Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review

PLoS One. 2020 Jun 4;15(6):e0234187. doi: 10.1371/journal.pone.0234187. eCollection 2020.

Abstract

Background: COVID-19 has created an extraordinary global health crisis. However, with limited understanding of the effects of COVID-19 during pregnancy, clinicians and patients are forced to make uninformed decisions.

Objectives: To systematically evaluate the literature and report the maternal and neonatal outcomes associated with COVID-19.

Search strategy: PubMed, MEDLINE, and EMBASE were searched from November 1st, 2019 and March 28th, 2020.

Selection criteria: Primary studies, reported in English, investigating COVID-19-positive pregnant women and reporting their pregnancy and neonatal outcomes.

Data collection and analysis: Data in relation to clinical presentation, investigation were maternal and neonatal outcomes were extracted and analysed using summary statistics. Hypothesis testing was performed to examine differences in time-to-delivery. Study quality was assessed using the ICROMS tool.

Main results: Of 73 identified articles, nine were eligible for inclusion (n = 92). 67.4% (62/92) of women were symptomatic at presentation. RT-PCR was inferior to CT-based diagnosis in 31.7% (26/79) of cases. Maternal mortality rate was 0% and only one patient required intensive care and ventilation. 63.8% (30/47) had preterm births, 61.1% (11/18) fetal distress and 80% (40/50) a Caesarean section. 76.92% (11/13) of neonates required NICU admission and 42.8% (40/50) had a low birth weight. There was one indeterminate case of potential vertical transmission. Mean time-to-delivery was 4.3±3.08 days (n = 12) with no difference in outcomes (p>0.05).

Conclusions: COVID-19-positive pregnant women present with fewer symptoms than the general population and may be RT-PCR negative despite having signs of viral pneumonia. The incidence of preterm births, low birth weight, C-section, NICU admission appear higher than the general population.

Publication types

  • Systematic Review

MeSH terms

  • Betacoronavirus / isolation & purification
  • Betacoronavirus / physiology
  • Cesarean Section
  • Clinical Laboratory Techniques
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / pathology
  • Coronavirus Infections / transmission
  • Female
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / pathology
  • Pneumonia, Viral / transmission
  • Pregnancy
  • Pregnancy Complications, Infectious / virology*
  • Pregnancy Outcome
  • Premature Birth / virology

Supplementary concepts

  • COVID-19
  • COVID-19 diagnostic testing
  • severe acute respiratory syndrome coronavirus 2

Grant support

The authors received no specific funding for this work.