Introduction
Coronaviruses (CoVs) are a large viral family, known since the mid-1960s, that cause
respiratory infections in humans and animals. Some coronaviruses can cause severe
respiratory syndromes, such as severe acute respiratory syndrome (SARS) and Middle
East respiratory syndrome (MERS). Severe acute respiratory syndrome is caused by the
SARS-associated coronavirus (SARS-CoV), with the first reports being made in China
in 2002. Middle East respiratory syndrome, in turn, is a respiratory disease caused
by the MERS-CoV. It was identified in 2012, and, since 2016, it has been drastically
reduced after public health efforts to prevent transmission of MERS-CoV.[1]
[2] Recently, a new coronavirus has been identified, SARS-CoV-2, and it is associated
with the coronavirus disease 2019 (COVID-19).[1]
[3]
[4]
[5]
The most common symptoms at onset of COVID-19 illness are fever, cough, and fatigue,
while other symptoms include sputum production, dyspnea, headache, hemoptysis, and
diarrhea.[3]
[6] Some patients with COVID-19 have laboratory changes such as lymphopenia, thrombocytopenia,
and elevation of C-reactive protein (CRP). D-dimer elevation can also be identified
and serves as an indication of a worse prognosis of COVID-19, although this is already
a parameter normally increased in pregnant women.[7]
[8] Changes in radiographs are common in symptomatic patients with saturation < 95%,
manifesting as pneumonia.[7]
Many patients can be asymptomatic, which facilitates virus spread.[7] According to the World Health Organization (WHO), on August 10, 2020, there were
19,718,030 people infected globally, with 728,013 confirmed deaths.[9] In Brazil, on the same date, the number of people infected was 3,035,422, with 101,049
deaths,[10] and among these, 199 were puerperal women.[11]
Severe acute respiratory syndrome coronavirus and MERS-CoV have caused adverse maternal-fetal
outcomes, such as maternal death, intrauterine fetal growth restriction, spontaneous
abortion, and premature birth. Thus, considering that these viruses are similar, as
they belong to the same genus Betacoronavirus, one can admit an adverse potential in pregnant women infected with SARS-Cov-2;[3]
[4]
[12] however, due to its recent discovery, little is known about its relationship with
pregnancy. Therefore, this review aimed to analyze reports related to SARS-CoV-2 infection
in pregnancy and postpartum as well as its consequences in the maternal-fetal sphere
in order to assist in the management of these patients.
Results
Clinical, Laboratory, and Imaging Features in Pregnant Women with Suspected or Proven
COVID-19
It is known that pregnant women have a higher risk of severe morbidity and mortality
when affected by other respiratory infections, such as influenza and SARS-CoV. Therefore,
they should be considered a population at risk for COVID-19.[13]
[14]
[15] Adverse maternal-fetal outcomes (e. g. premature birth) have been reported in the literature. However, this information
is based on limited data and it is not clear that these results are related to maternal
infection.[13]
The Brazilian Ministry of Health included high-risk pregnant women in the risk group
for complications caused by SARS-CoV-2 infection. It also emphasizes that urgent measures
for specific clinical management must be respected for this population, such as early
medication and not delaying radiographic exams regardless of the gestational period.[15]
[16] In addition, the possibility of worsening the infection caused by SARS-CoV-2 in
pregnant women cannot be ruled out.[17] The coronavirus clinical management protocol (COVID-19) in primary health care of
the Brazilian Ministry of Health has also emphasized the relocation of health professionals
who are pregnant, especially if their pregnancy is high-risk. Furthermore, this protocol
also establishes that both pregnant and puerperal women should receive priority care.[15]
Therefore, pregnant women with SARS-CoV-2 infection, even with a mild course, should
be monitored including bi-monthly fetal growth ultrasound monitoring and Doppler assessment,
due to the potential risk of restricted fetal intrauterine growth.[18] Due to the delay in reverse transcript polymerase chain reaction (RT-PCR) tests,
chest computed tomography (CT) in the third trimester may be an effective way to screen
for COVID-19 pneumonia in pregnant women, particularly in areas with outbreaks in
progress.[19]
In a study by Ellington et al.,[20] data were collected from 91,412 women diagnosed with COVID-19, aged 15 to 44 years,
8.98% of whom were pregnant. Symptoms were reported by 97.7% of pregnant women and
96.2% of non-pregnant women. However, the risk of hospitalization was 5.4 times higher
for pregnant women, while the risk of admission to the intensive care unit (ICU) and
