Semin Respir Crit Care Med 2023; 44(01): 050-065
DOI: 10.1055/s-0042-1758853
Review Article

A Review of Coronavirus Disease 2019 in Pregnancy

Jarrod Zamparini
1   Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2   Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
,
Robin Saggers
3   Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
4   Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
,
Chandia Edward Buga
5   Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
6   Department of Obstetrics and Gynaecology, Thelle Mogoerane Regional Hospital, Vosloorus, South Africa
› Author Affiliations

Abstract

Pregnancy is an independent risk factor for morbidity and mortality in coronavirus disease 2019 (COVID-19) with increased rates of operative delivery, intensive care unit admission, and mechanical ventilation as well as a possible increased risk of death, independent of other risk factors, compared with nonpregnant women with COVID-19. Furthermore, pregnancy outcomes are worse in those with COVID-19 with increased risk for preeclampsia, venous thromboembolism, preterm birth, miscarriage, and stillbirth compared with pregnant women without COVID-19. Importantly, pregnant women of nonwhite ethnicity appear to be at greater risk of severe COVID-19, necessitating improved access to care and closer monitoring in these women. The management of COVID-19 in pregnancy is largely similar to that in nonpregnant people; however, there is an important emphasis on multidisciplinary team involvement to ensure favorable outcomes in both mother and baby. Similarly, vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is safe in pregnancy and improves maternal and neonatal outcomes.



Publication History

Article published online:
16 January 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
  • 2 Chen Y, Peng H, Wang L. et al. Infants born to mothers with a new coronavirus (COVID-19). Front Pediatr 2020; 8: 104
  • 3 Liu D, Li L, Wu X. et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol 2020; 215 (01) 127-132
  • 4 Breslin N, Baptiste C, Gyamfi-Bannerman C. et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2 (02) 100118
  • 5 Breslin N, Baptiste C, Miller R. et al. Coronavirus disease 2019 in pregnancy: early lessons. Am J Obstet Gynecol MFM 2020; 2 (2, supplement): 100111
  • 6 Ferrazzi EM, Frigerio L, Cetin I. et al. COVID-19 obstetrics task force, Lombardy, Italy: executive management summary and short report of outcome. Int J Gynaecol Obstet 2020; 149 (03) 377-378
  • 7 Zambrano LD, Ellington S, Strid P. et al. CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team. Update: Characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status—United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (44) 1641-1647
  • 8 Allotey J, Stallings E, Bonet M. et al; for PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370: m3320
  • 9 Badr DA, Mattern J, Carlin A. et al. Are clinical outcomes worse for pregnant women at ≥20 weeks' gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching. Am J Obstet Gynecol 2020; 223 (05) 764-768
  • 10 Jering KS, Claggett BL, Cunningham JW. et al. Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19. JAMA Intern Med 2021; 181 (05) 714-717
  • 11 Knight M, Bunch K, Vousden N. et al; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
  • 12 Budhram S, Vannevel V, Botha T. et al. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: an International Network of Obstetric Survey Systems-based cohort study. Int J Gynaecol Obstet 2021; 155 (03) 455-465
  • 13 Metz TD, Clifton RG, Hughes BL. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Association of SARS-CoV-2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA 2022; 327 (08) 748-759
  • 14 Kyle MH, Glassman ME, Khan A. et al. A review of newborn outcomes during the COVID-19 pandemic. Semin Perinatol 2020; 44 (07) 151286
  • 15 Dashraath P, Wong JLJ, Lim MXK. et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020; 222 (06) 521-531
  • 16 Wastnedge EAN, Reynolds RM, van Boeckel SR. et al. Pregnancy and COVID-19. Physiol Rev 2021; 101 (01) 303-318
  • 17 Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis 2006; 12 (11) 1638-1643
  • 18 Brandstadter JD, Yang Y. Natural killer cell responses to viral infection. J Innate Immun 2011; 3 (03) 274-279
  • 19 Veenstra van Nieuwenhoven AL, Heineman MJ, Faas MM. The immunology of successful pregnancy. Hum Reprod Update 2003; 9 (04) 347-357
  • 20 Hall OJ, Klein SL. Progesterone-based compounds affect immune responses and susceptibility to infections at diverse mucosal sites. Mucosal Immunol 2017; 10 (05) 1097-1107
  • 21 Hall OJ, Nachbagauer R, Vermillion MS. et al. Progesterone-based contraceptives reduce adaptive immune responses and protection against sequential influenza A virus infections. J Virol 2017; 91 (08) e02160-e16
  • 22 Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol 2015; 73 (03) 199-213
  • 23 de Souza Silva GA, da Silva SP, da Costa MAS. et al. SARS-CoV, MERS-CoV and SARS-CoV-2 infections in pregnancy and fetal development. J Gynecol Obstet Hum Reprod 2020; 49 (10) 101846
  • 24 Frise C, Collins S. Oxford Handbook of Obstetric Medicine. 1st ed.. Oxford, United Kingdom: Oxford University Press; 2020
  • 25 Goodnight WH, Soper DE. Pneumonia in pregnancy. Crit Care Med 2005; 33 (10, suppl): S390-S397
  • 26 Ie S, Rubio ER, Alper B, Szerlip HM. Respiratory complications of pregnancy. Obstet Gynecol Surv 2002; 57 (01) 39-46
  • 27 Herrey AS, Osman A, Soma-Pillay P, Sliwa K, Ntusi NAB. COVID-19 and the cardiovascular system in pregnancy. SAHJ 2020; 17 (03) DOI: 10.24170/17-3-4375.
