COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Prognosis Turan O, Hakim A, Dashraath P, et al. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. Int J Gynaecol Obstet. 2020 Jul 24. doi: 10.1002/ijgo.13329.
Abstract

BACKGROUND: Pregnant women represent a potentially high-risk population in the COVID-19 pandemic.

OBJECTIVE: To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID-19.

SEARCH STRATEGY: Relevant databases were searched up until May 29, 2020.

SELECTION CRITERIA: Case series/reports of hospitalized pregnant women with laboratory-confirmed COVID-19.

DATA COLLECTION AND ANALYSIS: PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools.

MAIN RESULTS: Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory-confirmed SARS-CoV-2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D-dimer and interleukin-6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID-19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours.

CONCLUSIONS: Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D-dimer and interleukin-6 levels are predictive of poor pregnancy outcomes in COVID-19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Obstetrics
Pediatric Neonatology
Infectious Disease
Emergency Medicine
Respirology/Pulmonology
FM/GP/Obstetrics
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Comments from MORE raters

Emergency Medicine rater

This systemic review evaluated clinical characteristics and outcomes of pregnant women with confirmed COVID-19. It included 63 observational studies with 637 women, of which 76.5% experienced mild disease. Just over one third of live births were preterm, and over half of these were iatrogenic in women with mild COVID-19 and no complications. 2% of neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. Advanced age, obesity, diabetes, and elevated D-dimer and IL-6 were associated with poor outcomes. Although this is the first systematic review evaluating this population and outcomes in COVID-19, the retrospective observational nature of the included studies increase the risk for bias.

Emergency Medicine rater

This is a systematic review of maternal and neonatal outcomes of pregnant women with covid19. The search was fairly thorough and numerous studies were found; although, all were observational studies. As would have been expected, outcomes were better for patients with less severe COVID-19 symptoms. Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D-dimer and interleukin-6 levels are associated with poor outcomes. The results are more helpful in determining prognosis than in guiding treatment but can be used to reassure women with mild symptoms that their prognosis is usually good.

Emergency Medicine rater

Weak evidence based on case series, but "early" COVID-19 observational data nonetheless to inform evolving policies around the management of pregnancy when SARS-CoV-2 infection occurs.

Infectious Disease rater

Interesting, but probably outdated already because of: Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020 | MMWR - https://www.cdc.gov/mmwr/volumes/69/wr/mm6938e1.htm..... “Among 598 hospitalized pregnant women with COVID-19, 55% were asymptomatic at admission. Severe illness occurred among symptomatic pregnant women, including intensive care unit admissions (16%), mechanical ventilation (8%), and death (1%). Pregnancy losses occurred for 2% of pregnancies completed during COVID-19-associated hospitalizations and were experienced by both symptomatic and asymptomatic women.”

Internal Medicine rater

I don't follow the Ob literature.

Obstetrics rater

Another review on COVID in pregnancy. It is too early to determine the quality of these reports. Many of the initial case series were biased and do not reflect the current status of COVID in pregnancy.

Respirology/Pulmonology rater

Interesting review of observational studies that is of interest to patients who acquire COVID during pregnancy and for the physician who care for them.