mechanical ventilation was 1.5 and 1.7, respectively, compared to the group of non-pregnant
women.[20] In addition to the common laboratory findings in people with COVID-19, all pregnant
women with SARS-CoV-2 pneumonia also presented D-dimer levels above the normal range,
even considering the normal elevation usually found in pregnancy. Two (29%) patients
had different degrees of abnormal liver function, as well as an increase in alanine
aminotransferase (ALT) and/or aspartate aminotransferase (AST). Interleukin-6 was
tested in four patients, all with levels above the normal range. Two patients had
chronic diseases (polycystic ovaries and hypothyroidism) and three had co-infection
(two due to H1N1 and one due to Legionella pneumophila). According to chest computed tomography (CT), 6 (86%) patients had bilateral pneumonia,
and the rest (14%) had unilateral pneumonia. After the follow-up period, all patients
were discharged from the hospital. Four neonates were released without testing for
SARS-CoV-2, and there were no signs of fever or pathological jaundice after 28 days.
Three neonates were under observation and were tested, the result was positive in
1 of them 36 hours after birth, even with negative viral tests of cord blood and placenta.
The neonate with a positive test did not have a fever or cough, had mild signs of
breathing difficulty and a chest X-ray revealed mild pneumonia. After 28 days of life,
the baby had two negative results on the molecular test and was discharged.[8]
Wu et al.[21] evaluated 23 pregnant women with COVID-19, most of whom were asymptomatic (n = 15).
Among the asymptomatic pregnant women, six were at risk of miscarriage or premature
rupture of the membrane. When comparing the average hospital stay, asymptomatic patients
had a shorter hospital stay (14 days) than symptomatic patients (25.5 days).[21]
Physiological gestational changes and pathological disorders, such as endocrine and/or
vascular disorders, which occur during high-risk pregnancies, may influence the pathogenesis
and/or clinical presentation of SARS-CoV-2 infection in pregnant women.[22] The human placenta expresses an excessive amount of the angiotensin-converting enzyme
2 (ECA2),[23] which is the SARS-CoV-2 cell receptor,[24] whose main function is to regulate blood pressure and fetal development.[23] Thus, a possible intrauterine infection by COVID-19 can alter the ACE2 expression
and trigger hypertensive complications during pregnancy, such as preeclampsia.[22]
Hypertensive syndromes are the most frequent complications in pregnancy and are the
leading cause of maternal death in Brazil, mainly in its severe forms, such as preeclampsia
and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome.[25]
[Figure 1] shows the most frequent complications in pregnancy.
Fig. 1 Most frequent complications in pregnancy.
In a study by Mendoza et al.,[26] 42 pregnant women with gestational age greater than 20 weeks and diagnosed with
COVID-19 were classified as severe and non-severe according to the type of pneumonia.
Eight pregnant women developed severe pneumonia requiring admission to the intensive
care unit (ICU), and 6 of these women had characteristics of preeclampsia. When analyzing
the criteria for preeclampsia/HELLP syndrome, it was found that only one case had
all the requirements (increased lactate dehydrogenase [LDH], placental subperfusion,
and abnormal angiogenic state). Thus, the authors suggested that the other 5 cases
of preeclampsia can be explained by complications related to COVID-19.[26]
Although there are few specific data on SARS-CoV-2, other analyzed viruses and respiratory
viruses can bring serious conditions to pregnant women and should guide the care of
pregnant women with COVID-19 until additional data becomes available. Given the above,
the consensus among experts was that pregnant women should be isolated to avoid contamination.[1]
According to Zhang et al. (2020),[27] even the infection with mild symptoms of COVID-19 reduces lung function. Therefore,
with early isolation and drug treatment, cases are less likely to progress to severe
pneumonia. However, vigilance should be increased, and, if necessary, pregnancy must
be interrupted as soon as possible to prevent the development of the disease to severe
and critical stages. At the same time, multidisciplinary cooperation is essential
to jointly guarantee the safety of the mother-child binomial.[27]
Even during the pandemic, research is conducted on the impacts of COVID-19 infection
on the clinical presentation and perinatal and/or puerperal outcomes; however, the
data are still limited and are not conclusive regarding the risk of developing severe
forms of COVID-19 associated with pregnancy. However, due to the physiological changes
of the gestational period, pregnant women can be seriously affected by some infections.
