*Dominika Dunder1, Julia Nosko1, Olga Grabowska1, Lukasz Szarpak2
COVID-19 and pregnancy
1Student’s Journal Club, Lazarski University, Warsaw, Poland
2Faculty of Medicine, Lazarski University, Warsaw, Poland
To the Editor
Coronavirus disease 2019 (COVID-19) is an acute infectious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The novel coronavirus disease was first diagnosed and described in December 2019 in central China (city of Wuhan, Hubei province) (1). COVID-19 infection may range from mild infection of the upper respiratory tract, lower respiratory tract with life-threatening pneumonia with acute respiratory failure syndrome (1). This virus is broadly susceptible to all age, from the youngest newborns to the oldest. Pregnant women and their fetuses are at high risk to infect with a virus during outbreaks of infectious diseases (2). They are also more exposed to respiratory pathogens, so on that account they may be more susceptible to COVID-19 infection than the general population (1). Therefore, the epidemic has raised concerns about the possibility of vertical transmission of the virus from mother to fetus (3).
SARS-CoV-2 is the seventh member of the family of CoVs that infect humans. The genetic sequence of SARS-CoV-2 is ≥ 70% similar to that SARS-CoV, and SARS-CoV-2 is capable of using the same cell entry receptor (ACE2) as SARS-CoV to infect humans. However, SARS-CoV-2 spike (surface spike glycoprotein) binds to human ACE2 with approximately 10-20-fold higher affinity than the SARS-CoV spike, making it easier to spread from human to human (4).
At the present time, there is only little data available about the risk of vertical transmission from mother to child due to the small number of published cases. Preliminary information suggests that pregnant women are not more severely affected than the general population (5), however the available research results show that there is a theoretical risk of vertical transmission, as the ACE2 receptor is widely expressed in the placenta. In the limited number of available cases in which newborns were born from mothers with COVID-19, there have been 2 neonates tested positive for SARS-CoV-2 from COVID-19-infected mothers. However, there have been no confirmed cases of vertical transmission among the 46 other neonates, born to COVID-19-infected mothers reported thus far (2).
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Piśmiennictwo
1. Liu H, Wang LL, Zhao SJ et al.: Why are pregnant women susceptible to COVID-19? An immunological viewpoint. J Reprod Immunol 2020; 139: 103122.
2. Dashraath P, Wong JLJ, Lim MXK et al.: Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020 Mar 23. pii: S0002-9378(20)30343-4.
3. Panahi L, Amiri M, Pouy S: Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy: a Narrative Review. Arch Acad Emerg Med 2020; 8(1): e34.
4. Li H, Liu SM, Yu XH et al.: Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents 2020 Mar 29: 105951.
5. Rasmussen SA, Smulian JC, Lednicky JA et al.: Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020; 222(5): 415-426.
6. Wong SF, Chow KM, Leung TN et al.: Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191(1): 292-297.
7. Ng PC, Leung CW, Chiu WK et al.: SARS in newborns and children. Biol Neonate 2004; 85(4): 293-298.
8. Zhu H, Wang L, Fang C et al.: Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9(1): 51-60.
9. Chen H, Guo J, Wang C et al.: 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.
10. Huang C, Wang Y, Li X et al.: Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
11. Maxwell C, McGeer A, Tai KFY, Sermer M: No. 225-Management Guidelines for Obstetric Patients and Neonates Born to Mothers With Suspected or Probable Severe Acute Respiratory Syndrome (SARS). J Obstet Gynaecol Can 2017; 39(8): e130-e137.
12. Assiri A, Abedi GR, Al Masri M et al.: Middle East Respiratory Syndrome Coronavirus Infection During Pregnancy: A Report of 5 Cases From Saudi Arabia. Clin Infect Dis 2016; 63(7): 951-953.
13. Thevarajan I, Nguyen THO, Koutsakos M et al.: Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med 2020; 26(4): 453-455.
14. Chen S, Huang B, Luo DJ et al.: Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases. Zhonghua Bing Li Xue Za Zhi 2020; 49(0): E005.
