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Am J Perinatol 2024; 41(08): 1077-1085
DOI: 10.1055/a-1792-4535
Original Article

Vertical Transmission of SARS-CoV-2 during Pregnancy: A Prospective Italian Cohort Study

Simonetta Costa
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Lucia Giordano 
2   Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Anthea Bottoni
2   Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Eloisa Tiberi
2   Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Simona Fattore
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Roberta Pastorino
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Nicoletta Di Simone
3   Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
,
Antonio Lanzone
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Danilo Buonsenso
2   Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Piero Valentini
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Paola Cattani
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Rosaria Santangelo
4   Department of Laboratory and Infectivology Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
,
Maurizio Sanguinetti 
4   Department of Laboratory and Infectivology Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
,
Giovanni Scambia
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Giovanni Vento
1   Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Funding None.
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Abstract

Objective The extent of vertical transmission (VT) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from mothers their fetuses or neonates is still uncertain. We aimed to determine the incidence of VT.

Study Design In this prospective cohort study. All mother diagnosed with SARS-CoV-2 infection at the time of delivery or up to 1 week prior and their neonates, managed in a tertiary referral hospital for pregnancy complicated by coronavirus disease 2019 (COVID-19) in Rome, from April 2 to December 22, 2020, were included. Maternal infection was defined as nasopharyngeal swab test results positive for SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR). Biological samples were collected before, at, and after delivery to test positivity for SARS-CoV-2 RT-PCR and anti-SARS-CoV-2-specific antibodies.

Results The cohort included 95 women and 96 neonates with documented SARS-CoV-2 test results. Four neonates (4.2%) tested positive. The incidence of VT, according to the guidance criteria for diagnosing perinatal SARS-CoV-2 infection, was 5.2%. Neonatal symptoms were due to prematurity or fetal distress: symptomatic infants had lower median (min–max) gestational age, 38.1 (29.3–40.6) versus 39.3 (33.9–41.9) weeks (p = 0.036), and 1-minute and 5-minute Apgar scores, 9 (3–9) versus 9 (7–10) (p = 0.036) and 10 (6–10) versus 10 (8–10) (p = 0.012), respectively, than asymptomatic infants and needed more frequent assistance in the delivery room (22.2 vs 2.5%; p = 0.008). Only six (7.1%) neonates had anti-SARS-CoV-2-specific antibodies, despite the ongoing maternal infection.

Conclusion The incidence of VT is low as is the detection of specific anti-SARS-CoV-2 antibodies in cord blood when infection is contracted late in pregnancy. This would suggest poor protection of infants against horizontal transmission of the virus.

Key Points

  • VT of SARS-CoV-2 from pregnant mothers to fetuses or neonates can be possible.

  • In this prospective cohort study, the incidence of VT is found to be 5.2%.

  • VT is low but exists.

Keywords

pregnancy - SARS-CoV-2 infection - vertical transmission - perinatal transmission - neonates

Authors' Contributions

All the authors had a substantial contribution to the conception of the work, the acquisition and analysis of data for the work, and final approval of the version to be published. All the authors agreed to be accountable for all aspects of the work. S. C. and L. G. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. S. C., L. G., A. B., P. C., D. B., A. L., N. D. S., G. V. were involved with the concept and design. S. C., L. G., E. T., P. C., N. D. S. were involved with acquisition, analysis, or interpretation of data. The drafting of the manuscript is done by S. C., L. G., A. B., P. C. while S. C., L. G., P. C. are responsible for critical revision of the manuscript for important intellectual content and the statistical analysis is done by S. C., S. F.




Publication History

Received: 15 September 2021

Accepted: 04 March 2022

Accepted Manuscript online:
09 March 2022

Article published online:
17 May 2022

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