Outcome of COVID-19 Contracted in the First and Second Trimester of Pregnancy: A Systematic Review

Background: Pregnant women are more susceptible to COVID-19 infection than the overall population, due to immunologic and anatomic alterations. Since January 2020, the multitude of studies published have described the outcomes of COVID-19 during the third trimester of pregnancy. The aim of this systematic review is to conduct a search of the literature on SARS-CoV-2 infection in the first and second trimester and report on its outcomes. Methods: The review was conducted based on PRISMA guidelines. We conducted a comprehensive search in Medline, PubMed, and Embase. Articles reporting on pregnancy, perinatal and fetal outcomes of COVID-19 infected women with confirmed diagnosis were eligible. The quality of the studies was assessed using the appropriate methodology. Results: The search resulted in 7,380 articles, of which 424 were reviewed. A total of 17 studies met our inclusion criteria. The percentage of women admitted to the hospital during the first trimester was 47%, with a reported 2% receiving respiratory support. Moreover, the percentage of first trimester women who underwent a miscarriage or abortion was 11%. The percentage of pregnant women who were hospitalized during the second trimester was 44%, while 2.5% were admitted to the ICU and 1.6% received respiratory support, whereas 1.4% were intubated or mechanically ventilated. The percentage of maternal mortality was 2% and 4% during the first trimester and second trimester, respectively. Conclusion: Pregnant women who have been infected during the first and second trimester need to be monitored carefully. There are insufficient good-quality studies assessing those infected during early pregnancy.