Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis

Citation: Karimi L, Makvandi S, Vahedian-Azimi A, Sathyapalan T, Sahebkar A. Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis. J Pregnancy. 2021 Mar 5;2021:8870129. doi: 10.1155/2021/8870129. PMID: 33728066; PMCID: PMC7938334.

• Pregnant women are at a higher risk for acquiring viral respiratory infections and severe pneumonia due to physiological changes in their immune and cardiopulmonary systems
• Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes.
• Main questions of the study: What is the mortality rate of COVID-19 in pregnant and postpartum women, and how many and what type of comorbidities were found in recovered and deceased patients? What were the disease symptoms and the mode of delivery in the maternal deaths?
• This is a meta-analysis of 117 studies including a total of 11758 pregnant women aged between 15 and 48 years.
• Most subjects were infected during third trimester
• Maternal mortality was 1.3%
• In all of the fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. After them, dyspnea (58.3%) and myalgia (50%) were the most common symptoms, respectively. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare.
• Risk factors for severe disease and death in pregnancy include older mean age (especially ≥35 years), obesity, preexisting medical comorbidities (particularly hypertension and diabetes or more than one comorbidity), and being unvaccinated
• The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term.

Limitations:

• No available data on first and early second trimester of pregnancy infections
• Only studies written in English were included
• Retrospective design

Strengths:

• Relatively high sample size
• Inclusion of studies from different countries and study participants from a variety of socioeconomic status

Conclusion:

• COVID-19 infection was associated with higher rates (and pooled proportions) of cesarean section in pregnant women and their mortality
• The findings of the study can be a guide to prenatal counseling for pregnant women
• However, based on the results of the study COVID-19 infection cannot be considered as an indication for caesarian delivery.