Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China

Yan Ting Wu; Jun Liu; Jing Jing Xu; Yan Fen Chen; Wen Yang; Yang Chen; Cheng Li; Yu Wang; Han Liu; Chen Zhang; Ling Jiang; Zhao Xia Qian; Andrew Kawai; Ben Willem Mol; Cindy Lee Dennis; Guo Ping Xiong; Bi Heng Cheng; Jing Yang; He Feng Huang

doi:10.1371/journal.pmed.1003195

Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China

Yan Ting Wu, Jun Liu, Jing Jing Xu, Yan Fen Chen, Wen Yang, Yang Chen, Cheng Li, Yu Wang, Han Liu, Chen Zhang, Ling Jiang, Zhao Xia Qian, Andrew Kawai, Ben Willem Mol, Cindy Lee Dennis, Guo Ping Xiong, Bi Heng Cheng, Jing Yang, He Feng Huang

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Abstract

BACKGROUND: As of June 1, 2020, coronavirus disease 2019 (COVID-19) has caused more than 6,000,000 infected persons and 360,000 deaths globally. Previous studies revealed pregnant women with COVID-19 had similar clinical manifestations to nonpregnant women. However, little is known about the outcome of neonates born to infected women. METHODS AND FINDINGS: In this retrospective study, we studied 29 pregnant women with COVID-19 infection delivered in 2 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and 30 neonates (1 set of twins). Maternal demographic characteristics, delivery course, symptoms, and laboratory tests from hospital records were extracted. Neonates were hospitalized if they had symptoms (5 cases) or their guardians agreed to a hospitalized quarantine (13 cases), whereas symptom-free neonates also could be discharged after birth and followed up through telephone (12 cases). For hospitalized neonates, laboratory test results and chest X-ray or computed tomography (CT) were extracted from hospital records. The presence of antibody of SARS-CoV-2 was assessed in the serum of 4 neonates. Among 29 pregnant COVID-19-infected women (13 confirmed and 16 clinical diagnosed), the majority had higher education (56.6%), half were employed (51.7%), and their mean age was 29 years. Fourteen women experienced mild symptoms including fever (8), cough (9), shortness of breath (3), diarrhea (2), vomiting (1), and 15 were symptom-free. Eleven of 29 women had pregnancy complications, and 27 elected to have a cesarean section delivery. Of 30 neonates, 18 were admitted to Wuhan Children's Hospital for quarantine and care, whereas the other 12 neonates discharged after birth without any symptoms and had normal follow-up. Five hospitalized neonates were diagnosed as COVID-19 infection (2 confirmed and 3 suspected). In addition, 12 of 13 other hospitalized neonates presented with radiological features for pneumonia through X-ray or CT screening, 1 with occasional cough and the others without associated symptoms. SARS-CoV-2 specific serum immunoglobulin M (IgM) and immunoglobulin G (IgG) were measured in 4 neonates and 2 were positive. The limited sample size limited statistical comparison between groups. CONCLUSIONS: In this study, we observed COVID-19 or radiological features of pneumonia in some, but not all, neonates born to women with COVID-19 infection. These findings suggest that intrauterine or intrapartum transmission is possible and warrants clinical caution and further investigation. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000031954 (Maternal and Perinatal Outcomes of Women with coronavirus disease 2019 (COVID-19): a multicenter retrospective cohort study).

Original language	English
Article number	e1003195
Number of pages	19
Journal	PLoS Medicine
Volume	17
Issue number	7
DOIs	https://doi.org/10.1371/journal.pmed.1003195
Publication status	Published - 28 Jul 2020

Bibliographical note

Funding: YTW: National Key Research and Development Program of China (2018YFC1002804), http://www.most.gov.cn; YTW: National Key Research and Development Program of China (2016YFC1000203), http://www.most.gov.cn. CL: COVID-19 Prevention and Control Program of International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University (2020-COVID-19-04), https://www.ipmch.com.cn. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability: All the research data are available at the ResMen Manager of Chinese Clinical Trial Registry (www.medresman.org), and the registration number is ChiCTR2000031954 (http://www.medresman.org.cn/pub/cn/proj/projectshshow.aspx?proj=1810).

