Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. Issue 1 (16th January 2023)

• Record Type: Journal Article
• Authors: Smith, Emily R; Oakley, Erin; Grandner, Gargi Wable; Ferguson, Kacey; Farooq, Fouzia; Afshar, Yalda; Ahlberg, Mia; Ahmadzia, Homa; Akelo, Victor; Aldrovandi, Grace; Tippett Barr, Beth A; Bevilacqua, Elisa; Brandt, Justin S; Broutet, Nathalie; Fernández Buhigas, Irene; Carrillo, Jorge; Clifton, Rebecca; Conry, Jeanne; Cosmi, Erich; Crispi, Fatima; Crovetto, Francesca; Delgado-López, Camille; Divakar, Hema; Driscoll, Amanda J; Favre, Guillaume; Flaherman, Valerie J; Gale, Chris; Gil, Maria M; Gottlieb, Sami L; Gratacós, Eduard; Hernandez, Olivia; Jones, Stephanie; Kalafat, Erkan; Khagayi, Sammy; Knight, Marian; Kotloff, Karen; Lanzone, Antonio; Le Doare, Kirsty; Lees, Christoph; Litman, Ethan; Lokken, Erica M; Laurita Longo, Valentina; Madhi, Shabir A; Magee, Laura A; Martinez-Portilla, Raigam Jafet; McClure, Elizabeth M; Metz, Tori D; Miller, Emily S; Money, Deborah; Moungmaithong, Sakita; Mullins, Edward; Nachega, Jean B; Nunes, Marta C; Onyango, Dickens; Panchaud, Alice; Poon, Liona C; Raiten, Daniel; Regan, Lesley; Rukundo, Gordon; Sahota, Daljit; Sakowicz, Allie; Sanin-Blair, Jose; Söderling, Jonas; Stephansson, Olof; Temmerman, Marleen; Thorson, Anna; Tolosa, Jorge E; Townson, Julia; Valencia-Prado, Miguel; Visentin, Silvia; von Dadelszen, Peter; Adams Waldorf, Kristina; Whitehead, Clare; Yassa, Murat; Tielsch, Jim M;
• Other Names: author non-byline.; Langenegger Eduard author non-byline.; Sam-Agudu Nadia A. author non-byline.; Gachuno Onesmus W. author non-byline.; Sekikubo Musa author non-byline.; Mukwege Denis M. author non-byline.; Omore Richard author non-byline.; Ouma Gregory author non-byline.; Onyango Clayton author non-byline.; Otieno Kephas author non-byline.; Were Zacchaeus Abaja author non-byline.; Were Joyce author non-byline.; İlter Pinar Birol author non-byline.; Mboizi Robert author non-byline.; Hookham Lauren author non-byline.; Meli Federica author non-byline.; Bonanni Giulia author non-byline.; Romanzi Federica author non-byline.; Torcia Eleonora author non-byline.; Ilio Chiara di author non-byline.; Ananth Cande V. author non-byline.; Hill Jennifer author non-byline.; Reddy Ajay author non-byline.; Patrick Haylea Sweat author non-byline.; Baba Vuyelwa author non-byline.; Adam Mary author non-byline.; Mlandu Philiswa author non-byline.; Adam Yasmin author non-byline.; Strehlau Renate author non-byline.
• Is Part Of: BMJ global health. Volume 8:Issue 1(2023)
• Publication Date: 2023-01-16
• Subjects: COVID-19 -- Maternal health -- Epidemiology; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2022-009495
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Introduction: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. Methods: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. Results: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women. Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12). Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. Conclusions: This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.