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Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study

Our take —

This case series from China provides early data showing positive maternal and neonatal outcomes among a very small sample of 7 pregnant women with mild COVID-19 disease in the later part of their third trimester. Though one neonate was infected with SARS-CoV-2 at 36 hours after birth, the mode of transmission was indeterminate, as the placenta and cord blood results were negative. Larger studies are needed to evaluate vertical transmission, and to assess maternal and fetal outcomes of SARS-CoV-2 infections in earlier stages of pregnancy.

Study design

Case Series

Study population and setting

This case series included 7 women who were 37-41 weeks pregnant with laboratory-confirmed COVID-19 pneumonia who were admitted to Tongji Hospital in Wuhan, China from January 1 to February 8, 2020. Neonatal outcomes were assessed during hospitalization and by phone interview 28 days after birth.

Summary of Main Findings

Fever was the only common symptom at admission (6/7). Shortness of breath, cough, and diarrhea present in one patient each. All had pneumonia (6 had bilateral pneumonia). While leucocyte counts were normal, absolute lymphocyte counts were reduced, and CRP, D-dimer, and erythrocyte sedimentation rate were elevated. All women received oxygen by nasal catheter, multiple antiviral treatments, antibiotics, and traditional Chinese medicines, and five women began corticosteroids after delivery. Cesarean section was performed on all at an average gestational age of 39 weeks. All neonates had normal birth weights and Apgar scores, and none had reported symptoms or complications 28 days after birth. Among the three neonates tested for SARS-CoV-2 by nasopharyngeal swab, one tested positive 36 hours after birth. However, the virus was not found in the associated placental or cord blood samples. The infected neonate had a mild clinical course with no fever or cough, mild shortness of breath, and mild pulmonary infection on chest x-ray, and was discharged after two weeks of neonatal care.

Study Strengths

The pregnant women in the case series were characterized on many important factors, including medical history, multiple laboratory parameters, radiographic data, and detailed data on interventions received.

Limitations

The study included only seven women, all with mild disease, and is not adequate to reliably characterize the clinical manifestations and neonatal outcomes of COVID-19 in late pregnancy. The study is not informative about the effects of COVID-19 in earlier pregnancy during organogenesis or maturation. The series does not provide data on outcomes of vaginal births among mothers with COVID-19. Finally, the study did not systematically assess perinatal transmission, testing for SARS-CoV-2 in only three of the infants; the timing and methods for testing of neonates and specimens relevant to vertical transmission were not described.

Value added

This Case Series was the first published study on COVID-19 in pregnancy.