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Severe Coronavirus Infections in Pregnancy: A Systematic Review
Romeo R Galang1, Karen Chang, Penelope Strid
1Division of Reproductive Health and the Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, and the Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Insights
Pregnant women infected with MERS-CoV, SARS-CoV, or SARS-CoV-2 may experience severe illness and adverse pregnancy outcomes. This review of case reports highlights risks and informs early public health actions for COVID-19.
Area of Science:
- Infectious Diseases
- Maternal-Fetal Medicine
- Virology
Background:
- Severe coronavirus infections, including MERS-CoV, SARS-CoV, and SARS-CoV-2 (COVID-19), pose potential risks to pregnant women.
- Understanding the impact of these infections on maternal and neonatal outcomes is crucial for public health and clinical guidance.
Purpose of the Study:
- To systematically review case reports of MERS-CoV, SARS-CoV, and SARS-CoV-2 infections during pregnancy.
- To summarize the clinical presentation, illness course, and pregnancy/neonatal outcomes associated with these infections.
Main Methods:
- Systematic literature review of case reports from MEDLINE and ClinicalTrials.gov up to April 23, 2020.
- Inclusion of articles reporting case-level data on MERS-CoV, SARS-CoV, and SARS-CoV-2 in pregnant women.
- Abstraction of clinical presentation, illness course, maternal health, and pregnancy outcomes.
Main Results:
- Analysis of 46 publications detailing 12 MERS-CoV, 17 SARS-CoV, and 98 SARS-CoV-2 cases in pregnant women.
- Clinical presentation ranged from asymptomatic to severe fatal disease, similar to the general population.
- Reported adverse outcomes included severe maternal morbidity/mortality, pregnancy loss, preterm delivery, and evidence of vertical transmission.
Conclusions:
- Data from case reports, though limited, indicate that pregnant women with MERS-CoV, SARS-CoV, or SARS-CoV-2 may be at risk for adverse maternal and neonatal outcomes.
- Findings can inform early public health actions and clinical decision-making for COVID-19.
- Further systematic data collection is needed to better define the effects of these infections on pregnant women and neonates.
Objective:
To inform the current coronavirus disease 2019 (COVID-19) outbreak, we conducted a systematic literature review of case reports of Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, during pregnancy and summarized clinical presentation, course of illness, and pregnancy and neonatal outcomes.
Data Sources:
We searched MEDLINE and ClinicalTrials.gov from inception to April 23, 2020.
Methods Of Study Selection:
We included articles reporting case-level data on MERS-CoV, SARS-CoV, and SARS-CoV-2 infection in pregnant women. Course of illness, indicators of severe illness, maternal health outcomes, and pregnancy outcomes were abstracted from included articles.
Tabulation, Integration, And Results:
We identified 1,328 unique articles, and 1,253 articles were excluded by title and abstract review. We completed full-text review on 75, and 29 articles were excluded by full-text review. Among 46 publications reporting case-level data, eight described 12 cases of MERS-CoV infection, seven described 17 cases of SARS-CoV infection, and 31 described 98 cases of SARS-CoV-2 infection. Clinical presentation and course of illness ranged from asymptomatic to severe fatal disease, similar to the general population of patients. Severe morbidity and mortality among women with MERS-CoV, SARS-CoV, or SARS-CoV-2 infection in pregnancy and adverse pregnancy outcomes, including pregnancy loss, preterm delivery, and laboratory evidence of vertical transmission, were reported.
Conclusion:
Understanding whether pregnant women may be at risk for adverse maternal and neonatal outcomes from severe coronavirus infections is imperative. Data from case reports of SARS-CoV, MERS-CoV, and SAR-CoV-2 infections during pregnancy are limited, but they may guide early public health actions and clinical decision-making for COVID-19 until more rigorous and systematically collected data are available. The capture of critical data is needed to better define how this infection affects pregnant women and neonates. This review was not registered with PROSPERO.
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