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Karimi H, Mansouri V, Rezaei N. Vertical transmission and maternal passive immunity post-SARS-CoV-2. Future Virol 2023:10.2217/fvl-2023-0089. [PMID: 37822684 PMCID: PMC10564388 DOI: 10.2217/fvl-2023-0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/22/2023] [Indexed: 10/13/2023]
Abstract
Since 2020, the highly contagious nature and various transmission routes of SARS-CoV-2 have rendered the pandemic interminable. Vertical transmission (VT) through the placenta and breast milk, which is frequent for certain virus types, is thought to exist for SARS-CoV-2 and is hypothesized by many researchers. Conversely, antibodies are produced to counteract the effect of viruses. Since newborns' immunologic system cannot produce proper antibodies, maternal antibodies are usually transferred from mother to infant/fetus to meet the need. This theory leads to the hypothesis of transmission of antibodies through the placenta and breast milk following SARS-CoV-2 infection or vaccination. This paper further discusses these hypotheses, considering consequences of fetus/infant harm versus benefit.
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Affiliation(s)
- Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
| | - Vahid Mansouri
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 14194, Iran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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2
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Corrêa MTR, de Menezes VC, Gomes E, dos Santos EM. Potential risk of brain damage and poor developmental outcomes in children prenatally exposed to SARS-CoV-2: a systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021325. [PMID: 36921165 PMCID: PMC10013995 DOI: 10.1590/1984-0462/2023/41/2021325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/07/2022] [Indexed: 03/16/2023]
Affiliation(s)
| | | | - Elonir Gomes
- Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
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3
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Omar M, Youssef MR, Trinh LN, Attia AS, Elshazli RM, Jardak CL, Farhoud AS, Hussein MH, Shihabi A, Elnahla A, Zora G, Abdelgawad M, Munshi R, Aboueisha M, Toraih EA, Fawzy MS, Kandil E. Excess of cesarean births in pregnant women with COVID-19: A meta-analysis. Birth 2022; 49:179-193. [PMID: 34997608 DOI: 10.1111/birt.12609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/18/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies have suggested that cesarean birth in pregnant women with COVID-19 may decrease maternal adverse events and perinatal transmission. This systematic review aimed to evaluate variations in clinical presentation, laboratory findings, and maternal/neonatal outcomes in COVID-19 patients who delivered vaginally versus via cesarean. METHODS A comprehensive search following PRISMA guidelines was performed for studies published up to May 23, 2020, using PubMed, Web of Science, Scopus, Embase, Cochrane, Science Direct, and clinicaltrials.gov. Original retrospective and prospective studies, case reports, or case series with sufficient data for estimating the association of COVID-19 with different pregnancy outcomes with no language restriction and published in peer-reviewed journals were included. Pooled mean and arcsine transformation proportions were applied. Next, a two-arm meta-analysis was performed comparing the perinatal outcomes between the study groups. RESULTS Forty-two studies with a total of 602 pregnant women with COVID-19 were included. The mean age was 31.8 years. Subgroup analysis showed that Americans had the lowest gestational age (mean = 32.7, 95%CI = 27.0-38.4, P < 0.001) and the highest incidence of maternal ICU admission (95%CI = 0.45%-2.20, P < 0.001) of all nationalities in the study. There was no significant difference in perinatal complications, premature rupture of membrane, placenta previa/accreta, or gestational hypertension/pre-eclampsia between women who delivered vaginally versus by cesarean. Importantly, there were also no significant differences in maternal or neonatal outcomes. CONCLUSION Vaginal delivery was not associated with worse maternal or neonatal outcomes when compared with cesarean. The decision to pursue a cesarean birth should be based on standard indications, not COVID-19 status.
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Affiliation(s)
- Mahmoud Omar
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mohanad R Youssef
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Lily N Trinh
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Abdallah S Attia
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Rami M Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical Therapy, Horus University - Egypt, New Damietta, Egypt
| | | | - Ashraf S Farhoud
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisina, USA
| | - Mohammad H Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Areej Shihabi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Ahmed Elnahla
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Ghassan Zora
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Ruhul Munshi
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mohamed Aboueisha
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisina, USA.,Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
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Bosco A, Dessì A, Zanza C, Pintus R, Fanos V. Resolvins' Obesity-Driven Deficiency: The Implications for Maternal-Fetal Health. Nutrients 2022; 14:nu14081662. [PMID: 35458224 PMCID: PMC9029397 DOI: 10.3390/nu14081662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/10/2022] Open
Abstract
Since pregnancy is already characterized by mild but significant inflammatory activity in physiological conditions, when complicated by obesity the probability of a persistent inflammatory state increases, with consequent multiple repercussions that add up to the complications associated with acute inflammation. In this context, the role of resolvins, specialized pro-resolving mediators (SPMs), deriving from omega-3 essential fatty acids, may be crucial. Indeed, differential production in numerous high-risk conditions associated with both childbirth and neonatal health, the correlation between maternal omega-3 intake and resolvin concentrations in maternal blood and at the placental level, and the high values found in breast milk in the first month of breastfeeding, are some of the most important hallmarks of these autacoids. In addition, a growing body of scientific evidence supports the lack of SPMs, at the level of immune-metabolic tissues, in the case of obesity. Furthermore, the obesity-related lack of SPMs seems to be decisive in the context of the current outbreak of COVID-19, as it appears to be one of the causes associated with the higher incidence of complications and negative outcomes of SARS-CoV-2 infection. The usefulness of metabolomics in this field appears clear, given that through the metabolome it is possible to observe the numerous and complex interactions between the mother, the placenta and the fetus in order to identify specific biomarkers useful in the prediction, diagnosis and monitoring of the various obstetric conditions. However, further investigations are needed in order to evaluate the possible use of some resolvins as biomarkers of maternal–fetal outcomes but also to establish adequate integration values in pregnant women with omega-3 fatty acids or with more active derivatives that guarantee optimal SPM production under risky conditions.
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Sampieri CL, Montero H. [Review of new evidence about the possible vertical transmission of coronavirus disease-2019]. GACETA SANITARIA 2022; 36:166-172. [PMID: 32711871 PMCID: PMC7305917 DOI: 10.1016/j.gaceta.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To conduct a systematic review of original peer-reviewed studies, containing data on the identification of SARS-CoV-2 in clinical samples of amniotic fluid, placenta or membranes, umbilical cord blood, and human milk, from women with a clinically or confirmed diagnosis of COVID-19. These studies should have been published after the guide for the management of patients with COVID-19 from World Health Organization guide (available in March 13, 2020). RESULTS Seventeen studies were included, in which 143 clinical samples were identified (38 of amniotic fluid; 34 of placentas or membranes; 39 from umbilical cord blood and 32 from human milk). Among the 143 samples, nine were positive for SARS-CoV-2 RNA (one amniotic fluid sample obtained before rupturing the membranes; six samples of placenta or membranes, although authors indicate the possibility of contamination by maternal blood in three of these, and two samples of human milk). CONCLUSIONS Following our search criteria, we found no studies that demonstrate the detection of SARS-CoV-2, in conjunction with viral isolation and the evaluation of the infective capacity of viral particles, in clinical samples of amniotic fluid, placenta or membranes, umbilical cord blood and human milk, from women with a confirmed or clinical diagnosis of COVID-19. However, vertical transmission cannot be ruled out, larger studies are required that ideally locate in situ RNA and protein of SARS-CoV-2, as well as isolation that demonstrate the infective capacity of the viral particles.
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Affiliation(s)
- Clara Luz Sampieri
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa, Veracruz, México.
| | - Hilda Montero
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa, Veracruz, México
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6
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van Goudoever JB, Spatz DL, Hoban R, Dumitriu D, Gyamfi-Bannerman C, Berns M, McKechnie L, Davanzo R. Updating Clinical Practices to Promote and Protect Human Milk and Breastfeeding in a COVID-19 Era. Front Pediatr 2022; 10:867540. [PMID: 35558372 PMCID: PMC9086708 DOI: 10.3389/fped.2022.867540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/30/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices implemented early in the pandemic being mostly anti-breastfeeding, e.g., separation of mothers from their infants, and not evidence based. As the pandemic has progressed, evidence has emerged reconfirming the value of human milk and the importance of protecting and supporting breastfeeding, especially the initiation of lactation. However, it is clear that COVID-19 has changed the clinical care paradigm around breastfeeding and lactation support and, as such, it is imperative that practices adapt and evolve to maintain the emphasis on lactation support. We participated in a round table conference aiming to rescue and develop protocols and practices that support breastfeeding during the COVID-19 pandemic. One key area to target will be to maximize the use of the antenatal period. The early identification of lactation risk factors together with the development of person-centered methods to deliver breastfeeding information and education to parents-to-be will be critical. In addition, the establishment of a hospital culture that values breastfeeding and prioritizes the use of human milk will be integral for the motivation of health care professionals. That culture will also support active management of the initiation of lactation and the development of a 'back-up plan' toolkit to support the mother experiencing lactation difficulties. Post-discharge support will also be crucial with the development of both in-person and virtual lactation support programs, in particular for the immediate post-discharge period to benefit mothers who experience an early discharge process. These measures will allow for a new, adapted framework of practice that acknowledges the current COVID-19 paradigm and maintains the emphasis on the need to protect and support breastfeeding and the use of human milk.
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Affiliation(s)
| | - Diane L Spatz
- University of Pennsylvania School of Nursing & Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Rebecca Hoban
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, Canada
| | - Dani Dumitriu
- Columbia University Irving Medical Center, New York, NY, United States
| | | | - Monika Berns
- Charité - Universitätsmedizin, Klink für Neonatologie, Berlin, Germany
| | - Liz McKechnie
- Leeds Centre for Newborn Care, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Riccardo Davanzo
- Institute for Maternal and Child Health Institute, IRCCS "Burlo Garofolo", Trieste, Italy
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Florea RM, Sultana CM. COVID-19 and breastfeeding: can SARS-CoV-2 be spread through lactation? Discoveries (Craiova) 2021; 9:e132. [PMID: 34754901 PMCID: PMC8570917 DOI: 10.15190/d.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
SARS-CoV-2 is a new betacoronavirus that was first reported in the Hubei province, China, in December 2019. The virus is likely transmitted through air droplets. However, there are reported cases where SARS-CoV-2-RNA was found in other samples, such as blood or stool. Nonetheless, there is limited information concerning the presence of viral RNA in pregnancy-related samples, specifically breast milk. However unlikely, there is still uncertainty regarding the possibility of vertical transmission from mother to infant through breastfeeding. This review aims to synthetize the literature written so far on this topic.
Despite not being extensively researched, vertical transmission through breast milk seems unlikely. Case series showed that milk samples from mothers with COVID-19 were almost entirely negative. So far, there have been only 9 recorded cases of viral shedding in milk samples, uncertain however of the viability of the particles. Furthermore, WHO and UNICEF strongly encourage commencing breastfeeding after parturition, underlining the benefits of lactation. Moreover, some studies have proven the existence of IgG and IgA anti-SARS-CoV-2-antibodies in the maternal milk that could possibly play an important part in the neonate’s protection against the virus.
Vertical transmission through lactation seems unlikely, most studies pointing towards the safety of breastfeeding. However, further larger-scale studies need to be performed in order to clarify a yet uncertain matter.
