Download PDF
CC BY-NC-ND 4.0 · Avicenna J Med 2021; 11(04): 200-209
DOI: 10.1055/s-0041-1736540
Review Article

Fetal Complications in COVID-19 Infected Pregnant Woman: A Systematic Review and Meta-Analysis

Arjola Agolli 
1   Division of Clinical & Translational Research, Larkin Health System, South Miami, Florida, United States
,
Olsi Agolli
1   Division of Clinical & Translational Research, Larkin Health System, South Miami, Florida, United States
,
Diana Fiorela Sánchez Velazco 
2   Cayetano Heredia Peruvian University, San Martín de Porres, Peru
,
Md Ripon Ahammed 
3   National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
,
Mehrie Patel
1   Division of Clinical & Translational Research, Larkin Health System, South Miami, Florida, United States
,
Jose Cardona-Guzman 
4   Larkin Community Hospital System, South Miami, Florida, United States
,
Radhika Garimella 
5   Dr. N.T.R University of Health Sciences, India
,
Natcha Rummaneethorn
6   Metropolitan Hospital, New York, United States
,
Seema Bista
1   Division of Clinical & Translational Research, Larkin Health System, South Miami, Florida, United States
,
Rafael Abreu
4   Larkin Community Hospital System, South Miami, Florida, United States
,
Nikole Czapp
4   Larkin Community Hospital System, South Miami, Florida, United States
,
Manuel Garcia
4   Larkin Community Hospital System, South Miami, Florida, United States
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of this article.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Pregnancy is an immunocompromised state and, for this reason, a pregnant woman is at a higher risk of getting infected as compared with a healthy individual. There is limited data available regarding the impact of COVD-19 on pregnancy; however, the case of miscarriage due to placental infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in second trimester has already been reported.

Methods We searched for all published articles in PubMed, Science Direct, Cochrane, Scopus, and Embase. The literature search produced 167 relevant publications; 67 manuscripts were further excluded because they did not satisfy our inclusion criteria. Out of the remaining 100 articles, 78 were excluded after full text screening. Therefore, a total of 22 articles were eligible for review in our study.

Results Overall, these 22 studies included a total of 7,034 participants: 2,689 (38.23%) SARS-CoV-2 positive pregnant women, of which 2,578 (95.87%) were laboratory confirmed and 111 (4.13%) were clinically diagnosed. Among the positive patients, there were 174 (6.47%) cases of abortion, of them 168 (96.55%) were spontaneous abortions and 6 (3.45%) were missed. Most patients either reported mild symptoms of fever, cough, fatigue, and anosmia or they presented asymptomatic.

Conclusion Additional investigation and rigorous research are warranted to confirm placental pathology mechanisms concerning COVID-19 to protect maternal and fetal health.

