SARS-CoV-2 Infection in Pregnancy – a Review of the Current Literature and Possible Impact on Maternal and Neonatal Outcome

 

 Permissions and Reprints

Abstract

In December 2019, cases of pneumonia of unknown cause first started to appear in Wuhan in China; subsequently, a new coronavirus was soon identified as the cause of the illness, now known as Coronavirus Disease 2019 (COVID-19). Since then, infections have been confirmed worldwide in numerous countries, with the number of cases steadily rising. The aim of the present review is to provide an overview of the new severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) and, in particular, to deduce from it potential risks and complications for pregnant patients. For this purpose, the available literature on cases of infection in pregnancy during the SARS epidemic of 2002/2003, the MERS (Middle East respiratory syndrome) epidemic ongoing since 2012, as well as recent publications on cases infected with SARS-CoV-2 in pregnancy are reviewed and reported. Based on the literature available at the moment, it can be assumed that the clinical course of COVID-19 disease may be complicated by pregnancy which could be associated with a higher mortality rate. It may also be assumed at the moment that transmission from mother to child in utero is unlikely. Breastfeeding is possible once infection has been excluded or the disease declared cured.

• References/Literatur

• 1 Hui DS. Epidemic and Emerging Coronaviruses (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome). Clin Chest Med 2017; 38: 71-86
  CrossrefPubMedGoogle Scholar
• 2 Report It. Coronaviridae. 2011. Online: https://talk.ictvonline.org/ictv-reports/ictv_9th_report/positive-sense-rna-viruses-2011/w/posrna_viruses/222/coronaviridae last access: 04.03.2020
  PubMedGoogle Scholar
• 3 Li Q, Guan X, Wu P. et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020; DOI: 10.1056/NEJMoa2001316.
  CrossrefPubMedGoogle Scholar
• 4 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506
  CrossrefPubMedGoogle Scholar
• 5 Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020; DOI: 10.1016/S1473-3099(20)30120-1.
  CrossrefPubMedGoogle Scholar
• 6 Zhu N, Zhang D, Wang W. et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733
  CrossrefPubMedGoogle Scholar
• 7 Guan W-J, Ni Z-Y, Hu Y. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; DOI: 10.1056/NEJMoa2002032.
  CrossrefPubMedGoogle Scholar
• 8 Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020; DOI: 10.1001/jama.2020.2648.
  CrossrefPubMedGoogle Scholar
• 9 Holshue ML, DeBolt C, Lindquist S. et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020; 382: 929-936
  CrossrefPubMedGoogle Scholar
• 10 Yu ITS, Li Y, Wong TW. et al. Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus. N Engl J Med 2004; 350: 1731-1739
  CrossrefPubMedGoogle Scholar
• 11 Yong Z, Cao C, Shuangli Z. et al. Notes from the Field: Isolation of 2019-nCoV from a Stool Specimen of a Laboratory-Confirmed Case of the Coronavirus Disease 2019 (COVID-19). China CDC Weekly; 2020 Online: https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus/-2019-ncov-studies-research-academia/830233-china-isolation-of-2019-ncov-from-a-stool-specimen-of-a-laboratory-confirmed-case-of-the-coronavirus-disease-2019-covid-19 last access: 05.03.2020
  PubMedGoogle Scholar
• 12 WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020. Online: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf last access: 04.03.2020
  PubMedGoogle Scholar
• 13 Madinger NE, Greenspoon JS, Gray Ellrodt A. Pneumonia during pregnancy: Has modern technology improved maternal and fetal outcome?. Am J Obstet Gynecol 1989; 161: 657-662
  CrossrefPubMedGoogle Scholar
• 14 Rigby FB, Pastorek JG. Pneumonia During Pregnancy. Clin Obstet Gynecol 1996; 39: 107-119
  CrossrefPubMedGoogle Scholar
• 15 Benedetti TJ, Valle R, Ledger WJ. Antepartum pneumonia in pregnancy. Am J Obstet Gynecol 1982; 144: 413-417
  CrossrefPubMedGoogle Scholar
• 16 Berkowitz K, LaSala A. Risk factors associated with the increasing prevalence of pneumonia during pregnancy. Am J Obstet Gynecol 1990; 163: 981-985
