Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis

Jafari, M. and Pormohammad, A. and Sheikh Neshin, S.A. and Ghorbani, S. and Bose, D. and Alimohammadi, S. and Basirjafari, S. and Mohammadi, M. and Rasmussen-Ivey, C. and Razizadeh, M.H. and Nouri-Vaskeh, M. and Zarei, M. (2021) Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Reviews in Medical Virology.

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Abstract

In a large-scale study, 128176 non-pregnant patients (228 studies) and 10000 pregnant patients (121 studies) confirmed COVID-19 cases included in this Meta-Analysis. The mean (confidence interval CI) of age and gestational age of admission (GA) in pregnant women was 33 (28�37) years old and 36 (34�37) weeks, respectively. Pregnant women show the same manifestations of COVID-19 as non-pregnant adult patients. Fever (pregnant: 75.5%; non-pregnant: 74%) and cough (pregnant: 48.5%; non-pregnant: 53.5%) are the most common symptoms in both groups followed by myalgia (26.5%) and chill (25%) in pregnant and dysgeusia (27%) and fatigue (26.5%) in non-pregnant patients. Pregnant women are less probable to show cough (odds ratio OR 0.7; 95% CI 0.67�0.75), fatigue (OR: 0.58; CI: 0.54�0.61), sore throat (OR: 0.66; CI: 0.61�0.7), headache (OR: 0.55; CI: 0.55�0.58) and diarrhea (OR: 0.46; CI: 0.4�0.51) than non-pregnant adult patients. The most common imaging found in pregnant women is ground-glass opacity (57%) and in non-pregnant patients is consolidation (76%). Pregnant women have higher proportion of leukocytosis (27% vs. 14%), thrombocytopenia (18% vs. 12.5%) and have lower proportion of raised C-reactive protein (52% vs. 81%) compared with non-pregnant patients. Leucopenia and lymphopenia are almost the same in both groups. The most common comorbidity in pregnant patients is diabetes (18%) and in non-pregnant patients is hypertension (21%). Case fatality rate (CFR) of non-pregnant hospitalized patients is 6.4% (4.4�8.5), and mortality due to all-cause for pregnant patients is 11.3% (9.6�13.3). Regarding the complications of pregnancy, postpartum hemorrhage (54.5% 7�94), caesarean delivery (48% 42�54), preterm labor (25% 4�74) and preterm birth (21% 12�34) are in turn the most prevalent complications. Comparing the pregnancy outcomes show that caesarean delivery (OR: 3; CI: 2�5), low birth weight (LBW) (OR: 9; CI: 2.4�30) and preterm birth (OR: 2.5; CI: 1.5�3.5) are more probable in pregnant woman with COVID-19 than pregnant women without COVID-19. The most prevalent neonatal complications are neonatal intensive care unit admission (43% 2�96), fetal distress (30% 12�58) and LBW (25% 16�37). The rate of vertical transmission is 5.3% (1.3�16), and the rate of positive SARS-CoV-2 test for neonates born to mothers with COVID-19 is 8% (4�16). Overall, pregnant patients present with the similar clinical characteristics of COVID-19 when compared with the general population, but they may be more asymptomatic. Higher odds of caesarean delivery, LBW and preterm birth among pregnant patients with COVID-19 suggest a possible association between COVID-19 infection and pregnancy complications. Low risk of vertical transmission is present, and SARS-CoV-2 can be detected in all conception products, particularly placenta and breast milk. Interpretations of these results should be done cautiously due to the heterogeneity between studies; however, we believe our findings can guide the prenatal and postnatal considerations for COVID-19 pregnant patients. © 2020 John Wiley & Sons Ltd.

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