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

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

doi:10.1136/bmjgh-2022-009495

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

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

Centre of Excellence in Women and Child Health, East Africa

Research output: Contribution to journal › Article › peer-review

106 Citations (Scopus)

Abstract

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.

Original language	English
Article number	009495
Journal	BMJ Global Health
Volume	8
Issue number	1
DOIs	https://doi.org/10.1136/bmjgh-2022-009495
Publication status	Published - 16 Jan 2023

Keywords

COVID-19
Epidemiology
Maternal health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjgh-2022-009495

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Smith, E. R., Oakley, E., Grandner, G. W., Ferguson, K., Farooq, F., Afshar, Y., Ahlberg, M., Ahmadzia, H., Akelo, V., Aldrovandi, G., Tippett Barr, B. A., Bevilacqua, E., Brandt, J. S., Broutet, N., Fernández Buhigas, I., Carrillo, J., Clifton, R., Conry, J., Cosmi, E., ... Tielsch, J. M. (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), Article 009495. https://doi.org/10.1136/bmjgh-2022-009495

@article{986175aecca34158a9a15be442908801,

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

abstract = "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.",

keywords = "COVID-19, Epidemiology, Maternal health",

author = "Smith, {Emily R.} and Erin Oakley and Grandner, {Gargi Wable} and Kacey Ferguson and Fouzia Farooq and Yalda Afshar and Mia Ahlberg and Homa Ahmadzia and Victor Akelo and Grace Aldrovandi and {Tippett Barr}, {Beth A.} and Elisa Bevilacqua and Brandt, {Justin S.} and Nathalie Broutet and {Fern{\'a}ndez Buhigas}, Irene and Jorge Carrillo and Rebecca Clifton and Jeanne Conry and Erich Cosmi and Fatima Crispi and Francesca Crovetto and Camille Delgado-L{\'o}pez and Hema Divakar and Driscoll, {Amanda J.} and Guillaume Favre and Flaherman, {Valerie J.} and Chris Gale and Gil, {Maria M.} and Gottlieb, {Sami L.} and Eduard Gratac{\'o}s and Olivia Hernandez and Stephanie Jones and Erkan Kalafat and Sammy Khagayi and Marian Knight and Karen Kotloff and Antonio Lanzone and {Le Doare}, Kirsty and Christoph Lees and Ethan Litman and Lokken, {Erica M.} and {Laurita Longo}, Valentina and Madhi, {Shabir A.} and Magee, {Laura A.} and Martinez-Portilla, {Raigam Jafet} and McClure, {Elizabeth M.} and Metz, {Tori D.} and Miller, {Emily S.} and Deborah Money and Sakita Moungmaithong and Edward Mullins and Nachega, {Jean B.} and Nunes, {Marta C.} and Dickens Onyango and Alice Panchaud and Poon, {Liona C.} and Daniel Raiten and Lesley Regan and Gordon Rukundo and Daljit Sahota and Allie Sakowicz and Jose Sanin-Blair and Jonas S{\"o}derling and Olof Stephansson and Marleen Temmerman and Anna Thorson and Tolosa, {Jorge E.} and Julia Townson and Miguel Valencia-Prado and Silvia Visentin and {Von Dadelszen}, Peter and {Adams Waldorf}, Kristina and Clare Whitehead and Murat Yassa and Tielsch, {Jim M.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ",

