Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis
K F Walker, K O'Donoghue, N Grace, J Dorling, J L Comeau, W Li, J G Thornton, K F Walker, K O'Donoghue, N Grace, J Dorling, J L Comeau, W Li, J G Thornton
Abstract
Background: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified?
Objective: To estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction.
Search strategy: Two biomedical databases were searched between September 2019 and June 2020.
Selection criteria: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported.
Data collection and analysis: Data were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission.
Main results: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated.
Conclusions: Neonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother.
Tweetable abstract: Risk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.
Keywords: COVID-19; SARS-COV-2; artificial feeding; birth; breast-feeding; caesarean; disambiguation; duplicate publication; isolation; neonatal infection; pregnancy.
© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.
References
- Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004;191:292–7.
- Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID‐19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020;222:415–26.
- Alfaraj SH, Al‐Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus (MERS‐CoV) infection during pregnancy: report of two cases & review of the literature. J Microbiol Immunol Infect 2019;52:501–3.
- Mi J, Liu FC. Rate of caesarean section is alarming in China. Lancet 2014;383:1463.
- Gynaecologists RCoOa . Coronavirus (COVID‐19) Infection in Pregnancy. Information for Health Care Professionals. London: Royal College of Obstetricians and Gynaecologists; 2020.
- Bauchner H, Golub RM, Zylke J. Editorial concern‐possible reporting of the same patients with COVID‐19 in different reports. JAMA 2020;323:1256.
- Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, et al. Clinical characteristics of pregnant women with Covid‐19 in Wuhan, China. N Engl J Med 2020;382:e100(1)–(3).
- Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020;55:586–92.
- Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID‐19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand 2020;99:823–9.
- Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1–19) during pregnancy: a systematic review and meta‐analysis. Am J Obstet Gynecol MFM 2020;2:100107.
- Elshafeey F, Magdi R, Hindi N, Elshebiny M, Farrag N, Mahdy S, et al. A systematic scoping review of COVID‐19 during pregnancy and childbirth. Int J Gynaecol Obstet 2020;150:47–52.
- Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. COVID19 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol 2020;223:36–41. 10.1002/uog.22006
- Yang Z, Wang M, Zhu Z, Liu Y. Coronavirus disease 2019 (COVID‐19) and pregnancy: a systematic review. J Matern Fetal Neonatal Med 2020;55:1–4.
- Karimi‐Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical transmission of coronavirus disease 19 (COVID‐19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol 2020;39:246–50.
- Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS‐CoV‐2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand 2020;99:565–8.
- Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. BMJ 2009;339:b2535.
- Narvey M. Breastfeeding When Mothers Have Suspected or Proven COVID‐19. Ottawa, ON: Canadian Paediatric Society; 2020.
- Initiative UUBF . Statement on infant feeding on neonatal units during the coronavirus (COVID‐19) outbreak 2020 []. Accessed 12 June 2020.
- Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID‐19) in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020;223:111.E1–14.
- Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS‐CoV‐2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG 2020; 10.1111/1471-0528.16278
- Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID‐19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395:809–15.
Source: PubMed