Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China

Abstract

Background: As of June 1, 2020, coronavirus disease 2019 (COVID-19) has caused more than 6,000,000 infected persons and 360,000 deaths globally. Previous studies revealed pregnant women with COVID-19 had similar clinical manifestations to nonpregnant women. However, little is known about the outcome of neonates born to infected women.

Methods and findings: In this retrospective study, we studied 29 pregnant women with COVID-19 infection delivered in 2 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and 30 neonates (1 set of twins). Maternal demographic characteristics, delivery course, symptoms, and laboratory tests from hospital records were extracted. Neonates were hospitalized if they had symptoms (5 cases) or their guardians agreed to a hospitalized quarantine (13 cases), whereas symptom-free neonates also could be discharged after birth and followed up through telephone (12 cases). For hospitalized neonates, laboratory test results and chest X-ray or computed tomography (CT) were extracted from hospital records. The presence of antibody of SARS-CoV-2 was assessed in the serum of 4 neonates. Among 29 pregnant COVID-19-infected women (13 confirmed and 16 clinical diagnosed), the majority had higher education (56.6%), half were employed (51.7%), and their mean age was 29 years. Fourteen women experienced mild symptoms including fever (8), cough (9), shortness of breath (3), diarrhea (2), vomiting (1), and 15 were symptom-free. Eleven of 29 women had pregnancy complications, and 27 elected to have a cesarean section delivery. Of 30 neonates, 18 were admitted to Wuhan Children's Hospital for quarantine and care, whereas the other 12 neonates discharged after birth without any symptoms and had normal follow-up. Five hospitalized neonates were diagnosed as COVID-19 infection (2 confirmed and 3 suspected). In addition, 12 of 13 other hospitalized neonates presented with radiological features for pneumonia through X-ray or CT screening, 1 with occasional cough and the others without associated symptoms. SARS-CoV-2 specific serum immunoglobulin M (IgM) and immunoglobulin G (IgG) were measured in 4 neonates and 2 were positive. The limited sample size limited statistical comparison between groups.

Conclusions: In this study, we observed COVID-19 or radiological features of pneumonia in some, but not all, neonates born to women with COVID-19 infection. These findings suggest that intrauterine or intrapartum transmission is possible and warrants clinical caution and further investigation.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2000031954 (Maternal and Perinatal Outcomes of Women with coronavirus disease 2019 (COVID-19): a multicenter retrospective cohort study).

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: BWM is supported by a NHMRC Investigator grant (GNT1176437). BWM reports consultancy for ObsEva, Merck KGaA, iGenomix and Guerbet. These consultancies are not related to the current work. All other authors report no potential competing interests.

Figures

Fig 1. Flow chart of participants inclusion.

Of the 30 neonates born (including 1 set of twins), 18 were admitted to the Children’s Hospital to have further examination (5 with symptoms and 13 just for quarantine). The other 12 neonates discharged immediately did not undergo imaging screening, and follow-up showed no symptoms or abnormal findings. Among 18 neonates admitted to hospital, 17 neonates had pneumonia-like imaging changes. Five neonates were diagnosed with a COVID-19 infection, including 2 confirmed and 3 suspected. COVID-19, coronavirus disease 2019.

Fig 2. Chest X-ray or CT (transverse plane) images of 5 neonates diagnosed with COVID-19 infection (2 confirmed, 3 suspected) after birth, in the treatment, and before discharge.

(A-B, Patient 5) Chest CT images (A) obtained after birth showed peripheral GGOs in the posterior basal segment of left lung lower lobe. Chest X-ray film (B) before discharge showed no abnormal findings. (C-E, Patient 9) Chest CT images (C) showed diffuse GGO with multifocal consolidations in the peripheral regions of bilateral lungs. Chest X-ray film (D) in treatment showed patchy obscure shadows in bilateral lung lower fields. Chest X-ray film (E) before discharge showed complete disappearance of pneumonia. (F-H, Patient 10) Chest CT images (F) obtained after birth showed patchy GGO in the posterior basal segment of right lower lobe and large GGO in the posterior basal segment of left lower lobe. Chest X-ray film (G) in treatment showed significant release of pneumonia. Chest X-ray film (H) before discharge showed nothing abnormal findings except mild increased lung markings. (I-J, Patient 12) Chest CT images (I) obtained after birth showed peripheral focal consolidations in the posterior basal segments of bilateral lower lobes and multiple patchy GGO bilaterally. Chest X-ray film (J) showed partial absorption of pneumonia. (K-M, Patient 18) Chest CT images (K) obtained after birth showed reduced latency with GGO in bilateral lower lobes. Chest X-ray film (L) in treatment showed increased bilateral lung markings. Chest X-ray film (M) before discharge showed increased densities of previous existing pulmonary lesions with interlobular septal thickening. All images have been de-identified to protect patient privacy. COVID-19, coronavirus disease 2019; CT, computed tomography; GGO, ground-glass opacity.