Current best evidence for clinical care (more info)
INTRODUCTION: Descriptions of coronavirus disease-2019 (COVID-19) have focused on the non-pregnant adult population. This study aims to describe the clinical characteristics and perinatal outcomes of COVID-19 in pregnancy.
METHODS: We searched databases from December 2019 to April 30th, 2020. Eligible studies reported clinical characteristics, radiological findings and/or laboratory testing of pregnant women during infection. Data were pooled across studies using random-effects model.
RESULTS: Twenty-four studies (136 women) were included. Most common symptoms were fever (62.9%) and cough (36.8%). Laboratory findings included elevated C-Reactive Protein (57%) and lymphocytopenia (50%). Ground-glass opacity was the most common radiological finding (81.7%). Preterm birth rate was 37.7% and cesarean delivery rate was 76%. There was one maternal death. There were two fetal COVID-19 cases.
CONCLUSION: The clinical picture in pregnant women with COVID-19 did not differ from the non-pregnant population, however, the rate of preterm birth and cesarean delivery are considerably higher than international averages.
|Discipline / Specialty Area||Score|
|Family Medicine (FM)/General Practice (GP)||
This is a very well done meta-analysis that examines whether clinical signs and technical test results of COVID-19 infection are different in pregnant women than in the general population.
Before reading this systematic review of COVID-19 during pregnancy, I read at least five others published in which the results are practically the same and certainly many studies included are repeated in all reviews on the topic. This reinforces that systematic reviews are being overvalued and often published with the same results, not providing new scientific information for obstetricians like me.
This paper is a meta analysis of published studies, mostly from China, of pregnancies in the setting of SARS-CoV-2 infection. Although there are many flaws in this paper such as inclusion of case reports and little standardization of either epidemiologic or clinical data, it is important for its negatives. There does not appear to be significant vertical transmission of the virus. It does not appear to be teratogenic, and pre-term delivery and Caesarean section are common. The mothers appear to demonstrate the expected spectrum of COVID-19 disease. Another limitation is publication bias, that the authors acknowledge; mild cases are not likely to be reported. The paper provides useful guidance in managing the pregnant coronavirus-infected patient. A prospective study of pregnancy in the setting of COVID is urgently needed.
The rush to publish COVID studies has already resulted in several papers being retracted. Now we see a rush to do meta-analysis on papers rushed into print. The authors point out "the lack of high quality data", "incomplete documentation", and the number of small series and case reports. It's a bit soon for meta-analyses and review articles.