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American Journal of Obstetrics and Gynecology

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Coronavirus disease 2019 in pregnant women: a report based on 116 cases - 26/07/20

Doi : 10.1016/j.ajog.2020.04.014 
Jie Yan, MD, PhD a, 1, Juanjuan Guo, MD b, 1, Cuifang Fan, MD c, 1, Juan Juan, PhD a, 1, Xuechen Yu, MD b, Jiafu Li, MD b, Ling Feng, MD d, Chunyan Li, MD c, Huijun Chen, MD b, Yuan Qiao, MD b, Di Lei, MD c, Chen Wang, MD, PhD a, Guoping Xiong, MD e, Fengyi Xiao, MD f, Wencong He, MD g, Qiumei Pang, MD h, Xiaoling Hu, MD i, Suqing Wang, MD j, Dunjin Chen, MD k, Yuanzhen Zhang, MD b, Liona C. Poon, MD l, Huixia Yang, MD a, ⁎
a Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China 
b Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China, Clinical Medicine Research Center of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, China 
c Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, China 
d Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 
e Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Wuhan, China 
f Department of Obstetrics and Gynecology, The Central Hospital of Suizhou, Suizhou, China 
g Department of Obstetrics and Gynecology, Yichang Central People's Hospital, Yichang, China 
h Department of Obstetrics and Gynecology, Beijing You'An Hospital, Beijing, China 
i Department of Obstetrics and Gynecology, The People’s Hospital of Hanchuan, Hanchuan, Hubei Province, China 
j Department of Nutrition and Food Hygiene, School of Public Health, Wuhan University, Wuhan, China 
k Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China 
l Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region 

∗Corresponding author: Huixia Yang, MD.
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Abstract

Background

The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, is a global public health emergency. Data on the effect of coronavirus disease 2019 in pregnancy are limited to small case series.

Objective

To evaluate the clinical characteristics and outcomes in pregnancy and the vertical transmission potential of severe acute respiratory syndrome coronavirus 2 infection.

Study Design

Clinical records were retrospectively reviewed for 116 pregnant women with coronavirus disease 2019 pneumonia from 25 hospitals in China between January 20, 2020, and March 24, 2020. Evidence of vertical transmission was assessed by testing for severe acute respiratory syndrome coronavirus 2 in amniotic fluid, cord blood, and neonatal pharyngeal swab samples.

Results

The median gestational age on admission was 38+0 (interquartile range, 36+0–39+1) weeks. The most common symptoms were fever (50.9%, 59/116) and cough (28.4%, 33/116); 23.3% (27/116) patients presented without symptoms. Abnormal radiologic findings were found in 96.3% (104/108) of cases. Of the 116 cases, there were 8 cases (6.9%) of severe pneumonia but no maternal deaths. One of 8 patients who presented in the first trimester and early second trimester had a missed spontaneous abortion. Of 99 patients, 21 (21.2%) who delivered had preterm birth, including 6 with preterm premature rupture of membranes. The rate of spontaneous preterm birth before 37 weeks’ gestation was 6.1% (6/99). One case of severe neonatal asphyxia resulted in neonatal death. Furthermore, 86 of the 100 neonates tested for severe acute respiratory syndrome coronavirus 2 had negative results; of these, paired amniotic fluid and cord blood samples from 10 neonates used to test for severe acute respiratory syndrome coronavirus 2 had negative results.

Conclusion

Severe acute respiratory syndrome coronavirus 2 infection during pregnancy is not associated with an increased risk of spontaneous abortion and spontaneous preterm birth. There is no evidence of vertical transmission of severe acute respiratory syndrome coronavirus 2 infection when the infection manifests during the third trimester of pregnancy.

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Key words : ascending infection, coronavirus, coronavirus disease 2019, COVID-19, pandemic, pneumonia, pregnancy, pregnancy outcomes, pregnant women, preterm birth, PTB, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, spontaneous abortion, spontaneous preterm birth, spontaneous PTB, vertical transmission


Plan


 This study was supported by the Science and Technology Department of Hubei Province, New Pneumonia Emergency Science and Technology Project, perinatal management strategies and mother-to-child transmission of pregnant women infected with 2019-nCoV (grant number 2020FCA011). The funding agencies had no involvement in the study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the article for publication.
 The authors report no conflict of interest.
 Cite this article as: Yan J, Guo J, Fan C, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020;223:111.e1-14.


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Vol 223 - N° 1

P. 111.e1-111.e14 - juillet 2020 Retour au numéro
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