Sahil Naik, M.D., Nivedita Jha, M.D., Shivani Naik, M.D., Steven Lippmann, M.D.

The coronavirus disease COVID-19 can be infectious to everyone, from newborns to elderly people. The impact of COVID-19 during pregnancy is not known, but is a matter of concern regarding perinatal and maternal outcomes (1).

Physiological cardiovascular changes with increased metabolism, higher oxygen consumption, decreased functional residual capacity, and mismatches between ventilation and perfusion predispose pregnant women to respiratory complications (1). Altered immunity also increase susceptibility and severity of viral infections (1,2). Pregnant women infected with SARS-CoV-2 virus sometime experience hypoxic respiratory failure, adverse perinatal outcomes with intrauterine demise, growth restriction, premature rupture of membranes, preterm labor, and neonatal death (1,2). Since this condition has never been assessed before, there is little data about the influence of a COVID-19 infection during pregnancies (2,3).

The clinical characteristics of COVID-19-induced pneumonia in pregnant women are similar to those in non-pregnant adults (4,5). Fever, productive cough, headache, and myalgia are the common manifestation. Lymphocytopenia is a frequent laboratory finding (4,5).

Pregnancy outcomes after severe acute respiratory syndrome (SARS) with the SARS-CoV virus and/or Middle East respiratory syndrome (MERS) caused by MERS-CoV included miscarriage, preterm death, and maternal demise (6,7). The current COVID-19 virus being of the same family as SARS and MERS is a major concern.

Little information is available about teratogenicity, vertical transmission, and/or transmission during vaginal delivery or through breast milk; an increased prevalence of preterm deliveries is documented (2,5,8). COVID-19 may alter immune responses at the maternal-fetal interface and affect the well-being of mothers, fetuses, and infants (1). The COVID-19 nucleic acid was not detected in placentas or neonatal throat swabs by reverse transcriptase polymerase chain reaction (RT-PCR) diagnostic testing (3,5). Since infected mothers can transmit the COVID-19 virus via respiratory droplets during breastfeeding, contact precautions with newborns is advised (2,8).

Neonates have been COVID-19-infected after birth via direct contact with their mother or other relatives, at between 5-17 days of incubation time. Sick infants evidence tachypnea, regurgitation, vomiting, cough, and fever. Pneumothorax, liver disorders, thrombocytopenia, and pulmonary abnormalities imaged on chest scans are also documented (5).

Conclusions about the gestational result of COVID-19 infections remain unclear.  Precautions for pregnant women remain similar to those for the general population: avoid contact with ill persons, maintain respiratory hygiene, hand washing, disinfect contaminated surfaces, and quarantine if sick or when exposed to infected persons or someone testing positive for coronavirus. Prenatal clinics ought to screen patients, visitors, and others for fever, respiratory symptoms, and isolate those with viral illness concerns. Limiting visitors to labor /delivery units and postpartum wards is advised (3,8).

References

1. Liu H, Wang LL, Zhao SJ, et al. Why are pregnant women susceptible to COVID-19? An immunological viewpoint.  Journal of Reproductive Immunology. 2020;139:103122. Accessed November 13, 2020.
2. Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, et al. Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review. Fetal and Pediatric Pathology. 2020; 39,(3): 246-250.
3. Di Mascio D, Khalil A, Saccone G, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology.2020;2,(2): 100107. Accessed November 13, 2020.
4. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10229):809-815.
5. Panahi L, Amiri M, Pouy S. Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy; a Narrative Review. Archives of Academic Emergency Medicine. 2020;8(1): e34. Accessed November 13, 2020.
6. Zhao X, Jiang Y, Zhao Y, et al. Analysis of the susceptibility to COVID-19 in pregnancy and recommendations on potential drug screening. European Journal of Clinical Microbiology & Infectious Diseases. 2020; 39,(7): 1209-1220.
7. Schwartz DA. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes.  Archives of Pathology & Laboratory Medicine. 2020; 10:5858. Accessed November 13, 2020.
8. Rasmussen SA, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation. Obstetrics and Gynecology. 2020; 135,(5): 999-1002.