Maternal death related to COVID‐19: A systematic review and meta‐analysis focused on maternal co‐morbidities and clinical characteristics

BACKGROUND: Besides reducing the quality of obstetric care, the direct impact of COVID‐19 on pregnancy and postpartum is uncertain. OBJECTIVE: To evaluate the characteristics of pregnant women who died due to COVID‐19. SEARCH STRATEGY: Cochrane Library, Embase, MEDLINE, Scopus, and Google Scholar were searched from inception to February 2021. SELECTION CRITERIA: Studies that compared deceased and survived pregnant women with COVID‐19. DATA COLLECTION AND ANALYSIS: Relevant data were extracted and tabulated. The primary outcome was maternal co‐morbidity. MAIN RESULTS: Thirteen studies with 154 deceased patients were included. Obesity doubled the risk of death (relative risk [RR] 2.48, 95% confidence interval [CI] 1.41–4.36, I (2) = 0%). No differences were found for gestational diabetes (RR 5.71; 95% CI 0.77–42.44, I (2) = 94%) or asthma (RR 2.05, 95% CI 0.81–5.15, I (2) = 0%). Overall, at least one severe co‐morbidity showed a twofold increased risk of death (RR 2.26, 95% CI 1.77–2.89, I (2) = 76%). Admission to intensive care was related to a fivefold increased risk of death (RR 5.09, 95% CI 2.00–12.98, I (2) = 56%), with no difference in need for respiratory support (RR 0.53, 95% CI 0.23–1.48, I (2) = 95%) or mechanical ventilation (RR 4.34, 95% CI 0.96–19.60, I (2) = 58%). CONCLUSION: COVID‐19 with at least one co‐morbidity increases risk of intensive care and mortality.