Abstract:The world is currently affected by the invasion of a human to human highly transmissible novel corona virus classified as SARS-CoV-2. It causes a severe acute lower respiratory tract syndrome named corona virus disease . The virus is detected primarily by RT-PCR. The reproduction number (Ro) has been reported between 2.28 and 5.27]. It is beyond our objective to provide an in-depth discussion of the virus characteristics and its distinct viral clades and pathogenic behavior. On 30 January 2020 the World Health… Show more
“…The absence of neonatal COVID‐19 in Breslin et al 40 . and Qadri and Mariona 63 supports the guidelines for breastfeeding. The significance of one neonate testing positive for SARS‐CoV‐2 after rooming in and breastfeeding is uncertain 50 …”
Section: Discussionmentioning
confidence: 68%
“…No neonate tested positive for SARS‐CoV‐2 by nasopharyngeal swab rtPCR in Breslin et al 40 . and Qadri and Mariona, 63 while one neonate in Patane et al 55 . was SARS‐CoV‐2 positive at birth and hence permitted to breastfeed.…”
Section: Resultsmentioning
confidence: 99%
“…In severe infection, expression of breastmilk should be considered where possible. Breastfeeding from birth with the use of surgical mask and hand washing was permitted in four studies 40,50,55,63 . The absence of neonatal COVID‐19 in Breslin et al 40 .…”
Background: Since its emergence in December 2019, COVID-19 has spread to over 210 countries, with an estimated mortality rate of 3-4%. Little is understood about its effects during pregnancy. Aims: To describe the current understanding of COVID-19 illness in pregnant women, to describe obstetric outcomes and to identify gaps in the existing knowledge. Methods: Medline Ovid, EMBASE, World Health Organization COVID-19 research database and Cochrane COVID-19 in pregnancy spreadsheet were accessed on 18/4, 18/5 and 23/5 2020. Articles were screened via Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following were excluded: reviews, opinion pieces, guidelines, articles pertaining solely to other viruses, single case reports. Results: Sixty articles were included in this review. Some pregnant participants may have been included in multiple publications, as admission dates overlap for reports from the same hospital. However, a total of 1287 confirmed SARS-CoV-2 positive pregnant cases are reported. Where universal testing was undertaken, asymptomatic infection occurred in 43.5-92% of cases. In the cohort studies, severe and critical COVID-19 illness rates approximated those of the non-pregnant population. Eight maternal deaths, six neonatal deaths, seven stillbirths and five miscarriages were reported. Nineteen neonates were SARS-CoV-2 positive, confirmed by reverse transcription polymerase chain reaction of nasopharyngeal swabs. [Correction added on 2 September 2020, after first online publication: the number of neonates indicated in the preceding sentence has been corrected from 'Thirteen' to 'Nineteen'.] Conclusions: Where universal screening was conducted, SARS-CoV-2 infection in pregnancy was often asymptomatic. Severe and critical disease rates approximate those in the general population. Vertical transmission is possible; however, it is unclear whether SARS-CoV-2 positive neonates were infected in utero, intrapartum or postpartum. Future work should assess risks of congenital syndromes and adverse perinatal outcomes where infection occurs in early and mid-pregnancy.
“…The absence of neonatal COVID‐19 in Breslin et al 40 . and Qadri and Mariona 63 supports the guidelines for breastfeeding. The significance of one neonate testing positive for SARS‐CoV‐2 after rooming in and breastfeeding is uncertain 50 …”
Section: Discussionmentioning
confidence: 68%
“…No neonate tested positive for SARS‐CoV‐2 by nasopharyngeal swab rtPCR in Breslin et al 40 . and Qadri and Mariona, 63 while one neonate in Patane et al 55 . was SARS‐CoV‐2 positive at birth and hence permitted to breastfeed.…”
Section: Resultsmentioning
confidence: 99%
“…In severe infection, expression of breastmilk should be considered where possible. Breastfeeding from birth with the use of surgical mask and hand washing was permitted in four studies 40,50,55,63 . The absence of neonatal COVID‐19 in Breslin et al 40 .…”
Background: Since its emergence in December 2019, COVID-19 has spread to over 210 countries, with an estimated mortality rate of 3-4%. Little is understood about its effects during pregnancy. Aims: To describe the current understanding of COVID-19 illness in pregnant women, to describe obstetric outcomes and to identify gaps in the existing knowledge. Methods: Medline Ovid, EMBASE, World Health Organization COVID-19 research database and Cochrane COVID-19 in pregnancy spreadsheet were accessed on 18/4, 18/5 and 23/5 2020. Articles were screened via Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following were excluded: reviews, opinion pieces, guidelines, articles pertaining solely to other viruses, single case reports. Results: Sixty articles were included in this review. Some pregnant participants may have been included in multiple publications, as admission dates overlap for reports from the same hospital. However, a total of 1287 confirmed SARS-CoV-2 positive pregnant cases are reported. Where universal testing was undertaken, asymptomatic infection occurred in 43.5-92% of cases. In the cohort studies, severe and critical COVID-19 illness rates approximated those of the non-pregnant population. Eight maternal deaths, six neonatal deaths, seven stillbirths and five miscarriages were reported. Nineteen neonates were SARS-CoV-2 positive, confirmed by reverse transcription polymerase chain reaction of nasopharyngeal swabs. [Correction added on 2 September 2020, after first online publication: the number of neonates indicated in the preceding sentence has been corrected from 'Thirteen' to 'Nineteen'.] Conclusions: Where universal screening was conducted, SARS-CoV-2 infection in pregnancy was often asymptomatic. Severe and critical disease rates approximate those in the general population. Vertical transmission is possible; however, it is unclear whether SARS-CoV-2 positive neonates were infected in utero, intrapartum or postpartum. Future work should assess risks of congenital syndromes and adverse perinatal outcomes where infection occurs in early and mid-pregnancy.