Therefore, it is important to adopt precautionary measures against COVID-19 and systematic
monitoring of pregnant women, even if this monitoring occurs in the non-face-to-face
care. [Table 1] shows the findings of the main studies involving pregnant women with COVID-19 and
their newborns.
Table 1
Main results published on pregnant women with COVID-19 and their newborns
|
Number of pregnant patients
|
Delivery route
|
Maternal symptoms
|
Maternal/fetal complications
|
Study
|
Date of publication
|
|
09
|
Cesarean section
|
Seven patients had fever, four had cough, and two had malaise
|
One had flu, one had gestational hypertension, one had pre-eclampsia, two had fetal
distress, and three had a ruptured membrane
|
(Chen et al., 2020)[28]
|
March 07, 2020
|
|
17
|
Cesarean section
|
Four had fever, four had cough, one had fatigue, two had chest pain, one had dyspnea,
and one had diarrhea
|
Three underwent emergency cesarean section
|
(Chen et al., 2020)[29]
|
March 16, 2020
|
|
13
|
Ten cesarean sections, five of which were emergency. Three pregnant women were still
pregnant at the end of the study
|
Ten had fever, three had dyspnea, and one was asymptomatic
|
Three had fetal distress, one had a ruptured membrane, and one was stillborn
|
(Liu et al., 2020)[30]
|
March 5, 2020
|
|
01
|
Spontaneous vaginal
|
Fever, cough, headache, and myalgia
|
Gestational hypertension and hypothyroidism.
|
(Zambrano et al., 2020)[31]
|
March 25, 2020
|
|
07
|
Seven cesarean sections, two of which were emergency due to preeclampsia
|
Six had fever, one had cough, one had shortness of breath, and one had diarrhea.
|
Two patients had hypertension, blurred vision, and preeclampsia.
|
(Yang et al., 2020)[32]
|
June 2020
|
|
01
|
Vaginal delivery
|
Fever and dry cough
|
Premature rupture of the membrane
|
(Xiong et al., 2020)[33]
|
April 10, 2020
|
|
01
|
Emergency cesarean section
|
Fever
|
Intermittent fever in the postoperative period.
|
(Wang et al., 2020)[34]
|
March 12, 2020
|
|
23
|
Eighteen cesarean sections, two vaginal deliveries and three patients voluntarily
terminated the pregnancy in the first trimester
|
Four patients had fever, six had cough, one had nasal congestion, and 15 patients
were asymptomatic
|
One had fetal intrauterine hypoxia, two had a ruptured membrane, four had gestational
hypertension, and three had threat of miscarriage
|
(Wu et al., 2020)[21]
|
April 8, 2020
|
|
03
|
Vaginal deliveries
|
Fever, cough, and chest tightness
|
No complications
|
(Khan et al., 2020)[35]
|
March 19, 2020
|
|
04
|
Three cesarean sections and one vaginal delivery
|
Three had fever, two had cough, two had myalgia/fatigue, and two had headache
|
Two newborns had edema and rash
|
(Chen et al., 2020)[36]
|
March 16, 2020
|
|
07
|
Cesarean
|
Six patients had fever, one had cough, one had shortness of breath, and one had diarrhea
|
Three patients had uterine scars
|
(Yu et al., 2020)[8]
|
March 24, 2020
|
|
15
|
Ten cesarean sections, a vaginal delivery, and four patients were still pregnant at
the end of the study
|
Thirteen had fever, nine dyspnea, three myalgia, one diarrhea, one cough and one fatigue
|
Mild clinical manifestations
|
(Liu et al., 2020)[37]
|
July 2020
|
|
01
|
Emergency cesarean section
|
Fever
|
No complications
|
(Wang et al., 2020)[38]
|
February 28, 2020
|
|
09
|
Seven cesarean sections and two vaginal deliveries
|
Eight patients had fever, four had cough, one had diarrhea, and one had sore throat
|
Five neonates were cured, four remained in the hospital until the end of the study,
and one died
