Do pregnant women who contract COVID-19 suffer aggravated symptoms compared to non-pregnant women?

Submitted by: KArora 98

No.
NOTE: New research on COVID-19 comes out nearly every day. The state of our knowledge may change quickly so take this answer with a grain of salt.
This short answer was generated by aggregating the answers that each of the 6 studies below gave to the question (as indicated by State of K members) and adjusting for source quality and other factors. If key studies are missing or the answers attributed to individual studies are incorrect, the above answer could be wrong. For medical questions, don't rely on the information here. Consult a medical professional.


Chart summary of 6 studies examining this question

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SUMMARIES OF STUDIES
Total studies in list: 6
Sorted by publication year
1
Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections
"In early December 2019 a cluster of cases of pneumonia of unknown cause was identified in Wuhan, a city of 11 million persons in the People's Republic of China. Further investigation revealed these cases to result from infection with a newly identified coronavirus, termed the 2019-nCoV. The infection moved rapidly through China, spread to Thailand and Japan, extended into adjacent countries through infected persons travelling by air, eventually reaching multiple countries and continents. Similar to such other coronaviruses as those causing the Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), the new coronavirus was reported to spread via natural aerosols from human-to-human. In the early stages of this epidemic the case fatality rate is estimated to be approximately 2%, with the majority of deaths occurring in special populations. Unfortunately, there is limited experience with coronavirus infections during pregnancy, and it now appears certain that pregnant women have become infected during the present 2019-nCoV epidemic. In order to assess the potential of the Wuhan 2019-nCoV to cause maternal, fetal and neonatal morbidity and other poor obstetrical outcomes, this communication reviews the published data addressing the epidemiological and clinical effects of SARS, MERS, and other coronavirus infections on pregnant women and their infants. Recommendations are also made for the consideration of pregnant women in the design, clinical trials, and implementation of future 2019-nCoV vaccines."
AUTHORS
Schwartz DA
Graham AL
PUBLISHED
2020 in Viruses
High quality source
Yes
Yes
2
Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records
"BACKGROUND:Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection.METHODS:Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation.FINDINGS:All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8-9 and a 5-min Apgar score of 9-10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus.INTERPRETATION:The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy.FUNDING:Hubei Science and Technology Plan, Wuhan University Medical Development Plan."
AUTHORS
Luo F
Yu X
Wang C
Guo J
Chen H
Zhang W
PUBLISHED
2020 in The Lancet
High quality source
No
No
3
Clinical and CT Imaging Features of the COVID-19 Pneumonia: Focus on Pregnant Women and Children
"BACKGROUND:The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported.METHODS:Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared.FINDINGS:Compared with the non-pregnant adults group (n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed (n = 16) and clinically-diagnosed (n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults (P = 0·007, P < 0·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults (P = 0·001, P < 0·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twenty-three patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6-9 days after initial CT scans.INTERPRETATION:Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT."
AUTHORS
Liu H
Zhang T
Wang D
Liu F
Li J
Lan W
PUBLISHED
2020 in Journal of Infection
High quality source
Couldn't Identify
Couldn't Identify
4
An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes
"The emergence of a novel coronavirus, termed SARS-CoV-2, and the potentially life-threatening respiratory disease that it can produce, COVID-19, has rapidly spread across the globe creating a massive public health problem. Previous epidemics of many emerging viral infections have typically resulted in poor obstetrical outcomes including maternal morbidity and mortality, maternal-fetal transmission of the virus, and perinatal infections and death. This communication reviews the effects of two previous coronavirus infections - severe acute respiratory syndrome (SARS) caused by SARS-CoV and Middle East respiratory syndrome (MERS) caused by MERS-CoV - on pregnancy outcomes. In addition, it analyzes literature describing 38 pregnant women with COVID-19 and their newborns in China to assess the effects of SARS-CoV-2 on the mothers and infants including clinical, laboratory and virologic data, and the transmissibility of the virus from mother to fetus. This analysis reveals that unlike coronavirus infections of pregnant women caused by SARS and MERS, in these 38 pregnant women COVID-19 did not lead to maternal deaths. Importantly, and similar to pregnancies with SARS and MERS, there were no confirmed cases of intrauterine transmission of SARS-CoV-2 from mothers with COVID-19 to their fetuses. All neonatal specimens tested, including in some cases placentas, were negative by rt-PCR for SARS-CoV-2. At this point in the global pandemic of COVID-19 infection there is no evidence that SARS-CoV-2 undergoes intrauterine or transplacental transmission from infected pregnant women to their fetuses. Analysis of additional cases is necessary to determine if this remains true."
AUTHOR
Schwartz DA
PUBLISHED
2020 in Archives of Pathology & Laboratory Medicine
High quality source
No
No
5
Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis.
"OBJECTIVE. The purpose of this study was to describe the clinical manifestations and CT features of coronavirus disease (COVID-19) pneumonia in 15 pregnant women and to provide some initial evidence that can be used for guiding treatment of pregnant women with COVID-19 pneumonia. MATERIALS AND METHODS. We reviewed the clinical data and CT examinations of 15 consecutive pregnant women with COVID-19 pneumonia in our hospital from January 20, 2020, to February 10, 2020. A semiquantitative CT scoring system was used to estimate pulmonary involvement and the time course of changes on chest CT. Symptoms and laboratory results were analyzed, treatment experiences were summarized, and clinical outcomes were tracked. RESULTS. Eleven patients had successful delivery (10 cesarean deliveries and one vaginal delivery) during the study period, and four patients were still pregnant (three in the second trimester and one in the third trimester) at the end of the study period. No cases of neonatal asphyxia, neonatal death, stillbirth, or abortion were reported. The most common early finding on chest CT was ground-glass opacity (GGO). With disease progression, crazy paving pattern and consolidations were seen on CT. The abnormalities showed absorptive changes at the end of the study period for all patients. The most common onset symptoms of COVID-19 pneumonia in pregnant women were fever (13/15 patients) and cough (9/15 patients). The most common abnormal laboratory finding was lymphocytopenia (12/15 patients). CT images obtained before and after delivery showed no signs of pneumonia aggravation after delivery. The four patients who were still pregnant at the end of the study period were not treated with antiviral drugs but had achieved good recovery. CONCLUSION. Pregnancy and childbirth did not aggravate the course of symptoms or CT features of COVID-19 pneumonia. All the cases of COVID-19 pneumonia in the pregnant women in our study were the mild type. All the women in this study-some of whom did not receive antiviral drugs-achieved good recovery from COVID-19 pneumonia."
AUTHORS
Yang L
Wu X
Zheng D
Zheng C
Wang J
Li L et al
PUBLISHED
2020 in American Journal of Roentgenology
High quality source
No
No
6
Infection with SARS-CoV-2 in pregnancy. Information and proposed care. CNGOF
"A new coronavirus (SARS-CoV-2) highlighted at the end of 2019 in China is spreading across all continents. Most often at the origin of a mild infectious syndrome, associating mild symptoms (fever, cough, myalgia, headache and possible digestive disorders) to different degrees, SARS-Covid-2 can cause serious pulmonary pathologies and sometimes death.Data on the consequences during pregnancy are limited. The first Chinese data published seem to show that the symptoms in pregnant women are the same as those of the general population. There are no cases of intrauterine maternal-fetal transmission, but cases of newborns infected early suggest that there could be vertical perpartum or neonatal transmission. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described.Pregnancy is known as a period at higher risk for the consequences of respiratory infections, as for influenza, so it seems important to screen for Covid-19 in the presence of symptoms and to monitor closely pregnant women.In this context of the SARS-Covid-2 epidemic, the societies of gynecology-obstetrics, infectious diseases and neonatalogy have proposed a French protocol for the management of possible and proven cases of SARS-Covid-2 in pregnant women. These proposals may evolve on a daily basis with the advancement of the epidemic and knowledge in pregnant women. Subsequently, an in-depth analysis of cases in pregnant women will be necessary in order to improve knowledge on the subject."
AUTHORS
Lucet JC
Lescure X
Huissoud C
Deruelle P
Sibiude J
Peyronnet V
PUBLISHED
2020 in Gynécologie Obstétrique Fertilité & Sénologie
Q3
No
No







ADDITIONAL STUDIES TO CONSIDER ADDING TO LIST
Total additional studies: 33
State of K's algorithms generated the list of studies below based on the studies that were added to the above list. Some of these studies may also examine: "Do pregnant women who contract COVID-19 suffer aggravated symptoms compared to non-pregnant women?" If a study examines this question, add it to the list by pressing the button.

