Vertical transmission of SARS CoV-2: a systematic review

COVID-19 in a 26-week preterm neonate

SynopsisSARS‐CoV‐2 was detected in the vaginal and cervical fluid, amniotic fluid, cord blood, placental membranes, and breastmilk of pregnant women, therefore suggesting the possibility of vertical transmission.

The Importance of Continuing Breastfeeding during Coronavirus Disease-2019: In Support of the World Health Organization Statement on Breastfeeding during the Pandemic

IntroductionThe evidence for vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not well established. Therefore, the objective of this review is to summarize emerging evidence on the vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2.MethodsWe conducted a systematic search in PubMed, CINAHL, Web of Science, SCOPUS, and CENTRAL. Likewise, a search for preprint publications was conducted using MedRxiv and Research Square. Studies that addressed vertical transmission of SARS-CoV-2 (concept) among pregnant women infected by Covid-19 (population) in any setting (community, hospital, or home) in any country or context were considered for inclusion. Any types of studies or reports published between December 2019 and September 2020 addressing the effects of SARS-CoV-2 on pregnant women and their newborn babies were included. Studies were screened for eligibility against the inclusion criteria for the review by two reviewers.ResultsWe identified 51 studies reporting 336 newborns screened for COVID-19. From the 336 newborns screened for COVID-19, only 15 (4.4%) were positive for throat swab RT-PCR. All neonates with positive throat swab RT-PCR were delivered by cesarean section. Among neonates with throat swab SARS-CoV-2 positive only five (33.3%) had concomitant placenta, amniotic fluid, and cord blood samples tested, of which only one amniotic fluid sample is positive for RT PCR. Five neonates had elevated IgG and IgM but without intrauterine tissue tested. Four neonates had chest imaging suggestive of COVID-19 pneumonia.ConclusionCurrently there is not enough evidence on vertical virologic transmission of COVID-19 infection during the third trimester of pregnancy. Additionally, there is no evidence to support cesarean delivery, abstaining from breast feeding nor mother and infant separation. Further research involving an adequate sample size of breast milk, placenta, amniotic fluid, and cord blood to ascertain the possibility of vertical transmission and breast milk transfer is needed.

