Evidence map›Paper›PMID 36027953›Full record

SynthesisAmerican journal of obstetrics and gynecology2023

Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis.

Emily R Smith, Erin Oakley, Gargi Wable Grandner, Gordon Rukundo, Fouzia Farooq, Kacey Ferguson, Sasha Baumann, Kristina Maria Adams Waldorf, Yalda Afshar, Mia Ahlberg and 70 more

Abstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in American journal of obstetrics and gynecology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

80 authors.

Emily R SmithDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Electronic address: EmilySmith@gwu.edu.
Erin OakleyDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Gargi Wable GrandnerDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Gordon RukundoPeriCOVID (PREPARE)-Uganda Team, Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
Fouzia FarooqDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Kacey FergusonDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Sasha BaumannDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Kristina Maria Adams WaldorfDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA.
Yalda AfsharDivision of Maternal-Fetal Medicine, University of California, Los Angeles, Los Angeles, CA.
Mia AhlbergDivision of Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Homa AhmadziaDivision of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Victor AkeloCenters for Disease Control and Prevention, Kisumu, Kenya.
Grace AldrovandiDepartment of Pediatrics, University of California, Los Angeles, Los Angeles, CA.
Elisa BevilacquaDepartment of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
Nabal BraceroDepartment of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, PR; Puerto Rico Obstetrics and Gynecology (PROGyn).
Justin S BrandtDivision of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Natalie BroutetDepartment of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Jorge CarrilloDepartamento de Obstetricia y Ginecologia, Clinica Alemana de Santiago, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
Jeanne ConryInternational Federation of Gynecology and Obstetrics, London, United Kingdom.
Erich CosmiDepartment of Women's and Children's Health, Obstetrics and Gynecology Clinic, University of Padua, Padua, Italy.
Fatima CrispiBCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain.
Francesca CrovettoBCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain.
Maria Del Mar GilDepartment of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain; School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain.
Camille Delgado-LópezSurveillance for Emerging Threats to Mothers and Babies, Puerto Rico Department of Health, San Juan, PR.
Hema DivakarAsian Research & Training Institute for Skill Transfer, Bengaluru, India.
Amanda J DriscollCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD.
Guillaume FavreMaterno-fetal and Obstetrics Research Unit, Département Femme-Mère-Enfant, Lausanne University Hospital, Lausanne, Switzerland.
Irene Fernandez BuhigasDepartment of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain; School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain.
Valerie FlahermanDepartment of Pediatrics, University of California, San Francisco, San Francisco, CA.
Christopher GaleNeonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom.
Christine L GodwinDepartment of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Sami GottliebDepartment of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Eduard GratacósBCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain.
Siran HeDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Olivia HernandezGynecology and Obstetrics, Félix Bulnes Hospital and RedSalud Clinic, Santiago, Chile.
Stephanie JonesSouth African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Sheetal JoshiAsian Research & Training Institute for Skill Transfer, Bengaluru, India.
Erkan KalafatDepartment of Obstetrics and Gynecology, School of Medicine, Koç University, Istanbul, Turkey.
Sammy KhagayiKenya Medical Research Institute-Centre for Global Health Research, Kisumu, Kenya.
Marian KnightNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Karen L KotloffCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD.
Antonio LanzoneDepartment of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy.
Valentina Laurita LongoDepartment of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy.
Kirsty Le DoarePeriCOVID (PREPARE)-Uganda Team, Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda; Medical Research Council /Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Paediatric Infectious Disease Research Group, St George's University of London, London, United Kingdom.
Christoph LeesDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom.
Ethan LitmanDivision of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Erica M LokkenDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA.
Shabir A MadhiSouth African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Laura A MageeDepartment of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Institute of Women and Children's Health, King's College Hospital, London, United Kingdom.
Raigam Jafet Martinez-PortillaClinical Research Branch, National Institute of Perinatology, Mexico City, Mexico.
Torri D MetzDivision of Maternal-Fetal Medicine, The University of Utah Health, Salt Lake City, UT.
Emily S MillerDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Deborah MoneyDepartment of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada.
Sakita MoungmaithongDepartment of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong.
Edward MullinsDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom; George Institute for Global Health, London, United Kingdom.
Jean B NachegaDepartment of Epidemiology and Center for Global Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Marta C NunesSouth African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Dickens OnyangoKisumu County Department of Health, Kisumu, Kenya.
Alice PanchaudInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Service of Pharmacy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Liona C PoonDepartment of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong.
Daniel RaitenPediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Lesley ReganInternational Federation of Gynecology and Obstetrics, Imperial College London, London, United Kingdom.
Daljit SahotaDepartment of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong.
Allie SakowiczDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Jose Sanin-BlairMaternal-Fetal Unit, Universidad Pontificia Bolivariana, Medellín, Colombia.
Olof StephanssonDivision of Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Marleen TemmermanCentre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya.
Anna ThorsonDepartment of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Soe Soe ThwinDepartment of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Beth A Tippett BarrCenters for Disease Control and Prevention, Kisumu, Kenya; Nyanja Health Research Institute, Salima, Malawi.
Jorge E TolosaMaternal-Fetal Unit, Universidad Pontificia Bolivariana, Medellín, Colombia; Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Oregon Health & Science University, Portland, OR; Department of Obstetrics and Gynecology, Maternal Fetal Medicine, St. Luke's University Health Network, Bethlehem, PA.
Niyazi TugDepartment of Obstetrics and Gynecology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
Miguel Valencia-PradoDivision of Children with Special Medical Needs, Puerto Rico Department of Health, San Juan, PR.
Silvia VisentinDepartment of Women's and Children's Health, Obstetrics and Gynecology Clinic, University of Padua, Padua, Italy.
Peter von DadelszenDepartment of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Global Health Institute, King's College London, London, United Kingdom.
Clare WhiteheadDepartment of Maternal Fetal Medicine, University of Melbourne, Royal Women's Hospital, Melbourne, Australia.
Mollie WoodDepartment of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Huixia YangDepartment of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
Rebecca ZavalaDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
James M TielschDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.

Funding

FELLOWSHIP TRAINING PROGRAM IN VACCINOLOGYT32AI007524 · UNIVERSITY OF MARYLAND BALTIMORE · 1997 to 2025
$1.8M
Medical Research Council MC_PC_19066NIAID NIH HHS T32 AI007524World Health Organization 001
6 · The paper itself

Abstract

objectiveThis sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. DATA SOURCES: We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. STUDY ELIGIBILITY CRITERIA: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area.

methodsWe included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis.

resultsWe collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12-2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27-13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87-22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83-70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26-2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20-3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28-2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18-2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25-2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15-4.81).

conclusionWe found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.

Indexed as

Cardiovascular DiseasesCOVID-19HIV InfectionsHypertensionPregnancy ComplicationsPremature BirthFemaleHumansInfant, NewbornPostpartum PeriodPregnancyPregnancy OutcomeProspective StudiesRisk FactorsSARS-CoV-2ThinnessCOVID-2019maternal mortalityneonatal mortalitypneumoniapregnancypreterm birthSARS-CoV-2small-for-gestational-age

Identifiers

PMID36027953
PMCPMC9398561

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.