Pregnancy, alone, being associated with a state of immune alterations, exposes the maternal immune system to many challenges. Pregnant women, being a highly vulnerable group, need to be administered vaccines as early as possible; however, there is a lot of vaccine hesitancy among the population regarding immunization of pregnant women, who are avoided in the initial phases of most clinical trials. A look at available studies on the mechanisms of immune response in pregnant women and further, the reports of vaccine efficacy and outcomes among pregnant women against COVID-19 and EVD would definitely yield many insights that could be useful in the surveillance and planning of vaccination strategies for pregnant women against impending pathogenic RNA viruses.
(a) | |||||||||||||
Year of Study | Country | Study Approach | Case Type | Sample Size | Pre-Existing Medical Conditions | Need for Hospitalization | Maternal Mortality | Obstetric Complication | Perinatal Outcome | Reference | |||
2020 | 22 countries | Retrospective cohort study | Pregnant women with confirmed SARS-CoV-2 infection | 388 | Not available | ICU admission (11.1%) Mechanical Ventilation (9.3%) | 0.80% | Miscarriage (19.4%) Termination of pregnancy (1.1%) | Termination of pregnancy (1.1%) Pre-term birth (26.3%) Still birth (2.3%) Neonatal death (2%) SARS-CoV-2 positive (0.4%) | [10] | |||
2020 | United Kingdom | Prospective observational cohort study | pregnant women with confirmed SARS-CoV-2 infection | 427 | Asthma (7%) Hypertension (3%), Diabetes (3%) | Critical care (10%) | 1% | Pregnancy loss (1%) | Stillbirth (1%) Neonatal death (1%) Loss of Pregnancy (1%) SARS-CoV-2 positive (2%) | [11] | |||
2020 | Singapore | Prospective Cohort Study | Pregnant women with diagnosis of COVID-19 | 16 | Asthma (12.5%) HCV carriers (6.25%) | ICU admission (6.25%) | NIL | Spontaneous miscarriage (22.2%) | Neonatal death (6.25%) | [12] | |||
2020 | China | Retrospective Cohort study | Pregnant women who gave a single live birth between January 13 and March 18, 2020 | 65 | Not available | Higher need for Caesarean section (80%) | NIL | Gestational diabetes (3%) Gestational hypertension (11%) Pre-eclampsia (1%) | Pre-term birth (14%) Diarrhea (1.7%) Fever (5.17%) | [13] | |||
2020 | Iran | Prospective Cohort Study | Pregnant women with diagnosis of COVID-19 | 56 | Diabetes (16.1%) Hypertension (10.7%) Hypothyroidy (19.6%) | ICU admission (10.7%) Mechanical Ventilation (6.15%) Higher need for Caesarean section (67.3%) | NIL | Pre-eclampsia | Pre-term birth (34.5%) Perinatal death (3.6%) | [14] | |||
2020 | France | Retrospective Cohort study | Pregnant women with diagnosis of COVID-19 having a code for hospitalization for COVID-19 | 874 | Diabetes (1.3%) Hypertension (1.9%) | ICU admission (5.9%) Higher need for Caesarean section (33%) | 0.20% | Pre-eclampsia (4.8%) Gestational hypertension (2.3%) Postpartum hemorrhage (10%) | Pre-term birth (11.3%) | [15] | |||
2020 | Democratic Republic of the Congo | Case Study | Pregnant woman with confirmed SARS-CoV-2 infection | 1 | NIL | Caesarean section | NIL | Thrombotic vasculopathy in the placenta, Inflammatory appearance in the pelvic organs | SARS-CoV-2-infected Neonate, Perinatal death | [16] | |||
2020 | China | Retrospective Case Control study | Pregnant woman with confirmed SARS-CoV-2 infection, pregnant women with suspected infection and Control groups | 11 | Gestational diabetes (18.75%) Gestational hypertension (18.75%) Hypothyroidism (12.5%) | Caesarean section (87.5%) | NIL | Pre-eclampsia (6.25%) | Pre-term birth (18.8%), Low birth weight (17.6%) | [17] | |||
2020 | China | Case Study | Pregnant woman who was exposed to SARS-CoV-2 | 1 | NIL | Hospitalization Caesarean section | NIL | NIL | SARS-CoV-2-infected Neonate | [18] | |||
