Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis
Emily R. Smith, Erin Oakley, Gargi Wable Grandner, Kacey Ferguson, Fouzia Farooq, Yalda Afshar, Mia Ahlberg, Homa K. Ahmadzia, Victor Akelo, Grace M. Aldrovandi, Beth A. Tippett Barr, Elisa Bevilacqua, Justin S. Brandt, Nathalie Broutet, Irene Fernández‐Buhigas, J. Carrillo, Rebecca G. Clifton, Jeanne A. Conry, Erich Cosmi, F. Crispi, F. Crovetto, Camille Delgado‐López, Hema Divakar, Amanda J. Driscoll, Guillaume Favre, Valerie J. Flaherman, Chris Gale, Maria M Gil, Sami L. Gottlieb, E. Gratacós, Olivia Allende Hernández, Stephanie Jones, Erkan Kalafat, Sammy Khagayi, Marian Knight, Karen L. Kotloff, Antonio L’Abbate, Kirsty Le Doaré, C. Lees, Ethan Litman, Erica M. Lokken, Valentina Laurita Longo, Shabir A. Madhi, Laura A. Magee, R.J. Martinez‐Portilla, Elizabeth M. McClure, Tori D Metz, Emily S. Miller, Deborah Money, Sakita Moungmaithong, Edward Mullins, Jean B. Nachega, Marta C. Nunes, Dickens Onyango, Alice Panchaud, Liona C. Poon, Daniel J. Raiten, Lesley Regan, Gordon Rukundo, Daljit Singh Sahota, Allie Sakowicz, José Enrique Sanín-Blair, Jonas Söderling, Olof Stephansson, Marleen Temmerman, Anna Thorson, Jorge E. Tolosa, Julia Townson, Miguel Valencia‐Prado, Silvia Visentin, Peter von Dadelszen, Kristina M. Adams Waldorf, Clare Whitehead, Murat Yassa, Jim M Tielsch
Abstract
INTRODUCTION: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. METHODS: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. RESULTS: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. CONCLUSIONS: This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.