A Meta-Analysis for Prevalence of Cesarean Section, Preterm Birth, Stillbirth, and Low Birth Weight Deliveries in Infected Pregnant Women with COVID-19

Document Type : Systematic Review

Authors

1 Department of Obstetrics and Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran

3 Department of Pathology, Medical College of Georgia, Augusta, GA, USA

4 Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

5 Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

6 Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

7 Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

8 Department of Medical Laboratory Sciences, School of Paramedical Science, Shiraz University of Medical Sciences, Shiraz, Iran

9 Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

10 Department of Medical Genetics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Background: The aim of this meta-analysis was to estimate the prevalence of cesarean section (CS), preterm birth, stillbirth, and low birth weight deliveries (LBWD) in pregnant women with SARS-COV-2 infection.
Methods: All relevant studies were searched up to 30 February 2021.
Results: A total of 47 studies with 5970 infected pregnant women were included. There were 1010 CS, 55 stillbirths, 524 preterm birth, and 82 with LBWD. Pooled data showed that the prevalence of CS, preterm birth, stillbirth, and LBWD among women with SARS-COV-2 infection was 29.6% (95% CI 0.081-0.160), 2.1% (95% CI 0.081-0.160), 11.5% (95%
CI 0.081-0.160), and 2.1% (95% CI 0.081-0.160), respectively. Stratified analysis revealed that these pregnancy outcomes among Asian women were higher than Caucasians.
Conclusion: Our combined data revealed that the CS prevalence (29.6%) was the highest followed by preterm birth (11.5%), stillbirth (2.1%), and LBWD (2.1%) among women with COVID-19.