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Affiliation(s)
| | - Camelia Madalina Sultana
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Stefan S. Nicolau Virology Institute, Bucharest, Romania
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8
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Kuciel N, Sutkowska E, Biernat K, Hap K, Mazurek J, Demczyszak I. Assessment of the level of anxiety and pain in women who do and do not attend childbirth classes during the SARS-CoV-2 pandemic. Risk Manag Healthc Policy 2021; 14:4489-4497. [PMID: 34754255 PMCID: PMC8572113 DOI: 10.2147/rmhp.s311338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Participation in childbirth classes is aimed at learning to cope with the anxiety that accompanies a woman during her pregnancy and childbirth. The aim of the study was to answer the question whether the lack of access to childbirth classes affected anxiety and perinatal pain in pregnant women who gave birth during the pandemic period. MATERIALS AND METHODS This cross-sectional survey-based study involved women who were pregnant during the lockdown period. The respondents were asked to fill in the following questionnaires: a personal questionnaire, the Polish version of the Delivery Fear Scale and the Numeric Rating Scale for the assessment of average and maximum pain experienced during the labour. The survey was completed within 24-72 hours after the birth of the child. The obtained questionnaires were divided into 2 groups based on the information concerning attending or not attending childbirth classes (divided into subgroups): group A - patients participated in childbirth classes, and group B - patients did not participate in childbirth classes. RESULTS Groups were homogeneous in terms of age, weight, height, body mass index and week of gestation. Perception of anxiety did not differ between groups. There was a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there were no significant differences between groups in terms of mean and maximum pain during labour. CONCLUSION The level of anxiety and pain associated with childbirth is not modulated by childbirth classes during the pandemic period. There is s a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there are no significant differences between groups in terms of mean and maximum pain during labour.
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Affiliation(s)
- Natalia Kuciel
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Karolina Biernat
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Katarzyna Hap
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Justyna Mazurek
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Iwona Demczyszak
- Department and Division of Medical Rehabilitation, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
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9
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Lou F, Qin H, He S, Li M, An X, Song L, Tong Y, Fan H. The Benefits of Breastfeeding Still Outweigh the Risks of COVID-19 Transmission. Front Med (Lausanne) 2021; 8:703950. [PMID: 34568367 PMCID: PMC8455845 DOI: 10.3389/fmed.2021.703950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
- Fuxing Lou
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Hongbo Qin
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Shiting He
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Maochen Li
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Xiaoping An
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Lihua Song
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Huahao Fan
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
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10
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Szekeres-Bartho J, Csabai T, Gorgey E. Biologia futura: embryo-maternal communication via progesterone-induced blocking factor (PIBF) positive embryo-derived extracellular vesicles. Their role in maternal immunomodulation. Biol Futur 2021; 72:69-74. [PMID: 34554496 DOI: 10.1007/s42977-020-00060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Paternal antigens expressed by the foetus are recognized as foreign. Therefore,-according to the rules of transplantation immunity-the foetus ought to be "rejected". However, during normal gestation, maternal immune functions are re-adjusted, in order to create a favourable environment for the developing foetus. Some of the mechanisms that contribute to the altered immunological environment, for example, the cytokine balance and NK cell function, with special emphasis on the role of progesterone and the progesterone-induced blocking factor (PIBF) will be reviewed.
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Affiliation(s)
- Julia Szekeres-Bartho
- Department of Medical Biology, Central Electron Microscope Laboratory, Medical School, Pecs University, 12 Szigeti Street, 7624, Pecs, Hungary. .,National Laboratory On Reproduction, János Szentágothai Research Centre, Pecs University, Pecs, Hungary. .,Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary. .,MTA - PTE Human Reproduction Research Group, Pecs, Hungary.
| | - Timea Csabai
- Department of Medical Biology, Central Electron Microscope Laboratory, Medical School, Pecs University, 12 Szigeti Street, 7624, Pecs, Hungary.,National Laboratory On Reproduction, János Szentágothai Research Centre, Pecs University, Pecs, Hungary.,Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary.,MTA - PTE Human Reproduction Research Group, Pecs, Hungary
| | - Eva Gorgey
- Department of Medical Biology, Central Electron Microscope Laboratory, Medical School, Pecs University, 12 Szigeti Street, 7624, Pecs, Hungary.,National Laboratory On Reproduction, János Szentágothai Research Centre, Pecs University, Pecs, Hungary.,Endocrine Studies, Centre of Excellence, Pecs University, Pecs, Hungary.,MTA - PTE Human Reproduction Research Group, Pecs, Hungary
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11
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Zhu F, Zozaya C, Zhou Q, De Castro C, Shah PS. SARS-CoV-2 genome and antibodies in breastmilk: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:514-521. [PMID: 33568494 DOI: 10.1136/archdischild-2020-321074] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review and meta-analyse the rate of SARS-CoV-2 genome identification and the presence of SARS-CoV-2 antibodies in breastmilk of mothers with COVID-19. DESIGN A systematic review of studies published between January 2019 and October 2020 without study design or language restrictions. SETTING Data sourced from Ovid Embase Classic+Embase, PubMed, Web of Science, Scopus, relevant bibliographies and the John Hopkins University COVID-19 database. PATIENTS Mothers with confirmed COVID-19 and breastmilk tested for SARS-CoV-2 by RT-PCR or for anti-SARS-CoV-2 antibodies. MAIN OUTCOME MEASURES Presence of SARS-CoV-2 genome and antibodies in breastmilk. RESULTS We included 50 articles. Twelve out of 183 women from 48 studies were positive for SARS-CoV-2 genome in their breastmilk (pooled proportion 5% (95% CI 2% to 15%; I2=48%)). Six infants (50%) of these 12 mothers tested positive for SARS-CoV-2, with one requiring respiratory support. Sixty-one out of 89 women from 10 studies had anti-SARS-CoV-2 antibody in their breastmilk (pooled proportion 83% (95% CI 32% to 98%; I2=88%)). The predominant antibody detected was IgA. CONCLUSIONS SARS-CoV-2 genome presence in breastmilk is uncommon and is associated with mild symptoms in infants. Anti-SARS-CoV-2 antibodies may be a more common finding. Considering the low proportion of SARS-CoV-2 genome detected in breastmilk and its lower virulence, mothers with COVID-19 should be supported to breastfeed.
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Affiliation(s)
- Faith Zhu
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Zozaya
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Qi Zhou
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Charmaine De Castro
- Sidney Liswood Health Sciences Library, Sinai Health System, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada .,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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12
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Khamees RE, Taha OT, Ali TYM. Anxiety and depression during pregnancy in the era of COVID-19. J Perinat Med 2021; 49:674-677. [PMID: 34062628 DOI: 10.1515/jpm-2021-0181] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study aimed to evaluate anxiety and depression in pregnant women during this global disease. METHODS This was a cross-sectional study recruiting 120 pregnant women. The study was conducted at the outpatient clinic of a tertiary hospital. We recruited women attending for antenatal care. Anxiety was evaluated using an Arabic validated Kuwait University Anxiety Scale (KUAS). Depression was evaluated using a validated Arabic form of the Edinburgh Postnatal Depression Scale (EPDS). RESULTS The study included 48 (40%) nulliparous and 72 (60%) multiparous women. The mean KUAS scores for nulliparous and multiparous women were 45.27±10.78 and 47.28±10.62. Both nulliparous and multiparous women had a fairly high possibility of depression. Fifty-three (44.2%) of them reported scores ≥ of 14. Ninety-three (77.5%) women thought that COVID-19 pandemic would affect their pregnancies. There was a significant association between the number of women reporting fear related to the COVID-19 pandemic and their KUAS and EPDS scores (p-value <0.001 each). CONCLUSIONS COVID-19 affected the mental health of pregnant women to a great extent. Care should be directed to measures that would decrease the impact of this pandemic on vulnerable populations.
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Affiliation(s)
- Rasha E Khamees
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Omima T Taha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Tamer Yehia M Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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13
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Liu C, Mu C, Zhang Q, Yang X, Yan H, Jiao H. Effects of Infection with SARS-CoV-2 on the Male and Female Reproductive Systems: A Review. Med Sci Monit 2021; 27:e930168. [PMID: 34193809 PMCID: PMC8259353 DOI: 10.12659/msm.930168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Coronavirus Disease-2019 (COVID-19) is a rapidly spreading pandemic that began at the end of 2019. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Reproductive health has always been one of the most important healthcare problems, and the impacts of COVID-19 on the reproductive systems have become an emerging topic. The effects of infection with SARS-CoV-2 on males are more harmful than on females. The outcomes of pregnancy also can show the condition of male and female reproductive system health. The vertical transmission of SARS-CoV-2 significantly affects pregnancy healthy. SARS-CoV-2, antibody, and other factors, such as the decline of lymphocyte counts, and increased erythrocyte sedimentation rate, C-reactive protein, and D-dimer levels, are evidence of SARS-CoV-2 vertical transmission. Angiotensin-converting enzyme 2 (ACE2) is regarded as a virus receptor in the reproductive system. The expression and activity of ACE2 are influenced by sex hormones, especially the male sex hormones. The strength of immunity is crucial to fighting off viral infection. Antibodies against SARS-CoV-2 show different expression in male and female patients, and the antibodies have been regarded as having potential applications in COVID-19 prevention and treatment. This review aims to present the current status of what is known about the involvement of the male and female reproductive systems, as well as the effects on pregnancy health, during infection with SARS-CoV-2, and discusses the implications for future fertility.
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Affiliation(s)
- Chunlian Liu
- Center for Reproductive Medicine, General Hospital, Ningxia Medical University, Yinchuan, Ningxia, China (mainland).,Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia, China (mainland)
| | - Chunlan Mu
- Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia, China (mainland).,Department of Medical Genetics and Cell Biology, Basic Medicine Science College, Ningxia Medical University, Yinchuan, Ningxia, China (mainland)
| | - Qian Zhang
- Center for Reproductive Medicine, General Hospital, Ningxia Medical University, Yinchuan, Ningxia, China (mainland).,Center for Reproductive Medicine, Ningxia Medical University , Yinchuan，Ningxia, China (mainland)
| | - Xiwen Yang
- Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia, China (mainland).,Department of Medical Genetics and Cell Biology, Basic Medicine Science College, Ningxia Medical University, Yinchuan, Ningxia, China (mainland)
| | - Hui Yan
- Center for Reproductive Medicine, General Hospital, Ningxia Medical University, Yinchuan, Ningxia, China (mainland)
| | - Haiyan Jiao
- Key Laboratory of Fertility Preservation and Maintenance, Ministry of Education, Ningxia Medical University, Yinchuan, Ningxia, China (mainland).,Department of Medical Genetics and Cell Biology, Basic Medicine Science College, Ningxia Medical University, Yinchuan, Ningxia, China (mainland).,Key Laboratory of Reproduction and Genetics in Ningxia, Ningxia Medical University, Yinchuan, Ningxia, China (mainland)
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Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up. Infect Dis Obstet Gynecol 2021; 2021:9952701. [PMID: 34188437 PMCID: PMC8192194 DOI: 10.1155/2021/9952701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/22/2021] [Indexed: 01/10/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks postdischarge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6-40) and 3077.50 ± 697.64 gr (1720-3900), respectively. Apgar score of the first and fifth minutes in all neonates was ≥8 and ≥9 out of 10, respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP) in three infants are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results similar to those described for nonpregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.
