Smith, Emily REmily RSmithOakley, ErinErinOakleyGrandner, Gargi WableGargi WableGrandnerRukundo, GordonGordonRukundoFarooq, FouziaFouziaFarooqFerguson, KaceyKaceyFergusonBaumann, SashaSashaBaumannWaldorf, Kristina AdamsKristina AdamsWaldorfAfshar, YaldaYaldaAfsharAhlberg, MiaMiaAhlbergAhmadzia, HomaHomaAhmadziaAkelo, VictorVictorAkeloAldrovandi, GraceGraceAldrovandiBevilacqua, ElisaElisaBevilacquaBracero, NabalNabalBraceroBrandt, Justin SJustin SBrandtBroutet, NatalieNatalieBroutetCarrillo, JorgeJorgeCarrilloConry, JeanneJeanneConryCosmi, ErichErichCosmiCrispi, FatimaFatimaCrispiCrovetto, FrancescaFrancescaCrovettoGil, Maria Del MarMaria Del MarGilDelgado-López, CamilleCamilleDelgado-LópezDivakar, HemaHemaDivakarDriscoll, Amanda JAmanda JDriscollFavre, GuillaumeGuillaumeFavreBuhigas, Irene FernandezIrene FernandezBuhigasFlaherman, ValerieValerieFlahermanGale, ChristopherChristopherGaleGodwin, Christine LChristine LGodwinGottlieb, SamiSamiGottliebGratacós, EduardEduardGratacósHe, SiranSiranHeHernandez, OliviaOliviaHernandezJones, StephanieStephanieJonesJoshi, SheetalSheetalJoshiKalafat, ErkanErkanKalafatKhagayi, SammySammyKhagayiKnight, MarianMarianKnightKotloff, KarenKarenKotloffLanzone, AntonioAntonioLanzoneLongo, Valentina LauritaValentina LauritaLongoLe Doare, KirstyKirstyLe DoareLees, ChristophChristophLeesLitman, EthanEthanLitmanLokken, Erica MErica MLokkenMadhi, Shabir AShabir AMadhiMagee, Laura ALaura AMageeMartinez-Portilla, Raigam JafetRaigam JafetMartinez-PortillaMetz, Torri DTorri DMetzMiller, Emily SEmily SMillerMoney, DeborahDeborahMoneyMoungmaithong, SakitaSakitaMoungmaithongMullins, EdwardEdwardMullinsNachega, Jean BJean BNachegaNunes, Marta CMarta CNunesOnyango, DickensDickensOnyangoPanchaud Monnat, Alice Elke MartineAlice Elke MartinePanchaud MonnatPoon, Liona CLiona CPoonRaiten, DanielDanielRaitenRegan, LesleyLesleyReganSahota, DaljitDaljitSahotaSakowicz, AllieAllieSakowiczSanin-Blair, JoseJoseSanin-BlairStephansson, OlofOlofStephanssonTemmerman, MarleenMarleenTemmermanThorson, AnnaAnnaThorsonThwin, Soe SoeSoe SoeThwinTippett Barr, Beth ABeth ATippett BarrTolosa, Jorge EJorge ETolosaTug, NiyaziNiyaziTugValencia-Prado, MiguelMiguelValencia-PradoVisentin, SilviaSilviaVisentinvon Dadelszen, PeterPetervon DadelszenWhitehead, ClareClareWhiteheadWood, MollieMollieWoodYang, HuixiaHuixiaYangZavala, RebeccaRebeccaZavalaTielsch, James MJames MTielsch2024-10-112024-10-112023-02https://boris-portal.unibe.ch/handle/20.500.12422/87038OBJECTIVE This sequential, prospective meta-analysis (sPMA) 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, adverse birth outcomes. DATA SOURCES We prospectively invited study investigators to join the sPMA 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. STUDY APPRAISAL AND SYNTHESIS 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 two-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 (pre-existing diabetes, hypertension, cardiovascular disease) versus those without were at higher risk for COVID-19 severity and pregnancy health outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% CI: 1.12, 2.71) more likely to be admitted to the ICU. Pregnant women who were underweight before pregnancy were at higher risk of ICU admission (RR 5.53, 95% CI: 2.27, 13.44), ventilation (RR 9.36, 95% CI: 3.87, 22.63), and pregnancy-related death (RR 14.10, 95% CI: 2.83, 70.36). Pre-pregnancy obesity was also a risk factor for severe COVID-19 outcomes including ICU admission (RR 1.81, 95% CI: 1.26,2.60), ventilation (RR 2.05, 95% CI: 1.20,3.51), any critical care (RR 1.89, 95% CI: 1.28,2.77), and pneumonia (RR 1.66, 95% CI: 1.18,2.33). Anemic pregnant women with COVID-19 also had increased risk of ICU admission (RR 1.63, 95% CI: 1.25, 2.11) and death (RR 2.36, 95% CI: 1.15, 4.81). CONCLUSION We found that pregnant women with comorbidities including diabetes, 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, pre-pregnancy 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.enCoronavirus Disease 2019 Maternal Mortality Neonatal Mortality Pneumonia Pregnancy Preterm Birth SARS-CoV-2 Small-for-gestational Age600 - Technology::610 - Medicine & health300 - Social sciences, sociology & anthropology::360 - Social problems & social servicesarticle10.48350/1724003602795310.1016/j.ajog.2022.08.038