Objectives COVID-19 is a rapidly changing and developing emergency that requires constant re-evaluation of available data. We report a systematic review and meta analysis based on all published high quality data up to and including June 3rd 2021 on the maternal and neonatal outcomes in pregnant women infected with the Coronavirus Disease 2019 (COVID-19). Data Sources PubMed, SCOPUS, MEDLINE, ClinicalTrials.gov, and Web of Science databases were queried from inception up to June 3rd 2021. Study Eligibility Criteria We included all clinical studies (prospective and retrospective cohort studies, case-control studies, case series, and rapid communications) that reported data on any maternal and neonatal outcomes of pregnant women with COVID-19. Study Appraisal and Synthesis Methods Data were analyzed as pooled proportions or odds ratios (OR) and 95% confidence intervals (95% CI) in meta-analysis models. Results We included 111 studies enrolling 42754 COVID-19-positive pregnant women. From COVID-19-positive pregnant women, the incidence rate of cesarean section was 53.2% (95% CI: 48%–58.4%), 41.5% (95% CI: 36.3%–46.8%) for spontaneous vaginal delivery and 6.4% (95% CI: 4.5%–9.2%) for operative delivery. The rate of some adverse neonatal events was relatively high in mothers infected with COVID-19 including premature delivery (16.7%, 95% CI: 12.8%–21.5%), and low birthweight (16.7%, 95% CI: 12.8%–21.5%). Vertical transmission (3.5%, 95% CI: 2.7%–4.7%), neonatal death (3%, 95% CI: 2%–4%), stillbirth (1.9%, 95% CI: 1.5–2.4%) and maternal mortality (0.012% 95% CI: 0.010-0.014%) were rare adverse events. Mean birth weight was 3069.7g, 95% CI: 3009.7g–3129.8g). In the comparative analysis, COVID-19 significantly increased the risk of premature delivery (OR= 1. 48, [95% CI; 1 .22, 1.8]), preeclampsia (OR= 1. 6, [95% CI; 1.2, 2.1]), stillbirth (OR= 2.36, [95% CI 1.24, 4.462]), neonatal mortality (OR= 3.35, [95% CI; 1.07, 10.5]), and maternal mortality (OR= 3.08, [95% CI; 1.5, 6.3]). Pooled analyses were homogenous, with mild heterogeneity in premature delivery and preeclampsia outcomes. Conclusion Data must be interpreted with caution as limited data is available and no complete assessment of bias is possible at this time. Our data suggests that pregnant women who test positive for COVID-19 seem to be at higher risk for lower birth weights and premature delivery. There is no evidence at this time of the sharply increased maternal mortality that was seen with both the previous 2002 Middle East Respiratory Syndrome (MERS) and 2003 Severe Acute Respiratory Syndrome (SARS) pandemics.
- Pregnant women
- Risk factor