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Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases

Our take —

COVID-19 outcomes among pregnant women in China did not appear to be more severe in this study than among the wider population. Risks of spontaneous abortion and preterm birth did not appear to be elevated with SARS-CoV-2 infection, but background risks were not provided. There was one neonatal death out of 99 deliveries, and no maternal deaths, though follow-up was incomplete. Vertical transmission was not detected, consistent with smaller case reports. More comprehensive studies are needed to definitively rule out the possibility of vertical transmission during pregnancy, birth, and breastfeeding.

Study design

Case Series

Study population and setting

This case series included 116 pregnant women (mean age 30.8 years, median gestational age 38 weeks) with laboratory-confirmed or clinically confirmed COVID-19 from 25 hospitals in China from January 20 to March 4, 2020. Patient data were extracted from electronic medical records, including pregnancy and neonatal outcomes when available. Follow-up for outcomes was concluded on March 24, 2020. Neonatal pharyngeal swab samples were tested for presence of SARS-CoV-2 RNA. Additionally, a limited number of amniotic fluid, cord blood, vaginal secretions and breast milk samples were tested for SARS-CoV-2. The primary endpoint was a composite of ICU admission, mechanical ventilation, or death; secondary endpoints were spontaneous abortion, preterm delivery, Caesarean delivery, and vertical transmission of SARS-CoV-2 to neonates.

Summary of Main Findings

Eight patients had severe COVID-19 pneumonia and were admitted to the ICU; of these, two required invasive mechanical ventilation. There was one spontaneous abortion at five weeks. By the end of follow-up, there were no maternal deaths and 76 (66%) patients had been discharged. 99 (85%) women delivered babies during hospitalization, and 85 (86%) of these deliveries were Caesarean. No fetal deaths occurred; one neonate died of asphyxia two hours after birth, whose mother had required invasive mechanical ventilation after admission. Two births (2%) occurred before 34 weeks and 21 (21%) occurred before 37 weeks of gestation; of these, 6 involved preterm premature rupture of the membranes (PPROM). Zero positive tests for SARS-CoV-2 were observed among 86 neonates tested with pharyngeal swabs (10 of whom also had paired cord blood/amniotic fluid samples), vaginal secretion samples from 6 women, and breast milk samples from 12 women.

Study Strengths

Relative to other studies of COVID-19 in pregnant women, this is a larger sample with reasonably long follow-up.

Limitations

The pregnant women included in this study were symptomatic, and likely represent more severe clinical disease than all pregnant women infected with SARS-CoV-2. A large proportion (44%) of women were diagnosed clinically, without laboratory confirmation. By the end of follow-up, 40 women remained in the hospital, and 16 women had not yet delivered; outcome proportions may change with longer follow-up. Very few samples of vaginal secretion and breast milk were tested.

Value added

This is one of the largest studies to date of maternal and neonatal outcomes of SARS-CoV-2 infection in pregnant women.