After completing this article, readers should be able to: Over the past 50 to 60 years, human milk has been described and recognized as the best first food for human infants; breast is best! Human milk provides substantial nutritional, cognitive, emotional, and immunologic benefits for the infant. Such ongoing acclamation is based on the observations and experiences of mothers, families, midwives, doulas, nutritionists, nurses, physicians, and scientists.Over the past 30 years, scientific study and research have accumulated and now constitute a large body of evidence documenting the actual benefits of breastfeeding for the infant and the mother. This article examines and references much of this evidence-based data in describing human milk and how it contributes to the health and well-being of infants and mothers.The Agency for Healthcare Research and Quality (AHRQ) Report on Breastfeeding in Developed Countries summarizes evidence (published in English through May 2006) on breastfeeding in maternal and infant health. (1) More than 9,000 abstracts were considered, and data from more than 400 individual studies were included after evidence-based review of meta-analyses, updated systematic review of the data, and newly performed systematic reviews. It is important to emphasize that this report included data from developed countries only. Table 1presents definitions of breastfeeding that are particularly useful in "quantification" as standard definitions used in clinical studies.Nineteen specific outcomes were reviewed by the AHRQ research team, including 13 for term infants and six for mothers. The outcomes for infants were: incidence of acute otitis media, atopic dermatitis, gastrointestinal (GI) infections, lower respiratory tract infections, asthma, obesity, type 1 and 2 diabetes, childhood leukemia, infant mortality, and sudden infant death syndrome as well as cognitive development and the risk of cardiovascular disease. Factors studied in mothers were: return to prepregnancy weight and incidence of type 2 diabetes, osteoporosis, postpartum depression, breast cancer, and ovarian cancer.For infants, the meta-analyses or systematic reviews strongly favored breastfeeding over not breastfeeding for a reduced risk of acute otitis media, GI infections, asthma (regardless of whether there was a family history of asthma), type 2 diabetes, leukemia, and sudden infant death syndrome. The meta-analysis of GI infections reported a crude odds ratio for 14 cohort studies of 0.36 (95% confidence interval [CI] 0.32 to 0.41) strongly favoring breastfeeding (ever) in reducing the risk of GI infection in infants younger than 1 year of age (Fig. 1). Another analysis reported on two case-control studies demonstrating a summary odds ratio of 0.54 (95% CI 0.36 to 0.80) again favoring breastfeeding. A separate analysis demonstrated that infants breastfeeding exclusively for greater than 3 months' or greater than 6 months' duration had significant reductions in the risk of acute otitis media compared with infants who were never breastfed. The analysis of infants developing atopic dermatitis (who had a family history of atopic disease) demonstrated that the risk for atopic dermatitis was lower in infants breastfed exclusively for longer than 3 months compared with children who were breastfed for less than 3 months. An analysis examining lower respiratory tract infections showed an overall reduced risk of hospitalization due to lower respiratory tract infections in infants (<1 year of age) who were breastfed exclusively for 4 months or longer compared with infants who were never breastfed (Fig. 1).The report presented two meta-analyses and a systematic review demonstrating a reduced risk of breast cancer associated with breastfeeding primarily in premenopausal women. One meta-analysis that included 45 studies showed a 4.3% reduction in risk for each year of breastfeeding. A second meta-analysis that included 23 studies demonstrated a 28% reduced risk of breast cancer for 12 months or more of breastfeeding. The AHRQ team performed a meta-analysis of 9 "fair" quality studies that included 4,387 cases of ovarian cancer and more than 10,000 controls. This new meta-analysis showed an association between breastfeeding and a reduced risk of ovarian cancer. Cumulative lifetime breastfeeding duration of more than 12 months was associated significantly with a decreased risk of ovarian cancer compared with never breastfeeding. This benefit was not seen for cumulative duration of breastfeeding of less than 12 months (Fig. 2). Additional data are needed to confirm a dose-response relationship between breastfeeding and a reduced risk of ovarian cancer.The analysis for type 2 diabetes, involving two very large cohort studies, showed that breastfeeding was associated with a reduced risk of developing type 2 diabetes in women who did not have a history of gestational diabetes. Each additional year of lifelong breastfeeding was associated with a 4% to 12% risk reduction in the two different cohorts. Breastfeeding did not appear to lead to a reduced risk of developing type 2 diabetes in women who had gestational diabetes. The studies on return to prepregnancy weight, osteoporosis, and postpartum depression were unable to demonstrate an association between breastfeeding and these specific maternal health outcomes due to methodologic issues and the effect of other contributing factors or confounders.These high-quality, evidence-based data from the AHRQ Report support breastfeeding as providing significant health benefits to both the mother and infant, even in developed countries. A larger body of evidence from developing countries examines the benefits of breastfeeding in locales where the risk of infection in infants and children is high due to poor sanitation, low water quality, contaminated food sources, and other variables. This benefit is well documented for diarrheal disease, respiratory infections, and otitis media.Beyond the evidence-based medicine measures is the realm of attachment and bonding between infant and mother and the psychological and developmental benefits of breastfeeding for the mother and infant. How these spheres are influenced by breastfeeding has been studied extensively in many different countries and cultures. Close and frequent contact between the mother and infant, especially skin-to-skin contact, affects