Severe COVID-19 during Pregnancy and Possible Vertical TransmissionFunding None.
07. April 2020
07. April 2020
18. April 2020 (online)
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.
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.
- 1 Huang C, Wang Y, Li X. , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
- 2 Dashraath P, Jing Lin Jeslyn W, Mei Xian Karen L. , et al. Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy. Am J Obstet Gynecol 2020; 0 (00) S0002-9378(20)30343-4
- 3 Liu D, Li L, Wu X. , et al. pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. Am J Roentgenol 2020 (e-pub ahead of print): . Doi: 10.2214/AJR.20.23072
- 4 Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020; 12 (02) 194
- 5 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
- 6 Iqbal SN, Overcash R, Mokhtari N. , et al. An uncomplicated delivery in a patient with COVID-19 in the United States. N Engl J Med 2020; DOI: 10.1056/NEJMc2007605.
- 7 Breslin N, Baptiste C, Miller R. , et al. COVID-19 in pregnancy: early lessons. Am J Obstet Gynecol MFM 2020 (e-pub ahead of print) Doi: 10.1016/j.ajogmf.2020.100111
- 8 Vincenzo B. . Coronavirus disease 2019 (COVID-19): Pregnancy issues. Available at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues?search=covid%20pregnancy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3682062658 . Accessed April 04, 2020
- 9 Zhou F, Yu T, Du R. , et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062
- 10 Peng YD, Meng K, Guan HQ. , et al. [Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV] (in Chinese). Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48: E004 (e-pub ahead of print) . Doi: 10.3760/cma.j.cn112148-20200220-00105
- 11 Fan C, Lei D, Fang C. , et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry?. Clin Infect Dis 2020 (epub ahead of print) Doi: 10.1093/cid/ciaa226
- 12 Yang H, Wang C, Poon LC. Novel coronavirus infection and pregnancy. Ultrasound Obstet Gynecol 2020; 55 (04) 435-437
- 13 Li Y, Zhao R, Zheng S. , et al. Early release - lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerging Infectious Diseases 2020 26. (06). Doi: 10.3201/eid2606.200287
- 14 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020 (epub ahead of print) Doi: 10.1001/jama.2020.4621
- 15 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020 (e-pub ahead of print). Doi: 10.1001/jama.2020.4861
- 16 Melville JM, Moss TJM. The immune consequences of preterm birth. Front Neurosci 2013; 7: 79 . Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC365928 . Accessed April 14, 2020