  CrossrefPubMedGoogle Scholar
• 17 WHO. Consensus Document on the Epidemiology of Severe Acute Respiratory Syndrome (SARS). 2003. Online: https://www.who.int/csr/sars/en/WHOconsensus.pdf last access: 04.03.2020
  PubMedGoogle Scholar
• 18 Anker M. Pregnancy and emerging diseases. Emerg Infect Dis 2007; 13: 518-519 author reply 519
  CrossrefPubMedGoogle Scholar
• 19 Wong SF, Chow KM, Leung TN. et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191: 292-297
  CrossrefPubMedGoogle Scholar
• 20 Ng PC, Leung CW, Chiu WK. et al. SARS in newborns and children. Biol Neonate 2004; 85: 293-298
  CrossrefPubMedGoogle Scholar
• 21 Shek CC, Ng PC, Fung GP. et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics 2003; 112: e254
  CrossrefPubMedGoogle Scholar
• 22 Lam CM, Wong SF, Leung TN. et al. A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome. BJOG 2004; 111: 771-774
  CrossrefPubMedGoogle Scholar
• 23 Zhang JP, Wang YH, Chen LN. et al. [Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome]. Zhonghua Fu Chan Ke Za Zhi 2003; 38: 516-520
  PubMedGoogle Scholar
• 24 Robertson CA, Lowther SA, Birch T. et al. SARS and Pregnancy: A Case Report. Emerg Infect Dis 2004; 10: 345-348
  CrossrefPubMedGoogle Scholar
• 25 Stockman LJ, Lowther SA, Coy K. et al. SARS during Pregnancy, United States. Emerg Infect Dis 2004; 10: 1689-1690
  CrossrefPubMedGoogle Scholar
• 26 Yudin MH, Steele DM, Sgro MD. et al. Severe acute respiratory syndrome in pregnancy. Obstet Gynecol 2005; 105: 124-127
  CrossrefPubMedGoogle Scholar
• 27 WHO. Middle East respiratory syndrome coronavirus (MERS-CoV). 2019. Online: https://www.who.int/emergencies/mers-cov/en/ last access: 04.03.2020
  PubMedGoogle Scholar
• 28 Drosten C, Meyer B, Muller MA. et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med 2014; 371: 828-835
  CrossrefPubMedGoogle Scholar
• 29 Yadav S, Rawal G, Baxi M. An Overview of the Latest Infectious Diseases around the World. 2016. J Community Health Manag 2016; 3: 41-43 doi:10.5958/2394-2770.2016.00014.4
  PubMedGoogle Scholar
• 30 Robert Koch-Institut. Informationen des RKI zu MERS-Coronavirus. 2019. Online: https://www.rki.de/DE/Content/InfAZ/M/MERS_Coronavirus/MERS-CoV.html last access: 05.03.2020
  PubMedGoogle Scholar
• 31 Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect 2019; 52: 501-503
  CrossrefPubMedGoogle Scholar
• 32 Ng WF, Wong SF, Lam A. et al. The placentas of patients with severe acute respiratory syndrome: a pathophysiological evaluation. Pathology 2006; 38: 210-218
  CrossrefPubMedGoogle Scholar
• 33 Zhu H, Wang L, Fang C. et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9: 51-60
  CrossrefPubMedGoogle Scholar
• 34 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; DOI: 10.1016/S0140-6736(20)30360-3.
  CrossrefPubMedGoogle Scholar
• 35 Chen S, Huang B, Luo DJ. et al. [Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases]. Zhonghua Bing Li Xue Za Zhi 2020; 49: E005
  PubMedGoogle Scholar
• 36 Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow?. Acta Obstet Gynecol Scand 2020; DOI: 10.1111/aogs.13836.
  CrossrefPubMedGoogle Scholar
• 37 Rasmussen SA, Smulian JC, Lednicky JA. et al. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. Am J Obstet Gynecol 2020; DOI: 10.1016/j.ajog.2020.02.017.
  CrossrefPubMedGoogle Scholar
• 38 Europäisches Institut für Stillen und Laktation e.V.. Coronavirus/COVID-19 und Stillen: Aktuelle Empfehlungen. 2020. Online: http://www.stillen-institut.com/de/coronavirus-covid-19-und-stillen-aktuelle-empfehlungen.html?fbclid=IwAR3F8_iFQDAmyHxhGHtGlXPLy8VPGKFW9DlOsFKH2cTqE2ci6_rEN7yed3c last access: 09.03.2020
  PubMedGoogle Scholar
• 39 Hinweise und FAQ vom Berufsverband der Frauenärzte e. V. (BVF) und der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe e. V. (DGGG) vereint im German Board and College of Obstetrics and Gynecology (GBCOG) zu den Risiken des Coronavirus (SARS-CoV-2) für schwangere Frauen und Säuglinge. Online: https://www.dggg.de/news/hinweise-und-faq-zum-coronavirus-fuer-schwangere-und-saeuglinge-1181/ last access: 19.03.2020
  PubMedGoogle Scholar