Am J Perinatol 2023; 40(06): 688-696
DOI: 10.1055/s-0041-1733783
Original Article

Severity of Maternal SARS-CoV-2 Infection in Pregnancy Predicts Neonatal Outcomes

Beril Yasa
1   Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
,
Seyma Memur
1   Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
,
Dilek Yavuzcan Ozturk
1   Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
,
Onur Bagci
1   Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
,
Sait Ilker Uslu
1   Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
,
Ibrahim Polat
2   Perinatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
,
Merih Cetinkaya
1   Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
› Author Affiliations
Funding None.

Abstract

Objective The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak had an enormous global impact. Pregnant women with SARS-CoV-2 appear to have higher morbidity and mortality. This study aimed to evaluate the effect of the severity of maternal SARS-CoV-2 infection on neonatal outcomes.

Study Design The clinical and laboratory data of 40 women and neonates evaluated retrospectively.

Results This retrospective study showed that SARS-CoV-2 infection had an adverse impact on neonatal outcomes proportionally with the maternal disease severity including increased prematurity rates, postnatal resuscitation need, prolonged hospital stay and longer ventilatory support requirement in infants born to mothers with moderate or severe disease.

Conclusion Maternal disease severity had adverse effects on neonatal outcomes. The severity of maternal disease was found to be associated with increased rates of prematurity, requirement of postnatal resuscitation, prolonged hospital stay, and longer ventilatory support.

Key Points

  • SARS-CoV-2 pandemic is a problem for pregnant women.

  • Vertical transmission has been shown in limited studies.

  • Maternal disease severity may have impact on neonatal outcomes.

Authors' Contributions

B.Y. and M.C. conceptualized and designed the study, and they also involved in data acquisition, analysis, and interpretation of data. S.M., D.Y.O., O.B., S.I.U., and I.P. were involved in acquisition and analysis of data. B.Y. drafted the article and M.C. finally approved the submitted version.


Note

Local ethical committee approval was obtained for the study (Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital, approval no: 2021–21). The study was performed in accordance with the Declaration of Helsinki.




