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Research papers
Medwave 2020;20(11):e8084 doi: 10.5867/medwave.2020.11.8084
Perinatal outcomes and serological results in neonates of pregnant women seropositive to SARS-CoV-2: A cross-sectional descriptive study
Carmen Dávila-Aliaga, Marcos Espínola-Sánchez, Elina Mendoza-Ibáñez, Enrique Guevara-Ríos, Elsa Torres-Marcos, Rosmary Hinojosa-Pérez, Ylia Espinoza-Vivas, Ricardo Álvarez-Carrasco, Carlos Velásquez-Vásquez, Luis Meza-Santibáñez, Oswaldo Gonzales-Carrillo, Pedro Arango-Ochante, Augusto Racchumí-Vela, Claudia Saldaña-Díaz
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Key Words: SARS-CoV-2, serology, pregnancy, pregnancy outcome, infant, newborn

Abstract

Introduction
SARS-CoV-2 has spread rapidly throughout the world. However, its ability to cause severe disease is not homogeneous according to sex and the different age groups.

Objective
To determine perinatal characteristics, morbidity, mortality, and serological results in neonates from seropositive pregnant women to SARS-CoV-2.

Methods
We did a retrospective, descriptive, cross-sectional study. We included all newborns from positive pregnant women to SARS-CoV-2, between April 15 and May 10, 2020, who delivered in the National Perinatal Maternal Institute of Peru. The study extracted maternal and neonatal variables collected from the medical charts. The data were analyzed using descriptive statistics and Fischer's exact test.

Results
One hundred fourteen neonates were identified, 36.8% IgM/IgG positive for SARS-CoV-2, 7% IgG, and 56.2% had negative serology. The obstetric complications were premature rupture of membranes (14.9%) and preterm birth (8,8%). 8.8% of newborns had an Apgar score of less than or equal to six minutes, and of those, only one persisted after five minutes; three newborns died. There was an association between the type of maternal immunoglobulin and the serology of the newborn (p < 0.05). No association was observed between perinatal results and maternal immunoglobulin type (p > 0.05) or serological results in the newborn for SARS-CoV-2 (p > 0.05).

Conclusion
43.9% of seropositive mothers' neonates to SARS-CoV-2 had a positive serological result, more frequently type IgM/IgG. 10.5% of the neonates had some morbidity, more frequent prematurity, low birth weight, and 2.6% died. Perinatal results were not associated with the type of immunoglobulin of mothers seropositive to SARS-CoV-2; similarly, perinatal results were not associated with serological results in the newborn.


 

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Introducción
El SARS-CoV-2 tiene una rápida expansión por todo el mundo, sin embargo, su capacidad para causar enfermedad grave no es homogénea según sexo y edad.

Objetivo
Determinar las características perinatales, morbilidad, mortalidad y resultados serológicos en neonatos de gestantes seropositivas para SARS-CoV-2.

Métodos
Estudio transversal, descriptivo y retrospectivo. Participaron todos los neonatos cuyas madres presentaron resultado seropositivo para SARS-CoV-2 antes del parto, entre el 15 de abril y 10 de mayo de 2020 en el Instituto Nacional Materno Perinatal de Perú. Se recogió información materna y neonatal a partir de sus historias clínicas. En el análisis se usó estadística descriptiva y prueba exacta de Fisher.

Resultados
Se identificaron 114 neonatos, el 36,8% presentó inmunoglobulinas M y G positivas para SARS-CoV-2; el 7% inmunoglobulinas G y 56,2% fue no reactivo. Las complicaciones obstétricas más frecuentes fueron rotura prematura de membranas (14,9%) y parto pretérmino (8,8%). El 8,8% de los neonatos presentaron un puntaje Apgar al minuto menor o igual a seis, y de ellos solo uno persistió a los cinco minutos; tres neonatos fallecieron. Se evidenció asociación entre el tipo de inmunoglobulina materna y la serología de su recién nacido (p < 0,05). No se observó asociación entre resultados perinatales y el tipo de inmunoglobulinas materna (p > 0,05), ni con los resultados serológicos en el neonato para SARS-CoV-2 (p > 0,05).

Conclusión
El 43,9% de neonatos de madre seropositiva a SARS-CoV-2 tuvo un resultado serológico positivo, siendo más frecuente de tipo Inmunoglobulinas M e Inmunoglobulinas G. El 10,5% de los neonatos presentó alguna morbilidad, siendo más frecuente prematuridad y bajo peso al nacer y el 2,6% falleció. Los resultados perinatales no estuvieron asociadas al tipo de inmunoglobulina de las madres seropositivas a SARS-CoV-2. De igual modo, los resultados perinatales no estuvieron asociados a los resultados serológicos en el neonato.

