key: cord-0751073-qdnco5ep authors: Moreira, Licia Maria Oliveira; Patiño, Jesus; Oliveira, Patricia; Costa, Heloina Moura; Santiago, Ana Cecilia; Campos, Gúbio Soares; Sardi, Silvia Inês; Menezes, Carlos; Lyra, Priscila Pinheiro Ribeiro; Netto, Eduardo Martins title: SARS-CoV-2 infection in pregnant women and newborns in two maternity hospitals in Salvador-Bahia, Brazil. date: 2021-05-24 journal: Braz J Infect Dis DOI: 10.1016/j.bjid.2021.101591 sha: 1f10b320f7ddec693cf7e64167cc14d95d99f999 doc_id: 751073 cord_uid: qdnco5ep The outbreak of the new coronavirus (SARS-CoV-2) causing the coronavirus disease (COVID-19) has spread globally. As of June 18, 2020, a high maternal mortality rate due to SARS-CoV-2 infections was identified in Brazil, representing most of the world cases at that time. An observational, cross-sectional study was performed with pregnant women admitted in two maternity hospitals located in Salvador/Bahia and their newborns, from May 24(th) up to July 17(th) of 2020. Among 329 pregnant women enrolled at hospital admission, a high prevalence (n=28; 8.5%) of pregnant women with COVID-19 was observed, as well as a high proportion of asymptomatic cases (n=19; 67.9%). Two newborns had detectable SARS-CoV-2 but evolved without abnormalities. This data highlight the importance of identifying pregnant women with COVID-19 for proper isolation measures to prevent in-hospital transmission. pregnant women admitted in two maternity hospitals located in Salvador/Bahia and their newborns, from May 24 th up to July 17 th of 2020. Among 329 pregnant women enrolled at hospital admission, a high prevalence (n=28; 8.5%) of pregnant women with COVID-19 was observed, as well as a high proportion of asymptomatic cases (n=19; 67.9%). Two newborns had detectable SARS-CoV-2 but evolved without abnormalities. This data highlight the importance of identifying pregnant women with COVID-19 for proper isolation measures to prevent in-hospital transmission. The Severe Acute Respiratory Syndrome caused by coronavirus 2 (SARS-CoV-2) is spreading extremely fast throughout the world, with an enormous medical burden, social and economic impact. Almost all countries were heavily affected by the infection with thousands of deaths. 1 Up to March 2021, Brazil reported almost thirteen million people infected with more than 330,000 deaths distributed throughout the country, 2 the world's third place in number of infection and second in number of deaths at that time. Infection affects all age groups, but pregnant women and newborns may have significantly higher morbidity and mortality. 3, 4 A dramatic maternal mortality rate due to COVID-19 in Brazil (12.7%) represented most of the world cases. A total of 58.9% of women who died were admitted to an intensive care unit (ICU), and above all, 22.6% did not have access to an ICU bed before dying. 5 Considering the COVID-19 pandemic, the potential benefits of universal testing in pregnant women could include the ability to use COVID-19 status to improve hospital isolation practices and implementation of preventive actions. 5 Two newborns from the 28 positive mothers had detectable SARS-CoV-2. Both were born at 40 weeks of pregnancy by cesarean section with adequate weight for gestational age. The two mothers whose babies were SARS-CoV-2 positive had neither comorbidities nor experienced any intercurrences during pregnancy. One of these mothers was febrile for two weeks before testing, had a placenta presenting sings of infection, and her newborn had an unveventful hospitalization with normal cranial ultrasonography, normal blood count and negative RT-PCR for SARS-CoV-2 at discharge. The other infected newborn's mother was asymptomatic, also evolved without abnormalities but the placenta had signs of inflammation, villitis and perivilositis. Four more pregnant women had positive anti-coronavirus IgM. Serological evaluation of the newborns showed IgG positive in three of them. A high prevalence (8.5%) of pregnant women infected with SARS-CoV-2 at hospital admission was observed, and 67.9% of them had no symptoms of coronavirus disease. These rates are lower than those previously reported by Sutton et al. (15.4% and 87.9%, respectively) 8 during the peak incidence in New York City/NY, but similar to the 10% prevalence and 74% of asymptomatic pregnant women reported at the University of Birmingham as a WHO Collaborating Center for Women's Health. 9 Reports of SARS-CoV-2 asymptomatic infection from case series of universal COVID-19 testing in the obstetric population ranges from 43.5% to 92%. [10] [11] [12] [13] There was enough evidence in this study of SARS-CoV-2 vertical transmission, as the two newborns found positive were children born to positive mothers with already known infection and delivered by cesarean section with all delivery isolation care. Thus, direct contact either from mother's saliva droplets expelled during speech and/or cough, or caregivers, family members, or even health team members 14, 15 could be excluded. Transplacental hematogenic route is being reported, although rarely. 16 In our study, the risk could not be assessed as only two newborns were found positive. Not unexpected, both of them had good outcome for their infection, in line with other reports suggesting that COVID-19 in pregnancy does not seem to be a risk factor for disease severity at the neonatal period. [10] [11] [12] 17 In the case of one the two newborns there were inflammatory signs in the placenta, like those reported by Shanes et al. 18 who found maternal vascular malperfusion, particularly abnormal or injured maternal vessels, and intervillous thrombi. In general, SARS-CoV-2 infection is uncommon in neonates, with an incidence of 5.6 [95% CI 4.3-7.1] per 10,000 live births in the UK. However, unexpected prevalence of 14.5% has been reported. 19, 20 Our study has some limitations. On one hand, RT-PCR was only performed for detecting the presence of SARS-CoV-2 as part of this study protocol. On the other hand, only oropharyngeal and nasal swab were collected, when theoretically, umbilical cord blood, amniotic and gastric fluid, anal swabs, or stool from neonates could have been sampled for detecting SARS-CoV-2. 21 This report calls attention for a necessity to fast and precise identification of COVID-19 infected pregnant women upon hospital admission for proper implementation of isolation measures to prevent hospital transmission. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard Secretaria de Vigilância em Saúde Can SARS-CoV-2 Infection Be Acquired In Utero? Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates The tragedy of COVID-19 in Brazil: 124 maternal deaths and counting Prefeitura de Salvador. Indicadores COVID-19. Available at National Center for Immunization and Respiratory Diseases (NCIRD) D of VD. Use Only 2019-Novel Coronavirus (2019-nCoV) Real-time RT-PCR Primers and Probes Universal Screening for SARS-CoV-2 in Women Admitted for Delivery Prevalence of COVID-19 in pregnant and postnatal women COVID-19 and pregnancy: A review of clinical characteristics, obstetric outcomes and vertical transmission The Effects of Pregnancy on Women With COVID-19: Maternal and Infant Outcomes A Systematic Review of Treatment and Outcomes of Pregnant Women With COVID-19-A Call for Clinical Trials Universal COVID-19 testing in the obstetric population: Impacts on public health Royal College of Pediatrics and Child Health Covid-19 e Amamentação: Nota Técnica N o 8/2020 Transplacental transmission of SARS-CoV-2 infection Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis Placental Pathology in COVID-19 Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance Prevalence and Risk Factors of Neonatal Covid-19 Infection: A Single-Centre Observational Study The clinical course of SARS-CoV-2 positive neonates All authors declare that they have no conflict interests.Funding: This study was financed by the Fundação José Silveira