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. Synopsis Pregnant women with COVID‐19 infection and at least one severe co‐morbidity experience increased risk of death and admission to the intensive care unit.