The following is a summary of “Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis,” published in the February 2023 issue of Obstetrics and Gynecology by Smith, et al.

For a sequential, prospective meta-analysis, researchers sought to identify characteristics that increased the likelihood of bad outcomes, including illness severity, maternal morbidities, newborn mortality and morbidity, and unfavorable birth outcomes, in COVID-19-positive pregnant and postpartum women.

Through scholarly research networks, starting in March 2020, they prospectively invited study investigators to participate in the sequential, prospective meta-analysis. Studies that recruited at least 25 consecutive instances of COVID-19 in pregnancy within a predetermined catchment region qualified as eligible studies.

Individual patient data from 21 participating studies were included. In order to create harmonized variables for risk factors and outcomes, the data quality has to be evaluated. The removal of duplicate cases. Using a two-stage meta-analysis, pooled estimates of the absolute and relative risk of unfavorable outcomes were created, comparing individuals with and without each risk factor.

About 21,977 instances of SARS-CoV-2 infection in pregnancy or postpartum were among the 33 countries and territories from which we gathered data. They discovered that women with comorbidities—pre-existing cardiovascular disease, hypertension, and diabetes mellitus—were more susceptible to COVID-19 severity and unfavorable pregnancy outcomes than those without comorbidities (fetal death, preterm birth, low birth weight). HIV and COVID-19 participants had a higher likelihood of being admitted to the critical care unit of 1.74 times (95% CI, 1.12-2.71). An increased risk of ventilation (relative risk, 9.36; 95% CI, 3.87-22.63), intensive care unit admission (relative risk, 5.53; 95% CI, 2.27-13.44), and pregnancy-related death (relative risk, 14.10; 95% CI, 2.83-70.36) was found in pregnant women who were underweight before becoming pregnant. Obesity before pregnancy was also associated with a higher risk of severe COVID-19 outcomes, such as pneumonia (relative risk, 1.66; 95% CI, 1.18-2.33) and admission to an intensive care unit (relative risk, 1.81; 95% CI, 1.26–2.60), ventilation (relative risk, 2.05; 95% CI, 1.20-3.51), and any critical care (relative risk, 1.89; 95% CI, 1.28-2.77). Anemic pregnant women with COVID-19 also had a higher chance of dying (relative risk, 2.36; 95% CI, 1.15–4.81) and being admitted to an intensive care unit (relative risk, 1.63; 95% Cl, 1.25-2.11).

They discovered that severe COVID-19-related outcomes, maternal morbidities, and poor delivery outcomes were more likely in pregnant women with comorbidities such as diabetes mellitus, hypertension, and cardiovascular disease. Additionally, they discovered a number of lesser-known risk factors, including anemia, HIV infection, and being underweight before conception. Pregnant women with these extra risk factors should get special attention for prevention and treatment, even though they are already a high-risk demographic.

Reference: ajog.org/article/S0002-9378(22)00680-9/fulltext