To the Editor: Despite the large and rapidly rising number of cases of coronavirus disease 2019 (Covid-19) and resulting deaths, 1 there are limited data about the clinical characteristics of pregnant women with the disease. 2,3 We extracted information regarding epidemiologic, clinical, laboratory, and radiologic characteristics, treatment, and outcomes of pregnant women with Covid-19 through the epidemic reporting system of the National Health Commission of China, which stores the medical records of all 50 designated hospitals in Wuhan city. From December 8, 2019, to March 20, 2020, we identified 118 pregnant women with Covid-19 in Wuhan according to the criteria of the Chinese Clinical Guidance for Covid-19 Pneumonia Diagnosis and Treatment; 84 women (71%) had positive polymerase-chain-reaction (PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the remaining 34 (29%) had suggestive findings on computed tomography (CT) of the chest. Criteria for mild, severe, and critical disease and other methodologic details are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org. The pregnant patients represented 0.24% of all reported patients with Covid-19 at these hospitals during this time. The median age of the women was 31 years (interquartile range, 28 to 34); 55 of 106 (52%) were nulliparous, and 75 of 118 (64%) had been infected with SARS-CoV-2 in the third trimester. The most common symptoms in 112 women with available data were fever (in 75%) and cough (in 73%) (Table 1). Lymphopenia was present in 51 of 116 patients (44%). A total of 88 of the 111 women (79%) who underwent chest CT had infiltrates in both lungs. Additional clinical data are provided in the Supplementary Appendix. * The denominators of patients who were included in each analysis are provided if they differed from the total numbers in the relevant study group. Percentages may not total 100 because of rounding. Covid-19 denotes coronavirus disease 2019, and IQR interquartile range. † Asymptomatic patients were screened because of exposure to persons with confirmed or suspected Covid-19. ‡ The signs and symptoms listed include those reported to occur before admission and during hospitalization. Data were extracted from the medical record and may not reflect complete accounting of symptoms. § The reason that there were 70 live births but 68 deliveries was that there were 2 sets of twins. ¶ These abortions were induced because of the patient's concern about Covid-19. ‖ The data shown are as of March 20, 2020. ** The Apgar score at 1 minute was available for 66 babies.

Objective: To provide clinical management guidelines for novel coronavirus in pregnancy. Methods:On February 5, 2020, a multidisciplinary teleconference comprising Chinese physicians and researchers was held and medical management strategies of COVID-19 infection in pregnancy were discussed. Results:Ten key recommendations were provided for the management of COVID-19 infections in pregnancy. Conclusion:Currently, there is no clear evidence regarding optimal delivery timing, the safety of vaginal delivery, or whether cesarean delivery prevents vertical transmission at the time of delivery; therefore, route of delivery and delivery timing should be individualized based on obstetrical indications and maternal-fetal status.

To understand Wuhan residents’ psychological reactions to the COVID-19 epidemic and offer a reference point for interventions, an online questionnaire survey was conducted. It included the Disorder 7-Item Scale (GAD-7), the Patient Health Questionnaire 9-Item Scale (PHQ-9), Athens Insomnia Scale, and Simplified Coping Style Questionnaire. Categorical data were reported as numbers and percentages. Multivariate logistic regression models were used to evaluate the association between demographic factors and anxiety, depression, sleep disorder, and passive coping style. A total of 1242 Wuhan residents investigated, 27.5% had anxiety, 29.3% had depression, 30.0% had a sleep disorder, and 29.8% had a passive response to COVID-19. Being female was the risk factor for anxiety (OR = 1.62) and sleep disorder (OR = 1.36); being married was associated with anxiety (OR = 1.75); having a monthly income between 1000 and 5000 CNY (OR = 1.44, OR = 1.83, OR = 2.61) or >5000 CNY (OR = 1.47, OR = 1.45, OR = 2.14) was a risk factor for anxiety, depression, and sleep disorder; not exercising (OR = 1.45, OR = 1.71, OR = 1. 85, OR = 1.71) was a common risk factor for anxiety, depression, sleep disorder, and passive coping style; and having a higher education level (bachelor’s degree and above) (OR = 1.40) was associated with having a sleep disorder. Wuhan residents’ psychological status and sleep quality were relatively poorer than they were before the COVID-19 epidemic; however, the rate of passive coping to stress was relatively higher.

Background and Purpose Published cohorts of children with arterial ischemic stroke (AIS) in the 1990s to early 2000s reported five-year cumulative recurrence rates approaching 20%. Since then, utilization of antithrombotic agents for secondary stroke prevention in children has increased. We sought to determine rates and predictors of recurrent stroke in the current era. Methods The Vascular effects of Infection in Pediatric Stroke (VIPS) study enrolled 355 children with AIS at 37 international centers from 2009–2014, and followed them prospectively for recurrent stroke. Index and recurrent strokes underwent central review and confirmation, as well as central classification of stroke etiologies, including arteriopathies. Other predictors were measured via parental interview or chart review. Results Of the 355 children, 354 survived their acute index stroke, and 308 (87%) were treated with an antithrombotic medication. During a median follow-up of 2.0 years (interquartile range, 1.0–3.0), 40 children had a recurrent AIS, and none had a hemorrhagic stroke. The cumulative stroke recurrence rate was 6.8% (95% CI 4.6–10%) at one month and 12% (8.5–15%) at one year. The sole predictor of recurrence was presence of an arteriopathy, which increased the risk of recurrence 5-fold compared to an idiopathic AIS (hazard ration 5.0, 95% CI 1.8–14). The one-year recurrence rate was 32% (95% CI 18–51%) for moyamoya, 25% (12–48%) for transient cerebral arteriopathy, and 19% (8.5–40%) for arterial dissection. Conclusions Children with AIS, particularly those with arteriopathy, remain at high risk for recurrent AIS despite increased utilization of antithrombotic agents. Therapies directed at the arteriopathies themselves are needed.