|
(Zhu et al., 2020)[39]
|
February 09, 2020
|
|
01
|
Vaginal delivery
|
Fever, chills, dry cough, and myalgia
|
No complications
|
(Iqbal et al., 2020)[40]
|
April 01, 2020
|
|
05
|
Three vaginal deliveries, one cesarean section due to gestational diabetes and one
emergency cesarean section due to fetal tachycardia
|
All pregnant women had postpartum fever
|
Two patients developed gestational diabetes, and one developed preeclampsia
|
(Chen et al., 2020)[41]
|
March 28, 2020
|
|
01
|
Cesarean section
|
Fever, nasal congestion, and respiratory distress
|
No complications
|
(Dong et al., 2020)[42]
|
March 26, 2020
|
|
02
|
Cesarean section
|
Two patients had fever, two had nasal congestion, and one had chills. One had fever,
nasal congestion, sore throat, and a rash
|
No complications
|
(Fan et al., 2020)[43]
|
March 17, 2020
|
|
Case: 16 COVID-19 pregnant women
Control: 45 healthy pregnant women
|
Caesarean section
|
Fifteen pregnant women with COVID-19 had mild pneumonia, and one of them had severe
pneumonia
|
One patient in the control group was in a more serious condition. No patient in the
case group was in critical condition
|
(Zhang et al., 2020)[27]
|
March 25, 2020
|
|
8.207
|
Not informed
|
1,799 patients had cough, 1,190 had fever, 1,323 had myalgia, 989 chills, 1,409 had
headache, 497 had diarrhea, 682 had nausea or vomiting, 350 had abdominal pain, 326
had runny nose, and 587 had new loss of taste or smell
|
Risk of hospitalization 5.4 times higher than non-pregnant women. Risk of being admitted
to the ICU and receiving mechanical ventilation was 1.5 and 1.7, respectively, compared
to the group of non-pregnant women
|
(Ellington et al., 2020)[20]
|
June 26, 2020
|
Abbreviations: COVID-19, coronavirus disease 2019; ICU, intensive care unit.
Management of Pregnant Women with COVID-19
Prenatal and postpartum care cannot be postponed or canceled. Therefore, maternity
services must be adapted quickly to provide safe care, minimizing the risk of spreading
COVID-19. Unfortunately, health services will suffer from lack of professionals, as
they also become ill and/or need to isolate themselves during this pandemic period.[44]
[45]
According to the Brazilian Ministry of Health (2020),[46] prenatal consultations should take place in a timely manner for pregnant women who
do not have flu-like symptoms, paying attention to the prevention of agglomerations
and the best hygiene practices. Pregnant women with flu-like symptoms, on the other
hand, must have their elective procedures (consultations and routine exams) postponed
for 14 days and, when necessary, be seen in an isolated place from other patients.[46] However, it is worth mentioning that depending on the region of the country, there
may be specific guidelines. As an example, in Minas Gerais (Brazil), the State Department
of Health stated in a technical note issued on April 1, 2020 that in an area with
a high flow due to the COVID-19 pandemic, the flexibility of prenatal consultations
at usual risk may occur, at clinical criteria. However, the minimum number of consultations
and examinations recommended by the Ministry of Health of Brazil and the World Health
Organization must be maintained.[47]
In a randomized, double-blind study conducted in the United States and Canada, the
use of hydroxychloroquine as postexposure prophylaxis was evaluated. The participants
were divided into two groups, 414 received hydroxychloroquine and 407 received placebo.
All participants had home or occupational exposure to patients diagnosed with COVID-19.
