COVID-19 and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes.
COVID-19 and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes.
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COVID-19 与妊娠：对临床表现、垂直传播以及孕产妇和围产期结局的总体回顾。
DOI：
10.1371/journal.pone.0253974
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Buekens P
中科院分区：
文献类型：
--
作者：
Ciapponi A;Bardach A;Comandé D;Berrueta M;Argento FJ;Rodriguez Cairoli F;Zamora N;Santa María V;Xiong X;Zaraa S;Mazzoni A;Buekens P
我们根据Cochrane方法和PRISMA报告声明（PROSPERO-CRD42020208783）对COVID-19对孕产妇和儿童健康影响的最佳证据进行了系统综述（SRs）总结。我们检索了2020年1 - 10月的文献数据库和COVID-19研究网站。我们选择了相关的SRs，报告了适当的检索策略、数据综合、偏倚风险评估和/或描述COVID-19和妊娠结局的纳入研究的个体描述。两位审稿人通过covid - ence网络软件独立选择研究，进行数据提取，并通过AMSTAR-2工具评估其质量。分歧经协商一致解决。根据预定义的标准，对每个SR的结果进行综合，并为最新的、相关的、全面的和最高质量的结果提供GRADE证据表。我们在检索到的608篇文献中纳入了66篇观察性研究的SRs，其中大多数（61/66）的总体质量“极低”。我们发现SRs之间的初级研究重叠程度相对较低。妊娠期最常见的COVID-19临床表现为发热（28-100%）、轻度呼吸道症状（20-79%）、c反应蛋白升高（28-96%）、淋巴细胞减少（34-80%）和诊断影像学肺炎征象（7-99%）。最常见的产妇结局是剖腹产（23-96%）和早产（14-64%）。大多数婴儿无症状（16-93%）或出现发热（0-50%）、低出生体重（5-43%）或早产（2-69%）。COVID-19孕妇与非COVID-19孕妇接受有创通气的比值比（OR）为1.88(95%可信区间[CI] 1.36 ~ 2.60)，其婴儿入住新生儿重症监护病房的比值比（OR）为3.13 （95%CI 2.05 ~ 4.78）。据估计，先天性传播或通过母乳传播的风险较低，但密切接触可能存在风险。这一综合综述表明，感染COVID-19的孕妇可能面临不良妊娠和分娩结局的风险增加，先天性传播的风险较低。
We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783). We searched literature databases and COVID-19 research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR’s results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables. We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had "critically low" overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 clinical findings during pregnancy were fever (28–100%), mild respiratory symptoms (20–79%), raised C-reactive protein (28–96%), lymphopenia (34–80%), and pneumonia signs in diagnostic imaging (7–99%). The most frequent maternal outcomes were C-section (23–96%) and preterm delivery (14–64%). Most of their babies were asymptomatic (16–93%) or presented fever (0–50%), low birth weight (5–43%) or preterm delivery (2–69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 versus non-COVID-19 pregnant women was 1.88 (95% Confidence Interval [CI] 1.36–2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05–4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks. This comprehensive overview supports that pregnant women with COVID-19 may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.
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