A baby girl in Texas has been born infected with COVID-19. This is the strongest evidence to date that  transmission of SARS-CoV-2 can occur during pregnancy. This data comes from a report found in The Pediatric Infectious Disease Journal (PIDJ).

The findings "suggest in-utero transmission" of COVID-19 from an infected mother to her infant, according to the case report by Julide Sisman, MD, and colleagues of The University of Texas Southwestern Medical Center, Dallas.

Can COVID-19 Be Transmitted While Pregnant?

"Numerous infants have now been delivered to pregnant women diagnosed with SARS-CoV-2, and the majority of these infants are without respiratory illness or positive molecular evidence for SARS-CoV-2," comments Amanda S. Evans, MD, one of the lead authors of the new study. "Our study is the first to document intrauterine transmission of the infection during pregnancy, based on immunohistochemical and ultrastructural evidence of SARS-CoV-2 infection in the fetal cells of the placenta."

First Documented Transmission of COVID-19 During Pregnancy

The baby girl was born prematurely at 34 weeks to a mother diagnosed with COVID-19, who also had type 2 diabetes. Delivery happened after the mother had a premature rupture of the membranes. The baby was born LGA or Large for Gestational Age, and treated in the neonatal ICU due to prematurity and possible SARS-CoV-2 exposure.

While appearing healthy with normal breathing and other vital signs, the second day of life some problems began to appear. She developed a fever along with mild breathing problems.

"It is unlikely that the respiratory distress observed in this infant was due to prematurity since it did not start until the second day of life," the researchers write.

The infant then tested positive for SARS-CoV-2 infection at 24 and 48 hours after birth. She was treated with supplemental oxygen for several days but didn't require a ventilator. Providers continued to conduct COVID-19 tests and those tests continued to remain positive for up to 14 days. At 21 days, the mother and her child were sent home.

Placenta Examination

The researchers examined the placenta, which showed signs of tissue inflammation. In addition, specialized tests documented the presence of coronavirus particles as well as a protein (SARS-CoV-2 nucleocapsid protein) specific for the COVID-19 virus in fetal cells of the placenta. Together, these findings confirmed that the infection was transmitted in the womb, rather than during or after birth.

Although data on COVID-19 remains very limited, "Intrauterine transmission of SARS-CoV-2 appears to be a rare event," Dr. Sisman and colleagues conclude. They highlight several urgent priorities for further research, including the mechanisms and risk factors of in-utero SARS-CoV-2 transmission and the outcomes of congenital COVID-19 in infants.

"We wanted to be very careful of our interpretation of this data, but now is an even more important time for pregnant women to protect themselves from COVID-19," comments Dr. Evans. She adds, "The CDC has thoughtful guidance on ways to reduce risk of infection." (See https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html)

Additional Evidence

Two additional case reports in PIDJ also describe "vertical" transmission of SARS-Co-V2 from mother to infant occurring under different circumstances. Together, the three cases highlight the important but difficult distinction between virus transmission occurring before or during/after delivery (intrauterine versus intrapartum), according to a commentary led by George K. Siberry, MD, of the US Agency for International Development and Associate Chief Editor of PIDJ. Dr. Siberry and coauthors write: "As these cases illustrate, evaluation for vertical - and especially intrauterine - SARS-CoV-2 infection can be challenging, and assessment is often limited by lack of optimal testing of appropriate specimens obtained at specific time points."

Ob/Gyn and Pediatric Software

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APA Sisman, Julide MD*; Jaleel, Mambarambath A. MD*; Moreno, Wilmer MD†; Rajaram, Veena MD‡; Collins, Rebecca R.J. MD‡; Savani, Rashmin C. MBChB*; Rakheja, Dinesh MD‡; Evans, Amanda S. MD§ INTRAUTERINE TRANSMISSION OF SARS-COV-2 INFECTION IN A PRETERM INFANT, The Pediatric Infectious Disease Journal: July 10, 2020 - Volume Online First - Issue -
doi: 10.1097/INF.0000000000002815

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