  • 28 Hantoushzadeh S, Shamshirsaz AA, Aleyasin A. et al. Maternal death due to COVID-19. Am J Obstet Gynecol 2020; 223 (01) 109.e1-109.e16
  • 29 Hellgren M. Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost 2003; 29 (02) 125-130
  • 30 MBRRACE-UK Saving Lives, Improving Mothers' Care – Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017–19.; 2021. Accessed May 20, 2022 at: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-_FINAL_-_WEB_VERSION.pdf
  • 31 Thomas MR, Scully M. Clinical features of thrombosis and bleeding in COVID-19. Blood 2022; 140 (03) 184-195
  • 32 Helms J, Tacquard C, Severac F. et al; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020; 46 (06) 1089-1098
  • 33 Nana M, Hodson K, Lucas N, Camporota L, Knight M, Nelson-Piercy C. Diagnosis and management of COVID-19 in pregnancy. BMJ 2022; 377: e069739
  • 34 Coad F, Frise C. Considerations for women with COVID-19 admitted to hospital. Obstet Med 2022. Doi: 10.1177/1753495X221083504
  • 35 Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020; 12 (02) 194
  • 36 Lam CM, Wong SF, Leung TN. et al. A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome. BJOG 2004; 111 (08) 771-774
  • 37 Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: report of two cases & review of the literature. J Microbiol Immunol Infect 2019; 52 (03) 501-503
  • 38 Assiri A, Abedi GR, Al Masri M, Bin Saeed A, Gerber SI, Watson JT. Middle east respiratory syndrome coronavirus infection during pregnancy: a report of 5 cases from Saudi Arabia. Clin Infect Dis 2016; 63 (07) 951-953
  • 39 Diriba K, Awulachew E, Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. Eur J Med Res 2020; 25 (01) 39
  • 40 Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008; 14 (01) 95-100
  • 41 Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol 2011; 205 (01) 10-18
  • 42 Fassett MJ, Lurvey LD, Yasumura L. et al. Universal SARS-Cov-2 screening in women admitted for delivery in a large managed care organization. Am J Perinatol 2020; 37 (11) 1110-1114
  • 43 McClymont E, Albert AY, Alton GD. et al; CANCOVID-Preg Team. Association of SARS-CoV-2 infection during pregnancy with maternal and perinatal outcomes. JAMA 2022; 327 (20) 1983-1991
  • 44 Vousden N, Bunch K, Morris E. et al. The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS). PLoS One 2021; 16 (05) e0251123
  • 45 Vousden N, Ramakrishnan R, Bunch K. et al. Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: data from the UK Obstetric Surveillance System national cohort. 2021 (e-pub ahead of print). Doi: 10.1101/2021.07.22.21261000
  • 46 Nachega JB, Sam-Agudu NA, Machekano RN. et al; AFREhealth Research Collaboration on COVID-19 and Pregnancy. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy in Sub-Saharan Africa: a 6-country retrospective cohort analysis. Clin Infect Dis 2022 (e-pub ahead of print). Doi: org/10.1093/cid/ciac294
  • 47 Villar J, Ariff S, Gunier RB. et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr 2021; 175 (08) 817-826
  • 48 Magnus MC, Oakley L, Gjessing HK. et al. Pregnancy and risk of COVID-19: a Norwegian registry-linkage study. BJOG 2022; 129 (01) 101-109
  • 49 Jafari M, Pormohammad A, Sheikh Neshin SA. et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: a systematic review and meta-analysis. Rev Med Virol 2021; 31 (05) 1-16
  • 50 Palomo M, Youssef L, Ramos A. et al. Differences and similarities in endothelial and angiogenic profiles of preeclampsia and COVID-19 in pregnancy. Am J Obstet Gynecol 2022; 227 (02) 277.e1-277.e16
  • 51 Mendoza M, Garcia-Ruiz I, Maiz N. et al. Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG 2020; 127 (11) 1374-1380
