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Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

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 ORCID:, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Adams Waldorf, Kristina, Whitehead, Clare, Yassa, Murat, Tielsch, Jim M., and Perinatal COVID PMA Study Collaborators, Langenegger, Eduard, Sam-Agudu, Nadia A., Gachuno, Onesmus W., Sekikubo, Musa, Mukwege, Denis M., Omore, Richard, Ouma, Gregory, Onyango, Clayton, Otieno, Kephas, Were, Zacchaeus Abaja, Were, Joyce, İlter, Pinar Birol, Mboizi, Robert, Hookham, Lauren, Meli, Federica, Bonanni, Giulia, Romanzi, Federica, Torcia, Eleonora, Ilio, Chiara di, Ananth, Cande V., Hill, Jennifer, Reddy, Ajay, Patrick, Haylea Sweat, Baba, Vuyelwa, Adam, Mary, Mlandu, Philiswa, Adam, Yasmin and Strehlau, Renate 2023. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. BMJ Global Health 8 (1) , e009495. 10.1136/bmjgh-2022-009495

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: License information from Publisher: LICENSE 1: URL:, Start Date: 2023-01-03, Type: open-access
Publisher: BMJ Publishing Group
Date of First Compliant Deposit: 15 February 2023
Date of Acceptance: 24 August 2022
Last Modified: 08 May 2023 22:32

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