Only add studies that examine the same question. Do not add studies that are merely on the same topic.

Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study
"Background
In December, 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. The number of affected pregnant women is increasing, but scarce information is available about the clinical features of COVID-19 in pregnancy. This study aimed to clarify the clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19.

Methods
In this retrospective, single-centre study, we included all pregnant women with COVID-19 who were admitted to Tongji Hospital in Wuhan, China. Clinical features, treatments, and maternal and fetal outcomes were assessed.

Findings
Seven patients, admitted to Tongji Hospital from Jan 1, to Feb 8, 2020, were included in our study. The mean age of the patients was 32 years (range 29–34 years) and the mean gestational age was 39 weeks plus 1 day (range 37 weeks to 41 weeks plus 2 days). Clinical manifestations were fever (six [86%] patients), cough (one [14%] patient), shortness of breath (one [14%] patient), and diarrhoea (one [14%] patient). All the patients had caesarean section within 3 days of clinical presentation with an average gestational age of 39 weeks plus 2 days. The final date of follow-up was Feb 12, 2020. The outcomes of the pregnant women and neonates were good. Three neonates were tested for SARS-CoV-2 and one neonate was infected with SARS-CoV-2 36 h after birth.

Interpretation
The maternal, fetal, and neonatal outcomes of patients who were infected in late pregnancy appeared very good, and these outcomes were achieved with intensive, active management that might be the best practice in the absence of more robust data. The clinical characteristics of these patients with COVID-19 during pregnancy were similar to those of non-pregnant adults with COVID-19 that have been reported in the literature."
AUTHORS
X Lin
S Wang
Z Xiong
Q Kang
W Li
N Yu
PUBLISHED
2020 in The Lancet Infectious Diseases

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Coronavirus Disease 2019 (COVID-19) During Pregnancy: A Case Series
"Background: Coronavirus disease 2019 (COVID-19) is a new viral respiratory disease and whether pregnant women are at increased risk of infection is unknown. Viral pneumonia is an important indirect cause of maternal death. Little is known about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Objective: To describe the clinical characteristics of COVID-19 in pregnancy and their newborn infant, and we sought to explored whether the SARS-CoV-2 can be intrauterine vertically transmitted. Study Design: The study was a case series study conducted in the obstetric ward of Tongji Hospital affiliated to Huazhong University of science and technology, Wuhan, China. Demographic, clinical, laboratory and radiological profiles of the SARS-CoV-2 infection case series. A systematic testing procedure for SARS-CoV-2 infection using oropharyngeal swab, placenta tissue, vaginal mucus, and breast milk of mothers. and oropharyngeal swab, umbilical cord blood, and serum of newborns was conducted. Results: We have conducted the most thorough virological assessment to date, and we include a longer clinical observation in mother-infant dyads during hospitalization. The clinical course and outcomes of three pregnant women who acquired SARS-CoV-2 infection late pregnancy are described in mother-infant dyads. Two had caesarean delivery in their third trimester. All patients showed an uneventful perinatal course, and a successful outcome. No infants became infected by vertical transmission or during delivery. Conclusion: No evidence to suggest the potential risk of intrauterine vertical transmission in the case series and further in-depth study is needed. Both the pregnancy woman and infant showed fewer adverse maternal and neonatal outcomes."
AUTHORS
B Zhang
J Chen
L Chen
Q Zhang
Q Wang
W Liu
PUBLISHED
2020 in Preprints

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An Update on SARS-COV-2/COVID-19 with Particular Reference on Its Clinical Pathology, Pathogenesis, Immunopathology and Mitigation Strategies – A Review
"Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus named Severe Acute Respiratory Syndrome - Coronavirus-2 (SARS-CoV-2), emerged in early December 2019 in China and attained a pandemic situation worldwide by its rapid spread to nearly 167 countries with 287.239 confirmed cases and 11.921 human deaths with a case fatality rate (CFR) of around 4 per cent. Bats were considered as the reservoir host, and the search of a probable intermediate host is still going on. Animals have anticipated culprit of SARS-CoV-2 as of now. The disease is mainly manifested by pneumonia and related respiratory signs and symptoms, but the involvement of the gastrointestinal system and nervous system is also suggested. The severe form of the disease associated with death is mainly reported in older and immune-compromised patients with pre-existing disease history. Death in severe cases is attributed to respiratory failure associated with hyperinflammation. Cytokine storm syndrome associated with rampant inflammation in response to SARS-CoV-2 infection is considered as the leading killer of COVID-19 patients. COVID-19 patients were reported with higher levels of many pro-inflammatory cytokines and chemokines like IFN-g, IL-1b, IP-10, and MCP-1. Furthermore, severe cases of COVID-19 revealed higher levels of TNF-&amp;alpha;, G-CSF, and MIP-1A. Blood profile of the COVID-19 patients exhibits lymphopenia, leucopenia, thrombocytopenia and RNAaemia along with increased levels of aspartate aminotransferase. SARS-CoV-2 infection in pregnant women does not lead to fetus mortalities unlike other zoonotic coronaviruses like SARS-CoV and MERS-CoV, with no evidence of intrauterine transmission to neonates. Rapid and confirmatory diagnostics have been developed, and high efforts are being made to develop effective vaccines and therapeutics. In the absence of any virus-specific therapeutic, internationally health care authorities are recommending adoption of effective prevention and control measures to counter and contain this pandemic virus. This paper is an overview of this virus and the disease with a particular focus on SARS-COV-2 / COVID-19 clinical pathology, pathogenesis and immunopathology along with a few recent research developments."
AUTHORS
Mamta Pathak
Shailesh Kumar Patel
Rajendra Singh
Kuldeep Dhama
Alfonso J. Rodriguez-Morales
D. Katterine Bonilla-Aldana et al
PUBLISHED
2020 in MDPI AG

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A Case Report of Neonatal 2019 Coronavirus Disease in China
"Abstract
In December 2019, the coronavirus disease (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and now has spread in many countries. Pregnant women are a population susceptible to COVID-19 and are more likely to have complications and even progress to severe illness. We report a case of neonatal COVID-19 in China with pharyngeal swabs testing positive by real-time reverse-transcription polymerase chain reaction assay 36 hours after birth. However, whether the case is a vertical transmission from mother to child remains to be confirmed."
AUTHORS
Shaoshuai Wang
Jingyi Zhang
Yong Cao
Ling Chen
Lili Guo
Ling Feng et al
PUBLISHED
2020 in Clinical Infectious Diseases

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Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study
"Abstract

Background
The ongoing epidemics of coronavirus disease 2019 (COVID-19) have caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia.


Methods
We conducted a case-control study to compare clinical characteristics, maternal and neonatal outcomes of pregnant women with and without COVID-19 pneumonia.


