The Association between Maternal COVID-19 and the Rates of Cesarean: A Systematic Review

Background: Maternal COVID-19 infection has been reported to be associated with an increase in the rates of C-sections. However, studies have not reported this association consistently. Therefore, this systematic review and meta-analysis were conducted regarding this issue. Methods: We identified all publications up to January 2021 in databases of PubMed, Scopus, and Web of Science. In addition, we reviewed gray literature and conference proceedings. The pooled odds ratios (OR) and 95% confidence intervals (CI) measured from eligible studies were used as random effect estimates of association among studies. Heterogeneity testing using I2 statistics was performed to assess variance between the studies. Results: The pooled estimates of OR did not report a significant association between COVID-19 and the risk of cesarean section, respectively (OR = 2.02, 95% CI = 0. 4 to 3.64). There was low heterogeneity among the studies reporting the risk of diseases associated with cesarean section among children based on OR (I²=12.7%, P=0.333). The P-values for Begg’s and Eggers regression were 0.573 and 0.555, respectively. Conclusion: While we did not find an association between COVID-19 and increased rates of cesarean sections, we cannot exclude a type II error; therefore, additional studies, including large cohort studies by controlling confounding variables, should be performed in the future.