Most Susceptible Duo in COVID-19 Crisis: A Literature Review
Bhavana Bhushan Lakhkar, Bhushita Guru, Sachin Damke, Smita Damke
Abstract
Background and Aims: December 2019 onward, the COVID-19 infection has created havoc in the world. This review aims to pool in the experiences of obstetricians and neonatologists to help provide some guidance to clinicians and researchers about managing COVID-19 infection in pregnant women and the neonates.
The study analyzed the susceptibility of pregnant women and the neonates to COVID-19 infection and the disease severity and mortality in pregnant women and the neonates due to this infection. We also attempted to find evidence of vertical transmission of the COVID-19 virus.
Materials and Methods: Several databases (PubMed, MEDLINE, CINAHL, Google Scholar, and EMBASE) were explored, and relevant articles published between December 2019 and May 2020 were collated. A total of 46 published articles and 1 press note were selected for this review. A few landmark studies published during the preparation of this review were also included.
Results: A total of 558 COVID-19–positive pregnant women were studied in 5 case reports, 20 case series, and 1 press note, with 443 deliveries and 445 neonates (2 sets of twins). Of the 329 pregnant women in whom the disease severity was reported, 232 (70.5%) women had mild disease, and 72 (21.8%) women were asymptomatic. However, comorbidities did not affect the severity of the disease. There were 2 (0.35%) maternal deaths, 2 (0.43%) neonatal deaths, and 1 (0.22%) stillbirth.
Of the 452 real-time polymerase chain reaction (RT-PCR) tests done in neonates, only 3 neonates had symptoms and none died. Although the neonates of COVID-19–positive mothers were kept away from them, these neonates had high levels of serum IgM and interleukins, and the results of the RT-PCR test of their nasopharyngeal swabs were positive for the COVID-19 virus (even at 16 hours after birth). This suggests the possibility of vertical transmission. The reproductive tissue and breast milk tested negative for the COVID-19 virus.
Conclusions: Pregnant women are not additionally vulnerable to COVID-19 infection or its severity, although recent studies show a high susceptibility in some ethnic groups. Maternal and neonatal morbidity and mortality are low. Some evidence of vertical transmission is seen. Symptomatic disease in neonates is rare. Neonates can be left with their mothers, subject to the mothers practicing proper hand hygiene and using masks. The neonates should be breastfed.
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