COVID-19 and pregnancy: A review of clinical characteristics, obstetric outcomes and vertical transmission

Elicia Pettirosso, Michelle Giles, Stephen Cole, Megan Rees

Research output: Contribution to journalReview ArticleResearchpeer-review

95 Citations (Scopus)


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. Thirteen neonates were SARS-CoV-2 positive, confirmed by reverse transcription polymerase chain reaction of nasopharyngeal swabs. 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.

Original languageEnglish
Pages (from-to)640-659
Number of pages20
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Issue number5
Publication statusPublished - Oct 2020


  • COVID-19
  • novel coronavirus
  • pregnancy
  • SARS-CoV-2

Cite this