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Systematic Review and Meta-analysis of Maternal, Foetal and Neonatal Outcomes Among Pregnant Patient

Association between Covid-19 and Pregnancy Outcomes

Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 and was declared a global pandemic in Pregnant people and infants may be particularly susceptible to Covid-19 because the physiologic changes of pregnancy involve cardiorespiratory and immune systems, which mayresult in an altered response to SARS-CoV-2 infection in pregnancy. Fetuses may be exposed to during critical periods of fetal development.

The nature of the association between Covid-19 and pregnancy outcomes remains unclear, and meta-analyses involving patients with COVID-19 who are pregnant are limited. Previous reviews have focused mostly on prevalence estimates from case reports or case series that are difficult to interpret and potentially biased. systematic review suggested that people who are pregnant did not have an increased risk of  infection or symptomatic Covid19, but they were at risk of severe Covid-19 compared with those who were not pregnant.

However, this review included suspected COVID-19 cases in addition to confirmed cases.5 Although some recent observational studies have suggested that people with confirmed asymptomatic and symptomatic Covid 19 as well as mild and severe infections, be at risk of adverse pregnancy outcomes, we are unaware of any systematic reviews that have comprehensively evaluated these data. We performed a systematic review and meta-analysis of maternal, fetal and neonatal outcomes among pregnant patients with Covid-19. We aimed to determine the association between infection and adverse pregnancy outcomes, including preeclampsia, preterm birth and stillbirth.

This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources, search strategy and study selection We performed a systematic search of MEDLINE, Embase, ClinicalTrials. gov, medRxiv and Cochrane databases upto, to identify observational studies with comparative data for people with covid 19 who were pregnant Our search strategy followed the Peer Review of Electronic Search Strategies guidelines. We searched the databases using a combination of Medical Subject Headings (MeSH) terms and keywords for “severe acute respiratory syndrome coronavirus 2  or 2019 novel coronavirus or “pregnancy,” with language restricted to English abstracts. We also manually searched references cited in these articles to identify any additional studies.

Two investigators independently screened the titles and abstracts identified by the electronic searches, compared selected studies and resolved discrepancies by discussion. We scrutinized and selected full-length articles of studies evaluating Covid-19 in pregnancy and maternal and infant outcomes that met the following inclusion criteria: observational study; population included pregnant people infection was confirmed by a polymerase chain reaction (PCR) test or with codes for confirmed Covid-19 from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision  comparisons included patients with Covid-19 versus those without Covid-19, patients with symptomatic versus those with asymptomatic Covid-19, or severe versus mild Covid19; outcomes included maternal, fetal or neonatal morbidity and mortality; comparative data needed to calculate effect sizes were available; and methodologic quality assessment criteria in the Newcastle–Ottawa Scale suggested low or moderate risk of bias.

We excluded studies that met at least 1 of the following exclusion criteria: reviews, case reports or case series; studies with no comparison data; and studies that included cases of infective pneumonia caused by other viral agents. If more than 1  study was published that involved the same cohort with identical outcomes, we included the report containing the most comprehensive information to avoid including the same data twice

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