Evidence map›Paper›PMID 33811827›Full record

SynthesisThe Lancet. Global health2021

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis.

Barbara Chmielewska, Imogen Barratt, Rosemary Townsend, Erkan Kalafat, Jan van der Meulen, Ipek Gurol-Urganci, Pat O'Brien, Edward Morris, Tim Draycott, Shakila Thangaratinam and 5 more

Erratum issuedOpen access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 621 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
621citing papers in PubMed, 9 pooled it
147.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

621 citing papers in PubMed, 9 syntheses or guidelines pooled it, 1,081 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Trial
  11. Trial
  12. Review
  13. Article
  14. Article
  15. Article
  16. Right-sizing Incentives.Journal of development economics · 2026
    Article
  17. Maternal deaths in the UK before and during the COVID-19 pandemic.Acta obstetricia et gynecologica Scandinavica · 2026
    Article
  18. Article
  19. Article
  20. The association of in utero SARS-CoV-2 exposure on neurodevelopmental outcomes at 12 and 22 months.Journal of perinatology : official journal of the California Perinatal Association · 2026
    Article

561 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 10 institutions in 2 countries.

Barbara ChmielewskaFetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK.
Imogen BarrattFetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK.
Rosemary TownsendFetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK.
Erkan KalafatDepartment of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey; Department of Obstetrics and Gynaecology, School of Medicine, Koc University, Istanbul, Turkey.
Jan van der MeulenDepartment of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Ipek Gurol-UrganciDepartment of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Pat O'BrienThe Royal College of Obstetricians and Gynaecologists, London, UK; University College London Hospitals NHS Foundation Trust, London, UK.
Edward MorrisThe Royal College of Obstetricians and Gynaecologists, London, UK; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Tim DraycottThe Royal College of Obstetricians and Gynaecologists, London, UK; North Bristol NHS Trust Department of Women's Health, Westbury on Trym, UK.
Shakila ThangaratinamInstitute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, UK.
Kirsty Le DoarePaediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, UK.
Shamez LadhaniPaediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, UK; Immunisation and Countermeasures Division, Public Health England, London, UK; British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK.
Peter von DadelszenDepartment of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Laura MageeDepartment of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Asma KhalilFetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, UK. Electronic address: akhalil@sgul.ac.uk.
St George’s University Hospitals NHS Foundation Trust · GBKing's College London · GBLondon School of Hygiene & Tropical Medicine · GBSt George's, University of London · GBKoç University · TRNorth Bristol NHS Trust · GBPublic Health England · GBRoyal College of Obstetricians and Gynaecologists · GBUniversity College London · GBUniversity of Birmingham · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic.

methodsWe did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753).

findingsThe search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07-1·54]; I

interpretationGlobal maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. Some outcomes show considerable disparity between high-resource and low-resource settings. There is an urgent need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises.

fundingNone.

Indexed as

COVID-19Global HealthPregnancy OutcomeFemaleHumansInfant, NewbornPregnancy

Identifiers

PMID33811827
PMCPMC8012052
OpenAlexW3152089607

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.