Keywords

References

  1. Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: Maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med 2020; 144(7): 799-805.
  2. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis 2020; 20(5): 559-64.
  3. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9(1): 51-60.
  4. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395(10226): 809-15.
  5. Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province. Zhonghua Fu Chan Ke Za Zhi 2020; 55(3): 166-71. [In Chinese].
  6. Antikchi MH, Neamatzadeh H, Ghelmani Y, Jafari-Nedooshan J, Dastgheib SA, Kargar S, et al. The risk and prevalence of COVID-19 infection in colorectal cancer patients: a systematic review and meta-analysis. J Gastrointest Cancer 2020; 52(1): 73-9.
  7. Schwartz DA. The effects of pregnancy on women with COVID-19: maternal and infant outcomes. Clin Infect Dis 2020; 71(16): 2042-4.
  8. Schwartz DA, Graham AL. Potential maternal and infant outcomes from coronavirus 2019-NCOV (SARS-CoV-2) infecting pregnant women: Lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020; 12(2): 194.
  9. Schwartz DA, Dhaliwal A. Infections in pregnancy with Covid-19 and other respiratory RNA virus diseases are rarely, if ever, transmitted to the fetus: Experiences with coronaviruses, parainfluenza, metapneumovirus respiratory syncytial virus, and influenza. Arch Pathol Lab Med 2020; 144: 920-8.
  10. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: What obstetricians need to know. Am J Obstet Gynecol 2020; 222(5): 415-26.
  11. Galang RR, Chang K, Strid P, Snead MC, Woodworth KR, House LD, et al. Severe coronavirus infections in pregnancy: A systematic review. Obstet Gynecol 2020; 136(2): 262-72.
  12. Takemoto MLS, Menezes MO, Andreucci CB, Knobel R, Sousa LAR, Katz L, et al. Maternal mortality and COVID-19. J Matern Fetal Neonatal Med 2020: 1-7.
  13. Juusela A, Nazir M, Gimovsky M. Two cases of coronavirus 2019-related cardiomyopathy in pregnancy. Am J Obstet Gynecol MFM 2020; 2(2): 100113.
  14. Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status. MMWR Morb Mortal Wkly Rep 2020; 69(25): 769-75.
  15. Zimmermann P, Curtis N. COVID-19 in children, pregnancy and neonates: A review of epidemiologic and clinical features. Pediatr Infect Dis J 2020; 39(6): 469-77.
  16. Schwartz DA, Mohagheghi P, Beigi B, Zafaranloo N, Moshfegh F, Yazdani A. Spectrum of neonatal COVID-19 in Iran: 19 infants with SARS-CoV-2 perinatal infections with varying test results, clinical findings and outcomes. J Matern Fetal Neonatal Med 2020:1-10.
  17. Dhir SK, Kumar J, Meena J, Kumar P. Clinical features and outcome of SARS-CoV-2 infection in neonates: A systematic review. J Trop Pediatr 2020; 67(3): fmaa059.
  18. Schwartz DA, Morotti D, Beigi B, Moshfegh F, Zafaranloo N, Patanè L. Confirming vertical fetal infection with COVID-19: Neonatal and pathology criteria for early onset and transplacental transmission of SARS-CoV-2 from infected pregnant mothers. Arch Pathol Lab Med 2020; 144(12): 1451-6.
  19. Patanè L, Morotti D, Giunta MR, Sigismondi C, Piccoli MG, Frigerio L, et al. Vertical transmission of coronavirus disease 2019: severe acute respiratory syndrome coronavirus 2 RNA on the fetal side of the placenta in pregnancies with coronavirus disease 2019-positive mothers and neonates at birth. Am J Obstet Gynecol MFM 2020; 2(3): 100145.
  20. Schwartz DA, Thomas KM. Characterizing COVID-19 maternal-fetal transmission and placental infection using comprehensive molecular pathology. EBioMedicine 2020; 60: 102983.
  21. Schwartz DA, Morotti D. Placental pathology of COVID-19 with and without fetal and neonatal infection: Trophoblast necrosis and chronic histiocytic intervillositis as risk factors for transplacental transmission of SARS-CoV-2. Viruses 2020; 12(11): 1308.
  22. Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: A review. Fetal Pediatr Pathol 2020; 39(3): 246-50.
  23. Bahrami R, Dastgheib SA, Niktabar SM, Amooee A, Lookzadeh MH, Mirjalili SR, et al. Association of BMP4 rs17563 polymorphism with nonsyndromic cleft lip with or without cleft palate risk: Literature review and comprehensive meta-analysis. Fetal Pediatr Pathol 2020; 40(4): 305-19.
  24. Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol 2020; 92(9): 1556-61.
  25. Wu X, Sun R, Chen J, Xie Y, Zhang S, Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. Int J Gynaecol Obstet 2020; 150(1): 58-63.
  26. Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: A preliminary analysis. AJR Am J Roentgenol 2020; 215(1): 127-32.
  27. Liu Y, Chen H, Tang K, Guo Y. Withdrawn: Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020; S0163-4453(20)30109-2.
  28. Liu W, Wang J, Li W, Zhou Z, Liu S, Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med 2020; 14(2): 193-8.
  29. Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; 174(7): 722-5.
  30. Khan S, Jun L, Nawsherwan, Siddique R, Li Y, Han G, et al. Association of COVID-19 with pregnancy outcomes in health-care workers and general women. Clin Microbiol Infect 2020; 26(6): 788-90.