the mother's attachment to the infant positively. The positive feelings affected by the close (skin-to-skin) and frequent early contact facilitate successful breastfeeding, longer duration of breastfeeding, and more attachment behavior (fondling, kissing, and caressing the infant). Recognition of these effects has led to more direct contact between the infant and his or her parents in the delivery and postpartum areas. Such recognition has supported the recommendation to allow placement of the infant in direct skin-to-skin contact with the mother in the first hour after birth to encourage successful breastfeeding. The multiple contributory factors to infant development makes it difficult to demonstrate a causative connection between early skin-to-skin contact or breastfeeding and overall infant and child development, emotional stability, personality, attachment, or person-to-person interactions.The impact of different methods of feeding infants on the onset of allergy has been researched. A meta-analysis of 18 prospective studies involving term infants who had a family history of atopy found a reduction of 42% (95% CI, 8% to 59%) in the risk of atopic dermatitis for infants breastfed for at least 3 months compared with those who were breastfed for less than 3 months. (1)Studies on asthma were less definitive. The AHRQ reported that breastfeeding for at least 3 months was calculated to provide a 27% (95% CI, 8% to 41%) reduction in the risk of asthma in children who had no family history of asthma compared with children who were not breastfed. Children who had a family history of asthma had a 40% risk (95% CI, 18% to 57%) reduction in the occurrence of asthma before 10 years of age if breastfed for 3 months compared with those not breastfed. The risk for children older than 10 years is less clear. Exclusive breastfeeding for the first 6 months is recommended by the American Academy of Pediatrics (AAP) for many reasons, including reducing the risk of allergy. Further if supplementation is necessary, an amino acid-based formula is recommended (hypoallergenic formula).The milk available in the breast after 16 weeks' gestation is called prepartum milk. When the infant delivers and is placed at the breast (or is allowed to find his or her way) to suckle, the milk is colostrum for the next few days. A gradual change from this transition milk to mature milk usually occurs by 14 days. Postpartum colostrum is called "the first immunization" because it contains high concentrations of antibodies and other infection-protective elements, including cells. Colostrum is high in total protein, low in carbohydrate, and lower in fat than mature milk. The amount of milk produced in the first 24 hours after birth is approximately 50 g, with 190 g produced by the second 24 hours, 400 g by the third 24 hours, and 1,100 g/24 hours by the fourteenth day (800 to 1,000 mL). Human milk and cow milk differ substantially in their composition (Table 2).The proteins differ in quality and quantity. In its unaltered form, cow milk contains too much protein, too much casein, too much sodium, and too much phosphorus and has too high a solute load for a human infant. Formulas have been designed to improve these issues. Cow milk does not contain any taurine, an amino acid that has high concentrations in human milk and is essential to infant brain growth. The profile of amino acids in cow milk differs significantly from human milk, especially phenylalanine and tyrosine, which are at high concentrations in cow milk and formula and contribute to problems in phenylketonuria.The effect of higher protein in infant formula recently has been questioned by investigators of the obesity epidemic. It has been suggested that a constant intake of high protein in infancy stimulates the metabolic rate and contributes to the long-term obesity of formula-fed infants. After processing, cow milk and infant formulas contain no cells, no enzymes, and no antibodies or other active protective agents and do not support the maintenance of physiologic flora of the infant's GI tract.Docosahexaenoic acid (DHA) has received considerable attention because studies in preterm infants have demonstrated improved visual acuity and auditory acuity in those fed human milk compared with those fed regular preterm formula. When DHA was added to formula, the acuity improved but did not reach the scores achieved by breastfed infants. DHA and omega-3 fatty acids derived from bacterial culture are added to many formulas, although a benefit has not been proven.Vitamin concentrations in human and cow milk are comparable, except for vitamin C, which is significantly higher in human milk (100 mg/d). Vitamins in infant formula exceed the concentrations found naturally. Vitamin D has become an important issue because the vitamin D generated in human skin from exposure to sunshine has diminished through the use of sunscreen, wearing of clothing to shade from the sun, pollution of the air by industrial waste, and migration of dark-skinned populations to climates with less sun. Pregnant women have been documented in recent decades to pass less vitamin D to the fetus, so newborns lack sufficient stores at birth. As a result, breastfed infants now are given 400 U daily from birth. Investigative work continues on the benefits of providing pregnant and lactating women with 1,000 U of vitamin D daily. Most, but not all, infant formulas contain 400 U of vitamin D in 26 to 32 oz of reconstituted formula.Vitamin K content presents an important issue for the newborn who is born with low concentrations, even when the mother receives extra doses at the time of delivery. Hemorrhagic disease of the newborn, with GI or intracranial hemorrhage and generalized bleeding, can present early or up to several weeks after birth and is due to relative deficiencies of vitamin K-dependent coagulation factors. Such deficiency has resulted in all newborns receiving 1 mg of vitamin K intramuscularly at birth, regardless of the proposed mode of feeding. If vitamin K is administered orally, multiple doses should be provided. Formula has extra vitamin K, so an infant who receives 26 to 32 oz per day of formula receives 4 mg of vitamin K orally daily. Concentrations in human milk and cow milk are lower.Neonates and infants are immunologically immature and at increased risk for infection. Such developmental immune