Contrary to the previous understanding of the disease, COVID-19 may be passed to the fetus, studies in JAMA suggest. Image by Sharon McCutcheon via Unsplash.
We have previously noted in these Bulletins and in our monthly newsletter, the VOICE, that early Chinese data suggested that COVID-19 demonstrates fewer adverse effects on pregnancy than the influenza virus, which is known to cause more severe disease in pregnancy and is associated with significantly increased prematurity risk. We also pointed out that the virus apparently does not cross the placenta into the fetus. We also, however, pointed out that those were very preliminary data and that caution was, therefore, indicated in interpreting those results.
As of today, three studies offer potential suggestions to the contrary: A single case report from China published in this week’s JAMA claims birth by cesarean section of as single infant to a mother with confirmed COVID-19. The infant allegedly demonstrated immediately after birth IgM antibodies to the virus. IgM antibodies are immediate response antibodies within 30 days from infection and, because of their size, are not able to pass the placental barrier. If found at birth in an infant, they, therefore, must have been produced by the infant in-utero prior to birth in response to presence of COVID-19 in the fetus.
A second study from China in the same JAMA issue reported on 6 women infected with COVID-19. Like the first case, they all delivered by cesarean and at term. Two of the 6 newborns demonstrated mildly elevated IgM levels as well. The first case and 2 newborns in the second paper also demonstrated elevated inflammatory cytokines, suggestive of inflammatory responses of their immune systems.
Both of these reports, therefore, raise the possibility of virus transmission to the fetus via the placenta. The good news, however, is that none of the newborns cultured positive for the virus, nor did any of the newborns demonstrate any clinical symptoms and all were delivered in excellent condition at term.
A third study from China, published in JAMA Pediatrics investigated 33 neonates born to infected mothers. Among those only 3/33 (9.1%) neonates were found to be infected. Testing was, however, done 48 hours after birth and, as an accompanying editorial noted, the COVID-19 infection in the 3 newborns may have occurred after delivery.
In summary, the picture, therefore, is still rather murky but it increasingly looks like COVID-19 may be behaving similarly to the influenza virus. The American College of Obstetricians and Gynecologists (ACOG), therefore, published an opinion that pregnant women should be considered an at-risk population for COVID-19 (i.e., like with influenza virus, may have an increased risk of catching the virus).
Within this context, ACOG and the Center for Disease Control and Prevention (CDC) recommend that mothers with confirmed COVID-19 after birth be separated from their newborns for at least two weeks. Being pregnant and delivering during COVI-19 times also creates other inconveniences: Hospitals have greatly restricted visiting opportunities to labor floors and postpartum units. Birth celebrations in families, therefore, often have to take place via Skype.
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Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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