System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Systematic Review Meta-Analysis Epublish 3 citations

PubMed: 40258634 DOI: 10.1136/bmjgh-2024-015815

Global maternal mortality associated with SARS-CoV-2 infection: a systematic review and meta-analysis.

BMJ Glob Health 10(4)

Authors: Kathryn Barry, Silvia Fernández-García, Alya Khashaba, Gabriel Ruiz-Calvo, Miriam Roncal Redin, Ghadir Mahmoud, Magnus Yap, Yasmin King, Dengyi Zhou, Massa Mamey, Isabella Shepherd-Evans, Jameela Sheikh, Heidi Lawson, Tania Kew, Kehkashan Ansari, Shruti Attarde, Adeolu Banjoko, Helen Fraser, Megan Littmoden, Tanisha Rajah, Kate Walker, Keelin O'Donoghue, Madelon van Wely, Elizabeth van Leeuwen, Elena Kostova, Heinke Kunst, Asma Khalil, Vanessa Brizuela, Edna Kara, Caron Rahn Kim, Anna Thorson, Olufemi T Oladapo, Lynne Mofenson, Mercedes Bonet, Javier Zamora, John Allotey, Shakila Thangaratinam

Affiliations

  • College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
  • WHO Collaborating Centre for Global Women's Health, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK.
  • Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
  • Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
  • Medical School, University of Nottingham, Nottingham, UK.
  • University College Cork, Cork, Ireland.
  • Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
  • Department of Obstetrics Gynecology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
  • Blizard Institute, Queen Mary University of London, London, UK.
  • Barts Health NHS Trust, London, UK.
  • St George's University of London, London, UK.
  • UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
  • Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, District of Columbia, USA.
  • CIBER Epidemiology and Public Health (CIPERESP), Madrid, Spain.
  • WHO Collaborating Centre for Global Women's Health, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK.
  • NIHR Birmingham Biomedical Centre (BRC), University Hospitals Birmingham, Birmingham, UK.
  • Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
  • Liverpool Women's NHS Foundation Trust, Liverpool, UK.
  • NIHR North West Coast Applied Research Collaboration, University of Liverpool, Liverpool, UK.

Abstract

BACKGROUND

Pregnant and recently pregnant women infected with SARS-CoV-2 are at increased risk of death and serious complications than those without the infection. The extent of variation in mortality rates in pregnant women with SARS-CoV-2 infection across regions, and the causes of death are not known. We systematically reviewed all available evidence on the variation in mortality rates in pregnant women with SARS-CoV-2 infection across geographical and country income groups, and the reported cause of death.

METHODS

We searched major databases (December 2019-January 2023) including Medline, LILACS, BIREME and Embase. We included studies that reported deaths in at least 10 consecutive pregnant or recently pregnant women with confirmed SARS-CoV-2 infection and assessed the studies' risk of bias. We calculated the summary estimates of any cause of death as proportions with 95% CIs using a multilevel random-effects logistic regression model. Subgroup analyses were performed by geographical region and country income groups. We used International Statistical Classification of Diseases and Related Health Problems-Maternal Mortality to categorise the reported cause of death.

FINDINGS

From 1 326 315 citations, we included 169 studies (319 172 women with confirmed SARS-CoV-2 infection; 4253 women died). The overall rate of unspecified maternal death was 0.87% (95% CI 0.64% to 1.16%). There were significant differences between geographical regions in rates of maternal mortality, with the highest rates in Sub-Saharan Africa (3.48%; 95% CI 0.66% to 16.42%) and Latin America and the Caribbean (3.16%, 95% CI 1.53% to 6.43%). Rates of maternal mortality varied by country income groups, with the highest rates in low-income countries (4.66%, 95% CI 0.75% to 24.07%). Among women with reported cause of death, 98.6% (2,390/2,423) of deaths were attributable to COVID-19.

INTERPRETATION

Rates of deaths in pregnant and recently pregnant women with SARS-CoV-2 infection vary significantly across regions and by country income groups, with the highest burden in Sub-Saharan Africa and low-income countries. COVID-19 is the main reported cause of death.

PROSPERO REGISTRATION NUMBER

CRD42020224120.

MeSH

Pregnant Women, Sars-Cov-2, Mortality, Global Health, Income, Cause Of Death, Covid-19, Maternal Mortality, Severe Acute Respiratory Syndrome-Related Coronavirus, Infections