PURPOSE:

• Walker et al. (BJOG, 2020) sought to investigate the risk for vertical transmission in women with COVID-19 around the time of delivery
• A systematic analysis was performed, including an effort to address duplicate reporting in previous studies

METHODS:

• Systematic review and critical analysis (Search from April through May, 2020)
  • Authors sought out full text copies of any studies that may be eligible for inclusion
• Eligibility criteria for studies
  • Pregnant women with confirmed (positive test or high clinical suspicion) COVID-19
  • Case reports or case series | No language restriction
• Rates of infection were determined for the following
  • Mode of birth (cesarean or vaginal)
  • Breast or formula feeding
  • Rooming in or isolation
• Studies underwent disambiguation to avoid duplication of patients among different reports

RESULTS:

• 49 studies included
  • 666 neonates | 655 pregnant women
  • 11 twins
• Infected neonates: 4%
• Duplicate pregnancies (in Chinese data) were identified and were properly accounted for in subsequent analyses

Mode of Delivery

• Neonatal infection rates based on mode of delivery
  • Vaginal delivery: 2.7%
  • Cesarean: 5.3%

Breast vs Formula Feeding

• Among neonates with confirmed COVID-19
  • Breast fed: 7
  • Formula: 3
  • Expressed breast milk: 1
  • Unreported: 17

Rooming In vs Isolation

• Among neonates with confirmed COVID-19
  • Isolated: 7
  • Rooming in: 5
  • Not reported: 16

CONCLUSION:

• Overall, there was a low rate of neonatal infection following maternal COVID-19 infection
• There does not appear to be a greater risk for vertical SARS-CoV-2 transmission based on mode of delivery, breast feeding or rooming in
• The authors acknowledge limitations including
  • Not all newborns tested for SARS-CoV-2
  • Case series have possibility of bias | More severe cases are more likely to be reported
  • “…disappointing that details of outcome and care” were not available and should be considered a “missed opportunity”
  • Due to low newborn infection rate, ‘n’ of infected neonates is still relatively small and appropriate caution should be used in interpreting the data
• The authors conclude that

There is no evidence that isolating the baby away from the mother is beneficial if such precautions are taken, and encouraging the baby to spend time with its mother is likely to help with breastfeeding and bonding

We recommend that separation only occurs where this is necessary for clinical indications

Learn More – Primary Sources:

Maternal transmission of SARS‐COV‐2 to the neonate, and possible routes for such transmission: A systematic review and critical analysis

Related ObG Topics:

Coronavirus and Pregnancy: CDC Guidance and Professional Recommendations

The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital

Vertical Transmission in Pregnancies with Confirmed COVID-19

COVID-19 Case Series: Pregnancy and Infant Outcomes