Pregnancy in the time of COVID-19

By Atoosa Amel

Just before the country went under lockdown, I was listening to two radio presenters talking about the names parents could give their newborns that fitted in with the pandemic theme. They came up with names like “Pandi”, “Quarantina” and “Corona-Lisa”. One of the presenters said that when the children grow up to be teenagers, they will be referred to as “quaranteens”. Some of you might also remember the couple who named their twins Corona and Covid! All jokes aside, being pregnant at this time is quite stressful. Are pregnant mothers more likely to develop severe symptoms of COVID-19? Will the infected mother be able to pass the virus to her child? Will there be complications? These are all questions that plague a mothers’ mind.

Juan.et.al1 conducted a systematic review aimed to identify the effects of COVID-19 on maternal, perinatal, and neonatal outcomes. The review data only looked at peer-review articles where the mother was clinically diagnosed with COVID-19 at the time of admission. The health of the mother as well as the baby, was tracked during the perinatal stages. These criteria narrowed the find to 24 studies (9 case studies & 15 case reports) which included 324 pregnant women with age ranging from 24 to 44. The gestational age at the time of admission ranged from 5 to 41 weeks.

 

A deeper dive into the potential of vertical transmission of the virus from infected mother to fetus

There is some controversy regarding this matter. Two studies, with ten total combined patients with COVID-19 in their third trimester, sampled cord blood, amniotic fluid, and neonatal throat swabs2,3. All samples were negative for SARS-CoV-2. This indicates that, at least in the late stage of pregnancy, the transmission of the virus is unlikely. However, the one positive neonatal nasal swab and amniotic fluid test from the case reports contradicts this 1.

Two other studies looked at IgM antibodies in three neonates born to SARS-CoV-2 infected mothers4,5. Although all three neonates had IgM antibodies in their blood, their throat swabs were negative. One neonate was tested repeatedly for SARS-CoV-2 IgG and IgM antibodies, and it was observed that IgG antibody levels declined rapidly within 14 days, followed by a decline in IgM levels. This indicated that the antibodies were probably derived from the mother through the placenta, and they were not produced due to infection in the neonate.

Concluding remarks:

I want to point out a few features about the cases with maternal deaths that were covered in this review. Firstly, all these patients were from the same country and province; thus, epidemiological factors might play a role in this case. Secondly, the average maternal age in the case series was 36.7 ± 7.3 years and was higher than the patients in the other case series (30.3 ± 3.6 years). The patients did not have pre-existing comorbidities such as asthma or cardiovascular disease, and the authors of this paper believed the patients received optimal care. However, no detail regarding the cause(s) of death was provided.

Our knowledge of SARS-CoV-2 infection is still minimal. There are so many factors that could increase a person’s risk of severe infection such as epigenetics, access to adequate healthcare, exposure to pollution, delay in reporting, etc. The same factors apply to pregnant women. What I have presented is just some statistics gathered from a few studies, and they are far from being conclusive. The case studies presented do not have internal controls. On the other hand, there could be instances were the mothers were asymptomatic and miscarriages were not recorded as part of the data. All in all, there are not enough good-quality data that can be used to form unbiased conclusions. For now, the best advice for concerned pregnant mothers is to practice good hygiene and social distancing.

References:

  1. Juan J, Gil M, Rong Z, Zhang Y, Yang H, Poon L. Effect of coronavirus disease 2019 (COVID‐19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound in Obstetrics & Gynecology. 2020;56(1):15-27.
  2. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong Q, Liao J, Yang H, Hou W, Zhang Y. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.Lancet. 2020;395(10226):809-815. doi: 10.1016/S0140-6736(20)30360-3.
  3. Lei D, Wang C, Li C, Fang C, Yang W, Cheng B, Wei M, Xu X, Yang H, Wang S, Fan C. Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases. Chin J Perinat Med 2020; 23: 225–231.
  4. Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, Long X. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020:e204861. doi: 10.1001/jama.2020.4861.
  5. Dong L, Tian J, He S, Zhu C, Wang J, Liu C, Yang J. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020:e204621. doi: 10.1001/jama.2020.4621.

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