Severe coronavirus infection in pregnancy: challenging cases report

Reis, Helena Lúcia Barroso dos; Boldrini, Neide Aparecida Tosato; Caldas, João Victor Jacomele; Paz, Ana Paula Calazans da; Ferrugini, Carolina Loyola Prest; Miranda, Angélica Espinosa

doi:10.1590/s1678-9946202062049

Cited by 17 publications

(24 citation statements)

References 13 publications

(19 reference statements)

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“…The percentage we observed is roughly consistent with the results previously reported by Zeng et al 47 . Overall, many suspected cases have been reported thus far 11,19,23,26,[48][49][50][51][52][53][54][55][56][57] . Neonates born to infected mothers must be tested and carefully clinically monitored.…”

Section: Discussionmentioning

confidence: 99%

Analysis of SARS-CoV-2 vertical transmission during pregnancy

et al. 2020

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The impact of SARS-CoV-2 infection during gestation remains unclear. Here, we analyse the viral genome on maternal and newborns nasopharyngeal swabs, vaginal swabs, maternal and umbilical cord plasma, placenta and umbilical cord biopsies, amniotic fluids and milk from 31 mothers with SARS-CoV-2 infection. In addition, we also test specific anti-SARS-CoV-2 antibodies and expression of genes involved in inflammatory responses in placentas, and in maternal and umbilical cord plasma. We detect SARS-CoV-2 genome in one umbilical cord blood and in two at-term placentas, in one vaginal mucosa and in one milk specimen. Furthermore, we report the presence of specific anti-SARS-CoV-2 IgM and IgG antibodies in one umbilical cord blood and in one milk specimen. Finally, in the three documented cases of vertical transmission, SARS-CoV-2 infection was accompanied by a strong inflammatory response. Together, these data support the hypothesis that in utero SARS-CoV-2 vertical transmission, while low, is possible. These results might help defining proper obstetric management of COVID-19 pregnant women, or putative indications for mode and timing of delivery.

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Section: Discussionmentioning

confidence: 99%

Analysis of SARS-CoV-2 vertical transmission during pregnancy

et al. 2020

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“…Severe respiratory disease requiring extra-ordinary treatment or monitoring is consistently described [ 2 , 10 , 13 , 14 , 19 , 28 , 30 – 33 , 39 – 41 , 43 , 44 , 46 , 47 , 59 , 61 , 66 – 91 ]. Cardiac disease may accompany the latter [ 92 ].…”

Section: Maternal Infection With Sars-cov-2mentioning

confidence: 99%

“…A study from Spain found that nearly 50% of patients with pneumonia subsequently suffered what would have been classified as severe disease [ 86 ]. Regardless, however, COVID-19 can be directly implicated as a cause of maternal demise [ 4 , 12 , 21 , 30 , 32 – 34 , 39 – 41 , 44 , 47 , 68 , 72 , 76 , 80 , 88 , 93 – 98 ]. In Brazil, most such maternal deaths were occurring in the postpartum period [ 96 ].…”

Section: Maternal Infection With Sars-cov-2mentioning

confidence: 99%

“…In a large American cohort, perinatal COVID-19 infection was estimated at 2.6% [ 108 ]. Most studies, however, report an infrequency of neonatal SARS-CoV-2 infection at birth or thereafter despite maternal infection of varying severity [ 1 – 3 , 13 , 16 , 19 , 20 , 22 – 25 , 29 , 30 , 35 , 38 , 41 , 42 , 46 , 47 , 51 , 55 , 59 – 61 , 66 , 68 , 72 , 82 , 90 , 100 , 104 – 107 , 109 , 110 , 112 , 113 , 117 – 120 , 123 , 126 , 128 , 129 , 139 , 162 , 168 , 185 , 188 , 191 , 193 , 196 , 197 , 213 , 222 , 228 , 237 – 244 ]. The latter has also been evident despite some newborn exposure to maternal breastfeeding [ 82 , 118 , 127 , 136 , 241 ].…”

Section: Antenatal or Neonatal Infection With Sars-cov-2mentioning

confidence: 99%

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A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19

Cimolai

2021

SN Compr. Clin. Med.

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The maternal-fetal/newborn unit is established at risk for COVID-19 infection. This narrative review summarizes the contemporary and cumulative publications which detail maternal infection, antenatal and newborn infections, and maternal/fetal/newborn management and prevention. There is a wide spectrum of maternal disease, but the potential for severe disease albeit in a minority is confirmed. COVID-19 carries risk for preterm delivery. Pregnant females can suffer multisystem disease, and co-morbidities play a significant role in risk. Congenital infection has been supported by several anecdotal reports, but strong confirmatory data are few. No typical congenital dysmorphisms are evident. Nevertheless, placental vascular compromise must be considered a risk for the fetus during advanced maternal infections. Clinical manifestations of newborn infection have been mild to moderate and relatively uncommon. Proven antiviral therapy is of yet lacking. The mode of delivery is a medical decision that must include patient risk assessment and patient directives. Both presymptomatic and asymptomatic mothers and offspring can complicate infection control management with the potential for spread to others in several regards. In the interim, infections of the maternal-fetal-newborn unit must be taken seriously both for the disease so caused and the potential for further dissemination of disease.

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“…In the new coronavirus pandemic (COVID-19), the MDSC have been reported to play an important role in the early phase of symptoms, increasing their frequency on blood in the first days of signals and symptoms, and it was related to poor outcome in severe acute respiratory syndrome in hospitalized patients. Pregnancy is a risk factor for COVID-19 severity, given the Brazilian high mortality rate of 12.7% in June 2020 withing pregnant, which may be associated with the change of the immunity [92][93][94].…”

Section: Summary Of Interferon Lambda (Ifn-λ) Function During Normal mentioning

confidence: 99%

Innate Immunity Modulation during Zika Virus Infection on Pregnancy: What We Still Need to Know for Medical Sciences Breakthrough

Azamor¹,

Torrentes-Carvalho²,

Vasconcelos³

et al. 2021

Cell Interaction - Molecular and Immunological Basis for Disease Management

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Zika virus (ZIKV), an arthropod-borne flavivirus, was classified as reemerging infectious disease and included as neglected tropical disease. During the recent ZIKV outbreak in South America, it has been demonstrated that ZIKV infection during pregnancy is strongly associated with fetal loss, malformations and neurological disorders in newborns. Despite the first line of host immune defense is related to innate immunity activation, the immunological homeostasis is essential for pregnancy success. Although the dynamic changes in maternal-fetal immunity is not completely understood and poorly investigated, the knowledge of immune responses during gestation is very important for infectious disease prevention and control, as ZIKV. Here, we put together more and new information about the innate immunity during gestation, highlighting three parts probably involved with clinical outcome and/or not well explored in literature: 1) type III interferon; 2) innate regulatory cells; and 3) cell death pathways modulation. Additionally, we will be focused on discussing how the dynamic responses of innate immune system during pregnancy and its effects in newborns, could be modulated by ZIKV, as well as how efforts on development of new/old drugs and vaccines could be effective for ZIKV prevention and control to provide a successful pregnancy.

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Severe coronavirus infection in pregnancy: challenging cases report

Abstract: This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Cited by 17 publications

References 13 publications

Analysis of SARS-CoV-2 vertical transmission during pregnancy

Analysis of SARS-CoV-2 vertical transmission during pregnancy

A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19

Innate Immunity Modulation during Zika Virus Infection on Pregnancy: What We Still Need to Know for Medical Sciences Breakthrough

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