The results of this study demonstrated that the use of hydroxychloroquine as postexposure
prophylaxis has no benefits.[48]
A retrospective cohort study was carried out with 1,438 patients admitted to 25 hospitals
in New York to assess the association between hospital mortality caused by SARS-CoV-2
and the use of hydroxychloroquine or azithromycin. The authors concluded that there
were no statistically significant differences in mortality between groups.[49]
It is very important to carry out an adequate clinical evaluation, establish criteria
and prioritize the use of drugs indicated by the WHO (through the Solidarity study)
and the Brazilian Ministry of Health, even if there is still no specific treatment
for COVID-19. Other drugs should be used in very severe cases and in the absence of
response to therapies.[50]
It is worth mentioning that, for some drugs, there are already more robust reports,
but still without solid evidence of use in critically ill patients and not in mild
cases. Therefore, caution, equilibrium, and common sense, combined with controlled
scientific studies should be used to deal with this pandemic therapeutically. [Tables 2] and [3] shows the therapies under study against COVID-19 infection.
Table 2
Drugs recommended by the World Health Organization, in the Solidarity study, for the
treatment of COVID-19, on July 6, 2020
|
Drug
|
Use in pregnant women
|
References
|
|
Remdesivir
|
It was not possible to evaluate the effectiveness and/or safety of its use in pregnant
women. The Food and Drug Administration (FDA) has authorized its compassionate use
for the treatment of severe COVID-19 in children and pregnant women.
|
(McCoy et al., 2020)[51]
(Lim et al., 2020)[52]
|
|
Lopinavir/ritonavir with interferon beta-1
|
It presented a good safety profile in its use in pregnant women. The results of this
study with Interferon beta 1 suggested that there was no increased risk of miscarriage
or congenital anomalies.
|
(Tookey et al., 2016)[53]
(Hellwig et al., 2020)[54]
|
Table 3
Drugs recommended by Brazilian Ministry of Health for the treatment of COVID-19
|
Drug
|
Use in pregnant women
|
References
|
|
Chloroquine
|
Chloroquine can induce adverse ophthalmic and cardiac effects on the fetus. It is
also genotoxic. Use should be carefully assessed.
|
(Lacroix et al., 2020)[55]
|
|
Hydroxychloroquine
|
In the treatment of autoimmune diseases, it is not associated with any increased risk
of birth defects, spontaneous abortions, fetal death, or prematurity.
Hydroxychloroquine can induce adverse ophthalmic and cardiac effects on the fetus.
It is also genotoxic. Use should be carefully assessed.
|
(Lacroix et al., 2020; Sperber et al., 2009)[55]
[56]
|
|
Azithromycin
|
In most studies, there were no significant associations between the use of azithromycin
in pregnant women and congenital malformations.
|
(Keskin-Arslan et al., 2020)[57]
|
Maternal-fetal Care
According to the United States Center for Disease Control and Prevention (CDC), health
professionals should follow some recommendations when performing obstetric procedures
in pregnant patients with confirmed or suspected COVID-19 diagnosis, from prehospitalization
to discharge of the mother and baby.[51]
[52]
[53]
[54]
[55]
[56]
[57]
[58]
[59]
[60] It is worth mentioning that, in Brazil, the diagnosis in pregnant women must follow
the same protocol for the general adult population and that attention should be paid
to the signs and symptoms that demonstrate clinical severity.[46]
Prehospital care includes notification of the obstetrics unit for the proper delivery
room preparation, for the correct use of personal protective equipment (PPE) by the
health professionals involved and conduct in accordance with biosafety rules.[46]
During hospitalization, care must be taken to avoid new infections, and newborn isolation
should be discussed with health professionals. If the mother expresses the desire
to breastfeed, she should be instructed on the precautions to be followed, such as
proper hygiene, use of the breast pump or use of a mask, if she chooses to breastfeed.[46] The benefits of breastfeeding outweigh any potential risks of transmitting the virus
through breast milk.[25]
[61]
The American College of Obstetricians and Gynecologists recommends that doctors should
follow the CDC's Interim Clinical Guidelines for the management of patients with confirmed
coronavirus disease (COVID-19).[13] Recommendations are that even if the ideal maternal-newborn care plan is to maintain
this binomial, the temporary separation of the newborn from a mother with confirmed
or suspected COVID-19 should be strongly considered to reduce the risk of transmission
to the newborn.[62]
The WHO recommends that the mother and the newborn should stay together and practice
skin-to-skin contact, including hygiene and respiratory care for the mother, especially
immediately after birth and during breastfeeding establishment, if the mother or her
babies are cases suspected or confirmed of COVID-19.[63]
Delivery routes should be individualized based on the obstetric indications and preferences
of the pregnant woman. Cesarean section is ideally performed only when clinically
justified. Decisions on the corticosteroids use for fetal pulmonary maturation, emergency
childbirth, and termination of pregnancy are challenging conditions and must be based
on many factors, such as gestational age, severity of maternal condition, and fetal
viability and well-being, within a multiprofessional assessment.[64]
[65]
Vertical Transmission of SARS-Cov-2
A systematic review article[66] included 24 studies that analyzed the effects of COVID-19 on pregnant women and
newborns. Regarding clinical symptoms, fever was the most common symptom, occurring
in 62.9% of patients, coughing in 36.8%, and sore throat in 22.6%. All deliveries
were carried out in a negative pressure room, and care was taken to avoid contamination
of the 94 newborns, 31 of whom were premature. The average birth weight was 3,127.6g.
