Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait

Abstract

Background: In late December of 2019, a novel coronavirus (SARS-CoV-2) was identified in the Chinese city Wuhan among a cluster of pneumonia patients. While it is known that pregnant women have reduced immunity and they are at risk for COVID-19 infection during the current pandemic, it is not clear if the disease manifestation would be different in pregnant women from non-pregnant women. Objectives: To describe the maternal and neonatal clinical features as well as outcome of pregnancies complicated with SARS-CoV-2 infection. Methods: In this retrospective national-based study, we analyzed the medical records of all SARS-CoV-2 positive pregnant patients and their neonates who were admitted to New-Jahra Hospital, Kuwait, between March 15th 2020 and May 31st 2020. The outcomes of pregnancies were assessed until the end date of follow-up (June 15th 2020). Results: A total of 185 pregnant women were enrolled with a median age of 31 years (interquartile range, IQR: 27.5-34), and median gestational age at diagnosis was 29 weeks (IQR: 18-34). The majority (88%) of the patients had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). During the study period, 141 (76.2%) patients continued their pregnancy, 3 (1.6%) had a miscarriage, 1 (0.5%) had intrauterine fetal death and only 2 (1.1%) patients developed severe pneumonia and required intensive care. Most of the neonates were asymptomatic, and only 2 (5%) of them tested positive on day 5 by nasopharyngeal swab testing. Conclusion: Pregnant women do not appear to be at higher risk to the COVID-19 than the general population. The clinical features of pregnant women with SARS-CoV-2 infection were similar to those of the general population having SARS-CoV-2 infection. Favorable maternal and neonatal outcomes reinforce the existing evidence and may guide healthcare professionals in the management of pregnancies complicated with SARS-CoV-2 infection.

Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

“…Several cases of neonates infected by SARS-CoV-2 are reported in the literature and here we have systematically analyzed and synthesized them. Our findings confirm that SARS-CoV-2 can infect neonates and that the majority of these infections occur 17 Case report France a PR 6 Good Aghdam 18 Case report Iran PR 4 Intermediate Alonso Diaz 19 Case report Spain PR 5 Intermediate Alzamora 20 Case report Peru PR 3 Intermediate Ayed 21 Case series Kuwait Preprint 1 Low Banerjee 22 Case series India PR 2 Low Barbero 23 Retrospective cohort study Spain PR n.a. Intermediate Buonsenso 24 Case series Italy PR 4 Intermediate Carosso 25 Case report Italy PR 4 Intermediate Chacon-Aguilar 26 Case report Spain PR 5 Intermediate Coronado Munoz 27 Case report USA PR 4 Intermediate Demirjian 28 Case report UK PR 4 Intermediate Dong 29 Case report China PR 6 Good Dumpa 30 Case report USA PR 6 Good Eghbalian 31 Case report Iran PR 4 Intermediate Feng 32 Case series China PR 3 Intermediate Fenizia 33 Case series Italy PP 5 Intermediate Ferrazzi 34 Case series Italy PR 1 Low Garazzino 35 Case series Italy PR 2 Low Gonzales Brabin 36 Case report Spain PR 3 Intermediate Gordon 37 Case report UK PR 2 Low Gregorio-Hernandez 38 Case series Spain PR 5 Intermediate Groß 39 Case series Germany PR 5 Intermediate Han 40 Case report South Korea PR 6 Good Hantoushzadeh 41 Case series Iran PR 6 Good Hasan 42 Case series Bangladesh Preprint 6 Good Hu 43 Case series China PR 6 Good Ibarra Rios 44 Case report Mexico Preprint 5 Intermediate Kanburoglu 45 Case report Turkey PR 1 Low Kayem 46 Case series France PR 1 Low Kirtsman 47 Case report Canada PR 6 Good Knight 48 Retrospective cohort study UK PR n.a.…”

“…Inflammatory markers (Creactive protein and procalcitonin) were increased in 15 (15.5%) out of 97 neonates 20,27,38,40,43,45,49,59,70,72,[80][81][82]88 . Lung imaging was abnormal in 62 (64%) out of 97 neonates and consisted of an interstitialalveolar pattern at lung ultrasound or chest X-ray and ground-glass opacities at CT-scan 17,19,21,23,27,29,32,36,38,44,45,51,53,55,58,59,[64][65][66][69][70][71]73,[77][78][79][80]82,85,88,90 . One neonate presenting with neurological manifestations also showed bilateral gliosis of the deep white periventricular and subcortical matter, together with signs of cerebral vasculitis, which was not totally remitted at the hospital discharge 77 .…”

Necrotizing Enterocolitis in Preterm Infants Born to Mother with COVID-19

“…Asphyxia was confirmed by an Apgar score of >5 at 5 min [15]. Respiratory failures in mothers due to COVID-19 have contributed to asphyxia [16]. In this study, maternal respiratory failure was described with intubated mothers.…”

“…Compared to pregnant women without COVID-19, pregnant women with confirmed COVID-19 were significantly more likely to have premature births [19]. A study conducted by Ayed et al [16] who showed that most infants (73.3%) born to COVID-19 positive mothers were term and most had a birth weight of more than 2500 g. Another study by Anand et al [20] showed that premature births to COVID-19 positive mothers tended to be more numerous than full-term births (51% vs. 49%). The results of this study demonstrated that the majority of preterm infants born to mothers who confirmed COVID-19 had a gestational age of 34-<37 weeks (60%) and a birth weight of 1500-<2500 g (88.9%).…”

Neurodevelopmental outcomes of infants born to mothers with SARS-CoV-2 infection during pregnancy: A national prospective study in Kuwait

“…Ethics approval was granted by the Ethics Committee of the Ministry of Health of Kuwait, (2021-1638), Government of Kuwait. Demographic details were collected for all infants enrolled in the follow-up study. Maternal clinical and neonatal data from acute hospital admissions were collected by retrospective chart review of the included participants and have been previously published [17].…”