Keywords

Adult
Betacoronavirus/isolation & purification
China/epidemiology
Coronavirus Infections/diagnosis
Female
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical
Male
Pandemics
Pneumonia, Viral/diagnosis
Pregnancy
Pregnancy Complications, Infectious/diagnosis
Retrospective Studies
MOTHERS
BORN
FETAL

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Copyright: © 2020 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/
Final published version, 1.31 MBLicence: CC BY

Cite this

Wu, Y. T., Liu, J., Xu, J. J., Chen, Y. F., Yang, W., Chen, Y., Li, C., Wang, Y., Liu, H., Zhang, C., Jiang, L., Qian, Z. X., Kawai, A., Mol, B. W., Dennis, C. L., Xiong, G. P., Cheng, B. H., Yang, J., & Huang, H. F. (2020). Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China. PLoS Medicine, 17(7), Article e1003195. https://doi.org/10.1371/journal.pmed.1003195

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title = "Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China",

abstract = "BACKGROUND: As of June 1, 2020, coronavirus disease 2019 (COVID-19) has caused more than 6,000,000 infected persons and 360,000 deaths globally. Previous studies revealed pregnant women with COVID-19 had similar clinical manifestations to nonpregnant women. However, little is known about the outcome of neonates born to infected women. METHODS AND FINDINGS: In this retrospective study, we studied 29 pregnant women with COVID-19 infection delivered in 2 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and 30 neonates (1 set of twins). Maternal demographic characteristics, delivery course, symptoms, and laboratory tests from hospital records were extracted. Neonates were hospitalized if they had symptoms (5 cases) or their guardians agreed to a hospitalized quarantine (13 cases), whereas symptom-free neonates also could be discharged after birth and followed up through telephone (12 cases). For hospitalized neonates, laboratory test results and chest X-ray or computed tomography (CT) were extracted from hospital records. The presence of antibody of SARS-CoV-2 was assessed in the serum of 4 neonates. Among 29 pregnant COVID-19-infected women (13 confirmed and 16 clinical diagnosed), the majority had higher education (56.6%), half were employed (51.7%), and their mean age was 29 years. Fourteen women experienced mild symptoms including fever (8), cough (9), shortness of breath (3), diarrhea (2), vomiting (1), and 15 were symptom-free. Eleven of 29 women had pregnancy complications, and 27 elected to have a cesarean section delivery. Of 30 neonates, 18 were admitted to Wuhan Children's Hospital for quarantine and care, whereas the other 12 neonates discharged after birth without any symptoms and had normal follow-up. Five hospitalized neonates were diagnosed as COVID-19 infection (2 confirmed and 3 suspected). In addition, 12 of 13 other hospitalized neonates presented with radiological features for pneumonia through X-ray or CT screening, 1 with occasional cough and the others without associated symptoms. SARS-CoV-2 specific serum immunoglobulin M (IgM) and immunoglobulin G (IgG) were measured in 4 neonates and 2 were positive. The limited sample size limited statistical comparison between groups. CONCLUSIONS: In this study, we observed COVID-19 or radiological features of pneumonia in some, but not all, neonates born to women with COVID-19 infection. These findings suggest that intrauterine or intrapartum transmission is possible and warrants clinical caution and further investigation. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000031954 (Maternal and Perinatal Outcomes of Women with coronavirus disease 2019 (COVID-19): a multicenter retrospective cohort study).",

keywords = "Adult, Betacoronavirus/isolation & purification, China/epidemiology, Coronavirus Infections/diagnosis, Female, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Male, Pandemics, Pneumonia, Viral/diagnosis, Pregnancy, Pregnancy Complications, Infectious/diagnosis, Retrospective Studies, MOTHERS, BORN, FETAL",

