Coronavirus disease 2019 in pregnant women: a report based on 116 cases

Yan, Jie; Guo, Jiao; Fan, Cuifang; Juan, Juan; Yu, Xuechen; Li, Jiafu; Li, Feng; Li, Chunyan; Chen, Huijun; Qiao, Yuan; Di, Lijun; Wang, Chen; Xiong, Guoping; Xiao, Feng; He, Wencong; Pang, Qiumei; Hu, Xiaoling; Wang, Haihui; Chen, Dunjin; Zhang, Yuanzhen; Poon, Liona C.; Yang, Huixia

doi:10.1016/j.ajog.2020.04.014

Cited by 634 publications

(1,008 citation statements)

References 23 publications

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“…Periconceptional fever has been linked to neural tube defects, with epidemiological evidence that this risk is attenuated by folic acid supplementation [20]. Current data do not suggest an increased risk of miscarriage or early pregnancy loss in pregnancies with COVID-19 [5]. Likewise, previous results in pregnant women infected with SARS-CoV and MERS-CoV did not demonstrate a clear causal relationship with these complications [21].…”

Section: Fetal Complicationsmentioning

confidence: 74%

Coronavirus Disease 2019 in Pregnancy: A Clinical Management Protocol and Considerations for Practice

et al. 2020

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The coronavirus disease 2019 (COVID-19) pandemic has represented a major impact to health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. The mother and fetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-fetal medicine practice have suffered profound changes to adapt to the pandemic. In addition, there are aspects specific to and gestation that should be known by specialists in order to correctly diagnose the disease, classify the severity, distinguish specific signs of COVID-19 from those of obstetric complications, and take the most appropriate management decisions. In this review we present in a highly concise manner an evidence-based protocol for the management of CO-VID-19 in pregnancy. We briefly contemplate all relevant as-pects that we believe a specialist in obstetrics and maternal medicine should know, ranging from basic concepts about the disease and protection measures in the obstetric setting to more specific aspects related to maternal-fetal management and childbirth.[1]. With 220,000 infections and more than 22,000 deaths, Spain is the third country in number of cases [1]. In this paper, we aimed to share our management protocol and address considerations for maternal-fetal medicine practice based on a qualitative review of existing data. Disease TransmissionAvailable information [2] suggests that the infection was originally zoonotic. Still, the current transmission is person to person by respiratory droplets after contact with an infected person (< 2 m) or direct contact with contaminated surfaces by infected secretions [3]. Transmission could also occur through infected faeces, but the propagation throughout this route is much less relevant [4]. The possibility of vertical transmission is highly unlikely and has not been demonstrated in the Chinese CO-VID-19 outbreak [5] or in previous epidemics by other similar coronaviruses (severe acute respiratory syndrome [SARS]-CoV and Middle East respiratory syndrome [MERS]-CoV) [6,7]. Based on limited data, there is no evidence of the presence of the virus in genital fluids, urine, amniotic fluid, or breast milk [8]. The low maternal viremia found in this infection [9] also suggests a negligible placental seeding. However, most data on vertical transmission are based on women who had infection during the third trimester, and information regarding vertical transmission earlier in pregnancy is lacking.Reported cases of newborn infection probably came from horizontal transmission. The usual incubation period is about 4-6 days, which can vary between 2 and 14 days [10]. The median duration of viral shedding is 20.0 days (being the 75th centile at 24 days) [11].

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Section: Fetal Complicationsmentioning

confidence: 74%

Coronavirus Disease 2019 in Pregnancy: A Clinical Management Protocol and Considerations for Practice

et al. 2020

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“…34 This systematic review had several strengths. We undertook a meticulous process in identifying duplicate reporting: (i) case reports from China were excluded, (ii) when a hospital had published their cases more than once, only the paper with the biggest data or published on the later date was included, (iii) we were able to identify the duplicates from our own publication, 11 which is the biggest cohort series with available pregnancy outcome data from China and (iv) when necessary we contacted the corresponding authors using their native language, i.e. Chinese and Spanish, thus increasing the chance of receiving a response from them.…”

Section: Discussionmentioning

confidence: 99%

“…We decided to combine laboratory-confirmed and clinically diagnosed COVID-19 cases in our analysis because both groups had similar outcomes. 11 We believed it was important to include the clinically diagnosed cases in this review as clinically diagnosed cases had typical COVID-19 chest CT findings and significant epidemiological exposure. Only two cases of maternal death had been reported, as of April 23, 2020, in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Amongst the 100 neonates born to these women, none was infected with SARS-CoV-2. 11 Based on very scarce data to-date, conflicting evidence from nuclei acid-based testing and antibodies testing in neonates born to mothers with COVID-19 has raised further controversy in relation to the risk of vertical transmission during pregnancy. 12,13 The objective of this study was to perform a systematic review of available published All rights reserved.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies

Juan

Gil

Zeng

et al. 2020

Preprint

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Contribution:What are the novel findings of this work?Amongst a few cases from the case-series that had qRT-PCR testing in vaginal mucus and breast milks, the results were negative for SARS-CoV-2. Similarly, some of the cases from the case-series had qRT-PCR testing in amniotic fluid, cord blood, neonatal throat swab and neonatal feces, and the results were negative for SARS-CoV-2.Amongst the case-reports, there were two maternal deaths and two neonates tested positive for SARS-CoV-2 at 16 / 24 hours of life. What are the clinical implications of this work?The subject of vertical transmission of SARS-CoV-2 remains controversial and more data is needed to investigate this possibility. In order to collect meaningful pregnancy and perinatal outcome data, we urge researchers and investigators to reference previously published cases in their publications and to record such reporting when the data of a case is being entered into a registry or several registries. ABSTRACT ObjectiveTo perform a systematic review of available published literature on pregnancies affected by COVID-19 to evaluate the effects of COVID-19 on maternal, perinatal and neonatal outcomes.

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“…Published case series from China have not reported any maternal deaths related to COVID-19. 1,2,3 However, maternal mortalities associated with COVID-19 have been reported recently from several other countries in mainstream news and social media (https://ripetomato.org/2020/04/05/covid-19-in-pregnancy-news-reports/) as well as in the scientific literature. 8,9 The Public Health Agency of Sweden has also reported one maternal death, which was not included in the data analysis of pregnant women admitted to intensive care.…”

mentioning

confidence: 99%

Severe maternal morbidity and mortality associated with COVID‐19: The risk should not be downplayed

Westgren

Pettersson

Hagberg

et al. 2020

Acta Obstet Gynecol Scand

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Coronavirus disease 2019 in pregnant women: a report based on 116 cases

Cited by 634 publications

References 23 publications

Coronavirus Disease 2019 in Pregnancy: A Clinical Management Protocol and Considerations for Practice

Coronavirus Disease 2019 in Pregnancy: A Clinical Management Protocol and Considerations for Practice

Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies

Severe maternal morbidity and mortality associated with COVID‐19: The risk should not be downplayed

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