• Ozlem Turan, Amir Hakim, Pradip Dashraath, Jeslyn Wong Jing Lin WJL Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Alison Wright, and Rezan Abdul-Kadir.
• Department of Obstetrics and Gynecology, Royal Free Hospital NHS Trust, London, UK.
• Int J Gynaecol Obstet. 2020 Oct 1; 151 (1): 7-16.

BackgroundPregnant women represent a potentially high-risk population in the COVID-19 pandemic.ObjectiveTo summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID-19.Search StrategyRelevant databases were searched up until May 29, 2020.Selection CriteriaCase series/reports of hospitalized pregnant women with laboratory-confirmed COVID-19.Data Collection And AnalysisPRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools.Main ResultsOverall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory-confirmed SARS-CoV-2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D-dimer and interleukin-6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID-19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours.ConclusionsAdvanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D-dimer and interleukin-6 levels are predictive of poor pregnancy outcomes in COVID-19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.© 2020 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

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