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Leyser M, Marques FJP, do Nascimento OJM. POTENTIAL RISK OF BRAIN DAMAGE AND POOR DEVELOPMENTAL OUTCOMES IN CHILDREN PRENATALLY EXPOSED TO SARS-COV-2: A SYSTEMATIC REVIEW. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2021; 40:e2020415. [PMID: 34076204 PMCID: PMC8240623 DOI: 10.1590/1984-0462/2022/40/2020415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/06/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To perform a systematic literature review to analyze existing data on the neurological effects of coronavirus on newborns. DATA sources: We followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), and searched the PubMed and Embase platforms for the keywords [brain damage OR pregnancy OR developmental outcomes] and [coronavirus OR SARS-CoV-2 OR SARS-CoV OR MERS-CoV] between January 1, 2000 and June 1, 2020. DATA synthesis: Twenty-three reports described the course of pregnant women exposed to SARS-CoV-2, SARS-CoV, or MERS-CoV during the gestational period, eight to SARS-CoV-2, eight to SARS-CoV, and seven to MERS-CoV. No data were found on abnormalities in brain development or on a direct link between the virus and neurological abnormalities in the human embryo, fetus, or children. Spontaneous miscarriage, stillbirth, and termination of pregnancy were some complications connected with SARS/MERS-CoV infection. SARS-CoV-2 is not currently associated with complications in the gestational period. CONCLUSIONS The literature has no data associating exposure to coronavirus during pregnancy with brain malformations and neurodevelopmental disorders. However, despite the lack of reports, monitoring the development of children exposed to SARS-CoV-2 is essential given the risk of complications in pregnant women and the potential neuroinvasive and neurotropic properties found in previous strains.
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16
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Salami VU, Okoduwa SIR, Chris AO, Ayilara SI, Okoduwa UJ. Opinion Review of Socioeconomic Impact of COVID-2019 on Women's Health. Front Glob Womens Health 2021; 2:647421. [PMID: 34816201 PMCID: PMC8593962 DOI: 10.3389/fgwh.2021.647421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
The global battle to survive the onslaughts of the Coronavirus Disease 2019 (COVID-19) started in December 2019 and continues today. Women and girls have borne the brunt of the hardship resulting from the health crises. This paper examined the effects of COVID-19 on women. Socioeconomic factors resulting from the pandemic, especially in relation to women's health, were discussed after studying published articles. They include gender specificity and COVID-19, the economic toll of COVID-19 on women, pregnancy and COVID-19, gender-based violence due to COVID-19, and health-care impacts of COVID-19. Making up the majority in the healthcare workforce, women were at higher risk of infection with COVID-19 due to their exposure as caregivers to infected patients. The pandemic took its toll on them as part of the greater population in the informal sector of the economy due to the lockdown directive, as many experienced severe monetary shortages and job losses. Pregnant women infected with COVID-19 were prone to severe diseases, maternal complications, and death due to their weakened immunity and exposure during clinical procedures. Gender-based violence was observed to have increased across the globe for women. The results of this review strongly indicate that women are disproportionately affected by the ongoing COVID-19 health crisis. This review will help health-care professionals and policymakers arrive at properly-thought-through decisions to better manage health crises. Governments and all key players should address the challenge by devising effective policies with a gendered view.
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Affiliation(s)
- Victory U. Salami
- Scientific and Industrial Research Department, National Research Institute for Chemical Technology, Zaria, Nigeria
| | - Stanley I. R. Okoduwa
- Department of Biochemistry, Babcock University, Ilishan-Remo, Nigeria
- Directorate of Research and Development, Nigerian Institute of Leather and Science Technology, Zaria, Nigeria
| | - Aimee O. Chris
- Department of Biochemistry, Babcock University, Ilishan-Remo, Nigeria
| | - Susannah I. Ayilara
- Scientific and Industrial Research Department, National Research Institute for Chemical Technology, Zaria, Nigeria
| | - Ugochi J. Okoduwa
- Industrial and Environmental Pollution Department, National Research Institute for Chemical Technology, Zaria, Nigeria
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17
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AbdelMassih A, Fouda R, Essam R, Negm A, Khalil D, Habib D, Afdal G, Ismail HA, Aly H, Genedy I, El Qadi L, Makki L, Shulqamy M, Hanafy M, AbdelMassih M, Ibrahim M, Ebaid M, Ibrahim M, El-Husseiny N, Ashraf N, Shebl N, Menshawey R, Darwish R, ElShahawi R, Ramadan R, Albala S, Imran S, Ahmed S, Khaldi S, Abohashish S, Paulo S, Omar Y, Tadros MA. COVID-19 during pregnancy should we really worry from vertical transmission or rather from fetal hypoxia and placental insufficiency? A systematic review. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [PMCID: PMC8047589 DOI: 10.1186/s43054-021-00056-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background COVID-19 is the largest outbreak to strike humanity. The wide scale of fatalities and morbidities lead to a concurrent pandemic of uncertainty in scientific evidence. Conflicting evidences are released on daily basis about the neonatal outcomes of COVID-19-positive mothers. The aim of this study was to use the relevant case reports and series to determine the percentage of newborns who test positive for COVID-19 who are born to COVID-19-positive mothers. Secondary outcomes included examining laboratory abnormalities among COVID-19-positive neonates, and any depicted placental abnormalities in COVID-19-positive mothers. For this purpose, systematic review was performed on all studies reporting primary data on fetus-mother pairs with COVID-19. Data bases were searched for studies that met our inclusion and exclusion criteria. Results Final screening revealed 67 studies, from which the primary data of 1787 COVID-19 mothers were identified and had their pregnancy outcome analyzed. Only 2.8% of infants born to COVID-19-positive mothers tested positive, and this finding is identical to percentages reported in former Coronaviridae outbreaks, whereas 20% manifested with intrauterine hypoxia alongside placental abnormalities suggestive of heavy placental vaso-occlusive involvement. Conclusions These findings suggest that while vertical transmission is unlikely, there appears to be an underlying risk of placental insufficiency due to the prothrombotic tendency observed in COVID-19 infection. Guidelines for proper prophylactic anticoagulation in COVID-positive mothers need to be established.
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18
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Matar R, Alrahmani L, Monzer N, Debiane LG, Berbari E, Fares J, Fitzpatrick F, Murad MH. Clinical Presentation and Outcomes of Pregnant Women With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 72:521-533. [PMID: 32575114 PMCID: PMC7337697 DOI: 10.1093/cid/ciaa828] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Descriptions of coronavirus disease 2019 (COVID-19) have focused on the nonpregnant adult population. This study aims to describe the clinical characteristics and perinatal outcomes of COVID-19 in pregnancy. METHODS We searched databases from December 2019 to 30 April 2020. Eligible studies reported clinical characteristics, radiological findings, and/or laboratory testing of pregnant women during infection. Data were pooled across studies using a random-effects model. RESULTS Twenty-four studies (136 women) were included. The most common symptoms were fever (62.9%) and cough (36.8%). Laboratory findings included elevated C-reactive protein (57%) and lymphocytopenia (50%). Ground-glass opacity was the most common radiological finding (81.7%). Preterm birth rate was 37.7% and cesarean delivery rate was 76%. There was 1 maternal death. There were 2 fetal COVID-19 cases. CONCLUSIONS The clinical picture in pregnant women with COVID-19 did not differ from the nonpregnant population; however, the rate of preterm birth and cesarean delivery are considerably higher than international averages.
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Affiliation(s)
- Reem Matar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Layan Alrahmani
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Nasser Monzer
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Labib G Debiane
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Henry Ford, Detroit, Michigan, USA
| | - Elie Berbari
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jawad Fares
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Fidelma Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mohammad H Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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19
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GÜRBÜZ T, GÖKMEN O, KAPTAN G, İNANLI E, KARADENİZ SB, ERSAHİN SÖYLEMEZ N, SÖYLEMEZ İ. Investigating anxiety, depression and obsessive-compulsive disorders among the pregnant women during Covid-19 pandemic. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.769006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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20
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Abstract
In this chapter, we will discuss the infection history and epidemiology, the viral structure of COVID 19 or SARS-CoV-2, mode of transmission, virulence, and pathogenesis of disease, and we also discuss how it was started and its relation to other coronaviruses. Then we will mention the relation to pregnancy, how it can affect pregnant female, sequelae on pregnancy course and labor, and effect on fetus and neonates.
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21
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Wang RY, Zheng KQ, Xu BZ, Zhang W, Si JG, Xu CY, Chen H, Xu ZY, Wu XM. Healthy neonate born to a SARS-CoV-2 infected woman: A case report and review of literature. World J Clin Cases 2020; 8:6016-6025. [PMID: 33344600 PMCID: PMC7723697 DOI: 10.12998/wjcc.v8.i23.6016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered coronavirus that has generated a worldwide outbreak of infections. Many people with coronavirus disease-2019 (COVID-19) have developed severe illness, and a significant number have died. However, little is known regarding infection by the novel virus in pregnant women. We herein present a case of COVID-19 confirmed in a woman delivering a neonate who was negative for SARS-CoV-2 and related it to a review of the literature on pregnant women and human coronavirus infections.
CASE SUMMARY The patient was a 36-year-old pregnant woman in her third trimester who had developed progressive clinical symptoms when she was confirmed as infected with SARS-CoV-2. Given the potential risks for both the pregnant woman and the fetus, an emergency cesarean section was performed, and the baby and his mother were separately quarantined and cared for. As a result, the baby currently shows no signs of SARS-CoV-2 infection (his lower respiratory tract samples were negative for the virus), while the mother completely recovered from COVID-19.
CONCLUSION Although we presented a single case, the successful result is of great significance for pregnant women with SARS-CoV-2 infection and with respect to fully understanding novel coronavirus pneumonia.
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Affiliation(s)
- Rong-Yue Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Ke-Qiong Zheng
- Department of Obstetrics and Gynecology, The Yueqing People’s Hospital, Wenzhou 325600, Zhejiang Province, China
| | - Bo-Zhong Xu
- Department of Obstetrics and Gynecology, The Yueqing People’s Hospital, Wenzhou 325600, Zhejiang Province, China
| | - Wei Zhang
- Department of Obstetrics and Gynecology, The Yueqing People’s Hospital, Wenzhou 325600, Zhejiang Province, China
| | - Jin-Ge Si
- Department of Obstetrics and Gynecology, The Zhongshan Affiliated Hospital of Sun Yat-Sen University, Zhongshan 528400, Guangdong Province, China
| | - Chong-Yong Xu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Hua Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zhang-Ye Xu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Xin-Mei Wu
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Wang RY, Zheng KQ, Xu BZ, Zhang W, Si JG, Xu CY, Chen H, Xu ZY, Wu XM. Healthy neonate born to a SARS-CoV-2 infected woman: A case report and review of literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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23
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Chu H, Li J, Yan J, Bai T, Schnabl B, Zou L, Yang L, Hou X. Persistent SARS-CoV-2 RNA Positive in Feces but Negative in Breastmilk: A Case Report of COVID-19 in a Breastfeeding Patient. Front Med (Lausanne) 2020; 7:562700. [PMID: 33344466 PMCID: PMC7738631 DOI: 10.3389/fmed.2020.562700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022] Open
Abstract
COVID-19 is a pandemic infectious disease. Whether SARS-CoV-2 was transmitted through breast milk is unknown. Here, we report a breastfeeding woman with COVID-19 presenting with gastrointestinal symptoms and persistent SARS-CoV-2 RNA positivity in both her oropharyngeal swabs and feces, but negativity in her breastmilk. After appearance of serum SARS-CoV-2-IgG, she began to bottle feed her baby with breastmilk without transmission. This report facilitates the understanding of breastfeeding-related risks in COVID-19.
