COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Prognosis Ashraf MA, Keshavarz P, Hosseinpour P, et al. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Pregnancy and the Possibility of Vertical Transmission. J Reprod Infertil. 2020 Jul-Sep;21(3):157-168.
Abstract

Background: There is a growing need for information regarding maternal and neonatal outcomes during coronavirus pandemic. In this study, a comprehensive investigation was done regarding the possibility of vertical transmission using the available data in the literature.

Methods: A systematic search was conducted using electronic databases, including PubMed, Scopus, Web of Science, Embase, and Scholar. All studies containing infected COVID-19 pregnant women who had given birth were included, and the search was done up to April 14, 2020.

Results: Overall, 21 articles were reviewed, and clinical characteristics of 90 pregnant patients and 92 neonates born to mothers infected with COVID-19 were reviewed. The most common symptoms included fever, cough, and dyspnea. The main laboratory findings included leukocytosis, lymphopenia, thrombocytopenia, and elevated C-reactive protein. The most commonly reported complications were preterm labor and fetal distress. Three mothers were admitted to ICU and required mechanical ventilation; among them, one died, and one was on extracorporeal membrane oxygenation. Overall, 86 neonates were tested for the possibility of vertical transmission and 82 cases were negative in RT-PCR, while 4 were positive. Out of 92 neonates, one died, and one was born dead. Nineteen patients reported having no symptoms, while breathing problems and pneumonia were reported as the most common neonatal complications.

Conclusion: There were no differences in the clinical characteristics of pregnant women and non-pregnant COVID-19 patients. COVID-19 infection has caused higher incidence of fetal distress and premature labor in pregnant women. Although the possibility of vertical transmission in infected pregnant women is rare, four neonates' test results for COVID-19 infection were positive in this review.

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

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

Emerging information about COVID and pregnancy but without any prevalence/incidence data, the use is limited. In women who do get COVID in pregnancy, the morbidity and mortality in mother, and to a lesser extent baby, would appear high but no comparative data are presented. The review collected studies published by early April, so this will data will be very incomplete and may change as more series are reported.

FM/GP/Obstetrics rater

This is a systematic review summarizing recent literature regarding COVID-19 and pregnancy. The review is well written, probably most maternal medicine specialists already know the details or have read a similar review.

Infectious Disease rater

Another systematic review on the COVID-19 topic without a meta-analysis.

Obstetrics rater

Most obstetric practitioners are already aware of the information reported by this already outdated systematic review.

Obstetrics rater

This article is based on less than 100 cases worldwide. The tables in this article are not explained in full. For example, it remains unknown how many newborns were born premature. There are a few typographical and gramatic errors in the article that gives it the appearance that it was put together hastily and published without thorough editorial review.

Obstetrics rater

As more information is rapidly emerging about the risk for maternal-to-fetal transmission of SARS-CoV-2 infection, it is too early to jump to definite conclusions with evidence of vertical transmission from mother to child based in a systematic review of a few selected cases. This is especially true because COVID-19 infection is based on isolation of the virus from the nasopharynx or oropharynx rather than isolation of the virus from blood. Otherwise, a fetal cord blood or neonatal blood sample would be the most reliable method of detecting intrauterine infection because a positive nasopharynx or oropharynx swab from the neonate may indicate colonisation of the neonatal upper airway during childbirth but not necessarily an active viral infection.

Pediatric Neonatology rater

I think most neonatologists know there *may* be vertical transmission. This is a nice collation of the available studies, but it doesn't result in new information, in my opinion. It reaffirms current knowledge about COVID-19 and possible vertical transmission.