COVID-19 during pregnancy should we really worry from vertical transmission or rather from fetal hypoxia and placental insufficiency? A systematic review and meta -analysis

AbdelMassih, Antoine Fouda Raghda Essam Rana Negm Alhussein Khalil Dalia Habib Dalia Afdal George Ismail Habiba-Allah Aly Hadeer Genedy Ibrahim Qadi Layla El Makki Leena Shulqamy Maha Hanafy Maram AbdelMassih Marian Ibrahim Marina Ebaid Mohamed Ibrahim Monica El-Husseiny Nadine Ashraf Nirvana Shebl Noura Menshawey Rahma Darwish Rama ElShahawi Rana Ramadan Rana Albala Sadra Imran Salwa Ahmed Sama Khaldi Samer Abohashish Sara Paulo Stavro Omar Yasmin Tadros Mourad Alfy

Background: COVID-19 is the largest outbreak to strike humanity. The wide scale of fatalities and morbidities lead to a concurrent pandemic of uncertainty in scientific evidence. Conflicting evidences are released on daily basis about the neonatal outcomes of COVID-19 positive mothers. The aim of this study was to use the relevant case reports and series to determine the percentage of newborns who test positive in COVID-19 positive mothers. Secondary outcomes included examining laboratory and placental abnormalities among fetus-mother pairs. Methods: : Systematic review was performed on all studies reporting primary data on fetus-mother pairs with COVID-19. Data bases were searched for studies that met our inclusion and exclusion criteria. Results: : Final screening revealed 66 studies, from which the primary data of 1787 mother-infant pairs was obtained. Only 2.8% of mother infant pairs were tested positive, and this finding is identical to percentages reported in former coronaviridae outbreaks. Whereas, 20% manifested with intrauterine hypoxia alongside placental abnormalities suggestive of heavy placental vaso-occlusive involvement. Conclusions: : These findings suggest that while vertical transmission is unlikely, there appears to be an underlying risk of placental insufficiency due to the prothrombotic tendency observed in COVID-19 infection. Guidelines for proper prophylactic anticoagulation in COVID positive mothers need to be established.