Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis
Journal
BMJ Global Health
ISSN
2059-7908
Date Issued
2023
Author(s)
Emily R Smith
Erin Oakley
Gargi Wable Grandner
Kacey Ferguson
Fouzia Farooq
Yalda Afshar
Mia Ahlberg
Homa Ahmadzia
Victor Akelo
Grace Aldrovandi
Beth A Tippett Barr
Elisa Bevilacqua
Justin S Brandt
Nathalie Broutet
Irene Fernández Buhigas
CarrilloTermini, Jorge
Rebecca Clifton
Jeanne Conry
Erich Cosmi
Fatima Crispi
Francesca Crovetto
Camille Delgado-López
Hema Divakar
Amanda J Driscoll
Guillaume Favre
Valerie J Flaherman
Chris Gale
Maria M Gil
Sami L Gottlieb
Eduard Gratacós
Olivia Hernandez
Stephanie Jones
Erkan Kalafat
Sammy Khagayi
Marian Knight
Karen Kotloff
Antonio Lanzone
Kirsty Le Doare
Christoph Lees
Ethan Litman
Erica M Lokken
Valentina Laurita Longo
Shabir A Madhi
Laura A Magee
Raigam Jafet Martinez-Portilla
Elizabeth M McClure
Tori D Metz
Emily S Miller
Deborah Money
Sakita Moungmaithong
Edward Mullins
Jean B Nachega
Marta C Nunes
Dickens Onyango
Alice Panchaud
Liona C Poon
Daniel Raiten
Lesley Regan
Gordon Rukundo
Daljit Sahota
Allie Sakowicz
Jose Sanin-Blair
Jonas Söderling
Olof Stephansson
Marleen Temmerman
Anna Thorson
Jorge E Tolosa
Julia Townson
Miguel Valencia-Prado
Silvia Visentin
Peter von Dadelszen
Kristina Adams Waldorf
Clare Whitehead
Murat Yassa
Jim M Tielsch
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Introduction</jats:title><jats:p>Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.</jats:p><jats:p>Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).</jats:p><jats:p>Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.</jats:p></jats:sec>
Subjects
covid-19
;
epidemiology
;
maternal health
;
adverse outcome
;
article
;
artificial ventilation
;
body mass
;
cesarean section
;
cohort analysis
;
comparative study
;
coronavirus disease 2019
;
eclampsia
;
female
;
fetus outcome
;
first trimester pregnancy
;
gestational age
;
human
;
immunoassay
;
intensive care
;
live birth
;
low birth weight
;
major clinical study
;
maternal morbidity
;
maternal mortality
;
meta analysis
;
mortality risk
;
newborn
;
newborn morbidity
;
newborn mortality
;
newcastle-ottawa scale
;
obesity
;
preeclampsia
;
pregnancy outcome
;
pregnant woman
;
premature labor
;
prospective study
;
risk assessment
;
secondary analysis
;
stillbirth
;
study
;
thromboembolism
;
very low birth weight