. doi: 10.1111/aogs.13867. Epub 2020 Apr 20.

INTRODUCTION: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to an unprecedented global health crisis. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The objective of this study was to summarize the clinical manifestations and maternal and perinatal outcomes of COVID-19 during pregnancy.

MATERIAL AND METHODS: We searched databases for all case reports and series from 12 February to 4 April 2020. Multiple terms and combinations were used including COVID-19, pregnancy, maternal mortality, maternal morbidity, complications, clinical manifestations, neonatal morbidity, intrauterine fetal death, neonatal mortality and SARS-CoV-2. Eligibility criteria included peer-reviewed publications written in English or Chinese and quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR-confirmed SARS-CoV-2 infection. Unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, cases with suspected COVID-19 that were not confirmed by a laboratory test, and unreported maternal or perinatal outcomes were excluded. Data on clinical manifestations, maternal and perinatal outcomes including vertical transmission were extracted and analyzed.

RESULTS: Eighteen articles reporting data from 108 pregnancies between 8 December 2019 and 1 April 2020 were included in the current study. Most reports described women presenting in the third trimester with fever (68%) and coughing (34%). Lymphocytopenia (59%) with elevated C-reactive protein (70%) was observed and 91% of the women were delivered by cesarean section. Three maternal intensive care unit admissions were noted but no maternal deaths. One neonatal death and one intrauterine death were also reported.

CONCLUSIONS: Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 and perinatal deaths were reported. Vertical transmission of the COVID-19 could not be ruled out. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.

Discipline / Specialty Area Score
Infectious Disease
Public Health
Pediatrics (General)
Pediatric Hospital Medicine
Pediatric Neonatology
Comments from MORE raters

FM/GP/Obstetrics rater

The first 108 patients is not enough to draw conclusions about much, in my opinion. Plus, these patients are from such varied locations. I'd be more confident in a report of 108 patients from NYC hospitals (where they probably have 508 patients or 1008 patients worth of experience).

Obstetrics rater

In Covid-19, there is a lot of interest. Now many doctors are keen to know more.

Pediatric Hospital Medicine rater

This is a timely and relevant addition to the literature in a region where the social distancing practices were distinct. Comparison of Sweden's approach relative to other parts of the world will prove to be exceedingly important.

Pediatrics (General) rater

The systematic review suffers from the problem that there is limited information on the prevalence, because of the lack of universal testing.

Public Health rater

This is an important review but in a rapidly changing field, already out of date. It is important to have a definitive review inclusive of the best studies with appropriate designs and diagnostics to assess birth and perinatal outcomes. The review should also distinguish between early and late infections and the effect of maternal co-morbidities.