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SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes

BACKGROUND: Perform a systematic review and meta-analysis of SARS-CoV-2 infection and pregnancy. METHODS: Databases (Medline, Embase, Clinicaltrials.gov, Cochrane Library) were searched electronically on 6th April and updated regularly until 8th June 2020. Reports of pregnant women with reverse tran...

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Autores principales: Khalil, Asma, Kalafat, Erkan, Benlioglu, Can, O'Brien, Pat, Morris, Edward, Draycott, Tim, Thangaratinam, Shakila, Le Doare, Kirsty, Heath, Paul, Ladhani, Shamez, von Dadelszen, Peter, Magee, Laura A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334039/
https://www.ncbi.nlm.nih.gov/pubmed/32838230
http://dx.doi.org/10.1016/j.eclinm.2020.100446
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author Khalil, Asma
Kalafat, Erkan
Benlioglu, Can
O'Brien, Pat
Morris, Edward
Draycott, Tim
Thangaratinam, Shakila
Le Doare, Kirsty
Heath, Paul
Ladhani, Shamez
von Dadelszen, Peter
Magee, Laura A.
author_facet Khalil, Asma
Kalafat, Erkan
Benlioglu, Can
O'Brien, Pat
Morris, Edward
Draycott, Tim
Thangaratinam, Shakila
Le Doare, Kirsty
Heath, Paul
Ladhani, Shamez
von Dadelszen, Peter
Magee, Laura A.
author_sort Khalil, Asma
collection PubMed
description BACKGROUND: Perform a systematic review and meta-analysis of SARS-CoV-2 infection and pregnancy. METHODS: Databases (Medline, Embase, Clinicaltrials.gov, Cochrane Library) were searched electronically on 6th April and updated regularly until 8th June 2020. Reports of pregnant women with reverse transcription PCR (RT-PCR) confirmed COVID-19 were included. Meta-analytical proportion summaries and meta-regression analyses for key clinical outcomes are provided. FINDINGS: 86 studies were included, 17 studies (2567 pregnancies) in the quantitative synthesis; other small case series and case reports were used to extract rarely-reported events and outcome. Most women (73.9%) were in the third trimester; 52.4% have delivered, half by caesarean section (48.3%). The proportion of Black, Asian or minority ethnic group membership (50.8%); obesity (38.2%), and chronic co-morbidities (32.5%) were high. The most commonly reported clinical symptoms were fever (63.3%), cough (71.4%) and dyspnoea (34.4%). The commonest laboratory abnormalities were raised CRP or procalcitonin (54.0%), lymphopenia (34.2%) and elevated transaminases (16.0%). Preterm birth before 37 weeks’ gestation was common (21.8%), usually medically-indicated (18.4%). Maternal intensive care unit admission was required in 7.0%, with intubation in 3.4%. Maternal mortality was uncommon (~1%). Maternal intensive care admission was higher in cohorts with higher rates of co-morbidities (beta=0.007, p<0.05) and maternal age over 35 years (beta=0.007, p<0.01). Maternal mortality was higher in cohorts with higher rates of antiviral drug use (beta=0.03, p<0.001), likely due to residual confounding. Neonatal nasopharyngeal swab RT-PCR was positive in 1.4%. INTERPRETATION: The risk of iatrogenic preterm birth and caesarean delivery was increased. The available evidence is reassuring, suggesting that maternal morbidity is similar to that of women of reproductive age. Vertical transmission of the virus probably occurs, albeit in a small proportion of cases. FUNDING: N/A
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spelling pubmed-73340392020-07-06 SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes Khalil, Asma Kalafat, Erkan Benlioglu, Can O'Brien, Pat Morris, Edward Draycott, Tim Thangaratinam, Shakila Le Doare, Kirsty Heath, Paul Ladhani, Shamez von Dadelszen, Peter Magee, Laura A. EClinicalMedicine Research Paper BACKGROUND: Perform a systematic review and meta-analysis of SARS-CoV-2 infection and pregnancy. METHODS: Databases (Medline, Embase, Clinicaltrials.gov, Cochrane Library) were searched electronically on 6th April and updated regularly until 8th June 2020. Reports of pregnant women with reverse transcription PCR (RT-PCR) confirmed COVID-19 were included. Meta-analytical proportion summaries and meta-regression analyses for key clinical outcomes are provided. FINDINGS: 86 studies were included, 17 studies (2567 pregnancies) in the quantitative synthesis; other small case series and case reports were used to extract rarely-reported events and outcome. Most women (73.9%) were in the third trimester; 52.4% have delivered, half by caesarean section (48.3%). The proportion of Black, Asian or minority ethnic group membership (50.8%); obesity (38.2%), and chronic co-morbidities (32.5%) were high. The most commonly reported clinical symptoms were fever (63.3%), cough (71.4%) and dyspnoea (34.4%). The commonest laboratory abnormalities were raised CRP or procalcitonin (54.0%), lymphopenia (34.2%) and elevated transaminases (16.0%). Preterm birth before 37 weeks’ gestation was common (21.8%), usually medically-indicated (18.4%). Maternal intensive care unit admission was required in 7.0%, with intubation in 3.4%. Maternal mortality was uncommon (~1%). Maternal intensive care admission was higher in cohorts with higher rates of co-morbidities (beta=0.007, p<0.05) and maternal age over 35 years (beta=0.007, p<0.01). Maternal mortality was higher in cohorts with higher rates of antiviral drug use (beta=0.03, p<0.001), likely due to residual confounding. Neonatal nasopharyngeal swab RT-PCR was positive in 1.4%. INTERPRETATION: The risk of iatrogenic preterm birth and caesarean delivery was increased. The available evidence is reassuring, suggesting that maternal morbidity is similar to that of women of reproductive age. Vertical transmission of the virus probably occurs, albeit in a small proportion of cases. FUNDING: N/A Elsevier 2020-07-03 /pmc/articles/PMC7334039/ /pubmed/32838230 http://dx.doi.org/10.1016/j.eclinm.2020.100446 Text en © 2020 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Paper
Khalil, Asma
Kalafat, Erkan
Benlioglu, Can
O'Brien, Pat
Morris, Edward
Draycott, Tim
Thangaratinam, Shakila
Le Doare, Kirsty
Heath, Paul
Ladhani, Shamez
von Dadelszen, Peter
Magee, Laura A.
SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes
title SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes
title_full SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes
title_fullStr SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes
title_full_unstemmed SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes
title_short SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes
title_sort sars-cov-2 infection in pregnancy: a systematic review and meta-analysis of clinical features and pregnancy outcomes
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334039/
https://www.ncbi.nlm.nih.gov/pubmed/32838230
http://dx.doi.org/10.1016/j.eclinm.2020.100446
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