Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review

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.