Potential Effect of COVID-19 on Maternal and Infant Outcome: Lesson From SARS

Abstract

The coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is highly infectious and its ongoing outbreak has been declared a global pandemic by the WHO. Pregnant women are susceptible to respiratory pathogens and the development of severe pneumonia, suggesting the urgent need to assess the potential maternal and infant outcome of pregnancy with COVID-19. The intrauterine vertical transmission potential of SARS-CoV-2 also remains controversial. Herein, we discuss the potential effect of COVID-19 on maternal and infant outcomes based on current studies, including those published in Chinese, in a total of 80 mothers with COVID-19 and 80 infants. We also comprehensively explored the mother-to-child transmission routes of SARS-CoV-2, in particular the route of intrauterine vertical transmission. Given SARS-CoV-2 is a sister to SARS-CoV, of the SARS-related coronavirus species, we made a comprehensive comparison between them to learn from experiences with SARS. Although there is no evidence supporting the intrauterine vertical transmission of SARS-CoV-2, our comprehensive analysis suggests that the adverse maternal and infant outcomes caused by COVID-19 cannot be underestimated. Further, we speculated that the inconsistency between nucleic acids and serological characteristics IgM to SARS-CoV-2 of infants' specimens may be caused by the disruption of the amniotic barrier by the inflammatory factors induced by SARS-CoV-2 infection. Our review is beneficial to understand the effect of SARS-CoV-2 on maternal and infant outcomes.

Maternal and Neonatal Clinico-Demographic Profile and Outcomes During the Covid-19 Pandemic at the Chinese General Hospital and Medical Center

“…5 This was also similar to the study of Wang et al where universal SARS-CoV-2 screening for women admitted for delivery found that all women with positive test results were asymptomatic at the time of testing. 9 The same study also noted that the clinical characteristics of COVID-19 infection in pregnancy were similar to those reported for non-pregnant adults with COVID-19 infection. In brief, Wang et al reported the typical symptoms in positive pregnant women, includes fever, cough, myalgia, malaise and sore throat, and none of them developed severe COVID-19 pneumonia or died.…”

“…Wang et al also reported that there was no positive RT-PCR result in neonate specimens obtained within 24 hours post-birth, implying no virologic evidence for congenital infection. 9 However, the serologic characteristics of infants reported showed 3 neonates with elevated IgM antibodies to SARS-CoV-2 born to mothers with COVID-19, suggesting a possible vertical transmission of SARS-CoV-2 from mother to newborn. They suggested that this inconsistency may be due to the disruption of the placenta or amniotic barrier caused by the inflammatory mediators from mothers that, induced by SARS-CoV-2, facilitates the transfer of IgG and IgM.…”

“…In brief, Wang et al reported the typical symptoms in positive pregnant women, includes fever, cough, myalgia, malaise and sore throat, and none of them developed severe COVID-19 pneumonia or died. 9 Salvatore et al also noted 18 of the 22 mothers who were symptomatic within 7 days of delivery, that 18 (82%) had cough, 9 of whom also reported a fever. 7 These findings were similar to our study wherein 2 out of the 22 COVID-19 positive mothers presented with mild symptoms, both had cough as a presenting symptom upon admission.…”

Maternal and Neonatal Outcomes of Healthy Pregnant Women With COVID-19 Versus High-risk Pregnant Women: A Multi-Center Case-Control Comparison Study

“…Although COVID-19 has been linked to a high risk of maternal mortality and severe maternal illness (Akhtar et al, 2020) its effect on the development and outcome of infants should be taken into account. For instance, during the SARS-CoV outbreak, maternal pneumonia was related with a high incidence of adverse pregnancy outcomes (Wang, Wang et al, 2020). In the current study, the results were similar to earlier studies and no severe neonatal adverse outcomes of COVID-19 was found (Zheng, et al, 2020).…”

Ultrasound Placental Remodeling Patterns and Pathology Characteristics in Patients with History of Mild SARS-CoV-2 Infection during Pregnancy

“…Concerns arose regarding its impact on vulnerable populations, such as pregnant women, maternal–fetal effects, and long-term consequences [ 2 , 3 ]. Despite evidence that vertical transmission of SARS-CoV-2 is unlikely, it is essential to establish potential maternal–fetal short- and long-term consequences of SARS-CoV-2 infection, especially the potential neuro-cognitive and psychologic outcome of the offspring [ 4 , 5 , 6 ].…”