Covid-19 in pregnancy
Jim G. Thornton
Division of Child Health, Obstetrics and Gynaecology, School of
Medicine, University of Nottingham. NG5 1PB
Email:
jim.thornton@nottingham.ac.uk
Two papers in this issue, on births to Covid-19 infected mothers, are
important additions to this rapidly evolving literature. They are both
broadly reassuring.
The paper from Lombardy, the epicentre of the pandemic in Italy, is the
first detailed report of pregnancies from this large region (Ferrazzi et
al. BJOG 2020 xxxx). Among 42 affected women, 19 developed pneumonia, of
whom seven required oxygen and four critical care. Eighteen babies were
delivered by Caesarean, although in eight the indication was unrelated
to Covid-19. Three babies tested positive for SARS-COV-2. Two to women
who had developed Covid-19 postnatally and had breast-fed without a
mask; the presumed source was the mother. One baby who delivered
vaginally and did not breast-feed, developed respiratory symptoms
requiring one day’s ventilation and tested positive. No mothers or
babies died.
The paper from China reports SARS-COV-2 viral tests in a range of body
fluids from mothers and babies with COVID-19, cared for at Renmin
Hospital of Wuhan University (RHWU) (Yanting Wu et al. BJOG 2020 xxxx).
This hospital appears on the Global Research Identifier Database (GRID)
here https://grid.ac/institutes/grid.412632.0. Readers should know
that the GRID database reports that RHWU has the following English
aliases “People’s Hospital of Wuhan University”, “Hubei Provincial
People’s Hospital”, “First Affiliated Hospital of Wuhan University”,
“Wuhan University Renmin Hospital” and “Hubei General Hospital”.
This raises the possibility that some or all of the cases may have been
reported previously.
With this proviso, the detailed information that 1/9 stool samples, 0/13
vaginal samples, and 1/3 breast milk samples were positive is important.
Of the five babies who have delivered, none tested positive for
Covid-19, although two, both preterm, had pneumonia diagnosed on chest x
ray. Apart from one biochemical pregnancy in the first trimester in
which a serum human chorionic gonadotrophin of 25.9 IU/L reverted to
negative, no mothers or babies died.
Taken together with other accumulating data, it is already clear that
Covid-19 is less severe in pregnancy than the two previous coronavirus
infections, Severe Acute Respiratory Syndrome-related coronavirus (SARS)
and Middle East Respiratory Syndrome-related coronavirus (MERS).
Nevertheless, four of the mothers from Lombardy required critical care,
and there have been other reports of both mother and baby deaths in
association with Covid-19. It remains an important disease in pregnancy,
which should be taken seriously.
No disclosures. A completed disclosure of interest form is
available to view online as supporting information.