Mother transmitted COVID-19 to baby during pregnancy, physicians report
Although both mother and baby recovered, the case highlights the
importance of limiting COVID-19 exposure for pregnant women

Date:
August 24, 2020
Source:
UT Southwestern Medical Center
Summary:
A pregnant mother who tested positive for COVID-19 transmitted
the virus causing the disease to her prematurely born baby, UT
Southwestern physicians report. Both were treated and recovered.



FULL STORY ==========================================================================
A pregnant mother who tested positive for COVID-19 transmitted the
virus causing the disease to her prematurely born baby, UT Southwestern physicians report. Both were treated and recovered.


==========================================================================
The case, detailed in an article published last month in The Pediatric Infectious Disease Journal, adds to a growing body of evidence that the
SARS- CoV-2 virus can be transmitted in utero. It also underscores the importance of limiting COVID-19 exposure for pregnant women.

"Especially with the rising prevalence of the virus here in Texas, it's
very important to bring to the forefront this finding that mothers and
infants can be affected by COVID-19, transmission can occur during
pregnancy, and pregnant mothers need to protect themselves," says
Amanda Evans, M.D., an assistant professor of pediatrics specializing in infectious diseases at UT Southwestern and senior author of the paper. "We don't know whether there are any long-term effects of COVID-19 infection
in babies." Although more than 20 million people around the world
have been infected with SARS-CoV-2 -- the virus that causes COVID-19 --
data on how the virus affects pregnant women have been limited. An early
study out of Wuhan, China, concluded that SARS-CoV-2 transmission from
mother to baby was unlikely, since the researchers found no copies of the
virus in any amniotic fluid, umbilical cord blood, or breast milk. But
a handful of more recent studies have suggested there may be isolated
instances in which such viral transmission does occur during pregnancy.

In the case described in the paper, a woman who was 34 weeks pregnant
visited the emergency room with signs of premature labor and was admitted
to the COVID unit at Parkland Memorial Hospital when she tested positive
for the SARS-CoV- 2 virus. While she did not have the typical respiratory symptoms associated with COVID-19, she did have a fever and diarrhea,
which suggested possible viral infection.

"At that time, we were doing universal testing of anyone with the
most common symptoms of COVID-19, including respiratory symptoms and gastrointestinal symptoms" says Wilmer Moreno, M.D., an assistant
professor of obstetrics and gynecology at UTSW who was involved in
the case.



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The woman, who did not know how she acquired the virus, remained
hospitalized because of her COVID-19 diagnosis. Three days after
admission, her water broke.

Following an eight-hour labor in early May, she gave birth to a healthy 7- pound, 3-ounce girl.

"The baby really did fine the first 24 hours of life," says Julide
Sisman, M.D., an associate professor of pediatrics who cared for the
newborn and first author of the paper. "But because she was prematurely
born to a COVID-19- positive mother, we did admit her to the NICU in
a special area away from other babies." About 24 hours after birth,
the newborn developed a fever that spiked, and she also showed signs
of respiratory distress, including an abnormally high breathing rate
and lower levels of oxygen in her blood. Sisman and her colleagues ran
tests for viruses and bacteria. While other tests came back negative,
a COVID-19 test was positive at both 24 and 48 hours after birth.

"At that time, the knowledge we had was that transmission doesn't occur
in utero, so we really weren't expecting that at all," says Sisman.

To help pin down how and when the transmission between mother and baby occurred, Dinesh Rakheja, M.D., a UTSW professor of pathology who holds
the John Lawrence and Patsy Louise Goforth Chair in Pathology, analyzed
the placenta from the pregnancy.



==========================================================================
"We found signs of inflammation and evidence that the baby had been
stressed," says Rakheja. "And then, to look for the virus, we did tests
beyond those routinely done." He and his colleagues first examined thin
slices of the placenta under an electron microscope, spotting structures
that looked like viruses. Then they tested small samples of the placenta
for the SARS-CoV-2 virus. Currently available commercial tests for the
COVID-19 virus all rely on bodily fluids, rather than solid tissues,
to test for the virus. So Rakheja co-opted a test that had originally
been developed for the 2003 SARS virus. Adapted for the new coronavirus,
the immunohistochemical test enabled the pathologist to identify the nucleocapsid protein of the SARS-CoV-2 virus.

Neither the mother nor the baby had severe enough symptoms to warrant
treatment other than oxygen and fluids, and both fully recovered. The
baby stayed in the hospital for three weeks and was then released.

"About a week later, I followed up with the family and the baby was doing really great, and still gaining weight," says Evans. "The mom was also
doing well." More data -- including not only individual case reports
but large cohort studies -- are needed to better understand how COVID-19 affects both pregnant women and babies, the physicians agree. At UTSW,
the case increased awareness that it's possible for newborns to be born
already harboring the virus.

"The fact that this can occur, even if rare, illustrates how important it
is to limit exposure for mothers and newborns," says Moreno. "Anything,
like telemedicine visits, that can eliminate the need for mom to be
around other people will be very helpful." Other UTSW clinicians who contributed to this case report were Mambarambath Jaleel, Veena Rajaram, Rebecca Collins, and Rashmin Savani.


========================================================================== Story Source: Materials provided by UT_Southwestern_Medical_Center. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Julide Sisman, Mambarambath A. Jaleel, Wilmer Moreno, Veena Rajaram,
Rebecca R.J. Collins, Rashmin C. Savani, Dinesh Rakheja, Amanda
S. Evans.

Intrauterine Transmission of SARS-COV-2 Infection in a Preterm
Infant.

Pediatric Infectious Disease Journal, 2020; Publish Ahead of Print
DOI: 10.1097/INF.0000000000002815 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200824092001.htm

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