  • 52 Papageorghiou AT, Deruelle P, Gunier RB. et al. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol 2021; 225 (03) 289.e1-289.e17
  • 53 Mullins E, Hudak ML, Banerjee J. et al; PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021; 57 (04) 573-581
  • 54 Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health Estats 2022. Doi: 10.15620/cdc:113967
  • 55 Pattinson R, Fawcus S, Gebhardt S, Niit R, Soma-Pillay P. The impact of COVID-19 on pregnancy in 2020 compared with 2019: interim fact sheet. 2021: 47 Accessed June 21, 2022 at: https://www.samrc.ac.za/sites/default/files/attachments/2021-03-31/SA%20report_Covid-19_2020%20pregnancy%20vs%202019_Provinces_Service%20use_Pattison%20etal_Mar21.pdf
  • 56 Vousden N, Ramakrishnan R, Bunch K. et al. Management and implications of severe COVID-19 in pregnancy in the UK: data from the UK Obstetric Surveillance System national cohort. Acta Obstet Gynecol Scand 2022; 101 (04) 461-470
  • 57 Dileep A, ZainAlAbdin S, AbuRuz S. Investigating the association between severity of COVID-19 infection during pregnancy and neonatal outcomes. Sci Rep 2022; 12 (01) 3024
  • 58 Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 2021; 193 (16) E540-E548
  • 59 Vousden N, Ramakrishnan R, Bunch K. et al. Severity of maternal infection and perinatal outcomes during periods of SARS-CoV-2 wildtype, alpha, and delta variant dominance in the UK: prospective cohort study. BMJ Med 2022;1(01): Doi: 10.1136/bmjmed-2021-000053
  • 60 Smith DD, Pippen JL, Adesomo AA, Rood KM, Landon MB, Costantine MM. Exclusion of pregnant women from clinical trials during the coronavirus disease 2019 pandemic: a review of international registries. Am J Perinatol 2020; 37 (08) 792-799
  • 61 National Institutes of Health. NIH COVID-19 Treatment Guidelines. Special Considerations in Pregnancy. COVID-19 Treatment Guidelines. Accessed June 22, 2022 at: https://www.covid19treatmentguidelines.nih.gov/special-populations/pregnancy/
  • 62 Royal College of Obstetricians & Gynaecologists. Coronavirus (COVID-19) Infection in Pregnancy Version 15. Published online March 7, 2022. Accessed June 22, 2022 at: https://www.rcog.org.uk/media/xsubnsma/2022-03-07-coronavirus-covid-19-infection-in-pregnancy-v15.pdf
  • 63 Halscott T, Vaught J. The SMFM COVID-19 Task Force. Society for Maternal-Fetal Medicine Management Considerations for Pregnant Patients With COVID-19. Published online February 2, 2021. Accessed June 15, 2022 at: https://s3.amazonaws.com/cdn.smfm.org/media/2734/SMFM_COVID_Management_of_COVID_pos_preg_patients_2-2-21_(final).pdf
  • 64 Kons KM, Wood ML, Peck LC. et al. Exclusion of reproductive-aged women in COVID-19 vaccination and clinical trials. Womens Health Issues 2022 (e-pub ahead of print). Doi: 10.1016/j.whi.2022.06.004
  • 65 RECOVERY Trial. Randomised evaluation of COVID-19 therapy: the RECOVERY trial: Collaborators' Meeting 4th January 2022. Presented at: January 4, 2022. Accessed June 22, 2022 at: https://www.recoverytrial.net/files/recovery-collaborators-meeting-2022-01-04.pdf
  • 66 Knight M. Randomised Evaluation Of COVID-19 Therapy (RECOVERY) for pregnant and breastfeeding women. Published online December 22, 2021. Accessed June 22, 2022 at: https://www.recoverytrial.net/files/recovery-in-pregnant-women-for-hcp-v15-1-2021-12-22.pdf
  • 67 Elwood C, Raeside A, Watson H. et al. Committee Opinion No. 400: COVID-19 and Pregnancy. Published online February 15, 2021. Accessed June 22, 2022 at: https://sogc.org/common/Uploaded%20files/Latest%20News/Committee%20Opinion%20No.%20400%20COVID-19%20and%20Pregnancy.pdf
  • 68 Tolcher MC, McKinney JR, Eppes CS. et al. Prone positioning for pregnant women with hypoxemia due to coronavirus disease 2019 (COVID-19). Obstet Gynecol 2020; 136 (02) 259-261