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Affiliation(s)
- Huikuan Chu
- Division of Gastroenterology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Li
- Division of Gastroenterology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Yan
- Division of Gastroenterology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tai Bai
- Division of Gastroenterology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Bernd Schnabl
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Li Zou
- Department of Obstetrics & Gynecology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Yang
- Division of Gastroenterology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohua Hou
- Division of Gastroenterology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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Chen M, Zeng J, Liu X, Sun G, Gao Y, Liao J, Yu J, Luo X, Qi H. Changes in physiology and immune system during pregnancy and coronavirus infection: A review. Eur J Obstet Gynecol Reprod Biol 2020; 255:124-128. [PMID: 33125977 PMCID: PMC7566677 DOI: 10.1016/j.ejogrb.2020.10.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the 3rd epidemic coronavirus after severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Since December 2019, the outbreak of the Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 has aroused great attention around the world. Pregnant women and their fetuses have been concerned as a high-risk population. We explained why pregnant women are susceptible to coronavirus in terms of their adaptive changes in physiology and immune system during pregnancy, and described the associations between maternal clinical symptoms, perinatal outcomes and coronavirus infections.
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Affiliation(s)
- Miaomiao Chen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China; Maternal and Child Health Hospital of Hubei Province, No. 745 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, China
| | - Jing Zeng
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiyao Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Guoqiang Sun
- Maternal and Child Health Hospital of Hubei Province, No. 745 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, China
| | - Ying Gao
- Maternal and Child Health Hospital of Hubei Province, No. 745 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, China
| | - Jiujiang Liao
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jiaxiao Yu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xin Luo
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Hcini N, Maamri F, Picone O, Carod JF, Lambert V, Mathieu M, Carles G, Pomar L. Maternal, fetal and neonatal outcomes of large series of SARS-CoV-2 positive pregnancies in peripartum period: A single-center prospective comparative study. Eur J Obstet Gynecol Reprod Biol 2020; 257:11-18. [PMID: 33310656 PMCID: PMC7705341 DOI: 10.1016/j.ejogrb.2020.11.068] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe the proportions of asymptomatic, mild and severe diseases in infected pregnant women admitted for delivery. To compare maternal, fetal and neonatal outcomes of SARS-CoV-2 infected pregnant women with those of non-infected patients. STUDY DESIGN Through an universal PCR testing for SARS-COV-2 at admission (not symptoms-based), this prospective cohort study enrolled all pregnant women admitted for delivery between 16th of June and the 16th of August 2020 in the West French Guiana Hospital Center. RESULTS 507 pregnant women were included during the study period, of which 137 (27 %) were infected with SARS-COV-2. On admission, only 34/137 (24.8 %) of these patients presented with clinical symptoms. Among asymptomatic women, 16 /103 (15 %) became symptomatic after diagnosis. Throughout the delivery hospitalization and follow-up, 87/137 (63.5 %) remained always asymptomatic, 45/137 (32.8 %) developed a mild COVID-19 and 5/137 (3.6 %) developed a severe infection. SARS-CoV-2 infected patients were more likely to have post-partum hemorrhage >500 mL (14.2 % vs 7.2 %, RR 2.0 [95 %CI 1.1-3.4]), to be transfused (5.5 % vs 1.1 %, RR 4.9 [1.5-16.6]), and to be hospitalized in ICU (3.6 % vs 0.8 %, RR 4.5 [95 %CI 1.1-18.6] than uninfected ones. Intra-uterine fetal demises were more common in infected mothers compared to controls (5.1 % vs 1.1 %, RR 4.7 [95 % CI 1.4-45.9). Among 108 neonates from infected mothers tested at birth, none tested positive (0/108). When tested between 25 and 42 h after delivery, 4/29 (13.7 %) were positive for SARS-CoV-2 RT-PCR on nasopharyngeal swabs and remained asymptomatic. CONCLUSION Pregnant women admitted for delivery and diagnosed with a SARS-COV-2 infection through an universal screening were symptomatic in only a quarter of cases. Their risks of post-partum hemorrhage, transfusion and admission to ICU were higher than those of uninfected patients. They also presented a higher risk of intra-uterine fetal demise. There were no other differences in maternal, obstetrical or neonatal outcomes.
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Affiliation(s)
- Najeh Hcini
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana.
| | - Fatma Maamri
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Olivier Picone
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France. Université de Paris. Inserm IAME-U1137, Paris, France. Groupe de Recherche sur les Infections pendant la grossesse (GRIG)
| | - Jean-Francois Carod
- Department of Biology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Véronique Lambert
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Meredith Mathieu
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Gabriel Carles
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department "Woman-Mother-Child", Lausanne University Hospital, Lausanne, Switzerland
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Rodrigues C, Baía I, Domingues R, Barros H. Pregnancy and Breastfeeding During COVID-19 Pandemic: A Systematic Review of Published Pregnancy Cases. Front Public Health 2020; 8:558144. [PMID: 33330308 PMCID: PMC7719788 DOI: 10.3389/fpubh.2020.558144] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023] Open
Abstract
Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19. Methods: Searches were conducted in PubMed®, Scopus®, Web of Science®, and MedRxiv® up to 26th June 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality. Results: We identified 161 original studies reporting 3,985 cases of pregnant women with COVID-19 (1,007 discharged while pregnant). The 2,059 published cases with pregnancy outcomes resulted in 42 abortions, 21 stillbirths, and 2,015 live births. Preterm birth occurred in 23% of cases. Around 6% of pregnant women required admission to an intensive care unit and 28 died. There were 10 neonatal deaths. From the 163 cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus, 10 were positive. Sixty-one newborns were positive for SARS-CoV-2. Four breast milk samples from 92 cases showed evidence of SARS-CoV-2. Conclusion: Emerging evidence suggests that vertical transmission is possible, however, there is still a limited number of reported cases with intrapartum samples. Information, counseling and adequate monitoring are essential to prevent and manage adverse effects of SARS-CoV-2 infection during pregnancy.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Inês Baía
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Rosa Domingues
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Henrique Barros
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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27
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Gribble K, Marinelli KA, Tomori C, Gross MS. Implications of the COVID-19 Pandemic Response for Breastfeeding, Maternal Caregiving Capacity and Infant Mental Health. J Hum Lact 2020; 36:591-603. [PMID: 32757878 DOI: 10.1177/0890334420949514] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Karleen Gribble
- 89381 School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Kathleen A Marinelli
- 12227 University of Connecticut School of Medicine, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Cecília Tomori
- 15851 Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Marielle S Gross
- 223121 Johns Hopkins Berman Institute of Bioethics, Bloomberg School of Public Health, Baltimore, MD, USA
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28
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Sharps MC, Hayes DJL, Lee S, Zou Z, Brady CA, Almoghrabi Y, Kerby A, Tamber KK, Jones CJ, Adams Waldorf KM, Heazell AEP. A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection. Placenta 2020; 101:13-29. [PMID: 32911234 PMCID: PMC7443324 DOI: 10.1016/j.placenta.2020.08.018] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, was first identified after a cluster of cases in Wuhan, China in December 2019. Whether vertical transmission or placental pathology might occur following maternal infection during pregnancy remains unknown. This review aimed to summarise all studies that examined the placenta or neonates following infection with SARS-CoV-2, or closely related highly pathogenic coronavirus (SARS-CoV-1, or the Middle East respiratory syndrome coronavirus (MERS-CoV)). Structured literature searches found 50 studies that met the inclusion criteria. Twenty studies reported placental histopathology findings in third trimester placentas following maternal SARS-CoV-2 infection. Using the Amsterdam Consensus criteria to categorise the histopathology results, evidence of both fetal vascular malperfusion (35.3% of cases; 95% Confidence Interval (CI) 27.7-43.0%) and maternal vascular malperfusion (46% of cases; 95% CI 38.0-54.0%) were reported, along with evidence of inflammation in the placentas (villitis 8.7% cases, intervillositis 5.3% of cases, chorioamnionitis 6% of cases). The placental pathologies observed in SARS-CoV-2 were consistent with findings following maternal SARS-CoV-1 infection. Of those tested, a minority of neonates (2%) and placental samples tested positive for SARS-CoV-2 infection (21%). Limited conclusions can be drawn about the effect of maternal SARS-CoV-2 infection on placental pathology as most lack control groups and the majority of reports followed third trimester infection. Collaboration to maximise the number of samples examined will increase the reliability and generalisability of findings. A better understanding of the association between maternal SARS-CoV-2 infection and placental pathology will inform maternity care during the coronavirus pandemic.
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MESH Headings
- Betacoronavirus/pathogenicity
- Betacoronavirus/physiology
- COVID-19
- Coronavirus Infections/epidemiology
- Coronavirus Infections/pathology
- Coronavirus Infections/physiopathology
- Coronavirus Infections/transmission
- Female
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Pandemics
- Placenta/blood supply
- Placenta/pathology
- Placenta/virology
- Placental Circulation/physiology
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/pathology
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/transmission
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/pathology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/virology
- Severe acute respiratory syndrome-related coronavirus/pathogenicity
- Severe acute respiratory syndrome-related coronavirus/physiology
- SARS-CoV-2
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Affiliation(s)
- Megan C Sharps
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK.
| | - Dexter J L Hayes
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK
| | - Stacey Lee
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK; Division of Pharmacy and Optometry, Faculty of Biology, Medicine & Health, University of Manchester, UK
| | - Zhiyong Zou
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK
| | - Chloe A Brady
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK
| | - Yousef Almoghrabi
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK
| | - Alan Kerby
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK
| | - Kajal K Tamber
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK
| | - Carolyn J Jones
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK
| | | | - Alexander E P Heazell
- Tommy's Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine & Health, 5th Floor St. Mary's Hospital, University of Manchester, Manchester, UK; St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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29
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Rodríguez-Blanco N, Vegara-Lopez I, Aleo-Giner L, Tuells J. [Scoping review of coronavirus case series (SARS-CoV, MERS-CoV and SARS-CoV-2) and their obstetric and neonatal results]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:313-326. [PMID: 32683837 PMCID: PMC7528416 DOI: 10.37201/req/064.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The appearance of new infectious diseases, such as COVID-19, poses a challenge in monitoring pregnancy and preventing obstetric and neonatal complications. A scoping review has the objective to review the information available in pregnant women infected with the MERS-CoV, SARSCoV, SARS-CoV-2 coronaviruses to assess the similarities in terms of and differences in the clinical characteristics of the mothers and neonatal outcomes. METHODS We carried out a bibliographic search (scoping review) according to the PRISMA guidelines between March and April 2020 in the MEDLINE, SciELO, and CUIDEN databases and the Elsevier COVID-19 Information Center. RESULTS We analyzed 20 articles with a total of 102 cases. 9 of MERS-CoV, 14 of SARS-CoV and 79 of SARS-CoV-2. Fever (75.5%) and pneumonia (73.5%) were the most frequent symptoms in infected pregnant women. The most frequent obstetric complications were the threat of premature delivery (23.5%) and caesarean section (74.5%). No vertical transmission was documented in any of the infants. CONCLUSIONS All three coronaviruses produce pneumonia with very similar symptoms, being milder in the case of SARSCoV2. Despite documented obstetric complications, neonatal outcomes are mostly favorable. Increased knowledge is needed to improve and prevent obstetric and neonatal complications from these infections in pregnant women.
