COVID-19 – Global variations in the burden and its outcomes in pregnant women

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

by Jameela Sheikh, Heidi Lawson, John Allotey, Magnus Yap, Rishab Balaji, Tania Kew, Elena Stallings, Dyuti Coomar, Andrea Gaetano-Gil, Javier Zamora, Shakila Thangaratinam, on behalf of the PregCOV-19 Living Systematic Review Consortium

BMJ Global Health 2022;7:e010060. (Open access)

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).

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 mirror the Covid-19 burden and global maternal and offspring inequalities.

The overall rate of SARS-CoV-2 infection in pregnant women admitted to or attending hospital for any reason was 8% (95% CI 7% to 9%), 135 studies, 920,893 women.

What is already known on this topic
To date, only one narrative systematic review reported global variations in SARS-CoV-2 outcomes in pregnant women and their offspring. The review assessed a variation of outcomes, including preterm birth, therapeutics for managing Covid-19 in pregnant women, intensive care admission and hospital length of stay. The results demonstrated varying preterm birth rates in pregnant women with SARS-CoV-2 infection globally.

What this study adds
To the best of our knowledge, this is the first meta-analysis to assess the global variations in the rates of SARS-CoV-2 infection in pregnant women and its associated outcomes by geographical region and country income level. By including data from 57 countries involving over two million pregnant women, we identified significant global differences in SARS-CoV-2 infection and its health outcomes in mother and baby in countries by geographical regions and income levels. Through this work, we highlight the magnitude of differences in the burden of the disease across regions and countries in line with underlying disparities in overall health outcomes.

How this study might affect research, practice or policy
The evidence from our research highlights the need for further research into the underlying causes of the trends in the data to provide solutions to improve healthcare outcomes for pregnant women and their babies in areas with a higher disease burden and poorer outcomes. Furthermore, necessary interventions are required to tackle healthcare inequalities in the context of Covid-19. As the pandemic evolves, future research should assess the impact of disease variants and vaccination programmes on the global variation of the rates of SARS-CoV-2 in pregnant women and its associated health outcomes.