The clinical therapy of COVID-19 infection during pregnancy is still insufficient and limited. The current literature on COVID-19 infection during pregnancy and childbirth is summarized in this article, with a focus on maternal and neonatal outcomes. From June 1 to September 7, 2020, a systematic search of pertinent medical subject heading (MeSH) terms, covered by the electronic databases Web of Science and Scopus, PubMed, Google Scholar, and SID key phrases including coronavirus or COVID-19 and pregnancy was undertaken. The search and selection criteria were restricted to English and Farsi literature. COVID-19 in pregnancy articles of all types were considered in the study. The references of relevant studies were also searched. After deleting duplicate and ineligible items, a total of 21 articles were collected. We found 21 studies with a total of 6,569 pregnant women who had COVID-19 infection: only one publication provided disease severity: 368 (95.6%) mild cases, 14 (3.6%) severe cases, and three (0.8%) serious cases. A total of 6,569 women gave birth more often by caesarean than by vaginal delivery. With multiple organ dysfunction syndromes (MODS), some women developed symptoms that necessitated ICU admission. The most commonly administered treatments for pregnant women with COVID-19 were hydroxychloroquine, Beclomethasone, Calamine, diclofenac sodium, Methylprednisolone, Azithromycin, Ganciclovir, Chinese herbal medicine, and Oseltamivir. The most commonly reported symptoms were fever and cough, followed by rhinorrhea, chest tightness, dyspnea, nasal congestion, and myalgias. Maternal outcomes included premature rupture of membranes, maternal death (21), gestational diabetes, preeclampsia, placental abruption, fetal distress, anemia, preterm birth (< 37 weeks), and fetal growth restriction, miscarriage, hypertension, and influenza. Neonatal intensive care unit (NICU) admission, prematurity, birth weight 2,500 g, preterm delivery (37 weeks), fetal discomfort, neonatal asphyxia, stillbirth (5), and neonatal death (9) were among the outcomes for babies. All of the infants had good Apgar scores. Prenatal and neonatal outcomes appear to be favorable in the majority of cases. Pregnant women and babies should be considered particularly vulnerable populations in terms of COVID-19 preventive and management strategies.
Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. American Journal of Obstetrics and Gynecology. 2020;223(1):36–41.
2.
Islam N, Shkolnikov VM, Acosta RJ, Klimkin I, Kawachi I, Irizarry RA, et al. Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries. BMJ. :n1137.
3.
Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. 2020;2(2):100107.
4.
Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 12(2):194.
5.
Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review. Fetal and Pediatric Pathology. 2020;39(3):246–50.
6.
Ashokka B, Loh MH, Tan CH, Su LL, Young BE, Lye DC, et al. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. American Journal of Obstetrics and Gynecology. 2020;223(1):66-74.e3.
7.
Schwartz DA. An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Archives of Pathology & Laboratory Medicine. 2020;144(7):799–805.
8.
Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. American Journal of Obstetrics and Gynecology. 2020;222(5):415–26.
9.
Cao D, Yin H, Chen J, Tang F, Peng M, Li R, et al. Clinical analysis of ten pregnant women with COVID-19 in Wuhan, China: A retrospective study. International Journal of Infectious Diseases. 2020;95:294–300.
10.
Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. American Journal of Obstetrics and Gynecology. 2020;222(6):521–31.
11.
Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. The Lancet Infectious Diseases. 2020;20(5):559–64.
12.
Yang Z, Wang M, Zhu Z, Liu Y. Coronavirus disease 2019 (COVID-19) and pregnancy: a systematic review. The Journal of Maternal-Fetal & Neonatal Medicine. 2022;35(8):1619–22.
13.
Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morbidity and Mortality Weekly Report. 69(25):769–75.
14.
Berghella V. Coronavirus disease 2019 (COVID-19): Pregnancy issues. UpToDate Internet Apr. 2020;24.
15.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 2020;395(10226):809–15.
16.
Wang Y, Liu Y, Liu L, Wang X, Luo N, Li L. Clinical Outcomes in 55 Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Who Were Asymptomatic at Hospital Admission in Shenzhen, China. The Journal of Infectious Diseases. 2020;221(11):1770–4.
17.
Panahi L, Amiri M, Pouy S. Risks of novel coronavirus disease (COVID-19) in pregnancy; a narrative review. Arch Emerg Med. 2020;8(1).
