Journal club papers
Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. AJOG(MFM) 25/03/20
- Systematic review including 19 studies (mostly from China) – data on 79 hospitalised pregnant women affected by CoV infections (41 COVID-19, 12 MERS, 26 SARS)
- Most common symptoms included fever, cough and dyspnoea with 92% reported to have pneumonia.
- There was an overall rate of 12.3% maternal death when ALL the coronaviruses were included, including the higher mortality MERs and SARS.
- Preterm birth was the most common adverse pregnancy outcome (24% <37/40), with increased rates of preeclampsia (16%), FGR (12%) and miscarriage (39%), but reported across ALL CoV infections
For COVID-19 specifically, outcomes appear reassuring around 42 cases:
- For COVID-19 only 9% ICU admissions and 0% maternal deaths
- For COVID-19 alone there was insufficient data on first trimester outcomes or rates of FGR/PE
- For COVID-19 alone there was a perinatal loss rate of 7% (2/41), but the confidence interval is wide.
- For COVID-19 there was a 0% rate of vertical transmission (0/42)
- For COVID-19 there was a 41% rate of preterm birth <37 weeks. However, while not made clear in the review, it is possible many of these were iatrogenic where the clinical staff deliberately delivered the baby for maternal indications
Take home message – there may be an increased risk of preterm birth amongst women hospitalised with COVID-19. Overall, outcomes seem reassuring.
Also, we suggest growth surveillance after recovered COVID-19 should be considered, and probably CEFM in labour, but mainly based on data from the other CoV infections.
Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Jonas F Ludvigsson. Acta Paediatrica 23/03/2020
- Systematic literature review of 44 relevant scientific papers (and 1 letter-to-Editor, NEJM) published between 1st Jan and 18th Mar 2020, with the majority of data from China.
- Children (<19yrs, median age of diagnosis 7yrs) have so far only accounted for 1-5% of COVID-19 diagnoses.
- The majority of children with confirmed or suspected disease were asymptomatic or had mild-moderate symptoms, including cough, sore throat and low-grade fever, or less commonly (<10%) diarrhoea, vomiting, rhinorrhoea and myalgia.
- Severe disease in children was rare – the largest study to date (>2,000 children) reported only 5.2% with severe disease and 0.6% in a critical condition (respiratory failure, shock or multi-organ failure).
- Only two deaths in children less than 19 years old have been reported in the literature to date
- Newborn cases have been reported – the data are scarce, but the studies reported nil evidence of vertical transmission.
- There is currently insufficient evidence to comment on the prevalence of comorbidities in those children affected.
- COVID-19 in children appears to be milder than in adults, their prognosis is better and deaths are rare.
Two small retrospective reviews (seven and nine cases each) were recently published in the Lancet detailing maternal and neonatal characteristic following COVID-19 infection during pregnancy. In both reports, all women were admitted after 36 gestational weeks and maternal outcomes were no more severe than the non-pregnant population.
Clear vertical transmission was not shown by either report, however, not all neonates were tested, and numbers are very small.
Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Chen et al. Lancet 07/03/2020
- Nine confirmed cases, none with pre-existing co-morbidities.
- Maternal outcomes were similar to non-pregnant patients with COVID-19 and none developed severe pneumonia requiring mechanical ventilation.
- Pregnancy complications that appeared after COVID-19 infection included fetal distress (two cases) and premature rupture of membranes (two cases).
- All were delivered via caesarean section, with four at preterm gestations (all > 36 weeks).
- All were liveborn with normal 1- and 5-minute Apgar scores.
- Amniotic fluid, cord blood, neonatal throat swabs and breastmilk samples were collected from six patients – all were negative for SARS-CoV-2.
Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Yu et al. Lancet 24/03/2020
- Seven patients presented with fever (6/7), cough (1/7), shortness of breath (1/7) and diarrhoea (1/7). Co-infections were present in three patients, two with H1N1 and one with Legionella pneumophila.
- Maternal outcomes were again similar to non-pregnant COVID-19 patients and none required ICU admission.
- All women were delivered via caesarean section from 37 – 41+5 gestational weeks.
- Neonatal birthweights and Apgar scores were normal.
- Of the three neonates tested for SARS-CoV-2, one returned a positive swab within 36 hours of delivery. However, cord blood and placenta samples from this patient were both negative, suggesting this may not have been due to vertical transmission.