Concerning news on COVID-19’s effects on pregnancies and newborns

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.

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.

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. 

CHR’s COVID-19 Bulletins

  1. COVID-19 accelerating the changing practice of assisted reproduction (published on October 16, 2020)
  2. [Preprint by Norbert Gleicher, MD] COVID-10 pandemic through the eyes of a New York City fertility center (published on August 20, 2020)
  3. News you, likely, will not find in the media (Published on July 6, 2020)
  4. Notable reports in medical literature and the media on COVID-19 and immunity against it (Published on July 6, 2020)
  5. COVID-19 cases rapidly increase in South and Western U.S. states but that will help build herd immunity (Published on June 29, 2020)
  6. Are we witnessing a second wave of COVID-19 outbreak? (Published on June 22, 2020)
  7. WHO was wrong about asymptomatic patients being contagious & other COVID-19 fake news (Published on June 10, 2020)
  8. Updated COVID-19 precautions at CHR (Published on June 9, 2020)
  9. What we now know about COVID-19 and what it means for mitigation strategies (Published on May 22, 2020)
  10. COVID-19 response in retrospect, as well as going forward (Published on May 7, 2020)
  11. The essence of the COVID-19 pandemic (Published on May 7, 2020)
  12. Practical consequences of COVID-19 for CHR’s fertility patients (Published May 7, 2020)
  13. IVF after COVID-19: ASRM and SART release reopening guidelines for IVF centers (Published on 4/29/2020)
  14. One medical expert, missing from all COVID-19 task forces, who should be listened to (Published on 4/29/2020)
  15. Governments worldwide should have let herd immunity develop rather than cause one of the worst recessions on wild guesses of “experts” (Published 4/27/2020)
  16. Reciprocal collaboration among IVF centers for cycle monitoring may be on the wane (Published 4/22/2020)
  17. Is embryo freezing better than IVF during COVID-19 outbreak? (Published on 4/17/2020)
  18. When to restart fertility treatments after COVID-19 (Published on 4/17/2020)
  19. “Reopening” of fertility centers after COVID-19: How that may look like (Published on 4/17/2020)
  20. Some IVF centers may never reopen (Published on 4/17/2020)
  21. Skepticism warranted for “expert opinions” on COVID-19 (Published on 4/13/2020)
  22. Fertility Providers’ Alliance tries to reframe ASRM’s reaffirmation of COVID-19 guidelines as FPA victory (Published on 4/6/2020)
  23. States in the Northeast may see first signs of “flattening the curve” (Published on 4/6/2020)
  24. Reported death rate exaggerated by the media, shelter in place or herd immunity, first COVID-19 antibody test approved, and more (Published on 4/3/2020)
  25. What can I do to continue on my fertility journey? [VIDEO] (Filmed on 3/26/2020, published on 4/2/2020)
  26. “Controversy” over ASRM recommendation hints at investor interest’s power grab amid COVID-19 pandemic (Published on 4/2/2020)
  27. Pregnant women concerned over delivery and babies during COVID-19 pandemic (Published 4/1/2020)
  28. ASRM’s COVID-19 Task Force reaffirms previous recommendations (Published 4/1/2020)
  29. To stay open or not: IVF centers argue over ASRM guidelines on COVID-19 and fertility treatments (Published 3/27/2020)
  30. Concerning news on COVID-19’s effects on pregnancy and newborn (Published 3/27/2020)
  31. What’s urgent is urgent and what’s not urgent isn’t: Explaining ASRM recommendations on fertility treatments during COVID-19 pandemic (Published 3/26/2020)
  32. Patient autonomy and “do no harm” principles mean CHR continues to offer fertility diagnosis and treatments during COVID-19 crisis (Published 3/23/2020)
  33. ASRM and SART’s recommendations on fertility treatment during COVID-19 outbreak (Published 3/18/2020)
  34. CHR’s response to the COVID-19 outbreak: What we are doing to protect our patients, staff and community (Published 3/13/2020)
  35. Does COVID-19 have an effect on fertility? (Published 3/13/2020) 
  36. What happens if I get quarantined during an IVF cycle? (Published 3/13/2020)
  37. What happens if CHR is closed for quarantine during my IVF cycle? (Published 3/13/2020) 
  38. What should fertility patients do during the coronavirus outbreak? (Published 3/13/2020) 
  39. Should international patients of IVF do anything differently during the outbreak? (Published 3/13/2020) 
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.