Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China; Clinical Medicine Research Centre of Prenatal Diagnosis and Birth Health in Hubei Province, Wuhan, Hubei, China.
Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China.
Lancet. 2020 Mar 7;395(10226):809-815. doi: 10.1016/S0140-6736(20)30360-3. Epub 2020 Feb 12.
Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection.
Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation.
All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8-9 and a 5-min Apgar score of 9-10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus.
The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy.
Hubei Science and Technology Plan, Wuhan University Medical Development Plan.
先前关于 2019 年新型冠状病毒病（COVID-19）引起的肺炎暴发的研究基于一般人群的信息。关于 COVID-19 肺炎的孕妇，有限的数据可用。本研究旨在评估妊娠合并 COVID-19 肺炎的临床特征以及 COVID-19 感染的宫内垂直传播潜力。
回顾性分析 2020 年 1 月 20 日至 1 月 31 日期间，9 名在中国武汉武汉大学中南医院确诊为实验室确诊的 COVID-19 肺炎的孕妇（即母亲咽喉拭子样本对严重急性呼吸综合征冠状病毒 2 [SARS-CoV-2]呈阳性）的临床记录、实验室结果和胸部 CT 扫描。通过检测羊水、脐血和新生儿咽喉拭子样本中是否存在 SARS-CoV-2，评估宫内垂直传播的证据。还从患者首次哺乳后采集和测试了母乳样本。
所有 9 名患者均在孕晚期行剖宫产。7 例患者出现发热。还观察到其他症状，包括咳嗽（9 例中的 4 例）、肌痛（3 例）、咽痛（2 例）和不适（2 例）。2 例胎儿有窘迫迹象。9 例患者中有 5 例淋巴细胞减少症（<1.0×10⁹个细胞/L）。3 例患者转氨酶浓度升高。截至 2020 年 2 月 4 日，无患者发展为严重 COVID-19 肺炎或死亡。记录了 9 例活产。新生儿中未观察到窒息。新生儿 1 分钟 Apgar 评分为 8-9 分，5 分钟 Apgar 评分为 9-10 分。对 6 名患者的羊水、脐血、新生儿咽喉拭子和母乳样本进行了 SARS-CoV-2 检测，所有样本均检测为病毒阴性。
孕妇 COVID-19 肺炎的临床特征与非妊娠成人 COVID-19 肺炎患者的报告相似。从这一小组病例中得出的结果表明，目前没有证据表明在妊娠晚期发生 COVID-19 肺炎的女性中存在由垂直传播引起的宫内感染。
湖北省科技计划，武汉大学医学发展计划。