Authors: Carmen Dávila-Aliaga[1,2], Marcos Espínola-Sánchez[1,3], Elina Mendoza-Ibáñez[1], Enrique Guevara-Ríos[1,4], Elsa Torres-Marcos[1], Rosmary Hinojosa-Pérez[1], Ylia Espinoza-Vivas[1], Ricardo Álvarez-Carrasco[1], Carlos Velásquez-Vásquez[1], Luis Meza-Santibáñez[1], Oswaldo Gonzales-Carrillo[1], Pedro Arango-Ochante[1], Augusto Racchumí-Vela[1], Claudia Saldaña-Díaz[1]

Affiliation:
[1] Instituto Nacional Materno Perinatal, Lima, Perú
[2] Universidad Nacional Federico Villarreal, Lima, Perú
[3] Universidad Privada del Norte, Lima, Perú
[4] Universidad Nacional Mayor de San Marcos, Lima, Perú

E-mail: marcosespinola.es@gmail.com

Author address:
[1] Santa Rosa, 941, Cercado de Lima
Lima, Perú
15003

Citation: Dávila-Aliaga C, Espínola-Sánchez M, Mendoza-Ibáñez E, Guevara-Ríos E, Torres-Marcos E, Hinojosa-Pérez R, et al. Perinatal outcomes and serological results in neonates of pregnant women seropositive to SARS-CoV-2: A cross-sectional descriptive study. Medwave 2020;20(11):e8084 doi: 10.5867/medwave.2020.11.8084

Submission date: 13/8/2020

Acceptance date: 30/11/2020

Publication date: 21/12/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by three reviewers, double-blind

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  1. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020 Feb 10;12(2):194. | CrossRef | PubMed |
  2. Duran P, Berman S, Niermeyer S, Jaenisch T, Forster T, Gomez Ponce de Leon R, et al. COVID-19 and newborn health: systematic review. Rev Panam Salud Publica. 2020 Apr 27;44:e54. | CrossRef | PubMed |
  3. Organización Mundial de la Salud. Coronavirus disease (COVID-2019) situation reports-130. 2020. Geneva: Organización Mundial de la Salud; 2020. [On line] | Link |
  4. Ministerio de Salud. Casos confirmados por Coronavirus COVID-19 ascienden a 183 198 en el Perú (Comunicado N° 121). 2020. Lima: MINSA; 2020 [On line]. | Link |
  5. Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020 May 12;323(18):1848-1849. | CrossRef | PubMed |
  6. Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020 May 12;323(18):1846-1848. | CrossRef | PubMed |
  7. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020 Mar 7;395(10226):809-815. | CrossRef | PubMed |
  8. Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review. Fetal Pediatr Pathol. 2020 Jun;39(3):246-250. | CrossRef | PubMed |
  9. Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. | CrossRef | PubMed |
  10. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020 Feb;9(1):51-60. | CrossRef | PubMed |
  11. Josep Argimon Pallás, Josep Jiménez Villa. Métodos de Investigación Clínica y Epidemiolçogica. 4ª edición. Barcelona: Elsevier; 2013.
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  13. Aguilar-Gamboa F. Desafíos para el manejo y detección de pacientes con COVID-19 en Latinoamérica. Rev Exp Med. 2020;6(1):63-7. | CrossRef |
  14. Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020 Jul;223(1):111.e1-111.e14. | CrossRef | PubMed |
  15. Mendoza M, Garcia-Ruiz I, Maiz N, Rodo C, Garcia-Manau P, Serrano B, et al. Pre-eclampsia- like syndrome induced by severe COVID-19: a prospective observational study. BJOG. 2020 Oct;127(11):1374-1380. | CrossRef | PubMed |
  16. Walker KF, O'Donoghue K, Grace N, Dorling J, Comeau JL, Li W, et al. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG. 2020 Oct;127(11):1324-1336. | CrossRef | PubMed |
  17. Organización Panamericana de la Salud. COVID-19: Recomendaciones para el cuidado integral de mujeres embarazadas y recién nacidos. 2020. Geneva: Organización Mundial de la Salud; 2020 [On line]. | Link |
  18. Blumberg DA, Underwood MA, Hedriana HL, Lakshminrusimha S. Vertical Transmission of SARS-CoV-2: What is the Optimal Definition? Am J Perinatol. 2020 Jun;37(8):769-772. | CrossRef | PubMed |
  19. Soler MJ, Lloveras J, Batlle D. Enzima conversiva de la angiotensina 2 y su papel emergente en la regulación del sistema renina-angiotensina [Angiotensin converting enzyme 2 and its emerging role in the regulation of the renin angiotensin system]. Med Clin (Barc). 2008 Jul 12;131(6):230-6. Spanish. | CrossRef | PubMed |
  20. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Mar;579(7798):270-273. | CrossRef | PubMed |
  21. Llaque P. Infección por el nuevo coronavirus 2019 en niños. Rev Peru Med Exp Salud Publica. 2020 Apr Jun;37(2):335-340. Spanish. | CrossRef | PubMed |
  22. Santos Sara. Transmisión vertical SARS-CoV-2. Rev. Esp. Salud Publica. 2020 [On line]. | Link |
  23. Vivanti AJ, Vauloup-Fellous C, Prevot S, Zupan V, Suffee C, Do Cao J, et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020 Jul 14;11(1):3572. | CrossRef | PubMed |
  24. Bravo-Grau S, Cruz J. Estudios de exactitud diagnóstica: Herramientas para su Interpretación. Rev Chil Radiol. 2015; 21(4):158-164. | CrossRef |
  25. Medina M. Generalidades de las pruebas diagnósticas, y su utilidad en la toma de decisiones médicas. Rev. Colomb. Psiquiat. 2011;40(4):787-797. | CrossRef |
  26. Simões E Silva AC, Leal CRV. Is SARS-CoV-2 Vertically Transmitted? Front Pediatr. 2020 May 15;8:276. | CrossRef | PubMed |
Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020 Feb 10;12(2):194. | CrossRef | PubMed |