  31. Li N, Han L, Peng M, Lv Y, Ouyang Y, Liu K, et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020; 71(16): 2035-41.
  32. Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150(1): 53-7.
  33. Wu C, Yang W, Wu X, Zhang T, Zhao Y, Ren W, et al. Clinical manifestation and laboratory characteristics of SARS-CoV-2 infection in pregnant women. Virologica Sinica 2020; 35(3): 305-10.
  34. Zeng Y, Lin L, Yan Q, Wei W, Yang BX, Huang R, et al. Update on clinical outcomes of women with COVID‐19 during pregnancy. Int J Gynaecol Obstet 2020; 150(2): 264-6.
  35. Mahajan NN, Ansari M, Gaikwad C, Jadhav P, Tirkey D, Pophalkar MP, et al. Impact of SARS-CoV-2 on multiple gestation pregnancy. Int J Gynaecol Obstet 2020; 152(2): 220-5.
  36. Nayak AH, Kapote DS, Fonseca M, Chavan N, Mayekar R, Sarmalkar M, et al. Impact of the coronavirus infection in pregnancy: A preliminary study of 141 patients. J Obstet Gynaecol India 2020; 70(4): 256-61.
  37. Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, Arian SE, et al. Maternal death due to COVID-19. Am J Obstet Gynecol 2020; 223(1): 109. e1-109. e16.
  38. Jenabi E, Bashirian S, Khazaei S, Masoumi SZ, Ghelichkhani S, Goodarzi F, et al. Pregnancy outcomes among symptomatic and asymptomatic women infected with COVID-19 in the west of Iran: a case-control study. J Matern Fetal Neonatal Med 2020: 1-3.
  39. Ayed A, Embaireeg A, Benawadh A, Al-Fouzan W, Hammoud M, Al-Hathal M, et al. Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait. BMC Pregnancy Childbirth 2020; 20(1): 754.
  40. Sahin D, Tanacan A, Erol SA, Anuk AT, Yetiskin FDY, Keskin HL, et al. Updated experience of a tertiary pandemic center on 533 pregnant women with COVID‐19 infection: A prospective cohort study from Turkey. Int J Gynaecol Obstet 2020; 152(3): 328-34.
  41. Egerup P, Olsen LF, Christiansen A-M, Hellerung, Westergaard D, Severinsen ER, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies at delivery in women, partners, and newborns. Obstet Gynecol 2021; 137(1): 49-55.
  42. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG 2020: 127(9): 1116-21.
  43. Savasi VM, Parisi F, Patanè L, Ferrazzi E, Frigerio L, Pellegrino A, et al. Clinical findings and disease severity in hospitalized pregnant women with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2020; 136(2): 252-8.
  44. Govind A, Essien S, Karthikeyan A, Fakokunde A, Janga D, Yoong W, et al. Re: Novel coronavirus COVID-19 in late pregnancy: Outcomes of first nine cases in an inner city London hospital. Eur J Obstet Gynecol Reprod Biol 2020; 251: 272-4.
  45. Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107.
  46. Pereira A, Cruz-Melguizo S, Adrien M, Fuentes L, Marin E, Perez-Medina T. Clinical course of coronavirus disease-2019 in pregnancy. Acta Obstet Gynecol Scand 2020; 99(7): 839-47.
  47. Martínez-Perez O, Vouga M, Melguizo SC, Acebal LF, Panchaud A, Muñoz-Chápuli M, et al. Association between mode of delivery among pregnant women with COVID-19 and maternal and neonatal outcomes in Spain. JAMA 2020; 324(3): 296-9.
  48. Update registratie COVID-19 positieve zwangeren in NethOSS. [Online]. [cited 13 Oct 2021]; Avilable from: URL: https://www.nvog.nl/actueel/registratie-van-covid-19-positieve-zwangeren-in-nethoss
  49. Sentilhes L, De Marcillac F, Jouffrieau C, Kuhn P, Thuet V, Hansmann Y, et al. Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth. Am J Obstet Gynecol 2020; 223(6): 914. e1-914. e15.
  50. Kayem G, Lecarpentier E, Deruelle P, Bretelle F, Azria E, Blanc J, et al. A snapshot of the Covid-19 pandemic among pregnant women in France. J Gynecol Obstet Hum Reprod 2020; 49(7): 101826.
  51. Hcini N, Maamri F, Picone O, Carod J-F, Lambert V, Mathieu M, et al. Maternal, fetal and neonatal outcomes of large series of SARS-CoV-2 positive pregnancies in peripartum period: a single-center prospective comparative study. Eur J Obstet Gynecol Reprod Biol 2020; 257: 11-8.
  52. Tsatsaris V, Mariaggi A-A, Launay O, Couffignal C, Rousseau J, Ancel PY, et al. SARS-COV-2 IgG antibody response in pregnant women at delivery. J Gynecol Obstet Hum Reprod 2020; 50(7): 102041.
  53. Blitz MJ, Rochelson B, Minkoff H, Meirowitz
    N, Prasannan L, London V, et al. Maternal mortality among women with coronavirus disease 2019 admitted to the intensive care unit. Am J Obstet Gynecol; 223(4): 595-599.e5.
  54. London V, McLaren R, Atallah F, Cepeda C, McCalla S, Fisher N, et al. The relationship between status at presentation and outcomes among pregnant women with COVID-19. Am J Perinatol 2020; 37(10): 991-4.
  55. Lokken EM, Walker CL, Delaney S, Kachikis A, Kretzer NM, Erickson A, et al. Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol 2020; 223(6): 911.e1-911.e14.
  56. Qadri Q, Rasool R, Afroze D, Naqash S, Gulzar GM, Yousuf A, et al. Study of TLR4 and IL-8 gene polymorphisms in H.pylori-induced inflammation in gastric cancer in an ethnic kashmiri population. Immunological Investigations 2014; 43(4): 324-36.
  57. Andrikopoulou M, Madden N, Wen T, Aubey JJ, Aziz A, Baptiste CD, et al. Symptoms and critical illness among obstetric patients with coronavirus disease 2019 (COVID-19) infection. Obstet Gynecol 2020; 136(2): 291-9.
