In This Article
- Preliminary reports indicate that pregnant women with COVID-19 do not experience substantially worse outcomes than the general public
- For the most part, severe COVID-19 in pregnant women can be managed as in other adults
- It's unknown whether SARS-CoV-2 can be vertically transmitted
- Only rare reports indicate poor outcomes of neonates born to women with COVID-19
Published data on COVID-19 in pregnancy are limited, but maternal mortality appears to be similar to that in the general public, according to a fast literature update posted on April 20, 2020. However, some studies suggest the possibility of increased risk of neonatal complications.
The update was written by Lisa Bebell, MD, physician in the Infectious Disease Division, Laura N. Brenner, MD, pulmonologist in the Division of Pulmonary and Critical Care Medicine and Tiara Calhoun, MD, Internal Medicine and Global Medicine resident, of Massachusetts General Hospital, with advisory review by Jeannie Kelly, MD, MS, and Jake Hirshberg, MD, from the Department of Obstetrics and Gynecology at the Washington University School of Medicine.
Managing Severe COVID-19 in Pregnant Women
Severe COVID-19 in pregnant women should generally be managed as in other adults, with consultation from experts in maternal-fetal medicine and neonatology if possible. Additional pointers:
- Vasodilator therapy with nitric oxide and neuromuscular blockade with cisatracurium or vecuronium are considered safe in pregnancy
- Prone positioning is safe if performed with OB/GYN guidance
- Some evidence suggests corticosteroids may worsen COVID-19; however, on a case-by-case basis, the benefit to the fetus may support the use of betamethasone or dexamethasone for fetal lung maturity up to 34 weeks' gestation
Consultation with experts in maternal–fetal medicine and neonatology should be a priority when possible.
In four published cases, neonates born to mothers with COVID-19 had symptoms consistent with SARS-CoV-2 or a positive PCR test on the first or second day of life. Hospital transmission remains a possibility in those cases, but SARS-CoV-2 antibodies at birth were reported in two other infants.
The case reports should be balanced against seven large case series that found no symptoms or positive PCR tests among neonates of women with COVID-19.
Some but not all case series suggest poorer outcomes (preterm birth, ICU admission, mortality) in infants born to women with COVID-19. They are limited by small numbers and incomplete data. It's possible that poor neonatal outcomes are related to maternal illness rather than the direct effects of SARS-CoV-2 on the fetus.
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