Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis.

INTRODUCTION Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. METHODS We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. RESULTS We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. CONCLUSIONS This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol

Panel III: Water

The Duke Journal of Comparative and International Law hosted a symposium on the global impact of the local management of environmental resources. By looking at the property-related aspects of international environmental law, the Symposium explored development concerns and the impact of resource management systems on national economies. Appearing: Coalter G. Lathrop (Duke University School of Law), Erica Thorson (Lewis & Clark Law School), Julia Mahoney (University of Virginia School of Law), panelists ; Adebola Ogunba (Duke University Nicholas School of the Environment and Earth Sciences), moderator

Practiced at the Art of Deception: The Failure of Columbia Basin Salmon Recovery Under the Endangered Species Act

The saga of Columbia Basin salmon recovery is one of the foremost natural resource restoration efforts in the United States over the last quarter-century. Although development of the world\u27s largest integrated hydroelectric system crippled the Columbia\u27s salmon runs, Congress declared in 1980 that salmon and hydropower were to become co-equals in the management of Columbia Basin dams. That declaration did not prevent the listing of most Columbia Basin salmon runs under the Endangered Species Act (ESA), however. Widely perceived as a Draconian, economically insensitive statute, the ESA has proved extremely pliable in the case of Columbia Basin salmon. The National Oceanic and Atmospheric Administration (NOAA), the agency charged with implementing the statute in the case of salmon, consistently chose to exercise its discretion to largely preserve status quo hydropower and navigation operations. While this rather remarkable development has apparently escaped the attention of congressional reformers attempting to make the ESA more economically accountable, it has not escaped the attention of many in the Pacific Northwest. As a result, a series of lawsuits over the last decade has challenged NOAA\u27s ESA implementation. The suits have, for the most part, born fruit. NOAA\u27s two most recent biological opinions have been struck down, and the federal district court has indicated that without a drastic change in course, salmon recovery is headed for a train wreck. Thus, the Columbia Basin salmon story appears about to embark on a new era of active judicial oversight. This article explains how and why this development came to be, and charges that NOAA and the federal agencies operating Columbia Basin dams have engaged in longstanding deceptive practices, in an attempt to mislead the public and Congress into thinking that meaningful salmon restoration is underway, when in fact it has never been seriously attempted