Abstract

Background
Since its emergence in December 2019, COVID‐19 has spread to over 210 countries, with an estimated mortality rate of 3–4%. Little is understood about its effects during pregnancy.

Aims
To describe the current understanding of COVID‐19 illness in pregnant women, to describe obstetric outcomes and to identify gaps in the existing knowledge.

Methods
Medline Ovid, EMBASE, World Health Organization COVID‐19 research database and Cochrane COVID‐19 in pregnancy spreadsheet were accessed on 18/4, 18/5 and 23/5 2020. Articles were screened via Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The following were excluded: reviews, opinion pieces, guidelines, articles pertaining solely to other viruses, single case reports.

Results
Sixty articles were included in this review. Some pregnant participants may have been included in multiple publications, as admission dates overlap for reports from the same hospital. However, a total of 1287 confirmed SARS‐CoV‐2 positive pregnant cases are reported. Where universal testing was undertaken, asymptomatic infection occurred in 43.5–92% of cases. In the cohort studies, severe and critical COVID‐19 illness rates approximated those of the non‐pregnant population. Eight maternal deaths, six neonatal deaths, seven stillbirths and five miscarriages were reported. Nineteen neonates were SARS‐CoV‐2 positive, confirmed by reverse transcription polymerase chain reaction of nasopharyngeal swabs. [Correction added on 2 September 2020, after first online publication: the number of neonates indicated in the preceding sentence has been corrected from ‘Thirteen’ to ‘Nineteen’.]

Conclusions
Where universal screening was conducted, SARS‐CoV‐2 infection in pregnancy was often asymptomatic. Severe and critical disease rates approximate those in the general population. Vertical transmission is possible; however, it is unclear whether SARS‐CoV‐2 positive neonates were infected in utero, intrapartum or postpartum. Future work should assess risks of congenital syndromes and adverse perinatal outcomes where infection occurs in early and mid‐pregnancy.