In a recent BMJ Global Health article, researchers from diverse universities across the United States explain the findings of a sequential and prospective meta-analysis of more than 13,000 pregnant women. The risk of maternal, fetal, and neonatal morbidity and mortality in women diagnosed with the coronavirus disease 2019 (COVID-19) during pregnancy was evaluated by the researchers using a standardized data collection and analytical technique.
Covidien-19 and pregnancy
Due to several physiological, immunomodulatory, and mechanical changes brought on by pregnancy, women are frequently more vulnerable to specific diseases, such as COVID-19, and their severe repercussions.
This patient population may be more susceptible to death, intensive care unit (ICU) admission, preterm delivery, stillbirth, and neonatal care unit admission than expectant women without COVID-19, according to a meta-analysis of 47 studies. Another recent study discovered that COVID-19-positive pregnant women were more likely to need prolonged hospital stays with critical care for both the mother and child.
Despite these findings, the variety in outcome definitions, population-specific baseline risks, and COVID-19 diagnosis methodologies among these studies make it impossible for researchers to synthesize the knowledge on the effects of COVID-19 during pregnancy. Furthermore, little research has been done on pregnant women in low-income nations.
Concerning the study
Individual participant data (IPD) meta-analytical framework and harmonized data definitions were used in the current investigation to combine data from independent studies. Studies including pregnant women with suspected or confirmed COVID-19, as well as registries, single- and multi-site cohorts, and case-control studies, were all considered eligible. Notably, a COVID-19 diagnosis was established using polymerase chain reaction (PCR) assay, antigen tests, and serology testing after a known exposure, or in accordance with the World Health Organization’s classification of a suspected case (WHO).
The researchers detected any potential outliers and inconsistent values for crucial data points such as gestational age at delivery, mother age, and neonatal birth weight in order to guarantee the integrity of IPD for the study. Maternal mortality and morbidity, fetal and neonatal death and morbidity, unfavorable birth outcomes, and severe COVID-19 outcomes were the four patient outcome categories that were evaluated in the study.
The final analysis comprised a total of 12 investigations completed between February 2020 and July 2021. 12 nations, including Ghana, China-Hong Kong, Italy, Kenya, Nigeria, South Africa, Spain, Sweden, the Democratic Republic of the Congo, Turkey, Uganda, and the United States, participated in these investigations. Thus, a total of 11,194 pregnant women who tested negative for COVID-19 and 1,942 pregnant women who had COVID-19 were included.
The risk of maternal morbidity and mortality is increased by COVID-19.
A diagnosis of COVID-19 at any stage during pregnancy enhanced the woman’s risk for all crucial COVID-19 indications when compared to pregnant women who were negative for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These severe COVID-19 side effects included pneumonia that was identified by a doctor, ICU admission, and any usage of ventilation.
More particular, COVID-19 increased by 3% and 4%, respectively, the absolute risk of ICU admission and the need for critical care during pregnancy. Compared to pregnant women who tested negative for SARS-CoV-2 and had a COVID-19 diagnosis, the likelihood that they would need critical care was five times higher.
Notably, pregnant women with symptomatic COVID-19 had a higher prevalence of these negative consequences. Additionally, pregnant women with symptomatic illness had a considerably higher risk of maternal death than pregnant women who were not infected.
COVID-19 enhanced the risk of maternal death among the three included studies that documented deaths during the research period. Pregnant women with COVID-19 also had an increased risk of pre-eclampsia, thromboembolic illness, and hypertensive disorders during pregnancy.
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Pregnant women with a COVID-19 diagnosis had a slightly increased cesarean section risk. A noteworthy finding was that there was no discernible difference in the risk of premature labor, hemorrhage, placental abruption, eclampsia, or intrapartum cesarean delivery.
Maternal COVID-19 and negative neonatal outcomes
Infants born to moms with a COVID-19 diagnosis have an increased risk of admission to the neonatal intensive care unit (NICU). These results are in line with those of other research, such as the INTERCOVID trial, which found that SARS-CoV-2-infected women had a higher risk of giving birth prematurely.
Additionally, children born to infected moms had a higher chance of being moderately preterm, preterm, and having a low birth weight.
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Conclusions
Symptomatic infections were an even bigger risk factor for these negative impacts, even while a diagnosis of COVID-19 significantly raised the risk of a number of maternal morbidity and mortality markers as well as a number of newborn outcomes.
When considered as a whole, our results highlight the significance of ongoing awareness among expectant mothers to prevent SARS-CoV-2 infection by vaccination and the use of non-pharmaceutical measures such as masks and social seclusion.
