key: cord-266564-imj1lcy9
authors: Liu, Yangli; Chen, Haihong; Tang, Kejing; Guo, Yubiao
title: Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy
date: 2020-03-05
journal: J Infect
DOI: 10.1016/j.jinf.2020.02.028
sha: 
doc_id: 266564
cord_uid: imj1lcy9

nan

Tang and colleagues, in this Journal, drew readers attention to emerging COVID19[1].

We focused on the pregnant COVID19 patients. Given the maternal physiologic and immune function changes in pregnancy [2] , pregnant individuals might face greater risk of getting infected by SARS-CoV-2 and might have more complicated clinical events. We described epidemiological, clinical characteristics, pregnancy and perinatal outcomes of all hospitalized pregnant patients diagnosed with COVID-19 in China.

We identified all hospitalized pregnant patients with laboratory-confirmed SARS-CoV-2 infection between December 8, 2019, and February 25, 2020 officially reported by the central government, in areas outside Wuhan, China. Information including age, geographic location, epidemiological history, prenatal course, maternal and newborn hospital course, discharge data and outcome were obtained by Centers for Disease Control and Prevention and Local Health Commission. When necessary, we attempted to contact local hospital or patients by telephone to supply missing information. This investigation was part of an emergency public health outbreak investigation and therefore not subject to institutional review board.

There were a total of 13 Chinese patients with SARS-CoV-2 admitted to hospitals outside of Wuhan (Table) . There were 3 patients from Zhejiang, 3 from other cities of Hubei and 1 each from Fujian, Shanxi, Beijing, Guangdong, Jiangxi, Heilongjiang and Anhui. The maternal age ranged between 22 to 36 years. Two women were less than 28 weeks of gestation and the other 11 patients were in their third trimesters at presentation. None of the patients had underlying medical disease. Previous studies suggested that COVID-19 is more likely to affect older males with comorbidities [3] . We reported 13 pregnant COVID-19 patients in China, indicating pregnant women also susceptible to SARS-CoV-2. Clinical manifestations of the pregnant COVID-19 patients in this study varied widely from asymptomatic to very severe, similar to previous report in non-pregnant patients [4] . Most of the pregnant patients had mild to moderate symptoms. Fever and fatigue were the principal symptoms, and less common symptoms were sore throat and shortness of breath. Almost all the patients had a clear epidemiologic history.

One of the 13 patients (7.6%) developed severe pneumonia requiring ICU care with multiple organ dysfunction syndrome in the third trimester in our study, similarity with the general population reported to be with critical rate of 5% [5] .

Cytokine storm might be the reason for very severe cases since Chaolin Huang et al [6] found that compared with non-ICU patients, ICU patients had higher plasma levels of various cytokines.

Five patients of thirteen (38%) were delivered by emergency cesarean section because of pregnancy complications including fetal distress, premature rupture of the membrane and stillbirth. Six patients (46%) had preterm labour. These perinatal complications could be ascribed to the virus infection as well as the physiologic changes that reducing the woman intolerant to hypoxia during late pregnancy [7] .

Fortunately, no severe neonatal asphyxia was observed in the nine livebirths and no vertical transmission was found.

In conclusion, our report showed pregnant women are also susceptible to SARS-CoV-2 infection. SARS-CoV-2 may increase health risks to both mothers and infants during pregnancy. Efforts should be taken to reduce the infection rate of SARS-CoV-2 both in pregnant and perinatal period, and more intensive attention should be paid to pregnant patients.

All authors declare that they have no competing interests. 

Emergence of a novel coronavirus causing respiratory illness from Wuhan

Emerging infections and pregnancy

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Middle East Respiratory Syndrome Coronavirus Infection During Pregnancy: A Report of 5

Cases From Saudi Arabia