Dataset Information

Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol.

ABSTRACT: Introduction: Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic.

Methods and analysis: We plan to undertake a living systematic review to assess the prevalence, clinical manifestations, risk factors, rates of maternal and perinatal complications, potential for mother-to-child transmission, accuracy of diagnostic tests and effectiveness of treatment for COVID-19 in pregnant and postpartum women (including after miscarriage or abortion). We will search Medline, Embase, WHO COVID-19 database, preprint servers, the China National Knowledge Infrastructure system and Wanfang databases from 1 December 2019. We will supplement our search with studies mapped by Cochrane Fertility and Gynaecology group, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), COVID-19 study repositories, reference lists and social media blogs. The search will be updated every week and not be restricted by language. We will include observational cohort (?10 participants) and randomised studies reporting on prevalence of COVID-19 in pregnant and postpartum women, the rates of clinical manifestations and outcomes, risk factors in pregnant and postpartum women alone or in comparison with non-pregnant women with COVID-19 or pregnant women without COVID-19 and studies on tests and treatments for COVID-19. We will additionally include case reports and series with evidence on mother-to-child transmission of SARS-CoV-2 in utero, intrapartum or postpartum. We will appraise the quality of the included studies using appropriate tools to assess the risk of bias. At least two independent reviewers will undertake study selection, quality assessment and data extraction every 2?weeks. We will synthesise the findings using quantitative random effects meta-analysis and report OR or proportions with 95% CIs and prediction intervals. Case reports and series will be reported as qualitative narrative synthesis. Heterogeneity will be reported as I² and ?² statistics.

Ethics and dissemination: Ethical approval is not required as this is a synthesis of primary data. Regular updates of the results will be published on a dedicated website (https://www.birmingham.ac.uk/research/who-collaborating-centre/pregcov/index.aspx) and disseminated through publications, social media and webinars.

Prospero registration number: CRD42020178076.

SUBMITTER: Yap M

PROVIDER: S-EPMC7712931 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol.

Yap Magnus M Debenham Luke L Kew Tania T Chatterjee Shaunak Rhiju SR Allotey John J Stallings Elena E Coomar Dyuti D Lee Siang Ing SI Qiu Xiu X Yuan Mingyang M Clavé Llavall Anna A Dixit Anushka A Zhou Dengyi D Balaji Rishab R van Wely Madelon M Kostova Elena E van Leeuwen Elisabeth E Mofenson Lynne L Kunst Heinke H Khalil Asma A Tiberi Simon S Thomas James J Brizuela Vanessa V Broutet Nathalie N Kara Edna E Kim Caron C Thorson Anna A Rayco-Solon Pura P Pardo-Hernandez Hector H Oladapo Olufemi Taiwo OT Zamora Javier J Bonet Mercedes M Thangaratinam Shakila S

BMJ open 20201202 12

<h4>Introduction</h4>Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic.<h4>Methods and analysis</h4>We plan to undertake a living systematic review to assess the prevalence, clinical manifestations, risk factors, rates of maternal and perinatal complications, potential for mother-to-child transmission, accuracy of diagnostic tests and effectiveness ...[more]

PMID: 33268430

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Project description:OBJECTIVE:To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). DESIGN:Living systematic review and meta-analysis. DATA SOURCES:Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 26 June 2020, along with preprint servers, social media, and reference lists. STUDY SELECTION:Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. DATA EXTRACTION:At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. RESULTS:77 studies were included. Overall, 10% (95% confidence interval 7% to14%; 28 studies, 11?432 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (39%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% confidence interval 0.22 to 0.85; I2=74%; 5 studies; 80?521 women) and myalgia (0.48, 0.45 to 0.51; I2=0%; 3 studies; 80?409 women) and were more likely to need admission to an intensive care unit (1.62, 1.33 to 1.96; I2=0%) and invasive ventilation (1.88, 1.36 to 2.60; I2=0%; 4 studies, 91?606 women). 73 pregnant women (0.1%, 26 studies, 11?580 women) with confirmed covid-19 died from any cause. Increased maternal age (1.78, 1.25 to 2.55; I2=9%; 4 studies; 1058 women), high body mass index (2.38, 1.67 to 3.39; I2=0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14 to 3.48; I2=0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31 to 4.80; I2=12%; 2 studies; 858 women) were associated with severe covid-19 in pregnancy. Pre-existing maternal comorbidity was a risk factor for admission to an intensive care unit (4.21, 1.06 to 16.72; I2=0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40 to 14.37; I2=0%; 2 studies; 313 women). Spontaneous preterm birth rate was 6% (95% confidence interval 3% to 9%; I2=55%; 10 studies; 870 women) in women with covid-19. The odds of any preterm birth (3.01, 95% confidence interval 1.16 to 7.85; I2=1%; 2 studies; 339 women) was high in pregnant women with covid-19 compared with those without the disease. A quarter of all neonates born to mothers with covid-19 were admitted to the neonatal unit (25%) and were at increased risk of admission (odds ratio 3.13, 95% confidence interval 2.05 to 4.78, I2=not estimable; 1 study, 1121 neonates) than those born to mothers without covid-19. CONCLUSION:Pregnant and recently pregnant women are less likely to manifest covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are high in pregnant women with covid-19 than in pregnant women without the disease. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42020178076. READERS' NOTE:This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

