March 20, 2020 

COVID-19 Not Transmitted from Mother to Fetus According to Case Study in Wuhan, China

By Aaron Ryan, Partner and Jenny Wells, Paralegal

According to a report posted on Frontiers in Pediatrics, doctors followed four pregnant women from the epicenter of the COVID-19 pandemic – Wuhan, China – who tested positive for COVID-19. The women all gave birth while actively symptomatic. The conclusion after testing and observation was that the COVID-19 virus did not pass from the mother to the fetus, and the infants were born without any of the respiratory signs of COVID-19.

The report considered the cases of four women in Wuhan, China, who all contracted COVID-19 in their 3rd trimesters and showed symptoms.
  • "On admission, the regular symptoms of pregnant mothers with COVID-19 were fever (three out of four patients), cough (two out of four patients), myalgia or fatigue (two out of four patients), and headache (two out of four patients)."
  • "The most important question is whether the COVID-19 could be transmitted vertically to the fetus from the pregnant mother to cause a clinically significant infection. Recently, a finding from nine other cases suggested that there is no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy."
  • "Of the three infants, for who consent to be diagnostically tested was provided, none tested positive for the virus. None of the infants developed serious clinical symptoms such as fever, cough, diarrhea, or abnormal radiologic or hematologic evidence, and all four infants were alive at the time of hospital discharge."
The article concludes that COVID-19 does not appear to be transmitted vertically from mother to fetus, which is consistent with prior studies (e.g., studies of perinatal transmission of SARS).

COVID-19 and Breastfeeding
The CDC has developed Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for COVID-19. Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding. In the limited cases reported to date, no evidence of virus has been found in the breast milk of women infected with COVID-19; however, it is not yet known if COVID-19 can be transmitted through breast milk (ie, infectious virus in the breast milk).

Practice Advisories
March 13, 2020 – The American College of Obstetricians and Gynecologists (ACOG) issued a “Practice Advisory: Novel Coronavirus 2019 (COVID-19).” At that time, ACOG noted that it was unclear whether COVID-19 could cross through the transplacental route to the fetus, but recent studies suggested it does not. Regardless, the recommendation is for obstetricians to take a thorough history to explore potential exposure and to presume that pregnant women positive with COVID-19 will be at a higher risk of illness, mobility and mortality and manage those patients accordingly.

The Society for Maternal-Fetal Medicine (SMFM) has released guidance on the maternal, fetal and neonatal implications of the disease. The guidance complements the Practice Advisory recently released by the American College of Obstetricians and Gynecologists (ACOG) and the evolving guidance from the Centers for Disease Control and Prevention (CDC).

In addition, ACOG and the SMFM have developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19. View the algorithm.