COVID-19 in Pregnancy—Perinatal Outcomes and Vertical Transmission Preventative Strategies, When Considering More Transmissible SARS-CoV-2 Variants

Abstract

The COVID-19 pandemic affected the physical and mental health of people around the world and left unprepared health care systems struggling to mount an adequate response. Understanding the impact of COVID-19 on pregnancy in terms of perinatal and fetal outcomes is essential to propose strategies for mminimising viral transmission. Overall, 91 pregnant women in labour, or with indication for induction of labour, with COVID-19 were admitted to hospital. On the day of admission, each pregnant woman underwent a nasopharyngeal swab to validate SARS-CoV-2 infection. Whenever delivery was by caesarean section, an amniotic fluid sample was collected after uterus incision. Neonates were tested twice: first by nasopharyngeal swab at birth and secondly either at 24 h after (when babies were isolated) or at discharge (when rooming-in). All samples underwent rRT-PCR testing for SARS-CoV-2. The SARS-CoV-2 RNA tests by nasopharyngeal swab of the pregnant women produced positive results in 47 patients. This cohort gave birth to 48 infants who were double tested by nasopharyngeal swab and included in the prospective observational study. Moreover, in this same cohort, 39 amniotic fluid samples were taken during caesarean section. All samples underwent rRT-PCR testing for SARS-CoV-2 and came back negative. The study results suggest a low risk of vertical transmission of COVID-19 and favourable perinatal outcomes due to adequate preventative strategies. This approach may prove to be more beneficial in the new SARS-CoV-2 variants era.

Mother-to-child transmission of SARS-CoV-2 infection in high-income countries: a systematic review and meta-analysis of prospective observational studies

“…In 14 studies the mother-infant dyad was enabled to stay together after birth 24 h a day 13 , 14 , 18 , 19 , 21 , 23 – 27 , 29 , 31 , 32 , 36 , in 6 it was not allowed 17 , 20 , 28 , 30 , 33 , 33 and in the remaining 6 studies 15 , 16 , 22 , 35 , 37 , 38 , there was no information about it. In 12 studies two or more preventive measures were undertaken 14 , 17 , 19 , 21 , 23 , 26 , 27 , 29 – 31 , 33 , 34 , in 10 only one or no one 13 , 15 , 16 , 18 , 20 , 22 , 24 , 25 , 28 , 36 and in the remaining 4 studies there was no information about preventive measures 32 , 35 , 37 , 38 . Considering only the studies in which rooming in practice was performed, at least two preventive measures were adopted in 8 of these studies 14 , 19 , 21 , 23 , 26 , 27 , 29 , 31 , one or no preventive measures were adopted in 5 studies 13 , 18 , 24 , 25 , 36 …”

“…In 12 studies two or more preventive measures were undertaken 14 , 17 , 19 , 21 , 23 , 26 , 27 , 29 – 31 , 33 , 34 , in 10 only one or no one 13 , 15 , 16 , 18 , 20 , 22 , 24 , 25 , 28 , 36 and in the remaining 4 studies there was no information about preventive measures 32 , 35 , 37 , 38 . Considering only the studies in which rooming in practice was performed, at least two preventive measures were adopted in 8 of these studies 14 , 19 , 21 , 23 , 26 , 27 , 29 , 31 , one or no preventive measures were adopted in 5 studies 13 , 18 , 24 , 25 , 36 and in one study it was not specified 32 . The quality assessment evaluation is provided in the supplementary online table .…”

“…The quality assessment evaluation is provided in the supplementary online table . We hereby provide a short summary of the NOS grading: Eight studies were considered as “high-quality” with a score ≥ 7, whereas twelve studies were considered “medium-quality”, having a score comprised between 4 and 6 15 , 18 , 20 , 24 , 25 , 34 – 36 .…”

Impact of COVID-19 on Fetal Outcomes in Pregnant Women: A Systematic Review and Meta-Analysis

“…BMI: Four studies [ 17 , 24 , 26 , 33 ] reported BMIs for patients and controls, which were not significantly different between the two groups (SMD 0.35; CI 95% −0.178; 0.848; p = 0.2) ( Supplementary Figure S3 ). There was inter-study heterogeneity (I 2 = 86%, p = 0.000; Q = 22.600), as well as an absence of publication bias, as derived from the symmetry of the funnel plots and Egger’s test (intercept 11.95, 95% CI −72.06, 95.96; p = 0.30).…”

“…Diabetes: The analyses of 16 studies [ 15 , 16 , 17 , 19 , 24 , 25 , 26 , 28 , 30 , 31 , 33 , 39 , 41 , 44 , 45 ] revealed that the risk of diabetes was not significantly different between patients and controls (OR 1.039; CI 95% 0.825; 1.309; p = 0.7) ( Supplementary Figure S5 ), an absence of inter-study heterogeneity, as shown by the I 2 test (I 2 = 27%, p = 0.128) and the Q-test (Q-value = 21.279), and publication bias, as shown by the symmetry of the funnel plots and the Egger’s test (intercept −0.477, 95% CI −1.62, 0.67; p = 0.19). No study was found to be sensitive enough to alter the results ( Supplementary Figure S6 ).…”