Original Article: An Analysis of 38 Pregnant Women with 2 COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes, David A. Schwartz, Arch Pathol Lab Med
Autor of Summary: Gabriella Assante; Reviewer: Daria Di Filippo
Original Article Published on March 17th, 2020
This review describes the effect of SARS and MERS infections on pregnancy outcomes and analyses the COVID19 outbreak with a closer look at 38 pregnant women and their newborns in China.
Changes in the cardiovascular and respiratory systems and the development of immunologic adaptations expose pregnant women to a higher risk of developing severe respiratory disease.
During the SARS epidemic, 12 pregnant women were reported as infected and 3 of them died during the pregnancy. No vertical transmission was found.
MERS was instead reported in 11 pregnant women with a variety of adverse clinical outcomes such as maternal deaths, intensive care treatment infants and perinatal deaths but vertical transmission was ruled out.
5 hospitals from the epicentre of COVID19 pandemic in China, have reported a total of 38 pregnant women infected.
- The Hospital of Wuhan University recorded 9 mothers between 26 and 40 years old at the third trimester of pregnancy. All of them had underlying clinical conditions (gestational diabetes, cardiovascular diseases, etc).
At admission they had fever, cough (4/9), myalgia (3/9), sore throat (2/9), malaise (2/9), GI symptoms (1/9) and shortness of breath (1/9). Increase in PCR (6/9), lymphopenia (5/9), AST and ALT (3/9) and abnormalities in chest CT scan (8/9) were found. None of the patients developed sever pneumonia, all of them delivered with caesarean section. Both neonatal and mothers’ tests were negative.
- The Hospital of Huazhong University reported 3 cases of women between 30 and 34 years old with fever or cough and CT abnormalities. All of them had a positive perinatal outcome without vertical transmission.
- Hubei province hospitals have described 9 pregnancies, between 25 and 35 years of age, with fever and/or cough. CT scans revealed abnormalities and all of them tested positive except one symptomatic patient with viral interstitial pneumonia despite a negative test. No one presented sever pneumonia. Seven of the mothers delivered by caesarean section and two by vaginal delivery. 6 infants had shortness of breath, 2 were febrile and 1 had a rapid heart rate. GI symptoms were present in 4 infants, whereas 7 newborns had abnormal CT scan and 1 thrombocytopenia with liver dysfunction. All of them were negative for Sars-CoV-2 when tested between 1 and 9 days after the born.
- The Hospital of Soochow University reported a 28 years old pregnant woman at 30 weeks GA with one week fever, and two SARS-CoV 2 negative test. CT scan showed patchy consolidation and the third test turned up positive. An emergency caesarean section was performed for decreased fetal movements. All tests were negative for mother and baby.
- The Central Hospital of Qianjiang City reported 16 pregnant women in their third trimester of pregnancy comparing them to health pregnant women. In the anamnesis of the COVID19+ cohort, 3 women had gestational diabetes, 3 premature rupture of membranes, 3 preterm deliveries, 2 scarred uterus, 2 B-Lynch suture procedure. At recent medical history 3 presented cough, chest tightness, shortness of breath and diarrhea resistant to all treatments, one had pneumonia. All 16 mothers delivered by caesarean section. All newborns were discharged healthy.
Overall, Intrauterine transmission is one of the most serious complications of viral diseases occurring during pregnancy. Among the 30 neonates born to these women, for whom obstetrical outcomes and SARS-CoV-2 status were available, there were no confirmed cases of SARS-CoV-2 infection despite some perinatal complications. Furthermore, in those cases where placentas were tested for SARS-CoV-2, the results were negative. Lack of maternal-fetal transmission of SARS-CoV-2 is consistent with past experiences with other coronavirus infections – SARS and MERS – occurring in pregnant.