Keywords

coronavirus - COVID-19 - pregnancy loss - abortion - pregnancy


Publication History

Article published online:
15 November 2021

© 2021. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Chowdhury TI, Choudhury TR, Rahman MM, Das TR, Alam J. Spontaneous abortion in pregnancies having COVID-19 infection in Bangladesh: a series of cases. SSRN Electron J January 2021 DOI: 10.2139/ssrn.3760523
    Google Scholar
  • 2 Rotshenker-Olshinka K, Volodarsky-Perel A, Steiner N, Rubenfeld E, Dahan MH. COVID-19 pandemic effect on early pregnancy: are miscarriage rates altered, in asymptomatic women?. Arch Gynecol Obstet 2021; 303 (03) 839-845
    CrossrefPubMedGoogle Scholar
  • 3 Cascella M, Rajnik M, Cuomo A. Features, evaluation, and treatment of coronavirus (COVID-19). - PubMed. StatPearls. Published 2021. Accessed April 17, 2021 at: https://pubmed.ncbi.nlm.nih.gov/32150360/
    Google Scholar
  • 4 Bergsbaken T, Fink SL, Cookson BT. Pyroptosis: host cell death and inflammation. Nat Rev Microbiol 2009; 7 (02) 99-109
    CrossrefPubMedGoogle Scholar
  • 5 Cosma S, Carosso AR, Cusato J. et al. Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients. Am J Obstet Gynecol 2021; 224 (04) 391.e1-391.e7
    CrossrefPubMedGoogle Scholar
  • 6 Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol 2015; 73 (03) 199-213
    CrossrefPubMedGoogle Scholar
  • 7 Veenstra van Nieuwenhoven AL, Heineman MJ, Faas MM. The immunology of successful pregnancy. Hum Reprod Update 2003; 9 (04) 347-357
    CrossrefPubMedGoogle Scholar
  • 8 Druckmann R, Druckmann MA. Progesterone and the immunology of pregnancy. J Steroid Biochem Mol Biol 2005; 97: 389-396
    CrossrefPubMedGoogle Scholar
  • 9 Young BC, Stanic AK, Panda B, Rueda BR, Panda A. Longitudinal expression of Toll-like receptors on dendritic cells in uncomplicated pregnancy and postpartum. Am J Obstet Gynecol 2014; 210 (05) 445.e1-445.e6
    CrossrefPubMedGoogle Scholar
  • 10 Piccinni MP, Romagnani S. Regulation of fetal allograft survival by a hormone-controlled Th1- and Th2-type cytokines. Immunol Res 1996; 15 (02) 141-150
    CrossrefPubMedGoogle Scholar
  • 11 Di Renzo GC, Giardina I. Coronavirus disease 2019 in pregnancy: consider thromboembolic disorders and thromboprophylaxis. Am J Obstet Gynecol 2020; 223 (01) 135
    CrossrefPubMedGoogle Scholar
  • 12 Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: incidence, pathophysiology, and management. Thromb Res 2020; 194: 101-115
    CrossrefPubMedGoogle Scholar
  • 13 Whittaker E, Bamford A, Kenny J. et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324 (03) 259-269
    CrossrefPubMedGoogle Scholar
  • 14 Hosier H, Farhadian SF, Morotti RA. et al. SARS-CoV-2 infection of the placenta. J Clin Invest 2020; 130 (09) 4947-4953
    CrossrefPubMedGoogle Scholar
  • 15 Dashraath P, Wong JLJ, Lim MXK. et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020; 222 (06) 521-531
    CrossrefPubMedGoogle Scholar
  • 16 Baud D, Greub G, Favre G. et al. Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection. JAMA 2020; 323 (21) 2198-2200
    CrossrefPubMedGoogle Scholar
  • 17 Yan J, Guo J, Fan C. et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020; 223 (01) 111.e1-111.e14
    CrossrefPubMedGoogle Scholar
  • 18 Rana MS, Usman M, Alam MM. et al. First trimester miscarriage in a pregnant woman infected with COVID-19 in Pakistan. J Infect 2021; 82 (01) e27-e28
    CrossrefPubMedGoogle Scholar
  • 19 Wong TC, Lee ZY, Sia TLL, Chang AKW, Chua HH. Miscarriage risk in COVID-19 infection. SN Compr Clin Med 2020; 2 (09) 1-4
    CrossrefPubMedGoogle Scholar
  • 20 Schjenken JE, Tolosa JM, Paul JW, Clifton VL, Smith R. Mechanisms of maternal immune tolerance during pregnancy. In: Zheng J. ed. Recent Advances Research Human Placenta. Vol. 11. Croatia: InTech; 2012: 211-242
    Google Scholar
  • 21 Buonsenso D, Costa S, Sanguinetti M. et al. Neonatal late onset infection with severe acute respiratory syndrome coronavirus 2. Am J Perinatol 2020; 37 (08) 869-872
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Chen L, Li Q, Zheng D. et al. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med 2020; 382 (25) e100
    CrossrefPubMedGoogle Scholar
  • 23 Di Mascio D, Sen C, Saccone G. et al. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. J Perinat Med 2020; 48 (09) 950-958
