COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Prognosis Lopes de Sousa AF, Carvalho HEF, Oliveira LB, et al. Effects of COVID-19 Infection during Pregnancy and Neonatal Prognosis: What Is the Evidence? Int J Environ Res Public Health. 2020 Jun 11;17(11). pii: ijerph17114176. doi: 10.3390/ijerph17114176.
Abstract

BACKGROUND: This study's aims are to assess the current evidence presented in the literature regarding the potential risks of COVID-19 infection among pregnant women and consequent fetal transmission.

METHODS: a systematic literature review assessing papers published in the most comprehensive databases in the field of health intended to answer the question, "What are the effects of COVID-19 infection during pregnancy, and what is the neonatal prognosis?"

RESULTS: 49 papers published in 2020 were eligible, presenting low levels of evidence. A total of 755 pregnant women and 598 infants were assessed; more than half of pregnant women had C-sections (379/65%). Only 493 (82%) infants were tested for SARS-CoV-2, nine (2%) of whom tested positive. There is, however, no evidence of vertical transmission based on what has been assessed so far, considering there are knowledge gaps concerning the care provided during and after delivery, as well as a lack of suitable biological samples for testing SARS-CoV-2.

CONCLUSIONS: We cannot rule out potential worsening of the clinical conditions of pregnant women infected with SARS-CoV-2, whether the infection is associated with comorbidities or not, due to the occurrence of respiratory disorders, cardiac rhythm disturbances, and acid-base imbalance, among others. We recommend relentless monitoring of all pregnant women in addition to testing them before delivery or the first contact with newborns.

Ratings
Discipline / Specialty Area Score
Obstetrics
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Family Medicine (FM)/General Practice (GP)
Public Health
Pediatric Hospital Medicine
Pediatric Neonatology
Comments from MORE raters

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

The conclusions of this study are contentious given the limitations admitted in the discussion. The stringent advice to avoid contact between mother and baby where there is risk of COVID-19 infection, ignores the enormous known health benefits of immediate mother-baby contact after birth. The study is not of direct relevance to primary care in the UK.

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

This interesting review summarizes the evidence on a relevant and timely topic. However, this is not a specially strong review; it combines two different research questions and does not define a control group of women not exposed to the infection.

Intensivist/Critical Care rater

There is an interesting question and good methodology is used for the paper. However, there are very few data and very low level of evidence ... uncertainty is the master word, but it has to be said that apparently there is not a big problem in this context.

Obstetrics rater

This is one of many recent papers on this topic. I'm not sure how much it adds to the literature in view of the low level of evidence studies included in the review.

Obstetrics rater

This is a good update on Covid infection in pregnancy reassuring that only 2% of neonates are infected.

Pediatric Neonatology rater

The urgency by journal editors to publish papers related to COVID-19 has led to an overwhelming number of publications on this topic. However, on carefully examining the literature, the number of original papers offering new information on neonatal infection with SARS-Cov-2 is limited; there is significant duplication of results in multiple publications. The high profile retraction of papers from the adult literature is also to be noted. Readers should exercise extreme caution in quoting and interpreting papers published over the last few months. Further high-quality papers with rigorous methods are awaited.

Pediatric Neonatology rater

This is useful information.

Public Health rater

This issue is more relevant for ob/gyn.

Public Health rater

There are quite a few publications including live reviews summarising literature on this important topic.