COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Prognosis Gao YJ, Ye L, Zhang JS, et al. Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis. BMC Infect Dis. 2020 Aug 3;20(1):564. doi: 10.1186/s12879-020-05274-2.

BACKGROUND: The recent COVID-19 outbreak in Wuhan, China, has quickly spread throughout the world. In this study, we systematically reviewed the clinical features and outcomes of pregnant women with COVID-19.

METHODS: PubMed, Web of Science, EMBASE and MEDLINE were searched from January 1, 2020, to April 16, 2020. Case reports and case series of pregnant women infected with SARS-CoV-2 were included. Two reviewers screened 366 studies and 14 studies were included. Four reviewers independently extracted the features from the studies. We used a random-effects model to analyse the incidence (P) and 95% confidence interval (95% CI). Heterogeneity was assessed using the I2 statistic.

RESULTS: The meta-analysis included 236 pregnant women with COVID-19. The results were as follows: positive CT findings (71%; 95% CI, 0.49-0.93), caesarean section (65%; 95% CI, 0.42-0.87), fever (51%; 95% CI, 0.35-0.67), lymphopenia (49%; 95% CI, 0.29-0.70), coexisting disorders (33%; 95% CI, 0.21-0.44), cough (31%; 95% CI, 0.23-0.39), fetal distress (29%; 95% CI, 0.08-0.49), preterm labor (23%; 95% CI, 0.14-0.32), and severe case or death (12%; 95% CI, 0.03-0.20). The subgroup analysis showed that compared with non-pregnant patients, pregnant women with COVID-19 had significantly lower incidences of fever (pregnant women, 51%; non-pregnant patients, 91%; P < 0.00001) and cough (pregnant women, 31%; non-pregnant patients, 67%; P < 0.0001).

CONCLUSIONS: The incidences of fever, cough and positive CT findings in pregnant women with COVID-19 are less than those in the normal population with COVID-19, but the rate of preterm labor is higher among pregnant with COVID-19 than among normal pregnant women. There is currently no evidence that COVID-19 can spread through vertical transmission.

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

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

Torn on this one. Is this a possible finding that feveris a less useful marker of COVID in pregnant women? However, there are significant concerns about quality of evidence. The results are hard to interpret with any certainty. So it may be useful to flag to clinicians to be aware of this, but with significant caveats?

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

Testing all pregnant women in search of SARS-Cov-2 infection and screening with low-dose radiation CT Thorax Scan with protective measures for symptomatic or high-risk women with other coexisting disordes may be a diagnostic strategy for future obstetrics care and preparations for preterm delivery if there is confirmed because the higher incidence reported in this study 11% vs 23%. Interestingly, no extrapulmonary symptoms other than fever such as anosmia, dysgeusia, or diarrhea were reported in patients infected with SARS-Cov-2.

Pediatric Neonatology rater

As a neonatologist, I find this paper is not very interesting because most of indicators are related to characteristics of pregnant women, not newborn babies. Most neonatologists already know that there is currently no evidence that COVID-19 can spread through vertical transmission.

Pediatric Neonatology rater

As neonatologist, I find this article supports non-vertical transmission, but we still need more RCT to confirm these data. The article helps to formulate clinical treatment strategies for pregnant women with COVID-19.

Pediatric Neonatology rater

As a neonatologist, I find pregnancy outcome with COVID-19 is very important.