Two neonates tested positive for COVID-19. Amniotic fluid, placental fluid, umbilical
cord, and gastric juice tested negative. There were three fetal deaths, two due to
multiple organ failure and disseminated intravascular coagulation, and the other death
because the neonate was cyanotic. No case of severe neonatal asphyxia was observed.
The placenta and decidua are the main interfaces between the mother and the fetus
during pregnancy.[67] And, as already reported, the human placenta expresses ACE2[23] and, therefore, may be fundamental for the vertical transmission of SARS-CoV-2.[22] However, the COVID-19 impact on the intrauterine environment is still unclear, as
well as whether vertical transmission occurs during a maternal infection. The main
studies that have assessed the possibility of vertical transmission are described
in [Table 4].
Table 4
Main studies assessing the possibility of vertical transmission of SARS-CoV-2
|
Number of pregnant women
|
Age of pregnant women
|
Pregnancy period
|
Premature birth
|
Average birth weight
|
1-minute Apgar score
|
5-minute Apgar score
|
Vertical transmission signals
|
Study
|
Date of publication
|
|
1
|
30 years
|
35 weeks
|
One newborn
|
Not informed
|
Not informed
|
Not informed
|
RT-PCR not detected
|
(Li et al., 2020)[68]
|
26 de junho de 2020
|
|
9
|
26–40 years
|
36–39 weeks + 4 days
|
4 newborns
|
Two newborns had low birth weight
|
8–9
|
9–10
|
Six newborns had RT-PCR undetected at birth. It was not possible to investigate the
other newborns at the time of birth.
|
(Chen et al., 2020)[28]
|
March 07, 2020
|
|
17
|
28.7–29.5 years
|
Three pregnant women: < 37 weeks
14 pregnant women: ≥ 37 weeks
|
Three newborns
|
Not informed
|
7–9
|
9–10
|
RT-PCR not detected
|
(Chen et al., 2020)[29]
|
March 16, 2020
|
|
13
|
22–36 years
|
25–38 weeks
|
6 newborns
|
Not informed
|
Nine newborns had an Apgar score of 10
|
Not informed
|
RT-PCR not detected
|
(Liu et al., 2020)[30]
|
March 05, 2020
|
|
01
|
41 years
|
31 weeks
|
One newborn
|
1,500 g
|
Not informed
|
Not informed
|
RT-PCR not detected in nasopharyngeal sample
|
(Zambrano et al., 2020)[31]
|
March 25, 2020
|
|
07
|
Not informed
|
36–37 weeks
|
Four late preterm infants
|
2,096 g ± 660 g
|
8–9
|
9–10
|
RT-PCR not detected
|
(Yang et al., 2020)[32]
|
June 2020
|
|
01
|
25 years
|
38 weeks + 4 days
|
No
|
3,070 g
|
9
|
10
|
RT-PCR not detected in samples of amniotic fluid, smear of the newborn's throat and
rectum.
|
(Xiong et al., 2020)[33]
|
April 10, 2020
|
|
01
|
34 years
|
40 weeks
|
No
|
3,205 g
|
8
|
9
|
RT-PCR detected from pharynx swab collected 36 hours after birth. Cord and placenta
samples were negative.
