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COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Prognosis Smith V, Seo D, Warty R, et al. Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review. PLoS One. 2020 Jun 4;15(6):e0234187. doi: 10.1371/journal.pone.0234187. eCollection 2020.
Abstract

BACKGROUND: COVID-19 has created an extraordinary global health crisis. However, with limited understanding of the effects of COVID-19 during pregnancy, clinicians and patients are forced to make uninformed decisions.

OBJECTIVES: To systematically evaluate the literature and report the maternal and neonatal outcomes associated with COVID-19.

SEARCH STRATEGY: PubMed, MEDLINE, and EMBASE were searched from November 1st, 2019 and March 28th, 2020.

SELECTION CRITERIA: Primary studies, reported in English, investigating COVID-19-positive pregnant women and reporting their pregnancy and neonatal outcomes.

DATA COLLECTION AND ANALYSIS: Data in relation to clinical presentation, investigation were maternal and neonatal outcomes were extracted and analysed using summary statistics. Hypothesis testing was performed to examine differences in time-to-delivery. Study quality was assessed using the ICROMS tool.

MAIN RESULTS: Of 73 identified articles, nine were eligible for inclusion (n = 92). 67.4% (62/92) of women were symptomatic at presentation. RT-PCR was inferior to CT-based diagnosis in 31.7% (26/79) of cases. Maternal mortality rate was 0% and only one patient required intensive care and ventilation. 63.8% (30/47) had preterm births, 61.1% (11/18) fetal distress and 80% (40/50) a Caesarean section. 76.92% (11/13) of neonates required NICU admission and 42.8% (40/50) had a low birth weight. There was one indeterminate case of potential vertical transmission. Mean time-to-delivery was 4.3±3.08 days (n = 12) with no difference in outcomes (p>0.05).

CONCLUSIONS: COVID-19-positive pregnant women present with fewer symptoms than the general population and may be RT-PCR negative despite having signs of viral pneumonia. The incidence of preterm births, low birth weight, C-section, NICU admission appear higher than the general population.

Ratings
Discipline / Specialty Area Score
Pediatric Neonatology
Infectious Disease
Family Medicine (FM)/General Practice (GP)
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

The review is interesting, but limited by the small sample size, and probably just counting the most serious cases (98% pneumonia).

Pediatric Neonatology rater

Again, too soon for this kind of meta-analysis. The quality of this report is not very high, as they admit. Reports from the US suggest a high rate of asymptomatic positivity in OB patients that is not reported here. The most interesting detail is the number of "false negatives" diagnosed by CT scan.

Pediatric Neonatology rater

This article provides needed evidence (although of moderate to low quality) about outcomes (maternal and neonatal) for COVID-19 positive pregnant women. The data suggests that maternal morbidity and mortality is lower than in some other viral diseases and and that vertical transmission of COVID-19 is low. The high rate of preterm delivery and low birth weight are concerning. It is difficult to interpret the high rate of NICU admission, as this may have been affected by hospital policy for isolation of at risk infants.