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Affiliation(s)
- N Rodríguez-Blanco
- Noelia Rodriguez-Blanco, Departamento de Ciencias Biomédicas. Universidad CEU Cardenal Herrera. Plaza Reyes Católicos nª19. 03204. Elche (Alicante) Spain.
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30
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Lackey KA, Pace RM, Williams JE, Bode L, Donovan SM, Järvinen KM, Seppo AE, Raiten DJ, Meehan CL, McGuire MA, McGuire MK. SARS-CoV-2 and human milk: What is the evidence? MATERNAL & CHILD NUTRITION 2020; 16:e13032. [PMID: 32472745 PMCID: PMC7300480 DOI: 10.1111/mcn.13032] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022]
Abstract
The novel coronavirus SARS-CoV-2 has emerged as one of the most compelling and concerning public health challenges of our time. To address the myriad issues generated by this pandemic, an interdisciplinary breadth of research, clinical and public health communities has rapidly engaged to collectively find answers and solutions. One area of active inquiry is understanding the mode(s) of SARS-CoV-2 transmission. Although respiratory droplets are a known mechanism of transmission, other mechanisms are likely. Of particular importance to global health is the possibility of vertical transmission from infected mothers to infants through breastfeeding or consumption of human milk. However, there is limited published literature related to vertical transmission of any human coronaviruses (including SARS-CoV-2) via human milk and/or breastfeeding. Results of the literature search reported here (finalized on 17 April 2020) revealed a single study providing some evidence of vertical transmission of human coronavirus 229E; a single study evaluating presence of SARS-CoV in human milk (it was negative); and no published data on MERS-CoV and human milk. We identified 13 studies reporting human milk tested for SARS-CoV-2; one study (a non-peer-reviewed preprint) detected the virus in one milk sample, and another study detected SARS-CoV-2 specific IgG in milk. Importantly, none of the studies on coronaviruses and human milk report validation of their collection and analytical methods for use in human milk. These reports are evaluated here, and their implications related to the possibility of vertical transmission of coronaviruses (in particular, SARS-CoV-2) during breastfeeding are discussed.
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Affiliation(s)
- Kimberly A. Lackey
- Margaret Ritchie School of Family and Consumer SciencesUniversity of IdahoMoscowIdahoUSA
| | - Ryan M. Pace
- Margaret Ritchie School of Family and Consumer SciencesUniversity of IdahoMoscowIdahoUSA
| | - Janet E. Williams
- Department of Animal and Veterinary SciencesUniversity of IdahoMoscowIdahoUSA
| | - Lars Bode
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence (MOMI CORE)University of CaliforniaSan DiegoCaliforniaUSA
| | - Sharon M. Donovan
- Department of Food Science and Human Nutrition and Institute of Genomic BiologyUniversity of IllinoisUrbanaIllinoisUSA
| | - Kirsi M. Järvinen
- Department of Pediatrics, Division of Allergy and ImmunologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Antti E. Seppo
- Department of Pediatrics, Division of Allergy and ImmunologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Daniel J. Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Courtney L. Meehan
- Department of AnthropologyWashington State UniversityPullmanWashingtonUSA
| | - Mark A. McGuire
- Department of Animal and Veterinary SciencesUniversity of IdahoMoscowIdahoUSA
| | - Michelle K. McGuire
- Margaret Ritchie School of Family and Consumer SciencesUniversity of IdahoMoscowIdahoUSA
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31
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Diriba K, Awulachew E, Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. Eur J Med Res 2020; 25:39. [PMID: 32887660 PMCID: PMC7471638 DOI: 10.1186/s40001-020-00439-w] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Coronavirus is challenging the global health care system from time to time. The pregnant state, with alterations in hormone levels and decreased lung volumes due to a gravid uterus and slightly immunocompromised state may predispose patients to a more rapidly deteriorating clinical course and can get a greater risk of harm for both the mother and fetus. Therefore, this systematic review was aimed to assess the effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and its possibility of vertical maternal-fetal transmission. METHODS A systematic search was conducted on PubMed, Web of Science, Embase, Google Scholar and the Cochrane Library until the end of April. All authors independently extracted all necessary data using excel spreadsheet form. Only published articles with fully accessible data on pregnant women infected with SARS-CoV, MARS-CoV, and SARS-CoV-2 were included. Data on clinical manifestations, maternal and perinatal outcomes were extracted and analyzed. RESULT Out of 879 articles reviewed, 39 studies involving 1316 pregnant women were included. The most common clinical features were fever, cough, and myalgia with prevalence ranging from 30 to 97%, while lymphocytopenia and C-reactive protein were the most common abnormal laboratory findings (55-100%). Pneumonia was the most diagnosed clinical symptom of COVID-19 and non-COVID-19 infection with prevalence ranged from 71 to 89%. Bilateral pneumonia (57.9%) and ground-glass opacity (65.8%) were the most common CT imaging reported. The most common treatment options used were hydroxychloroquine (79.7%), ribavirin (65.2%), and oxygen therapy (78.8%). Regarding maternal outcome, the rate of preterm birth < 37 weeks of gestation was 14.3%, preeclampsia (5.9%), miscarriage (14.5%, preterm premature rupture of membranes (9.2%) and fetal growth restriction (2.8%). From the total coronavirus infected pregnant women, 56.9% delivered by cesarean, 31.3% admitted to ICU, while 2.7% were died. Among the perinatal outcomes, fetal distress rated (26.5%), neonatal asphyxia rated (1.4%). Only, 1.2% of neonates had apgar score < 7 at 5 min. Neonate admitted to ICU was rated 11.3%, while the rate of perinatal death was 2.2%. In the current review, none of the studies reported transmission of CoV from the mother to the fetus in utero during the study period. CONCLUSION Coronavirus infection is more likely to affect pregnant women. Respiratory infectious diseases have demonstrated an increased risk of adverse maternal obstetrical complications than the general population due to physiological changes occurred during pregnancy. None of the studies reported transmission of CoV from the mother to the fetus in utero, which may be due to a very low expression of angiotensin-converting enzyme-2 in early maternal-fetal interface cells.
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Affiliation(s)
- Kuma Diriba
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Ephrem Awulachew
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Eyob Getu
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
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32
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AlQahtani MA, AlDajani SM. A systemic review of vertical transmission possibility in pregnant women with coronavirus disease 2019-positive status. J Family Med Prim Care 2020; 9:4521-4525. [PMID: 33209756 PMCID: PMC7652163 DOI: 10.4103/jfmpc.jfmpc_475_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/27/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
An unknown pneumonia outbreak has been reported by hospitals in Wuhan, China, in late December 2019. A public health emergency of international concern announced by the World Health Organization (WHO) on the January 31, 2020. The virus named by the WHO as coronavirus disease 2019 (COVID-19). The cases reached (266,073 cases) and deaths (11,184 deaths) globally by the end of March 21, 2020, and considered as a pandemic. By a systemic review, articles and case reports revealed 74 pregnant women for the possibility of vertical transmission of the virus from COVID-19-infected mother to infant. Review also showed that there is no difference between pregnant and nonpregnant regarding clinical manifestations. Concerning the vertical transmission, none of the positive mothers had a positive infant with COVID-19 except 1 case report that showed the infant had positive COVID-19 by the throat swab, yet negative cord blood, placenta, and mother's breast milk.
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Affiliation(s)
- Moath A. AlQahtani
- College of Medicine Department, AlMaarefa University, Riyadh, Saudi Arabia
| | - Sultan M. AlDajani
- College of Medicine Department, AlMaarefa University, Riyadh, Saudi Arabia
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33
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Wenling Y, Junchao Q, Xiao Z, Ouyang S. Pregnancy and COVID-19: management and challenges. Rev Inst Med Trop Sao Paulo 2020; 62:e62. [PMID: 32876296 PMCID: PMC7458076 DOI: 10.1590/s1678-9946202062062] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
The consequences of COVID-19 infecting pregnant women and the potential risks of vertical transmission have become a major issue. Since little is currently known about COVID-19 in pregnancy, the understanding of COVID-19 in this particular group will be updated in time, and a comprehensive review will be useful to evaluate the impact of COVID-19 in pregnancy. Based on recently published literature and official documents, this review provides an introduction to the pathogenesis, pathology, and clinical features of COVID-19 and has focused on the current researches on clinical features, pregnancy outcomes and placental histopathological analysis from pregnant women infected with SARS-CoV-2 in comparison with SARS-CoV and MERS-CoV. These viruses trigger a cytokine storm in the body, produce a series of immune responses, and cause changes in peripheral leukocytes and immune system cells leading to pregnancy complications that may be associated with viral infections. The expression of ACE2 receptors in the vascular endothelium may explain the histological changes of placentas from pregnant women infected by SARS-CoV-2. Pregnant women with COVID-19 pneumonia show similar clinical characteristics compared with non-pregnant counterparts. Although there is no unequivocal evidence to support the fetal infection by intrauterine vertical transmission of SARS, MERS and SARS-CoV-2 so far, more and more articles began to report maternal deaths due to COVID-19. In particular, from February 26, 2020 (date of the first COVID-19 case reported in Brazil) until June 18, 2020, Brazil reported 124 maternal deaths. Therefore, pregnant women and neonates require special attention regarding the prevention, diagnosis and management of COVID-19.
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Affiliation(s)
- Yao Wenling
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Qiu Junchao
- Department of Obstetrics, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhirong Xiao
- Department of Obstetrics, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shi Ouyang
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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34
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Galang RR, Chang K, Strid P, Snead MC, Woodworth KR, House LD, Perez M, Barfield WD, Meaney-Delman D, Jamieson DJ, Shapiro-Mendoza CK, Ellington SR. Severe Coronavirus Infections in Pregnancy: A Systematic Review. Obstet Gynecol 2020; 136:262-272. [PMID: 32544146 PMCID: PMC7942856 DOI: 10.1097/aog.0000000000004011] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To inform the current coronavirus disease 2019 (COVID-19) outbreak, we conducted a systematic literature review of case reports of Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, during pregnancy and summarized clinical presentation, course of illness, and pregnancy and neonatal outcomes. DATA SOURCES We searched MEDLINE and ClinicalTrials.gov from inception to April 23, 2020. METHODS OF STUDY SELECTION We included articles reporting case-level data on MERS-CoV, SARS-CoV, and SARS-CoV-2 infection in pregnant women. Course of illness, indicators of severe illness, maternal health outcomes, and pregnancy outcomes were abstracted from included articles. TABULATION, INTEGRATION, AND RESULTS We identified 1,328 unique articles, and 1,253 articles were excluded by title and abstract review. We completed full-text review on 75, and 29 articles were excluded by full-text review. Among 46 publications reporting case-level data, eight described 12 cases of MERS-CoV infection, seven described 17 cases of SARS-CoV infection, and 31 described 98 cases of SARS-CoV-2 infection. Clinical presentation and course of illness ranged from asymptomatic to severe fatal disease, similar to the general population of patients. Severe morbidity and mortality among women with MERS-CoV, SARS-CoV, or SARS-CoV-2 infection in pregnancy and adverse pregnancy outcomes, including pregnancy loss, preterm delivery, and laboratory evidence of vertical transmission, were reported. CONCLUSION Understanding whether pregnant women may be at risk for adverse maternal and neonatal outcomes from severe coronavirus infections is imperative. Data from case reports of SARS-CoV, MERS-CoV, and SAR-CoV-2 infections during pregnancy are limited, but they may guide early public health actions and clinical decision-making for COVID-19 until more rigorous and systematically collected data are available. The capture of critical data is needed to better define how this infection affects pregnant women and neonates. This review was not registered with PROSPERO.
