Facing COVID-19 in Pregnant Women and Newborns
While meeting extraordinary clinical demands during the pandemic, our obstetricians and other specialists continue to generate scientific papers. This includes two recent studies that provide important insight on differences in outcomes between pregnant women with and without coronavirus and the outcomes of neonates to mothers born with perinatal SARS-CoV-2 infection.
Comparing Outcomes of Pregnant Women With and Without COVID-19
Obstetrics and pediatrics teams at Weill Cornell Medicine conducted a prospective cohort study of pregnant women admitted for delivery at three NewYork-Presbyterian hospitals to determine the differences between those women with and without COVID-19. The women were universally tested via nasopharyngeal swab for SARS‐CoV‐2 using reverse transcriptase polymerase chain reaction; all infants of mothers with COVID‐19 also underwent SARS‐CoV‐2 testing. Their findings were published in the November 2020 issue of BJOG.
Of 675 women >20 weeks’ gestation admitted for delivery, 10.4 percent were positive for SARS‐CoV‐2, of whom 78.6 percent were asymptomatic. The researchers observed differences in sociodemographics and comorbidities between women with symptomatic vs. asymptomatic vs. no COVID‐19. In women with symptomatic COVID‐19, cesarean delivery rates were 46.7 percent; 45.5 percent in women with asymptomatic COVID‐19; and 30.9 percent in women who did not have COVID‐19. Postpartum complications, including fever, hypoxia, and readmission, occurred in 12.9 percent of women with COVID‐19 vs. 4.5 percent of women without COVID‐19. None of the women required mechanical ventilation and no maternal deaths occurred.
Among 71 infants tested, none were positive for SARS‐CoV‐2. The placental pathology showed an increased frequency of fetal vascular malperfusion, indicating thrombi in fetal vessels, in women with COVID-19 (48.3 percent) vs. without COVID‐19 (11.3 percent).
The researchers observed that among pregnant women with COVID‐19 at delivery, there was an increase in cesarean deliveries and frequency of maternal complications in the postpartum period. They also noted that intraplacental thrombi may have maternal and fetal implications for COVID‐19 infections remote from delivery.
Prabhu M, Cagino K, Matthews KC, Friedlander RL, Glynn SM, Kubiak JM, Yang YJ, Zhao Z, Baergen RN, DiPace JI, Razavi AS, Skupski DW, Snyder JR, Singh HK, Kalish RB, Oxford CM, Riley LE. Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: a prospective cohort study. BJOG. 2020 Nov;127(12):1548-1556.
Assessing Mother-to-Newborn Transmission of SARS-CoV-2
Among the more salient questions raised by obstetricians, maternal-fetal medicine specialists, neonatologists, and pediatricians as they cared for pregnant women with COVID-19 and their newborns during the pandemic was the risk of vertical and/or postnatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from mother to baby.
To shed light on the potential for adverse outcomes in this population, Columbia faculty undertook a multidisciplinary retrospective analysis of the first 101 neonates born to 100 mothers with perinatal SARS-CoV-2 infection positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. SARS-CoV-2 testing results represented the primary outcome measure in newborns.
Their comprehensive analysis included associations between maternal COVID-19 severity, newborn characteristics (mode of delivery, sex, birth weight, small or large for gestational age), and the clinical course (NICU admissions, Apgar scores, breastfeeding frequency, hour of life at newborn bath, need for resuscitation, phototherapy if performed, weight loss, laboratory and radiology data as applicable for NICU courses, and age at discharge).
Their study, which the authors believe was the largest series of newborns born to mothers positive for or with suspected SARS-CoV-2 infection to date, provided encouraging data, including low rates of testing-based vertical or perinatal transmission and no clinical evidence for neonatal SARS-CoV-2 infection. They note the outcomes were particularly reassuring in that the study involved mothers with a range of clinical presentations.
Dumitriu D, Emeruwa UN, Hanft E, Liao GV, Ludwig E, Walzer L, Arditi B, Saslaw M, Andrikopoulou M, Scripps T, Baptiste C, Khan A, Breslin N, Rubenstein D, Simpson LL, Kyle MH, Friedman AM, Hirsch DS, Miller RS, Fernández CR, Fuchs KM, Keown MK, Glassman ME, Stephens A, Gupta A, Sultan S, Sibblies C, Whittier S, Abreu W, Akita F, Penn A, D'Alton ME, Orange JS, Goffman D, Saiman L, Stockwell MS, Gyamfi-Bannerman C. Outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection at a large medical center in New York City. JAMA Pediatrics. 2020 Oct 12:e204298.