Maternal and neonatal outcomes in pregnant women with COVID-19: a systemic review

Objective: To fully understand the maternal and neonatal outcomes in pregnant women with COVID-19 and explore the evidence of intrauterine vertical transmission of 2019-nCoV by analyzing clinical and laboratory information in peer-reviewed publications on COVID-19 in pregnant women Methods: PubMed, Embase, China National Knowledge Infrastructure, China Academic Journals, and Wanfang Databases were searched to retrieve articles on COVID-19 in pregnancy published from December 1, 2019, to April 9, 2020 In addition, the World Health Organization COVID-19 Database and the reference lists in each included article were also searched All included cases were positive for 2019-nCoV nucleic acid with maternal and neonatal outcomes regardless of delivery or not Clinical manifestations, perinatal and neonatal outcomes were analyzed systematically Results: This study reviewed 29 publications involving 146 pregnant women who tested positive for 2019-nCoV nucleic acid and their 116 newborns (including two twins) Five cases of severe COVID-19 and three cases of unidentified type that were admitted to ICU for treatment were severe symptoms, accounting for 5 5% (8/146) of all cases Totally, 69 9% (102/146) of the women underwent cesarean section and 8 2% (12/146) gave birth vaginally Thirty (20 5%) women continued their pregnancies One case (0 7%, 1/146) terminated the pregnancy at 26 weeks of gestation due to bidirectional affective disorder and one (0 7%, 1/146) received artificial abortion at 6 weeks of gestation Fever (58 2%, 85/146) and cough (32 9%, 48/146) were the most common symptoms However, 15 8% (23/146) of the pregnant women were asymptomatic on admission and symptoms appeared or became worse after delivery in 20 5% (30/146) Lymphocytopenia (49 6%, 56/113) and elevated C-reactive protein (58 4%, 66/113) were the main laboratory findings The most common computed tomography (CT) finding was bilateral multiple patchy ground-glass opacity in lungs (79 7%, 94/118) The outcomes of 92 2% (107/116) of the newborns were good, and the rest 7 8% (9/116) showed different abnormalities of varying degrees Among the nine newborns, six showed different degrees of dyspnea, cyanosis and vomiting including one died of multiple organ failure and disseminated intravascular coagulation;one tested positive for viral nucleic acid 36 hours after birth;one was stillbirth due to unknown reason, but intrauterine vertical transmission was excluded;one neonatal death in a critically ill mother undergoing cesarean delivery Conclusions: Pregnant women are less likely to progress to severe COVID-19 and mostly have a good outcome Despite reports of adverse neonatal outcomes, evidence of intrauterine vertical transmission of 2019-nCoV remains insufficient Copyright © 2020 by the Chinese Medical Association