“… 78 Pooling studies from outside of China revealed that 19 of 539 neonates born to mothers with COVID-19 infection had positive results for SARS-CoV-2 by NP swab, yielding a pooled proportion of 3.5%. 12 , 18 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 Combining all 38 cohort or case series studies in a meta-analysis, of all 936 neonates tested, 27 had positive results for SARS-CoV-2 RNA by NP swab either immediately after birth or within 48 hours of birth, yielding a pooled proportion of 3.2% (95% CI, 2.2–4.3) ( Figures 2 and 3 ). Figure 2 Rate of vertical transmission according to neonatal testing source COVID-19 , coronavirus disease 2019; IgM , immunoglobulin M; NP , nasopharyngeal.…”
Objective
This study aimed to conduct a systematic review of the current literature to determine estimates of vertical transmission of coronavirus disease 2019 based on early RNA detection of severe acute respiratory syndrome coronavirus 2 after birth from various neonatal or fetal sources and neonatal serology.
Data Sources
Eligible studies published until May 28, 2020, were retrieved from PubMed, EMBASE, medRxiv, and bioRxiv collection databases.
Study Eligibility Criteria
This systematic review included cohort studies, case series, and case reports of pregnant women who received a coronavirus disease 2019 diagnosis using severe acute respiratory syndrome coronavirus 2 viral RNA test and had reported data regarding the testing of neonates or fetuses for severe acute respiratory syndrome coronavirus 2 immediately after birth and within 48 hours of birth. A total of 30 eligible case reports describing 43 tested neonates and 38 cohort or case series studies describing 936 tested neonates were included.
Study Appraisal and Synthesis Methods
The methodological quality of all included studies was evaluated by a modified version of the Newcastle-Ottawa scale. Quantitative synthesis was performed on cohort or case series studies according to the neonatal biological specimen site to reach pooled proportions of vertical transmission.
Results
Our quantitative synthesis revealed that of 936 neonates from mothers with coronavirus disease 2019, 27 neonates had a positive result for severe acute respiratory syndrome coronavirus 2 viral RNA test using nasopharyngeal swab, indicating a pooled proportion of 3.2% (95% confidence interval, 2.2–4.3) for vertical transmission. Of note, the pooled proportion of severe acute respiratory syndrome coronavirus 2 positivity in neonates by nasopharyngeal swab in studies from China was 2.0% (8/397), which was similar to the pooled proportion of 2.7% (14/517) in studies from outside of China. Severe acute respiratory syndrome coronavirus 2 viral RNA testing in neonatal cord blood was positive in 2.9% of samples (1/34), 7.7% of placenta samples (2/26), 0% of amniotic fluid (0/51), 0% of urine samples (0/17), and 9.7% of fecal or rectal swabs (3/31). Neonatal serology was positive in 3 of 82 samples (3.7%) (based on the presence of immunoglobulin M).
Conclusion
Vertical transmission of severe acute respiratory syndrome coronavirus 2 is possible and seems to occur in a minority of cases of maternal coronavirus disease 2019 infection in the third trimester. The rates of infection are similar to those of other pathogens that cause congenital infections. However, given the paucity of early trimester data, no assessment can yet be made regarding the rates of vertical transmission in early pregnancy and potential risk for consequent fetal morbidity and mortality.
“…Although maternal parameters were reported in previous studies,maternal outcomes were not included in our review. [102][103][104][105][106][107][108][109][110][111][112][113][114][115] The outcome so far is favourable for the foetus despite the risks to the mother for ICU admissions and mechanical ventilation seen in other studies.3 116 There is no significant increase in preterm birth but there is a significantly increased risk of CS in mothers with COVID-19.…”
ObjectiveWe aimed to conduct a systematic review of the available literature to determine the effects of confirmed cases of COVID-19 in pregnant women from the foetal perspective by estimation of mother to child transmission, perinatal outcome and possible teratogenicity.MethodsData sources: eligible studies between 1 November 2019 and 10 August 2020 were retrieved from PubMed, Embase, LitCovid, Google Scholar, EBSCO MEDLINE, CENTRAL, CINAHL, MedRXiv, BioRXiv and Scopus collection databases. English language case reports, case series and cohort studies of SARS-CoV-2 confirmed pregnant women with data on perinatal outcome, congenital anomalies and mother to child transmission were analysed.Results38 case reports, 34 cohort and case series describing 1408 neonates were included for evidence acquisition of mother to child transmission. 29 case reports and 31 case series and cohort studies describing 1318 foetuses were included for the evaluation of perinatal outcome and congenital anomalies. A pooled proportion of 3.67% neonates had positive SARS-CoV-2 viral RNA nasopharyngeal swab results and 7.1% had positive cord blood samples. 11.7% of the placenta, 6.8% of amniotic fluid, 9.6% of faecal and rectal swabs and none of the urine samples were positive. The rate of preterm labour was 26.4% (OR=1.45, 95% CI 1.03 to 2.03 with p=0.03) and caesarean delivery (CS) was 59.9% (OR=1.54, 95% CI 1.17 to 2.03 with p=0.002). The most common neonatal symptom was breathing difficulty (1.79%). Stillbirth rate was 9.9 per 1000 total births in babies born to COVID-19 mothers.ConclusionChances of mother to child transmission of the SARS-CoV-2 virus is low. The perinatal outcome for the foetus is favourable. There is increased chances of CS but not preterm delivery.The stillbirth and neonatal death rates are low. There are no reported congenital anomalies in babies born to SARS CoV-2 positive mothers.
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