key: cord-0982140-46bc8mxw authors: Uygun-Can, B.; Acar-Bolat, B. title: CLINICAL PROPERTIES AND DIAGNOSTIC METHODS OF COVID-19 INFECTION IN PREGNANCIES: META-ANALYSIS date: 2020-06-07 journal: nan DOI: 10.1101/2020.06.06.20123901 sha: f3f0b6c4de907353f461aaf1bbfeac0009d6251b doc_id: 982140 cord_uid: 46bc8mxw We aimed to summarize reliable medical evidence by the meta-analysis of all published retrospective studies that examined data based on the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by clinical symptoms, molecular (RT-PCR) diagnosis and characteristic CT imaging features in pregnant women. MEDLINE PubMed, SCOPUS, ISI Web of Science, Clinical Key, and CINAHL databases were used to select the studies. Then, 384 articles were received, including the studies until 01/MAY/2020. As a result of the full-text evaluation, 12 retrospective articles covering all the data related were selected. A total of 181 pregnant cases with SARS-CoV-2 infections were included in the meta-analysis within the scope of these articles. According to the results, the incidence of fever was 38.1% (95% CI: 14.2-65%), and cough was 22% (95% CI: 10.8-35.2%) among all clinical features of pregnant cases with SARS-CoV-2 infection. So, fever and cough are the most common symptoms in pregnant cases with SARS-CoV-2 infection, and 91.8% (95% CI: 76.7-99.9%) of RT-PCR results are positive. Moreover, abnormal CT incidence is 97.9% (95% CI: 94.2-99.9%) positive. No case was death. However, as this virus spreads globally, it should not be overlooked that the incidence will increase in pregnant women and may be in the risky group. RT-PCR and CT can be used together in an accurate and safe diagnosis. In conclusion, these findings will provide important guidance for current studies regarding the clinical features and correct detection of SARS-CoV-2 infection in pregnant women, as well as whether it will create emergency tables that will require the use of a viral drug. CoV, which caused severe airway symptoms and diseases associated with a high 95 mortality rate (10-30%, respectively), were limited to a one-time outbreak and were 96 predominantly of regional significance . The pandemic spreading can be fatal when healthcare professionals are not ready to 105 manage the infection, as now seen in the COVID-19 outbreak. The SARS-CoV-2 106 virus was also isolated from asymptomatic individuals, and affected patients showed 107 contagiousness even 2 weeks after symptoms ceased (Dashraath, Lin, et al., 2020) . 108 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. . https://doi.org/10.1101/2020.06.06.20123901 doi: medRxiv preprint borders. 110 As the epidemic of COVID-19 spreads rapidly, pregnant women have drawn attention 111 to the prevention and control of COVID-19 infection due to being at risk of respiratory 112 infection, especially flu. Physiological and mechanical changes in pregnancy increase 113 susceptibility to infections in general and promote rapid progression to respiratory 114 failure, especially when the cardiovascular system is affected. Thus, they represent a 115 high-risk group during infectious outbreaks (Dashraath, Wong, et al., 2020) . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. . https://doi.org/10.1101/2020.06.06.20123901 doi: medRxiv preprint (Stang, 2010) . The quality scores of all varied from 0 to 9 (Table 1) (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. The meta-analysis of incidence rates was conducted using the "metafor" package in 161 R version 3.6.2 (Viechtbauer, 2010) . It includes 12 studies, with a total of 181 162 patients. We employed the random-effects model according to assessing 163 heterogeneity of the meta-analysis. 164 The publication bias was detected by Egger's test. The test results and 165 corresponding P values are presented in Table 2 . The Egger's test indicated that 166 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. transformation. The results are given for the summary incidence rate and confidence 178 interval in Table 3 . 179 The incidence of fever was 38% (95% CI: 14% -35%) and cough was 22% (95% CI: Table 3 . (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. . https://doi.org/10.1101/2020.06.06.20123901 doi: medRxiv preprint in a few, but significant numbers of pregnant cases, but specific risk factors for a fatal 218 outcome during pregnancy have not been clarified . 219 In addition, in another study, Zhao et al.(2020) , the angiotensin-converting enzyme 2 220 (ACE2) SARS-CoV-2 receptor, they found that in healthy lung tissue, ACE2 is mainly 221 expressed by type I and type II alveolar epithelial cells. Type II alveolar cells (83%) (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. if they have chronic diseases or complications (Qiao, 2020) . Therefore, pregnant 317 women should be considered as an critical risk group in the prevention and treatment 318 of COVID-19 infection. In addition to recent studies, previous pandemic experiences 319 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 7, 2020. . https://doi.org/10.1101/2020.06.06.20123901 doi: medRxiv preprint should be considered in the prevention and control of this infection. Our findings will 320 provide valuable guidance for current clinical trials. We are also of the opinion that 321 our results can give an idea about the necessity of using a viral drug in the treatment 322 of SARS -CoV -2 infections in pregnant women. In summary, pregnant women with 323 SARS-CoV-2 infection should be closely monitored for early diagnosis. Currently, 324 pregnancy may complicate the clinical course of COVID-19, but the fact that the 325 cases in this group are not in the risky age group defined for COVID-19 may give an 326 idea that their condition will not be as bad as in the pregnant tables in MERS or 327 SARS infections . 328 329 We believe that this research may be critical in determining methods and even saving 331 lives in the early diagnosis and treatment of pregnant women in current and future 332 outbreaks. 333 334 All data generated or analyzed during this study are included in this article. 336 The authors declare that there are no conflicts of interest. 338 BUC designed the research model and determination of these articles to be included 340 in the study. BAB contributed to the realization of the study by applying meta-341 analysis. Both authors contributed to article selection and data interpretation, 342 reviewed and approved the final article. 343 This work was not supported. 345 We would like to express our gratitude to all healthcare professionals working hard 346 on these challenging days. 347 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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