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Vertical Transmission of SARS-CoV-2 (COVID-19): Are Hypotheses More than Evidences?Funding None.
In spite of the increasing, accumulating knowledge on the novel pandemic coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), questions on the coronavirus disease-2019 (COVID-19) infection transmission from mothers to fetuses or neonates during pregnancy and peripartum period remain pending and have not been addressed so far. SARS-CoV-2, a RNA single-stranded virus, has been detected in the amniotic fluid, in the cord blood and in the placentas of the infected women. In the light of these findings, the theoretical risk of intrauterine infection for fetuses, or of peripartum infection occurring during delivery for neonates, has a biological plausibility. The extent of this putative risk might, however, vary during the different stages of pregnancy, owing to several variables (physiological modifications of the placenta, virus receptors' expression, or delivery route). This brief review provides an overview of the current evidence in this area. Further data, based on national and international multicenter registries, are needed not only to clearly assess the extent of the risk for vertical transmission, but also to ultimately establish solid guidelines and consistent recommendations.
Questions on the COVID-19 infection transmission from mothers to fetuses or neonates during pregnancy and peripartum period remain pending so far.
The theoretical risk of intrauterine infection for fetuses, or of neonatal infection during delivery for neonates, has a biological plausibility.
A caution is recommended in the interpretation of clinical and laboratory data in neonates.
C.A. and D.U.D.R. conceptualized and designed the review, analyzed the reported cases, drafted the initial manuscript, and reviewed and revised the manuscript. C.T., L.C., M.C., P.M., and M.S reviewed the extracted data and analyzed the cases and reviewed and revised the ﬁnal manuscript including all tables and the ﬁgure. All authors critically reviewed the manuscript for important intellectual content. All authors approved the ﬁnal manuscript as submitted and agreed to be accountable for all aspects of the work.
A shorter communication on this topic in Italian has been initially sent to the bulletin of the Italian Society of Neonatology (SIN Informa).
Article published online:
05 August 2020
Thieme Medical Publishers
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- 1 Setti L, Passarini F, De Gennaro G. et al. Airborne transmission route of COVID-19: why 2 meters/6 feet of inter-personal distance could not be enough. Int J Environ Res Public Health 2020; 17 (08) E2932
- 2 Wang W, Xu Y, Gao R. et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020; 323: 1843-1844
- 3 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
- 4 Chen Y, Peng H, Wang L. et al. Infants born to mothers with a new coronavirus (COVID-19). Front Pediatr 2020; 8: 104
- 5 Liu W, Wang J, Li W, Zhou Z, Liu S, Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med 2020; 14 (02) 193-198
- 6 Costa S, Posteraro B, Marchetti S. et al. Excretion of SARS-CoV-2 in human breastmilk samples. Clin Microbiol Infect 2020; (e-pub ahead of print). DOI: 10.1016/j.cmi.2020.05.027.
- 7 Sethuraman N, Jeremiah SS, Ryo A. Interpreting diagnostic tests for SARS-CoV-2. JAMA 2020; 2020: E1-E3
- 8 Dong L, Tian J, He S. et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323: 1846-1848
- 9 Zeng H, Xu C, Fan J. et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020; 323: 1848-1849
- 10 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero? More definitive evidence is needed. JAMA 2020; 323: 1788-1789
- 11 Li Y, Zhao R, Zheng S. et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis 2020; 26 (06) 1335-1336
- 12 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; ciaa200 (e-pub ahead of print). DOI: 10.1093/cid/ciaa200.
- 13 Penfield CA, Brubaker SG, Limaye MA. et al. Detection of SARS-CoV-2 in placental and fetal membrane samples. Am J Obstet Gynecol MFM 2020; (e-pub ahead of print). DOI: 10.1016/j.ajogmf.2020.100133.
- 14 Patanè L, Morotti D, Giunta MR. et al. Vertical transmission of COVID-19: SARS-CoV-2 RNA on the fetal side of the placenta in pregnancies with COVID-19 positive mothers and neonates at birth. Am J Obstet Gynecol MFM 2020; 2020: 100145
- 15 De Rose DU, Piersigilli F, Ronchetti MP. , et al; Study Group of Neonatal Infectious Diseases of The Italian Society of Neonatology (SIN). Novel coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020; 46 (01) 56
- 16 Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review. JAMA 2020; 323: 1824-1836
- 17 Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible?. Lancet Gastroenterol Hepatol 2020; 5 (04) 335-337
- 18 Yan J, Li R-Q, Wang H-R. et al. Potential influences of COVID-19/ACE2 on female reproductive system 2020. OSF Preprints DOI: 10.1093/molehr/gaaa030.