Results
During January 24 to February 29, 2020, there were sixteen pregnant women with confirmed COVID-19 pneumonia and eighteen suspected cases who were admitted to labor in the third trimester. Two had vaginal delivery and the rest took cesarean section. Few patients presented respiratory symptoms (fever and cough) on admission, but most had typical chest CT images of COVID-19 pneumonia. Compared to the controls, COVID-19 pneumonia patients had lower counts of white blood cells (WBC), neutrophils, C-reactive protein (CRP), and alanine aminotransferase (ALT) on admission. Increased levels of WBC, neutrophils, eosinophils, and CRP were found in postpartum blood tests of pneumonia patients. There were three (18.8%) and three (16.7%) of the mothers with confirmed or suspected COVID-19 pneumonia had preterm delivery due to maternal complications, which were significantly higher than the control group. None experienced respiratory failure during hospital stay. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.


Conclusion
Severe maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had vaginal delivery or caesarean section. Mild respiratory symptoms of pregnant women with COVID-19 pneumonia highlight the need of effective screening on admission.
"
AUTHORS
Linli Yue
Yin Ouyang
Yuxia Lv
Lefei Han
Guoqiang Sun
Lin Chen et al
PUBLISHED
2020 in Clinical Infectious Diseases

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Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study
"Background
The ongoing epidemics of coronavirus disease 2019 (COVID-19) have caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia.
Methods
We conducted a case-control study to compare clinical characteristics, maternal and neonatal outcomes of pregnant women with and without COVID-19 pneumonia.
Results
During January 24 to February 29, 2020, there were sixteen pregnant women with confirmed COVID-19 pneumonia and eighteen suspected cases who were admitted to labor in the third trimester. Two had vaginal delivery and the rest took cesarean section. Few patients presented respiratory symptoms (fever and cough) on admission, but most had typical chest CT images of COVID-19 pneumonia. Compared to the controls, COVID-19 pneumonia patients had lower counts of white blood cells (WBC), neutrophils, C-reactive protein (CRP), and alanine aminotransferase (ALT) on admission. Increased levels of WBC, neutrophils, eosinophils, and CRP were found in postpartum blood tests of pneumonia patients. There were three (18.8%) and two (10.5%) of the mothers with confirmed or suspected COVID-19 pneumonia had preterm delivery due to maternal complications, which were significantly higher than the control group. None experienced respiratory failure during hospital stay. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.
Conclusion
Severe maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had vaginal delivery or caesarean section. Mild respiratory symptoms of pregnant women with COVID-19 pneumonia highlight the need of effective screening on admission."
AUTHORS
Linli Yue
Yin Ouyang
Yuxia Lv
Lefei Han
Guoqiang Sun
Lin Chen et al
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province
"Objective: To study the effect of COVID-19 on pregnancy outcomes and neonatal prognosis in Hubei Province. Methods: A retrospective comparison of the pregnancy outcomes was done between 16 women with COVID-19 and 45 women without COVID-19. Also, the results of laboratory tests, imaging examinations, and the 2019-nCoV nucleic acid test were performed in 10 cases of neonatal deliverd from women with COVID-19. Results: (1) Of the 16 pregnant women with COVID-19, 15 cases were ordinary type and 1 case was severe type. No one has progressed to critical pneumonia. The delivery method of the two groups was cesarean section, and the gestational age were (38.7±1.4) and (37.9±1.6) weeks, there was no significant difference between the two groups (P> 0.05). Also, there wee no significant differences in the intraoperative blood loss and birth weight of the newborn between the two groups (all P>0.05). (2) Ten cases of neonates delivered from pregnant women with COVID-19 were collected. The 2019-nCoV nucleic acid test were all negative. There were no significant differences in fetal distress, meconium-stained amniotic fluid, preterm birth, and neonatal asphyxia between the two groups (all P>0.05). (3) In the treatment of uterine contraction fatigue, carbetocin or carboprost tromethamine was used more in cesarean section for pregnant women with COVID-19 (1.3±0.6), compared with Non-COVID-19 group (0.5±0.7), the difference was statistically significant (P=0.001). Conclusions: If there is an indication for obstetric surgery or critical illness of COVID-19 in pregnant women, timely termination of pregnancy will not increase the risk of premature birth and asphyxia of the newborn, but it is beneficial to the treatment and rehabilitation of maternal pneumonia. Preventive use of long-acting uterotonic agents could reduce the incidence of postpartum hemorrhage during surgery. 2019-nCoV infection has not been found in neonates deliverd from pregnant women with COVID-19."
AUTHORS
Wei M
Jiang Y
Zhang L
LI Ji
Zhou XC
Cheng BH
PUBLISHED
2020 in Chinese Medical Association

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Literature review
Clinical characteristics of COVID-19 infection in pregnant women: a systematic review and meta-analysis
"Background: On December 2019, Novel coronavirus disease (COVID-19) was detected in Wuhan, China, and then spread around the world. There is little information about effects of COVID-19 on Pregnant women and newborns as a sensitive population. The current study is a systemic review and Meta-analysis to measure the risks and determine the presentations of COVID-19 in pregnant women and newborn.
Methods: online data bases were searched on march 20. Heterogeneity of the included studies was assessed using the Cochran Q test and Higgins I2 statistic and expressed as percentage. All data were analyzed with 95% confidence intervals.
Results: A total of 7 studies involving 50 participants with Positive test of COVID-19 were enrolled. Mean age of pregnant women was 30.57 years old and the Mean Gestational age was 36.9 weeks. Other variables such as Apgar score, birth weight, Sign and symptoms, Complications and Laboratory data were Analyzed.
Conclusion: Our findings showed same clinical characteristics in pregnant women as in non-pregnant adults, with the main symptoms being cough and fever. No vertical transmission was seen and all patients delivered healthy neonates. Our findings would be of great help to the decision making process, regarding the management of pregnant women diagnosed with COVID-19."
AUTHORS
Harunor Rashid
Bahareh Amin
Laleh Shariati
Zahra Heidari
Golnaz Vaseghi
Sina Arabi et al
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019
"BACKGROUND
There is little information about the coronavirus disease 2019 (Covid-19) during pregnancy. This study aimed to determine the clinical features and the maternal and neonatal outcomes of pregnant women with Covid-19.

METHODS
In this retrospective analysis from five hospitals, we included pregnant women with Covid-19 from January 1 to February 20, 2020. The primary composite endpoints were admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Secondary endpoints included the clinical severity of Covid-19, neonatal mortality, admission to neonatal intensive care unit (NICU), and the incidence of acute respiratory distress syndrome (ARDS) of pregnant women and newborns.

RESULTS
Thirty-three pregnant women with Covid-19 and 28 newborns were identified. One (3%) pregnant woman needed the use of mechanical ventilation. No pregnant women admitted to the ICU. There were no moralities among pregnant women or newborns. The percentages of pregnant women with mild, moderate, and severe symptoms were 13 (39.4%),19(57.6%), and 1(3%). One (3.6%) newborn developed ARDS and was admitted to the NICU. The rate of perinatal transmission of SARS-CoV-2 was 3.6%.

