Objective: To evaluate the performance of INTERGROWTH-21st and World Health Organization (WHO) fetal growth charts to identify small-for-gestational-age (SGA) and fetal growth restriction (FGR) neonates as well as their specific risks for adverse neonatal outcomes. Design: Multicenter cross-sectional study. Setting: Ten maternity units across four Latin American countries, 2016-2018. Population: 67,968 singleton live births. Methods: According to each standard, the neonates were classified as SGA and FGR (birthweight <10th and <3rd centiles, respectively). Main Outcomes Measures: The relative risk (RR) and diagnostic performance for the occurrence of a low Apgar score and low ponderal index were calculated for each standard. Results: The WHO charts identified more neonates as SGA than IG-21st (13.9% vs. 7%, respectively). 6.9% babies were considered SGA only by the WHO chart. Compared to normally grown babies, neonates classified as FGRs by both standards had the highest RR for a low Apgar (RR: 5.57; 95% CI: 3.99–7.78), followed by those SGA by both curves (RR: 3.27; 95% CI: 2.52–4.24), while SGAs identified by WHO alone did not have an additional risk (RR: 0.87; 95% CI: 0.55–1.39). Furthermore, the diagnostic odds ratio for a low Apgar was higher when INTERGROWTH-21st was used than when SGA and FGR were defined by WHO charts. Conclusions: In a large population of singleton deliveries from Latin America, the WHO fetal growth charts seem to identify significantly more SGA neonates than the INTERGROWTH-21st charts, but the diagnostic performance of the latter for low Apgar score and low ponderal index is better.

Background: COVID-19 is a new pandemic disease with severe respiratory outcome. However, there is little evidence of this condition during pregnancy based on small case series reports. Objective: to perform a systematic review and meta-analysis of proportions of case series focused on maternal and perinatal outcomes of COVID-19 during pregnancy. Search strategy: LILACS and Medline were searched from inception until April 24th, 2020. Selection criteria: all case series or case control studies involving SARS-CoV2 infection during pregnancy and neonatal period were identified. Excluded were duplicated data, case reports of individual patients or without clinical data. Data collection and analysis: a total of 14 studies were included. When possible, pooled proportions with 95% confidence interval through a random effect model were estimated. Heterogeneity was estimated with the use of I2 statistics and Tau2 test. Main results: Most common symptoms were fever (58%; I2= 69%) and cough (33%; I2= 65%). A pathognomonic CT-Scan was observed in 92% of patients (I2= 0%). Lymphopenia and increased D-dimer were observed in 50% (I2= 82%), and 80% (I2= 0%) of patients at admission, respectively. There were no maternal deaths, with 2 cases of neonatal death, both with negative SARS-CoV2 PCR. Vertical transmission was observed in 5 neonates. Conclusions: This systematic review and meta-analysis confirms that COVID-19 during pregnancy is associated with good maternal and perinatal outcome. Evidence of vertical transmission should be confirmed with larger cohorts. Funding: none. Key words: meta-analysis, COVID-19, vertical transmission, perinatal outcome, pregnancy.