The Differences in Clinical Presentation, Management, and Prognosis of Laboratory-Confirmed COVID-19 between Pregnant and Non-Pregnant Women: A Systematic Review and Meta-Analysis

Int J Environ Res Public Health. 2021 May 24;18(11):5613. doi: 10.3390/ijerph18115613.


Background: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people across the globe. Previous coronavirus outbreaks led to worsened symptoms amongst pregnant women, suggesting that pregnant women are at greater risk.

Objectives: Our aim is to investigate the differences in clinical presentation, management, and prognosis of COVID-19 infection in pregnant and non-pregnant women.

Methods: We ran a search on electronic databases and analysis of the relevant articles was done using Revie Manager 5.4.

Results: The review consists of nine studies comprising 591,058 women (28,797 pregnant and 562,261 non-pregnant), with most of the data derived from two large studies. The risk of experiencing fever (RR: 0.74; 95% CI: 0.64-0.85), headache (RR: 0.77; 95% CI: 0.74-0.79), myalgia (RR: 0.92; 95% CI: 0.89-0.95), diarrhea (RR: 0.40, 95% CI: 0.39-0.43), chest tightness (RR: 0.86; 95% CI: 0.77-0.95), and expectoration (RR: 0.45; 95% CI: 0.21-0.97) were greater amongst non-pregnant COVID-19-infected women. Pregnant women with COVID-19 were less likely to be obese (RR: 0.68; 95% CI: 0.63-0.73) or have a smoking history (RR: 0.32; 95% CI: 0.26-0.39). COVID-19-infected non-pregnant women had a higher frequency of comorbidity such as chronic cardiac disease (RR: 0.58; 95% CI: 0.44-0.77), renal disease (RR: 0.45; 95% CI: 0.29-0.71), and malignancy (RR: 0.82; 95% CI: 0.68-0.98), compared to COVID-19-infected pregnant women. The risk of ICU admission (RR: 2.26; 95% CI: 1.68-3.05) and requirement of invasive mechanical ventilation (RR: 2.68; 95% CI: 2.07-3.47) were significantly higher amongst pregnant women.

Conclusions: Although the frequency of risk factors and the risk of experiencing clinical symptoms of COVID-19 were higher among non-pregnant women, COVID-19-infected pregnant women had a higher requirement of ICU admission and invasive mechanical ventilation compared to non-pregnant COVID-19-infected women. More well-conducted studies from varying contexts are needed to draw conclusions. Prospero registration: CRD42020204638.

Keywords: COVID-19; SARS-CoV-2; child-bearing age women; coronavirus 2; non-pregnant adults; pregnant.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • COVID-19*
  • Female
  • Humans
  • Laboratories*
  • Pandemics
  • Pregnancy
  • Pregnant Women
  • SARS-CoV-2