2020 | USA | Case Series | Pregnant women with suspected COVID-19 infection | 92 | NIL | Hospitalization (1.1%) | NIL | low morbidity | One fetal demise, but not sure whether it is due to COVID-19 | [19] | |||
2020 | Sweden | Case Series | Critically ill pregnant or newly delivered women positive for COVID-19 | 5 | Gestational diabetes (2 out of 5) Gestational Hypothyroidism (1 out of 5) Situs Inversus (1 out of 5) | Hospitalization for an average of 20 days (4 out of 5) Intubation (4 out of 5) | NIL | Severe respiratory distress syndromeCardiac arrest (1 out of 5) | NIL | [20] | |||
2020 | USA | Retrospective cohort study | Possible exposure or infection and positive COVID-19 test | 1609 | Chronic pulmonary disease (12.6%) Cardiac arrhythmia (10.4%) Hypertension (6.5%) Hypothyroidism (5%) Diabetes (3%) | Hospitalization (60.5%) | 0.20% | Not available | NIL | [21] | |||
2020 | USA | Retrospective cohort study | Pregnant and post-partum patients with SARS-CoV-2 infection | 2352 | Chronic pulmonary disease (12%) Hypertension (6.9%) Thyroid disease (3.9%) Diabetes (3.8%) | ICU admission (3.7%) | 0.20% | Post-partum hemorrhage (2.6%) Other infections (2.3%) Hypertensive disorders of pregnancy (10.1%) | Fetal/neonatal death (2.5%) Miscarriage (1.2%) Stillbirth (0.5%) Preterm birth (17.7%) | [22] | |||
2020 | USA | Observational Cohort study | Women who delivered and had SARS-CoV-2 infection during pregnancy | 252 | Gestational diabetes (3%) Chronic hypertension (5%) | Hospitalization (6%) | NIL | Pre-eclampsia (11%) Chorioamnionitis (10%) Excessive blood loss (7%) | Neonatal SARS-CoV-2 infection (3%) | [23] | |||
2020 | Iran | Retrospective case Control study | Pregnant women with COVID-19 positive test and a positive chest X-ray result | 110 | Hypertension (5.45%) Diabetes (9.09%) Asthma (5.45%) | ICU admission (6.9%) Requirement for invasive ventilation (1.7%) | NIL | Abortion (21.42%) Post-partum hemorrhage (5%) Pre-term birth (25%) | Still birth (5%) Fetal distress (10%) Low birth weight (10%) NICU admission (10%) | [24] | |||
2021 | 18 countries | Cohort study | Pregnant women with diagnosis of COVID-19 | 706 | Hypertension (3.7%), Diabetes (4.7%), Chronic respiratory disease (3.5%), Endocrine dysfunction (10.6%) | ICU admission (8.4%) | 1.60% | Hypertension Pre-eclampsia Anemia Infections | Pre-term birth (22.5%) Low birth weight (20.5%) SARS-CoV-2 positive (57.1%) | [25] | |||
(b) | |||||||||||||
Year of Study | Country | Study Approach | Case Type | Sample Size | Maternal Age | Gestational Age of Infection | Comorbidity | Clinical Presentation | Need for Hospitalization/ICU Admission | Maternal Mortality | Obstetric Morbidity | Perinatal Outcome | Reference |
1995 | Kikwit | Cohort Study | Ebola positive Pregnant women | 15 | 24–38 (mean age 32) | First trimester (27%), second trimester (40%) and third trimester (33%) | Not available | Fever (100%), asthenia (100%), abdominal pain (100%), conjunctivitis (100%), anorexia (100%), diarrhea (100%), arthralgia (100%), dysphagia (100%), headache (100%) | Admitted to General Hospital | 95.5% death | Genital bleeding (100%) | Abortion (67%), curettage performed due to incomplete abortion (20%), still birth (6.7%) | [26] |
2000 | North Uganda | Case study | Ebola positive Pregnant women | 1 | 31 | 28 weeks | Placenta had a moderate amount of malarial parasite pigment | Conjunctival injection, diffuse abdominal tenderness, and slight pulmonary rales | Admitted to ETU | Maternal survival | Placenta had mild subchorionitis | Still birth | [27] |
2012 | Congo | Case study | Ebola positive Pregnant women | 1 | 29 | 7 months | Not available | Fever, vomiting, dysphagia and diarrhea, drowsiness and wheezing, Dyspnea, coma stage 1b, light exophthalmos, cold limbs and sub icterus | Admitted to ETU | Maternal death | Dystocia | Death of neonate | [28] |