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Affiliation(s)
- Romeo R Galang
- Division of Reproductive Health and the Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, and the Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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35
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Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, Kouretas D, Spandidos DA, Tsatsakis A. Obesity ‑ a risk factor for increased COVID‑19 prevalence, severity and lethality (Review). Mol Med Rep 2020; 22:9-19. [PMID: 32377709 PMCID: PMC7248467 DOI: 10.3892/mmr.2020.11127] [Citation(s) in RCA: 230] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Coronaviruses (CoVs), enveloped positive-sense RNA viruses, are a group of viruses that cause infections in the human respiratory tract, which can be characterized clinically from mild to fatal. The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is the virus responsible. The global spread of COVID‑19 can be described as the worst pandemic in humanity in the last century. To date, COVID‑19 has infected more than 3,000,000 people worldwide and killed more than 200,000 people. All age groups can be infected from the virus, but more serious symptoms that can possibly result in death are observed in older people and those with underlying medical conditions such as cardiovascular and pulmonary disease. Novel data report more severe symptoms and even a negative prognosis for the obese patients. A growing body of evidence connects obesity with COVID‑19 and a number of mechanisms from immune system activity attenuation to chronic inflammation are implicated. Lipid peroxidation creates reactive lipid aldehydes which in a patient with metabolic disorder and COVID‑19 will affect its prognosis. Finally, pregnancy‑associated obesity needs to be studied further in connection to COVID‑19 as this infection could pose high risk both to pregnant women and the fetus.
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Affiliation(s)
- Demetrios Petrakis
- Laboratory of Toxicology, Medical School, University of Crete, 71409 Heraklion, Greece
| | - Denisa Margină
- ‘Carol Davila’ University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Biochemistry, 020956 Bucharest, Romania
| | | | - Fotios Tekos
- Department of Biochemistry-Biotechnology, University of Thessaly, 41500 Larissa, Greece
| | - Miriana Stan
- ‘Carol Davila’ University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Toxicology, 020956 Bucharest, Romania
| | - Dragana Nikitovic
- Laboratory of Histology-Embryology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios Kouretas
- Department of Biochemistry-Biotechnology, University of Thessaly, 41500 Larissa, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71110 Heraklion, Greece
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, 71409 Heraklion, Greece
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36
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Gulati A, Pomeranz C, Qamar Z, Thomas S, Frisch D, George G, Summer R, DeSimone J, Sundaram B. A Comprehensive Review of Manifestations of Novel Coronaviruses in the Context of Deadly COVID-19 Global Pandemic. Am J Med Sci 2020; 360:5-34. [PMID: 32620220 PMCID: PMC7212949 DOI: 10.1016/j.amjms.2020.05.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
Since December 2019, the global pandemic caused by the highly infectious novel coronavirus 2019-nCoV (COVID-19) has been rapidly spreading. As of April 2020, the outbreak has spread to over 210 countries, with over 2,400,000 confirmed cases and over 170,000 deaths.1 COVID-19 causes a severe pneumonia characterized by fever, cough and shortness of breath. Similar coronavirus outbreaks have occurred in the past causing severe pneumonia like COVID-19, most recently, severe acute respiratory syndrome coronavirus (SARS-CoV) and middle east respiratory syndrome coronavirus (MERS-CoV). However, over time, SARS-CoV and MERS-CoV were shown to cause extrapulmonary signs and symptoms including hepatitis, acute renal failure, encephalitis, myositis and gastroenteritis. Similarly, sporadic reports of COVID-19 related extrapulmonary manifestations emerge. Unfortunately, there is no comprehensive summary of the multiorgan manifestations of COVID-19, making it difficult for clinicians to quickly educate themselves about this highly contagious and deadly pathogen. What is more, is that SARS-CoV and MERS-CoV are the closest humanity has come to combating something similar to COVID-19, however, there exists no comparison between the manifestations of any of these novel coronaviruses. In this review, we summarize the current knowledge of the manifestations of the novel coronaviruses SARS-CoV, MERS-CoV and COVID-19, with a particular focus on the latter, and highlight their differences and similarities.
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Affiliation(s)
| | | | | | | | | | - Gautam George
- Departments of Medicine; Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ross Summer
- Departments of Medicine; Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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de Souza Silva GA, da Silva SP, da Costa MAS, da Silva AR, de Vasconcelos Alves RR, Ângelo Mendes Tenório FDC, da Silva Melo AR, de Freitas AC, Lagos de Melo CM. SARS-CoV, MERS-CoV and SARS-CoV-2 infections in pregnancy and fetal development. J Gynecol Obstet Hum Reprod 2020; 49:101846. [PMID: 32599304 PMCID: PMC7319644 DOI: 10.1016/j.jogoh.2020.101846] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Abstract
Recently, in China, in 2019, a new type of disease has arisen caused by a new strain of coronavirus, the SARS-CoV-2 virus, considered extremely worrying due to its high infectivity power and the easy ability to spread geographically. For patients in general, the clinical features resulting from respiratory syndromes can trigger an asymptomatic condition. However, 25 % of patients infected by SARS-CoV-2 can progress to severity. Pregnant women are an unknown field in this complex process, and although they have symptoms similar to non-pregnant women, some points should be considered, such as complications during pregnancy and postpartum. Thus, the aim of this study was to understand the consequences of pregnancy and fetal development, caused by infections by the SARS-CoV, MERS-CoV and SARS-CoV-2 viruses. Among the aforementioned infections, MERS-CoV seems to be the most dangerous for newborns, inducing high blood pressure, pre-eclampsia, pneumonia, acute renal failure, and multiple organ failure in mother. This also causes a higher occurrence of emergency cesarean deliveries and premature births, in addition, some deaths of mothers and fetuses were recorded. Meanwhile, SARS-CoV and SARS-CoV-2 appear to have less severe symptoms. Furthermore, although a study found the ACE2 receptor, used by SARS-CoV-2, widely distributed in specific cell types of the maternal-fetal interface, there is no evidence of vertical transmission for any of the coronaviruses. Thus, the limited reported obstetric cases alert to the need for advanced life support for pregnant women infected with coronaviruses and to the need for further investigation for application in clinical practice.
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Affiliation(s)
- Guilherme Antonio de Souza Silva
- Laboratory of Immunological and Antitumor Analysis, Department of Antibiotics, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Suéllen Pedrosa da Silva
- Laboratory of Protein Biochemistry, Department of Biochemistry, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Marcos Aurélio Santos da Costa
- Laboratory of Histology, Department of Histology and Embryology, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Abdênego Rodrigues da Silva
- Laboratory of Protein Biochemistry, Department of Biochemistry, Bioscience Center, Federal University of Pernambuco, Brazil.
| | | | | | - Alanne Rayssa da Silva Melo
- Laboratory of Molecular Studies and Experimental Therapy, Department of Genetics, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Antonio Carlos de Freitas
- Laboratory of Molecular Studies and Experimental Therapy, Department of Genetics, Bioscience Center, Federal University of Pernambuco, Brazil.
| | - Cristiane Moutinho Lagos de Melo
- Laboratory of Immunological and Antitumor Analysis, Department of Antibiotics, Bioscience Center, Federal University of Pernambuco, Brazil.
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Li Y, Zhao R, Zheng S, Chen X, Wang J, Sheng X, Zhou J, Cai H, Fang Q, Yu F, Fan J, Xu K, Chen Y, Sheng J. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerg Infect Dis 2020; 26:1335-1336. [PMID: 32134381 PMCID: PMC7258467 DOI: 10.3201/eid2606.200287] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A woman with coronavirus disease in her 35th week of pregnancy delivered an infant by cesarean section in a negative-pressure operating room. The infant was negative for severe acute respiratory coronavirus 2. This case suggests that mother-to-child transmission is unlikely for this virus.
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Forestieri S, Marcialis MA, Migliore L, Panisi C, Fanos V. Relationship between pregnancy and coronavirus: what we know. J Matern Fetal Neonatal Med 2020; 35:1997-2008. [PMID: 32498581 DOI: 10.1080/14767058.2020.1771692] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The identification in China in December 2019 of a new coronavirus (SARS-CoV-2) immediately rekindled the spotlight on a problem also addressed in the past during the epidemics of SARS in 2002-2003 and MERS in 2012: the implications of a possible infection during pregnancy, both for pregnant women and for fetuses and infants. Pregnancy is characterized by some changes involving both the immune system and the pulmonary physiology, exposing the pregnant woman to a greater susceptibility to viral infections and more serious complications. The objective of this review is therefore to analyze the relationship between pregnancy and known coronaviruses, with particular reference to SARS-CoV-2.
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Affiliation(s)
| | | | - Lucia Migliore
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | | | - Vassilios Fanos
- Neonatal Intensive Care Unit, AOU Cagliari, Cagliari, Italy.,Department of Surgery, University of Cagliari, Cagliari, Italy
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Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, Choolani M, Mattar C, Su LL. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020; 222:521-531. [PMID: 32217113 PMCID: PMC7270569 DOI: 10.1016/j.ajog.2020.03.021] [Citation(s) in RCA: 669] [Impact Index Per Article: 133.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2-2.5, indicating that 2-3 persons will be infected from an index patient. A serious public health emergency, it is particularly deadly in vulnerable populations and communities in which healthcare providers are insufficiently prepared to manage the infection. As of March 16, 2020, there are more than 180,000 confirmed cases of COVID-19 worldwide, with more than 7000 related deaths. The SARS-CoV-2 virus has been isolated from asymptomatic individuals, and affected patients continue to be infectious 2 weeks after cessation of symptoms. The substantial morbidity and socioeconomic impact have necessitated drastic measures across all continents, including nationwide lockdowns and border closures. Pregnant women and their fetuses represent a high-risk population during infectious disease outbreaks. To date, the outcomes of 55 pregnant women infected with COVID-19 and 46 neonates have been reported in the literature, with no definite evidence of vertical transmission. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory failure in the gravida. Furthermore, the pregnancy bias toward T-helper 2 (Th2) system dominance, which protects the fetus, leaves the mother vulnerable to viral infections, which are more effectively contained by the Th1 system. These unique challenges mandate an integrated approach to pregnancies affected by SARS-CoV-2. Here we present a review of COVID-19 in pregnancy, bringing together the various factors integral to the understanding of pathophysiology and susceptibility, diagnostic challenges with real-time reverse transcription polymerase chain reaction (RT-PCR) assays, therapeutic controversies, intrauterine transmission, and maternal-fetal complications. We discuss the latest options in antiviral therapy and vaccine development, including the novel use of chloroquine in the management of COVID-19. Fetal surveillance, in view of the predisposition to growth restriction and special considerations during labor and delivery, is addressed. In addition, we focus on keeping frontline obstetric care providers safe while continuing to provide essential services. Our clinical service model is built around the principles of workplace segregation, responsible social distancing, containment of cross-infection to healthcare providers, judicious use of personal protective equipment, and telemedicine. Our aim is to share a framework that can be adopted by tertiary maternity units managing pregnant women in the flux of a pandemic while maintaining the safety of the patient and healthcare provider at its core.
