Maternal Mother-to-Child Coronavirus Transmission Unlikely
A research letter published early by the US Centers for Disease Control and Prevention (CDC) suggests that mother-to-child transmission of the SARS-CoV-2 coronavirus is unlikely.
This June 2020 letter reports a woman confirmed with the coronavirus disease-2019 (COVID-19) on the basis of a sputum sample, in her 35th week of pregnancy, delivered an infant by cesarean section in Zhejiang Province, China, who was found negative for the SARS-CoV-2 virus.
Published by the CDC on March 5, 2020, this study analyzed the mother’s epidemiologic history to determine the timeline of her virus infection.
On day 1 of her hospitalization, the pregnant woman had a dry cough and a temperature of 37.2°C.
The chest auscultation was slightly thicker in the right lung but not the left lung. Chest radiography showed scattered multiple patchy infiltrates in both lungs. Laboratory findings were slightly abnormal.
She received antiviral treatment (oral lopinavir 200 mg and ritonavir 50 mg, each 2×/d), as well as methylprednisolone (40 mg 1×/d) to relieve inflammation effusion.
Her cough resolved on day 2 of hospitalization.
On February 8 (day 3 of hospitalization), SARS-CoV-2 RNA remained in the woman’s sputum, and the fetal heart rate monitor showed 110 beats/min.
A consultation with an obstetrician resulted in a recommendation for an emergency cesarean section.
The woman underwent a lower uterus cesarean section in a negative-pressure operating room.
All persons in the delivery room wore protective suits.
Cefoperazone sodium/sulbactam sodium (intravenous drip, 2 g/ 8 h) was infused to prevent infection at the surgical site, and the methylprednisolone dose was doubled.
She delivered a normal baby boy without complications.
On the delivery day, although the woman’s sputum was positive, serum, urine, feces, amniotic fluid, umbilical cord blood and placenta, and breast milk samples were negative.
An oropharyngeal swab specimen, obtained immediately after he was taken from the uterus, indicated he was negative for SARS-CoV-2, and he was sent to the negative-pressure ward.
During the next 2 days, the infant’s oropharyngeal swab, blood, feces, and urine samples remained negative for SARS-CoV-2 throughout testing at 7 different times.
On days 4 and 5 of hospitalization, the woman’s sputum tests were negative for SARS-CoV-2, and she remained afebrile.
Her respiratory specimens were positive for SARS-CoV-2 after 4 days of serial testing.
However, no SARS-CoV-2 RNA was detected in fecal, urine, and blood samples.
The woman was discharged from the hospital on February 19, and her infant was discharged on February 24th.
In a previous descriptive study of SARS-CoV-2 infection published on February 10, 2020, 7 of 9 pregnant women delivered their infants through cesarean section; 10 SARS-CoV-2–negative infants were born.
In conclusion, ‘we report a pregnant woman with SARS-CoV-2 infection who delivered a healthy infant, suggesting that mother-to-child transmission is unlikely for this virus.’
‘We believe that effective implementation of protection measures during delivery, including a negative-pressure delivery room, may help prevent the infant from acquiring SARS-CoV-2 infection.’
‘Because our conclusions are limited by our sample size of 1, we cannot definitively state whether a cesarean section is better than vaginal delivery for preventing transmission from a pregnant mother with SARS-CoV-2 infection.’
Dr. Li is a deputy chief physician in the Department of Obstetrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. Her primary research interests include critical illness in obstetrics, prenatal diagnosis, and fetal medicine.
No conflicts of interest were disclosed.
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