- 19 Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS One 2020; 15 (04) e0230295
- 20 Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effects of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcomes: a systematic review. Ultrasound Obstet Gynecol 2020; DOI: 10.1002/uog.22088.
- 21 Pierce-Williams RA, Burd J, Felder L. et al. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol MFM 2020; (e-pub ahead of print). DOI: 10.1016/j.ajogmf.2020.100134.
- 22 Ferrazzi E, Frigerio L, Savasi V. et al. Vaginal delivery in SARS-CoV-2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG An Int J Obstet Gynaecol 2020; (e-pub ahead of print). DOI: 10.1111/1471-0528.16278.
- 23 Salvatori G, De Rose DU, Concato C. et al. Managing COVID-19-positive maternal-infant dyads: an Italian experience. Breastfeed Med 2020; 15 (05) 347-348
- 24 Lackey KA, Pace RM, Williams JE. et al. SARS-CoV-2 and human milk: what is the evidence?. Matern Child Nutr 2020; (e-pub ahead of print). DOI: 10.1111/mcn.13032.
- 25 Kirtsman M, Diambomba Y, Poutanen SM. et al. Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection. CMAJ 2020; 192 (24) E647-E650
- 26 Tam PCK, Ly KM, Kernich ML. et al. Detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human breast milk of a mildly symptomatic patient with coronavirus disease 2019 (COVID-19). Clin Infect Dis 2020; (e-pub ahead of print). DOI: 10.1093/cid/ciaa673.
- 27 Groß R, Conzelmann C, Müller JA. et al. Detection of SARS-CoV-2 in human breastmilk. Lancet 2020; 395 (10239): 1757-1758
- 28 Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. Breastfeeding and coronavirus disease-2019: ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr 2020; 16 (03) e13010
- 29 PAN-COVID. Pregnancy and neonatal outcomes for women with COVID-19 Registry (PAN-COVID study). 2020 . Accessed June 30 at: https://pan-covid.org/
- 30 Zamaniyan M, Ebadi A, Aghajanpoor Mir S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn 2020; (e-pub ahead of print). DOI: 10.1002/pd.5713.
- 31 Alonso Diaz C, Maestro ML, Moral Pumarega MT, Florez Anton B, Pallas Alonso C. First case of neonatal infection due to COVID-19 in Spain. An Pediatr (Engl Ed) 2020; 92 (04) 237-238
- 32 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
- 33 Hu X, Gao J, Luo X. et al. Severe acute respiratory syndrome transmission in neonates born to mothers with coronavirus disease 2019. Obstet Gynecol 2020; 136: 1-3
- 34 Kuhrt K, McMicking J, Nanda S, Nelson-Piercy C, Shennan A. Placental abruption in a twin pregnancy at 32 week's gestation complicated by COVID-19, without vertical transmission to the babies. Am J Obstet Gynecol MFM 2020; (e-pub ahead of print). DOI: 10.1016/j.ajogmf.2020.100135.
- 35 Lu D, Sang L, Du S, Li T, Chang Y, Yang X-A. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol 2020; (e-pub ahead of print). DOI: 10.1002/jmv.25927.
- 36 Mehta H, Ivanovic S, Cronin A. et al. Novel coronavirus-related acute respiratory distress syndrome in a patient with twin pregnancy: a case report. Case Rep Womens Health 2020; 27: e00220
- 37 Piersigilli F, Carkeek K, Hocq C. et al. COVID-19 in a 26-week preterm neonate. Lancet Child Adolesc Health 2020; 4 (06) 476-478
- 38 Sun M, Xu G, Yang Y. et al. Evidence of mother-newborn infection with COVID-19. Br J Anaesth 2020; (e-pub ahead of print). DOI: 10.1016/j.bja.2020.04.066.
- 39 Xiong X, Wei H, Zhang Z. et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID-19. J Med Virol 2020; 1-3 DOI: 10.1002/jmv.25857.
- 40 Yan J, Guo J, Fan C. et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020; (e-pub ahead of print). DOI: 10.1016/j.ajog.2020.04.014.
- 41 Yang P, Wang X, Liu P. et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol 2020; 127: 104356
- 42 Zeng L, Xia S, Yuan W. et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; (e-pub ahead of print). DOI: 10.1001/jamapediatrics.2020.0878.