  • 69 Roca O, Caralt B, Messika J. et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 2019; 199 (11) 1368-1376
  • 70 Nugraha PK, Utariani A, Setiawan P, Semedi BP. ROX index as a predictor of intubation risk and 28-day mortality in COVID-19 patients with acute respiratory distress syndrome. Int J Scientific Advances 2022;3(01): Doi: 10.51542/ijscia.v3i1.4
  • 71 Zaboli A, Ausserhofer D, Pfeifer N. et al. The ROX index can be a useful tool for the triage evaluation of COVID-19 patients with dyspnoea. J Adv Nurs 2021; 77 (08) 3361-3369
  • 72 Donders F, Lonnée-Hoffmann R, Tsiakalos A. et al; ISIDOG Covid-Guideline Workgroup. ISIDOG recommendations concerning COVID-19 and pregnancy. Diagnostics (Basel) 2020; 10 (04) 243
  • 73 O'Neil ER, Lin H, Shamshirsaz AA. et al. Pregnant and peripartum women with COVID-19 have high survival with extracorporeal membrane oxygenation: an extracorporeal life support organization registry analysis. Am J Respir Crit Care Med 2022; 205 (02) 248-250
  • 74 Horby P, Lim WS, Emberson JR. et al; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021; 384 (08) 693-704
  • 75 Wagner C, Griesel M, Mikolajewska A. et al. Systemic corticosteroids for the treatment of COVID-19. Cochrane Database Syst Rev 2021; 8: CD014963
  • 76 Agarwal A, Rochwerg B, Lamontagne F. et al. A living WHO guideline on drugs for covid-19. BMJ 2020; 370: m3379 . Doi: 10.1136/bmj.m3379
  • 77 Bhimraj A, Morgan RL, Shumaker AH. et al. Infectious diseases society of america guidelines on the treatment and management of patients with COVID-19 Version 9.0. Published online June 10, 2022. Accessed June 22, 2022 at: https://www.idsociety.org/globalassets/idsa/practice-guidelines/covid-19/treatment/idsa-covid-19-gl-tx-and-mgmt-v9.0.0.pdf
  • 78 Jorgensen SCJ, Davis MR, Lapinsky SE. A review of remdesivir for COVID-19 in pregnancy and lactation. J Antimicrob Chemother 2021; 77 (01) 24-30
  • 79 Hammond J, Leister-Tebbe H, Gardner A. et al; EPIC-HR Investigators. Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19. N Engl J Med 2022; 386 (15) 1397-1408
  • 80 Society for Maternal-Fetal Medicine. FDA Issues EUA for the Treatment of Mild-to-Moderate COVID-19. Maternal-Fetal Medicine Subspecialists Support Use in Pregnant Patients. Accessed June 22, 2022 at: https://s3.amazonaws.com/cdn.smfm.org/media/3287/Treatment_1.10.pdf
  • 81 Paxlovid Drug-Drug Interactions. COVID-19 Treatment Guidelines. Accessed June 24, 2022 at: https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ritonavir-boosted-nirmatrelvir–paxlovid-/paxlovid-drug-drug-interactions/
  • 82 National Institutes of Health. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Accessed June 24, 2022 at: https://www.covid19treatmentguidelines.nih.gov/
  • 83 Jorgensen SCJ, Lapinsky SE. Tocilizumab for coronavirus disease 2019 in pregnancy and lactation: a narrative review. Clin Microbiol Infect 2022; 28 (01) 51-57
  • 84 Servante J, Swallow G, Thornton JG. et al. Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: a systematic review and critical analysis. BMC Pregnancy Childbirth 2021; 21 (01) 108
  • 85 Spyropoulos AC, Goldin M, Giannis D. et al; HEP-COVID Investigators. Efficacy and safety of therapeutic-dose heparin vs standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19: The HEP-COVID randomized clinical trial. JAMA Intern Med 2021; 181 (12) 1612-1620
  • 86 Sholzberg M, Tang GH, Rahhal H. et al; RAPID trial investigators. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial. BMJ 2021; 375 (2400): n2400