2014 | Liberia | Case Study | Ebola positive Pregnant women | 1 | 31 | Third trimester | Not available | vomiting, diarrhea, bleeding, and semi consciousness | Admitted to ETU | Maternal death | Not available | Intrauterine fetal death | [29] |
2014 | Guinea | Case Study | Ebola positive Pregnant woman | 1 | 40 | 4th month | Not available | abdominal pain, diarrhea and fever | Admitted to ETU | Maternal survival | Vaginal bleeding | Still birth | [30] |
2014 | Southern Guinea | Case study | Ebola positive Pregnant women | 2 | 20’s | 7 months | Malaria (50%) | Asthenia, fever, and vomiting, Anasarca (50%) | Admitted to ETU | Maternal survival (100%) | Absence of uterine contraction, cervical dilation (50%) and fetal heartbeat, hypertonic uterus (50%), post-partum hemorrhage (50%), suspected chorioamnionitis (50%) | Still birth (100%) | [31] |
2014 | Sierra Leone | Case study | Ebola positive Pregnant women | 1 | 34 | 36 | Not available | Headache, cough, and arthralgia | Admitted to ETU | Maternal survival | Hydropic Placenta | Still birth | [32] |
2014 | Sierra Leone | Cohort Study | Ebola positive Pregnant women | 55 | Mean age 25 | Not available | Not available | Fever (86.8%), fatigue or weakness (81.1%), nausea or vomiting (64.2%), headache (66%), muscle or joint pain (58.5%), vaginal bleeding (32.1%), unexplained bleeding (20.8%), and sore throat (13.2%) | Admitted to ETU | Not available | Vaginal bleeding (32%) | Not available | [33] |
2014 | Sierra Leone | Cohort Study | Ebola positive Pregnant women | 67 | Mean age 23 | 28–37 weeks | Not available | Fever (86.8%), abdominal pain (75.5%), fatigue (81.1%), nausea (64.2%) | Admitted to ETU | Maternal death (79%) | Vaginal bleeding (32%), obstetric hemorrhage (29.8%) and eclampsia (1.5%) | Spontaneous abortion (20.9%), Fetal death (5 out of 6), Still birth (8) | [34] |
2014 | Sierra Leone | Case study | qPCR negative, IgG positive | 1 | 19 | 36 weeks | Sickle cell anemia | Symptom free | Admitted to ETU | Maternal survival | Not available | Intrauterine fetal death, heavily macerated baby | [35] |
2014–15 | Liberia and Sierra Leone | Retrospective Cohort study | Ebola positive Pregnant women | 13 | 20-32 | Not available | Not available | Abdominal pain (85%) and nausea/vomiting (69%), Bleeding (30%), Hiccups (8%) and non-hemorrhagic rash (8%) | Admitted to ETU | 46% death | Not available | Preterm delivery (15%), Perinatal death (15%), Abortion (15%), Termination of pregnancy (7.6%), | [36] |
2014–2015 | Sierra Leone | Case series | Ebola positive Pregnant women (83.3%), Ebola survivor (16.6%) | 6 | 18-38 | Third trimester | Not available | Muscle pain (16.6%), headache (16.6%), diarrhea (16.6%), vomiting (16.6%) | Admitted to ETU | Maternal death (66.6%) | Postpartum hemorrhage (50%), hypovolemic shock (16.6%) | Neonate death (83.3%), still birth (16.6%) | [37] |
2015 | Sierra Leone | Case Study | Ebola positive Pregnant woman | 1 | 22 | 5 months | Not available | Anorexia, muscle pain, and joint pain | Admitted to ETU | Maternal survival | Leaking fluid | Intrauterine fetal death | [30] |
2015 | Sierra Leone | Case Study | IgG, IgM positive | 1 | 20 | Not available | Severe back pain, loss of appetite, and intense fatigue | Delivery attended by village traditional birth attendant | Maternal survival | Leakage of bloody fluid from vagina | Still birth | [38] | |
2016 | Guinea | Case Study | Ebola positive Pregnant women | 1 | 25 | 28th week | Not available | Hyperthermia, asthenia, and conjunctival infection | Admitted to ETU | Maternal death post delivery | Severe vaginal bleeding with signs of coagulopathy | Survived after treatment | [39] |
This entry is adapted from 10.3390/pathogens11070800