Vertical Transmission of SARS-CoV-2 during Pregnancy: A Prospective Italian Cohort Study

Simonetta Costa; Lucia Giordano; Anthea Bottoni; Eloisa Tiberi; Simona Fattore; Roberta Pastorino; Nicoletta Di Simone; Antonio Lanzone; Danilo Buonsenso; Piero Valentini; Paola Cattani; Rosaria Santangelo; Maurizio Sanguinetti; Giovanni Scambia; Giovanni Vento

doi:10.1055/a-1792-4535

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(08): 1077-1085
DOI: 10.1055/a-1792-4535

Original Article

Vertical Transmission of SARS-CoV-2 during Pregnancy: A Prospective Italian Cohort Study

Simonetta Costa

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Lucia Giordano

²Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Anthea Bottoni

²Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Eloisa Tiberi

²Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Simona Fattore

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Roberta Pastorino

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Nicoletta Di Simone

³Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy

,

Antonio Lanzone

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Danilo Buonsenso

²Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Piero Valentini

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Paola Cattani

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Rosaria Santangelo

⁴Department of Laboratory and Infectivology Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy

,

Maurizio Sanguinetti

⁴Department of Laboratory and Infectivology Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy

,

Giovanni Scambia

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Giovanni Vento

¹Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

› Author Affiliations

Abstract

Objective The extent of vertical transmission (VT) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from mothers their fetuses or neonates is still uncertain. We aimed to determine the incidence of VT.

Study Design In this prospective cohort study. All mother diagnosed with SARS-CoV-2 infection at the time of delivery or up to 1 week prior and their neonates, managed in a tertiary referral hospital for pregnancy complicated by coronavirus disease 2019 (COVID-19) in Rome, from April 2 to December 22, 2020, were included. Maternal infection was defined as nasopharyngeal swab test results positive for SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR). Biological samples were collected before, at, and after delivery to test positivity for SARS-CoV-2 RT-PCR and anti-SARS-CoV-2-specific antibodies.

Results The cohort included 95 women and 96 neonates with documented SARS-CoV-2 test results. Four neonates (4.2%) tested positive. The incidence of VT, according to the guidance criteria for diagnosing perinatal SARS-CoV-2 infection, was 5.2%. Neonatal symptoms were due to prematurity or fetal distress: symptomatic infants had lower median (min–max) gestational age, 38.1 (29.3–40.6) versus 39.3 (33.9–41.9) weeks (p = 0.036), and 1-minute and 5-minute Apgar scores, 9 (3–9) versus 9 (7–10) (p = 0.036) and 10 (6–10) versus 10 (8–10) (p = 0.012), respectively, than asymptomatic infants and needed more frequent assistance in the delivery room (22.2 vs 2.5%; p = 0.008). Only six (7.1%) neonates had anti-SARS-CoV-2-specific antibodies, despite the ongoing maternal infection.

Conclusion The incidence of VT is low as is the detection of specific anti-SARS-CoV-2 antibodies in cord blood when infection is contracted late in pregnancy. This would suggest poor protection of infants against horizontal transmission of the virus.

Key Points

VT of SARS-CoV-2 from pregnant mothers to fetuses or neonates can be possible.
In this prospective cohort study, the incidence of VT is found to be 5.2%.
VT is low but exists.

Keywords

pregnancy - SARS-CoV-2 infection - vertical transmission - perinatal transmission - neonates

Full Text

References

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