SARS-CoV-2 in Pregnancy: Where and What Is the Evidence?

Background: The emergence of a novel coronavirus (SARS-CoV-2) has had the world on high alert since December 2019. Pregnancy is associated with various physiological changes that predispose this subset of patients to severe respiratory infections. Although no maternal deaths related to SARS-CoV-2 have been reported at this time, it has been suggested that it may follow a similar pattern to SARS and MERS. Methods: We conducted a systematic review on March 25, 2020 and a repeat PUBMed search on April 10, 2020. Studies evaluating pregnant patients with SARS-CoV-2 infection at any time during their pregnancy were included. Due to scarcity of available data, the authors chose to include as many studies as fitted the criteria. Findings: The initial electronic literature search yielded 84 results. We reviewed 16 articles with a total of 155 pregnant patients and 118 perinatal outcomes described. Evidence proposes a similar rate of severe cases of SARS-CoV-2 in pregnant women and the general population. Even with guidelines advising against C-section in infected patients, the frequency of cesarean deliveries is high. Studies have suggested lack of vertical transmission, but a recent report has shown the presence of IgM antibodies in a newborn. Interpretation: The limited data on the clinical course, maternal and perinatal outcomes of COVID-19 in pregnancy associated with a wide variation in the methodology makes accurate data interpretation difficult. This review will add to the growing body of evidence on the topic to better inform decision making and optimize patient outcomes. Funding Statement: None. Declaration of Interests: The authors declare no competing interests.