Publication History

Received: 15 May 2021

Accepted: 25 June 2021

Article published online:
28 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Van Keulen BJ, Romijn M, Bondt A. et al. Breastmilk; a source of SARS-CoV-2 specific IgA antibodies. medRxiv 2020; DOI: 10.1101/2020.08.18.20176743.
  • 2 World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Accessed 2021 at: https://covid19.who.int
  • 3 Garg S, Kim L, Whitaker M. et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019–COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (15) 458-464
  • 4 Kucirka LM, Norton A, Sheffield JS. Severity of COVID-19 in pregnancy: a review of current evidence. Am J Reprod Immunol 2020; 84 (05) e13332
  • 5 Lokken EM, Huebner EM, Taylor GG. et al. For the Washington State COVID-19 in Pregnancy Collaborative. Disease severity, pregnancy outcomes and maternal deaths among pregnant patients with SARS-CoV-2 infection in Washington state. Am J Obs Perinatol 2020 https://doi.org/10.1016/j.ajog.2020.12.122
  • 6 Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020; 222 (05) 415-426
  • 7 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) 1-16
  • 8 Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 2021; 193 (16) E540-E548
  • 9 Sankaran D, Nakra N, Cheema R, Blumberg D, Lakshminrusimha S. Perinatal SARS-CoV-2 infection and neonatal COVID-19: a 2021 update. Neoreviews 2021; 22 (05) e284-e295
  • 10 Sánchez-Luna M, Fernández Colomer B, de Alba Romero C. et al; SENEO COVID-19 Registry Study Group. Neonates born to mothers with COVID-19: data from the Spanish Society of Neonatology Registry. Pediatrics 2021; 147 (02) e2020015065
  • 11 Kadiwar S, Smith JJ, Ledot S. et al. Were pregnant women more affected by COVID-19 in the second wave of the pandemic?. Lancet 2021; 397 (10284): 1539-1540
  • 12 Özkan H, Erdeve Ö, Kutman HGK. Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment. Turk Pediatri Ars 2018; 53 (Suppl. 01) S45-S54
  • 13 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
  • 14 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based onstaging criteria. Pediatr Clin North Am. 1986; 33 (01) 179-201
  • 15 Volpe JJ. Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage of the premature infant. In: Volpe JJ. ed. Neurology of the Newborn. 5th edition. Philadelphia: Elsevier; 2008: 517-588
  • 16 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
  • 17 Satar M, Arısoy AE, Çelik IH. Turkish Neonatal Society guideline on neonatal infections-diagnosis and treatment. Turk Pediatri Ars 2018; 53 (Suppl. 01) S88-S100
  • 18 Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19) (online). Accessed May 27, 2020 at: https://www.ncbi.nlm.nih.gov/pubmed/32150360
  • 19 Wastnedge EAN, Reynolds RM, Van Boeckel SR, Stock SJ, Denison FC, Maybin JA. et al. Pregnancy and COVID-19. Physiol Rev 2021; 1 101 (01) 303-318
  • 20 Reinhard G, Noll A, Schlebusch H, Mallmann P, Ruecker AV. Shifts in the TH1/TH2 balance during human pregnancy correlate with apoptotic changes. Biochem Biophys Res Commun 1998; 245 (03) 933-938
  • 21 Dashraath P, Wong JLJ, Lim MXK. et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020; 222 (06) 521-531
  • 22 Gujski M, Humeniuk E, Bojar I. Current state of knowledge about SARS-CoV-2 and COVID-19 disease in pregnant women. Med Sci Monit 2020; 26 (26) e924725
  • 23 Ellington S, Strid P, Tong VT. et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status – United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (25) 769-775
  • 24 Qiancheng X, Jian S, Lingling P. et al; sixth batch of Anhui medical team aiding Wuhan for COVID-19. Coronavirus disease 2019 in pregnancy. Int J Infect Dis 2020; 95 (95) 376-383
  • 25 Breslin N, Baptiste C, Gyamfi-Bannerman C. et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2 (02) 100118
  • 26 Pierce-Williams RAM, Burd J, Felder L. et al. Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. Am J Obstet Gynecol MFM 2020; 2 (03) 100134
  • 27 Vintzileos WS, Muscat J, Hoffmann E. et al. Screening all pregnant women admitted to labor and delivery for the virus responsible for coronavirus disease 2019. Am J Obstet Gynecol 2020; 223 (02) 284-286
  • 28 Kotlyar AM, Grechukhina O, Chen A. et al. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224 (01) 35-53.e3
  • 29 Levy A, Yagil Y, Bursztyn M, Barkalifa R, Scharf S, Yagil C. ACE2 expression and activity are enhanced during pregnancy. Am J Physiol Regul Integr Comp Physiol 2008; 295 (06) R1953-R1961
  • 30 Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150 (01) 53-57
  • 31 Pereira A, Cruz-Melguizo S, Adrien M, Fuentes L, Marin E, Perez-Medina T. Clinical course of coronavirus disease-2019 in pregnancy. Acta Obstet Gynecol Scand 2020; 99 (07) 839-847
  • 32 Dumitriu D, Emeruwa UN, Hanft E. et al. Outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection at a large medical center in New York City. JAMA Pediatr 2021; 175 (02) 157-167
  • 33 Zeng H, Xu C, Fan J. et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020; 323 (18) 1848-1849
  • 34 Knight M, Bunch K, Vousden N. et al; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
  • 35 SONPM National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection, Section on Neonatal-Pernatal Medicine. American Academy of Pediatrics. Accessed 2021 at: https://my.visme.co/view/ojq9qq8e-npc-19-registry
  • 36 Erdeve Ö, Çetinkaya M, Baş AY. et al. The Turkish Neonatal Society proposal for the management of COVID-19 in the neonatal intensive care unit. Turk Pediatri Ars 2020; 55 (02) 86-92
  • 37 Oncel MY, Akın IM, Kanburoglu MK. et al; Neo-Covid Study Group. A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society. Eur J Pediatr 2021; 180 (03) 733-742
  • 38 Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020; 55 (05) 586-592
  • 39 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; 174 (07) 722-725
  • 40 Salvatore CM, Han JY, Acker KP. et al. Neonatal management and outcomes during the COVID-19 pandemic: an observational cohort study. Lancet. 2020 . Accessed 2020 at: https://doid.org/10.1016/52352-4642(20)30235-2
  • 41 Shalish W, Lakshminrusimha S, Manzoni P, Keszler M, Sant'Anna GM. Covid-19 and neonatal respiratory care: current evidence and practical approach. Am J Perinatol 2020; 37 (08) 780-791
  • 42 Cook J, Harman K, Zoica B, Verma A, D'Silva P, Gupta A. Horizontal transmission of severe acute respiratory syndrome coronavirus 2 to a premature infant: multiple organ injury and association with markers of inflammation. Lancet Child Adolesc Health 2020; 4 (07) 548-551
  • 43 Kanburoglu MK, Tayman C, Oncel MY. et al. A multicentered study on epidemiologic and clinical characteristics of 37 neonates with community-acquired COVID-19. Pediatr Infect Dis J 2020; 39 (10) e297-e302
  • 44 Brandt JS, Hill J, Reddy A. et al. Epidemiology of COVID 19 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes. Am J Obstet Gynecol 2020; DOI: 10.1016/j.ajog.2020.09.043.