  58. [58]      Pierce-Williams RAM, Burd J, Felder L, Khoury R, Bernstein PS, Avila K, et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM 2020; 2(3): 100134.
  59. Malhotra Y, Miller R, Bajaj K, Sloma A, Wieland D, Wilcox W. No change in cesarean section rate during COVID-19 pandemic in New York City. Eur J Obstet Gynecol Reprod Biol 2020; 253: 328-9.
  60. Prabhu M, Cagino K, Matthews K, Friedlander R, Glynn S, Kubiak J, et al. Pregnancy and postpartum outcomes in a universally tested population for SARS‐CoV‐2 in New York City: a prospective cohort study. BJOG 2020; 127(12): 1548-56.
  61. Ahlberg M, Neovius M, Saltvedt S, Söderling J, Pettersson K, Brandkvist C, et al. Association of SARS-CoV-2 test status and pregnancy outcomes. JAMA 2020; 324(17): 1782-5.
  62. Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2(2): 100118.
  63. Delahoy MJ, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and maternal and birth outcomes of hospitalized pregnant women with laboratory-confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morb Mortal Wkly Rep 2020; 69(38): 1347-54.
  64. Adhikari EH, Moreno W, Zofkie AC, MacDonald L, McIntire DD, Collins RRJ, et al. Pregnancy outcomes among women with and without severe acute respiratory syndrome coronavirus 2 infection. JAMA Netw Open 2020; 3(11): e2029256.
  65. Bauer ME, Bernstein K, Dinges E, Delgado C, El-Sharawi N, Sultan P, et al. Obstetric anesthesia during the COVID-19 pandemic. Anesth Analg 2020; 131(1): 7-15.
  66. Chen D, Yang H, Cao Y, Cheng W, Duan T, Fan C, et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet 2020; 149(2): 130-6.
  67. Dixon T, Bhatia K, Columb M. The SARS-CoV-2 effect: an opportunity to reduce general anaesthesia rates for Caesarean section? Br J Anaesth 2020; 125(3): e324-6.
  68. Khalil A, Kalafat E, Benlioglu C, O’Brien P, Morris E, Draycott T, et al. SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes. EClinicalMedicine 2020; 25: 100446.
  69. Gao YJ, Ye L, Zhang JS, Yin YX, Liu M, Yu HB, et al. Clinical features and outcomes of pregnant women with COVID-19: A systematic review and meta-analysis. BMC Infectious Diseases 2020; 20(1): 564.
  70. Capobianco G, Saderi L, Aliberti S, Mondoni M, Piana A, Dessole F, et al. COVID-19 in pregnant women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252: 543-58.
  71. Dubey P, Reddy SY, Manuel S, Dwivedi AK. Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252: 490-501.
  72. Narang K, Enninga EAL, Gunaratne MDSK, Ibirogba ER, Trad ATA, Elrefaei A, et al. SARS-CoV-2 infection and COVID-19 during pregnancy: A multidisciplinary review. Mayo Clin Proc 2020; 95(8): 1750-65.
  73. Khalil A, von Dadelszen P, Draycott T, Ugwumadu A, O’Brien P, Magee L. Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic. JAMA 2020; 324(7): 705-6.
  74. Vogel JP, Chawanpaiboon S, Moller AB, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol 2018; 52: 3-12.
  75. Vakilian K, Ranjbaran M, Khorsandi M, Sharafkhani N, Khodadost M. Prevalence of preterm labor in Iran: A systematic review and meta-analysis. Int J Reprod Biomed 2015; 13(12): 743-8.
  76. Muchie KF, Lakew AM, Teshome DF, Yenit MK, Sisay MM, Mekonnen FA, et al. Epidemiology of preterm birth in Ethiopia: Systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20(1): 574.
  77. Yang R, Mei H, Zheng T, Fu Q, Zhang Y, Buka S, et al. Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: a population-based cohort study in Wuhan, China. BMC Med 2020; 18(1): 330.
  78. World Health Organization. One stillbirth occurs every 16 seconds, according to first ever joint UN estimates. [Online]. [cited 08 Oct 2020]; Avilable from: URL: https://www.who.int/news/item/08-10-2020-one-stillbirth-occurs-every-16-seconds-according-to-first-ever-joint-un-estimates
  79. Wald A. Does COVID-19 cause stillbirth? NEJM Journal Watch 2020; 2020.
  80. Di Toro F, Gjoka M, Di Lorenzo G, De Seta F, Maso G, Risso FM, et al. Impact of COVID-19 on maternal and neonatal outcomes: a systematic review and meta-analysis. Clin Microbiol Infect 2020; 27(1): 36-46.
  81. K. C. A, Basel PL, Singh S. Low birth weight and its associated risk factors: Health facility-based case-control study. PLoS One 2020; 15(6): e0234907.
  82. Girma S, Fikadu T, Agdew E, Haftu D,
    Gedamu G, Dewana Z, et al. Factors associated with low birthweight among newborns delivered at public health facilities of Nekemte town, West Ethiopia: A case control study. BMC Pregnancy Childbirth 2019; 19(1): 220.
  83. Chhea C, Ir P, Sopheab H. Low birth weight of institutional births in Cambodia: Analysis of the demographic and health surveys 2010-2014. PLoS One 2018; 13(11): e0207021.
  84. Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, et al. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2017; 35 (48 Pt A): 6492-500.
World Journal of Peri and Neonatology
Volume 4, Issue 1
June 2021
Pages 23-39

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  • Receive Date: 04 November 2021
  • Accept Date: 04 November 2021

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