Perinatal outcome and possible vertical transmission of coronavirus disease 2019: experience from North India

Abstract

Background: The consequences of SARS-CoV-2 on mother and fetus remain unknown due to a lack of robust evidence from prospective studies. Purpose: This study evaluated the effect of COVID-19 on neonatal outcomes and the scope of vertical transmission. Methods: This ambispective observational study enrolled pregnant women with COVID-19 in North India from April 1 to August 31, 2020 to evaluate neonatal outcomes and the risk of vertical transmission. Results: A total of 44 neonates born to 41 COVID-19-positive mothers were evaluated. Among them, 28 (68.3%) patients (two sets of twins) were delivered within 7 days of testing positive for COVID-19, 23 (56%) patients (two sets of twins) were delivered by cesarean section; 13 (29.5%) newborns hada low birth weight; seven (15.9%) were preterm; and six (13.6%) required neonatal intensive care unit admission, reflecting an increased incidence of cesarean delivery and low birth weight but zero neonatal mortality. Samples of cord blood, placental membrane, vaginal fluid, amniotic fluid, peritoneal fluid (in case of cesarean section), and breast milk for COVID-19 reverse transcription polymerase chain reaction tested negative in 22 prospective delivery cases. Nasopharyngeal swabs of two newborns tested positive for COVID-19: one at 24 hours and the other on day 4 of life. In the former case, biological samples were not collected as the mother was asymptomatic and her COVID-19 report was available post-delivery; hence, the source of infection remained inconclusive. In the latter case, all samples tested negative, ruling out the possibility of vertical transmission. All neonates remained asymptomatic on follow-up. Conclusion: COVID-19 does not have direct adverse effects on the fetus per se. The possibility of vertical transmission is almost negligible, although results from larger trials are required to confirm our findings.

Ways to Address Perinatal Mast Cell Activation and Focal Brain Inflammation, including Response to SARS-CoV-2, in Autism Spectrum Disorder

“…One recent paper that reviewed findings from 101 women infected with SARS-CoV-2 reported that there is vertical transmission of SARS-CoV-2 from the mother to the infant, with adverse effects on the newborn [ 74 ]. However, two other papers reported negligible transmission [ 75 , 76 ]. However, transmission may not be required for the virus to induce neuroinflammation, as it may affect peripheral nerves [ 77 ] or the developing brain via the Spike protein directly affecting brain cells [ 78 ].…”

Pregnancy outcomes and vertical transmission capability of SARS-CoV-2 infection among asymptomatic females

“…[ 14 ] A study conducted on 44 neonates by Sharma R et al . [ 15 ] showed a negligible possibility of vertical transmission of the SARS-CoV-2 virus. The natural history of COVID-19 infection is not fully understood; many genetic mutations occur in the virus that might be more virulent, so more epidemiological investigations should be done.…”

Babies born to mothers positive for SARS-CoV-2 – Are they in danger?

“…Interesting results of the study of Sharma et al [ 2 ] included comparably high percentages of preterm deliveries (14.6%) and caesarean sections (56.1%) ( Fig. 1 ).…”

“…Considerable studies have been conducted on these specific issues, and even though more studies need to be completed, studies to date assist with the shared decision-making of families and attending physicians. In this issue of Clinical and Experimental Pediatrics , Sharma et al [ 2 ] have explored these problems by an ambispective observational study that examined 44 neonates born to 41 SARS-CoV-2 positive mothers from North India. The results of the study showed no definite direct adverse effect on the fetus or newborn (perinatal outcome), and a negligible possibility of vertical transmission.…”

“…Rather, enthusiasm for vigorously investigating the biological samples including cord blood, placental membrane swab, vaginal fluid, amniotic fluid, peritoneal fluid (in case of caesarean section), and breast milk should be recognized. Owing to the design of the study of Sharma et al [ 2 ], the authors were able to collect the specimens from 28 mothers. Still, a few studies have discovered positive SARS-CoV-2 in some of the biological samples enumerated above.…”