Clinical, Laboratory, and Imaging Findings of Pregnant Women with Possible Vertical Transmission of SARS-CoV-2—Case Series

Abstract

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic significantly impacted the general population’s health. At times, the infection has unfavorably influenced pregnancy evolution and the result of birth. However, vertical transmission of the virus is rare and generates controversial discussions. The study aimed to highlight the clinical, laboratory, and imaging findings of pregnant women with confirmed Coronavirus Disease 2019 (COVID-19) with possible vertical transmission and identify possible factors that encourage vertical transmission. Between 1 April 2020 and 31 December 2021, 281 pregnant women diagnosed with COVID-19 gave birth in the Obstetrics and Gynecology Departments of the tertiary unit of County Emergency Clinical Hospital from Timisoara. Three newborns (1.06%) tested positive. The characteristic of these three cases was described as a short series. In two cases, the patients were asymptomatic. In one case, the patient developed a mild form of COVID-19 with a favorable evolution in all cases. We did not identify the presence of smoking history, vaccine before admission, atypical presentation, fever, or chest X-ray abnormalities. We note possible factors that encourage vertical transmission: Pregnancy-induced hypertension, thrombophilia, asymptomatic cough, an asymptomatic or mild form of the disease, a ruptured membrane, and cesarean. The laboratory results highlight the inconstant presence of some changes found in the list of potential predictors of the severity of the infection: Lymphopenia, high values of C-reactive protein, D-dimer, fibrinogen, platelets, Aspartate Aminotransferase, Lactate dehydrogenase, and ferritin. The study’s conclusion of this small group suggests that there may have been an intrauterine infection in late pregnancy and described characteristics of the pregnant women. Possible risk factors that could encourage vertical transmission have been identified.

COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

“…Low levels of iron have been reported in Romanian patients early on, accordingly to international data [ 56 , 72 , 88 ]; however, there have been cases of normal values reported [ 54 , 86 , 89 , 90 ], while others have reported high levels of FER, including in children [ 14 , 21 , 23 , 24 , 25 , 26 , 29 , 30 , 31 , 35 , 36 , 41 , 43 , 48 , 62 , 74 , 79 ], with a few rare cases of vertical transmission describing increased FER levels, as observed in Iacob et al’s study [ 64 ].…”

“…An increase in LDH activity was seen in many cases of severe COVID-19, which may be related to cell destruction as well as poor blood flow and oxygen delivery. Elevated LDH levels were observed in many studies of Romanian patients [ 21 , 26 , 33 , 34 , 79 ], with one study focusing on how these values could be related to thrombotic microangiopathy by presenting a case report of a patient with a complement gene variant (complement factor I) [ 80 ] and another focusing on a pediatric case, signaling the risk for a systemic inflammatory syndrome associated with COVID-19 in some children [ 23 ]. Neonatal vertical infection is rare; however, in those cases, LDH was elevated [ 64 ].…”

“…The study by Davidescu et al observed a statistically significant difference between elders and non-elders in regard to AST [ 62 ]. Other cases were reported with elevated levels as well, with a tendency towards elevated AST rather than a modified ALT [ 23 , 24 , 25 , 26 , 30 , 34 , 35 , 36 , 37 , 59 , 64 , 79 , 97 ].…”

“…Since the beginning of the pandemic, cases of elevated levels have been reported internationally and in Romanian patients, with a tendency to be even higher in elders, patients with a history of heart conditions, or severe cases [ 14 , 21 , 24 , 25 , 27 , 31 , 33 , 36 , 39 , 40 , 43 , 45 , 62 , 79 , 89 ].…”

Pregnancy Outcomes in SARS-CoV-2-Positive Patients: A 20-Month Retrospective Analysis of Delivery Cases

“…Despite evidence of placental histology and newborn immunological blood tests, the rate of reported congenital COVID-19 infection is very low, ranging from 3.2% to 8.40% [ 11 , 47 , 48 ]. In a previous study, our team also reported cases of possible vertical transmission [ 49 ]. When the newborns experience COVID-19 symptoms, they are likely to require respiratory support or to be transferred to a neonatal ICU, particularly if their mothers are symptomatic, too [ 50 ].…”