Birmingham, UK—Amid the trauma of a worldwide pandemic, expectant mothers have been among the most concerned, as pharmacists know. A new study explains why they probably weren’t overreacting.
The PregCOV-19 Living Systematic Review Consortium sought to determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019. The review and meta-analysis used studies from Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from December 1, 2019, to June 26, 2020. Preprint servers, social media, and reference lists were also scanned.
Eventually, 77 studies were included, with 10% (95% CI, 7%-14%; 28 studies, 11,432 women) of pregnant and recently pregnant women attending or admitted to a hospital for any reason were diagnosed as having suspected or confirmed COVID-19.
Researchers report that the most common clinical manifestations of COVID-19 in pregnancy were fever (40%) and cough (39%). Yet, compared with nonpregnant women of reproductive age, pregnant and recently pregnant women with COVID-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% CI, 0.22-0.85; I2 = 74%; 5 studies; 80,521 women) and myalgia (0.48, 0.45-0.51; I2 = 0%; 3 studies; 80,409 women).
Especially concerning was that expectant mothers were more likely to need admission to an ICU (1.62, 1.33-1.96; I2 = 0%) and invasive ventilation (1.88, 1.36-2.60; I2 = 0%; 4 studies, 91606 women). In fact, 73 pregnant women (0.1%, 26 studies, 11,580 women) with confirmed COVID-19 died from any cause.
Severe COVID-19 in pregnancy was associated with increased maternal age (1.78, 1.25-2.55; I2 =9%; 4 studies; 1,058 women), high body mass index (2.38, 1.67-3.39; I2 = 0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14-3.48; I2 = 0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31-4.80; I2 =12%; 2 studies; 858 women), the authors report.
In terms of serious novel coronavirus cases, pre-existing maternal comorbidity was a risk factor for admission to an ICU (4.21, 1.06-16.72; I2 = 0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40-14.37; I2 = 0%; 2 studies; 313 women).
Overall, the spontaneous preterm birth rate was 6% (95% CI, 3%-9%; I2 = 55%; 10 studies; 870 women) in women with COVID-19, according to the report. Researchers calculated that the odds of any preterm birth (3.01, 95% CI, 1.16-7.85; I2 = 1%; 2 studies; 339 women) were higher in pregnant women with COVID-19 compared with those without the disease.
The women’s offspring also fared worse, with a quarter of all neonates born to mothers with COVID-19 being admitted to the neonatal unit (25%); they also were at increased risk of admission (odds ratio 3.13, 95% CI, 2.05-4.78, I2 = not estimable; 1 study, 1121 neonates) than those born to mothers without COVID-19.
“Pregnant and recently pregnant women are less likely to manifest COVID-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for COVID-19,” the authors conclude. “Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are higher in pregnant women with covid-19 than in pregnant women without the disease.”