CONCLUSIONS
This report suggests that pregnant women are not at increased risk for severe illness or mortality with Covid-19 compared with the general population. The SARS-CoV-2 infection during pregnancy might not be associated with as adverse obstetrical and neonatal outcomes that are seen with the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy. (Funded by the National Key Research and Development Program.)"
AUTHORS
Qiong Yang
Ling Feng
Wen-cong He
Cui-fang Fan
Yu-ling Liu
Kutluk Oktay et al
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Literature review
COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes
"Background: The coronavirus disease 2019 (COVID-19); one of the most hazardous threats that the world has ever been faced, is now increasing exponentially worldwide. An increasing proportion of the women are now infected with this virus during their pregnancy, which may put them in danger in terms of adverse maternal and newborn outcomes. The aims of this systematic review were to summarize the possible symptoms, treatments, and pregnancy outcomes if the women are infected with COVID-19 during their pregnancy.
Methods: Four databases (Medline, Web of Science, Scopus, and CINAHL) were searched on March 25, 2020, using the following keywords: 'COVID-19', 'nCoV-2019', and 'coronavirus'. Articles included if they reported either the symptoms, treatments for the women who have been infected with the COVID-19 during their pregnancy or pregnancy outcomes. Further searches were conducted using the reference list of the selected articles and in the websites of the selected journals. All reported symptoms, treatments, and pregnancy outcomes were summarized through a narrative review of the selected articles' results.
Results: Total of eight studies selected for this study that comprises 100 infected pregnant women. The common symptoms of infection were fever (65%), cough (38%), fatigue (15%), and breathing difficulties (14%). Usual recommended treatments for general infected people to treat COVID-19 disease such as chloroquine, corticosteroids are not applicable for pregnant women because of potential adverse outcomes. Use of C-section was a common (85.4%) mode of delivery among the COVID-19 infected pregnant women than their counterparts. The occurrence of preterm birth (29.1%), and low birth weight (16.4%), were also among babies of the infected women.
Conclusions: The COVID-19 infected pregnant women often reported common symptoms of infection: fever, cough, and fatigue with numerous additional symptoms, including myalgia, and sore throat. The proposed treatments for infected pregnant women are different from what usually recommended for the general infected people. The healthcare providers may have appropriately informed about these symptoms and treatments; therefore, they could able to handle infection during pregnancy effectively, which may reduce the occurrence of adverse maternal and newborn consequences."
AUTHORS
Md. Mosfequr Rahman
Md. Rajwanul Haque
Juwel Rana
Md. Golam Mustagir
Md Nuruzzaman Khan
Md. Mostaured Ali Khan
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Literature review
Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy; a Narrative Review
"Introduction:
The outbreak of the new Coronavirus in China in December 2019 and subsequently in various countries around the world has raised concerns about the possibility of vertical transmission of the virus from mother to fetus. The present study aimed to review published literature in this regard.

Methods:
In this narrative review, were searched for all articles published in various databases including PubMed, Scopus, Embase, Science Direct, and Web of Science using MeSH-compliant keywords including COVID-19, Pregnancy, Vertical transmission, Coronavirus 2019, SARS-CoV-2 and 2019-nCoV from December 2019 to March 18, 2020 and reviewed them. All type of articles published about COVID-19 and vertical transmission in pregnancy were included.

Results:
A review of 13 final articles published in this area revealed that COVID-19 can cause fetal distress, miscarriage, respiratory distress and preterm delivery in pregnant women but does not infect newborns. There has been no report of vertical transmission in pregnancy, and it has been found that clinical symptoms of COVID-19 in pregnant women are not different from those of non-pregnant women.

Conclusion:
Overall, due to lack of appropriate data about the effect of COVID-19 on pregnancy, it is necessary to monitor suspected pregnant women before and after delivery. For confirmed cases both the mother and the newborn child should be followed up comprehensively."
AUTHORS
S Pouy
M Amiri
L Panahi
PUBLISHED
2020 in Archives of Academic Emergency Medicine

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COVID-19 in pregnant women
You can view the abstract at: https://doi.org/10.1016/s1473-3099(20)30175-4
AUTHORS
Nicole Ochsenbein-Kölble
Jehudith Fontijn
Manuel B Schmid
Christoph Berger
Dirk Bassler
PUBLISHED
2020 in The Lancet Infectious Diseases

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An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes
" The emergence of a novel coronavirus, termed SARS-CoV-2, and the potentially life-threating respiratory disease that it can produce, COVID-19, has rapidly spread across the globe creating a massive public health problem. Previous epidemics of many emerging viral infections have typically resulted in poor obstetrical outcomes including maternal morbidity and mortality, maternal-fetal transmission of the virus, and perinatal infections and death. This communication reviews the effects of two previous coronavirus infections - severe acute respiratory syndrome (SARS) caused by SARS-CoV and Middle East respiratory syndrome (MERS) caused by MERS-CoV - on pregnancy outcomes. In addition, it analyzes literature describing 38 pregnant women with COVID-19 and their newborns in China to assess the effects of SARS-CoV-2 on the mothers and infants including clinical, laboratory and virologic data, and the transmissibility of the virus from mother to fetus. This analysis reveals that unlike coronavirus infections of pregnant women caused by SARS and MERS, in these 38 pregnant women COVID-19 did not lead to maternal deaths. Importantly, and similar to pregnancies with SARS and MERS, there were no confirmed cases of intrauterine transmission of SARS-CoV-2 from mothers with COVID-19 to their fetuses. All neonatal specimens tested, including in some cases placentas, were negative by rt-PCR for SARS-CoV-2. At this point in the global pandemic of COVID-19 infection there is no evidence that SARS-CoV-2 undergoes intrauterine or transplacental transmission from infected pregnant women to their fetuses. Analysis of additional cases is necessary to determine if this remains true. "
AUTHOR
David A. Schwartz
PUBLISHED
2020 in Archives of Pathology & Laboratory Medicine

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Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Pregnancy In China: A Retrospective Cohort Study
"Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified as the cause of the ongoing worldwide epidemic of Coronavirus Disease 2019 (COVID-19) in China and worldwide. However, there were few studies about the effects of SARS-CoV-2 infection on pregnant women.
Methods In this retrospective cohort study, we enrolled 31 pregnant women and 35 non-pregnant women from Jan 28 to Feb 28, 2020 to evaluate the effects of SARS-CoV-2 infection during pregnancy. Inflammatory indices were used to assess the severity of COVID-19. Evidence of vertical transmission was determined by laboratory confirmation of SARS-CoV-2 in amniotic fluid, placenta, neonatal throat and anal swab and breastmilk samples.
Findings Compared with non-pregnant women, pregnant women had a significantly lower proportion of fever (54.8% vs. 87.5%, p= 0.006), a shorter average interval from onset to hospitalization, and a higher proportion of severe or critical COVID-19 (32.3% vs. 11.4%, p=0.039). Neutrophil-to-lymphocyte ratio (NLR) and systematic immune-inflammation-based prognostic index (SII) were significantly higher on admission in severe/critical pneumonia group than moderate pneumonia group. We could not detect the presence of SARS-CoV-2 by RT-PCR in amniotic fluid, placenta, neonatal throat and anal swab and breastmilk samples.
Conclusions The clinical symptoms of COVID-19 in pregnant women were insidious and atypical, compared with those in non-pregnant patients. SII and NLR could be a useful marker to evaluate the severity of COVID-19. There was no evidence of vertical transmission during pregnancy with SARS-CoV-2 infection."
AUTHORS
Shihuan Yu
Min Wu
Dujuan Yao
Hongyin Sun
Chaofei Han
Qingqing Luo et al
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Why are pregnant women susceptible to COVID-19? An immunological viewpoint
FUNDERS
National Key Research & Developmental Program of China
"The 2019 novel coronavirus disease (COVID-19) was first detected in December 2019 and became epidemic in Wuhan, Hubei Province, China. COVID-19 has been rapidly spreading out in China and all over the world. The virus causing COVID-19, SARS-CoV-2 has been known to be genetically similar to severe acute respiratory syndrome coronavirus (SARS-CoV) but distinct from it. Clinical manifestation of COVID-19 can be characterized by mild upper respiratory tract infection, lower respiratory tract infection involving non-life threatening pneumonia, and life-threatening pneumonia with acute respiratory distress syndrome. It affects all age groups, including newborns, to the elders. Particularly, pregnant women may be more susceptible to COVID-19 since pregnant women, in general, are vulnerable to respiratory infection. In pregnant women with COVID-19, there is no evidence for vertical transmission of the virus, but an increased prevalence of preterm deliveries has been noticed. The COVID-19 may alter immune responses at the maternal-fetal interface, and affect the well-being of mothers and infants. In this review, we focused on the reason why pregnant women are more susceptible to COVID-19 and the potential maternal and fetal complications from an immunological viewpoint."
AUTHORS
Ai-Hua Liao
Joanne Kwak-Kim
Si-Jia Zhao
Li-Ling Wang
Gil Mor
Hong Liu
PUBLISHED
2020 in Journal of Reproductive Immunology

