Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Gao, Yi-jie; Ye, Lei; Zhang, Jia-shuo; Yin, Yang-xue; Liu, Min; Yu, Hong-biao; Zhou, Rong

BACKGROUND: The recent COVID-19 outbreak in Wuhan, China, has quickly spread throughout the world. In this study, we systematically reviewed the clinical features and outcomes of pregnant women with COVID-19. METHODS: PubMed, Web of Science, EMBASE and MEDLINE were searched from January 1, 2020, to April 16, 2020. Case reports and case series of pregnant women infected with SARS-CoV-2 were included. Two reviewers screened 366 studies and 14 studies were included. Four reviewers independently extracted the features from the studies. We used a random-effects model to analyse the incidence (P) and 95% confidence interval (95% CI). Heterogeneity was assessed using the I(2) statistic. RESULTS: The meta-analysis included 236 pregnant women with COVID-19. The results were as follows: positive CT findings (71%; 95% CI, 0.49–0.93), caesarean section (65%; 95% CI, 0.42–0.87), fever (51%; 95% CI, 0.35–0.67), lymphopenia (49%; 95% CI, 0.29–0.70), coexisting disorders (33%; 95% CI, 0.21–0.44), cough (31%; 95% CI, 0.23–0.39), fetal distress (29%; 95% CI, 0.08–0.49), preterm labor (23%; 95% CI, 0.14–0.32), and severe case or death (12%; 95% CI, 0.03–0.20). The subgroup analysis showed that compared with non-pregnant patients, pregnant women with COVID-19 had significantly lower incidences of fever (pregnant women, 51%; non-pregnant patients, 91%; P < 0.00001) and cough (pregnant women, 31%; non-pregnant patients, 67%; P < 0.0001). CONCLUSIONS: The incidences of fever, cough and positive CT findings in pregnant women with COVID-19 are less than those in the normal population with COVID-19, but the rate of preterm labor is higher among pregnant with COVID-19 than among normal pregnant women. There is currently no evidence that COVID-19 can spread through vertical transmission.