This article was reviewed by Dr. Philip Lange, one of our subject matter experts.
The paper we’ll be demystifying can be found here, if you’d like to follow along!
TL;DR
Researchers found that the clinical characteristics among pregnant women infected with COVID-19 are similar to non-pregnant adults. It was also found that COVID-19 during pregnancy does not impact maternal and fetal outcomes.
Methods
The authors conducted a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A systematic review is a review of literature to answer a specific research question. To perform this review, systematic methods are used to identify and select relevant research studies, as well as to analyze data from the selected studies. These systematic methods must be transparent and be easily reproducible by others [1].
18 studies were included in the present study, which included 114 pregnant women.
Results
Pregnancy Outcomes Among Pregnant Women Infected with COVID-19
The most common COVID-19 symptoms among the pregnant women were cough and fever. Other common symptoms included: muscle pain and aches, fatigue, sore throat, diarrhea, and shortness of breath. Most of the women had relatively mild symptoms and had a regular or mild type of COVID-19. However, six patients developed severe disease. One of the six patients suffered from multiple organ failure and used extracorporeal membrane oxygenation, which provides respiratory and cardiac support.
Most of the pregnant women had a C-section delivery. This was mainly because of fetal distress, preeclampsia, previous history of C-sections and a risk of HIV transmission from mother to child by vaginal delivery.
Overall, the results of the study show that the clinical characteristics of pregnant women infected with COVID-19 are similar to non-pregnant adults. However, more case-control studies must be conducted to confirm these results.
COVID-19 Transmission During Pregnancy
The results also show that there is no evidence to conclude that COVID-19 during pregnancy could lead to the mother transmitting COVID-19 to the fetus. Additionally, there were no COVID-19 positive RT-PCR results found in the cord blood, placenta or amniotic fluid among the pregnant women in the study.
Fetal Outcomes
The most common adverse fetal outcomes reported were pre-term birth, fetal distress, low birthweight, neonatal death, neo-natal asphyxia, and stillbirth.
Current research focuses on fetal outcomes among pregnant women infected with COVID-19 during the third trimester. As a result, it is unclear whether infection during the first or second trimester will increase the prevalence and risk of adverse fetal outcomes.
Discussion
According to the researchers, it is extremely important to standardize the admission, screening, and management of all suspected and/or confirmed COVID-19 cases among pregnant women. It is also important for maternity wards to be prepared because COVID-19 during pregnancy may make childbirth and maternal care more difficult and complicated.
Limitations
The studies included in the review were considered low quality, thus limiting the interpretation of the review. The review also only included pregnant women who were infected with COVID-19 during their third trimester. Therefore, the results may not be generalizable to women infected during their first or second trimesters. Moreover, some patients were also still hospitalized and pregnant when the case reports were included in the review, thereby potentially limiting the results on fetal outcomes.
Conclusions
The results from this review show that the clinical characteristics among pregnant women infected with COVID-19 are similar to non-pregnant adults. Among this, the results also demonstrate that COVID-19 during pregnancy may not impact maternal and fetal outcomes.
Author’s Note
As this article was written over a year ago, I encourage everyone to seek out more up-to-date research on COVID-19 and pregnancy. Additionally, this article did not discuss how the on-going pandemic impacts prenatal care, which is pivotal. According to the World Health Organization, preventable pregnancy-related deaths continue to be unacceptably high. Adequate prenatal care is an important part of preventing pregnancy-related deaths [2]. Therefore, I believe that research on the impact of the COVID-19 pandemic on prenatal care is important.
An article published in early 2021 addressed the impact of the pandemic on prenatal care and stressed the importance of listening to the collective voices of women. I encourage you to read about it here.