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Affiliation(s)
- Pradip Dashraath
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore,Corresponding author: Pradip Dashraath, MBBS, MRCOG
| | | | - Mei Xian Karen Lim
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Li Min Lim
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Sarah Li
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore
| | - Arijit Biswas
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Citra Mattar
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Durankuş F, Aksu E. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study. J Matern Fetal Neonatal Med 2020; 35:205-211. [PMID: 32419558 DOI: 10.1080/14767058.2020.1763946] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: The 2019 coronavirus disease (COVID-19) outbreak that began in China has turned into a pandemic that threatens global health, thereby prompting the concentration of studies and clinical routines on treating and preventing the disease. However, research on the psychological effects of the pandemic on the general population, particularly pregnant women, is lacking. Accordingly, the present study investigated the effects of the COVID-19 pandemic on depression and anxiety in pregnant women.Study design: An anonymous survey for assessing depression and anxiety in pregnant women was designed, after which a link to the online questionnaire was sent to the participants, who were being treated in a private medical center. One of the researchers followed up with the respondents, among whom 260 returned their questionnaires.Results: Among the respondents, 35.4% (n = 92, case group) obtained scores higher than 13 on the Edinburgh Postpartum Depression Scale (EPDS). The comparison of the groups by years of education indicated statistically significant effects of COVID-19 on psychology, social isolation, and mean scores in the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). These effects were more severe in the case group than in the control group (psychology: 8.369 ± 2.003, social isolation: 8.000 ± 2.507, mean BDI and BAI scores: 20.565 ± 6.605 and 22.087 ± 8.689, respectively). A regression analysis revealed that the BDI scores and the disease's psychological effects, as well as the BAI scores and the illness's social isolation effects, exerted a statistically significant influence on the EPDS scores of the participants.Conclusion: This study illustrated the effects of the COVID-19 pandemic on the depression and anxiety levels of pregnant women. Our results point to an urgent need to provide psychosocial support to this population during the crisis. Otherwise, adverse events may occur during pregnancy and thus affect both mother and fetus.
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Affiliation(s)
- Ferit Durankuş
- Department of Pediatrics, Istanbul Medeniyet University, İstanbul, Turkey
| | - Erson Aksu
- Department of Gynecology and Obstetrics, Vatan Hospital, Rumeli University, Tekirdağ, Turkey
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Furlan MCR, Jurado SR, Uliana CH, Silva MEP, Nagata LA, Maia ACF. Revisión sistemática del embarazo y la infección por coronavirus: resultados maternos, fetales y neonatales. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.1211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introducción: Se sabe poco sobre los efectos del síndrome respiratorio agudo grave (SARS-CoV) durante el embarazo. El objetivo de este estudio es describir los resultados clínicos durante el embarazo en mujeres con SARS-CoV-1 y SARS-CoV-2 y su repercusión en la salud del feto y el recién nacido. Materiales y métodos: Revisión sistemática realizada en los motores de búsqueda del Portal de Periódicos de CAPES, Google Académico, LILACS y PubMed. Resultados: Se seleccionaron 27 artículos científicos. La tasa de mortalidad fue mayor en las mujeres embarazadas con el SARS-CoV-1 que en las que tenían el SARS-CoV-2. Los síntomas más comunes informados por las mujeres embarazadas con COVID-19 fueron fiebre y tos. La mayoría de las pruebas de SARS-CoV-1 y SARS-CoV-2 resultaron negativas en recién nacidos de madres infectadas. Ambos tipos de infecciones causaron retraso del crecimiento intrauterino y problemas respiratorios en recién nacidos. Discusión: La infección por SARS-CoV-1 y SARS-CoV-2 comparten características clínicas comunes como fiebre, tos seca, disnea, neumonía e ingreso a la Unidad de Cuidados Intensivos (UCI) para ventilación mecánica. Aunque en la literatura no se señala la transmisión vertical del coronavirus, se encontraron niveles de IgM en las muestras de sangre de los neonatos de las madres que tuvieron el SARS-CoV-2 durante el embarazo. Conclusiones: Es necesario realizar más estudios para comprender mejor los resultados clínicos maternos, fetales y neonatales del SARS-CoV-2 durante la gestación a fin de contribuir a las decisiones terapéuticas y de precaución sobre la infección
Como citar este articulo: Furlan, Mara Cristina Ribeiro; Jurado, Sonia Regina; Uliana, Catchia Hermes; Silva, Maria Eduarda Pascoaloto; Nagata, Letícia Akie; Maia, Anna Clara Freitas. Gravidez e infecção por coronavírus: desfechos maternos, fetais e neonatais – Revisão sistemática. Revista Cuidarte. 2020; 11(2): e1211. http://dx.doi.org/10.15649/cuidarte.1211
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Abstract
The recently emerged novel coronavirus pneumonia, named the coronavirus disease 2019 (COVID-19), shares several clinical characteristics with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and spread rapidly throughout China in December of 2019 (Huang et al., 2020). The pathogen 2019 novel coronavirus (2019-nCoV) is now named SARS coronavirus 2 (SARS-CoV-2) and is highly infectious. As of Apr. 9, 2020, over 80 000 confirmed cases had been reported, with an estimated mortality rate of 4.0% (Chinese Center for Disease Control and Prevention, 2020). Person-to-person transmission and familial clustering have been reported (Chan et al., 2020; Nishiura et al., 2020; Phan et al., 2020). However, there is no evidence of fetal intrauterine infection in pregnant women who have been infected with SARS-CoV-2 in their third trimester (Chen et al., 2020). It is unclear whether breastfeeding transmits the virus from previously infected and recovered mothers to their babies. Here we report the clinical course of a pregnant woman with COVID-19. In order to determine whether SARS-CoV-2 can be transmitted to newborns through breastfeeding, we measured viral RNA in the patient’s breastmilk samples at different time points after delivery.
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Affiliation(s)
- Guan-Jing Lang
- Department of Infectious Diseases, State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong Zhao
- Department of Infectious Diseases, State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Peyronnet V, Sibiude J, Deruelle P, Huissoud C, Lescure X, Lucet JC, Mandelbrot L, Nisand I, Vayssière C, Yazpandanah Y, Luton D, Picone O. [SARS-CoV-2 infection during pregnancy. Information and proposal of management care. CNGOF]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:436-443. [PMID: 32199996 PMCID: PMC7186548 DOI: 10.1016/j.gofs.2020.03.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 02/07/2023]
Abstract
A new coronavirus (SARS-CoV-2) highlighted at the end of 2019 in China is spreading across all continents. Most often at the origin of a mild infectious syndrome, associating mild symptoms (fever, cough, myalgia, headache and possible digestive disorders) to different degrees, SARS-Covid-2 can cause serious pulmonary pathologies and sometimes death. Data on the consequences during pregnancy are limited. The first Chinese data published seem to show that the symptoms in pregnant women are the same as those of the general population. There are no cases of intrauterine maternal-fetal transmission, but cases of newborns infected early suggest that there could be vertical perpartum or neonatal transmission. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. Pregnancy is known as a period at higher risk for the consequences of respiratory infections, as for influenza, so it seems important to screen for Covid-19 in the presence of symptoms and to monitor closely pregnant women. In this context of the SARS-Covid-2 epidemic, the societies of gynecology-obstetrics, infectious diseases and neonatalogy have proposed a French protocol for the management of possible and proven cases of SARS-Covid-2 in pregnant women. These proposals may evolve on a daily basis with the advancement of the epidemic and knowledge in pregnant women. Subsequently, an in-depth analysis of cases in pregnant women will be necessary in order to improve knowledge on the subject.
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Affiliation(s)
- V Peyronnet
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - J Sibiude
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - P Deruelle
- CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Service de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - C Huissoud
- University Lyon, University Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France; Inserm U846, stem cell and brain research institute, 18, avenue Doyen-Lepine, 69500 Bron, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - X Lescure
- Inserm IAME-U1137, 75000 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat Claude-Bernard, université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - J-C Lucet
- Inserm IAME-U1137, 75000 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - L Mandelbrot
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - I Nisand
- CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - C Vayssière
- Hôpital Paule-de-Viguier, CHU de Toulouse, 31000 Toulouse, France; Équipe SPHERE, Inserm UMR1027, université Toulouse III, 31000 Toulouse, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - Y Yazpandanah
- Inserm IAME-U1137, 75000 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat Claude-Bernard, université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - D Luton
- Service de gynécologie obstétrique, maternité Aline-de-Crepy, FHU Prematurity INSERM U1016, hôpital Bichat APHP, université de Paris, Institut Imagine, 75018 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - O Picone
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France.
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Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020; 222:415-426. [PMID: 32105680 PMCID: PMC7093856 DOI: 10.1016/j.ajog.2020.02.017] [Citation(s) in RCA: 621] [Impact Index Per Article: 124.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022]
Abstract
Coronavirus disease 2019 is an emerging disease with a rapid increase in cases and deaths since its first identification in Wuhan, China, in December 2019. Limited data are available about coronavirus disease 2019 during pregnancy; however, information on illnesses associated with other highly pathogenic coronaviruses (ie, severe acute respiratory syndrome and the Middle East respiratory syndrome) might provide insights into coronavirus disease 2019's effects during pregnancy. Coronaviruses cause illness ranging in severity from the common cold to severe respiratory illness and death. Currently the primary epidemiologic risk factors for coronavirus disease 2019 include travel from mainland China (especially Hubei Province) or close contact with infected individuals within 14 days of symptom onset. Data suggest an incubation period of ∼5 days (range, 2-14 days). Average age of hospitalized patients has been 49-56 years, with a third to half with an underlying illness. Children have been rarely reported. Men were more frequent among hospitalized cases (54-73%). Frequent manifestations include fever, cough, myalgia, headache, and diarrhea. Abnormal testing includes abnormalities on chest radiographic imaging, lymphopenia, leukopenia, and thrombocytopenia. Initial reports suggest that acute respiratory distress syndrome develops in 17-29% of hospitalized patients. Overall case fatality rate appears to be ∼1%; however, early data may overestimate this rate. In 2 reports describing 18 pregnancies with coronavirus disease 2019, all were infected in the third trimester, and clinical findings were similar to those in nonpregnant adults. Fetal distress and preterm delivery were seen in some cases. All but 2 pregnancies were cesarean deliveries and no evidence of in utero transmission was seen. Data on severe acute respiratory syndrome and Middle East respiratory syndrome in pregnancy are sparse. For severe acute respiratory syndrome, the largest series of 12 pregnancies had a case-fatality rate of 25%. Complications included acute respiratory distress syndrome in 4, disseminated intravascular coagulopathy in 3, renal failure in 3, secondary bacterial pneumonia in 2, and sepsis in 2 patients. Mechanical ventilation was 3 times more likely among pregnant compared with nonpregnant women. Among 7 first-trimester infections, 4 ended in spontaneous abortion. Four of 5 women with severe acute respiratory syndrome after 24 weeks' gestation delivered preterm. For Middle East respiratory syndrome, there were 13 case reports in pregnant women, of which 2 were asymptomatic, identified as part of a contact investigation; 3 patients (23%) died. Two pregnancies ended in fetal demise and 2 were born preterm. No evidence of in utero transmission was seen in severe acute respiratory syndrome or Middle East respiratory syndrome. Currently no coronavirus-specific treatments have been approved by the US Food and Drug Administration. Because coronavirus disease 2019 might increase the risk for pregnancy complications, management should optimally be in a health care facility with close maternal and fetal monitoring. Principles of management of coronavirus disease 2019 in pregnancy include early isolation, aggressive infection control procedures, oxygen therapy, avoidance of fluid overload, consideration of empiric antibiotics (secondary to bacterial infection risk), laboratory testing for the virus and coinfection, fetal and uterine contraction monitoring, early mechanical ventilation for progressive respiratory failure, individualized delivery planning, and a team-based approach with multispecialty consultations. Information on coronavirus disease 2019 is increasing rapidly. Clinicians should continue to follow the Centers for Disease Control and Prevention website to stay up to date with the latest information (https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html).
