Manifestations of COVID-19 in pregnant women with focus on gastrointestinal symptoms: a systematic review
Gastroenterology and Hepatology from Bed to Bench,
20 September 2020
Aim: This review study was conducted to evaluate the symptoms of COVID-19 in pregnant women with a focus on gastrointestinal symptoms.
Background: COVID-19 is a fatal respiratory disease caused by a novel coronavirus that quickly became a pandemic. Although the main symptoms of this disease include respiratory symptoms, gastrointestinal manifestations have also been observed in some patients suffering from COVID-19. Pregnant women are among the most vulnerable groups in the community to infectious diseases.
Methods: Scientific databases were searched for articles published up to May 8, 2020. Any type of study investigating the manifestations of COVID-19 in pregnant women was included. Symptoms of the disease in pregnant women with an emphasis on gastrointestinal symptoms were assessed.
Results: The search resulted in 852 titles and abstracts, which were narrowed down to 43 studies involving 374 women. The most common symptoms of patients were fever (59.1%) and cough (48.4%), respectively. Gastrointestinal symptoms included diarrhea (4.5%), abdominal pain (1.6%), nausea (0.8%), and loss of appetite (0.3%), respectively. In studies on pregnant women with gastrointestinal symptoms, 13 fetal abortions occurred, most of which were induced abortions due to the risks posed by COVID-19.In thirty cases, and infected pregnant women reported a history of chronic pregnancy-related diseases.
Conclusion: COVID-19 in pregnant women, similar to the general population, can present with gastrointestinal manifestations. The gastrointestinal tract can be a potential route for infection with the novel coronavirus.
Keywords: COVID-19, Novel Coronavirus Infection, Pregnancy, Diarrhea, Gastrointestinal Tract.
(Please cite as: Makvandi S, Ashtari S, Vahedian-Azimi A. Manifestations of COVID-19 in pregnant women with focus on gastrointestinal symptoms: a systematic review. Gastroenterol Hepatol Bed Bench 2020;13(4):305-312).
- COVID-19, Novel Coronavirus Infection, Pregnancy, Diarrhea, Gastrointestinal Tract.
Qiao J. What are the risks of COVID-19 infection in pregnant women? The Lancet 2020;395:760-2.
Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020:100118.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet 2020;395:497-506.
Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. AJOG2004;191:292-7.
Dashraath P, Jeslyn WJL, Karen LMX, Min LL, Sarah L, Biswas A, et al. Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy. AJOG 2020;222:521-31
Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr2020;52:102066.
Agarwal A, Chen A, Ravindran N, To C, Thuluvath PJ. Gastrointestinal and Liver Manifestations of COVID-19. J ClinExpHepatol2020;10:263-65.
Sellevoll HB, Saeed U, Young VS, Sandbæk G, Gundersen K, Mala T. Acute abdomen as an early symptom of COVID-19. Tidsskr Nor Legeforen 2020;10:4045.
Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, et al. Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China: N Engl J Med 2020;382:e100.
Zamaniyan M, Ebadi A, Aghajanpoor Mir S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn2020;10:1002.
Cao D, Yin H, Chen J, Tang F, Peng M, Li R, et al. Clinical analysis of ten pregnant women with COVID-19 in Wuhan, China: A retrospective study. Int J Infect Dis 2020;23:30263-70.
Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anesth2020;67655-63.
Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol2020;92:1556-61.
Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants Born to Mothers With a New Coronavirus (COVID-19). Front Pediatr 2020;8:1-5.
Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, et al. Perinatal Transmission of COVID-19 Associated SARS-CoV-2: Should We Worry? Clin Infect Dis2020;10:1093.
Khan S, Peng L, Siddique R, Nabi G, Nawsherwan, Xue M, et al. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infect Control HospEpidemiol 2020;41:748-50.
Khan S, Jun L, Nawsherwan, Siddique R, Li Y, Han G, et al. Association of COVID-19 with pregnancy outcomes in health-care workers and general women. ClinMicrobiol Infect2020;26:788-90.
Li J, Wang Y, Zeng Y, Song T, Pan X, Jia M, et al. Critically ill pregnant patient with COVID-19 and neonatal death within two hours of birth. Int J Gynaecol Obstet 2020;5:13189.
Li Y, Zhao R, Zheng S, Chen X, Wang J, Sheng X, et al. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerg Inf Dis 2020;26.
Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020;29:13188.
Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. AJR Am J Roentgenol 2020:1-6.
Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020.
Lu D, Sang L, Du S, Li T, Chang Y, Yang XA. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol 2020;24:25927.
Peng Z, Wang J, Mo Y, Duan W, Xiang G, Yi M, et al. Unlikely SARS-CoV-2 vertical transmission from mother to child: A case report. Journal of Infection and Public Health 2020;13:818-20.
Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, et al. Coronavirus disease 2019 in pregnancy. Int J Infect Dis 2020;95:376-83.
Wang S, Guo L, Chen L, Liu W, Cao Y, Zhang J, et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis 2020.
Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery.Clin Infect Dis 2020;71:844-6.
