COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Prognosis Amaral WND, Moraes CL, Rodrigues APDS, et al. Maternal Coronavirus Infections and Neonates Born to Mothers with SARS-CoV-2: A Systematic Review. Healthcare (Basel). 2020 Nov 24;8(4). pii: healthcare8040511. doi: 10.3390/healthcare8040511.
Abstract

The coronavirus disease 2019 (COVID-19) pandemic is continuously affecting the lives of all people. Understanding the impact of COVID-19 on pregnancy in terms of morbidity, mortality, and perinatal maternal and fetal outcomes is essential to propose strategies for prevention and infection control. Here, we conducted a systematic review to investigate pregnant women infected with COVID-19 in terms of signs and symptoms, type of delivery, comorbidities, maternal and neonatal outcomes, and the possibility of vertical transmission. A search on Embase and PubMed databases was performed on 31 October 2020. Observational studies and case reports on pregnant women infected with COVID-19 were included without language restrictions. The 70 selected studies included a total of 1457 pregnant women diagnosed with COVID-19 in the first, second, and third trimesters of pregnancy. The most common signs and symptoms were fever, cough, and nausea. The most frequent comorbidities were obesity, hypertensive disorders, and gestational diabetes. Among maternal and fetal outcomes, premature birth (n = 64), maternal death (n = 15), intrauterine fetal death or neonatal death (n = 16), cases of intrauterine fetal distress (n = 28), miscarriage (n = 7), decreased fetal movements (n = 19), and severe neonatal asphyxia (n = 5) were the most frequent. Thirty-nine newborns tested positive for SARS-CoV-2. Additionally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected in the placenta (n = 13) and breast milk (n = 6). This review indicates that COVID-19 during pregnancy can result in maternal, fetal, and neonatal complications. In addition, SARS-CoV-2 viral exposure of neonates during pregnancy and delivery cannot be ruled out. Thus, we highlight the need for long-term follow-up of newborns from mothers diagnosed with COVID-19 to establish the full implications of SARS-CoV-2 infection in these children.

Ratings
Discipline / Specialty Area Score
Infectious Disease
Obstetrics
Pediatric Neonatology
Comments from MORE raters

Obstetrics rater

This is a review of 70 studies, many with small number of patients and of low quality. There is a total of 1457 pregnant women with Covid-19. Nevertheless, in the context of the current pandemic and rapidly changing information, it is useful; although, severe disease in women who are pregnant is fortunately rare. Most of the preterm births and a quite high number of cesarean sections likely occurred in the context of severe maternal disease and our iatrogenic. The admission to neonatal intensive care of some 18% of the infants is likely also related to the iatrogenic prematurity. There is good news that most of the newborns of these infected mothers were Covid-19 negative.

Obstetrics rater

Most studies included in these review had low levels of evidence quality, this underlines the need of further research in the field. It is, however, important to understand that there is an increased prevalence of premature birth, maternal death, premature rupture of the membrane, intrauterine fetal death, neonatal death, miscarriage, decreased fetal movements, and severe neonatal asphyxia among cases of infected mothers.