Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

Abstract

Multiple reports have been published recently on characteristics of patients with COVID-19 in the general population, but there is little information on pregnancy-related presenting symptoms and outcomes. The goal of this study was to report clinical data as well as incidence of vertical transmission in pregnant patients with COVID-19. This retrospective chart review was performed on pregnant women admitted to Zhongnan Hospital of Wuhan University in China with confirmed COVID-19 between January 20 through January 31, 2020. Clinical, laboratory, and radiologic records were reviewed by two investigators. Additionally, analyses from amniotic fluid, cord blood samples, and neonatal throat samples from the time of delivery were included. Vertical transmission was defined as positive testing for COVID-19 in these samples. Descriptive statistics were used. There were nine patients included in the analysis. All were in the third trimester on admission, the earliest presenting at 36 weeks, 2 days and all had a known source of exposure to COVID-19. None of the patients had baseline comorbidities, but one patient had gestational hypertension and another developed pre-eclampsia. The most common symptoms of COVID-19 were fever on admission (78%), postpartum fever (67%), cough (44%), myalgia (33%), and sore throat (22%). Most had low or normal leukocyte count (78%) and 5 (56%) had lymphopenia. C-reactive protein was greater than 10mg/L in 75% of patients. One was found to be co-infected with influenza, and all were diagnosed with COVID-19 pneumonia and required oxygen therapy and antibiotics. Many (67%) also received antivirals. Regarding delivery, all nine were live births delivered via cesarean section with 1-min Apgar scores of 8-9 and 5-min Apgar scores of 9-10. Four of the 9 were delivered prematurely at 36 weeks (44%) for a variety of reasons including premature rupture of membranes, pre-eclampsia, or pneumonia. None of the fluid samples at birth were positive for COVID-19. Additionally, all of the mothers and babies were discharged from the hospital. Limitations discussed include the retrospective nature of data abstraction and small sample size. Additionally all patients enrolled were in the third trimester. The authors concluded that pregnant patients with COVID-19 present with similar symptoms as nonpregnant patients. Also, based on this limited sample, the mothers had a low risk of complications and all of the infants tested negative for COVID-19 after birth, suggesting that vertical transmission is unlikely. Comment: There are still many uncertainties about the disease course of COVID-19 in pregnant patients. This review is reassuring, however this is a very small sample size so caution should be used in applying these results to our day to day patients, especially those at earlier gestational ages. More studies should be conducted on pregnant patients with COVID-19 in all trimesters to have a more accurate picture of how this virus affects pregnancy-related outcomes.