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COVID-19 among Pregnant Mothers and Newborns

Japanese Chinese

As the article posted in this section has reported, it has become clear that most cases of COVID-19 among children are mild and deaths are very rare.

When a pregnant mother is infected with COVID-19, what is the condition of the mother, fetus and newborn? Pregnant mothers are said to be more susceptible by nature to infectious diseases. It is said that immunity weakens during pregnancy and the enlarged uterus puts pressure on the lungs, which lowers resistance to pneumonia and other infections. As for the fetus, it is known that infection with the rubella (German measles) or Erythema infectiosum (fifth disease) will result in serious after-effects. Furthermore, newborn infants have not yet formed the ability to produce antibodies, so their resistance to infection is low.

If a pregnant mother becomes infected with COVID-19, she will surely become very con-cerned not only about her own condition, but also about the effect on the fetus and child to be born, and this will be the cause of considerable anxiety. Here, based on two published studies, I would like to report on the actual condition of COVID-19 now in expectant moth-ers, the fetus, and newborn infants.

Dr. Mehreen Zaigham in Sweden searched 18 recently published medical articles (in English and Chinese) and studied the cases of the 108 pregnant mothers (average age of 29-32) in 5 countries (China, Sweden, U.S., South Korea and Honduras) who had been infected with COVID-19, and 86 newborn infants from this group of mothers. The number of newborn in-fants is lower than the number of pregnant mothers because 22 of the 108 women contracted COVID-19 in the first and second trimester of pregnancy, received treatment for COVID-19 before giving birth, and were discharged from the hospital. These 22 mothers had no after-effects and were discharged.

Of the remaining 86 pregnant mothers (one gave birth to twins) who were infected with COVID-19, all except three were mildly infected, and showing only symptoms such as fever, coughing, diarrhea, etc., have now recovered. Two of the three had severe pneumonia and were placed in an ICU unit, and both had chronic diseases such as obesity, diabetes, and liver disorder. One of the two patients was discharged without any aftereffects, but the other was still hospitalized with kidney failure when the case report (study) was made. The two newborn infants did not show any particular symptoms, and the PCR tests were also negative. Of the three women with severe cases, the remaining one developed multiple organ failure and acute respiratory distress syndrome (ARDS); she was given ECMO therapy and her child was stillborn. At the time of the report, the mother was still undergoing treatment, and further information has not been released.

As for fetus and infant, there was one case of fetal death (relation to COVID-19 unknown) and the abovementioned death, but the other 85 newborn infants were later released from the hospital without any aftereffects. In PCR testing, one infant tested positive, but did not have any symptoms.

Based on this study, it was found that although COVID-19 infection in pregnant women may become serious, in most cases, it displays mild symptoms, and also the possibility of vertical transmission to the newborn is low.

In addition to the above case, a study has been published in China regarding the clinical course in newborn infants infected with COVID-19. Professor Xiaolu Ma of Zhejiang University in Hangzhou, China has reported on the clinical cases of six newborn infants that have been announced in China. Five of the six cases were located in Wuhan and one in Xinyang. Five of the mothers were confirmed to be positive by PCR testing and one received a negative PCR test result, but was diagnosed with pneumonia based on a CT scan of her lungs and clinical condition.

As for symptoms of six newborns, three had fevers, two had difficulty nursing, three were vomiting, and only one was confirmed to have pneumonia by CT scan. All are improving and recovering without special treatment.

As for the transmission route, the virus is not detected in amniotic fluid and cord blood, and intrauterine infection does not seem to have occurred, but this cannot be confirmed due to the small sampling number.

Pregnant mothers now are not only concerned about becoming infected, but also about the effect on the child they are carrying. The studies report that in COVID-19 infection in pregnant women, even when compared to women of the same age group who are not pregnant, there is no difference in clinical symptoms; and among newborn infants, the cases are mostly mild.

In fact, pregnant women and newborns were indeed susceptible to COVID-19, and there were rare cases with severe infections, while there is no evidence indicating that they are more susceptible than those in other age groups.


References

  • Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic re-view of 108 pregnancies. Acta Obstet Gynecol Scand. 2020;00:1-7. https://doi.org/10.1111/aogs.13867
  • Ma X, Zhu J, Du L, Neonatal management during Coronavirus disease (COVID-19) outbreak: Chinese experiences. NeoReviews. 2020; doi: 10.1542/neo.21-5-e293
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sakakihara_2013.jpg Yoichi Sakakihara
M.D., Ph.D., Professor Emeritus, Ochanomizu University; Director of Child Research Net, Executive Advisor of Benesse Educational Research and Development Institute (BERD), President of Japanese Society of Child Science. Specializes in pediatric neurology, developmental neurology, in particular, treatment of Attention Deficit Hyperactivity Disorder (ADHD), Asperger's syndrome and other developmental disorders, and neuroscience. Born in 1951. Graduated from the Faculty of Medicine, the University of Tokyo in 1976 and taught as an instructor in the Department of the Pediatrics before working with Ochanomizu University.
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