{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:25:22Z","timestamp":1788258322415,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100013120","name":"European Medicines Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013120","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000196","name":"Canada Foundation for Innovation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009210","name":"Food and Drug Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009210","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Understanding the varied impact of COVID\u201019 severity on pregnancy outcomes is crucial for informed clinical management and targeted interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact of COVID\u201019 on pregnancy outcomes, distinguishing between pregnant women managed in primary care and those requiring hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search Strategy<\/jats:title>\n                    <jats:p>Regulatory authorities actively promoted global cooperation on COVID\u201019's impact during pregnancy. Data were obtained through these regulatory bodies and direct researcher communication rather than through systematic searches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection Criteria<\/jats:title>\n                    <jats:p>Data sources required secondary population\u2010based data to identify pregnancies with COVID\u201019, along with hospitalization, diagnostic and medication codes. Eligibility for the meta\u2010analysis was determined through protocol evaluation and researcher consultations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection and Analysis<\/jats:title>\n                    <jats:p>PRISMA\u2010IPD and Cochrane guidelines for prospective meta\u2010analysis were followed. Protocols and definitions were standardized across sources, and a common R script was developed. Initially, crude and adjusted relative risks (aRR) with 95% confidence intervals (CI) were calculated to assess adverse outcomes in pregnant women with and without COVID\u201019 in each data source. Estimates were stratified by trimester at infection and hospitalization status. Subsequently, data were pooled using a random\u2010effects meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>\n                      Data from 10 sources across seven countries contributed to the meta\u2010analysis, including 86\u2009210 pregnant women diagnosed with COVID\u201019, of whom 4.4% were hospitalized. Non\u2010hospitalized pregnant women with COVID\u201019 had no increased risks of adverse outcomes compared to pregnant women without COVID\u201019. However, hospitalized women with COVID\u201019 in each trimester had higher risks of cesarean section, preterm birth, and LBW compared to pregnant women without COVID\u201019. Hospitalization due to COVID\u201019 in the third trimester was associated with increased risk of stillbirth (aRR 5.90, 95% CI: 2.22\u201315.71,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). First\u2010trimester hospitalizations due to COVID\u201019 did not show heightened risks of GDM (aRR 2.08, 95% CI: 0.93\u20134.64,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200965%), pre\u2010eclampsia (aRR 1.79, 95% CI: 0.48\u20136.66,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200971%), or major congenital anomalies (aRR 1.30, 95% CI: 0.55\u20133.06,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>COVID\u201019 requiring hospitalization is associated with adverse pregnancy outcomes, emphasizing the need to prevent severe illness during pregnancy. This study also highlights the importance of international collaboration for gathering pregnancy data and shows that building global research networks is essential for responding to future health crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70694","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T09:59:12Z","timestamp":1765792752000},"page":"1197-1206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adverse outcomes among pregnant women with\n                    <scp>COVID<\/scp>\n                    \u201019 according to hospitalization status: A prospective individual participant data meta\u2010analysis in Europe and North America"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6295-3411","authenticated-orcid":false,"given":"Odette","family":"de Bruin","sequence":"first","affiliation":[{"name":"Department of Data Science &amp; Biostatistics, Julius Global Health University Medical Center Utrecht (UMCU)  Utrecht The Netherlands"},{"name":"Division Woman and Baby, Department of Obstetrics, Wilhelmina Children's Hospital University Medical Center Utrecht (UMCU)  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emeline","family":"Maisonneuve","sequence":"additional","affiliation":[{"name":"Institute of Primary Health Care (BIHAM) University of Bern  Bern Switzerland"},{"name":"Graduate School for Health Sciences (GHS) University of Bern  Bern Switzerland"},{"name":"Materno\u2010Fetal and Obstetrics Research Unit, Woman\u2010Mother\u2010Child Department Lausanne University Hospital  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eimir","family":"Hurley","sequence":"additional","affiliation":[{"name":"Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy University Oslo (UiO)  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedvig M. 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