Subscribe to RSS
DOI: 10.1055/a-2253-5665
Optimal Delivery Management for the Prevention of Early Neonatal SARS-CoV-2 Infection: Systematic Review and Meta-analysis
Funding L.P.B. has received funding from the National Institutes of Health, from the Gerber Foundation, and from the Children's Medical Center Foundation in Dallas, TX for unrelated research.![](https://www.thieme-connect.de/media/ajp/202412/lookinside/thumbnails/10-1055-a-2253-5665_23may0343-1.jpg)
Abstract
Objective Delivery management interventions (DMIs) were recommended to prevent delivery-associated transmission of maternal SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to infants without evidence of effect on early neonatal SARS-CoV-2 infection (ENI) and neonatal death <28 days of life (ND). This systematic review describes different DMI combinations and the frequency of ENI and ND.
Study Design Individual patient data were collected from articles published from January 1, 2020 to December 31, 2021 from Cochrane review databases, Medline, and Google Scholar. Article inclusion criteria were: documented maternal SARS-CoV-2 polymerase chain reaction (PCR)-positive status 10 days before delivery or symptomatic at delivery with a positive test within 48 hours, known delivery method, and known infant SARS-CoV-2 PCR result. Primary outcomes were ENI (positive PCR at 12 hours to 10 days) and ND. All characteristics were pooled using the DerSimonian–Laird inverse variance method. Primary outcome analyses were performed using logit transformation and random effect. Pooled results were expressed as percentages (95% confidence intervals). Continuity correction was applied for all pooled results if any included study has 0 event.
Results A total of 11,075 publications were screened. 117 publications representing 244 infants and 230 mothers were included. All publications were case reports. ENI and ND were reported in 23.4% (18.2–29.18) and 2.1% (0.67–4.72) of cases, respectively. Among cases with available information, DMIs were reported for physical environment (85–100%), delivery-specific interventions (47–100%), and infant care practices (80–100%). No significant comparisons could be performed between different DMI combinations due to small sample size.
Conclusion The evidence supporting any DMI in SARS-CoV-2-infected mothers to prevent ENI or ND is extremely limited. Limitations of this meta-analysis include high risk of bias, small sample size, and large confidence intervals. This identifies the need for multinational database generation and specific studies designed to provide evidence of DMI guidelines best suited to prevent transmission from mother to neonate.
Key Points
-
In this review we analyzed 2 years of maternal SARS-CoV-2 published cases.
-
We assessed association of delivery management interventions with infant SARS-CoV-2 infection.
-
We found no evidence supporting any DMI for that purpose.
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
* Authors contributed equally.
Publication History
Received: 25 May 2023
Accepted: 22 January 2024
Accepted Manuscript online:
24 January 2024
Article published online:
19 February 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
- 2 WHO. Pneumonia of unknown cause – China. Geneva: World Health Organization; . January 5, 2020
- 3 Qadri F, Mariona F. Pregnancy affected by SARS-CoV-2 infection: a flash report from Michigan. J Matern Fetal Neonatal Med 2022; 35 (09) 1805-1807
- 4 Smith ER, Oakley E, Grandner GW. et al; Perinatal COVID PMA Study Collaborators, Perinatal COVID PMA Study Collaborators. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. BMJ Glob Health 2023; 8 (01) e009495
- 5 Ning C, Wang H, Wu J, Chen Q, Pei H, Gao H. The COVID-19 vaccination and vaccine inequity worldwide: an empirical study based on global data. Int J Environ Res Public Health 2022; 19 (09) 5267
- 6 Bhattacharya O, Siddiquea BN, Shetty A, Afroz A, Billah B. COVID-19 vaccine hesitancy among pregnant women: a systematic review and meta-analysis. BMJ Open 2022; 12 (08) e061477
- 7 Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand 2020; 99 (07) 823-829