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MESH Headings
- Betacoronavirus
- COVID-19
- Coronavirus
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Disease Outbreaks
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Pandemics/prevention & control
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Complications, Infectious/virology
- Pregnancy Outcome
- Premature Birth
- SARS-CoV-2
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Affiliation(s)
- Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL; Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL.
| | - John C Smulian
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - John A Lednicky
- Department of Environmental and Global Health, University of Florida College of Public Health and Health Professions, and University of Florida Emerging Pathogens Institute, Gainesville, FL
| | - Tony S Wen
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, Vecchiet J, Nappi L, Scambia G, Berghella V, D'Antonio F. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020; 2:100107. [PMID: 32292902 PMCID: PMC7104131 DOI: 10.1016/j.ajogmf.2020.100107] [Citation(s) in RCA: 664] [Impact Index Per Article: 132.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this systematic review was to report pregnancy and perinatal outcomes of coronavirus spectrum infections, and particularly coronavirus 2019 (COVID-19) disease because of severe acute respiratory syndrome-coronavirus-2 infection during pregnancy. DATA SOURCES Medline, Embase, Cinahl, and Clinicaltrials.gov databases were searched electronically utilizing combinations of word variants for coronavirus or severe acute respiratory syndrome or SARS or Middle East respiratory syndrome or MERS or COVID-19 and pregnancy. The search and selection criteria were restricted to English language. STUDY ELIGIBILITY CRITERIA Inclusion criteria were hospitalized pregnant women with a confirmed coronavirus related-illness, defined as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), or COVID-19. STUDY APPRAISAL AND SYNTHESIS METHODS We used meta-analyses of proportions to combine data and reported pooled proportions, so that a pooled proportion may not coincide with the actual raw proportion in the results. The pregnancy outcomes observed included miscarriage, preterm birth, preeclampsia, preterm prelabor rupture of membranes, fetal growth restriction, and mode of delivery. The perinatal outcomes observed were fetal distress, Apgar score <7 at 5 minutes, neonatal asphyxia, admission to a neonatal intensive care unit, perinatal death, and evidence of vertical transmission. RESULTS Nineteen studies including 79 hospitalized women were eligible for this systematic review: 41 pregnancies (51.9%) affected by COVID-19, 12 (15.2%) by MERS, and 26 (32.9%) by SARS. An overt diagnosis of pneumonia was made in 91.8%, and the most common symptoms were fever (82.6%), cough (57.1%), and dyspnea (27.0%). For all coronavirus infections, the pooled proportion of miscarriage was 64.7% (8/12; 95% confidence interval, 37.9-87.3), although reported only for women affected by SARS in two studies with no control group; the pooled proportion of preterm birth <37 weeks was 24.3% (14/56; 95% confidence interval, 12.5-38.6); premature prelabor rupture of membranes occurred in 20.7% (6/34; 95% confidence interval, 9.5-34.9), preeclampsia in 16.2% (2/19; 95% confidence interval, 4.2-34.1), and fetal growth restriction in 11.7% (2/29; 95% confidence interval, 3.2-24.4), although reported only for women affected by SARS; 84% (50/58) were delivered by cesarean; the pooled proportion of perinatal death was 11.1% (5/60; 95% confidence interval, 84.8-19.6), and 57.2% of newborns (3/12; 95% confidence interval, 3.6-99.8) were admitted to the neonatal intensive care unit. When focusing on COVID-19, the most common adverse pregnancy outcome was preterm birth <37 weeks, occurring in 41.1% of cases (14/32; 95% confidence interval, 25.6-57.6), while the pooled proportion of perinatal death was 7.0% (2/41; 95% confidence interval, 1.4-16.3). None of the 41 newborns assessed showed clinical signs of vertical transmission. CONCLUSION In hospitalized mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, preterm birth is the most common adverse pregnancy outcome. COVID-19 infection was associated with higher rate (and pooled proportions) of preterm birth, preeclampsia, cesarean, and perinatal death. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy, although they should be interpreted with caution in view of the very small number of included cases.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, United Kingdom
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I. M. Sechenov Moscow State Medical University, Moscow Russia
| | - Danilo Buca
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Marco Liberati
- Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Jacopo Vecchiet
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University 'G. d'Annunzio' Chieti-Pescara, Chieti, Italy
| | - Luigi Nappi
- Departments of Obstetrics and Gynecology and Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Francesco D'Antonio
- Departments of Obstetrics and Gynecology and Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Donders F, Lonnée-Hoffmann R, Tsiakalos A, Mendling W, Martinez de Oliveira J, Judlin P, Xue F, Donders GGG. ISIDOG Recommendations Concerning COVID-19 and Pregnancy. Diagnostics (Basel) 2020; 10:E243. [PMID: 32338645 PMCID: PMC7235990 DOI: 10.3390/diagnostics10040243] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022] Open
Abstract
Providing guidelines to health care workers during a period of rapidly evolving viral pandemic infections is not an easy task, but it is extremely necessary in order to coordinate appropriate action so that all patients will get the best possible care given the circumstances they are in. With these International Society of Infectious Disease in Obstetrics and Gynecology (ISIDOG) guidelines we aim to provide detailed information on how to diagnose and manage pregnant women living in a pandemic of COVID-19. Pregnant women need to be considered as a high-risk population for COVID-19 infection, and if suspected or proven to be infected with the virus, they require special care in order to improve their survival rate and the well-being of their babies. Both protection of healthcare workers in such specific care situations and maximal protection of mother and child are envisioned.
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Affiliation(s)
| | | | - Aristotelis Tsiakalos
- Department Ob/Gyn, LETO Obstetrician Gynecological & Surgical Center, 11525 Athens, Greece;
| | - Werner Mendling
- German Center for Infections in Gynecology and Obstetrics, 42283 Wuppertal, Germany;
| | | | - Philippe Judlin
- Department OB/Gyn, CHU De Nancy—Université de Lorraine, 54000 Nancy, France;
| | - Fengxia Xue
- Department OB/Gyn, Tianjin Medical University General Hospital, Tianjin 30000, China;
| | - Gilbert G. G. Donders
- Femicare VZW Clinical Research for Women, 3300 Tienen, Belgium;
- Department Ob/Gyn, University Hospital Antwerp, 2650 Ekeren, Belgium
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48
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Unlikely SARS-CoV-2 vertical transmission from mother to child: A case report. J Infect Public Health 2020; 13:818-820. [PMID: 32305459 PMCID: PMC7151521 DOI: 10.1016/j.jiph.2020.04.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022] Open
Abstract
As the 2019 novel coronavirus disease (COVID-19) rapidly spread across China and to more than 70 countries, an increasing number of pregnant women were affected. The vertical transmission potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of great concern to the obstetrics, neonatologists, and public health agencies. Though some studies indicated the risk of vertical transmission is low, few cases have been reported with comprehensive serial tests from multiple specimens. In this case, a female preterm infant was born to a mother with confirmed COVID-19. She presented with mild respiratory distress and received general management and a short period of nasal continuous positive airway pressure support. During her stay at the hospital, a series of SARS-CoV-2 nucleic test from her throat and anal swab, serum, bronchoalveolar lavage fluid, and urine were negative. The nucleic acid test from the mother's amniotic fluid, vaginal secretions, cord blood, placenta, serum, anal swab, and breast milk were also negative. The most comprehensively tested case reported to date confirmed that the vertical transmission of COVID is unlikely, but still, more evidence is needed.
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49
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Lackey KA, Pace RM, Williams JE, Bode L, Donovan SM, Järvinen KM, Seppo AE, Raiten DJ, Meehan CL, McGuire MA, McGuire MK. SARS-CoV-2 and human milk: what is the evidence? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.04.07.20056812. [PMID: 32511431 PMCID: PMC7217082 DOI: 10.1101/2020.04.07.20056812] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The novel coronavirus SARS-CoV-2 has emerged as one of the most compelling public health challenges of our time. To address the myriad issues generated by this pandemic, an interdisciplinary breadth of research, clinical, and public health communities have rapidly engaged to find answers and solutions. One area of active inquiry is understanding the mode(s) of SARS-CoV-2 transmission. While respiratory droplets are a known mechanism of transmission, other mechanisms are possible. Of particular importance to global health is the possibility of vertical transmission from infected mothers to infants through breastfeeding or consumption of human milk. However, there is limited published literature related to vertical transmission of any human coronavirus (including SARS-CoV-2) via human milk and/or breastfeeding. There is a single study providing some evidence of vertical transmission of human coronavirus 229E, a single study evaluating presence of SARS-CoV in human milk (it was negative), and no published data on MERS-CoV and human milk. There are 9 case studies of human milk tested for SARS-CoV-2; none detected the virus. Importantly, none of the published studies on coronaviruses and human milk report validation of their analytical methods for use in human milk. These reports are evaluated here, and their implications related to the possibility of vertical transmission of coronaviruses (in particular, SARS-CoV-2) during breastfeeding are discussed.
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Affiliation(s)
- Kimberly A. Lackey
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, USA
| | - Ryan M. Pace
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, USA
| | - Janet E. Williams
- Department of Animal and Veterinary Sciences, University of Idaho, Moscow, ID, USA
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California, San Diego, La Jolla, CA, USA
| | - Sharon M. Donovan
- Department of Food Science and Human Nutrition and Institute of Genomic Biology, University of Illinois, Urbana, IL USA
| | - Kirsi M. Järvinen
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Antti E. Seppo
- Department of Pediatrics, Division of Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Daniel J. Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Courtney L. Meehan
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Mark A. McGuire
- Department of Animal and Veterinary Sciences, University of Idaho, Moscow, ID, USA
| | - Michelle K. McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, USA
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50
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New Corona Virus (COVID-19) Management in Pregnancy and Childbirth. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2020. [DOI: 10.5812/archcid.102938] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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