Maternal Transmission of SARS-COV-2 to the Neonate, and Possible Routes for Such Transmission: a Systematic Review and Critical Analysis

Overview

Journal BJOG

Specialty Gynecology & Obstetrics

Date 2020 Jun 13

PMID 32531146

Citations 129

Authors

K F Walker

K ODonoghue

N Grace

J Dorling

J L Comeau

W Li

J G Thornton

Affiliations

Soon will be listed here.

Abstract

Background: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified?

Objective: To estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction.

Search Strategy: Two biomedical databases were searched between September 2019 and June 2020.

Selection Criteria: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported.

Data Collection And Analysis: Data were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission.

Main Results: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated.

Conclusions: Neonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother.

Tweetable Abstract: Risk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.

Citing Articles

The costs of suboptimal breastfeeding in Ontario, Canada, and potential healthcare resource impacts from improving rates: a pediatric health system costing analysis.

Onah N, Hoy S, Slofstra K Int Breastfeed J. 2025; 20(1):9.

PMID: 39987118 PMC: 11846301. DOI: 10.1186/s13006-025-00702-y.

Prospective Analytical Case-Control Study of COVID-19 Positive Versus Negative Patients for Subclinical Placental Dysfunction.

Marwaha P, Bala J, Sharma S, Kaundal A, Chauhan N Iran J Pathol. 2024; 19(3):300-305.

PMID: 39687447 PMC: 11646204. DOI: 10.30699/IJP.2024.2017566.3225.

Cranial ultrasonographic findings in newborns exposed to SARS-CoV-2: a single-centre cross-sectional analysis.

Scalia B, Saporito M, Mauceri L, Saporito A, Privitera G, Ruggieri M Ital J Pediatr. 2024; 50(1):257.

PMID: 39633390 PMC: 11619645. DOI: 10.1186/s13052-024-01826-3.

In Situ Analyses of Placental Inflammatory Response to SARS-CoV-2 Infection in Cases of Mother-Fetus Vertical Transmission.

Morotti D, Tabano S, Gaudioso G, Radaelli T, Croci G, Bianchi N Int J Mol Sci. 2024; 25(16).

PMID: 39201511 PMC: 11355016. DOI: 10.3390/ijms25168825.

Maternal and Newborn Outcomes of SARS-CoV-2/COVID-19 and Pregnancy: Parallels and Contrasts with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome.

Li D, Zhang J, Zhang X, Chang Y, Vermund S Med Res Arch. 2024; 12(4).

PMID: 39118854 PMC: 11309002. DOI: 10.18103/mra.v12i4.5205.

References

Karimi-Zarchi M, Neamatzadeh H, Dastgheib S, Abbasi H, Reza Mirjalili S, Behforouz A . Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review. Fetal Pediatr Pathol. 2020; 39(3):246-250. PMC: 7157948. DOI: 10.1080/15513815.2020.1747120. View

Shah P, Diambomba Y, Acharya G, Morris S, Bitnun A . Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand. 2020; 99(5):565-568. PMC: 7262318. DOI: 10.1111/aogs.13870. View

Elshafeey F, Magdi R, Hindi N, Elshebiny M, Farrag N, Mahdy S . A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet. 2020; 150(1):47-52. PMC: 9087748. DOI: 10.1002/ijgo.13182. View

Mi J, Liu F . Rate of caesarean section is alarming in China. Lancet. 2014; 383(9927):1463-1464. DOI: 10.1016/S0140-6736(14)60716-9. View

Mullins E, Evans D, Viner R, OBrien P, Morris E . Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol. 2020; 55(5):586-592. DOI: 10.1002/uog.22014. View

Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L . Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. N Engl J Med. 2020; 382(25):e100. PMC: 7182016. DOI: 10.1056/NEJMc2009226. View

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W . Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226):809-815. PMC: 7159281. DOI: 10.1016/S0140-6736(20)30360-3. View

Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M . Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020; 2(2):100107. PMC: 7104131. DOI: 10.1016/j.ajogmf.2020.100107. View

Zaigham M, Andersson O . Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020; 99(7):823-829. PMC: 7262097. DOI: 10.1111/aogs.13867. View

10.

Wong S, Chow K, Leung T, Ng W, Ng T, Shek C . Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004; 191(1):292-7. PMC: 7137614. DOI: 10.1016/j.ajog.2003.11.019. View

11.

Yan J, Guo J, Fan C, Juan J, Yu X, Li J . Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020; 223(1):111.e1-111.e14. PMC: 7177142. DOI: 10.1016/j.ajog.2020.04.014. View

12.

Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S . Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020; 127(9):1116-1121. PMC: 7267664. DOI: 10.1111/1471-0528.16278. View

13.

Bauchner H, Golub R, Zylke J . Editorial Concern-Possible Reporting of the Same Patients With COVID-19 in Different Reports. JAMA. 2020; 323(13):1256. DOI: 10.1001/jama.2020.3980. View

14.

Alfaraj S, Al-Tawfiq J, Memish Z . Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect. 2018; 52(3):501-503. PMC: 7128238. DOI: 10.1016/j.jmii.2018.04.005. View

15.

Walker K, ODonoghue K, Grace N, Dorling J, Comeau J, Li W . Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG. 2020; 127(11):1324-1336. PMC: 7323034. DOI: 10.1111/1471-0528.16362. View

16.

Yang Z, Wang M, Zhu Z, Liu Y . Coronavirus disease 2019 (COVID-19) and pregnancy: a systematic review. J Matern Fetal Neonatal Med. 2020; 35(8):1619-1622. DOI: 10.1080/14767058.2020.1759541. View

17.

Della Gatta A, Rizzo R, Pilu G, Simonazzi G . Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol. 2020; 223(1):36-41. PMC: 7165087. DOI: 10.1016/j.ajog.2020.04.013. View

18.

Rasmussen S, Smulian J, Lednicky J, Wen T, Jamieson D . Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020; 222(5):415-426. PMC: 7093856. DOI: 10.1016/j.ajog.2020.02.017. View

19.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339:b2535. PMC: 2714657. DOI: 10.1136/bmj.b2535. View