Effects of COVID-19 Infection during Pregnancy and Neonatal Prognosis: What Is the Evidence?
Abstract
:1. Introduction
2. Materials and Methods
- Population (P) = pregnant women;
- Exposure (E) = COVID-19 infection;
- Comparison (C) = has not been an object of study;
- Outcome (O) = maternal and/or fetal infection by SARS-CoV-2.
3. Results
3.1. Findings from Case Reports
3.2. Findings from Descriptive Studies
3.3. Findings from Cross-Sectional Analytical Studies
3.4. Findings from Longitudinal Studies
4. Discussion
4.1. Characterization of Pregnant Women
4.2. Clinical Findings in Pregnant Women
4.3. Childbirth
4.4. Newborns
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Code | Reference | Study Design | Location | Level of Evidence | Limitations |
---|---|---|---|---|---|
1 | Fan et al. (2020) [13] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
2 | Chen et al. (2020) [14] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
3 | Li et al. (2020) [15] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
4 | Lee et al. (2020) [16] | Case report | Asia | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
5 | Xiaotong et al. (2020) [17] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
6 | Zambrano et al. (2020) [18] | Case report | Honduras | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
7 | Iqbal et al. (2020) [19] | Case report | United States of America | Very Low | Small sample size; single setting; without long-term follow-up; without additional assessments of the virus in amniotic fluid, umbilical cord blood or placenta tissue |
8 | Kang et al. (2020) [20] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
9 | Lu et al. (2020) [21] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
10 | Liao et al. (2020) [22] | Case report | China | Very Low | Small sample size; only third-trimester pregnant women; without information on the delivery or the isolation conditions of newborns after delivery |
11 | Buonsenso et al. (2020) [23] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
12 | Lowe e Bopp (2020) [24] | Case report | Australia | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
13 | Khan et al. (2020) [25] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
14 | Kalafat et al. (2020) [26] | Case report | Turkey | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
15 | Karami et al. (2020) [27] | Case report | Iran | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
16 | Dong et al. (2020) [28] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
17 | González et al. (2020) [29] | Case report | Spain | Very Low | Small sample size; only third-trimester pregnant women; without information on the delivery or the isolation conditions of the newborn after delivery |
18 | Alzamora et al. (2020) [30] | Case report | Peru | Very Low | Small sample size; single setting; without long-term follow-up; without additional assessments of the virus in amniotic fluid, umbilical cord blood or placenta tissue |
19 | Xiong et al. (2020) [31] | Case report | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
20 | Baud et al. (2020) [32] | Case report | Switzerland | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
21 | Kirtsman et al. (2020) [33] | Case report | Canada | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
22 | Liu et al. (2020) [34] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
23 | Chen et al. (2020) [35] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
24 | Yu et al. (2020) [36] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
25 | Zeng et al. (2020) [37] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
26 | Chen, Liao and Shao (2020) [38] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
27 | Liu et al. (2020) [39] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up |
28 | Zhu et al. (2020) [40] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; with little information on the exams performed |
29 | Chen et al. (2020) [41] | Cross-sectional descriptive | China | Very Low | Small sample size; without long-term follow-up |
30 | Yan et al. (2020) [42] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; without long-term follow-up |
31 | Breslin et al. (2020) [43] | Cross-sectional descriptive | United States of America | Very Low | Small sample size; without long-term follow-up |
32 | Chen et al. (2020) [44] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; without long-term follow-up |
