Screening for COVID‐19 at childbirth: is it effective?

Abstract

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Belgium has reported a proportionally high number of COVID-19-related deaths (Table S1, Figure S1)1. Although there is an increasing wealth of research regarding COVID-19, data on the prevalence and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and at delivery remain limited. Recent data from affiliated hospitals of Columbia University, NY, USA have demonstrated that the pandemic may have a greater impact in densely populated areas. Testing began initially based on symptoms, with a first report of a total of 43 pregnant women, of whom 29 presented with COVID-19 symptoms at admission and 14 were diagnosed during their stay2. According to the classification system of Wu et al. for severity of COVID-19 symptoms, 37 (86.0%) patients had mild symptoms and four (9.3%) had severe symptoms, and two (4.7%) were admitted to the intensive care unit (ICU)3. In parallel, the hospitals implemented a universal screening program using quantitative polymerase chain reaction to detect SARS-CoV-2, with 29 out of 210 (13.8%) asymptomatic women testing positive on admission for labor and delivery4. In order to contain the horizontal transmission between patients and healthcare workers, an increasing number of hospitals began using the universal screening program for patients at admission. We reviewed the medical records of all consecutive women admitted for delivery at four obstetric units in North-East Flanders, Belgium, since the local introduction of the universal screening program for SARS-CoV-2 on 30th March 2020. By 8th May, 473 women delivered, of whom 470 (99.4%) had been screened at admission. Thirteen (2.8%) women tested positive, of whom eight (61.5%) were asymptomatic, while four (30.8%) experienced mild upper-airway symptoms. No patients developed severe symptoms and there were therefore no ICU admissions or deaths, and no patients developed symptoms during hospitalization. One (7.7%) patient tested positive and had respiratory symptoms > 2 weeks prior to delivery, but had no residual symptoms at the time of delivery. Therefore, in our experience, fewer than one in 35 women admitted for delivery tested positive for SARS-CoV-2 infection in a country that was in an advanced form of lockdown since 18th March 2020. Only one in three women experienced mild symptoms. We believe that our findings are representative of the Belgian population, as Belgium's public health institute, Sciensano, estimated that 4.3% of the population is seropositive for SARS-CoV-2, based on 1327 blood samples from healthy blood donors assessed between 30th March and 16th April5. This suggests that, in areas such as Belgium that have a less dense population (383 inhabitants/km2), compared to metropolitan New York (10 431 inhabitants/km2), fewer women may have contracted SARS-CoV-2. Furthermore, the implementation and timing of a policy of far-reaching measures regarding restrictions on social contact may have influenced transmission rates. Our findings may guide clinical decision making, use of personal protective equipment and development of evidence-based guidelines during the current COVID-19 pandemic. More importantly, they may reassure the vulnerable population of pregnant women and their healthcare providers, helping to normalize the pregnancy and childbirth experience for the > 97% of women who test negative for SARS-CoV-2 at delivery. Many modifications and downscaling measures in maternal–fetal care have been taken, including spacing antenatal visits, applying telemedicine and limiting the presence of partners during visits or even delivery. Without questioning the severity of the pandemic, we should reflect on how pregnant women have perceived not receiving optimal antenatal care, in addition to their concerns about COVID-19. Table S1 COVID-19 patient data in Belgium Figure S1 Incidence (cases per 1000) of COVID-19 in Flanders and Brussels. Locations of four hospitals providing data for these analyses are indicated in red. Figure adapted from Sciensano ( https://www.sciensano.be/en). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.