Pregnant women treated in hospitals for Covid-19 appear to have a higher risk for being admitted to intensive care units than women of similar ages who are not pregnant, and they also have a higher risk for pre-term birth than women without the disease.
A living systematic review and meta-analysis consolidating data on women with suspected or confirmed Covid-19 during or around the time of pregnancy found that, compared to non-pregnant women of reproductive age, pregnant women were less likely to report having fever (odds ratio, 0.43, 95% CI, 0.22-0.85; I2=74%; 5 studies; 80,521 women) and myalgia (0.48, 95% CI, 0.45-0.51; I2=0%; 3 studies; 80,409 women); however, they were more likely to require ICU admission (1.62, 95% CI, 1.33-1.96; I2=0%) and invasive ventilation (1.88, 95% CI, 1.36-2.60; I2=0%; 4 studies, 91 606 women).
Findings from the living meta-analysis, which includes 77 studies so far, were published online Sep. 1 in The BMJ.
Researcher John Allotey, PhD, of the United Kingdom’s University of Birmingham, wrote that pregnant women have been thought to be a high-risk group for Covid-19, but reviews examining the issue have quickly become outdated as new evidence emerges.
Their living systematic review is being conducted to compare clinical features, risk factors, and outcomes among pregnant and recently pregnant women with suspected or confirmed Covid-19 with age-matched women who were not pregnant. The analysis will be updated regularly as new data become available.
Approximately 10% (95% CI, 7%-14%) of the 11,432 pregnant or recently pregnant women in the analysis treated at hospitals or admitted to hospitals for any reason were diagnosed with suspected or confirmed Covid-19, with the most common clinical manifestation of the disease in pregnancy being fever (40%) and cough (39%).
Among the other main findings:
- A total of 73 pregnant women (0.1%, 26 studies, 11,580 women) with confirmed Covid-19 died from any cause.
- The risk for severe disease was increased with greater maternal age (1.78, 95% CI, 1.25-2.55; I2=9%; 4 studies; 1,058 women), high body mass index (2.38, 95% CI, 1.67-3.39; I2=0%; 3 studies; 877 women), chronic hypertension (2.0, 95% CI, 1.14-3.48; I2=0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 95% CI, 1.31-4.80; I2=12%; 2 studies; 858 women).
- Pre-existing maternal comorbidities were risk factors for admission to an intensive care unit (4.21, 95% CI, 1.06 to 16.72; I2=0%; 2 studies; 320 women) and need for invasive ventilation (4.48, 95% CI, 1.40-14.37; I2=0%; 2 studies; 313 women).
With regard to preterm birth, the rate of spontaneous preterm birth was 6% (95% CI, 3%-9%; I2=55%; 10 studies; 870 women) in women with Covid-19. The odds of any preterm birth (3.01, 95% CI, 1.16-7.85; I2=1%; 2 studies; 339 women) was higher in pregnant women with Covid-19, compared with those without the disease.
One-in-four neonates born to mothers with Covid-19 were admitted to the neonatal unit (25%) and they were at increased risk of NICU admission (odds ratio 3.13, 95% CI, 2.05-4.78; 1 study, 1121 neonates), compared to babies born to mothers without Covid-19.
“Based on existing data, healthcare professionals should be aware that pregnant and recently pregnant women with Covid-19 might manifest fewer symptoms than the general population, with the overall pattern similar to that of the general population,” Allotey and colleagues wrote.
“Emerging comparative data indicate the potential for an increase in the rates of admission to ICU and invasive ventilation in pregnant women compared to non-pregnant women. Mothers with pre-existing comorbidities will need to be considered as a high-risk group for Covid-19, along with those who are obese and of greater maternal age.”
The researchers predicted that with the establishment of new national and global prospective cohorts of Covid-19, the sample size of their living meta-analysis will increase within several months.
“Our living systematic review and meta-analysis with its regular search and analyses updates is ideally placed to assess the impact of new findings on the rapidly growing evidence base,” they wrote.
- A living systematic review and meta-analysis consolidating data on women with suspected or confirmed Covid-19 during or around the time of pregnancy found that, compared to non-pregnant women of reproductive age, pregnant women were more likely to require ICU admission and invasive ventilation.
- The odds of preterm birth were increased in pregnant women with Covid-19 versus pregnant women who were not infected.
Salynn Boyles, Contributing Writer, BreakingMED
Funding for this study was provided by the World Health Organization.
The researchers declared no relationships or activites that might have influenced the submitted work.
Cat ID: 41
Topic ID: 83,41,190,926,41,192,927,151,928,925,934
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