Article Text

Global variations in the burden of SARS-CoV-2 infection and its outcomes in pregnant women by geographical region and country’s income status: a meta-analysis
  1. Jameela Sheikh1,
  2. Heidi Lawson1,
  3. John Allotey2,
  4. Magnus Yap1,
  5. Rishab Balaji1,
  6. Tania Kew1,
  7. Elena Stallings3,4,
  8. Dyuti Coomar2,
  9. Andrea Gaetano-Gil3,4,
  10. Javier Zamora2,3,
  11. Shakila Thangaratinam2,5
  12. on behalf of the PregCOV-19 Living Systematic Review Consortium
    1. 1College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
    2. 2Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
    3. 3Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
    4. 4CIBER Epidemiology and Public Health, Madrid, Spain
    5. 5Birmingham Women's Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
    1. Correspondence to Professor Shakila Thangaratinam; s.thangaratinam.1{at}bham.ac.uk

    Abstract

    Introduction The prevalence of COVID-19 and its impact varied between countries and regions. Pregnant women are at high risk of COVID-19 complications compared with non-pregnant women. The magnitude of variations, if any, in SARS-CoV-2 infection rates and its health outcomes among pregnant women by geographical regions and country’s income level is not known.

    Methods We performed a random-effects meta-analysis as part of the ongoing PregCOV-19 living systematic review (December 2019 to April 2021). We included cohort studies on pregnant women with COVID-19 reporting maternal (mortality, intensive care admission and preterm birth) and offspring (mortality, stillbirth, neonatal intensive care admission) outcomes and grouped them by World Bank geographical region and income level. We reported results as proportions with 95% confidence intervals (CI).

    Results We included 311 studies (2 003 724 pregnant women, 57 countries). The rates of SARS-CoV-2 infection in pregnant women varied significantly by region (p<0.001) and income level (p<0.001), with the highest rates observed in Latin America and the Caribbean (19%, 95% CI 12% to 27%; 13 studies, 38 748 women) and lower-middle-income countries (13%, 95% CI 6% to 23%; 25 studies, 100 080 women). We found significant differences in maternal and offspring outcomes by region and income level. Lower-middle-income countries reported significantly higher rates of maternal mortality (0.68%, 95% CI 0.24% to 1.27%; 3 studies, 31 136 women), intensive care admission (4.53%, 95% CI 2.57% to 6.91%; 54 studies, 23 420 women) and stillbirths (1.09%, 95% CI 0.48% to 1.88%; 41 studies, 4724 women) than high-income countries. COVID-19 complications disproportionately affected South Asia, which had the highest maternal mortality rate (0.88%, 95% CI 0.16% to 1.95%; 17 studies, 2023 women); Latin America and the Caribbean had the highest stillbirth rates (1.97%, 95% CI 0.9% to 3.33%; 10 studies, 1750 women).

    Conclusion The rates of SARS-CoV-2 infection in pregnant women vary globally, and its health outcomes mirror the COVID-19 burden and global maternal and offspring inequalities.

    PROSPERO registration number CRD42020178076.

    • COVID-19
    • Maternal health

    Data availability statement

    No data are available. No additional data are available.

    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    No data are available. No additional data are available.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • JS and HL are joint first authors.

    • Handling editor Seye Abimbola

    • Twitter @medstudentjam, @joallotey, @javierza67, @thangaratinam

    • Collaborators PregCOV-19 Living Systematic Review Consortium: Silvia Fernández-García, Megan Littmoden, Millie Manning, Adeolu Banjoko, Dengyi Zhou, Shruti Attarde, Ankita Gupta, Kehkashan Ansari, Yasmin King, Gurimaan Sandhu, Damilola Akande, Dharshini Sambamoorthi, Anoushka Ramkumar, Helen Fraser, Meghnaa Hebbar, Sophie Maddock, Tanisha Rajah, Alya Khashaba, Kathryn Barry, Massa Mamey, Wentin Chen, Halimah Khalil, Elena Kostova, Elena Stallings, Shaunak Chatterjee, Luke Debenham, Anna Clavé Llavall, Anushka Dixit, Siang Ing Lee, Xiu Qiu, Mingyang Yuan, Dyuti Coomar, Madelon van Wely, Elizabeth van Leeuwen, Heinke Kunst, Asma Khalil, Simon Tiberi, Vanessa Brizuela, Nathalie Broutet, Edna Kara, Caron Rahn Kim, Anna Thorson, Ramón Escuriet, Olufemi T Oladapo, Lynne Mofenson, Van T Tong, Sascha Ellington, Gianfranco Spiteri, Julien Beaute, Uma Ram, Ajith S Nair, Pura Rayco-Solon, and Hector Pardo-Hernandez.

    • Contributors ST and JA conceptualised the study. JS, HL, RB, MY and TK selected the studies. JA, JS, HL, MY and RB extracted the data. JS, HL and JZ conducted the analyses. JS and HL are joint first authors. All coauthors contributed to the writing of the manuscript and approved the final version. ST, JA and JZ are the guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding The main analysis of the PregCOV-19 Living Systematic Review Consortium was partially funded by the German Federal Ministry of Health (BMG) COVID-19 Research and Development support to the World Health Organization (WHO) and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization, supplementing the work undertaken for this project.

    • Disclaimer The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

    • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.