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Published on: June 24, 2020
Maternal Coronavirus Infections and Neonates Born to Mothers with SARS-CoV-2: A Systematic Review
Waldemar Naves do Amaral1, Carolina Leão de Moraes1, Ana Paula Dos Santos Rodrigues1
1Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Goiás, 74605-050 Goiânia, Brazil.
Insights
COVID-19 in pregnant women can lead to serious maternal and newborn complications, including premature birth and death. SARS-CoV-2 transmission to newborns during pregnancy and delivery is possible, necessitating long-term infant follow-up.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Neonatology
Background:
- The COVID-19 pandemic poses significant risks to pregnant individuals and their newborns.
- Understanding maternal and perinatal outcomes associated with SARS-CoV-2 infection is crucial for effective management and prevention strategies.
Purpose of the Study:
- To systematically review the impact of COVID-19 on pregnant women, focusing on clinical presentation, comorbidities, and maternal-neonatal outcomes.
- To investigate the potential for vertical transmission of SARS-CoV-2 from mother to child.
Main Methods:
- A systematic review of observational studies and case reports involving pregnant women with COVID-19.
- Searches conducted on Embase and PubMed databases up to October 31, 2020.
- Inclusion of 70 studies comprising 1457 pregnant women across all trimesters.
Main Results:
- Common symptoms included fever, cough, and nausea. Frequent comorbidities were obesity, hypertensive disorders, and gestational diabetes.
- Adverse outcomes included premature birth (64), maternal death (15), fetal/neonatal death (16), and intrauterine fetal distress (28).
- SARS-CoV-2 was detected in 39 newborns, 13 placentas, and 6 breast milk samples, indicating potential vertical transmission.
Conclusions:
- COVID-19 infection during pregnancy is associated with increased maternal, fetal, and neonatal morbidity and mortality.
- Vertical transmission of SARS-CoV-2 is a possibility, requiring further investigation.
- Long-term follow-up of infants born to mothers with COVID-19 is essential to understand the full implications of prenatal SARS-CoV-2 exposure.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic is continuously affecting the lives of all people. Understanding the impact of COVID-19 on pregnancy in terms of morbidity, mortality, and perinatal maternal and fetal outcomes is essential to propose strategies for prevention and infection control. Here, we conducted a systematic review to investigate pregnant women infected with COVID-19 in terms of signs and symptoms, type of delivery, comorbidities, maternal and neonatal outcomes, and the possibility of vertical transmission. A search on Embase and PubMed databases was performed on 31 October 2020. Observational studies and case reports on pregnant women infected with COVID-19 were included without language restrictions. The 70 selected studies included a total of 1457 pregnant women diagnosed with COVID-19 in the first, second, and third trimesters of pregnancy. The most common signs and symptoms were fever, cough, and nausea. The most frequent comorbidities were obesity, hypertensive disorders, and gestational diabetes. Among maternal and fetal outcomes, premature birth (n = 64), maternal death (n = 15), intrauterine fetal death or neonatal death (n = 16), cases of intrauterine fetal distress (n = 28), miscarriage (n = 7), decreased fetal movements (n = 19), and severe neonatal asphyxia (n = 5) were the most frequent. Thirty-nine newborns tested positive for SARS-CoV-2. Additionally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was detected in the placenta (n = 13) and breast milk (n = 6). This review indicates that COVID-19 during pregnancy can result in maternal, fetal, and neonatal complications. In addition, SARS-CoV-2 viral exposure of neonates during pregnancy and delivery cannot be ruled out. Thus, we highlight the need for long-term follow-up of newborns from mothers diagnosed with COVID-19 to establish the full implications of SARS-CoV-2 infection in these children.