33 | Ferrazzi et al. (2020) [45] | Cross-sectional descriptive | Italia | Low | Without long-term follow-up; not all newborns were tested immediately after birth; without additional assessments of the virus in amniotic fluid, umbilical cord blood or placenta tissue |
34 | Nie et al. (2020) [46] | Cross-sectional descriptive | China | Very Low | Small sample size; not all newborns were tested for SARS-CoV-2; without long-term follow-up. |
35 | Khan et al. (2020) [47] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up. |
36 | Hantoushzadeh et al. (2020) [48] | Cross-sectional descriptive | Iran | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up. |
37 | Qianchenga et al. (2020) [49] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up; absence of criteria for allocation to groups |
38 | Wu et al. (2020) [50] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; without long-term follow-up |
39 | Yang et al. (2020) [51] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; without additional assessments of the virus in amniotic fluid, umbilical cord blood or placenta tissue |
40 | Liu et al. (2020) [52] | Cross-sectional descriptive | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; without long-term follow-up; absence of criteria for allocation to groups |
41 | Zhang et al. (2020) [53] | Cross-sectional analytical | China | Low | Small sample size; single setting; lack of clear criteria to include control groups; little information on postpartum care provided to newborns |
42 | Liu et al. (2020) [54] | Cross-sectional analytical | China | Low | Small sample size; no clear criteria for inclusion in the control group; absence of tomography images for monitoring therapeutic effects in ambulatory pregnant women |
43 | Liao et al. (2020) [55] | Cross-sectional analytical | China | Low | Small sample size; single setting; without long-term follow-up; only third-trimester pregnant women |
44 | Wu et al. (2020) [56] | Cross-sectional analytical | China | Very Low | Small sample size; single setting; without long-term follow-up |
45 | Yue et al. (2020) [57] | Cross-sectional analytical | China | Low | Small sample size; single setting; only third-trimester pregnant women |
46 | Yang et al. (2020) [58] | Cross-sectional analytical | China | Low | Small sample size; single setting; only third-trimester pregnant women; not all newborns were tested for SARS-CoV-2 |
47 | Shanes et al. (2020) [59] | Cross-sectional analytical | United States of America | Low | Small sample size; single setting; not all newborns were tested for SARS-CoV-2 |
48 | Lin et al. (2020) [60] | Case-control | China | Very Low | Small sample size; single setting; only third-trimester pregnant women; retrospective; without clear inclusion criteria for cases and controls |
49 | Yin et al. (2020) [61] | Cohort | China | Low | Small sample size; single setting; without long-term follow-up; incomplete information on pregnant women; controls are 35 non-pregnant women of fertile age |
Code | Study Design | Setting and Participants | Clinical, Laboratory and Imaging Findings of Women and Type of Delivery | Newborns’ Clinical and Laboratory Findings |
---|---|---|---|---|
[13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33] | Case report | Setting: China (11/50%), Asia (1/5%), The Netherlands (1/5%), United States of America (1/5%), Turkey (1/5%), Iran (1/5%), Peru (1/5%), Italy (1/5%), Australia (1/5%), Switzerland (1/5%), and Canada (1/5%); - Pregnant women: 29 COVID-19 infected pregnant women with laboratory confirmation (29/100%), in the second (5/17%) or third (24/83%) trimester of pregnancy, mild or moderate (22/75%) and severe (5/17%) pneumonia; - 27 newborns: tested for SARS-CoV-2 (26/96%). | - Pregnancy associated comorbidity (27/93% assessed): no comorbidity (17/63%), fetal distress (5/16%), placenta previa (2/7%), gestational diabetes (1/4%), gestational hypertension (1/4%), prelabor rupture of membranes (1/4%), and thalassemia (1/4%); - Pre-existing diseases not related to pregnancy: Obesity (1/4%) and familial neutropenia (1/4%); - Signs and symptoms (29/100% assessed women): asymptomatic (1/3%); fever at admission (21/72%), cough (18/62%), post-partum fever (6/21%), myalgia (6/21%), dyspnea (5/17%), shivers (4/14%), sore throat (3/10%), chest pain (3/10%), fatigue (2/7%), malaise (1/3%), loss of taste and/or smell (1/3%); - Imaging (25/86% assessed women): suggestive chest CAT scan (24/96%); - Laboratory exams (26/90% assessed women): increased reactive C protein (18/69%), lymphocytopenia (15/58%), leukocytosis (6/23%), neutrophilia (5/19%), interleukin 6 (2/8%), elevated alanine transaminase (1/4%), immunoglobulin G (1/4%) and immunoglobulin M (1/4%); - Delivery (27/100 deliveries): C-section (21/78%)—due to comorbidities associated with pregnancy (10/50%) and (10/50%) due to the infection; vaginal (6/22%). - Maternal death (1/4%). | - 27 newborns - 24 assessed: normal APGAR index (22/92%), normal weight (18/75%), premature (10/41%); - 26 newborns tested: negative for SARS-CoV-2 (24/92%); positive (2/8%); - Neonatal death (2/7%); - Isolation of mother and newborn (13/48%); - Analysis of the placenta of 6 newborns: no alterations infection-related (6/100%). |
