Department of Pediatrics, Aga Khan University, Karachi, 74800, Pakistan.
Robinson Research Institute, University of Adelaide, Adelaide, 5005, Australia.
BMC Pregnancy Childbirth. 2021 Dec 1;21(1):801. doi: 10.1186/s12884-021-04250-1.
There is dearth of information on COVID-19's impact on pregnant women. However, literature reported trends of COVID-19 differ, depending on the presence of clinical features upon presentation.
This systematic review aimed to assess differences in risk factors, management, complications, and pregnancy and perinatal outcomes in symptomatic vs. asymptomatic pregnant women with confirmed SARS-CoV-2 infection.
A search was run on electronic databases to identify studies reporting COVID-19 in pregnancy. Meta-analysis was performed and odds ratios and mean difference with 95% confidence intervals were calculated using Review Manager 5.4. Review Prospero registration number CRD42020204662.
We included ten articles reporting data from 3158 pregnancies; with 1900 symptomatic and 1258 asymptomatic pregnant women. There was no significant difference in the mean age, gestational age, and body mass index between the two groups. The meta-analysis suggested that pregnant women who were obese (OR:1.37;95%CI:1.15 to 1.62), hypertensive (OR:2.07;95%CI:1.38 to 3.10) or had a respiratory disorder (OR:1.64;95%CI:1.25 to 2.16), were more likely to be symptomatic when infected with SARS-CoV-2. Pregnant women with Black (OR:1.48;95%CI:1.19 to 1.85) or Asian (OR:1.64;95%CI:1.23 to 2.18) ethnicity were more likely to be symptomatic while those with White ethnicity (OR:0.63;95%CI:0.52 to 0.76) were more likely to be asymptomatic. Cesarean-section delivery (OR:1.40;95%CI:1.17 to 1.67) was more likely amongst symptomatic pregnant women. The mean birthweight(g) (MD:240.51;95%CI:188.42 to 293.51), was significantly lower, while the odds of low birthweight (OR:1.85;95%CI:1.06 to 3.24) and preterm birth (< 37 weeks) (OR:2.10;95%CI:1.04 to 4.23) was higher amongst symptomatic pregnant women. Symptomatic pregnant women had a greater requirement for maternal ICU admission (OR:13.25;95%CI:5.60 to 31.34) and mechanical ventilation (OR:15.56;95%CI:2.96 to 81.70) while their neonates had a higher likelihood for Neonatal Intensive Care Unit admission (OR:1.96;95%CI:1.59 to 2.43). The management strategies in the included studies were poorly discussed, hence could not be analyzed.
The evidence suggests that the presence of risk factors (co-morbidities and ethnicity) increased the likelihood of pregnant women being symptomatic. Higher odds of complications were also observed amongst symptomatic pregnant women. However, more adequately conducted studies with adjusted analysis and parallel comparison groups are required to reach conclusive findings.
关于 COVID-19 对孕妇的影响，相关信息匮乏。然而，文献报道的 COVID-19 趋势因临床表现的存在而有所不同。
本系统评价旨在评估有症状与无症状 SARS-CoV-2 感染孕妇在风险因素、管理、并发症以及妊娠和围产期结局方面的差异。
检索电子数据库以鉴定 COVID-19 妊娠相关研究。采用 Review Manager 5.4 进行荟萃分析，计算比值比和 95%置信区间的均数差值。ReviewProspero 注册号 CRD42020204662。
我们纳入了 10 篇文章，这些文章报告了 3158 例妊娠数据；其中 1900 例孕妇有症状，1258 例无症状。两组间的平均年龄、孕龄和体重指数无显著差异。荟萃分析表明，肥胖（OR：1.37；95%CI：1.15 至 1.62）、高血压（OR：2.07；95%CI：1.38 至 3.10）或有呼吸系统疾病（OR：1.64；95%CI：1.25 至 2.16）的孕妇在感染 SARS-CoV-2 时更可能出现症状。黑人（OR：1.48；95%CI：1.19 至 1.85）或亚洲人（OR：1.64；95%CI：1.23 至 2.18）孕妇感染 SARS-CoV-2 时更可能出现症状，而白人（OR：0.63；95%CI：0.52 至 0.76）孕妇感染 SARS-CoV-2 时更可能无症状。有症状孕妇更可能行剖宫产（OR：1.40；95%CI：1.17 至 1.67）。有症状孕妇的平均出生体重（g）（MD：240.51；95%CI：188.42 至 293.51）显著降低，而低出生体重（OR：1.85；95%CI：1.06 至 3.24）和早产（＜37 周）（OR：2.10；95%CI：1.04 至 4.23）的发生率更高。有症状孕妇需要更多的母体 ICU 入院（OR：13.25；95%CI：5.60 至 31.34）和机械通气（OR：15.56；95%CI：2.96 至 81.70），而其新生儿更可能需要新生儿 ICU 入院（OR：1.96；95%CI：1.59 至 2.43）。纳入研究的管理策略讨论得很差，因此无法进行分析。
有证据表明，风险因素（合并症和种族）的存在增加了孕妇出现症状的可能性。有症状孕妇发生并发症的几率也更高。然而，需要进行更多设计良好的研究，进行调整分析和平行比较组，以得出明确的结论。
