The novel coronavirus (2019-nCoV) in pregnancy: What we need to know

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Correspondence

Thenovelcoronavirus(2019-nCoV)in pregnancy:Whatweneedtoknow

Coronaviruses (CoVs) are the largest group of viruses belongingto the Nidovirales order.They are enveloped, non-segmentedpositive-senseRNAviruses[1].TheNovel Coronavi-rus(2019-nCoV),alsoknownasWuhancoronavirus,causesthe 2019-nCoVacute respiratory disease,or COVID-19. The initial casesof2019-nCoVoccurredinWuahn,ChinainDecember2019 [2].Basedonarecentepidemiologicstudythereisevidencethat human-to-human transmission has occurred among close contacts since the middle of December 2019 [3]. As of 3 February2020,17,238laboratory-con_ﬁrmedcasesof2019-nCoV havebeenreportedincluding361deaths [4].Thediseasehas alreadyspreadto19countries outsideChina,with newcases continuingtoemergedaily.Recently,Chenetal.reportednine casesofpregnantwomenwith2019-nCoV[5].While coronavi-rusinfectionisacommonandusuallyself-limitinginfection,in aspeciﬁcpopulationlikepregnantwomen,complicationsofthe diseaseappeartobemorerelevant,andpregnantwomenare particularlysusceptibletomorbidityandmortality,especiallyin caseofhighpathogenicityCoVssuchassevereacuterespiratory syndrome (SARS COV) or Middle East respiratory syndrome (MERS COV)[6].

PriorcasesofCoVsinpregnancyhavebeenreported.Wongetal. [7] reportedpregnancyand perinataloutcomesof womenwith severeacuterespiratorysyndrome,including12casesofSARS-CoV duringthe2002–2003pandemic.Ofthem,morethan50%ofthe women reported early abortion with ﬁrst-trimester infection, whileinthosewhocontractedthevirusinthesecond-trimester,40 %ofintrauterinegrowthrestriction,and80%ofpretermdelivery

were reported. Moreover,three women (25 %) diedduring the pregnancy.Alfarajetal.[8]reportedinaliteraturereview11cases ofpatientswithMiddleEastrespiratorysyndrome(MERS COV) duringpregnancy.Ofthem91%hadadverseoutcomes,withthree perinataldeaths.

Fourpaperson2019-nCoVinpregnancyhavebeenpublishedso far.591,011ChenS.etal.inapaperpublishedinChinesedescribed clinicalcharacteristicsand placental pathology ofthree women withcon_ﬁrmed2019-nCoVwhodeliveredbycesareandelivery[9]. Allwomenpresentedwithfever,onebeforedeliveryandtwoin postpartum. Authors foundvariousdegrees ofﬁbrin deposition insideandaroundthevilliwithlocalsyncytialnoduleincreasesin allthreeplacentas.Onecaseofplacentashowedtheconcomitant morphology of chorionic hemangioma and another one with massiveplacentalinfarction.Nopathologicalchangeofvillitisand chorioamnionitiswasobservedinourobservationofthreecases. Allsamplesfromthreeplacentaswerenegativeforthenucleicacid of2019-nCoV[9].ChenH.etal.reporteddatafromninepregnant womenwith2019-nCoV[5].Noclinicalorserologicevidenceof vertical trasmission was noticed, and noneonatal deaths were reported[5].ChenYetal.[10]reporteddatafromfourfull-term singleton infants who were born to pregnant women tested positivefor2019-nCoVinthecityofWuhan.Ofthethreeinfants, for whoconsenttobediagnostically testedwasprovided,none testedpositiveforthevirus.Noneoftheinfantsdevelopedserious clinical, and all four infantswere alive at thetime of hospital discharge[10].

The overall maternal and perinatal outcomes of pregnant womenwithSARS COVandMERS COVarereportedinTable1. Notably, infection of 2019-nCoV during pregnancy seems less seriouscomparedtoinfectionofSARS COVandMERS COVwith nocasesofmaternaldeath,orperinataldeath.

Table1

PublishedcasesofMERS COV,SARS COV,and2019-nCoVinpregnantwomen.

Wong20047 _Alfaraj₂₀₁₉8 _Chen_H.₂₀₂₀5 _Chen_S.₂₀₂₀9 _Chen_Y.₂₀₂₀10 _Total

Infection SARS-COV MERS-COV 2019-nCoV 2019-nCoV 2019-nCoV –

Numberofinfectedwomen 12 11 9 3 4 39

Womenwithﬁrsttrimesterinfection 7 1 0 0 0 8

Abortioninwomenwithﬁrsttrimesterinfection 4/7(57.1%) 0/1 – – – 4/8(50.0%)

Womenwithsecondorthirdtrimesterinfection 5 10 9 3 4 31

IUGRinwomenwithsecondorthirdtrimesterinfection 2/5(40.0%) Notreported 0/9 Notreported Notreported 2/14(14.3%) PTBinwomenwithsecondorthirdtrimesterinfection 4/5(80.0%) 3/10(30.0%) 4/9(44.4%) 1/3(33.3%) 0/4 12/31(38.7%) Cesareandelivery 4/5(80.0%) 4/10(40.0%) 9/9(100%) 3/3(100%) 3/4(75.0%) 23/31(74.2%)

