Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

Emily R. Smith, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA emilysmith@gwu.edu.
Erin Oakley, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Gargi Wable Grandner, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Kacey Ferguson, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Fouzia Farooq, Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
Yalda Afshar, Division of Maternal Fetal Medicine, University of California Los Angeles, Los Angeles, California, USA.
Mia Ahlberg, Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden.
Homa Ahmadzia, Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Victor Akelo, Office of the Director, US Centers for Disease Control and Prevention, Kisumu, Kenya.
Grace Aldrovandi, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA.
Beth A. Tippett Barr, Office of the Director, US Centers for Disease Control and Prevention, Kisumu, Kenya.
Elisa Bevilacqua, Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy.
Justin S. Brandt, Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Nathalie Broutet, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland.
Irene Fernández Buhigas, Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain.
Jorge Carrillo, Departamento de Obstetricia y Ginecologia, Universidad del Desarrollo Facultad de Medicina Clinica Alemana, Santiago, Chile.
Rebecca Clifton, The Biostatistics Center, The George Washington University Milken Institute School of Public Health, Rockville, Maryland, USA.
Jeanne Conry, International Federation of Gynecology and Obstetrics, London, UK.
Erich Cosmi, Department of Women's and Children's Health, University of Padua, Padova, Italy.
Fatima Crispi, Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Francesca Crovetto, Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Camille Delgado-López, Surveillance for Emerging Threats to Mothers and Babies, Puerto Rico Department of Health, San Juan, Puerto Rico.
Hema Divakar, Asian Research and Training Institute for Skill Transfer (ARTIST), Bengaluru, India.
Amanda J. Driscoll, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Guillaume Favre, Materno-Fetal and Obstetrics Research Unit, Department 'Femme-Mère-Enfant', Lausanne University Hospital, Lausanne, Switzerland.
Valerie J. Flaherman, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
Chris Gale, Neonatal Medicine, School of Public Health, Imperial College London Faculty of Medicine, London, UK.
Maria M. Gil, Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain.
Sami L. Gottlieb, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland.
Eduard Gratacós, Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Olivia Hernandez, Gynecology and Obstetrics, Felix Bulnes Hospital and RedSalud Clinic, Santiago, Chile.
Stephanie Jones, South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

BMJ global health

Volume

8

Issue

1

DOI

10.1136/bmjgh-2022-009495

Keywords

COVID-19; Epidemiology; Maternal health

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.

Department

Global Health

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