Coronavirus disease 2019 during pregnancy: a systematic review of reported cases
Anna Nunzia Della Gatta, Roberta Rizzo, Gianluigi Pilu, Giuliana Simonazzi, Anna Nunzia Della Gatta, Roberta Rizzo, Gianluigi Pilu, Giuliana Simonazzi
Abstract
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.
Keywords: COVID-19; SARS-CoV-2; cesarean delivery; coronavirus pneumonia; fetal death; neonatal outcomes; preterm birth; stillbirth; vertical transmission novel coronavirus; viral pneumonia.
Copyright © 2020 Elsevier Inc. All rights reserved.
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References
- World Health Organization Coronavirus disease (COVID-19) pandemic. Available at:
- Wu Y.C., Chen C.S., Chan Y.J. The outbreak of COVID-19: an overview. J Chin Med Assoc. 2020;83:217–220.
- Di Mascio D., Khalil A., Saccone G., et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020 [Epub ahead of print]
- Royal College of Obstetricians & Gynaecologists Coronavirus (COVID-19) infection in pregnancy. Information for healthcare professionals. Version 8. 2020. Available at:
- National Health Commission of China New coronavirus pneumonia prevention and control program [in Chinese]. 4th ed. 2020. Available at:
- Chen H., Guo J., Wang C., 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;395:809–815.
- Chen S., Huang B., Luo D.J., et al. Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases. Zhonghua Bing Li Xue Za Zhi. 2020;49:E005.
- Li Y., Zhao R., Zheng S., et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis J. 2020 [Epub ahead of print]
- Liang H., Acharya G. Novel corona virus disease (COVID-19) in pregnancy: what clinical recommendations to follow? Acta Obstet Gynecol Scand. 2020;99:439–442.
- Liu Y., Chen H., Tang K., Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020 [Epub ahead of print]
- Moher D., Liberati A., Tetzlaff J., et al. and the PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med. 2009;151:264–269.
- Mullins E, Evans D, Viner RM, O’Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol [In press].
- Murad M.H., Sultan S., Haffar S., Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018;23:60–63.
- Yang H., Wang C., Poon L.C. Novel coronavirus infection and pregnancy. Ultrasound Obstet Gynecol. 2020;55:435–437.
- Zhang L., Jiang Y., Wei M., et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province. Zhonghua Fu Chan Ke Za Zhi. 2020;55:E009.
- Zhu H., Wang L., Fang C., et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9:51–60.
- Schuchat A. Reflections on pandemics, past and present. Am J Obstet Gynecol. 2011;204(6 Suppl 1):S4–S6.
- Adhikari E.H., Nelson D.B., Johnson K.A., et al. Infant outcomes among women with Zika virus infection during pregnancy: results of a large prenatal Zika screening program. Am J Obstet Gynecol. 2017;216:292.e1–292.e8.
- Avram C.M., Greiner K.S., Tilden E., Caughey A.B. Point-of-care HIV viral load in pregnant women without prenatal care: a cost-effectiveness analysis. Am J Obstet Gynecol. 2019;221:265.e1–265.e9.
- Avram C.M., Greiner K.S., Tilden E., Caughey A.B. Additional considerations regarding point-of-care HIV viral load in pregnant women without prenatal care. Am J Obstet Gynecol. 2020 [Epub ahead of print]
- Schwartz D.A., Graham A.L. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12 doi: 10.3390/v12020194.
- Rasmussen S.A., Smulian J.C., Lednicky J.A., Wen T.S., Jamieson D.J. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020 [Epub ahead of print]
Source: PubMed