Browsing by Author "Aldrovandi, Grace"

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    Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS- CoV- 2 infection: an individual participant data meta- analysis
    (2023) Smith, Emily R.; Oakley, Erin; Wable Grandner, Gargi; Ferguson, Kacey; Farooq, Fouzia; Afshar, Yalda; Ahlberg, Mia; Ahmadzia, Homa; Akelo, Victor; Aldrovandi, Grace; Tippett Barr, Beth A.; Bevilacqua, Elisa; Brandt, Justin S.; Broutet, Nathalie; Fernández Buhigas, Irene; Carrillo Termini, Jorge; Clifton, Rebecca; Conry, Jeanne; Cosmi, Erich; Crispi, Fatima; Crovetto, Francesca; Delgado-López, Camille; Divakar, Hema; Driscoll, Amanda J.; Favre, Guillaume; Flaherman, Valerie J.; Gale, Chris; Gil, Maria M.; Gottlieb, Sami L.; Gratacós, Eduard; Hernandez, Olivia; Jones, Stephanie; Kalafat, Erkan; Khagayi, Sammy; Knight, Marian; Kotloff, Karen; Lanzone, Antonio; Le Doare, Kirsty; Lees, Christoph; Litman, Ethan
    Introduction Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. Methods We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. Results We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women. Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12). Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. Conclusions This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.
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    Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis
    (2023) Smith, Emily; Oakley, Erin; Wable Grandner, Gargi; Rukundo, Gordon; Farooq, Fouzia; Ferguson, Kacey; Baumann, Sasha; Adams Waldorf, Kristina Maria; Afshar, Yalda; Ahlberg, Mia; Ahmadzia, Homa; Akelo, Victor; Aldrovandi, Grace; Bevilacqua, Elisa; Bracero, Nabal; Brandt, Justin S.; Broutet, Natalie; Carrillo Termini, Jorge; Jeanne Conry, Jeanne; Cosmi, Erich; Crispi, Fatima; Crovetto, Francesca; Gil, Maria del Mar; Delgado-López, Camille; Divakar, Jeanne Hema; Driscoll, Amanda J.; Favre, Guillaume; Fernandez Buhigas, Irene; Flaherman, Valerie; Gale, Christopher; Godwin, Christine L.; Gottlieb, Sami; Gratacós, Eduard; He, Siran; Olivia Hernandez, Olivia; Jones, Stephanie; Joshi, Sheetal; Kalafat, Erkan; Khagayi, Sammy; Knight, Marian; Kotloff, Karen L.
    Objective This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. Data Sources We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. Study Eligibility Criteria Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. Methods We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. Results We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12–2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27–13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87–22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83–70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26–2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20–3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28–2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18–2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25–2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15–4. Conclusion We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19–related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.

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