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JMIR Pediatr Parent
. 2022 Mar 22.
doi: 10.2196/31579. Online ahead of print.
An Association of Pregnancy with Coronavirus Cytokine Storm: Systematic Review and Meta-Analysis
John Kyalo Muthuka 1 , Michael Kiptoo 2 , Kelly Oluoch 3 , Everlyn Nyamai 3
Affiliations
- PMID: 35319475
- DOI: 10.2196/31579
Abstract
Background: Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 cytokine storm, some, in contrast.
Objective: The aim of the current study was to examine the relationship between pregnancy status and the clinical COVID -19 severity characterized by cytokine storm through a systematic review and meta-analysis.
Methods: We searched Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing theCOVID-19 severity cytokine storm outcome were included. The COVID-19 severity characterized by cytokine storm was described using parameters such as; Intensive Care Unit Admission, Invasive Mechanical Ventilation, Mechanical Ventilation, Hospital Admission, Pro and Inflammatory cytokine levels, consolidation on chest CT scan, pulmonary infiltration, extreme fevers as characteristic of cytokine storm, syndromic severity, higher neutrophil count indicative of cytokine storm and severe COVI-19 presentation.
Results: A total of 17 articles detailing 840332 COVID-19 women were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 cytokine storm (random effect model, OR=2.47; 95% CI: 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24352 (3.1%) among pregnant and non-pregnant women with COVI-19 respectively. Heterogeneity analysis shifted from: (random effect model, OR=2.47; 95% CI: 1.63-3.73; P<.001) to (fixed effect model, OR= 7.41; 95% CI: 7.02-7.83; P<.001) revealing a correlation between severe pregnancy status and COVID-19 with cytokine storm. A funnel plot was used to evaluate publication bias and revealed considerable heterogeneity between all the pooled studies (I² = 98 %; P<.001). Furthermore, this updated analysis showed substantially low heterogeneity (I² = 29 %; P = 0.19
, while a funnel plot revealed no publication bias. Further to this, the sub-analysis between Single Centre and Multiple Centre studies demonstrated seemingly the same as heterogeneity (I2 = 72 and (I2 = 98), respectively. Sensitivity analysis on each sub-group revealed that pregnancy was significantly related to severe COVID-19 with cytokine storm from single Centre studies, (fixed effect model, OR= 3.97; 95% CI: 2.26-6.95; P< .001) with very low heterogeneity (I² = 2 %; P = 0.42).Conclusions: Being pregnant is clearly associated with experiencing a severe COVID-19 characterized by a cytokine storm. The SARS-CoV-2 epidemic should serve as an impetus for pregnant women diagnosed with COVID-19, and map out salient risk factors associated with its severity.