In a recent study published in the Cureus journal, researchers assessed the impact of early onset coronavirus disease 2019 (COVID-19) on maternal, fetal, and neonatal characteristics.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its mutants have adversely affected the global healthcare system, resulting in widespread morbidity and mortality. Data demonstrating the impact of the pandemic on pregnancy outcomes, neonatal outcomes of SARS-CoV-2 infected babies, and the probability of viral transmission from the mother to the child is still insufficient.
About the study
In the present study, researchers reported the fetal and maternal characteristics of pregnant women diagnosed with COVID-19 and neonatal and maternal characteristics of neonates having early onset COVID-19.
The team conducted a prospective cohort study at a tertiary referral center in North India. The study included all pregnant women displaying severe to critical SARS-CoV-2 infection and neonates with early onset COVID-19. The pregnant women were tested for COVID-19 during admission to the referral center via reverse transcriptase-polymerase chain reaction (RT-PCR).
The women were screened for SARS-CoV-2 infection for severe or critical disease as per the definitions by the Chinese Center for Disease Control and Prevention. The severe infection was characterized by dyspnea, blood oxygen saturation of 93% or less in room air, and respiratory rate of more than 30 per minute. The critical disease was characterized by septic shock, respiratory failure, and/or multiple organ failure or dysfunction.
The team obtained data related to demography, known comorbidities, symptomatology, gestation period, pregnancy-associated complications, information regarding investigations and management, hospital stay duration, intensive care unit (ICU) stay, the requirement of external ventilation, and pregnancy outcomes such as neonatal and maternal outcome recorded from the time of hospital admission to either discharge or hospital death.
All neonates born to SARS-CoV-2-infected mothers were tested for COVID-19 using throat and nasopharyngeal samples. Neonatal and maternal characteristics such as Apgar score, neonatal ICU (NICU) admission, birth weight, neonatal morbidities, respiratory support, and mortality were recorded for neonates having early-onset COVID-19. The team also noted any SARS-CoV-2 presence on different maternal samples such as amniotic fluid, placental swabs, cord blood, and cervical and vaginal swabs obtained at the time of birth to assess the possibility of viral transmission from mother to child.
The study results showed that 165 COVID-19-positive pregnant women were hospitalized at the study center. In the first and third COVID-19 waves of infections, the team found no severe SARS-CoV-2 infections during pregnancy and no early-onset COVID-19 in neonates. In the second wave between March and June 2021, 15 pregnant women had severe COVID-19 and 11 neonates had early-onset COVID-19. Among the pregnant women having severe infections, the mean age was 29.13±4.01 years, while the mean gestational age during admission was 25.57±4.69 weeks. Approximately 73.33% of the women were in their second, and the rest were in their third trimester of pregnancy.
Among the symptomatic pregnant women, 93.33% had breathlessness, cough, and pneumonia. Furthermore, at the time of admission, 46.67% had tachycardia, 73.33% had tachypnea and required supplemental oxygen, and 60% had intrauterine fetal death (IUFD). Furthermore, 13.33% of the pregnant women had gestational diabetes mellitus, 6.67% had intrahepatic cholestasis of pregnancy, 13.33% had preeclampsia or eclampsia, 80% had anemia, and 33.33% had oligohydramnios.
The team also noted that 15 women required ICU admission, including most of those who needed invasive ventilatory support. Additionally, it was reported that almost three-fourths of the patients displayed alanine transaminase and high total leucocyte count, while 100% had elevated aspartate transaminase. Furthermore, two-thirds of the patients had normal procalcitonin levels and elevated D-dimer levels.
All the pregnant patients who required ventilatory support died due to COVID-19. A total of four women recovered during the study period and continued pregnancy with live fetuses. Two of the 11 women gave birth to two live babies, with both having COVID-19 positive nasopharyngeal and oropharyngeal samples. One of the neonates succumbed to COVID-19 due to perinatal asphyxia.
None of the neonates having early-onset COVID-19 had SARS-CoV-2 symptoms. Among the 11 neonates, four needed treatment with positive-pressure ventilation, high-flow nasal oxygen, chest compressions, and invasive and non-invasive ventilation. Two of the neonates succumbed during the study period. However, the need for neonatal interventions and death was attributed to sepsis, prematurity, and perinatal asphyxia, rather than COVID-19.
Furthermore, neonatal early-onset of COVID-19 was associated with the presence of SARS-CoV-2 in different maternal samples obtained at the time of birth. SARS-CoV-2 positivity of either placental membrane, amniotic fluid, or cervical and vaginal swab in six pregnant mothers highlighted the probability of intrapartum or antepartum transmission.
Overall, the study findings showed that severe SARS-CoV-2 infection during pregnancy was reported predominantly in the second trimester and was related to a high incidence of maternal mortality and intrauterine fetal demise.