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

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).
He-Feng Huang and colleagues describe outcomes for infants born to women with COVID-19 early in the outbreak in China.
Author summary Why was this study done? Previous studies suggest COVID-19 infections in pregnant women are not more severe than in women of similar age. However, little is known about the outcome of neonates born to COVID-19-infected women. What did the researchers do and find? We analyzed the clinical features of all pregnant women with COVID-19 infection delivered in 2 of the 5 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and their neonates. Among the 30 neonates born to 29 pregnant COVID-19-infected women (1 set of twins), 5 were diagnosed as having COVID-19 (2 confirmed and 3 suspected), and the other 12 neonates presented radiological features of pneumonia, but none were diagnosed with pneumonia. Three neonates developed necrotizing enterocolitis, although none of them were premature. What do these findings mean? A considerable number of, but not all, neonates born to COVID-19-infected women developed COVID-19 (5/30) or had pneumonia-like radiological features (17/30). Intrapartum precaution should not be underestimated, and intrauterine transmission should be considered based on current evidence. Term neonates born to COVID-19-infected women are vulnerable to develop necrotizing enterocolitis.