COVID-19 Infection During Pregnancy: Fetus as a Patient Deserves More Attention

J Perinat Med. 2020 Jun 25;48(5):438-440. doi: 10.1515/jpm-2020-0181.

Abstract

The novel coronavirus disease 2019 (COVID-19) pandemic is causing concern also for the management and outcome of COVID-19-positive pregnant women and their offspring, as reported cases are rare. Current evidence suggests the association of COVID-19 infection in pregnancy with both severe maternal morbidity requiring intensive care and perinatal complications (preterm birth with consequent neonatal morbidity and even perinatal death). Most of the reported cases focused specifically on the maternal outcomes and possible vertical transmission, but less attention has been paid to fetus as a patient in such pregnancies. The use of antenatal steroids and fetal neuroprotection with magnesium sulfate is clearly underreported. Several recently issued guidelines suggest lowering the upper gestational age for antenatal steroid administration and also advocate extreme caution or even restraining from the use of magnesium sulfate. Also, the rate of cesarean deliveries among COVID-19 women is unacceptably high. Here we provide arguments for NOT changing the existing guidelines and caution against cesarean delivery that was the prevalent delivery mode in the reported cases and case series.

Keywords: COVID-19; antenatal steroids; delivery mode; fetal neuroprotection; pregnancy.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Betacoronavirus*
  • Coronavirus Infections / therapy*
  • Coronavirus Infections / transmission
  • Delivery, Obstetric / methods
  • Female
  • Fetal Therapies / methods*
  • Fetal Therapies / standards
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control
  • Magnesium Sulfate / therapeutic use
  • Neuroprotective Agents / therapeutic use
  • Pandemics
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / transmission
  • Practice Guidelines as Topic
  • Pregnancy
  • Pregnancy Complications, Infectious / therapy*
  • Premature Birth / therapy
  • Premature Birth / virology
  • Prenatal Care / methods*
  • Prenatal Care / standards

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Neuroprotective Agents
  • Magnesium Sulfate

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2