Am J Perinatol 2020; 37(10): 1055-1060
DOI: 10.1055/s-0040-1712161
Short Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review

1   The First Clinical College of Chongqing Medical University, Chongqing, China
2   Department of Obstetrics, Chengdu Jinjiang Maternity and Child Health Hospital, Chengdu, China
Yi Liu
2   Department of Obstetrics, Chengdu Jinjiang Maternity and Child Health Hospital, Chengdu, China
› Author Affiliations
Further Information

Publication History

24 April 2020

26 April 2020

Publication Date:
13 May 2020 (online)


Objective The aim of this study is to summarize currently available evidence on vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Study Design A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement.

Results A total of 22 studies comprising 83 neonates born to mothers diagnosed with coronavirus disease 2019 were included in the present systematic review. Among these neonates, three were confirmed with SARS-CoV-2 infection at 16, 36, and 72 hours after birth, respectively, by nasopharyngeal swab real-time polymerase chain reaction (RT-PCR) tests; another six had elevated virus-specific antibody levels in serum samples collected after birth, but negative RT-PCR test results. However, without positive RT-PCR tests of amniotic fluid, placenta, or cord blood, there is a lack of virologic evidence for intrauterine vertical transmission.

Conclusion There is currently no direct evidence to support intrauterine vertical transmission of SARS-CoV-2. Additional RT-PCR tests on amniotic fluid, placenta, and cord blood are needed to ascertain the possibility of intrauterine vertical transmission. For pregnant women infected during their first and second trimesters, further studies focusing on long-term outcomes are needed.

Key Points

  • We review neonates of mothers diagnosed with coronavirus disease 2019 detected by RT-PCR.

  • No direct virologic evidence of vertical transmission has been reported.

  • No evidence that cesarean delivery is safer than vaginal delivery.

  • More RT-PCR tests on amniotic fluid, placenta, and cord blood are recommended.

  • References

  • 1 Zhu N, Zhang D, Wang W. , et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382 (08) 727-733
  • 2 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
  • 3 Lv M, Luo X, Estill J. , et al; On Behalf Of The Covid-Evidence And Recommendations Working Group. Coronavirus disease (COVID-19): a scoping review. Euro Surveill 2020; 25 (15) 25
  • 4 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
  • 5 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; 37 (08) 861-865
  • 6 Li M, Xu M, Zhan W, Han T, Zhang G, Lu Y. Report of the first cases of mother and infant infections with 2019 novel coronavirus in Xinyang City Henan Province. Chin J Infect Dis 2020; DOI: 10.3760/cma.j.issn.1000-6680.2020.0007.
  • 7 Yu N, Fang Z, Wu J. Novel coronavirus pnuemonia in pregnancy: perinatal outcomes. Progress Obstet Gynecol 2020; DOI: 10.1002/uog.22006.
  • 8 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020; 323 (18) 1848-1849
  • 9 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020
  • 10 Arora N, Sadovsky Y, Dermody TS, Coyne CB. Microbial vertical transmission during human pregnancy. Cell Host Microbe 2017; 21 (05) 561-567
  • 11 Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol 2015; 73 (03) 199-213
  • 12 Shih YF, Liu CJ. Mother-to-infant transmission of hepatitis B virus: challenges and perspectives. Hepatol Int 2017; 11 (06) 481-484
  • 13 Zheng Q, Duan T, Jin L. Single-cell RNA expression profiling of ACE2 and AXL in the human maternal–fetal interface. Reprod Dev Med 2020 . Available at:;year=2020;volume=4;issue=1;spage=7;epage=10;aulast=Zheng . Accessed April 30, 2020
  • 14 Chen S, Huang B, Luo D. Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases. Chin J Patho 2020; DOI: 10.3760/cma.j.cn112151-20200225-00138.
  • 15 De Santis M, Cavaliere AF, Straface G, Caruso A. ubella infection in pregnancy. Reprod Toxicol 2006; 21 (04) 390-398
  • 16 Chen D, Yang H, Cao Y. , et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet 2020; 149 (02) 130-136
  • 17 Qi H, Luo X, Zheng Y. , et al. Safe delivery for COVID-19 infected pregnancies. BJOG 2020; DOI: 10.1111/1471-0528.16231.
  • 18 Chen X, Li Y, Wang J, Cai H, Cao H, Sheng J. Pregnant women complicated with corona virus disease 2019 (COVID-19): a clinical analysis of 3 cases. J Zhejiang Univ 2020. DOI: 10.3785/j.issn.1008-9292.2020.03.08
  • 19 Khan S, Peng L, Siddique R, et al. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infect Cont Hosp Ep 2020. DOI: 10.1017/ice.2020.84
  • 20 Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean J Anesthesiol 2020. DOI: 10.4097/kja.20116
  • 21 Lei D, Wang C, Li C, et al. Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases. Chin J Perinat Med 2020. DOI: 10.3760/cma.j.cn113903-20200216-00117
  • 22 Li Y, Zhao R, Zheng S, et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis 2020. DOI: 10.3201/eid2606.200287
  • 23 Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020. DOI: 10.1016/j.jinf.2020.02.028
  • 24 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. DOI: 10.2214/AJR.20.23072
  • 25 González RD, Ocampo PJ, González BL, Santana-Cabrera L. Pregnancy and perinatal outcome of a woman with COVID-19 infection. Revista Clínica Española 2020. DOI: 10.1016/j.rce.2020.04.006
  • 26 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020. DOI: 10.1093/cid/ciaa200
  • 27 Xiong X, Wei H, Zhang Z, et al. Vaginal Delivery Report of a Healthy Neonate Born to a Convalescent Mother with COVID19. J Med Virol 2020. DOI: 10.1002/jmv.25857
  • 28 Yao L, Wang J, Zhao J, Cui J, Hu Z. Asymptomatic COVID-19 infection in pregnant woman in the third trimester: a case report. Chin J Perinat Med 2020. DOI: 10.3760/cma.j.cn113903-20200221-00143
  • 29 Zhang L, Jiang Y, Wei M, et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province. Chin J Obstet Gynecol 2020. DOI:10.3760/cma.j.cn112141-20200218-00111
  • 30 Zhou R, Chen Y, Lin C, et al. Asymptomatic COVID-19 in pregnant woman with typical chest CT manifestation: a case report. Chin J Perinat Med 2020. DOI: 10.3760/cma.j.cn113903-20200220-00134
  • 31 Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020;9(1):51–60
  • 32 Zhuang S, Guo J, Cao Y, et al. Perinatal novel coronavirus infection: a case report. Chin J Perinat Med 2020. DOI: 10.3760/cma.j.issn.1007-9408.2020.02.003