Vertical Transmission in Pregnancies with Confirmed COVID-19

PURPOSE:

• Chen at al. (Lancet, 2020)  sought to assess vertical transmission in the initial cohort of pregnant patients in Wuhan (capital of Hubei province) with confirmed COVID-19 infection

METHODS:

• Participants 
  • 9 pregnant patients who were admitted with  COVID-19 pneumonia  
• The following  were tested for virus to determine  intrauterine vertical  transmission 
  • Amniotic fluid | Cord blood | Neonatal throat swab | Breastmilk samples after the first lactation 

RESULTS:

• Gestational age range: 36w0d to 39w4d  
• All 9  patients had a caesarean  delivery  in their third trimester for the following indications   
  • Severely elevated ALT or AST | COVID-19 pneumonia 
  • Mature | COVID-19 pneumonia 
  • History of C-section (×2) | COVID-19 pneumonia 
  • Pre-eclampsia | COVID-19 pneumonia 
  • Fetal distress | COVID-19 pneumonia 
  • History of stillbirth (×2) | COVID-19 pneumonia 
  • PROM | COVID-19 pneumonia 
  • Fetal distress | COVID-19 pneumonia 
  • PROM | COVID-19 pneumonia 

Note:  The authors state that “Uncertainty about the risk of intrapartum mother-to-child transmission by vaginal delivery ” was  the reason  COVID-19 pneumonia was considered an indication for cesarean delivery  

• Presenting maternal symptoms 
  • Fever:  7  patients 
  • Lymphopenia  (<1.0 × 10⁹ cells per L): 5 patients   
  • Cough: 4 patients 
  • Myalgia: 3 patients 
  • Sore throat: 2 patients  
  • Malaise: 2 patients 

Note:  None of the patients progressed to severe pneumonia   

• Fetal  status 
  • “Fetal distress”: 2 cases  
  • 9 live births, all with normal Apgar scores (8  to  9  at 1 min  and 9 to 10  at 5 min)  
  • No neonatal asphyxia  
  • All samples tested negative for the virus  

CONCLUSION:

• Presentation and clinical findings for  COVID-19 pneumonia  showed no difference between pregnant women and the general population 
• No evidence (in this small study) of intrauterine infection attributable to  vertical transmission  

Learn More – Primary Sources

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

COVID-19 Case Series: Pregnancy and Infant Outcomes

PURPOSE:

• Chen et al. (Frontiers in Pediatrics) provide an update on 4 infants, born to women with COVID-19

METHODS:

• Case series from city of Wuhan (capital of Hubei province)
• Participants
  • Infants of mothers had tested positive for COVID-19

RESULTS:

• 4 mothers tested positive | Symptomatic | Infected with COVID-19 during the 3rd trimester

Maternal Findings

• Symptoms were typical of COVID-19
  • Fever: 3/4 patients
  • Cough: 2/4 patients
  • Myalgia or fatigue: 2/4 patients
  • Headache: 2/4 patients
  • Dyspnea: 1 patient
• Labs
  • Lymphocytes below the normal range (lymphocyte count <1.1 × 109/L): 4/4 patients
  • Lymphopenia (lymphocyte count <1.0 × 109/L): 2/4 patients
  • Anemia: 1/4 patients
• Imaging
  • Bilateral abnormalities on chest CT images: 4/4 patients
• Fetal assessment
  • Reduced fetal movement (1 patient)

Delivery

• Mode of delivery
  • Cesarean delivery: 3/4 patients
  • Vaginal delivery: 1/4 patients (patient presented in labor)
  • 4 full-term infants (3 male and 1 female) | Immediately isolated from mothers

Maternal Outcome

• Maternal recovery: 3 of 4 patients were discharged between days 3 to 5 following delivery
• Respiratory support: 1 patient required respiratory support but did survive
• All mothers were healthy on discharge and at follow-up visit

Infant Outcome

• Normal Apgar scores | None had serious clinical symptoms (e.g., fever)
• 3 infants tested negative for COVID-19 | 1 infant not tested because there was no consent
• Two infants with rashes of different shape and distribution
  • 1 infant: Maculopapules scattered all over the body and facial skin ulceration on the forehead (size about 0.3 × 0.5 cm2) | Resolved without treatment
  • 1 infant: Day 2 appearance of small miliary red papules with resolution on day 10 without treatment (Table 2) | Transient tachypnea of the newborn (TTN) requiring nasal- Continuous Positive Airway Pressure (nCPAP) | Discharged day 7
• All infants were healthy at time of post-discharge follow-up visit

CONCLUSION:

• Authors recognize limited dataset
• Unclear if there is any relationship between rash and COVID-19
• No vertical transmission noted and children all discharged from hospital in good health

Learn More – Primary Sources:

Infants Born to Mothers With a New Coronavirus (COVID-19)