BMJ Global Health (Nov 2022)

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

  • ,
  • Gianfranco Spiteri,
  • Olufemi T Oladapo,
  • Nathalie Broutet,
  • Xiu Qiu,
  • Shakila Thangaratinam,
  • Hector Pardo-Hernandez,
  • Heinke Kunst,
  • Vanessa Brizuela,
  • Javier Zamora,
  • Asma Khalil,
  • Simon Tiberi,
  • John Allotey,
  • Elena Stallings,
  • Magnus Yap,
  • Shaunak Chatterjee,
  • Tania Kew,
  • Luke Debenham,
  • Anna Clavé Llavall,
  • Anushka Dixit,
  • Dengyi Zhou,
  • Rishab Balaji,
  • Siang Ing Lee,
  • Mingyang Yuan,
  • Dyuti Coomar,
  • Elena Kostova,
  • Edna Kara,
  • Caron Rahn Kim,
  • Anna Thorson,
  • Lynne Mofenson,
  • Pura Rayco-Solon,
  • Jameela Sheikh,
  • Heidi Lawson,
  • Kehkashan Ansari,
  • Ramón Escuriet,
  • Van T Tong,
  • Kathryn Barry,
  • Wentin Chen,
  • Halimah Khalil,
  • Silvia Fernández-García,
  • Megan Littmoden,
  • Yasmin King,
  • Gurimaan Sandhu,
  • Adeolu Banjoko,
  • Alya Khashaba,
  • Meghnaa Hebbar,
  • Millie Manning,
  • Ankita Gupta,
  • Andrea Gaetano-Gil,
  • Shruti Attarde,
  • Damilola Akande,
  • Dharshini Sambamoorthi,
  • Anoushka Ramkumar,
  • Helen Fraser,
  • Sophie Maddock,
  • Tanisha Rajah,
  • Massa Mamey,
  • Madelon van Wely,
  • Elizabeth van Leeuwen,
  • Sascha Ellington,
  • Julien Beaute,
  • Uma Ram,
  • Ajith S Nair

DOI
https://doi.org/10.1136/bmjgh-2022-010060
Journal volume & issue
Vol. 7, no. 11

Abstract

Read online

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.