  • 87 ATTACC Investigators, ACTIV-4a Investigators, REMAP-CAP Investigators. Therapeutic anticoagulation with heparin in noncritically ill patients with COVID-19. N Engl J Med. 2021; 385 (09) 790-802
  • 88 Sultan AA, West J, Tata LJ, Fleming KM, Nelson-Piercy C, Grainge MJ. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012; 156 (03) 366-373
  • 89 Di Toro F, Gjoka M, Di Lorenzo G. et al. Impact of COVID-19 on maternal and neonatal outcomes: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27 (01) 36-46
  • 90 Gale C, Quigley MA, Placzek A. et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. Lancet Child Adolesc Health 2021; 5 (02) 113-121
  • 91 Woodworth KR, Olsen EO, Neelam V. et al; CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team, COVID-19 Pregnancy and Infant Linked Outcomes Team (PILOT). Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy - SET-NET, 16 jurisdictions, March 29-October 14, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (44) 1635-1640
  • 92 Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand 2020; 99 (05) 565-568
  • 93 Beesley MA, Davidson JR, Panariello F. et al. COVID-19 and vertical transmission: assessing the expression of ACE2/TMPRSS2 in the human fetus and placenta to assess the risk of SARS-CoV-2 infection. BJOG 2022; 129 (02) 256-266
  • 94 Wong YP, Khong TY, Tan GC. The effects of COVID-19 on placenta and pregnancy: what do we know so far?. Diagnostics (Basel) 2021; 11 (01) 94
  • 95 Baergen RN, Heller DS. Placental pathology in COVID-19 positive mothers: Preliminary Findings. Pediatr Dev Pathol 2020; 23 (03) 177-180
  • 96 Walker KF, O'Donoghue K, Grace N. et al. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG 2020; 127 (11) 1324-1336
  • 97 Chambers C, Krogstad P, Bertrand K. et al. Evaluation for SARS-CoV-2 in breast milk from 18 infected women. JAMA 2020; 324 (13) 1347-1348
  • 98 Perl SH, Uzan-Yulzari A, Klainer H. et al. SARS-CoV-2-specific antibodies in breast milk after COVID-19 vaccination of breastfeeding women. JAMA 2021; 325 (19) 2013-2014
  • 99 DeSisto CL, Wallace B, Simeone RM. et al. Risk for stillbirth among women with and without COVID-19 at delivery hospitalization—United States, March 2020-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70 (47) 1640-1645
  • 100 Pfizer and BioNTech. FDA Briefing Document Pfizer-BioNTech COVID-19 Vaccine. Published online December 10, 2020. Accessed February 1, 2021 at: https://www.fda.gov/media/144245/download
  • 101 Moderna Tx Inc. FDA Briefing Document Moderna COVID-19 Vaccine. Published online December 17, 2020. Accessed January 27, 2021 at: https://www.fda.gov/media/144434/download
  • 102 Janssen Biotech, Inc.. FDA Briefing Document: Janssen Ad26.COV2.S Vaccine for the Prevention of COVID-19. Published online February 26, 2021. Accessed November 11, 2022 at: https://www.fda.gov/media/146217/download
  • 103 Lindsey B, Kampmann B, Jones C. Maternal immunization as a strategy to decrease susceptibility to infection in newborn infants. Curr Opin Infect Dis 2013; 26 (03) 248-253
  • 104 Ciobanu AM, Dumitru AE, Gica N, Botezatu R, Peltecu G, Panaitescu AM. Benefits and risks of IgG transplacental transfer. Diagnostics (Basel) 2020; 10 (08) 583
  • 105 Madhi SA, Cutland CL, Kuwanda L. et al; Maternal Flu Trial (Matflu) Team. Influenza vaccination of pregnant women and protection of their infants. N Engl J Med 2014; 371 (10) 918-931
  • 106 Whitehead CL, Walker SP. Consider pregnancy in COVID-19 therapeutic drug and vaccine trials. Lancet 2020; 395 (10237): e92
  • 107 Luxi N, Giovanazzi A, Capuano A. et al; Ilmiovaccino COVID19 collaborating group. COVID-19 vaccination in pregnancy, paediatrics, immunocompromised patients, and persons with history of allergy or prior SARS-CoV-2 infection: overview of current recommendations and pre- and post-marketing evidence for vaccine efficacy and safety. Drug Saf 2021; 44 (12) 1247-1269
