How does coronavirus disease 2019 (COVID-19) affect pregnant women and neonates?

Updated: Jun 25, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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The US COVID-19 PRIORITY study (Pregnancy coRonavIrus Outcomes RegIsTrY) pregnancy registry is open. Additionally, the study has a dashboard for real time data. 

The CDC COVID-NET data published in September 2020 reported that among 598 hospitalized pregnant women with COVID-19, 55% were asymptomatic at admission. Severe illness occurred among symptomatic pregnant women, including intensive care unit admissions (16%), mechanical ventilation (8%), and death (1%). Pregnancy losses occurred for 2% of pregnancies completed during COVID-19-associated hospitalizations, and were experienced by both symptomatic and asymptomatic women. [66]

A multicenter study involving 16 Spanish hospitals reported outcomes of 242 pregnant women diagnosed with COVID-19 during their third trimester from March 13 to May 31, 2020. The women and their 248 newborns were monitored until the infant was 1 month old. COVID-19 positive who were hospitalized had a higher risk of ending their pregnancy via C-section (P = 0.027). Newborns whose mothers had been admitted owing to their COVID-19 infection had a higher risk of premature delivery (P = 0.006). No infants died and no vertical or horizontal transmission was detected. Infants exclusively breastfed at discharge was 41.7% and was 40.4% at 1 month. [67]

A cohort study of pregnant women (n = 64) with severe or critical COVID-19 disease hospitalized at 12 US institutions between March 5, 2020, and April 20, 2020 has been published. At the time of the study, most women (81%) received hydroxychloroquine; 7% of women with severe disease and 65% with critical disease received remdesivir. All women with critical disease received either prophylactic or therapeutic anticoagulation.  One 1 case of maternal cardiac arrest occurred, but there were no cases of cardiomyopathy or maternal death. Half of the women (n=32) delivered during their hospitalization (34% severe group; 85% critical group). Additionally, 88% with critical disease delivered preterm during their disease course, with 16 of 17 (94%) pregnant women giving birth through cesarean delivery. Overall, 15 of 20 (75%) women with critical disease delivered preterm. There were no stillbirths or neonatal deaths or cases of vertical transmission. [68]  

Adhikari and colleagues published a cohort study evaluating 252 pregnant women with COVID-19 in Texas. Maternal illness at initial presentation was asymptomatic or mild in 95%of  women, and 3% developed severe or critical illness. Compared with COVID negative pregnancies, there was no difference in the composite primary outcome of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate. Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. There were no placental pathologic differences by illness severity. [69]


A study by Chambers and colleagues found human milk is unlikely to transmit SARS-CoV-2 from infected mothers to infants. The study included 64 milk samples provided by 18 mothers infected with COVID-19. Samples were collected before and after COVID-19 diagnosis. No replication-competent virus was detectable in any of their milk samples compared with samples of human milk that were experimentally infected with SARS-CoV-2. [70]

Mothers who have been infected with SARS CoV-2 may have neutralizing antibodies expressed in breast milk. In an evaluation of 37 milk samples from 18 women, 76% contained SARS-CoV-2-specific IgA, and 80% had SARS-CoV-2-specific IgG. 62% of the milk samples were able to neutralize SARS-CoV-2 infectivity in vitro. These results support recommendations to continue breastfeeding with masking during mild-to-moderate maternal COVID-19 illness. [71]


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