- 8 Khoury JE, Atkinson L, Bennett T, Jack SM, Gonzalez A. COVID-19 and mental health during pregnancy: the importance of cognitive appraisal and social support. J Affect Disord 2021; 282: 1161-1169
- 9 Khoury JE, Atkinson L, Bennett T, Jack SM, Gonzalez A. Coping strategies mediate the associations between COVID-19 experiences and mental health outcomes in pregnancy. Arch Women Ment Health 2021; 24 (06) 1007-1017
- 10 Lavizzari A, Klingenberg C, Profit J. et al. International comparison of guidelines for managing neonates at the early phase of the SARS-CoV-2 pandemic. Pediatr Res 2021; 89 (04) 940-951
- 11 Zeng L, Xia S, Yuan W. et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; 174 (07) 722-725
- 12 Chandrasekharan P, Vento M, Trevisanuto D. et al. Neonatal resuscitation and postresuscitation care of infants born to mothers with suspected or confirmed SARS-CoV-2 infection. Am J Perinatol 2020; 37 (08) 813-824
- 13 Hudak ML, Flannery DD, Barnette K. et al; AMERICAN ACADEMY OF PEDIATRICS NPC-19 REGISTRY INVESTIGATORS. Maternal and newborn hospital outcomes of perinatal SARS-CoV-2 infection: a national registry. Pediatrics 2023; 151 (02) e2022059595
- 14 Angelidou A, Sullivan K, Melvin PR. et al. Association of maternal perinatal SARS-CoV-2 infection with neonatal outcomes during the COVID-19 pandemic in Massachusetts. JAMA Netw Open 2021; 4 (04) e217523
- 15 National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. Centers for Disease Control and Prevention; . Accessed January 30, 2024 at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
- 16 National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Considerations for inpatient obstetric healthcare settings. Centers for Disease Control and Prevention; . Accessed January 30, 2024 at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
- 17 Lin C, Chu SM, Hsu JF. et al. Delivery management of suspected or confirmed COVID-19 positive mothers. Pediatr Neonatol 2021; 62 (05) 476-482
- 18 Sunuwar N, Jaishi PP, Twayana AR, Neupane PK, Neupane SK. A retrospective study of COVID during pregnancy and the outcome of vaginal delivery. Ann Med Surg (Lond) 2022; 84: 104880
- 19 Villar J, Soto Conti CP, Gunier RB. et al; INTERCOVID-2022 International Consortium. Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study. Lancet 2023; 401 (10375): 447-457
- 20 Kurtser MA. Coronavirus infection COVID-19 and pregnancy. Herald Russ Acad Sci 2022; 92 (04) 445-451
- 21 Wang W, Xu Y, Gao R. et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020; 323 (18) 1843-1844
- 22 Hoffmann M, Kleine-Weber H, Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181 (02) 271-280.e8
- 23 Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS One 2020; 15 (04) e0230295
- 24 Pringle KG, Tadros MA, Callister RJ, Lumbers ER. The expression and localization of the human placental prorenin/renin-angiotensin system throughout pregnancy: roles in trophoblast invasion and angiogenesis?. Placenta 2011; 32 (12) 956-962
- 25 Valdés G, Neves LA, Anton L. et al. Distribution of angiotensin-(1-7) and ACE2 in human placentas of normal and pathological pregnancies. Placenta 2006; 27 (2–3): 200-207
- 26 Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46 (04) 586-590
- 27 Xiao AT, Tong YX, Zhang S. Profile of RT-PCR for SARS-CoV-2: a preliminary study from 56 COVID-19 patients. Clin Infect Dis 2020; 71 (16) 2249-2251
- 28 Zamaniyan M, Ebadi A, Aghajanpoor Mir S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn 2020; 40 (13) 1759-1761
- 29 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
- 30 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; 37 (08) 861-865
- 31 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
- 32 Dong L, Tian J, He S. et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323 (18) 1846-1848
- 33 Zeng H, Xu C, Fan J. et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020; 323 (18) 1848-1849
- 34 Palatnik A, McIntosh JJ. Protecting labor and delivery personnel from COVID-19 during the second stage of labor. Am J Perinatol 2020; 37 (08) 854-856
- 35 Mick P, Murphy R. Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review. J Otolaryngol Head Neck Surg 2020; 49 (01) 29