Wu C, Yang W, Wu X, Zhang T, Zhao Y, Ren W, et al. Clinical Manifestation and Laboratory Characteristics of SARS-CoV-2 Infection in Pregnant Women. VirolSin 2020;1-6.
Wu X, Sun R, Chen J, Xie Y, Zhang S, Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. Int J Gynaecol Obstet 2020;150:58-63.
Xiong X, Wei H, Zhang Z, Chang J, Ma X, Gao X, et al. Vaginal Delivery Report of a Healthy Neonate Born to a Convalescent Mother with COVID19. J Med Virol 2020.
Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study.Lancet Infect Dis 2020;20:559-64.
Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020;9:51-60.
Browne PC, Linfert JB, Perez-Jorge E. Successful Treatment of Preterm Labor in Association with Acute COVID-19 Infection. Am J Perinatol 2020;37:866-8.
De Castro A, Abu-Hishmeh M, El Husseini I, Paul L. Haemophilus parainfluenzae endocarditis with multiple cerebral emboli in a pregnant woman with coronavirus.ID Cases 2019;18:e00593.
Hirshberg A, Kern-Goldberger AR, Levine LD, Pierce-Williams R, Short WR, Parry S, et al. Care of critically ill pregnant patients with COVID-19: a case series. Am J Obstet Gynecol 2020;223:286-90.
Iqbal SN, Overcash R, Mokhtari N, Saeed H, Gold S, Auguste T, et al. An Uncomplicated Delivery in a Patient with Covid-19 in the United States: N Engl J Med 2020;382:e34.
Juusela A, Nazir M, Gimovsky M. Two cases of coronavirus 2019-related cardiomyopathy in pregnancy. Am J Obstet Gynecol MFM 2020;2:100113.
Kelly JC, Dombrowksi M, O'Neil-Callahan M, Kernberg AS, Frolova AI, Stout MJ. False-Negative COVID-19 Testing: False-negative testing for severe acute respiratory syndrome coronavirus 2: consideration in obstetrical care. Am J Obstet Gynecol MFM 2020;2:100130.
Schnettler WT, Al Ahwel Y, Suhag A. Severe ARDS in COVID-19-infected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM 2020;2:100120.
Buonsenso D, Raffaelli F, Tamburrini E, Biasucci DG, Salvi S, Smargiassi A, et al. Clinical role of lung ultrasound for the diagnosis and monitoring of COVID-19 pneumonia in pregnant women. Ultrasound Obstet Gynecol 2020;56:106-9.
Carosso A, Cosma S, Borella F, Marozio L, Coscia A, Ghisetti V, et al. Pre-labor anorectal swab for SARS-CoV-2 in COVID-19 pregnant patients: is it time to think about it? Eur J ObstetGynecolReprodBiol 2020;249:98-9.
Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2 infected pregnant women in Northern Italy: a retrospective analysis. Bjog 2020;127:1116-21.
Martinelli I, Ferrazzi E, Ciavarella A, Erra R, Iurlaro E, Ossola M, et al. Pulmonary embolism in a young pregnant woman with COVID-19. Thromb Res 2020;191:36-7.
Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, Arian SE, et al. Maternal Death Due to COVID-19 Disease. Am J Obstet Gynecol 2020;223:109.e1-16.
Karami P, Naghavi M, Feyzi A, Aghamohammadi M, Novin MS, Mobaien A, et al. Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Med Infect Dis 2020:101665.
Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. Am J Perinatol 2020;37:861-5.
Lyra J, Valente R, Rosario M, Guimaraes M. Cesarean Section in a Pregnant Woman with COVID-19: First Case in Portugal. Acta Med Port 2020;33:429-31.
Kalafat E, Yaprak E, Cinar G, Varli B, Ozisik S, Uzun C, et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound ObstetGynecol2020;55:835-7.
Gidlöf S, Savchenko J, Brune T, Josefsson H. COVID-19 in pregnancy with comorbidities: More liberal testing strategy is needed. Acta Obstetricia et Gynecologica Scandinavica 2020;99:948-9.
Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA, Bustillo C, Gonzales G, Vallecillo-Chinchilla G, et al. A pregnant woman with COVID-19 in Central America. Travel Med Infect Dis 2020:101639.
Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean J Anesthesiol 2020;73:347-351.
Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)-China.China CDC Wkly 2020;2:113-22.
Liang W, Feng Z, Rao S, Xiao C, Xue X, Lin Z, et al. Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus. BMJ 2020;69:1141-3.
Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med2020;382:929-36.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.
Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal–oral transmission. Gastroenterology 2020;158:1518-9.
Guan G, Gao L, Wang J, Wen X, Mao T, Peng S, et al. Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia. Zhonghua Gan Zang Bing Za Zhi2020;28:E002.
Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395:809-15.
Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020;115:766-73.
Budden KF, Gellatly SL, Wood DL, Cooper MA, Morrison M, Hugenholtz P, et al. Emerging pathogenic links between microbiota and the gut–lung axis. Nat Rev Microbiol 2017;15:55-63.
Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID‐19. Diabetes Metab Res Rev 2020:e3319.
- Abstract Viewed: 0 times
- PDF Downloaded: 0 times