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Literature review
Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV-2 in women with COVID-19: A systematic review
"Abstract
Objective: The aim of this systematic review was to examine published and preprint reports for maternal and fetal outcomes in pregnant women with COVID-19 and also assess the incidence of maternal-fetal transmission of SARS CO-V-2 infection.
Design : Systematic review
Data sources:We searched PUMBED. Medline, Embase, MedRxiv and bioRxiv databases upto 31st March 2020 utilizing combinations of word variants for &amp;#34 coronavirus &amp;#34 or &amp;#34
COVID-19 &amp;#34 or &amp;#34 severe acute respiratory syndrome &amp;#34 or &amp;#34 SARS-COV-2 &amp;#34 and &amp;#34 pregnancy &amp;#34 . We also included data from preprint articles.
Study selection : Original case reports and case series on pregnant women with a confirmed diagnosis of SARS-CoV-2 infection.
Data extraction : We included 23 studies [China (20), USA (01), Republic of Korea (01) and Honduras, Central America (01) reporting the information on 172 pregnant women and 162 neonates. The primary outcome measures were maternal health characteristics and adverse pregnancy outcomes, neonatal outcomes and SARS-CoV-2 infection in neonates was extracted. Treatments given to pregnant women with COVID-19 were also recorded.
Results: Out of 172 women affected by COVID-19 in pregnancy, 160 women had delivered 162 newborns (2 set of twins, 12 ongoing pregnancies). In pregnant women with COVID-19, the most common symptoms were fever (54%), cough (35%), myalgia (17%), dyspnea (12%) and diarrhea (4%). Pneumonia was diagnosed by CT scan imaging in 100 % of COVID-19 pregnant women. Pregnancy complications included delivery by cesarean section (89%), preterm labor (21%), fetal distress (9%) and premature rupture of membranes (8%). The most common co-morbidities associated with pregnant women with COVID-19 were diabetes (11%), hypertensive disorders (9%), placental disorders (5%), co-infections (6%), scarred uterus (5%), hypothyroidism (5%) and anemia (4%). Amongst the neonates of COVID-19 mothers, preterm birth (23%), respiratory distress syndrome (14%), pneumonia (14%) low birth weight (11%), small for gestational age (3%) were reported. There was one still birth and one neonatal death reported. Vertical transmission rate of SARS-CoV-2 is estimated to be 11%.
Conclusion
In pregnant women with COVID-19, diabetes and hypertensive disorders are common co-morbidities and there is a risk of preterm delivery. Amongst the neonates born to mothers with COVID-19, respiratory distress syndrome and pneumonia are common occurrence. There is an evidence of vertical transmission of SARS-CoV-2 infection in women with COVID-19."
AUTHORS
Deepak Modi
Smita Mahale
Rahul Gajbhiye
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Literature review
Pregnancy during the evolving pandemic Coronavirus Disease 2019 (COVID-19): A rapid scoping review of evidence in the published literature
"Abstract
BackgroundWith more than 1 million confirmed cases of coronavirus disease 2019 (COVID-19) worldwide and more than 50,000 deaths, the pandemic of Severe Acute Respiratory Syndrome CoV (SARS-CoV-2) is rapidly evolving. SARS-CoV-2 can also pose a higher risk to pregnant women, due to their immunosuppression during pregnancy. This study investigates the emerging and most UpToDate published scientific literature on the clinical feature and management recommendations for pregnant women with COVID-19.MethodA wide range of published scientific literature was systematically searched from PubMed, Embase, Scopus, Web of Science, and “Global research on coronavirus disease (COVID-19)” managed by the World Health Organization, published between 1 January 2019 to 27 March 2020. No limitations were used for geographical location, and articles published in English were included in the review. Results for the eligible studies were charted, analyzed, and presented in a narrative format. ResultOur study identified 52 unique articles, and 29 of those articles were included in this review after fulltext screening. Participants were mostly in their third trimester and presented with fever, dry cough, myalgia, shortness, and difficulty in breathing. Ground-glass opacity in the computerized tomography scan of the chest was the cardinal feature of COVID-19 pneumonia. Except for two participants, severe pneumonia did not occur among pregnant women. Pregnant women with COVID-19 were treated with a wide range of antiviral drugs. Higher episodes of preterm birth and cesarean delivery were observed; however, it cannot be explicitly attributed to the SARS-CoV-2. There is no published evidence on the vertical transmission of SARS-CoV-2. Pregnancy with COVID-19 infection must be managed by a collaborative team of healthcare professionals during antenatal, delivery, or postnatal stage. Detailed contact tracing, investigating travel history, radiological assessment, and laboratory tests with regular fetal health monitoring must be done. ConclusionThe emerging evidence of higher perinatal complications puts pregnant women in a further vulnerable condition. Cautiousness is imperative during the clinical management of pregnant women with COVID-19, as there is no approved treatment regime available at this moment. More research is necessary to fill the gaps in the knowledge of the clinical spectrum of COVID-19 among pregnant women."
AUTHORS
Tasmeer Alam
Gulam Muhammed Al Kibria
Md Zabir Hasan
PUBLISHED
2020 in Research Square

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Severe COVID-19 during Pregnancy and Possible Vertical Transmission
"There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons.
Key Points
"
AUTHORS
Mauricio La Rosa
Camille M. Webb
Luis M. Valdez
David Caceres
Tania Paredes
Maria Claudia Alzamora
PUBLISHED
2020 in American Journal of Perinatology

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The Relationship between Status at Presentation and Outcomes among Pregnant Women with COVID-19
"
Objective This study was aimed to compare maternal and pregnancy outcomes of symptomatic and asymptomatic pregnant women with novel coronavirus disease 2019 (COVID-19).
Study Design This is a retrospective cohort study of pregnant women with COVID-19. Pregnant women were divided into two groups based on status at admission, symptomatic or asymptomatic. All testing was done by nasopharyngeal swab using polymerase chain reaction (PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Initially, nasopharyngeal testing was performed only on women with a positive screen (symptoms or exposure) but subsequently, testing was universally performed on all women admitted to labor and delivery. Chi-square and Wilcoxon's rank-sum tests were used to compare outcomes between groups.
Results Eighty-one patients were tested because of a positive screen (symptoms [n = 60] or exposure only [n = 21]) and 75 patients were universally tested (all asymptomatic). In total, there were 46 symptomatic women and 22 asymptomatic women (tested based on exposure only [n = 12] or as part of universal screening [n = 10]) with confirmed COVID-19. Of symptomatic women (n = 46), 27.3% had preterm delivery and 26.1% needed respiratory support while none of the asymptomatic women (n = 22) had preterm delivery or need of respiratory support (p = 0.007 and 0.01, respectively).
Conclusion Pregnant women who presented with COVID19-related symptoms and subsequently tested positive for COVID-19 have a higher rate of preterm delivery and need for respiratory support than asymptomatic pregnant women. It is important to be particularly rigorous in caring for COVID-19 infected pregnant women who present with symptoms.
Key Points
"
AUTHORS
Nelli Fisher
Fouad Atallah
Rodney McLaren Jr.
Viktoriya London
Janet L. Stein
Catherine Cepeda et al
PUBLISHED
2020 in American Journal of Perinatology

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Literature review
Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis
"Abstract
This systematic review and meta-analysis aimed to evaluate the impact of COVID-19 on pregnant women. We searched for qualified studies in PubMed, Embase, and Web of Science. The clinical characteristics of pregnant women with COVID-19 and their infants were reported as means and proportions with 95% confidence interval (CI). Nine studies involving with 93 pregnant women with COVID-19 and 103 infants were included in the meta-analysis. Pregnant women with COVID-19 have relatively mild symptoms. However, abnormal proportions of laboratory parameters were similar or even increased, compared to general population. Around 30% of pregnant women with COVID-19 experienced preterm delivery, whereas the mean birth weight was 3214.7g. Fetal death, severe neonatal asphyxia, and detection of SARS-CoV-2 were observed in about 2%, whereas no neonatal death was found. In conclusion, the current review will serve as an ideal basis for future considerations in the treatment and management of COVID-19 in pregnant women."
AUTHORS
Hye Sun Gwak
Kyung Eun Lee
Jeong Yee
Ha Young Yoon
Woorim Kim
Ji Min Han et al
PUBLISHED
2020 in Research Square

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Clinical characteristics and outcomes of childbearing-age women with Coronavirus disease 2019 in Wuhan: a retrospective, single-center study (Preprint)
"
BACKGROUND
Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly worldwide. Previous studies on pregnant patients were limited.