author = "Wu, {Yan Ting} and Jun Liu and Xu, {Jing Jing} and Chen, {Yan Fen} and Wen Yang and Yang Chen and Cheng Li and Yu Wang and Han Liu and Chen Zhang and Ling Jiang and Qian, {Zhao Xia} and Andrew Kawai and Mol, {Ben Willem} and Dennis, {Cindy Lee} and Xiong, {Guo Ping} and Cheng, {Bi Heng} and Jing Yang and Huang, {He Feng}",

note = "Funding: YTW: National Key Research and Development Program of China (2018YFC1002804), http://www.most.gov.cn; YTW: National Key Research and Development Program of China (2016YFC1000203), http://www.most.gov.cn. CL: COVID-19 Prevention and Control Program of International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University (2020-COVID-19-04), https://www.ipmch.com.cn. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Data Availability: All the research data are available at the ResMen Manager of Chinese Clinical Trial Registry (www.medresman.org), and the registration number is ChiCTR2000031954 (http://www.medresman.org.cn/pub/cn/proj/projectshshow.aspx?proj=1810). ",

year = "2020",

month = jul,

day = "28",

doi = "10.1371/journal.pmed.1003195",

language = "English",

volume = "17",

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TY - JOUR

T1 - Neonatal outcome in 29 pregnant women with COVID-19

T2 - A retrospective study in Wuhan, China

AU - Wu, Yan Ting

AU - Liu, Jun

AU - Xu, Jing Jing

AU - Chen, Yan Fen

AU - Yang, Wen

AU - Chen, Yang

AU - Li, Cheng

AU - Wang, Yu

AU - Liu, Han

AU - Zhang, Chen

AU - Jiang, Ling

AU - Qian, Zhao Xia

AU - Kawai, Andrew

AU - Mol, Ben Willem

AU - Dennis, Cindy Lee

AU - Xiong, Guo Ping

AU - Cheng, Bi Heng

AU - Yang, Jing

AU - Huang, He Feng

N1 - Funding: YTW: National Key Research and Development Program of China (2018YFC1002804), http://www.most.gov.cn; YTW: National Key Research and Development Program of China (2016YFC1000203), http://www.most.gov.cn. CL: COVID-19 Prevention and Control Program of International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University (2020-COVID-19-04), https://www.ipmch.com.cn. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Data Availability: All the research data are available at the ResMen Manager of Chinese Clinical Trial Registry (www.medresman.org), and the registration number is ChiCTR2000031954 (http://www.medresman.org.cn/pub/cn/proj/projectshshow.aspx?proj=1810).

PY - 2020/7/28

Y1 - 2020/7/28

N2 - BACKGROUND: As of June 1, 2020, coronavirus disease 2019 (COVID-19) has caused more than 6,000,000 infected persons and 360,000 deaths globally. Previous studies revealed pregnant women with COVID-19 had similar clinical manifestations to nonpregnant women. However, little is known about the outcome of neonates born to infected women. METHODS AND FINDINGS: In this retrospective study, we studied 29 pregnant women with COVID-19 infection delivered in 2 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and 30 neonates (1 set of twins). Maternal demographic characteristics, delivery course, symptoms, and laboratory tests from hospital records were extracted. Neonates were hospitalized if they had symptoms (5 cases) or their guardians agreed to a hospitalized quarantine (13 cases), whereas symptom-free neonates also could be discharged after birth and followed up through telephone (12 cases). For hospitalized neonates, laboratory test results and chest X-ray or computed tomography (CT) were extracted from hospital records. The presence of antibody of SARS-CoV-2 was assessed in the serum of 4 neonates. Among 29 pregnant COVID-19-infected women (13 confirmed and 16 clinical diagnosed), the majority had higher education (56.6%), half were employed (51.7%), and their mean age was 29 years. Fourteen women experienced mild symptoms including fever (8), cough (9), shortness of breath (3), diarrhea (2), vomiting (1), and 15 were symptom-free. Eleven of 29 women had pregnancy complications, and 27 elected to have a cesarean section delivery. Of 30 neonates, 18 were admitted to Wuhan Children's Hospital for quarantine and care, whereas the other 12 neonates discharged after birth without any symptoms and had normal follow-up. Five hospitalized neonates were diagnosed as COVID-19 infection (2 confirmed and 3 suspected). In addition, 12 of 13 other hospitalized neonates presented with radiological features for pneumonia through X-ray or CT screening, 1 with occasional cough and the others without associated symptoms. SARS-CoV-2 specific serum immunoglobulin M (IgM) and immunoglobulin G (IgG) were measured in 4 neonates and 2 were positive. The limited sample size limited statistical comparison between groups. CONCLUSIONS: In this study, we observed COVID-19 or radiological features of pneumonia in some, but not all, neonates born to women with COVID-19 infection. These findings suggest that intrauterine or intrapartum transmission is possible and warrants clinical caution and further investigation. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000031954 (Maternal and Perinatal Outcomes of Women with coronavirus disease 2019 (COVID-19): a multicenter retrospective cohort study).