[34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52] | Cross-sectional Descriptive | - Settings: China (16/85%), United States of America (1/5%), Italy (1/5%), and Iran (1/5%); - Pregnant women: 546 COVID-19 infected pregnant women, laboratorial diagnosis (409/75%), clinical diagnosis (109/20%), first trimester of pregnancy (39/7%), second trimester of pregnancy (44/8%), third trimester of pregnancy (463/85%), mild or moderate (482/88%) and severe (41/7%) pneumonia; - 429 newborns tested for SARS-CoV-2 (345/81%). | - Pregnancy related comorbidities (398/73% assessed): no comorbidity (139/35%), fetal distress (30/8%), gestational diabetes (30/7%), prelabor rupture of membranes (16/4%), gestational hypertension (12/3%), preeclampsia (7/2%), anemia (5/1%), uterine scar (4/1%), umbilical cord prolapse (4/1%), complete placenta previa (1/0,3%), thalassemia (1/0.3%), and multiple organ dysfunction syndrome/stillbirth (1/0.3%); - Pre-existing diseases not related to pregnancy: hepatitis B infection (4/1%), blood coagulation disorder (2/0.5%), influenza (2/0.5%), hypothyroidism (2/0.5%), schistosomiasis infection (1/0.3%), and hypoproteinemia (1/0.3%); - Signs and symptoms (512/94% assessed women): asymptomatic (55/11%), fever at admission (290/57%), cough (230/45%), dyspnea (65/13%), fatigue (55/11%), myalgia (45/9%), chest pain (38/7%), post-partum fever (23/5%), diarrhea (27/5%), sore throat (19/4%), malaise (5/1%), coryza (2/0.3%), and expectoration (2/0.3%); - Imaging (404/74% assessed women): suggestive chest CAT scan (377/93%); - Laboratory exams (402/74% assessed women): increased Reactive C protein (226/56%), lymphocytopenia (160/40%), leukocytosis (107/27%), elevated alanine transaminase (38/9%), elevated aspartate transaminase (38/9%), neutrophilia (9/2%), immunoglobulin G (5/1%), immunoglobulin M (4/1%), and interleukin 6 (4/1%); - Deliveries (421 deliveries): C-section (273/64%)—due to comorbidities associated with pregnancy (128/46%), due to the infection (74/27%), no information on motive (71/25%); vaginal (148/35%). - Maternal death (7/1%). | - Spontaneous abortion on the 5th week of pregnancy (1) - 429 newborns: normal APGAR index (417/97%), premature (74/17%); - Weight (307/72%): normal birth weight (292/95%), low birth weight (16/5%); - Newborns tested (345/80%): SARS-CoV-2 negative (338/98%), positive (7/2%); - Neonatal death: (8/2%); - 107 pregnant women assessed concerning isolation of which 97 were isolated from newborns; - Analysis of the placenta of 32 newborns: no alterations (32/100%). |
[53,54,55,56,57,58,59] | Cross-sectional analytical | - Setting: China (6/86%) and United States of America (1/14%); - Pregnant women: 133 COVID-19 infected pregnant women, laboratorial diagnosis (104/78%), clinical diagnosis (29/22%), first trimester of pregnancy (3/2%), second trimester of pregnancy (23/17%), third trimester of pregnancy (107/80%), mild or moderate pneumonia (132/99%), or severe pneumonia (1/1%); - 108 newborns tested for SARS-CoV-2 (102/94%). | - Pregnancy related comorbidities (116/87% assessed women): no comorbidity (75/65%), gestational diabetes (8/7%), prelabor rupture of membranes (6/5%), gestational hypertension (4/3%), threat of abortion (3/3%), fetal distress (3/3%), uterine scar (2/2%), B-Lynch suture or other compression suture (2/2%), preeclampsia (1/1%), asphyxia (1/1%), and gestational cholestasis (1/1%); - Pre-existing diseases not related to pregnancy: asthma (2/2%) and hepatitis B infection (1/1%). - Signs and symptoms (101/75% assessed women): asymptomatic (18/19%), fever at admission (31/31%), post-partum fever (29/29%), cough (27/27%), dyspnea (5/5%), fatigue (5/5%), chest pain (1/1%); - Imaging (101/75% assessed women): suggestive chest CAT scan (96/95%); - Laboratory exams (74/63% assessed women): increased Reactive C protein (58/78%), lymphocytopenia (57/77%), neutrophilia (57/77%), and leukocytosis (17/23%); - Deliveries (106 deliveries): C-section (59/65%)—due to comorbidities associated with pregnancy (10/17%), due to infection (19/32%), no information on motive (30/51%); vaginal (32/35%). | - 108 newborns: normal APGAR index (107/100%); - Weight (71/76%): normal birth weight (65/92%) and low birth weight (6/8%); - Prematurity: premature (8/7%); - Newborns tested (102/94%): SARS-CoV-2 negative test (102/100%); - Neonatal death (0); - 23 pregnant women were assessed concerning isolation and 20 were isolated from newborns; - Analysis of the placenta of 16 newborns: no alterations (16/100%). |
