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The 2019 novel coronavirus disease (COVID-19) is characterized by respiratory infection that can progress to fatal pneumonia. Pregnant women with influenza have disproportionate morbidity and mortality because of their relative immunosuppression and altered respiratory physiology. Now, investigators describe the natural history of COVID-19 among nine pregnant women in Wuhan, China, who were admitted with pneumonia between 36 weeks' and 39 weeks plus 4 days' gestation. All were in good health prior to pregnancy. One patient had gestational hypertension, one had preeclampsia, and four had premature labor.
All women tested positive for COVID-19 and were symptomatic, most commonly with fever and cough; eight also had patchy opacities on lung CT consistent with viral pneumonia. Laboratory results were notable for marked lymphopenia in five women and elevated liver function tests in three. None required mechanical ventilation. All infants were born by cesarean delivery; Apgar scores ranged from 8 to 10. COVID-19 was not detected in amniotic fluid, cord blood, newborn throat swabs, or breast milk samples collected from six of the women.
Chen H 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 Feb 12; [e-pub]. (https://doi.org/10.1016/S0140-6736(20)30360-3)
Comment
Despite symptomatic infection with documented viral pneumonia, COVID-19 did not appear substantially worse during late pregnancy than in nonpregnant persons. In addition, neonates did not show evidence of transplacental transmission. Although in all cases cesarean delivery was employed either for maternal indication or to reduce risk for vertical transmission, to suggest this as a universal preventive approach would be premature. Although these data suggest that the toll from COVID-19 is not exacerbated by pregnancy, we await analysis of larger case series.