Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis
Authors: Smith Emily R , Oakley Erin , Grandner Gargi Wable , Ferguson Kacey , Farooq Fouzia , Afshar Yalda , Ahlberg Mia , Ahmadzia Homa , Akelo Victor , Aldrovandi Grace , Tippett Barr Beth A , Bevilacqua Elisa , Brandt Justin S , Broutet Nathalie , Fernández Buhigas Irene , Carrillo Jorge , Clifton Rebecca , Conry Jeanne , Cosmi Erich , Crispi Fatima , Crovetto Francesca , Delgado-López Camille , Divakar Hema , Driscoll Amanda J , Favre Guillaume , Flaherman Valerie J , Gale Chris , Gil Maria M , Gottlieb Sami L , Gratacós Eduard , Hernandez Olivia , Jones Stephanie , Kalafat Erkan , Khagayi Sammy , Knight Marian , Kotloff Karen , Lanzone Antonio , Le Doare Kirsty , Lees Christoph , Litman Ethan , Lokken Erica M , Laurita Longo Valentina , Madhi Shabir A , Magee Laura A , Martinez-Portilla Raigam Jafet , McClure Elizabeth M , Metz Tori D , Miller Emily S , Money Deborah , Moungmaithong Sakita , Mullins Edward , Nachega Jean B , Nunes Marta C , Onyango Dickens , Panchaud Alice , Poon Liona C , Raiten Daniel , Regan Lesley , Rukundo Gordon , Sahota Daljit , Sakowicz Allie , Sanin-Blair Jose , Söderling Jonas , Stephansson Olof , Temmerman Marleen , Thorson Anna , Tolosa Jorge E , Townson Julia , Valencia-Prado Miguel , Visentin Silvia , von Dadelszen Peter , Adams Waldorf Kristina , Whitehead Clare , Yassa Murat , Tielsch Jim M 
Published: January 2023

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.