OBJECTIVE
The objective of our study was to evaluate the clinical characteristics and outcomes of pregnant and non-pregnant women with COVID-19.


METHODS
This study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 non-pregnant patients) who presented with laboratory-confirmed of COVID-19 in Tongji Hospital, Wuhan, China, from Jan 19 to Mar 2, 2020. Clinical outcomes were followed up to Mar 28, 2020.


RESULTS
Of 43 childbearing-age women in this study, none developed severe adverse illness and died. The median ages of pregnant and non-pregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within two weeks before onset (53% vs 19%, P=.02), and a lower proportion of other family members affected (24% vs 73%%, P=.004). Fever (47% vs 69%) and cough (53% vs 46%) were common onsets of symptoms for two groups. Abdominal pain (24%), vaginal bleeding (6%), reduced fetal movement (6%), and increased fetal movement (13%) were observed at onset in pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group (79% vs 56%, P&lt;.001; 15% vs 33%, P&lt;.001, respectively). In both groups were observed elevated concentration of high sensitivity C-reactive protein, erythrocyte sedimentation rate, aminotransferase and lactate dehydrogenase. Concentrations of alkaline phosphatase and D-dimer in the pregnant group were significantly higher than those of the non-pregnant group (119.0 vs 48.0 U/L, P&lt;.001; 2.1vs 0.3μg/mL, P&lt;.001). Both pregnant (4/10; 40%) and non-pregnant (8/15; 53%) women were tested positive for influenza A virus. A majority of pregnant and non-pregnant groups received antiviral (76% vs 96%) and antibiotic (76% vs 88%) therapy. Additionally, both pregnant (2/11; 18%) and non-pregnant (2/19; 11%) recovered women re-detected positive for SARS-CoV-2 after discharge.


CONCLUSIONS
The epidemiology, clinical and laboratory features of pregnant women with COVID-19 were diverse and atypical, which increased the difficulty of diagnosis. Most pregnant women with COVID-19 were mild and moderate, and rarely developed severe pneumonia and severe adverse outcomes.


CLINICALTRIAL
COVID-19; SARS-CoV-2; childbearing-age; pregnancy, clinical characteristics; outcomes
"
AUTHORS
Suhua Chen
Xuan Gao
Lijie Wei
Shaoshuai Wang
Ling Chen
Ling Feng et al
PUBLISHED
2020 in JMIR Publications Inc.

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COVID-19 in Pregnant Women: Case Series from One Large New York City Obstetrical Practice
"
Objective This study aimed to report a case series of pregnant women in New York City with confirmed or presumed coronavirus disease (COVID-19) infection.
Study Design Beginning March 22, 2020, all pregnant women from one large obstetrical practice in New York City were contacted regularly to inquire about symptoms of COVID-19 (fever, cough, shortness of breath, malaise, anosmia), or sick contacts. A running log was kept of these patients, as well as all patients who underwent COVID-19 testing. For this report, we included every patient with suspected COVID-19 infection, which was defined as at least two symptoms, or a positive COVID-19 nasopharyngeal polymerase chain reaction test.
Results From March 22, 2020 until April 30, 2020, 757 pregnant women in our practice were evaluated and 92 had known or suspected COVID-19 (12.2%, 95% confidence interval [CI]: 10.0–14.7%). Of these 92 women, 33 (36%) had positive COVID-19 test results. Only one woman required hospital admission for 5 days due to COVID-19 (1.1%, 95% CI: 0.2–5.9%). One other woman received home oxygen. No women required mechanical ventilation and there were no maternal deaths. One woman had an unexplained fetal demise at 14 weeks' gestation around the time of her COVID-19 symptoms. Twenty one of the 92 women have delivered, and all were uncomplicated.
Conclusions Among 92 women with confirmed or presumed COVID-19, the overall morbidity was low. These preliminary results are encouraging for pregnant women during the COVID-19 pandemic.
Key Points
"
AUTHORS
Nathan S. Fox
Stephanie Melka
PUBLISHED
2020 in American Journal of Perinatology

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Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2
"
Objective To date, no information on late-onset infection in newborns to mother with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contracted in pregnancy are available. This study aimed to evaluate postdischarge SARS-CoV-2 status of newborns to mothers with COVID-19 in pregnancy that, at birth, were negative to SARS-CoV-2.
Study Design This is an observational study of neonates born to mothers with coronavirus disease 2019 (COVID-19).
Results Seven pregnant women with documented SARS-CoV-2 infection have been evaluated in our institution. One woman had a spontaneous abortion at 8 weeks of gestational age, four women recovered and are still in follow-up, and two women delivered. Two newborns were enrolled in the study. At birth and 3 days of life, newborns were negative to SARS-CoV-2. At 2-week follow-up, one newborn tested positive although asymptomatic.
Conclusion Our findings highlight the importance of follow-up of newborns to mothers with COVID-19 in pregnancy, since they remain at risk of contracting the infection in the early period of life and long-term consequences are still unknown.
Key Points
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AUTHORS
Simonetta Costa
Maurizio Sanguinetti
Antonio Lanzone
Brunella Posteraro
Piero Valentini
Danilo Buonsenso et al
PUBLISHED
2020 in American Journal of Perinatology

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Guidance for the provision of antenatal services during the COVID-19 pandemic
" Novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), is a new strain of coronavirus causing the COVID-19 infection. The incubation period is estimated at 0–14 days (mean 5–6 days). The majority of people with COVID-19 infection have mild symptoms. Typical symptoms include a fever and cough which may progress to a severe pneumonia causing breathing difficulties. Severe symptoms are more likely in people with weakened immune systems, older people and people with long-term conditions. Pregnant women do not appear to be more susceptible to the consequences of an infection with COVID-19 than the general population. Special consideration should be given to pregnant women with concomitant medical illnesses. There is currently no evidence concerning transmission through genital fluids or breastmilk. "
AUTHORS
David Connor
Meg Wilkinson
Yana Richens
PUBLISHED
2020 in British Journal of Midwifery