Duran P, Berman S, Niermeyer S, Jaenisch T, Forster T, Gomez Ponce de Leon R, et al. COVID-19 and newborn health: systematic review. Rev Panam Salud Publica. 2020 Apr 27;44:e54. | CrossRef | PubMed |

Organización Mundial de la Salud. Coronavirus disease (COVID-2019) situation reports-130. 2020. Geneva: Organización Mundial de la Salud; 2020. [On line] | Link |

Ministerio de Salud. Casos confirmados por Coronavirus COVID-19 ascienden a 183 198 en el Perú (Comunicado N° 121). 2020. Lima: MINSA; 2020 [On line]. | Link |

Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020 May 12;323(18):1848-1849. | CrossRef | PubMed |

Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020 May 12;323(18):1846-1848. | CrossRef | PubMed |

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020 Mar 7;395(10226):809-815. | CrossRef | PubMed |

Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, Abbasi H, Mirjalili SR, Behforouz A, et al. Vertical Transmission of Coronavirus Disease 19 (COVID-19) from Infected Pregnant Mothers to Neonates: A Review. Fetal Pediatr Pathol. 2020 Jun;39(3):246-250. | CrossRef | PubMed |

Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. | CrossRef | PubMed |

Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020 Feb;9(1):51-60. | CrossRef | PubMed |

Josep Argimon Pallás, Josep Jiménez Villa. Métodos de Investigación Clínica y Epidemiolçogica. 4ª edición. Barcelona: Elsevier; 2013.

Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020 Feb 17;9(1):386-389. | CrossRef | PubMed |

Aguilar-Gamboa F. Desafíos para el manejo y detección de pacientes con COVID-19 en Latinoamérica. Rev Exp Med. 2020;6(1):63-7. | CrossRef |

Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020 Jul;223(1):111.e1-111.e14. | CrossRef | PubMed |

Mendoza M, Garcia-Ruiz I, Maiz N, Rodo C, Garcia-Manau P, Serrano B, et al. Pre-eclampsia- like syndrome induced by severe COVID-19: a prospective observational study. BJOG. 2020 Oct;127(11):1374-1380. | CrossRef | PubMed |

Walker KF, O'Donoghue K, Grace N, Dorling J, Comeau JL, Li W, et al. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG. 2020 Oct;127(11):1324-1336. | CrossRef | PubMed |

Organización Panamericana de la Salud. COVID-19: Recomendaciones para el cuidado integral de mujeres embarazadas y recién nacidos. 2020. Geneva: Organización Mundial de la Salud; 2020 [On line]. | Link |

Blumberg DA, Underwood MA, Hedriana HL, Lakshminrusimha S. Vertical Transmission of SARS-CoV-2: What is the Optimal Definition? Am J Perinatol. 2020 Jun;37(8):769-772. | CrossRef | PubMed |

Soler MJ, Lloveras J, Batlle D. Enzima conversiva de la angiotensina 2 y su papel emergente en la regulación del sistema renina-angiotensina [Angiotensin converting enzyme 2 and its emerging role in the regulation of the renin angiotensin system]. Med Clin (Barc). 2008 Jul 12;131(6):230-6. Spanish. | CrossRef | PubMed |

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Mar;579(7798):270-273. | CrossRef | PubMed |

Llaque P. Infección por el nuevo coronavirus 2019 en niños. Rev Peru Med Exp Salud Publica. 2020 Apr Jun;37(2):335-340. Spanish. | CrossRef | PubMed |

Santos Sara. Transmisión vertical SARS-CoV-2. Rev. Esp. Salud Publica. 2020 [On line]. | Link |

Vivanti AJ, Vauloup-Fellous C, Prevot S, Zupan V, Suffee C, Do Cao J, et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020 Jul 14;11(1):3572. | CrossRef | PubMed |

Bravo-Grau S, Cruz J. Estudios de exactitud diagnóstica: Herramientas para su Interpretación. Rev Chil Radiol. 2015; 21(4):158-164. | CrossRef |

Medina M. Generalidades de las pruebas diagnósticas, y su utilidad en la toma de decisiones médicas. Rev. Colomb. Psiquiat. 2011;40(4):787-797. | CrossRef |

Simões E Silva AC, Leal CRV. Is SARS-CoV-2 Vertically Transmitted? Front Pediatr. 2020 May 15;8:276. | CrossRef | PubMed |