Differential impact of COVID‐19 in pregnant women from high‐income countries and low‐ to middle‐income countries: A systematic review and meta‐analysis

• Published in: International journal of gynecology and obstetrics 2021-10, Vol.155 (1), p.48-56
• Main Authors: Gajbhiye, Rahul K., Sawant, Mamta S., Kuppusamy, Periyasamy, Surve, Suchitra, Pasi, Achhelal, Prusty, Ranjan K., Mahale, Smita D., Modi, Deepak N.
• Format: Article
• Language: English
• Subjects: coronavirus; COVID-19; death; Developed Countries; Developing Countries; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; newborn; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Outcome - epidemiology; Pregnant Women; Premature Birth; Review; SARS-CoV-2; stillbirth; vertical transmission
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.13793

Background SARS‐CoV‐2 has infected a large number of pregnant women. Objective To compare clinical, perinatal outcomes of women with COVID‐19 from high‐income countries (HICs) and low‐ to middle‐income countries (LMICs). Search strategy Online databases were searched. Selection criteria Original studies on pregnant women with COVID‐19 were included. Data collection and analysis Information on clinical presentation, co‐morbidities, pregnancy outcomes, neonatal outcomes, and SARS‐CoV‐2 infection in neonates was extracted. Main results The pooled estimate of SARS‐CoV‐2 positive neonates is 3.7%. Symptomatic presentations are less common in LMICs compared to HICs (odds ratio [OR] 0.38). Diabetes (OR 0.5), hypertension (OR 0.5), and asthma (OR 0.14) are commonly reported from HICs; hypothyroidism (OR 2.2), anemia (OR 3.2), and co‐infections (OR 6.0) are commonly reported in LMICs. The overall risk of adverse pregnancy outcomes is higher in LMICs compared to HICs (OR 2.4). Abortion (OR 6.2), stillbirths (OR 2.0), and maternal death (OR 7.8) are more common in LMICs. Preterm births and premature rupture of membranes are comparable in both groups. Neonatal deaths (OR 3.7), pneumonia (OR 7.5), and neonatal SARS‐CoV‐2 infection (OR 1.8) are commonly reported in LMICs. Conclusions In LMICs, pregnant women and neonates are more vulnerable to adverse outcomes due to COVID‐19. PROSPERO registration no: CRD42020198743. Synopsis Pregnant women and newborns in low‐ and middle‐income countries are more vulnerable and will require a rigorous clinical evaluation and proper follow‐up to minimize the adverse impact of COVID‐19.