Project description:Comprehensive HIV treatment and care makes it safer for women living with HIV (WLWH) to have the children they desire, partly through provision and appropriate use of effective contraception. However, nearly one third of WLWH in-care in a large Ugandan cohort became pregnant within 3 years of initiating ART and half of these incident pregnancies (45%) were unplanned. We therefore describe future pregnancy plans and associated factors among postpartum WLWH in rural southwestern Uganda in order to inform interventions promoting postpartum contraceptive uptake. This analysis includes baseline data collected from adult WLWH enrolled into a randomized controlled trial to evaluate the effect of family planning support versus standard of care at 12 months postpartum in southwestern Uganda. Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrolment. Among 320 enrolled women, mean age, CD4 count, and duration on ART was 28.9 (standard deviation [SD] 5.8) years, 395 cells/mm3 (SD = 62) and 4.6 years (SD = 3.9), respectively. One-hundred and eighty nine (59%) of women reported either personal (175, 55%) or partner (186, 58%) desire for more children in the next 2 years. Intentions to have more children was strongly associated with partner's desire for more children (AOR = 31.36; P < 0.000), referent pregnancy planned (AOR = 2.69; P = 0.050) and higher household income > 150,000 Shs per month (AOR = 1.37; P = 0.010). Previous use of modern contraception (AOR = 0.07; P = 0.001), increasing age (AOR = 0.34; P = 0.012), having > 2 own children living in a household (AOR = 0.42; P = 0.021) and parity > 2 (AOR = 0.59; P = 0.015) were associated with reduced odds of pregnancy intention. Our findings highlight the role male partners play in influencing pregnancy intentions postpartum and the importance of engaging men in sexual and reproductive health counselling about child spacing for the health of women, children, and families. This should be addressed alongside key individual-level social, demographic, economic and structural factors within which couples can understand risks of unplanned pregnancies and access effective contraceptive methods when they need or want them.

Project description:BackgroundSexual dysfunction refers to a chain of psychiatric, individual, and couple's experiences that manifests itself as a dysfunction in sexual desire, sexual arousal, orgasm, and pain during intercourse. The aim of this systematic review will be to assess the sexual dysfunction and determine the relevant factors to sexual dysfunction during pregnancy and postpartum.Methods and analysisAll observational studies, including descriptive, descriptive-analytic, case-control, and cohort studies published between 1990 and 2019, will be included in the study. Review articles, case studies, case reports, letter to editors, pilot studies, and editorial will be excluded from the study. The search will be conducted in the Cochrane Central Register, MEDLINE, Google Scholar, EMBASE, ProQuest, Scopus, WOS, and CINAHL databases. Eligible studies should assess at least one of the sexual dysfunction symptoms in pregnant women or in the first year postpartum. Quality assessment of studies will be performed by two authors independently based on the NOS checklist. This checklist is designed to assess the quality of observational studies. Data will be analyzed using Stata software ver. 11. Considering that the index investigated in the present study will be the level of sexual disorder, standard error will be calculated for each study using binomial distribution. The heterogeneity level will be investigated using Cochran's Q statistic and I2 index in a chi-square test at a significance level of 1.1. Predictable limitations of this study included a small number and unacceptable quality of studies.DiscussionThis systematic review addresses the factors associated with sexual dysfunction during pregnancy and postpartum. Considering the high prevalence of sexual dysfunction among women, the treatment of this problem has been highly sought after by the World Health Organization in recent years. The results of this study can help discover new strategies by introducing factors affecting women's sexual dysfunction, thereby eliminating or diminishing these factors, and play an important role in improving the quality of life of women during pregnancy and postpartum periods.Systematic review registrationPROSPERO CRD42018083554.

Project description:BackgroundEctopic pregnancy is a neglected and challenging gynecologic problem in developing countries including Ethiopia.ObjectiveThe present study is aimed at assessing the prevalence of ectopic pregnancy, its management outcomes, and factors associated with management outcomes in Tigray, North Ethiopia.MethodsWe employed a four-year retrospective cross-sectional study from September 2015 to August 2019. We extracted data about all pregnant mothers who were admitted and managed for EPs in Axum, Tigray. Ectopic pregnancy and its outcomes (favorable and unfavorable) were the dependent variables, and age, residence, ethnicity, religion, parity, history of abortion, history of EP, pelvic infections, history of surgical procedures, and use contraceptives were the independent variables. We employed descriptive statistics and bivariate and multivariate logistic regression analyses using SPSS. Ethical clearance was obtained from Axum University, Tigray, Ethiopia.ResultsThe overall prevalence of ectopic pregnancy was 0.52% of total deliveries, which equates to 1 : 193 deliveries. Surgery for ectopic pregnancy accounts for 7.6% of all gynecological surgeries. Most participants were in the age group 26-30 years and lived in rural areas. Among the different EP implantation sites, most cases (92.4%) occurred in the fallopian tube, followed by 5.1% in the ovary and 2.5% in abdominal EPs. Surgical management (laparotomy) was undertaken for all the 79 women diagnosed with EPs, including laparotomy (100%), salpingo-oophorectomy (17.7%), salpingectomy (73.9%), oophorectomy (3.4%), cornual resection (2.5%), and removal of concepts tissue 2.5. The record reports that intraoperative procedure was correctly managed for 47 (59.5%) women but the condition of EP procedure was ruptured for about two-thirds (63.3%) of the women. Thirty (38%) patients had developed some complications after surgery including anemia (hemoglobin < 10.5) (n = 12), fever (n = 10), wound infection (n = 2), and pneumonia (n = 2). Women who were from urban (AOR = 11.2, 95% CI: 2.65-47.2) and who had normal hemoglobin at presentation (AOR = 9.94, 95% CI: 2.03-48.7) were associated with favorable maternal outcomes.ConclusionsMore than one-third of women with ectopic pregnancies had an unfavorable maternal outcome, which was higher among rural residents and anemic mothers. Women living in rural areas and anemia during pregnancy should seek special attention in the management of EPs. We also recommend improving the data management of hospitals in Ethiopia.

Dataset Information

Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol.

Publications

Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol.

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