Consequences and implications of the coronavirus disease (COVID-19) on pregnancy and newborns: A comprehensive systematic review and meta-analysis

Abstract

Background: Pregnant patients are potentially vulnerable to COVID-19. Objectives: To clarify the clinical features of COVID-19 and analyze maternal/fetal morbidity and mortality and the obstetric and neonatal outcomes of pregnant patients. Search strategy: Embase, PubMed, Web of Science, CINAHAL, LILACS, Google Scholar, and Scopus. Selection criteria: Articles published from December 2019 to February 2021. Data collection and analysis: The reviewers extracted relevant data from the full-text. Data synthesis was performed using the R-4.1.0 Project for Statistical Computing for Windows. The meta-analysis of the included studies was carried out using the random-effects model (DerSimonian and Laird). Heterogeneity was measured using I2 analysis. Results: A total of 70 studies included 10 047 pregnant women with COVID-19, of whom 71.6% were in their third trimester. The most common symptoms were fever, cough, chest pain, dyspnea, and fatigue. Most newborns were delivered preterm (24%, 95% confidence interval [CI] 0.17–0.34, I2 = 93%) and via cesarean delivery (42%, 95% CI 0.38–0.47, I2 = 92%). There were 108 maternal mortalities (2%, 95% CI 0.01–0.03, I2 = 54%) and 50 abortions (5%, 95% CI 0.03–0.09, I2 = 73%). The neonatal outcomes included fetal distress (11%, 95% CI 0.06–0.19, I2 = 91%), birth weight (15%, 95% CI 0.10–0.21, I2 = 76%), APGAR <7 (19%, 95% CI 0.12–0.28, I2 = 43%), admission to the neonatal intensive care unit (28%, 95% CI 0.17–0.43, I2 = 90%), and fetal mortality (2%, 95% CI 0.01–0.03, I2 = 46%). Conclusion: There was no evidence of severe acute respiratory syndrome coronavirus-2 in the placenta, breast milk, umbilical cord, and amniotic fluid of pregnant patients. PROSPERO registration number: CRD42020181519.