18.
Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. American Journal of Roentgenology. 2020;215(1):127–32.
19.
Wang S, Guo L, Chen L, Liu W, Cao Y, Zhang J, et al. A Case Report of Neonatal 2019 Coronavirus Disease in China. Clinical Infectious Diseases. 2020;71(15):853–7.
20.
Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19. JAMA. 2020;324(13):1330.
21.
Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research. 2020;30(3):269–71.
22.
Mulangu S, Dodd LE, Davey RT, Tshiani Mbaya O, Proschan M, Mukadi D, et al. A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. New England Journal of Medicine. 2019;381(24):2293–303.
23.
Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, et al. Perinatal Transmission of 2019 Coronavirus Disease–Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry? Clinical Infectious Diseases. 2021;72(5):862–4.
24.
Elshafeey F, Magdi R, Hindi N, Elshebiny M, Farrag N, Mahdy S, et al. A systematic scoping review of COVID‐19 during pregnancy and childbirth. International Journal of Gynecology & Obstetrics. 2020;150(1):47–52.
25.
Asadi L, Tabatabaei RS, Safinejad H, Mohammadi M. New Corona Virus (COVID-19) Management in Pregnancy and Childbirth. Archives of Clinical Infectious Diseases. 15(COVID-19).
26.
Maxwell C, McGeer A, Tai KFY, Sermer M. No. 225-Management Guidelines for Obstetric Patients and Neonates Born to Mothers With Suspected or Probable Severe Acute Respiratory Syndrome (SARS). Journal of Obstetrics and Gynaecology Canada. 2017;39(8):e130–7.
27.
Fang Z, Yi F, Wu K, Lai K, Sun X, Zhong N, et al. Clinical Characteristics of Coronavirus Disease 2019 (COVID-19): An Updated Systematic Review.
28.
Maxwell C, McGeer A, Tai KFY, Sermer M, Farine D, Basso M, et al. Management Guidelines for Obstetric Patients and Neonates Born to Mothers With Suspected or Probable Severe Acute Respiratory Syndrome (SARS). Journal of Obstetrics and Gynaecology Canada. 2009;31(4):358–64.
29.
Khodamoradi Z, Boogar SS, Shirazi FKH, Kouhi P. COVID-19 and Acute Pulmonary Embolism in Postpartum Patient. Emerging Infectious Diseases. 2020;26(8):1937–9.
30.
Martinelli I, Ferrazzi E, Ciavarella A, Erra R, Iurlaro E, Ossola M, et al. Pulmonary embolism in a young pregnant woman with COVID-19. Thrombosis Research. 2020;191:36–7.
31.
Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul‐Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review. International Journal of Gynecology & Obstetrics. 2020;151(1):7–16.
32.
Liu Y, Chen H, Tang K, Guo Y. Withdrawn: Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. Journal of Infection. 2020;
33.
Hirshberg JS, Stout MJ, Raghuraman N. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. American Journal of Obstetrics & Gynecology MFM. 2020;2(3):100162.
34.
Gidlöf S, Savchenko J, Brune T, Josefsson H. COVID‐19 in pregnancy with comorbidities: More liberal testing strategy is needed. Acta Obstetricia et Gynecologica Scandinavica. 2020;99(7):948–9.
35.
Martínez-Perez O, Vouga M, Cruz Melguizo S, Forcen Acebal L, Panchaud A, Muñoz-Chápuli M, et al. Association Between Mode of Delivery Among Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain. JAMA. 2020;324(3):296.
36.
Salvatore CM, Han JY, Acker KP, Tiwari P, Jin J, Brandler M, et al. Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. The Lancet Child & Adolescent Health. 2020;4(10):721–7.
37.
Rodrigues C, Baía I, Domingues R, Barros H. Pregnancy and Breastfeeding During COVID-19 Pandemic: A Systematic Review of Published Pregnancy Cases. Frontiers in Public Health. 8.
38.
Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatrics. 2020;174(7):722.
39.
Kirtsman M, Diambomba Y, Poutanen SM, Malinowski AK, Vlachodimitropoulou E, Parks WT, et al. Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection. Canadian Medical Association Journal. 2020;192(24):E647–50.
40.
Khan S, Peng L, Siddique R, Nabi G, Nawsherwan, Xue M, et al. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infection Control & Hospital Epidemiology. 2020;41(6):748–50.
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