year = "2023",

month = jan,

day = "16",

doi = "10.1136/bmjgh-2022-009495",

language = "English",

volume = "8",

journal = "BMJ Global Health",

issn = "2059-7908",

publisher = "BMJ Publishing Group",

number = "1",

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Smith, ER, Oakley, E, Grandner, GW, Ferguson, K, Farooq, F, Afshar, Y, Ahlberg, M, Ahmadzia, H, Akelo, V, Aldrovandi, G, Tippett Barr, BA, Bevilacqua, E, Brandt, JS, Broutet, N, Fernández Buhigas, I, Carrillo, J, Clifton, R, Conry, J, Cosmi, E, Crispi, F, Crovetto, F, Delgado-López, C, Divakar, H, Driscoll, AJ, Favre, G, Flaherman, VJ, Gale, C, Gil, MM, Gottlieb, SL, Gratacós, E, Hernandez, O, Jones, S, Kalafat, E, Khagayi, S, Knight, M, Kotloff, K, Lanzone, A, Le Doare, K, Lees, C, Litman, E, Lokken, EM, Laurita Longo, V, Madhi, SA, Magee, LA, Martinez-Portilla, RJ, McClure, EM, Metz, TD, Miller, ES, Money, D, Moungmaithong, S, Mullins, E, Nachega, JB, Nunes, MC, Onyango, D, Panchaud, A, Poon, LC, Raiten, D, Regan, L, Rukundo, G, Sahota, D, Sakowicz, A, Sanin-Blair, J, Söderling, J, Stephansson, O, Temmerman, M, Thorson, A, Tolosa, JE, Townson, J, Valencia-Prado, M, Visentin, S, Von Dadelszen, P, Adams Waldorf, K, Whitehead, C, Yassa, M & Tielsch, JM 2023, 'Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: An individual participant data meta-analysis', BMJ Global Health, vol. 8, no. 1, 009495. https://doi.org/10.1136/bmjgh-2022-009495

TY - JOUR

T1 - Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection

T2 - An individual participant data meta-analysis

AU - Smith, Emily R.

AU - Oakley, Erin

AU - Grandner, Gargi Wable

AU - Ferguson, Kacey

AU - Farooq, Fouzia

AU - Afshar, Yalda

AU - Ahlberg, Mia

AU - Ahmadzia, Homa

AU - Akelo, Victor

AU - Aldrovandi, Grace

AU - Tippett Barr, Beth A.

AU - Bevilacqua, Elisa

AU - Brandt, Justin S.

AU - Broutet, Nathalie

AU - Fernández Buhigas, Irene

AU - Carrillo, Jorge

AU - Clifton, Rebecca

AU - Conry, Jeanne

AU - Cosmi, Erich

AU - Crispi, Fatima

AU - Crovetto, Francesca

AU - Delgado-López, Camille

AU - Divakar, Hema

AU - Driscoll, Amanda J.

AU - Favre, Guillaume

AU - Flaherman, Valerie J.

AU - Gale, Chris

AU - Gil, Maria M.

AU - Gottlieb, Sami L.

AU - Gratacós, Eduard

AU - Hernandez, Olivia

AU - Jones, Stephanie

AU - Kalafat, Erkan

AU - Khagayi, Sammy

AU - Knight, Marian

AU - Kotloff, Karen

AU - Lanzone, Antonio

AU - Le Doare, Kirsty

AU - Lees, Christoph

AU - Litman, Ethan

AU - Lokken, Erica M.

AU - Laurita Longo, Valentina

AU - Madhi, Shabir A.

AU - Magee, Laura A.

AU - Martinez-Portilla, Raigam Jafet

AU - McClure, Elizabeth M.

AU - Metz, Tori D.

AU - Miller, Emily S.

AU - Money, Deborah

AU - Moungmaithong, Sakita

AU - Mullins, Edward

AU - Nachega, Jean B.

AU - Nunes, Marta C.

AU - Onyango, Dickens

AU - Panchaud, Alice

AU - Poon, Liona C.

AU - Raiten, Daniel

AU - Regan, Lesley

AU - Rukundo, Gordon

AU - Sahota, Daljit

AU - Sakowicz, Allie

AU - Sanin-Blair, Jose

AU - Söderling, Jonas

AU - Stephansson, Olof

AU - Temmerman, Marleen

AU - Thorson, Anna

AU - Tolosa, Jorge E.

AU - Townson, Julia

AU - Valencia-Prado, Miguel

AU - Visentin, Silvia

AU - Von Dadelszen, Peter

AU - Adams Waldorf, Kristina

AU - Whitehead, Clare

AU - Yassa, Murat

AU - Tielsch, Jim M.

PY - 2023/1/16

Y1 - 2023/1/16

N2 - 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.

AB - 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.

KW - COVID-19

KW - Epidemiology

KW - Maternal health

UR - http://www.scopus.com/inward/record.url?scp=85146924226&partnerID=8YFLogxK

U2 - 10.1136/bmjgh-2022-009495

DO - 10.1136/bmjgh-2022-009495

M3 - Article

AN - SCOPUS:85146924226

SN - 2059-7908

VL - 8

JO - BMJ Global Health

JF - BMJ Global Health

IS - 1

M1 - 009495

ER -

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

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Keywords

UN SDGs

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