Stillbirth 0/5 2/10(20.0%) 0/9 0/3 0/4 2/31(6.5%)

Neonataldeath 0/12 1/10(10.0%) 0/9 0/3 0/4 1/38(2.6%)

Clinicalorserologicevidenceofverticaltrasmission 0/12 0/11 0/9 0/3 0/3* 0/39

AdmissiontoICU Notreported 7/11(63.3%) Notreported Notreported Notreported 7/11(63.3%)

Maternaldeath 3/12(25%) 3/11(27.3%) 0/9 0/3 0/4 6/39(15.4%)

MERS COV,MiddleEastrespiratorysyndrome;SARS COV,severeacuterespiratorysyndrome;IUGR,intrauterinegrowthrestriction;PTB,pretermbirth;ICU,intensivecare unit.

*

Oneneonatenottested.

https://doi.org/10.1016/j.ejogrb.2020.04.006

EuropeanJournalofObstetrics&GynecologyandReproductiveBiologyxxx(2019)xxx–xxx

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Pleasecitethisarticleinpressas:G.Saccone,etal.,Thenovelcoronavirus(2019-nCoV)inpregnancy:Whatweneedtoknow,EurJObstet Gynecol(2020),https://doi.org/10.1016/j.ejogrb.2020.04.006

ContentslistsavailableatScienceDirect

European

Journal

of

Obstetrics

&

Gynecology

and

Reproductive

Biology

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Inconclusion,strictmonitoringofwomenwithsuspected 2019-nCoV is ﬁrmly reccomended. Obstetricians should promptly recognize the symptoms of 2019-nCoV, and adequately assess severityandfetalwell-being.

DeclarationofCompetingInterest

Theauthorsreportnoconﬂictofinterest. References

[1]Fehr AR,Perlman S.Coronaviruses: anoverview oftheirreplication and pathogenesis.MethodsMolBiol2015;1282:1–23.

[2]PerlmanS.Anotherdecade,anothercoronavirus.NEnglJMed2020(January 24),doi:http://dx.doi.org/10.1056/NEJMe2001126.

[3]LiQ,GuanX,WuP,WangX,ZhouL,TongY,etal.Earlytransmissiondynamics inWuhan,China,ofnovelcoronavirus-infectedpneumonia.NEnglJMed2020 (January29),doi:http://dx.doi.org/10.1056/NEJMoa2001316.

[4]WHO. Novel coronavirus (2019-nCoV). Situation report—14. February3 (Accessed on February3, 2020. 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200203-sitrep-14-ncov.pdf? sfvrsn=f7347413_2.

[5]ChenH,GuoJ,WangC,LuoF,YuX,ZhangW,etal.Clinicalcharacteristicsand intrauterinevertical transmissionpotential ofCOVID-19infectioninnine pregnantwomen:aretrospectivereviewofmedicalrecords.Lancet2020;395 (March7(10226)):809–15.

[6]MeijerWJ,vanNoortwijk AG,BruinseHW,WensingAM. Inﬂuenzavirus infectioninpregnancy:areview.ActaObstetGynecolScand2015;94(August (8)):797–819.

[7]WongSF,KmChow,LeungTN,etal.Pregnancyandperinataloutcomesof women with severe acute respiratorysyndrome. Am J Obstet Gynecol 2004;191:292–7.

[8]Alfaraj SH,Al-Tawﬁq JA, Memish ZA. Middle Eastrespiratory syndrome coronavirus(MERS-CoV)infectionduringpregnancy:reportoftwocases& reviewoftheliterature.JMicrobiolImmunolInfect2019;52:501–3. [9]ChenS,HuangB,LuoDJ,LiX,YangF,ZhaoY,etal.[Pregnantwomenwithnew

coronavirus infection: a clinical characteristics and placental pathological analysis ofthreecases].ZhonghuaBingLiXueZaZhi2020;49(March1(0)),doi:http://dx. doi.org/10.3760/cma.j.cn112151-20200225-00138E005[Epubaheadofprint]. [10]ChenY,PengH,WangL,ZhaoY,ZengL,GaoH,etal.Infantsborntomothers withanewcoronavirus(COVID-19).FrontPediatr2020;16(March),doi:http:// dx.doi.org/10.3389/fped.2020.00104.

GabrieleSacconea,_*

FlorianaIlmaCarboneb FulvioZulloa a_Department_of_{Neuroscience,}_Reproductive_Sciences_and_Dentistry,

SchoolofMedicine,UniversityofNaplesFedericoII,Naples,Italy

b_Ospedale_Maggiore_Policlinico_Milano,_Milan,_Italy

* Correspondingauthor. E-mailaddress:gabriele.saccone.1990@gmail.com(G.Saccone). Received5March2020 Availableonlinexxx 2 Correspondence/EuropeanJournalofObstetrics&GynecologyandReproductiveBiologyxxx(2019)xxx–xxx

GModel

EURO11277No.ofPages2

Pleasecitethisarticleinpressas:G.Saccone,etal.,Thenovelcoronavirus(2019-nCoV)inpregnancy:Whatweneedtoknow,EurJObstet Gynecol(2020),https://doi.org/10.1016/j.ejogrb.2020.04.006