[60] | Case-control | - Setting: China; - Pregnant women: 16 pregnant women infected by COVID-19, laboratory diagnosis (16/100%), in the third trimester of pregnancy (16/100%), mild or moderate pneumonia (16/100%); - 17 newborns: tested for SARS-CoV-2 (3/18%). | - Pregnancy related comorbidities (16/100% pregnant women assessed): no comorbidities (5/31%), gestational diabetes (3/19%), gestational hypertension (2/13%), preeclampsia (1/6%), prelabor rupture of membranes (1/6%), Hepatitis B (1/6%); - Medical background: hypothyroidism (2/13%) and sinus tachycardia (1/6%); - Signs and symptoms (16/100% pregnant women studied): asymptomatic (4/25%), fever at admission (4/25%), post-partum fever (8/50%); - Imaging (16/100% pregnant women studied): suggestive chest CAT scan (10/63%); - Laboratory exams (16/100% pregnant women studied): increased reactive C protein (16/100%), neutrophilia (16/100%), lymphocytopenia (2/13%); - Deliveries (16 deliveries): C-section (14/87%)—does not mention the indication; vaginal (3/13%). | - 17 newborns: normal APGAR index (17/100%), normal weight (14/82%), premature (3/18%); - Newborns tested (3/18%): SARS-CoV-2 negative (3/100%); - Neonatal deaths (0); - pregnant women assessed for isolation (0); - Analysis of the placenta (0). |
[61] | Cohort | - Setting: China - Pregnant women: 31 pregnant women infected by COVID-19, laboratory diagnosis (31/100%), in the first trimester of pregnancy (4/13%), in the second trimester (5/16%), in the third trimester (22/71%), mild or moderate pneumonia (21/68%), severe pneumonia (10/32%); - 17 newborns tested for SARS-CoV-2 (17/100%). | - Pregnancy related comorbidities (31/100% pregnant women assessed): no comorbidities (28/90%) and gestational hypertension (1/3%). - Medical background: cardiovascular disease (1/3%) and diabetes (1/3%); - Signs and symptoms (31/100% pregnant women studied): asymptomatic (5/16%), fever at admission (17/55%), cough (15/48%), dyspnea (8/26%), fatigue (6/19%), expectoration (5/16%), myalgia (3/10), diarrhea (2/6%); - Imaging (31/100% pregnant women studied): Suggestive CT scan (31/100%); - Laboratory exams (31/100% pregnant women studied): neutrophilia (10/32%), increased aspartate transaminase (7/23%), - Deliveries (17): C-section (13/76%)—no description on the indication; vaginal (4/24%). | - 17 newborns: normal APGAR index (16/94%), normal weight (16/94%), premature (5/29%); - Newborns tested (17/100%): SARS-CoV-2 negative (17/100%); - neonatal death (0); - Pregnant women analyzed for isolation (0); - Analysis of the placenta (0). |
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Lopes de Sousa, Á.F.; Carvalho, H.E.F.d.; Oliveira, L.B.d.; Schneider, G.; Camargo, E.L.S.; Watanabe, E.; de Andrade, D.; Fernandes, A.F.C.; Mendes, I.A.C.; Fronteira, I. Effects of COVID-19 Infection during Pregnancy and Neonatal Prognosis: What Is the Evidence? Int. J. Environ. Res. Public Health 2020, 17, 4176. https://doi.org/10.3390/ijerph17114176
Lopes de Sousa ÁF, Carvalho HEFd, Oliveira LBd, Schneider G, Camargo ELS, Watanabe E, de Andrade D, Fernandes AFC, Mendes IAC, Fronteira I. Effects of COVID-19 Infection during Pregnancy and Neonatal Prognosis: What Is the Evidence? International Journal of Environmental Research and Public Health. 2020; 17(11):4176. https://doi.org/10.3390/ijerph17114176
Chicago/Turabian StyleLopes de Sousa, Álvaro Francisco, Herica Emilia Félix de Carvalho, Layze Braz de Oliveira, Guilherme Schneider, Emerson Lucas Silva Camargo, Evandro Watanabe, Denise de Andrade, Ana Fátima Carvalho Fernandes, Isabel Amélia Costa Mendes, and Inês Fronteira. 2020. "Effects of COVID-19 Infection during Pregnancy and Neonatal Prognosis: What Is the Evidence?" International Journal of Environmental Research and Public Health 17, no. 11: 4176. https://doi.org/10.3390/ijerph17114176