Severe COVID-19 during Pregnancy and Possible Vertical Transmission

Am J Perinatol. 2020 Jun;37(8):861-865. doi: 10.1055/s-0040-1710050. Epub 2020 Apr 18.

Abstract

There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons. KEY POINTS: · We report a severe presentation of COVID-19 in pregnancy requiring invasive ventilatory support.. · This is a case of positive RT-PCR in first day of life, suggesting possible vertical transmission.. · There were no detectable maternal antibodies for COVID-19 until after delivery..

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Betacoronavirus* / isolation & purification
  • Betacoronavirus* / pathogenicity
  • Cesarean Section / methods*
  • Clinical Laboratory Techniques / methods
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / physiopathology
  • Coronavirus Infections* / therapy
  • Coronavirus Infections* / transmission
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases* / physiopathology
  • Infant, Newborn, Diseases* / therapy
  • Infant, Newborn, Diseases* / virology
  • Infectious Disease Transmission, Vertical
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / physiopathology
  • Pneumonia, Viral* / therapy
  • Pneumonia, Viral* / transmission
  • Pregnancy
  • Pregnancy Complications, Infectious* / physiopathology
  • Pregnancy Complications, Infectious* / therapy
  • Pregnancy Complications, Infectious* / virology
  • Pregnancy Outcome
  • Respiration, Artificial / methods*
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / physiopathology
  • Respiratory Insufficiency* / therapy
  • Severity of Illness Index

Supplementary concepts

  • COVID-19
  • COVID-19 diagnostic testing
  • severe acute respiratory syndrome coronavirus 2

Grant support

Funding None.