Strong evidence of vertical transmission of the novel coronavirus from mother to child during pregnancy was reported at an offshoot of the virtual International AIDS Conference devoted to COVID-19.
Of 31 pregnant women infected with the SARS-CoV-2 coronavirus, two of their infants were born with the infection, reported Claudio Fenizia, MD, of the University of Milan in Italy.
“Our study shows that vertical transmission in utero from mother to child of COVID-19 is indeed possible,” Fenizia said at a virtual press conference at the online AIDS 2020 meeting.
The women were recruited for the study in March and April 2020 from three hospitals in Northern Italy – one of the regions hardest hit when the pandemic swept across Europe. “All the women we enrolled were towards the end of their pregnancies, in the late third trimesters,” Fenizia said.
The researchers collected numerous specimens from the women and their newborns, including the placenta, umbilical cord biopsies, maternal and umbilical cord blood, vaginal swabs, nasopharyngeal swabs of the newborns, the mother’s milk, and amniotic fluid. “We tested all of these specimens looking for the presence of the virus, and our results strongly suggest and support that vertical transmission in two cases,” Fenizia said.
In both cases of infection in infants, placenta specimens were positive for SARS-CoV-2, the virus that causes COVID-19. Fenizia noted that the initial tests did not find the virus, but further sampling of the placenta showed virus-positive results.
“The two babies were found to be positive through nasal swabs taken immediately upon delivery. One of the babies had IgM [immunoglobulin M] in the umbilical cord blood. Keep in mind that IgM is not usually transferred in the blood from the mother to the child, so the appearance of IgM is due to direct exposure of the fetus to the virus,” Fenizia said.
Caveats, he said, included that the number of women enrolled was too small to draw any firm conclusions. “This should be considered a preliminary study, and this is basically a picture of women in Italy at the beginning of the infection. There is a question mark as to what will happen if women get infected earlier on in their pregnancy,” Fenizia said. “Further studies should be performed on a wider sample of pregnant women.”
He and his colleagues also examined the inflammatory processes in the mothers and the children, covering different gestational ages, analyzing the placenta and umbilical cord blood looking for expression and release of inflammatory molecules.
“Indeed, we found quite strong enhanced inflammatory status in infected women compared with negative controls,” Fenizia said. “This is not really a surprise, but the placenta was extremely inflamed and the fetal blood showed higher expression of inflammatory molecules, and that could be more detrimental than even the infection itself during the pregnancy.”
Fenizia said both babies are doing well. One continued to test positive for a week after birth, and the other appeared to have just a transient infection that was not seen in subsequent tests.
He added that since the babies were infected within 2 weeks of delivery, he would not expect that the coronavirus infection would have long-lasting impact on their development. “So far, we are not aware of any consequences of infection in these babies, but it is just two cases so it is too early to determine any long-term risk for putative infected babies,” he said.
This preliminary work “should be considered a ringing bell that should drive awareness about a topic that has not been really well studied,” Fenizia said.
He noted that in one case, the breast milk of one women in the study was positive for evidence of the virus, but “it is far too early to determine if that was an infectious virus. I don’t think we can draw any conclusions about this unique sample.”
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, who participated in the press briefing, commented: “Generally, children have much less of a chance of having an adverse outcome, except maybe for newborns.”
To answer the question of whether children can easily transmit the disease, he said, a 6,000-family study is underway in the U.S. “Are they really poor transmitters or not? That has obvious implications when one thinks in terms of opening schools,” Fauci said.
Disclosures
Fenizia and Fauci disclosed no relevant relationships with industry.
Primary Source
International AIDS COVID Conference
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