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Di Mascio D, Khalil A, Saccone G, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020 Mar 25:100107. doi: 10.1016/j.ajogmf.2020.100107. (Systematic review)
Abstract

Objective: The aim of this systematic review was to report pregnancy and perinatal outcomes of Coronavirus (CoV) spectrum infections, and particularly COVID-19 disease due to SARS-COV-2 infection during pregnancy.

Data sources: Medline, Embase, Cinahl and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for "coronavirus" or "severe acute respiratory syndrome" or "SARS" or "Middle East respiratory syndrome" or "MERS" or "COVID-19" and "pregnancy". The search and selection criteria were restricted to English language.

Study eligibility criteria: Inclusion criteria were pregnant women with a confirmed Coronavirus related illness, defined as either SARS, MERS or COVID-19.

Study appraisal and synthesis methods: We used meta-analyses of proportions to combine data and reported pooled proportions. The pregnancy outcomes observed included miscarriage, preterm birth, pre-eclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score < 7 at five minutes, neonatal asphyxia, admission to neonatal intensive care unit, perinatal death, and evidence of vertical transmission.

Results: 19 studies including 79 women were eligible for this systematic review: 41 pregnancies (51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An overt diagnosis of pneumonia was made in 91.8% and the most common symptoms were fever (82.6%), cough (57.1%) and dyspnea (27.0%). For all CoV infections, the rate of miscarriage was 39.1% (95% CI 20.2-59.8); the rate of preterm birth < 37 weeks was 24.3% (95% CI 12.5-38.6); premature prelabor rupture of membranes occurred in 20.7% (95% CI 9.5-34.9), preeclampsia in 16.2% (95% CI 4.2-34.1), and fetal growth restriction in 11.7% (95% CI 3.2-24.4); 84% were delivered by cesarean; the rate of perinatal death was 11.1% (95% CI 84.8-19.6) and 57.2% (95% CI 3.6-99.8) of newborns were admitted to the neonatal intensive care unit. When focusing on COVID-19, the most common adverse pregnancy outcome was preterm birth < 37 weeks, occurring in 41.1% (95% CI 25.6-57.6) of cases, while the rate of perinatal death was 7.0% (95% CI 1.4-16.3). None of the 41 newborns assessed showed clinical signs of vertical transmission.

Conclusion: In mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, PTB is the most common adverse pregnancy outcome. Miscarriage, preeclampsia, cesarean, and perinatal death (7-11%) were also more common than in the general population. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy.

Ratings
Discipline Area Score
FM/GP/Obstetrics 7 / 7
Pediatric Neonatology 7 / 7
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Infectious Disease 6 / 7
Obstetrics 6 / 7
Public Health 6 / 7
Comments from MORE raters

FM/GP/Obstetrics rater

Great systematic review of a topic that is highly relevant for health care personnel and for all pregnant women with concerns and questions about COVID-19.

FM/GP/Obstetrics rater

A hugely significant review with fascinating findings. This will need to be regularly updated, but well worth the read.

Pediatric Neonatology rater

This is a very useful resource that gathered and analyzed the available litreture.

Pediatric Neonatology rater

This review is based on inclusion of limited number of subjects and hence the information should be interpreted with caution.
Comments from EvidenceAlerts subscribers

Dr. Andrew Jensen (4/29/2020 2:21 PM)

I'm skeptical of meta-analyses that lump together patients with SARS, MERS, and COVID-19. We know that COVID-19 is dramatically different from SARS and MERS with respect to its case fatality rate and transmissability. It seems foolhardy to assume COVID-19 is the same with regard to obstetric outcomes. Alternatively, there is a pre-print, not-yet-peer-reviewed "systematic scoping review" of COVID-19 patients in pregnancy available at the URL below. This includes several times more patients than this review does, all of them with the disease currently on everyone's mind. Bear in mind, however, that the term "scoping" in the review's title appears to mean that the authors performed no critical appraisal of the quality of the included case reports and case series:
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.13182