  • 108 Male V. SARS-CoV-2 infection and COVID-19 vaccination in pregnancy. Nat Rev Immunol 2022; 22 (05) 277-282
  • 109 BioNTech SE. A phase 2/3, placebo-controlled, randomized, observer-blind study to evaluate the safety, tolerability, and immunogenicity of a SARS-COV-2 RNA vaccine candidate (BNT162b2) against Covid-19 in healthy pregnant women 18 years of age and older. clinicaltrials.gov; 2022. Accessed May 25, 2022 at: https://clinicaltrials.gov/ct2/show/NCT04754594
  • 110 Janssen Vaccines & Prevention B.V.. An open-label, phase 2 study to evaluate the safety, reactogenicity, and immunogenicity of Ad26.COV2.S in healthy pregnant participants. clinicaltrials.gov; 2022. Accessed May 25, 2022 at: https://clinicaltrials.gov/ct2/show/NCT04765384
  • 111 El-Chaâr D. Pregnant and Lactating Individuals & Newborns COVID-19 Vaccination (PLAN-V): Prospective Cohort Study. clinicaltrials.gov; 2021. Accessed May 25, 2022 at: https://clinicaltrials.gov/ct2/show/NCT05115617
  • 112 Johns Hopkins University. The impact of COVID-19 on maternal and neonatal outcomes. clinicaltrials.gov; 2022. Accessed May 25, 2022 at: https://clinicaltrials.gov/ct2/show/NCT05197621
  • 113 Stock SJ, Carruthers J, Calvert C. et al. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland. Nat Med 2022; 28: 504-512
  • 114 Engjom H, van den Akker T, Aabakke A. et al. Severe COVID-19 in pregnancy is almost exclusively limited to unvaccinated women–time for policies to change. Lancet Reg Health Eur 2022; 13: 100313
  • 115 Halasa NB, Olson SM, Staat MA. et al; Overcoming COVID-19 Investigators, Overcoming COVID-19 Network. Effectiveness of maternal vaccination with mRNA COVID-19 vaccine during pregnancy against COVID-19-associated hospitalization in infants aged <6 months–17 states, July 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71 (07) 264-270
  • 116 Goldshtein I, Nevo D, Steinberg DM. et al. Association between BNT162b2 vaccination and incidence of SARS-CoV-2 infection in pregnant women. JAMA 2021; 326 (08) 728-735
  • 117 Shimabukuro TT, Kim SY, Myers TR. et al; CDC v-safe COVID-19 Pregnancy Registry Team. Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. N Engl J Med 2021; 384 (24) 2273-2282
  • 118 Better Outcomes Registry & Network (BORN) Ontario. COVID-19 Vaccination During Pregnancy in Ontario: Surveillance Report #1, Reporting Interval December 14, 2020 to May 31, 2021. Accessed May 29, 2022 at: https://www.bornontario.ca/en/whats-happening/resources/Documents/COVID-19-Vaccination-During-Pregnancy-in-Ontario-Report-1---FINAL.pdf
  • 119 Olson C. COVID-19 vaccine safety in pregnancy: updates from the v-safe COVID-19 Vaccine Pregnancy Registry. Presented at: Centers for Disease Control and Prevention; September 22, 2021. Accessed May 29, 2022 at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-09-22/09-COVID-Olson-508.pdf
  • 120 Zauche LH, Wallace B, Smoots AN. et al; CDC v-safe Covid-19 Pregnancy Registry Team. Receipt of mRNA COVID-19 vaccines and risk of spontaneous abortion. N Engl J Med 2021; 385 (16) 1533-1535
  • 121 Magnus MC, Örtqvist AK, Dahlqwist E. et al. Association of SARS-CoV-2 vaccination during pregnancy with pregnancy outcomes. JAMA 2022; 327 (15) 1469-1477
  • 122 Fell DB, Dhinsa T, Alton GD. et al. Association of COVID-19 vaccination in pregnancy with adverse peripartum outcomes. JAMA 2022; 327 (15) 1478-1487
  • 123 Ruderman RS, Mormol J, Trawick E. et al. Association of COVID-19 vaccination during early pregnancy with risk of congenital fetal anomalies. JAMA Pediatr 2022; 176 (07) 717-719