Congenital infection of SARS-CoV-2 in live-born neonates: a population-based descriptive study

Abstract

Objective This study aimed to evaluate the evidence of mother-to-child transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods This is a descriptive, multicenter, observational study in nine tertiary care hospitals throughout Spain. The study population was women with COVID-19 during pregnancy. Mother-to-child transmission was defined as positive real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) of SARS-CoV-2 in amniotic fluid, cord blood, placenta or neonatal nasopharyngeal swabs taken immediately after birth. Results We included 43 singleton pregnant women and one twin pregnancy, thus we obtained 45 samples of placenta, amniotic fluid and umbilical cord blood. The median gestational age at diagnosis was 34.7 weeks (range 14 to 41.3). The median interval between positive RT-PCR and delivery was 21.5 days (range 0 to 141 days). Fourteen women (31.8%, 95%CI 18.6-47.6%) were positive at the time of delivery. There was one singleton pregnancy with SARS-CoV-2 RT-PCR positive in the placenta, amniotic fluid and umbilical cord blood (2.2%, 95%CI 0.1-11.8%). Nasopharyngeal aspiration was performed on 38 neonates at birth, all of which were negative (0%, 95%CI 0-9.3%). In 11 neonates the nasopharyngeal aspiration was repeated at 24-48 hours, and one returned positive (9.1%, 95%CI 0.2-41.3%). Conclusions The presence of the SARS-CoV-2 in placenta, amniotic fluid and cord blood shows that mother-to-child transmission is possible but uncommon.

Coronavirus disease 2019 and the placenta: A literature review

“…The prevalence of placental infection in COVID-19-positive women is low (7.7–21%) [ 73 ]⁠.A few studies have demonstrated SARS-CoV-2 placental infection diagnosis by ISH, IHC, RT-PCR, and transmission electron microscopy (TEM) [ 11 , 15 , 31 , 34 , 52 , 53 , 58 , 61 , 62 , 64 , 65 , 67 , 71 , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] ]⁠. Viral RNA, proteins, and particles were mainly localized in the syncytiotrophoblasts [ 52 , 58 , 61 , 62 , 64 , 80 , 81 , 86 ]⁠.…”

“…Positive IgA or IgM serology and positive RT-PCR of sterile samples [ 109 ]⁠. A few confirmed cases of in utero transmission of SARS-CoV-2 have been reported in the literature [ 15 , 53 , 64 , 91 ]⁠. SARS-CoV-2 infection of the placenta does not always translate to vertical transmission but may cause placenta insufficiency and pathology, resulting in perinatal morbidity and mortality without infection [ 72 , 90 ]⁠.…”

Pattern of Congenital Heart Disease In Neonates Conceived In The COVID-19 Era: Single Neonatal Intensive Care Unit Experience

“…It results in still birth, cerebral palsy, brain infarcts and hypoxic ischemic encephalopathy. (12) Congenital COVID-19 was reported to be silent or cause respiratory distress, and in less than 3% cause severe pneumonia (13). It was also reported to cause miscarriage, preterm labor, and fetal demise (14).…”

Neuropathogenesis of severe acute respiratory syndrome coronavirus 2

“…In a cohort study of women infected late in pregnancy, SARS-CoV-2 viral RNA was detected in 23 out of 54 placentas [50]. Nevertheless, while vertical transmission of SARS-CoV-2 from mother to child has been described, it appears to be exceedingly rare [51][52][53][54][55][56][57][58]. Long-term neurodevelopmental outcomes of infants who were exposed to SARS-CoV-2 in utero remains an area for future targeted studies [59][60][61].…”