January 20, 2023
2 min read
Source/Disclosures
Disclosures:
The study was funded by a Bill & Melinda Gates Foundation grant to Smith. Please see the study for all other authors’ relevant financial disclosures.
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Being infected with SARS-CoV-2 at any time during pregnancy was associated with greater risks for maternal death, severe maternal morbidity and neonatal morbidity, according to the findings of an international meta-analysis.
Emily R Smith
“This study was borne from an informal weekly meeting of colleagues that started in early 2020 to discuss early cases of COVID-19 in pregnancy,” Emily R Smith, ScD, MPH, assistant professor of global health at the George Washington University Milken Institute School of Public Health, told Healio. “Since data was scarce, we agreed it would be valuable to standardize the way we pooled together data from all over the world.”
Data were derived from Smith ER, et al. BMJ Glob Health. 2023;doi:10.1136/bmjgh-2022-009495.
Smith and colleagues conducted a sequential, prospective meta-analysis of 12 ongoing studies from 12 countries to evaluate the risk for maternal and neonatal outcomes in SARS-CoV-2-infected women. Studies whose conductors agreed to participate in the meta-analysis by August 2020 were screened for eligibility. Eligible studies were registries, single or multisite cohorts or case-control by design and included at least 25 pregnant women with confirmed or suspected SARS-CoV-2 infection who were compared with pregnant women who were confirmed SARS-CoV-2 negative.
In total, 13,136 pregnant women were included for analyses, 1,942 of whom had a confirmed or suspected SARS-CoV-2 infection and 11,194 of whom were SARS-CoV-2 negative.
maternal outcomes
Compared with SARS-CoV-2-negative pregnant women, pregnant women with a SARS-CoV-2 infection were significantly more likely to be admitted to an ICU (eight studies; RR = 3.81; 95% CI, 2.03-7.17), receive mechanical ventilation (seven studies; RR = 15.23; 95% CI, 4.32-53.71) and receive critical care (seven studies; RR = 5.48; 95% CI, 2.57-11.72).
Women with a SARS-CoV-2 infection were also more likely to be diagnosed with pneumonia (six studies; RR = 23.46; 95% CI, 3.03-181.39), thromboembolic disease (eight studies; RR = 5.5; 95% CI, 1.12 -27.12), preeclampsia (nine studies; RR = 1.42; 95% CI, 1.13-1.78), preeclampsia or eclampsia (10 studies; RR = 1.46; 95% CI, 1.17-1.81) and hypertensive disorders of pregnancy (10 studies; RR = 1.25; 95% CI, 1.04-1.5).
SARS-CoV-2 infection was also associated with a greater risk for cesarean delivery (10 studies; RR = 1.1; 95% CI, 1.01-1.2) and maternal death (10 studies; RR = 7.68; 95% CI, 1.7-34.61 ).
neonatal outcomes
Neonates exposed to SARS-CoV-2 in utero had a greater risk for NICU admission vs. unexposed neonates (seven studies; RR = 1.86; 95% CI, 1.12-3.08), as well as a greater risk for low birth weight (12 studies; RR = 1.19; 95% CI, 1.02-1.4).
The risk for preterm birth was higher among women with vs. without SARS-CoV-2 infection (12 studies; RR = 1.27; 95% CI, 1.07-1.49), as was the risk for moderate preterm birth (12 studies; RR = 1.37; 95% CI, 1.05-1.79).
Sensitivity analyzes comparing pregnant women with symptomatic SARS-CoV-2 infection with those without an infection revealed similar risks.
“Pregnant people are at higher risk once they get COVID-19, so vaccines and boosters should be a priority for women of reproductive age and pregnant people,” Smith said. “Furthermore, careful clinical management of any pregnant patient is warranted. We are continuing to update these global estimates and answer additional questions about the use of COVID vaccines and therapeutics in pregnancy.”
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