    CrossrefPubMedGoogle Scholar
  • 24 Mattar CN, Kalimuddin S, Sadarangani SP. et al. Pregnancy outcomes in COVID-19: a prospective cohort study in Singapore. Ann Acad Med Singap 2020; 49 (11) 857-869
    CrossrefPubMedGoogle Scholar
  • 25 Hachem R, Markou GA, Veluppillai C, Poncelet C. Late miscarriage as a presenting manifestation of COVID-19. Eur J Obstet Gynecol Reprod Biol 2020; 252: 614
    CrossrefPubMedGoogle Scholar
  • 26 Shmakov RG, Prikhodko A, Polushkina E. et al. Clinical course of novel COVID-19 infection in pregnant women. J Matern Fetal Neonatal Med 2020; 1-7
    CrossrefPubMedGoogle Scholar
  • 27 Mayeur A, Binois O, Gallot V. et al. First follow-up of art pregnancies in the context of the COVID-19 outbreak. Eur J Obstet Gynecol Reprod Biol 2020; 253: 71-75
    CrossrefPubMedGoogle Scholar
  • 28 Sahin D, Tanacan A, Erol SA. et al. Updated experience of a tertiary pandemic center on 533 pregnant women with COVID-19 infection: a prospective cohort study from Turkey. Int J Gynaecol Obstet 2021; 152 (03) 328-334
    CrossrefPubMedGoogle Scholar
  • 29 Michel A-S, De Logiviere V, Schnuriger A, Lefebvre M, Maisonneuve E, Kayem G. Description of a late miscarriage case at 16 Weeks of Gestation associated with a SARS-CoV-2 infection. J Gynecol Obstet Hum Reprod 2021; 50 (03) 102064
    CrossrefPubMedGoogle Scholar
  • 30 D'Antonio F, Sen C, Mascio DDI. et al. On the behalf of the World Association of Perinatal Medicine working group on coronavirus disease 2019. Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019. Am J Obstet Gynecol MFM 2021; 3 (04) 100329
    CrossrefPubMedGoogle Scholar
  • 31 Sentilhes L, De Marcillac F, Jouffrieau C. et al. Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth. Am J Obstet Gynecol 2020; 223 (06) 914.e1-914.e15
    CrossrefPubMedGoogle Scholar
  • 32 la Cour Freiesleben N, Egerup P, Hviid KVR. et al. SARS-CoV-2 in first trimester pregnancy: a cohort study. Hum Reprod 2021; 36 (01) 40-47
    PubMedGoogle Scholar
  • 33 Ayed A, Embaireeg A, Benawadh A. et al. Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait. BMC Pregnancy Childbirth 2020; 20 (01) 754
    CrossrefPubMedGoogle Scholar
  • 34 Shende P, Gaikwad P, Gandhewar M. et al. Persistence of SARS-CoV-2 in the first trimester placenta leading to transplacental transmission and fetal demise from an asymptomatic mother. Hum Reprod 2021; 36 (04) 899-906
    CrossrefPubMedGoogle Scholar
  • 35 de Vasconcelos Gaspar A, Santos Silva I. SARS-CoV-2 in pregnancy-the first wave. Medicina (Kaunas) 2021; 57 (03) 241
    CrossrefPubMedGoogle Scholar
  • 36 Martinez-Perez O, Prats Rodriguez P, Muner Hernandez M. et al; Spanish Obstetric Emergency Group. The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis. BMC Pregnancy Childbirth 2021; 21 (01) 273
    CrossrefPubMedGoogle Scholar
  • 37 Pulinx B, Kieffer D, Michiels I. et al. Vertical transmission of SARS-CoV-2 infection and preterm birth. Eur J Clin Microbiol Infect Dis 2020; 39 (12) 2441-2445
    CrossrefPubMedGoogle Scholar
  • 38 Review WP. Abortion Rates by Country 2021. Accessed April 17, 2021 at: https://worldpopulationreview.com/country-rankings/abortion-rates-by-country
    Google Scholar
  • 39 Wastnedge EAN, Reynolds RM, van Boeckel SR. et al. Pregnancy and COVID-19. Physiol Rev 2021; 101 (01) 303-318
    CrossrefPubMedGoogle Scholar
  • 40 Dhaundiyal A, Kumari P, Jawalekar SS, Chauhan G, Kalra S, Navik U. Is highly expressed ACE 2 in pregnant women “a curse” in times of COVID-19 pandemic?. Life Sci 2021; 264: 118676
    CrossrefPubMedGoogle Scholar
  • 41 Poisson TM, Pierone Jr G. Placental pathology and fetal demise at 35 weeks of gestation in a woman with SARS-CoV-2 infection: a case report. Case Rep Womens Health 2021; 30: e00289
    CrossrefPubMedGoogle Scholar
  • 42 Muyayalo KP, Huang D-H, Zhao S-J, Xie T, Mor G, Liao A-H. COVID-19 and Treg/Th17 imbalance: potential relationship to pregnancy outcomes. Am J Reprod Immunol 2020; 84 (05) e13304
    CrossrefPubMedGoogle Scholar
  • 43 Yusuf KK, Dongarwar D, Ibrahimi S, Ikedionwu C, Maiyegun SO, Salihu HM. Expected surge in maternal mortality and severe morbidity among African-Americans in the era of COVID-19 pandemic. Int J MCH AIDS 2020; 9 (03) 386-389
    CrossrefPubMedGoogle Scholar