The 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
Introduction: COVID-19 is a fatal respiratory disease caused by a novel coronaviruses that quickly became a pandemic. Although the main symptoms of this disease include respiratory symptoms, the gastrointestinal manifestations have also been observed in some patients who suffered from COVID-19. Pregnant women are among the most vulnerable groups in the community to infectious diseases. This review study was conducted to evaluate the symptoms of COVID-19 in pregnant women with a focus on gastrointestinal symptoms.
Methods: We searched the scientific databases from their inception to May8, 2020. Any type of studies investigating the manifestations of COVID-19in pregnant women was included in the study. Symptoms of the disease in pregnant women were assessed with emphasis on gastrointestinal symptoms
Results: The search resulted in 852 titles and abstracts, which were narrowed down to 43 studiesinvolving 374 women. The most common symptoms of patients were fever (59.1%) and caught (48.4%), respectively. Gastrointestinal symptoms include diarrhea (4.5%), abdominal pain (1.6%), nausea (0.8%), and loss of appetite (0.3%), respectively. In studies of 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, infected pregnant women reported a history of the chronicpregnancy-related diseases.
Conclusion: COVID-19 in pregnant women, similar tothe general population, can present with gastrointestinal manifestations. The gastrointestinal tract can be a potential route for infection with the novel coronavirus. In pregnant women, regular screening is recommended for gastrointestinal symptoms of COVID-19 as well as respiratory symptoms.
- Novel coronavirus infection
- Gastrointestinal Tract
Qiao J. What are the risks of COVID-19 infection in pregnant women? The Lancet. 2020;395(10226):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. American Journal of Obstetrics & Gynecology 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(10223):497-506.
Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry. 2020;52.
Agarwal A, Chen A, Ravindran N, To C, Thuluvath PJ. Gastrointestinal and Liver Manifestations of COVID-19. Journal of Clinical and Experimental Hepatology. 2020.
Sellevoll HB, Saeed U, Young VS, Sandbæk G, Gundersen K, Mala T. Acute abdomen as an early symptom of COVID-19. Tidsskrift for Den norske legeforening. 2020.
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(20):30263-0.
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 Apr 17. doi: 10.1056/NEJMc2009226.
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. Canadian Journal of Anesthesia. 2020.
Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. Journal of Medical Virology. 2020.
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 Mar 16;8:104. doi: 10.3389/fped.2020.00104. eCollection 2020.
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? Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020.
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. Infection Control and Hospital Epidemiology. 2020.
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. Clinical Microbiology and Infection. 2020.
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(10):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. Emerging infectious diseases. 2020;26(6).
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(10):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 American journal of roentgenology. 2020:1-6.
Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. The Journal of infection. 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(10):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(5):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;27(20):30280-0.
Wang S, Guo L, Chen L, Liu W, Cao Y, Zhang J, et al. A case report of neonatal COVID-19 infection in China. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 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. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020.
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. Virologica Sinica. 2020.
Wu X, Sun R, Chen J, Xie Y, Zhang S, Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. International Journal of Gynecology and Obstetrics. 2020.
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. Journal of Medical Virology. 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. The Lancet Infectious Diseases. 2020;20(5):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. Translational Pediatrics. 2020;9(1):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;24(10):0040-1709993.
De Castro A, Abu-Hishmeh M, El Husseini I, Paul L. Haemophilus parainfluenzae endocarditis with multiple cerebral emboli in a pregnant woman with coronavirus. IDCases. 2019;18.
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 May 1. pii: S0002-9378(20)30515-9. doi: 10.1016/j.ajog.2020.04.029.
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 Apr 16;382(16):e34. doi: 10.1056/NEJMc2007605. Epub 2020 Apr 1.
Juusela A, Nazir M, Gimovsky M. Two cases of coronavirus 2019-related cardiomyopathy in pregnancy. Am J Obstet Gynecol MFM. 2020;3(100113):100113.
Kelly JC, Dombrowksi M, O'Neil-Callahan M, Kernberg AS, Frolova AI, Stout MJ. False-Negative COVID-19 Testing: Considerations in Obstetrical Care. Am J Obstet Gynecol MFM. 2020;28(100130):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;14(100120):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 Apr 26. doi: 10.1002/uog.22055.
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? European Journal of Obstetrics and Gynecology and Reproductive Biology. 2020.
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;27(10):1471-0528.
Martinelli I, Ferrazzi E, Ciavarella A, Erra R, Iurlaro E, Ossola M, et al. Pulmonary embolism in a young pregnant woman with COVID-19. Thrombosis Research. 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;28(20):30516-0.
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 Medicine and Infectious Disease. 2020.
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. Prenatal Diagnosis. 2020.
Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. American journal of perinatology. 2020.
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;20(10):13883.
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 in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2020.
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.
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 Medicine and Infectious Disease. 2020.
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 journal of anesthesiology. 2020.
Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly. .
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(6):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. New England Journal of Medicine. 2020;382(10):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(11):1061-9.
Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal–oral transmission. Gastroenterology. 2020;158(6):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 zhi= Zhonghua ganzangbing zazhi= Chinese journal of hepatology. 2020;28(2):E002-E.
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. The Lancet. 2020;395(10226):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. The American journal of gastroenterology. 2020;115.
Budden KF, Gellatly SL, Wood DL, Cooper MA, Morrison M, Hugenholtz P, et al. Emerging pathogenic links between microbiota and the gut–lung axis. Nature Reviews Microbiology. 2017;15(1):55.
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/metabolism research and reviews. 2020.
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