defects are only some of the factors that place infants at greater risk of infection. In the first 6 postnatal months, phagocyte function is immature, with limited ability to migrate to the site of infection, and reserve production of phagocytes in response to infection is limited. Cell-mediated immunity develops throughout childhood. Defects are particularly apparent in the first 6 months after birth, including decreased cytokine production, decreased natural killer cell function, poor stimulation of B cells for antibody production, and limited numbers of mature functioning T cells. In addition, function of the classical and alternative pathways of complement formation and activation is decreased. Immunoglobulin (Ig) production is limited in amount and repertoire, including poor isotype switching, limited IgG subclass production, and low serum IgA concentrations through 7 to 8 years of age.Human milk not only bolsters the infant's immature immune response by providing numerous bioactive factors that dynamically affect the innate, adaptive, and mucosal immunity against specific infectious agents but also by influencing immune system development and maturation of the mucosal barrier. A very clear dose-response relationship has been documented between the amount (full [exclusive], partial, token) and duration of breastfeeding and the benefits gained by the infant and mother. (See Table 1 for the definitions.) Most bioactive factors exert their effects at the level of the mucosal immune system. Igs are the best recognized and studied bioactive components in human milk. Igs in human milk are predominantly secretory IgA, with much smaller amounts of IgM and IgG. Colostrum contains higher amounts of Igs and immunologically competent mononuclear cells than transitional or mature milk. The Igs function by binding directly to specific microbial antigens, blocking binding and adhesion to host cells, enhancing phagocytosis, and modulating local immune response. Table 3 in the online edition of this article lists specific antibodies that have been identified in human milk.The actual antibodies against specific microbial agents present in an individual woman's milk depends on her exposure and response to the particular agents. Not every mother has antibodies in her milk against every microbe. The predominant action of Igs in human milk is seen at the mucosal level of the infant's mouth, nasopharynx, and GI tract, where they bind to and block the infectious entry of microbial agents through the mucosal barrier. Although best recognized and remembered in association with "specific" protection against individual infectious agents, Igs provide only a small portion of the overall immunologic benefit of human milk.Other important individual bioactive proteins include lactoferrin, lysozyme, alpha-lactalbumin, and casein. Lactoferrin exerts its effects via iron chelation, which contributes to limiting bacterial growth, blocking adsorption and penetration of viruses and adhesion of bacteria, and enhancing intestinal cell growth and repair. Lysozyme binds to endotoxin, increases macrophage activation, and contributes to bacterial cell wall lysis. Lactalbumin transports calcium and enhances the growth of Bifidobacterium, and a modified lactalbumin (in the gut) affects immune modulation. Casein limits adhesion of bacteria and facilitates the growth of Bifidobacterium. Carbohydrates are an important nutritional component in human milk, and the specific carbohydrates lactose, oligosaccharides, and glycoconjugates act as bioactive factors. Oligosaccharides act as prebiotics, enhancing the growth of specific probiotic bacteria in breastfed infants, and both oligosaccharides and glycoconjugates bind specific microbial antigens.Lipids in the form of triglycerides, long-chain polyunsaturated fatty acids, and free fatty acids (FFAs) have a lytic effect on many viruses and are active against Giardia as well. Nucleotides, nucleosides, and nucleic acids comprise more than 15% of the nonprotein nitrogen in human milk. Nucleotides serve many crucial roles in energy metabolism, nucleic acid production, and signal transduction, processes of increased importance during the cellular activation and replication related to an active immune response. Research related to the "essential" nature of nucleotides in protection against infection has led to the addition of nucleotides to some infant formulas. Cytokines and soluble receptors of cytokines are other examples of bioactive factors that serve several functions. Cytokines can act as functional growth factors and have both inflammatory and anti-inflammatory effects in different situations.Hormones and growth factors, including erythropoietin, epidermal growth factor, insulin, insulin-like growth factor, nerve growth factor, and transforming growth factor-alpha, stimulate the growth and maturation of the GI tract and, to a degree, systemic growth. These bioactive factors are less specific than Igs, but by acting in concert with multiple factors, they provide the major portion of protective effects from human milk.The concept of immune protection without an extensive and potentially damaging inflammatory response is gaining in significance in general medicine and in breastfeeding medicine. Many of the same protective bioactive factors act at the mucosal level without stimulating a significant inflammatory response, which indirectly decreases inflammation and possible local tissue damage. Certain factors limit further inflammatory stimulation: lactoferrin blocks activation of complement, and lysozyme inhibits neutrophil chemotaxis and limits formation of toxic oxygen radicals. Various enzymes in human milk break down inflammatory molecules: catalase destroys hydrogen peroxide, histaminase destroys histamine, and arylsulfatase degrades leukotrienes. Various soluble receptors in human milk (IL-1Ra, STNF-alpha R1 and R2) bind to specific cytokines, blocking their inflammatory action.Vitamins A, C, and E, which are present in higher concentrations in human milk than in cow milk, scavenge oxygen radicals. Catalase and glutathione peroxidase as well as lactoferrin serve multiple purposes and have antioxidant properties. Prostaglandins in human milk limit superoxide production. The sum total of these anti-inflammatory effects of human milk occurring at the mucosal level limits damage to the mucosal