Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic

Abstract

Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal–newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. Key Points

Maternal COVID-19 Infection Associated with Fetal Systemic Inflammatory Complications in COVID-19-Negative Neonates: A Case-Series

“…Placental inflammation on available pathology in our cohort as well as in other placental pathological studies in the setting of SARS-CoV-2 infection suggests a potential mechanism for hypoxic-ischemic and/or perinatal infarct pattern of injury that was observed. 6,14 In one case, there was evidence of in utero white matter injury which could also reflect early placental dysfunction. A recent manuscript reported that the placentas of two infants with neurologic findings born to mothers positive for SARS-CoV-2 were positive for SARS-CoV-2 proteins.…”

“…Vertical transmission of COVID has been shown to be rare. 6 A systemic inflammatory response, such as FIRS or MIS-N, is emerging as a potential source of neonatal morbidity and mortality in babies born to mothers with a history of COVID infection during pregnancy. 1 FIRS involves activation of the fetal immune response and the proposed mechanism of MIS-N is inflammation secondary to transplacental antibodies or cytokines.…”

“…4 A systematic review of studies of the placentas of women with SARS-CoV-2 infection found signs of placental inflammation, and several recent case reports have described infants of SARS-CoV-2-positive mothers with a presentation consistent with a systemic inflammatory immune response. [5][6][7][8][9] The systemic inflammation in some of these reports was noted in response to maternal viral infection in the absence of vertical transmission of the virus. 8 To date, two inflammatory entities have been described that may explain these findings in neonates: fetal inflammatory response syndrome (FIRS) and neonatal multisystem inflammatory syndrome (MIS-N).…”

Breastfeeding Practices for COVID-19-Infected Mothers: A Systematic Review and Meta-Analysis

“…The data are still insufficient regarding whether women with COVID-19 can transmit the virus to their newborns during labor and breastfeeding [ 6 ]. Thus, the guidelines for taking care of mother–newborn dyads have changed significantly during the pandemic [ 7 ]. The concern of possible transmission of the virus from an infected mother to her infant led to the disruption of some practices recognized as crucial for maternal bonding and breastfeeding initiation, such as skin-to-skin contact and rooming-in [ 8 ].…”

Post-Discharge Care Practices, Challenges and Outcomes in Newborn Infants of Mothers with SARS-CoV-2 Infection: Insights from Public Hospitals

“…[5][6][7][8][9] Horizontal transmission of COVID-19 to a newborn can occur with the possibility of occurrence during perinatal exposure, from infected family members or hospital staff while still admitted, breastmilk and breastfeeding should be strongly encouraged for the newborns as the chances of passing SARS-CoV-2 infection from mother to newborn causing serious illness are extremely low, vaccinations of women who are pregnant, planning to become pregnant, or were recently pregnant is safe and protect mothers from serious consequences of COVID-19; and adequate (two doses) COVID-19 vaccination in mother especially during the late second trimester and third trimester provides passive protective antibodies to newborns and reduce the overall severity of COVID-19 infection in newborns. 5,[9][10][11][12] Some questions are yet to be adequately answered such as the outcomes of newborns and infants exposed to COVID-19 beyond the rst few months of life, the impact of COVID-19 on the post-discharge home care practices and challenges and the effect of COVID-19 on post-discharge healthcare utilizations visits and outcomes. These questions although are currently limited to the context of the current COVID-19 pandemic, they are extremely important to be looked upon and hopefully would be helpful in case of similar future outbreaks.…”