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Adverse outcomes among pregnant women with COVID-19 according to hospitalization status: A prospective individual participant data meta-analysis in Europe and North America

Adverse outcomes among pregnant women with COVID-19 according to hospitalization status: A prospective individual participant data meta-analysis in Europe and North America

Odette de Bruin ^1,2, Emeline Maisonneuve ^3,4,5, Eimir Hurley ⁶, Hedvig M E Nordeng ^6,7, Anick Bérard ^8,9, Odile Sheehy ^8,9, Padma Kaul ¹⁰, Mayura U Shinde ¹¹, Austin Cosgrove ¹², Jennifer G Lyons ¹¹, Elizabeth Messenger-Jones ¹², Maria E Kempner ¹², Sengwee Toh ¹¹, Wei Hua ¹³, José J Hernández-Muñoz ¹³, Leyla Sahin ¹⁴, Carolyn E Cesta ¹⁵, David Hägg ¹⁵, Rosa Gini ¹⁶, Olga Paoletti ¹⁶, Beatriz Poblador-Plou ^17,18, Sue Jordan ¹⁹, Clara L Rodríguez-Bernal ^18,20, Francisco Sánchez-Sáez ^18,20, Régis Lassalle ²¹, Marie-Agnès Bernard ²¹, Fariba Ahmadizar ¹, Guillaume Favre ⁵, Alice Panchaud ^3,5,22, Kitty W M Bloemenkamp ², Kelly Plueschke ²³, Corinne de Vries ²³, Satu J Siiskonen ²⁴, Miriam C J M Sturkenboom ¹,

Odette de Bruin ^1,2, Emeline Maisonneuve ^3,4,5, Eimir Hurley ⁶

¹Department of Data Science & Biostatistics, Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
²Division Woman and Baby, Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
³Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁴Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland.
⁵Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
⁶Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University Oslo (UiO), Oslo, Norway.
⁷Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
⁸Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
⁹Research Center, Center Hospitalier Universitaire (CHU) de Sainte-Justine, Montreal, Quebec, Canada.
¹⁰Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
¹¹Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
¹²Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
¹³Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA.
¹⁴Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA.
¹⁵Department of Medicine Solna, Center for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.
¹⁶Epidemiology Unit, Tuscan Regional Healthcare Agency, Florence, Italy.
¹⁷EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.
¹⁸Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases, Institute of Health Carlos III, Madrid, Spain.
¹⁹Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK.
²⁰Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain.
²¹Bordeaux PharmacoEpi, INSERM CIC-P1401, Université de Bordeaux, Bordeaux, France.
²²Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
²³European Medicines Agency, Amsterdam, The Netherlands.
²⁴Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.

⁰Department of Data Science & Biostatistics, Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.

International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics +

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December 15, 2025

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View abstract on PubMed

Summary

This summary is machine-generated.

COVID-19 hospitalization during pregnancy increases risks for adverse outcomes like cesarean birth, preterm birth, and low birth weight. Preventing severe illness in pregnant individuals is crucial for better maternal and infant health.

Area Of Science

Obstetrics and Gynecology
Infectious Diseases
Public Health

Background

Understanding COVID-19's impact on pregnancy is vital for clinical care.
Severity of COVID-19 influences pregnancy outcomes.

Purpose Of The Study

To assess COVID-19's effect on pregnancy outcomes.
To differentiate impacts between primary care and hospitalized pregnant patients.

Main Methods

Prospective meta-analysis following PRISMA-IPD and Cochrane guidelines.
Utilized secondary population-based data from 10 sources across seven countries.
Calculated risks stratified by trimester and hospitalization status, then pooled estimates.

Main Results

86,210 pregnant women with COVID-19 included; 4.4% hospitalized.
Non-hospitalized COVID-19 cases showed no increased adverse outcomes.
Hospitalization linked to higher risks of cesarean section, preterm birth, low birth weight, and stillbirth (third trimester).

Conclusions

Hospitalized COVID-19 cases correlate with adverse pregnancy outcomes.
Preventing severe COVID-19 illness in pregnancy is essential.
International collaboration is key for pregnancy data and future health crisis response.

Keywords:

COVID‐19 adverse outcomes hospitalization international collaboration meta‐analysis pregnancy

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