Current best evidence for clinical care (more info)
OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several reports highlighted the risk of infection and disease in pregnant women and neonates. To assess the risk of clinical complications in pregnant women and neonates infected with SARS-CoV-2 carrying out a systematic review and meta-analysis of observational studies.
DATA SOURCES: Search of the scientific evidence was performed using the engines PubMed and Scopus, including articles published from December 2019 to 15 April 2020.
STUDY ELIGIBILITY CRITERIA: Only observational studies focused on the assessment of clinical outcomes associated with pregnancy in COVID-19 women were selected.
STUDY APPRAISAL AND SYNTHESIS METHODS: The first screening was based on the assessment of titles and abstracts, followed by the evaluation of full-texts. Qualitative variables were summarized with frequencies, whereas quantitative variables with central and variability indicators depending on their parametric distribution. Forest plots were used to describe point estimates and in-between studies variability. Study quality assessment was performed.
RESULTS: Thirteen studies were selected. All of them were carried out in China. The mean (SD) age and gestational age of pregnant women were 30.3 (1.5) years and 35.9 (2.9) weeks, respectively. The mean (SD) duration from the first symptoms to the hospital admission and to labour were 5.5 (2.0) and 9.5 (8.7) days, respectively. Patients mainly complained of fever and cough (pooled (95 % CI) proportions were 76.0 % (57.0 %-90.0 %) and 38.0 (28.0 %-47.0 %), respectively). Several antibiotics, antivirals, and corticosteroids were prescribed in different combinations. The pooled prevalence of maternal complications and of caesarean section were 45.0 % (95 % CI: 24.0 %-67.0 %) and 88.0 % (95 %CI: 82.0 %-94.0 %). A proportion of pregnant women less than 20 % were admitted to ICU. The pooled proportion of preterm infants was 23.0 % (95 %CI: 11.0 %-39.0 %). The most frequent neonatal complications were pneumonia and respiratory distress syndrome. The pooled percentage of infected neonates was 6.0 % (95 %CI: 2.0 %-12.0 %).
CONCLUSIONS: The present study suggests a high rate of maternal and neonatal complications in infected individuals. However, the current scientific evidence highlights a low risk of neonatal infection. Multicentre, cohort studies are needed to better elucidate the role of SARS-CoV-2 during pregnancy.
| Discipline / Specialty Area | Score |
|---|---|
| Infectious Disease | |
| Obstetrics | |
| Pediatric Neonatology | |
| Family Medicine (FM)/General Practice (GP) | |
As we research further the effects of SARS-CoV-2 in pregnant women, I find interesting the lack of confirmed diagnosis with RT-PCR in Nasopharyngeal swabs, serology IgM or IgG in these observational studies, or the previous health status of this women. It could be due to the time when they were studied. However, as it's more information regarding the amount of viral load affecting the severity of the disease COVID-19, this data could help establish strategies in public health policies and algorithms to treat the complications observed.
Althogh this is a very useful report, the biological behaviour of the SARS-CoV-2 and its pathogenesis seems to vary from one population to another. This metaanalysis only included studies done in China. A follow-up systemic review that includes reports from other countries should have greater generalizability.