key: cord-0953472-6ipapja4
authors: Martini, Anne E.
title: COVID-19 in pregnancy
date: 2020-09-11
journal: Glob Reprod Health
DOI: 10.1097/grh.0000000000000047
sha: 80afdf4e93c13f9b5b88fed835c92287d3e744de
doc_id: 953472
cord_uid: 6ipapja4

Evidence continues to emerge on the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) in pregnancy. Compared with previous coronavirus outbreaks (severe acute respiratory syndrome and Middle East respiratory syndrome), recent reports suggest that pregnant women who contract SARS-CoV-2 have lower rates of maternal and fetal complications; however, the incidence of preterm birth remains elevated. The potential for vertical transmission is still under investigation. Universal testing of women admitted to labor and delivery is being encouraged in most centers.

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also known as COVID-19) on pregnancy seems to differ from prior coronaviruses including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS-CoV). According to a recent review published by Segars and colleagues, COVID-19 has lower maternal mortality rates when compared wth SARS and MERS-CoV with most affected women recovering without delivery. In addition, pregnant women do not seem to be more susceptible to COVID-19 or manifest more severe symptomatology than the general population. Despite these factors, higher rates of preterm delivery and fetal growth restriction have been described ( Table 1) . At this time, miscarriage rates do not seem to be increased above those of the general population, though further studies are needed to understand the impact of the virus on earlier stages of pregnancy [1] .

The potential for vertical transmission remains under investigation. To date, COVID viral RNA has not been detected in amniotic fluid, cord blood, or breast milk [1] . Despite no documented reports of vertical transmission from SARS or MERS-CoV, 2 recent case reports in JAMA have suggested the possibility for vertical transmission with COVID infection. One case describes a COVID-19-positive woman who had positive placental culture for SARS-CoV2 after experiencing a secondtrimester miscarriage [2] . The other involves the detection of IgM antibodies for SARS-CoV-2 in a healthy neonate born to a COVID-19-positive mother [3] .

A study evaluating COVID testing in pregnant women presenting to labor and delivery demonstrated high rates of asymptomatic infections (13.5%) [4] . Interestingly, this same study noted that 10% of women that were asymptomatic, COVID-positive on admission developed severe symptoms postpartum. The link between postpartum manifestation of symptoms is still under investigation, but these findings are the primary driving force behind the push for universal COVID testing upon admission to labor and delivery.

The author declares that there is no financial conflict of interest with regard to the content of this report. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Prior and novel coronaviruses, COVID-19, and human reproduction: what is known?

Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection

Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn

Universal screening for SARS-CoV-2 in women admitted for delivery

Received 17 June 2020; Accepted 7 July 2020 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.