COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Prognosis Trocado V, Silvestre-Machado J, Azevedo L, et al. Pregnancy and COVID-19: a systematic review of maternal, obstetric and neonatal outcomes. J Matern Fetal Neonatal Med. 2020 Jul 7:1-13. doi: 10.1080/14767058.2020.1781809.
Abstract

BACKGROUND: There is limited information related to COVID-19 in pregnancy.

OBJECTIVES: Evaluate the impact of COVID-19 during pregnancy. Search strategy: Searches were systematically carried out in PubMed, Scopus database and WHO database. Selection criteria: Studies with information related to the effects of COVID-19 in pregnancy, concerning maternal, obstetric, and neonatal outcomes were included. Data collection and analysis: Data were extracted for systematic review following PRISMA guidelines. CARE and STROBE were used to evaluate the quality of data. Main Results: A total of 8 studies involving 95 pregnant women and 51 neonates were included. Overall, the quality was considered good in four studies, moderate in three and poor in one. Among pregnant women, 26% had a history of epidemiological exposure to SARS-CoV-2. The most common symptoms presented were fever (55%), cough (38%) and fatigue (11%). In 50 deliveries, 94% were cesarean sections and 35% were preterm births. Of the 51 neonates, 20% had low birth weight and 1 tested positive for Sars-CoV-2. There was 1 neonatal death, not related to the viral infection, and no cases of severe neonatal asphyxia.

CONCLUSIONS: The information compiled in this systematic review may help healthcare providers administer the best possible care.

Ratings
Discipline / Specialty Area Score
Obstetrics
Pediatric Neonatology
FM/GP/Obstetrics
Family Medicine (FM)/General Practice (GP)
Infectious Disease
Public Health
Comments from MORE raters

FM/GP/Obstetrics rater

The Covid-19 pandemic is moving too fast for the slow pace of systematic reviews. This systematic review was submitted April 23rd, and was based on articles published earlier than that, which were themselves based upon the tiny numbers in the earliest experiences of the pandemic. This report includes 95 patients total. By now, we probably have patient care experience with 9500 pregnant women all over the globe. In NYC's outbreak alone, I'm sure there were more than 95 patients. 95 patients is not enough patients from whom to draw conclusions. Furthermore, the c-section rate was a whopping 94%, yet no reason is given why these women underwent c-section. How am I to learn from the collected reports of 95 patients when no explanation is given? Was there 94% critical fetal distress? 94% of women so ill they could not labor (though major abdominal surgery is also not a great idea in severely ill women). Thus, I don't think anyone needs to read this.

Infectious Disease rater

This systematic review is methodologically appropriate, but based on case reports and case series and draws very tentative conclusions unlikely to influence clinical practice.