Maternal death related to COVID-19: A systematic review and meta-analysis focused on maternal co-morbidities and clinical characteristics

Background: Besides reducing the quality of obstetric care, the direct impact of COVID-19 on pregnancy and postpartum is uncertain.

Objective: To evaluate the characteristics of pregnant women who died due to COVID-19.

Search strategy: Cochrane Library, Embase, MEDLINE, Scopus, and Google Scholar were searched from inception to February 2021.

Selection criteria: Studies that compared deceased and survived pregnant women with COVID-19.

Data collection and analysis: Relevant data were extracted and tabulated. The primary outcome was maternal co-morbidity.

Main results: Thirteen studies with 154 deceased patients were included. Obesity doubled the risk of death (relative risk [RR] 2.48, 95% confidence interval [CI] 1.41-4.36, I² = 0%). No differences were found for gestational diabetes (RR 5.71; 95% CI 0.77-42.44, I² = 94%) or asthma (RR 2.05, 95% CI 0.81-5.15, I² = 0%). Overall, at least one severe co-morbidity showed a twofold increased risk of death (RR 2.26, 95% CI 1.77-2.89, I² = 76%). Admission to intensive care was related to a fivefold increased risk of death (RR 5.09, 95% CI 2.00-12.98, I² = 56%), with no difference in need for respiratory support (RR 0.53, 95% CI 0.23-1.48, I² = 95%) or mechanical ventilation (RR 4.34, 95% CI 0.96-19.60, I² = 58%).

Conclusion: COVID-19 with at least one co-morbidity increases risk of intensive care and mortality.