Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia.
Eur J Med Res. 2020 Sep 4;25(1):39. doi: 10.1186/s40001-020-00439-w.
Coronavirus is challenging the global health care system from time to time. The pregnant state, with alterations in hormone levels and decreased lung volumes due to a gravid uterus and slightly immunocompromised state may predispose patients to a more rapidly deteriorating clinical course and can get a greater risk of harm for both the mother and fetus. Therefore, this systematic review was aimed to assess the effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and its possibility of vertical maternal-fetal transmission.
A systematic search was conducted on PubMed, Web of Science, Embase, Google Scholar and the Cochrane Library until the end of April. All authors independently extracted all necessary data using excel spreadsheet form. Only published articles with fully accessible data on pregnant women infected with SARS-CoV, MARS-CoV, and SARS-CoV-2 were included. Data on clinical manifestations, maternal and perinatal outcomes were extracted and analyzed.
Out of 879 articles reviewed, 39 studies involving 1316 pregnant women were included. The most common clinical features were fever, cough, and myalgia with prevalence ranging from 30 to 97%, while lymphocytopenia and C-reactive protein were the most common abnormal laboratory findings (55-100%). Pneumonia was the most diagnosed clinical symptom of COVID-19 and non-COVID-19 infection with prevalence ranged from 71 to 89%. Bilateral pneumonia (57.9%) and ground-glass opacity (65.8%) were the most common CT imaging reported. The most common treatment options used were hydroxychloroquine (79.7%), ribavirin (65.2%), and oxygen therapy (78.8%). Regarding maternal outcome, the rate of preterm birth < 37 weeks of gestation was 14.3%, preeclampsia (5.9%), miscarriage (14.5%, preterm premature rupture of membranes (9.2%) and fetal growth restriction (2.8%). From the total coronavirus infected pregnant women, 56.9% delivered by cesarean, 31.3% admitted to ICU, while 2.7% were died. Among the perinatal outcomes, fetal distress rated (26.5%), neonatal asphyxia rated (1.4%). Only, 1.2% of neonates had apgar score < 7 at 5 min. Neonate admitted to ICU was rated 11.3%, while the rate of perinatal death was 2.2%. In the current review, none of the studies reported transmission of CoV from the mother to the fetus in utero during the study period.
Coronavirus infection is more likely to affect pregnant women. Respiratory infectious diseases have demonstrated an increased risk of adverse maternal obstetrical complications than the general population due to physiological changes occurred during pregnancy. None of the studies reported transmission of CoV from the mother to the fetus in utero, which may be due to a very low expression of angiotensin-converting enzyme-2 in early maternal-fetal interface cells.
冠状病毒不时对全球医疗保健系统构成挑战。妊娠状态由于子宫增大和肺容积减少以及免疫功能略受抑制，可能使患者的临床病程迅速恶化，并使母亲和胎儿面临更大的伤害风险。因此，本系统评价旨在评估冠状病毒感染（SARS-CoV-2、MERS-CoV 和 SARS-CoV）在怀孕期间的影响及其垂直母婴传播的可能性。
我们在 PubMed、Web of Science、Embase、Google Scholar 和 Cochrane Library 上进行了系统搜索，直到 4 月底。所有作者均使用 excel 电子表格形式独立提取所有必要数据。仅纳入了关于 SARS-CoV、MARS-CoV 和 SARS-CoV-2 感染孕妇的已发表文章，这些文章提供了完全可获取的数据。提取和分析了临床表现、母婴围生期结局的数据。
在审查的 879 篇文章中，纳入了 39 项涉及 1316 名孕妇的研究。最常见的临床特征是发热、咳嗽和肌痛，患病率为 30%至 97%，而淋巴细胞减少症和 C 反应蛋白是最常见的异常实验室发现（55%至 100%）。肺炎是 COVID-19 和非 COVID-19 感染最常见的临床症状，患病率为 71%至 89%。双侧肺炎（57.9%）和磨玻璃影（65.8%）是最常见的 CT 影像学报告。最常用的治疗方法是羟氯喹（79.7%）、利巴韦林（65.2%）和氧疗（78.8%）。关于母体结局，早产（＜37 周）的发生率为 14.3%，子痫前期（5.9%）、流产（14.5%）、早产胎膜早破（9.2%）和胎儿生长受限（2.8%）。在总冠状病毒感染孕妇中，56.9%经剖宫产分娩，31.3%入住 ICU，2.7%死亡。围生期结局中，胎儿窘迫发生率（26.5%），新生儿窒息发生率（1.4%）。只有 1.2%的新生儿在 5 分钟时 Apgar 评分为＜7。新生儿入住 ICU 的比例为 11.3%，围生期死亡率为 2.2%。在本次综述中，没有研究报告在研究期间冠状病毒从母亲垂直传播给胎儿。
冠状病毒感染更易影响孕妇。与一般人群相比，妊娠期间的生理变化使呼吸道传染病孕妇发生不良产科并发症的风险增加。在研究期间，没有研究报告冠状病毒从母亲垂直传播给胎儿，这可能是由于早期母胎界面细胞中血管紧张素转换酶-2的表达非常低。
