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Coronavirus disease 2019 during pregnancy: a systematic review of reported cases
Anna Nunzia Della Gatta1, Roberta Rizzo1, Gianluigi Pilu1
1Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
Insights
This systematic review found that while outcomes for pregnant women with COVID-19 are generally good, the high rate of cesarean deliveries, often preterm, is concerning. Further research is needed to understand the necessity of these interventions.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Public Health
Background:
- The coronavirus disease 2019 (COVID-19) pandemic has raised concerns regarding its impact on pregnant individuals and neonates.
- Understanding the clinical outcomes in this vulnerable population is crucial for guiding clinical practice and public health recommendations.
Purpose of the Study:
- To systematically review and synthesize the reported clinical outcomes for pregnant patients diagnosed with COVID-19.
- To evaluate the maternal and neonatal outcomes associated with COVID-19 in pregnancy.
Main Methods:
- A systematic literature search was conducted across PubMed, CINAHL, and Scopus databases.
- Studies involving pregnant women with a confirmed COVID-19 diagnosis (via nucleic acid test) were included, with no language restrictions.
- Included studies reported pregnancy and delivery outcomes. Methodological quality was assessed using the Murad et al. tool for case reports and series.
Main Results:
- Six studies comprising 51 pregnant women were included in the review.
- Of the 48 women who delivered, 46 underwent cesarean delivery, and 2 had vaginal births.
- One stillbirth and one neonatal death were reported among the included cases.
Conclusions:
- While vertical transmission of SARS-CoV-2 appears to be excluded and maternal/neonatal outcomes are generally favorable, a high incidence of preterm delivery via cesarean section is noted.
- The frequent use of cesarean delivery warrants further investigation regarding its necessity and indications in pregnant patients with COVID-19.
- COVID-19 in late pregnancy presents a complex clinical challenge, particularly concerning respiratory insufficiency.
Objective:
This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019.
Data Sources:
The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as "Coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy." There was no restriction of language to allow collection of as many cases as possible.
Study Eligibility Criteria:
All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included.
Study Appraisal And Synthesis Methods:
All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al.
Results:
Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported.
Conclusion:
Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.
