ABSTRACT
Background: Literature evaluating the effect of SARS-CoV-2 infection in exposed newborns during pregnancy is still scarce. Although a 3% rate of perinatal transmission has been described, there is not enough evidence of viral transmission in biological samples through microbiological techniques. Our aim is to describe perinatal transmission in newborns exposed to SARS-CoV-2 during pregnancy and their follow up. Methods: The study period is from March 15 to November 30, 2020. Exposed newborns of SARS-CoV-2 infected mothers (with microbiologically confirmed COVID-19 disease during pregnancy or delivery) were included at 13 hospitals in Spain. Demographic, clinical and microbiological data were collected. Biological samples including nasopharyngeal swab, blood, urine, and meconium from newborns and blood, placenta, and breast milk from mothers were collected for reverse transcription polymerase chain reaction (RT-PCR) analysis. Results: 282 exposed to SARS-CoV-2 neonates were recruited;130 cases during the first wave (March 15-July 31) and 152 during the second one (August 1- November 30). The prematurity birth-rate was 20% and 13% respectively. Overall, eleven newborns were positive for RT-PCR in nasopharyngeal swab, eight of them during the first 24-48 hours after birth. Three of them presented viral load in urine sample and another three in meconium sample. Only one RT-PCR was positive in maternal blood samples (1/115) and placenta (1/81). All newborns blood samples collected at delivery were negative for RT-PCR (0/70). There was no viral load either in breast milk samples (0/79). Placental immuno-histochemistry performed for SARS-CoV-2 showed no virus (0/16). Two newborn death were described none of them related to SARS-CoV-2. Those newborns exposed to SARS-CoV-2 were asymptomatic and with normal weight and psychomotor development at 6-months follow-up. Conclusion: Intrauterine SARS-CoV-2 transmission seems unlikely, describing a 3.9% rate of neonatal infection after delivery. A high rate of prematurity is described, mostly during the first wave. SARS-CoV-2 can be detected by RT-PCR in urine and meconium of neonates with positive nasopharyngeal RT-PCR, whereas it has not been detected in any newborn blood. The detection in maternal blood and placenta was anecdotal and it was not detected in breast milk samples. Except for the complications derived from prematurity, exposed newborns evolution was satisfactory.
ABSTRACT
Background: SARS-CoV2 infection severity during pregnancy and posible consequences for exposed newborns information is still unknown. The objective of this study is to analyse clinical and epidemiological characteristics of a SARS-CoV2 infected women during pregnancy and their newborns cohort. Methods: Multicentric observational study from the Spanish GENEO-COVID cohort (participating in RECLIP). Infected pregnant women and their newborns born from 15 March to 31 July with a 15 days follow up were included. Data regarding epidemiological, clinical, virological and immunological characteristics of the patients was collected. Results: Globally, 105 pregnant women with a median age of 34 (IQR: 29-37) years old and 107 newborns were included in the study. Median gestational age at diagnosis was 36.9 (IQR-33.4-39.2) weeks, and 6.7% os women were diagnosed in the second trimester. More than 34% of the women presented at least one comorbidity and almost 65% of women had COVID19 symptoms and 43% of them were treated for the infection. Overall, 30.8% had COVID-19 pneumonia and 4.8% were admitted to the intensive care unit (ICU) needing invasive mechanical ventilation. The rate of positive RT-PCR at delivery was 61.9%. There was a 36.2% rate of caesarean sections, associated with pneumonia during pregnancy OR:4.2 (95% CI 1.5,12.0) and lower gestational age at delivery OR:0.7 (95% CI: 0.6,0.9). Regarding newborns, 46.7% were male, 66.4% breastfed, with median Apgar 1' of 9 and Apgar 5' of 10. Almost 6% were small for gestational age and 16.8% needed admission to the neonatal ICU. Oxygen was needed by 12.1% and surfactant by 5.6% newborns. Prematurity rate was 20.6%, associated with pneumonia during gestation OR:7.0 (95% CI: 2.3,22.8) and with a positive RT-PCR at delivery OR:6.5 (95% CI: 1.8,31.8). No associations were found with age, comorbidities or blood group. No vertical transmission was reported but one newborn was horizontally infected. Two newborns died, one due to prematurity causes and another of unexpected sudden death during early skin-to-skin contact after delivery. Conclusion: Even there is no vertical transmission reported in this cohort, we found a case of horizontal transmission. SARS-CoV2 infection could produce COVID19 pneumonia during pregnancy, that increases caesarean sections and prematurity rates worsening exposed newborns prognosis. (Figure Presented).