barrier and facilitates its ongoing growth and development to further enhance human milk's protection of the infant.The concept that "normal" intestinal microflora influence the development of the local mucosal immunity and even "prime" systemic immunity is being supported by new research. Pathogen-associated molecular patterns in the microflora are recognized by toll-like receptors and may contribute to the expression of toll-like receptors on intestinal epithelial cells as well as lead to "programming" of systemic T-helper cell type 1 (TH1), TH2, and TH3-like T-cell responses. Probiotic bacteria are organisms that live in the additional benefits on the which include with between cells, production of increased production, increased production of specific fatty and development of the mucosal immune usually are oligosaccharides after lower the of the local and the amount of available enhance the growth of probiotic bacteria in the Oligosaccharides are the third component in human milk in of quantity. Cow milk and formula contain less than of the oligosaccharides in human milk by The microflora of breastfed infants include and Bifidobacterium, which comprise up to of the The small portion of bacteria include and as well as and other organisms in even smaller The microflora of formula-fed infants are primarily of organisms and in much larger numbers than in breastfed infants and include very small amounts of and Bifidobacterium. and oligosaccharides, acids, including which lower the in the and limit the growth of as and molecular that by of are the of GI microflora and factors influencing intestinal and immunologic development at the level of the studies have suggested a protective of specific intestinal microflora against the risk of developing in preterm and very all the evidence for the immunologic benefits of human milk and the protection infants against specific organisms and separate clinical data also the of specific infections through human milk or direct contact with an maternal Although only a few infections are through human milk human viruses 1 and 2 and and these viruses are important because of their for or in the infant. In addition, other infections that are by human milk or breast contact should be in specific of infection through human milk is compared with the more of for and infants. infection is occurring the infection is due to through the birth and postnatal infection occurs via or contact other than with the The predominant of and the of infection are important in different clinical of the for via human milk for organisms can be and 4 and in the online edition of this article for of the for bacteria and infection of the mother with or is a to breastfeeding. on have documented approximately a rate in breastfed infants, rate in infants, and rate in exclusively formula-fed infants. that 1 of human milk can contain 1,000 T cells with studies from of that have high of have reported significant reductions in of the from mother to infant with of breastfeeding or limiting breastfeeding to less than 6 months' infection in the mother is infection that can be via human milk to the infant. In the and other of the where is successful and to breastfeeding are and mothers who have infection have been not to their infants. In of the where there is an increased risk of infectious nutritional and significant and for infants who are not breastfed and feeding is not breastfeeding by an mother can the infant the best of is in human milk and can be as and Factors associated with an increased risk of via breastfeeding include feeding breastfeeding, duration of breastfeeding, maternal and high lower in the and or in the mother. studies have documented that of the mother with breastfeeding can lead to lower for infants and lower for both mothers and infants. of the infant with breastfeeding also has been associated with decreased to the infant. Additional research on breastfeeding, and the infant's and growth are needed before an can be infection or even recent infection in a breastfeeding mother is not a to breastfeeding. infection via human milk occurs but is if significant in the term infant. In breastfeeding has been described as immunization" in the term infant. and very infants are at risk for significant postnatal infection via breastfeeding. This postnatal infection is more to between 3 and 12 weeks when occurs and milk can the load in human milk. A has been for infants human milk in that include preterm and very infants. The mothers for before providing human milk to their infants, or human milk from mothers before its and infants in the for evidence of acute the protective effects of a is the only other for which there has been evidence for via human milk with any studies the of as well as IgM and IgG antibodies against in human milk, but no clear evidence significant in infants through breastfeeding by mothers who have infection. The viruses as or is through contact with skin that contain the on the mother's or not through in the milk. of breastfeeding and milk from the mother's breast that has an identified due to of these viruses may be for the infant with maternal usually is to allow breastfeeding to via the respiratory respiratory acute respiratory are not through human milk. Most by the time a specific respiratory is in the the infant has been via respiratory is no to breastfeeding or the use of human milk, except when disease in the mother the ability to human milk. The numerous bioactive factors Igs if it is early in the maternal in human milk can provide the infant some ongoing bacterial infections in the mother is infection of the or breast or breast that the bacteria the milk or directly the infant's (See Table 4 for bacterial infections in the The risk of in the mother is related to via respiratory which is the same for breastfeeding or formula-fed infants in contact with their mothers. or of the breast are Breastfeeding or use of human milk from the mother who has can the mother is receiving and the infant is receiving or A infection of the breast can with breastfeeding. Breastfeeding or use of human milk can when the mother is with the after a during the mother's 24 hours of for the infant in with the maternal additional the same used to a specific infection in the mother are used and are in the infant and in the mother's milk. do human milk, but usually in very low

