IRUS Total

Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: A sequential, prospective meta-analysis

File Description SizeFormat 
1-s2.0-S0002937822006809-main.pdfPublished version1.26 MBAdobe PDFView/Open
Title: Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: A sequential, prospective meta-analysis
Authors: Smith, ER
Oakley, E
Grandner, GW
Rukundo, G
Farooq, F
Ferguson, K
Baumann, S
Waldorf, KA
Afshar, Y
Ahlberg, M
Ahmadzia, H
Akelo, V
Aldrovandi, G
Bevilacqua, E
Bracero, N
Brandt, JS
Broutet, N
Carrillo, J
Conry, J
Cosmi, E
Crispi, F
Crovetto, F
Gil, MDM
Delgado-López, C
Divakar, H
Driscoll, AJ
Favre, G
Buhigas, IF
Flaherman, V
Gale, C
Godwin, CL
Gottlieb, S
Gratacós, E
He, S
Hernandez, O
Jones, S
Joshi, S
Kalafat, E
Khagayi, S
Knight, M
Kotloff, K
Lanzone, A
Longo, VL
Le Doare, K
Lees, C
Litman, E
Lokken, EM
Madhi, SA
Magee, LA
Martinez-Portilla, RJ
Metz, TD
Miller, ES
Money, D
Moungmaithong, S
Mullins, E
Nachega, JB
Nunes, MC
Onyango, D
Panchaud, A
Poon, LC
Raiten, D
Regan, L
Sahota, D
Sakowicz, A
Sanin-Blair, J
Stephansson, O
Temmerman, M
Thorson, A
Thwin, SS
Tippett Barr, BA
Tolosa, JE
Tug, N
Valencia-Prado, M
Visentin, S
Von Dadelszen, P
Whitehead, C
Wood, M
Yang, H
Zavala, R
Tielsch, JM
Item Type: Journal Article
Abstract: OBJECTIVE: This sequential, prospective meta-analysis (sPMA) sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to: disease severity, maternal morbidities, neonatal mortality and morbidity, adverse birth outcomes. DATA SOURCES: We prospectively invited study investigators to join the sPMA via professional research networks beginning in March 2020. STUDY ELIGIBILITY CRITERIA: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. STUDY APPRAISAL AND SYNTHESIS METHODS: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a two-stage meta-analysis. RESULTS: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (pre-existing diabetes, hypertension, cardiovascular disease) versus those without were at higher risk for COVID-19 severity and pregnancy health outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% CI: 1.12, 2.71) more likely to be admitted to the ICU. Pregnant women who were underweight before pregnancy were at higher risk of ICU admission (RR 5.53, 95% CI: 2.27, 13.44), ventilation (RR 9.36, 95% CI: 3.87, 22.63), and pregnancy-related death (RR 14.10, 95% CI: 2.83, 70.36). Pre-pregnancy obesity was also a risk factor for severe COVID-19 outcomes including ICU admission (RR 1.81, 95% CI: 1.26,2.60), ventilation (RR 2.05, 95% CI: 1.20,3.51), any critical care (RR 1.89, 95% CI: 1.28,2.77), and pneumonia (RR 1.66, 95% CI: 1.18,2.33). Anemic pregnant women with COVID-19 also had increased risk of ICU admission (RR 1.63, 95% CI: 1.25, 2.11) and death (RR 2.36, 95% CI: 1.15, 4.81). CONCLUSION: We found that pregnant women with comorbidities including diabetes, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly-known risk factors, including HIV infection, pre-pregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
Issue Date: 1-Feb-2023
Date of Acceptance: 7-Aug-2022
URI: http://hdl.handle.net/10044/1/99375
DOI: 10.1016/j.ajog.2022.08.038
ISSN: 0002-9378
Publisher: Elsevier
Start Page: 161
End Page: 177
Journal / Book Title: American Journal of Obstetrics and Gynecology
Volume: 228
Issue: 2
Copyright Statement: ©2022 Published by Elsevier Inc. This is an open access article under the CC BY IGO license (http://creativecommons.org/licenses/by/3.0/igo/).
Publication Status: Published
Conference Place: United States
Online Publication Date: 2022-08-24
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine
Imperial College London COVID-19
School of Public Health

This item is licensed under a Creative Commons License Creative Commons