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Effects of SARS-CoV-2 infection on pregnant women and their infants: A retrospective study in Wuhan, China
" Context: The pandemic of a novel coronavirus, termed SARS-CoV-2, has created an unprecedented global health burden. Objective: To investigate the effect of the SARS-CoV-2 infection on maternal, fetal, and neonatal morbidity and other poor obstetrical outcomes. Design: All suspected cases of pregnant women with Coronavirus Disease 2019 (COVID-19) admitted into one center of Wuhan from Jan 20, 2020 to March 19, 2020 were included. Detailed clinical data of those pregnancies with COVID-19 were retrospectively collected and analyzed. Results: Twenty-seven laboratory or clinically confirmed SARS-CoV-2 infection pregnant women (4 early pregnancies included) and 24 neonates born to the 23 late pregnant mothers were analyzed. On admission, 46.2% (13/27) of the patients had symptoms, including fever (11/27), cough (9/27) and vomiting (1/27). Decreased total lymphocytes count was observed in 81.6% (22/27) patients. Twenty-six patients showed typical viral pneumonia by chest computed tomography (CT) scan, while one patient confirmed with COVID-19 infection showed no abnormality on chest CT. One mother developed severe pneumonia three days after her delivery. No maternal and perinatal death occurred. Moreover, one early preterm newborn, born to a mother with complication of premature rupture of fetal membranes, highly suspected with SARS-CoV-2 infection, was SARS-CoV-2 negative after repeated real-time reverse transcriptase polymerase chain reaction testing. Statistical difference was observed between the groups of early pregnant and late pregnant women with COVID-19 in the occurrence of lymphopenia and thrombocytopenia. Conclusions: No major complication were reported among the studied cohort, though one serious case and one perinatal infection were observed. Much effort should be done to reduce the pathogenic effect of COVID-19 infection in pregnancies. "
AUTHORS
Li-ye Yang
Sudong Zhan
Guoping Xiong
Hui Yang
Bin Hu
PUBLISHED
2020 in Archives of Pathology & Laboratory Medicine

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COVID-19 in pregnancy: What do we really know?
"Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-to-child transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice."
AUTHORS
Andrei Mihalache
Mariam Nikpayam
Eli Vesale
Frederique Isnard-Bogillot
Marc Even
Jerome Bouaziz et al
PUBLISHED
2020 in F1000Research

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Clinical manifestation and neonatal outcomes of pregnant patients with COVID-19 pneumonia in Wuhan, China
"Abstract

Background
Clinical manifestation and neonatal outcomes of pregnant women with Corona Virus Disease 2019(COVID-19) were unclear in Wuhan, China.


Methods
We retrospectively analyzed clinical characteristics of pregnant and non-pregnant women with COVID-19 aged from 20 to 40, admitted between January 15 and March 15, 2020 at Union Hospital, Wuhan, and symptoms of pregnant women with COVID-19 and compared the clinical characteristics and symptoms to historic data previously reported for H1N1.


Results
Among 64 patients, 34 (53.13%) were pregnant, with higher proportion of exposure history (29.41% vs 6.67%) and more pulmonary infiltration on CT test (50% vs 10%) comparing to non-pregnant women. Of pregnant patients, 27 (79.41%) completed pregnancy, 5 (14.71%) had natural delivery, 18 (52.94%) had cesarean section, and 4 (11.76%) had abortion, and 5 (14.71%) were asymptomatic. All 23 newborns had negative RT-PCR results and an average 1-minute Apgar Score was 8-9 points. Pregnant and non-pregnant patients show differences on symptoms like fever, expectoration, and fatigue, and on laboratory tests like: neutrophils, fibrinogen, D-dimer, and erythrocyte sedimentation rate. Pregnant patients with COVID-19 tend to have more mild symptoms than those with H1N1.


Conclusion
Clinical characteristics of pregnant patients with COVID-19 are less serious than non-pregnant. No evidence indicated that pregnant women may have fetal infection through vertical transmission of COVID-19. Pregnant patients with H1N1 had more serious condition than those with COVID-19.
"
AUTHORS
Dandan Li
Qing Zhang
Changxiao Yu
Hao Cui
Michael Ng
Yuwei Liu et al
PUBLISHED
2020 in Open Forum Infectious Diseases

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Emerging statistics on the Epidemiology of COVID-19: Making prevention in pregnancy less grievous than the disease
"Background: Pregnant women are a vulnerable group to the COVID-19 infection; although it is expected that adaptive changes of pregnancy put them at increased risk of adverse outcome from any respiratory tract infection, interventions for the COVID-19 may put them in more danger. Nigeria is one of the leading countries with very poor maternal mortality indices and many other sub-Saharan African nations are in the same boat. Contingency plans need to be put in place to prevent precipitous deterioration in mortality rates occasioned by the dreaded SARS- Cov-2 pandemic. This mini-review of literature and WHO global statistics is aimed to determine the trends in COVID-19 transmission and mortality rates to provide evidence-based information that may enable governments to tailor their interventions to the peculiar needs, of sub-Saharan African populations.
Main body: Emerging epidemiological trends on transmission and mortality within Africa and the worst affected regions of the world suggests better outcomes of this infection in sub-Saharan Africa, than in other regions of the world. Also, present data allude to similar outcomes between pregnant and non-pregnant women. The present containment measures of isolation and quarantine, including city-wide lockdowns, may put pregnant women at higher risk of death from other causes rather than COVID-19. The danger posed, is the limitation of access to emergency obstetric care services when pregnant women develop non-COVID-19 complications of pregnancy.
Conclusion: The COVID-19 pandemic has lower local transmission rates and fatality in Africa, the region where the virus arrived last. While special efforts should be geared at shielding the elderly and infirm from contracting the infection, preventive measures in pregnant women must allow for access to emergency obstetric care to forestall iatrogenic adverse maternal outcomes."
AUTHOR
John Imaralu
PUBLISHED
2020 in Babcock University Medical Journal (BUMJ)

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Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait
"Background: In late December of 2019, a novel coronavirus (SARS-CoV-2) was identified in the Chinese city Wuhan among a cluster of pneumonia patients. While it is known that pregnant women have reduced immunity and they are at risk for COVID-19 infection during the current pandemic, it is not clear if the disease manifestation would be different in pregnant women from non-pregnant women.
Objectives: To describe the maternal and neonatal clinical features as well as outcome of pregnancies complicated with SARS-CoV-2 infection.
Methods: In this retrospective national-based study, we analyzed the medical records of all SARS-CoV-2 positive pregnant patients and their neonates who were admitted to New-Jahra Hospital, Kuwait, between March 15th 2020 and May 31st 2020. The outcomes of pregnancies were assessed until the end date of follow-up (June 15th 2020).
Results: A total of 185 pregnant women were enrolled with a median age of 31 years (interquartile range, IQR: 27.5-34), and median gestational age at diagnosis was 29 weeks (IQR: 18-34). The majority (88%) of the patients had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). During the study period, 141 (76.2%) patients continued their pregnancy, 3 (1.6%) had a miscarriage, 1 (0.5%) had intrauterine fetal death and only 2 (1.1%) patients developed severe pneumonia and required intensive care. Most of the neonates were asymptomatic, and only 2 (5%) of them tested positive on day 5 by nasopharyngeal swab testing.
Conclusion: Pregnant women do not appear to be at higher risk to the COVID-19 than the general population. The clinical features of pregnant women with SARS-CoV-2 infection were similar to those of the general population having SARS-CoV-2 infection. Favorable maternal and neonatal outcomes reinforce the existing evidence and may guide healthcare professionals in the management of pregnancies complicated with SARS-CoV-2 infection."
AUTHORS
Monif Alhathal
Majeda Hammoud
Wadha Al-Fouzan
Asmaa Benawadth
Alia Embaireeg
Amal Ayed et al
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Extremely Preterm Infant Born to a Mother With Severe COVID-19 Pneumonia
" Little is known about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnant women, fetuses, and neonates, especially when the virus is contracted early in pregnancy. The literature is especially lacking on the effects of SARS-CoV-2 on extremely preterm (&lt;28 weeks gestation) infants who have underdeveloped immune systems. We report the case of an extremely preterm, 25-week 5-days old infant, born to a mother with severe COVID-19 (coronavirus disease-2019) pneumonia. In this case, there is no evidence of vertical transmission of SARS-CoV-2 based on reverse transcription-polymerase chain reaction testing, despite extreme prematurity. However, it appears that severe maternal COVID-19 may have been associated with extremely preterm delivery, based on observed histologic chorioamnionitis. This is the first reported case of an extremely preterm infant born to a mother with severe COVID-19 pneumonia who required intubation, and was treated with hydroxychloroquine, azithromycin, remdesivir, tocilizumab, convalescent plasma, inhaled nitric oxide, and prone positioning for severe hypoxemic respiratory failure prior to and after delivery of this infant. The infant remains critically ill with severe respiratory failure on high-frequency ventilation, inotropic support, hydrocortisone for pressor-resistant hypotension, and inhaled nitric oxide for severe persistent pulmonary hypertension with a right to left shunt across the patent ductus arteriosus and foramen ovale. Pregnant women or women planning to get pregnant should take all precautions to minimize exposure to SARS-CoV-2 to decrease adverse perinatal outcomes. "
AUTHORS
Rangasamy Ramanathan
Fiona B. Wertheimer
Amy M. Yeh
Theodore De Beritto
Molly C. Easterlin
PUBLISHED
2020 in Journal of Investigative Medicine High Impact Case Reports

