Maternal SARS-CoV-2 infection during pregnancy: possible impact on the infant

Abstract

The risk and potential consequences of mother-to-child transmission of severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2) during pregnancy are still a matter of debate. We studied the impact of SARS-CoV-2 infection on 56 complete households, including 27 newborns whose mothers were pregnant when exposed to the virus. Two PCR-confirmed perinatal SARS-CoV-2 transmissions with mild symptoms in affected neonates were recorded. In addition, we observed a severe eye malformation (unilateral microphthalmia, optic nerve hypoplasia, and congenital retinopathy) associated with maternal SARS-CoV-2 infection in weeks 5 and 6 of embryonic development. This embryopathy could not be explained by other infectious agents, genetic factors, drug use, or maternal disease during pregnancy. Eight other women with a history of SARS-CoV-2 infection prior to gestational week 12, however, delivered healthy infants.Conclusion: The repeated occurrence of mother-to-child transmission in our cohort with risks that remain incompletely understood, such as long-term effects and the possibility of an embryopathy, should sensitize researchers and stimulate further studies as well as support COVID-19 vaccination recommendations for pregnant women. Trial registration number: NCT04741412. Date of registration: November 18, 2020 What is Known: •Materno-fetal transmission of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) during pregnancy has rarely been reported so far, but was demonstrated in isolated cases. What is New: •In a study of complete households with documented SARS-CoV-2 infection, including a cohort of pregnant women, we observed perinatal coronavirus transmission at a higher frequency than expected. •We also describe a newborn boy with an eye malformation reminiscent of rubella embryopathy but associated with early gestation SARS-CoV-2 infection of his mother. •A coronavirus-related embryopathy, reported here for the first time, is a finding that requires further investigation.

Keywords: Case report; Coronavirus; Embryopathy; Malformation; Materno-fetal transmission.

Fig. 1

Malformation of the left eye associated with maternal SARS-CoV-2 infection during the first trimester of pregnancy. A Unilateral microphthalmia, microcornea, and persistent pupillary membrane in the newborn infant of a 40-year-old woman who had COVID-19 in gestational week 8. SARS-CoV-2 replication most likely occurred during Carnegie stages 15 and 16 of embryonic development. B Normal ocular fundus of the right eye, markedly different from that of the left eye (panel C) which is characterized by hypoplasia of the optic nerve, neurosensory retina, and retinal pigment epithelium, and by missing retinal vasculature. D Normal visually evoked potentials under binocular flash stimulation (P100 = 100.31 and 102.19 ms)