Am J Perinatol
DOI: 10.1055/s-0040-1710050
Short Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Severe COVID-19 during Pregnancy and Possible Vertical Transmission

1  Division of Maternal Fetal Medicine, British American Hospital, Lima, Peru
,
Tania Paredes
2  Division of Neonatology, British American Hospital, Lima, Peru
,
David Caceres
3  Division of Pulmonary Medicine, British American Hospital, Lima, Peru
,
Camille M. Webb
4  Division of Infectious Disease, University of Texas Medical Branch, Texas
5  Tropical Medicine Institute “Alexander von Humbolt,” Universidad Peruana Cayetano Heredia, Lima, Peru
,
Luis M. Valdez
5  Tropical Medicine Institute “Alexander von Humbolt,” Universidad Peruana Cayetano Heredia, Lima, Peru
6  Division of Infectious Disease, British American Hospital, Lima, Peru
,
1  Division of Maternal Fetal Medicine, British American Hospital, Lima, Peru
7  Division of Maternal Fetal Medicine, University of Texas Medical Branch, Texas
› Author Affiliations
Funding None.
Further Information

Publication History

07 April 2020

07 April 2020

Publication Date:
18 April 2020 (online)

Abstract

There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. 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, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons.

Key Points

  • We report a severe presentation of COVID-19 in pregnancy requiring invasive ventilatory support.

  • This is a case of positive RT-PCR in first day of life, suggesting possible vertical transmission.

  • There were no detectable maternal antibodies for COVID-19 until after delivery.