Preventing Postnatal Cytomegalovirus Infection in the Preterm Infant: Should It Be Done, Can It Be Done, and at What Cost?

Intrauterine environment and fetal allergic sensitization.

Perinatal COVID-19.

Noteworthy Professional News

The aim of this study was to measure and investigate correlations of lamotrigine concentrations in maternal as well as umbilical cord blood, amniotic fluid, and breast milk to account for the distribution of the drug. Concentrations of lamotrigine were measured in 19 mother–infant pairs at the time of delivery. To account for the penetration ratio into amniotic fluid, cord blood and breast milk, the concentration of lamotrigine in the particular environment was divided by the concentration in maternal serum. A no-intercept model was applied for associations between maternal serum concentrations, amniotic fluid, umbilical cord blood, and breast milk concentrations. The mean daily dosage of lamotrigine was 351.32 mg (range 50–650 mg). We detected associations between maternal serum and amniotic fluid (β = 0.088, p < 0.001), as well as umbilical cord (β = 0.939, p < 0.001) and breast milk (β = 0.964, p < 0.001). The median penetration ratio into amniotic fluid, cord blood, and breast milk was 0.68, 0.92, and 0.77, respectively. Lamotrigine concentrations in amniotic fluid, cord blood, and breast milk give evidence that the fetus/newborn is constantly exposed to lamotrigine. Maternal serum concentrations predicted exposure via amniotic fluid, umbilical cord, and breast milk. Data suggest that therapeutic drug monitoring can be recommended as part of the clinical routine in psychopharmacotherapy for pregnant or breastfeeding women.

The aim of this study was to measure and investigate correlations of lamotrigine concentrations in maternal as well as umbilical cord blood, amniotic fluid, and breast milk to account for the distribution of the drug. Concentrations of lamotrigine were measured in 19 mother-infant pairs at the time of delivery. To account for the penetration ratio into amniotic fluid, cord blood and breast milk, the concentration of lamotrigine in the particular environment was divided by the concentration in maternal serum. A no-intercept model was applied for associations between maternal serum concentrations, amniotic fluid, umbilical cord blood, and breast milk concentrations. The mean daily dosage of lamotrigine was 351.32mg (range 50-650mg). We detected associations between maternal serum and amniotic fluid (β=0.088, p<0.001), as well as umbilical cord (β=0.939, p<0.001) and breast milk (β=0.964, p<0.001). The median penetration ratio into amniotic fluid, cord blood, and breast milk was 0.68, 0.92, and 0.77, respectively. Lamotrigine concentrations in amniotic fluid, cord blood, and breast milk give evidence that the fetus/newborn is constantly exposed to lamotrigine. Maternal serum concentrations predicted exposure via amniotic fluid, umbilical cord, and breast milk. Data suggest that therapeutic drug monitoring can be recommended as part of the clinical routine in psychopharmacotherapy for pregnant or breastfeeding women.

Low levels of tenofovir in breast milk support breastfeeding in HBV-infected mothers treated with tenofovir disoproxil fumarate

Revisión de nuevas evidencias acerca de la posible transmisión vertical de la COVID-19

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Objective To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19. Methods This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Specimens of maternal vaginal swab were collected in six pregnant women, and the specimens of amniotic fluid, cord blood, neonatal throat swab and breast milk samples were collected in four pregnant women who had a delivery during our study. All samples were tested for the existence of COVID-19. Descriptive analysis was applied in this study. Results (1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37+5 weeks, which was 7 d after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and eight were treated with glucocorticoid. Six cases received immunotherapy. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit 2 d after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm baby was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above. Conclusions There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. So far, there is no evidence for vertical transmission or worsening perinatal outcome in mothers and babies. Key words: Coronavirus infections; COVID-19; Pneumonia, viral; Pregnancy, vertical transmission