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Universal SARS-Cov-2 Screening in Women Admitted for Delivery in a Large Managed Care Organization
FUNDERS
Kaiser Permanente Direct Community Benefit Funds
"
Objective The coronavirus disease 2019 (COVID-19) pandemic has created a need for data regarding the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women. After implementing universal screening for COVID-19 in women admitted for delivery, we sought to describe the characteristics of COVID-19 in this large cohort of women.
Study Design An observational study of women admitted to labor and delivery units in Kaiser Permanente Southern California (KPSC) hospitals between April 6 and May 11, 2020 who were universally offered testing for SARS-CoV-2 infection (n = 3,963). Hospital inpatient and outpatient physician encounter, and laboratory records were used to ascertain universal testing levels, test results, and medical and obstetrical histories. The prevalence of SARS-CoV-2 infection was estimated from the number of women who tested positive during labor per 100 women delivered.
Results Of women delivered during the study period, 3,923 (99.0%) underwent SARS-CoV-2 testing. A total of 17 (0.43%; 95% confidence interval: 0.23–0.63%) women tested positive, and none of them were symptomatic on admission. There was no difference in terms of characteristics between SARS-CoV-2 positive and negative tested women. One woman developed a headache attributed to COVID-19 3 days postpartum. No neonates had a positive test at 24 hours of life.
Conclusion The findings suggest that in pregnant women admitted for delivery between April 6 and May 11, 2020 in this large integrated health care system in Southern California, prevalence of SARS-CoV-2 test positive was very low and all patients were asymptomatic on admission.
Key Points
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AUTHORS
Michael J. Fassett
Darios Getahun
Vicki Chiu
Katia Bruxvoort
Neha Trivedi
Alex Fong et al
PUBLISHED
2020 in American Journal of Perinatology

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SARS-CoV-2 (COVID-19) infection in pregnant women: characterization of symptoms and syndromes predictive of disease and severity through real-time, remote participatory epidemiology.
"Background: From the beginning of COVID-19 pandemic, pregnant women have been considered at greater risk of severe morbidity and mortality. However, data on hospitalized pregnant women show that the symptom profile and risk factors for severe disease are similar to those among women who are not pregnant, although preterm birth, Cesarean delivery, and stillbirth may be more frequent and vertical transmission is possible. Limited data are available for the cohort of pregnant women that gave rise to these hospitalized cases, hindering our ability to quantify risk of COVID-19 sequelae for pregnant women in the community.
Objective: To test the hypothesis that pregnant women in community differ in their COVID-19 symptoms profile and disease severity compared to non-pregnant women. This was assessed in two community-based cohorts of women aged 18-44 years in the United Kingdom, Sweden and the United States of America.
Study design: This observational study used prospectively collected longitudinal (smartphone application interface) and cross-sectional (web-based survey) data. Participants in the discovery cohort were drawn from 400,750 UK, Sweden and US women (79 pregnant who tested positive) who self-reported symptoms and events longitudinally via their smartphone, and a replication cohort drawn from 1,344,966 USA women (162 pregnant who tested positive) cross-sectional self-reports samples from the social media active user base. The study compared frequencies of symptoms and events, including self-reported SARS-CoV-2 testing and differences between pregnant and non-pregnant women who were hospitalized and those who recovered in the community. Multivariable regression was used to investigate disease severity and comorbidity effects.
Results: Pregnant and non-pregnant women positive for SARS-CoV-2 infection drawn from these community cohorts were not different with respect to COVID-19-related severity. Pregnant women were more likely to have received SARS-CoV-2 testing than non-pregnant, despite reporting fewer clinical symptoms. Pre-existing lung disease was most closely associated with the severity of symptoms in pregnant hospitalized women. Heart and kidney diseases and diabetes were additional factors of increased risk. The most frequent symptoms among all non-hospitalized women were anosmia [63% in pregnant, 92% in non-pregnant] and headache [72%, 62%]. Cardiopulmonary symptoms, including persistent cough [80%] and chest pain [73%], were more frequent among pregnant women who were hospitalized. Gastrointestinal symptoms, including nausea and vomiting, were different among pregnant and non-pregnant women who developed severe outcomes.
Conclusions: Although pregnancy is widely considered a risk factor for SARS-CoV-2 infection and outcomes, and was associated with higher propensity for testing, the profile of symptom characteristics and severity in our community-based cohorts were comparable to those observed among non-pregnant women, except for the gastrointestinal symptoms. Consistent with observations in non-pregnant populations, comorbidities such as lung disease and diabetes were associated with an increased risk of more severe SARS-CoV-2 infection during pregnancy. Pregnant women with pre-existing conditions require careful monitoring for the evolution of their symptoms during SARS-CoV-2 infection."
AUTHORS
Benjamin Murray
Laura A Magee
Carole Helene Sudre
Wenjie Ma
Christina M Astley
Erika Molteni et al
PUBLISHED
2020 in Cold Spring Harbor Laboratory

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Fetomaternal outcome in COVID-19 infected pregnant women: a preliminary clinical study
"Background: WHO has declared COVID-19 infection a health emergency of international concern on 11th March, 2020. It is not clear whether clinical characteristics of pregnant women with COVID-19 differ from those of nonpregnant women and whether it aggravates COVID-19 symptoms and whether antiviral therapy is necessary for COVID-19 infected pregnant women.Methods: This is prospective study of 125 cases based on the compiled clinical data for pregnant women with COVID-19 between 15th April 2020 and 10th June 2020. A laboratory confirmed positive case of COVID-19 infection in pregnant women were included.Results: The most common symptoms at presentation were cough in 61.6% (77/125) and fever in 46.4% (58/125). Other reported symptoms were sore throat in 13.6% (17/125), myalgia in 10.4% (13/125) while 38.4% (48/125) were asymptomatic. There were total 97 deliveries (including 2 twins’ deliveries) among which 3 cases had IUD. Present study reported 96 live births. The incidence of missed abortion was 2.4% (3/125). The incidence of preterm birth before 37 weeks was 8.2% (8/97). Ninety-six (96.9%) of neonates were tested for SARS-CoV-2 viral nucleic acid on nasopharyngeal and pharyngeal samples and 16.67% (16/96) were resulted positive.Conclusions: At present, there is no evidence regarding the greater risk of pregnant women to succumb to COVID-19 infection and experience severe pneumonia. The risks of spontaneous abortion and preterm birth are not increased as reported in this study but shows possibility of vertical transmission when it manifests during the third trimester of pregnancy."
AUTHORS
Tanmay J. Chudasama
Babulal S. Patel
Pushpa A. Yadava
Sushma R. Shah
Sapana R. Shah
Parul T. Shah
PUBLISHED
2020 in International Journal of Reproduction, Contraception, Obstetrics and Gynecology

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