Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis

BJOG. 2020 Oct;127(11):1324-1336. doi: 10.1111/1471-0528.16362. Epub 2020 Jul 22.


Background: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified?

Objective: To estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction.

Search strategy: Two biomedical databases were searched between September 2019 and June 2020.

Selection criteria: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported.

Data collection and analysis: Data were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission.

Main results: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated.

Conclusions: Neonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother.

Tweetable abstract: Risk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.

Keywords: COVID-19; SARS-COV-2; artificial feeding; birth; breast-feeding; caesarean; disambiguation; duplicate publication; isolation; neonatal infection; pregnancy.

Publication types

  • Systematic Review

MeSH terms

  • Betacoronavirus
  • Bottle Feeding / statistics & numerical data*
  • Breast Feeding / statistics & numerical data*
  • Breast Milk Expression
  • COVID-19
  • Cesarean Section / statistics & numerical data*
  • China / epidemiology
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / transmission*
  • Delivery, Obstetric / statistics & numerical data
  • Female
  • Humans
  • Infant Formula*
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / statistics & numerical data*
  • Milk, Human
  • Mother-Child Relations
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / transmission*
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Risk Factors
  • SARS-CoV-2