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

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58 Citations (Scopus)


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 languageEnglish
Article number009495
JournalBMJ Global Health
Issue number1
Publication statusPublished - 16 Jan 2023


  • COVID-19
  • Epidemiology
  • Maternal health


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