AB - BACKGROUND: As of June 1, 2020, coronavirus disease 2019 (COVID-19) has caused more than 6,000,000 infected persons and 360,000 deaths globally. Previous studies revealed pregnant women with COVID-19 had similar clinical manifestations to nonpregnant women. However, little is known about the outcome of neonates born to infected women. METHODS AND FINDINGS: In this retrospective study, we studied 29 pregnant women with COVID-19 infection delivered in 2 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and 30 neonates (1 set of twins). Maternal demographic characteristics, delivery course, symptoms, and laboratory tests from hospital records were extracted. Neonates were hospitalized if they had symptoms (5 cases) or their guardians agreed to a hospitalized quarantine (13 cases), whereas symptom-free neonates also could be discharged after birth and followed up through telephone (12 cases). For hospitalized neonates, laboratory test results and chest X-ray or computed tomography (CT) were extracted from hospital records. The presence of antibody of SARS-CoV-2 was assessed in the serum of 4 neonates. Among 29 pregnant COVID-19-infected women (13 confirmed and 16 clinical diagnosed), the majority had higher education (56.6%), half were employed (51.7%), and their mean age was 29 years. Fourteen women experienced mild symptoms including fever (8), cough (9), shortness of breath (3), diarrhea (2), vomiting (1), and 15 were symptom-free. Eleven of 29 women had pregnancy complications, and 27 elected to have a cesarean section delivery. Of 30 neonates, 18 were admitted to Wuhan Children's Hospital for quarantine and care, whereas the other 12 neonates discharged after birth without any symptoms and had normal follow-up. Five hospitalized neonates were diagnosed as COVID-19 infection (2 confirmed and 3 suspected). In addition, 12 of 13 other hospitalized neonates presented with radiological features for pneumonia through X-ray or CT screening, 1 with occasional cough and the others without associated symptoms. SARS-CoV-2 specific serum immunoglobulin M (IgM) and immunoglobulin G (IgG) were measured in 4 neonates and 2 were positive. The limited sample size limited statistical comparison between groups. CONCLUSIONS: In this study, we observed COVID-19 or radiological features of pneumonia in some, but not all, neonates born to women with COVID-19 infection. These findings suggest that intrauterine or intrapartum transmission is possible and warrants clinical caution and further investigation. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000031954 (Maternal and Perinatal Outcomes of Women with coronavirus disease 2019 (COVID-19): a multicenter retrospective cohort study).

KW - Adult

KW - Betacoronavirus/isolation & purification

KW - China/epidemiology

KW - Coronavirus Infections/diagnosis

KW - Female

KW - Humans

KW - Infant, Newborn

KW - Infectious Disease Transmission, Vertical

KW - Male

KW - Pandemics

KW - Pneumonia, Viral/diagnosis

KW - Pregnancy

KW - Pregnancy Complications, Infectious/diagnosis

KW - Retrospective Studies

KW - MOTHERS

KW - BORN

KW - FETAL

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U2 - 10.1371/journal.pmed.1003195

DO - 10.1371/journal.pmed.1003195

M3 - Article

C2 - 32722722

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SN - 1549-1277

VL - 17

JO - PLoS Medicine

JF - PLoS Medicine

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M1 - e1003195

ER -

Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China

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UN SDGs

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