The changing landscape of SARS-CoV-2: Implications for the maternal-infant dyad

Abstract

The COVID-19 pandemic represents the greatest challenge to date faced by the medical community in the 21st century. The rate of rapid dissemination, magnitude of viral contagiousness, person to person transmission at an asymptomatic phase of illness pose a unique and dangerous challenge for all patients, including neonatal and obstetric patients. Although scientific understanding of the pathophysiology of the disease, nature of transmission, and efficacy of mitigation strategies is growing, neither a cure or vaccine have been developed. While COVID-19 is primarily a disease of older patients, infection is now seen across all age demographics with reports of illness in pregnant patients and infants. Altered hormone status and predominance of Th-2 immune helper cells may result in increased predisposition to SARS-CoV-2. Case reports of pregnant patients demonstrate a clinical presentation comparable to non-pregnant adults, but evidence of vertical transmission to the fetus is controversial. Neonatal reports demonstrate an inconsistent and non-specific phenotype, and it is often difficult to separate COVID-19 from the underlying conditions of prematurity or bacterial infection. The development of international registries to enable risk profiling of COVID-19 positive pregnant mothers and/or their offspring may facilitate the development of enhanced mitigation strategies, medical treatments and effective vaccinations.

Perinatal COVID-19: guideline development, implementation, and challenges

“…The creation of small and large just-in-time cohorts should be applauded. Yet, it is important to recognize how powerful a national population-based, longitudinal birth registry, which does not exist currently, could have been for driving evidence-based perinatal medicine during the current pandemic [ 54 , 55 ]. The creation and maintenance of such a database could provide invaluable data for ongoing studies and inevitable future pandemics.…”

Transmisión vertical de la CO VID-19: evidencias y recomendaciones

“…Al momento del parto, se recomienda la monitorización de los niveles de oxígeno y el bloqueo epidural en fases tempranas de labor para minimizar la necesidad de anestesia general 5 , así como el pinzamiento tardío del cordón umbilical. El parto vaginal es factible si comienza de manera espontánea, acortando el segundo periodo del trabajo de parto [23][24][25][26][27][28][29][30] .…”

Transmissão vertical e SARS-COV-2: o que sabemos até agora?

“…O vírus SARS-CoV-2 (severe acute respiratory disease coronavirus) pertence à família Coronaviridae, que tem como material genético o RNA de fita simples, o qual infecta células do epitélio respiratório humano por meio da atuação no receptor ACE2 (enzima conversora de angiotensina 2). A doença foi nomeada como Coronavirus Disease-2019 (COVID-19) pela Organização Mundial da Saúde (OMS), e declarada como pandemia em 11 de Março de 2020 (ELGIN et al, 2020). O vírus pode ser transmitido de pessoa para pessoa, direta ou indiretamente, pelas vias respiratória, oro-fecal e provavelmente sexual (DELFINO et al, 2020).…”