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Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.
Lancet. 2020 03 07; 395(10226):809-815.Lct

Abstract

BACKGROUND

Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection.

METHODS

Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation.

FINDINGS

All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8-9 and a 5-min Apgar score of 9-10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus.

INTERPRETATION

The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy.

FUNDING

Hubei Science and Technology Plan, Wuhan University Medical Development Plan.

Authors+Show Affiliations

Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China.State Key Laboratory of Virology/Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, Hubei, China.Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.Department of Paediatrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China. Electronic address: yanghuixia@bjmu.edu.cn.State Key Laboratory of Virology/Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, Hubei, China. Electronic address: houwei@whu.edu.cn.Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China. Electronic address: zhangyuanzhen@whu.edu.cn.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32151335

Citation

Chen, Huijun, et al. "Clinical Characteristics and Intrauterine Vertical Transmission Potential of COVID-19 Infection in Nine Pregnant Women: a Retrospective Review of Medical Records." Lancet (London, England), vol. 395, no. 10226, 2020, pp. 809-815.
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.
Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W., Li, J., Zhao, D., Xu, D., Gong, Q., Liao, J., Yang, H., Hou, W., & Zhang, Y. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet (London, England), 395(10226), 809-815. https://doi.org/10.1016/S0140-6736(20)30360-3
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 03 7;395(10226):809-815. PubMed PMID: 32151335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. AU - Chen,Huijun, AU - Guo,Juanjuan, AU - Wang,Chen, AU - Luo,Fan, AU - Yu,Xuechen, AU - Zhang,Wei, AU - Li,Jiafu, AU - Zhao,Dongchi, AU - Xu,Dan, AU - Gong,Qing, AU - Liao,Jing, AU - Yang,Huixia, AU - Hou,Wei, AU - Zhang,Yuanzhen, Y1 - 2020/02/12/ PY - 2020/02/04/received PY - 2020/02/08/revised PY - 2020/02/08/accepted PY - 2020/3/11/entrez PY - 2020/3/11/pubmed PY - 2020/3/19/medline SP - 809 EP - 815 JF - Lancet (London, England) JO - Lancet VL - 395 IS - 10226 N2 - BACKGROUND: Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. METHODS: Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. FINDINGS: All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8-9 and a 5-min Apgar score of 9-10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. INTERPRETATION: The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. FUNDING: Hubei Science and Technology Plan, Wuhan University Medical Development Plan. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/32151335/Clinical_characteristics_and_intrauterine_vertical_transmission_potential_of_COVID_19_infection_in_nine_pregnant_women:_a_retrospective_review_of_medical_records_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(20)30360-3 DB - PRIME DP - Unbound Medicine ER -