|
(Wang et al., 2020)[34]
|
March 12, 2020
|
|
23
|
21–37 years
|
Twenty pregnant women: > 28 weeks
3 pregnant women: < 12 weeks.
|
Not informed
|
Not informed
|
Not informed
|
9–10
|
RT-PCR not detected in 04 newborns. The SARS-CoV-2 infection was ruled out in the
others using diagnostic criteria.
|
(Wu et al., 2020)[21]
|
April 08, 2020
|
|
03
|
27–33 years
|
34 weeks + 6 days
39 weeks + 1 day
38 weeks + 2 days.
|
One newborn
|
3,373 g
|
8–9
|
9–10
|
RT-PCR not detected
|
(Khan et al., 2020)[35]
|
March 19, 2020
|
|
04
|
28–34 years
|
37 weeks + 2 days
39 weeks
37 weeks + 3 days
38 weeks + 4 days
|
None
|
3,400 g
|
7–8
|
8–9
|
RT-PCR not detected in three newborns. The other parents did not authorize.
|
(Chen et al., 2020)[36]
|
March 16, 2020
|
|
07
|
29–34 years
|
37–41 weeks
|
None
|
3,264 g
|
8–9
|
9–10
|
Four newborns have not been tested. Of the three who were tested, one tested positive
36 hours after birth
|
(Yu et al., 2020)[8]
|
March 24, 2020
|
|
15
|
23–40 years
|
12–38 weeks
|
None
|
Not informed
|
8
|
9
|
RT-PCR not detected
|
(Liu et al., 2020)[37]
|
July 2020
|
|
01
|
28 years
|
30 weeks
|
One newborn
|
1,830 g
|
9
|
10
|
RT-PCR not detected
|
(Wang et al., 2020)[38]
|
February 28, 2020
|
|
09
|
average age 30 years
|
31–39 weeks
|
Six newborns
|
2,423 g
|
7–10
|
8–10
|
RT-PCR not detected
|
(Zhu et al., 2020)[39]
|
February 09, 2020
|
|
01
|
34 years
|
39 weeks
|
None
|
Not informed
|
8
|
9
|
RT-PCR not detected
|
(Iqbal et al., 2020)[40]
|
April 1, 2020
|
|
05
|
25 to years
|
38 to 41 weeks
|
None
|
3,691 g
|
10
|
10
|
RT-PCR not detected
|
(Chen et al., 2020)[41]
|
March 28, 2020
|
|
01
|
29 years
|
34 weeks + two days
|
Not informed
|
3,120 g
|
9
|
10
|
RT-PCR not detected, High IgM and IgG
|
(Dong et al., 2020)[42]
|
March 26, 2020
|
|
02
|
29 and 34 years
|
36 weeks + five days
37 weeks
|
Not informed
|
3,145 g
|
9
|
10
|
RT-PCR not detected
|
(Fan et al., 2020)[43]
|
March 17, 2020
|
|
06
|
Not informed
|
Not informed
|
Not informed
|
Not informed
|
8–9
|
9–10
|
RT-PCR not detected. In two newborns high levels of IgM and IgG. And in three newborns
normal IgM and elevated IgG.
|
(Zeng et al., 2020)[69]
|
March 26, 2020
|
|
Case: 16 COVID-19 pregnant women
Control: 45 healthy pregnant women
|
Case: 24–34 years
Control: 24–40 years
|
Not informed
|
One newborn from the case group
|
Case: 2,300–3,750 g
Control: 2,180–4,100g
|
Not informed
|
Not informed
|
RT-PCR not detected in 10 newborns.
|
(Zhang et al., 2020)[27]
|
March 25, 2020
|
Abbreviations: COVID-19, coronavirus disease 2019; IgG, immunoglobulin G; IgM, immunoglobulin
M; RT-PCR, reverse transcription polymerase chain reaction; SARS-CoV2, severe acute
respiratory syndrome coronavirus 2.
The data to assess the COVID-19 severity in pregnant women are scarce, since most
studies had a limited number of participants. It is important to keep in mind that
the ideal is to do everything possible to minimize the chance of these patients contracting
disease, and, if they do, the measures recommended by the Brazilian Ministry of Health
and WHO should be adopted immediately.
