Pregnant women and neonatal cases positive for SARS-Cov-2: A brief literature review.

Since the novel virus SARS-Cov-2 began spreading in Wuhan, China, to other parts of the world, and eventually declared a pandemic, the concerns about the complications pregnant women could face if infected were many. It raised the question: “Is this disease transmissible from mother to the fetus?”  Many studies have been carried out in different parts of the world with differing outcomes, severity of the disease in infected patients, and results for COVID-19 tests among mothers and newborns.

An interesting case from Lima, Peru reported one of the first cases of COVID-19 positive RT-PCR on the first day of life. This is the case of a 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. She underwent cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. Sixteen hours after delivery, the neonatal nasopharyngeal swab tested positive for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR) while immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative [1].

Another case in China discussed a 34-year-old-woman with a history of hypothyroidism for 4 years treated with oral drugs, and with no history of hypertension, diabetes, or heart disease. At 40 weeks’ gestation, the patient developed vaginal bleeding, lower abdominal pain, and fever (37.8°C). She presented to the Wuhan Women and Children’s Medical Care Center, which referred her to the fever clinic of Wuhan Tongji Hospital where an emergency cesarean delivery was performed. The mother had been wearing an N95 mask throughout the operation, and the baby had no contact with the mother after birth. The mother had an intermittent fever on the first postoperative day with the highest temperature up to 38.3°C. Pharyngeal swab sampled for SARS-CoV-2 reported back as positive. As for the newborn, the result of the pharyngeal swab for SARS-CoV-2 was positive at 36 hours after birth and was transferred to Wuhan Children’s Hospital for further isolation. After finding evidence of neonatal infection, nucleic acid tests for SARS-CoV-2 on cord blood and placental specimens that we retained during the operation were performed, and the results were negative. The mother’s breast milk sample was negative for SARS-CoV-2 as well. [2]

Aside from individual case reports, many studies have been carried out with groups of COVID-19 positive pregnant women such as one study realized in NYU Langone Health, where all pregnant patients diagnosed with COVID-19 who gave birth between March 1, 2020 and April 20, 2020, were identified by a search of the electronic medical record. Charts were reviewed for documentation of SARS-CoV-2 RNA RT-PCR testing sent from either the placenta or membranes within 30 minutes following delivery. Of 11 placental or membrane swabs sent following delivery, 3 swabs were positive for SARS-CoV-2, all in women with moderate to severe COVID-19 illness at the time of delivery. None of the infants tested positive for SARS-CoV2 on days of life 1 through 5, and none demonstrated symptoms of COVID-19 infection. This is the first study to demonstrate the presence of SARS-CoV-2 RNA in placental or membrane samples. While there were no clinical signs of vertical transmission, these findings raised the possibility of intrapartum viral exposure [3].

In the majority of the studies, the most common symptoms reported at presentation among pregnant women were fever, cough, dyspnea/shortness of breath, and fatigue. Even though the number of studies and publications have increased in the lasts months, some studies conclude that despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good-quality data to draw unbiased conclusions with regard to the severity of the disease or specific complications of COVID-19 in pregnant women, as well as vertical transmission, perinatal and neonatal complications[4]. COVID-19 is a novel virus, many studies are being carried out to understand its behavior as of right now, and there are many more to come. As with many other aspects of the disease, the vertical transmission of the virus from mother to fetus will continue to be a topic of interest during this pandemic.

Sources

  1. Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission [published online ahead of print, 2020 Apr 18]. Am J Perinatol. 2020;10.1055/s-0040-1710050. doi:10.1055/s-0040-1710050
  2. Shaoshuai Wang, Lili Guo, Ling Chen, Weiyong Liu, Yong Cao, Jingyi Zhang, Ling Feng, A Case Report of Neonatal 2019 Coronavirus Disease in China, Clinical Infectious Diseases, , ciaa225, https://doi.org/10.1093/cid/ciaa225
  3. Penfield CA, Brubaker SG, Limaye MA, et al. Detection of SARS-COV-2 in Placental and Fetal Membrane Samples [published online ahead of print, 2020 May 8]. Am J Obstet Gynecol MFM. 2020;100133. doi:10.1016/j.ajogmf.2020.100133
  4. Juan, J., Gil, M. M., Rong, Z., Zhang, Y., Yang, H., & Poon, L. C. (2020). Effects of coronavirus disease 2019 (COVID-19) on maternal,perinatal, and neonatal outcomes: a systematic review. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 10.1002/uog.22088. Advance online publication. https://doi.org/10.1002/uog.22088

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