Global maternal mortality associated with SARS-CoV-2 infection: a systematic review and meta-analysis
Barry, Kathryn Fernández-García, Silvia Khashaba, Alya Ruiz-Calvo, Gabriel Roncal Redin, Miriam Mahmoud, Ghadir Yap, Magnus King, Yasmin Zhou, Dengyi Mamey, Massa
Barry, Kathryn
Fernández-García, Silvia
Khashaba, Alya
Ruiz-Calvo, Gabriel
Roncal Redin, Miriam
Mahmoud, Ghadir
Yap, Magnus
King, Yasmin
Zhou, Dengyi
Mamey, Massa
Affiliation
University of Birmingham; Hospital Universitario Ramón y Cajal; University of Nottingham; University College Cork; Amsterdam University Medical Centre; Queen Mary University of London; Barts Health NHS Trust; St George's University of London; World Health Organization; Elizabeth Glaser Pediatric AIDS Foundation; CIBER Epidemiology and Public Health; University Hospitals Birmingham NHS Foundation Trust; Liverpool Women's NHS Foundation Trust; University of Liverpool
Other Contributors
Gupta, Ankita
Dixit, Anushka
Akande, Damilola
Khalil, Halimah
Kumaran, Maurie
Hebbar, Meghnaa
Dixit, Anushka
Akande, Damilola
Khalil, Halimah
Kumaran, Maurie
Hebbar, Meghnaa
Publication date
2025-04-21
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Background: Pregnant and recently pregnant women infected with SARS-CoV-2 are at increased risk of death and serious complications than those without the infection. The extent of variation in mortality rates in pregnant women with SARS-CoV-2 infection across regions, and the causes of death are not known. We systematically reviewed all available evidence on the variation in mortality rates in pregnant women with SARS-CoV-2 infection across geographical and country income groups, and the reported cause of death.
Methods: We searched major databases (December 2019-January 2023) including Medline, LILACS, BIREME and Embase. We included studies that reported deaths in at least 10 consecutive pregnant or recently pregnant women with confirmed SARS-CoV-2 infection and assessed the studies' risk of bias. We calculated the summary estimates of any cause of death as proportions with 95% CIs using a multilevel random-effects logistic regression model. Subgroup analyses were performed by geographical region and country income groups. We used International Statistical Classification of Diseases and Related Health Problems-Maternal Mortality to categorise the reported cause of death.
Findings: From 1 326 315 citations, we included 169 studies (319 172 women with confirmed SARS-CoV-2 infection; 4253 women died). The overall rate of unspecified maternal death was 0.87% (95% CI 0.64% to 1.16%). There were significant differences between geographical regions in rates of maternal mortality, with the highest rates in Sub-Saharan Africa (3.48%; 95% CI 0.66% to 16.42%) and Latin America and the Caribbean (3.16%, 95% CI 1.53% to 6.43%). Rates of maternal mortality varied by country income groups, with the highest rates in low-income countries (4.66%, 95% CI 0.75% to 24.07%). Among women with reported cause of death, 98.6% (2,390/2,423) of deaths were attributable to COVID-19.
Interpretation: Rates of deaths in pregnant and recently pregnant women with SARS-CoV-2 infection vary significantly across regions and by country income groups, with the highest burden in Sub-Saharan Africa and low-income countries. COVID-19 is the main reported cause of death.
Citation
Barry K, Fernández-García S, Khashaba A, Ruiz-Calvo G, Roncal Redin M, Mahmoud G, Yap M, King Y, Zhou D, Mamey M, Shepherd-Evans I, Sheikh J, Lawson H, Kew T, Ansari K, Attarde S, Banjoko A, Fraser H, Littmoden M, Rajah T, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Kara E, Kim CR, Thorson A, Oladapo OT, Mofenson L, Bonet M, Zamora J, Allotey J, Thangaratinam S; PregCOV-19 Living Systematic Review Consortium. Global maternal mortality associated with SARS-CoV-2 infection: a systematic review and meta-analysis. BMJ Glob Health. 2025 Apr 21;10(4):e015815. doi: 10.1136/bmjgh-2024-015815.
Type
Article