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Wolfson Institute of Population Health

COVID-19 risks to pregnant women and their babies outlined in global research review

Pregnant women remain at increased risk of severe COVID-19, and their risk of being admitted to intensive care or needing invasive ventilation is higher than non-pregnant reproductive aged women with the virus, an ongoing global study has found.

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Pregnant women with COVID-19 are at increased risk of severe COVID-19, particularly if they are from ethnic minority backgrounds, or if they have pre-existing conditions like obesity, high blood pressure and diabetes, concludes the study involving Queen Mary University of London researchers, led by the University of Birmingham and World Health Organisation (WHO).

Their research, published in the BMJ, is part of a unique and ongoing living systematic review and meta-analysis of data, which began in April 2020, and follows the researchers’ first publication in the BMJ last August.

This latest publication details the researchers’ analysis of the results of 192 studies – an additional 115 studies than were included in their August publication - into the impact of COVID-19 on pregnant women and their babies.

The review found that one in 10 pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed with confirmed COVID-19. Overall, 339 pregnant women with confirmed COVID-19 died from any cause (0.02% of a total 41,664 women involved in 59 studies). The overall rates of stillbirth and neonatal death are low in women with suspected or confirmed COVID-19, the review found.

The most common clinical symptoms of COVID-19 in pregnant women were fever (40%) and cough (41%), although compared to non-pregnant women of reproductive age, pregnant and recently pregnant women with COVID-19 were more likely to by asymptomatic.

Increased maternal age, high body mass index, non-white ethnicity, and pre-existing comorbidity including chronic hypertension and diabetes were identified as risk factors for pregnant women developing severe COVID-19. While there is emerging evidence from the review that pregnancy specific conditions such as pre-eclampsia and gestational diabetes may be associated with severe covid-19, the authors state that more data are needed to robustly assess the association between pregnancy specific risk factors and COVID-19 related outcomes.

Dr Heinke Kunst, Senior Lecturer in Respiratory Medicine at Queen Mary, is an expert in COVID-19 related topics in Respiratory Medicine. Dr Simon Tiberi is an Infectious Diseases Consultant at Barts Health NHS Trust and Honorary Reader at Queen Mary, and expert in COVID related questions in Infectious Diseases. Both work as clinicians front-line with pregnant and non-pregnant COVID-19 patients and provided advice on the context and purpose of the living systematic review, the different variables collected, data extraction and results.

More information

Research paper: Allotey et al (Feb, 2021). ‘Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis'. BMJ.