Schwartz David A, Dhaliwal Amareen
Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA (Dr. Schwartz); Amareen Dhaliwal, BS, Boston University School of Medicine, Boston, MA, USA (Ms. Dhaliwal).
Arch Pathol Lab Med. 2020 Apr 27. doi: 10.5858/arpa.2020-0211-SA.
SARS-CoV-2, the agent of COVID-19, is similar to two other coronaviruses, SARS-CoV and MERS-CoV, in causing life-threatening maternal respiratory infections and systemic complications. Because of global concern for potential intrauterine transmission of SARS-CoV-2 from pregnant women to their infants, this report analyzes the effects on pregnancy of infections caused by SARS-CoV-2 and other respiratory RNA viruses, and examines the frequency of maternal-fetal transmission with SARS-CoV-2, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, respiratory syncytial virus (RSV), parainfluenza (HPIV) and metapneumovirus (hMPV). There have been no confirmed cases of intrauterine transmission reported with COVID-19 or any other coronavirus infections. Influenza virus, despite causing approximately one billion annual infections globally, has only a few cases of confirmed or suspected intrauterine fetal infections reported. RSV is in an unusual cause of illness among pregnant women, and with the exception of one premature infant with congenital pneumonia, no other cases of maternal-fetal infection are described. Parainfluenza virus and human metapneumovirus can produce symptomatic maternal infections but do not cause intrauterine fetal infection. In summary, it appears that the absence thus far of maternal-fetal transmission of the SARS-CoV-2 virus during the COVID-19 pandemic is similar to other coronaviruses, and is also consistent with the extreme rarity of suggested or confirmed cases of intrauterine transmission of other respiratory RNA viruses. This observation has important consequences for pregnant women as it appears that if intrauterine transmission of SARSCoV-2 does eventually occur, it will be a rare event. Potential mechanisms of fetal protection from maternal viral infections are also discussed.
新型冠状病毒肺炎（COVID-19）的病原体严重急性呼吸综合征冠状病毒2（SARS-CoV-2），与另外两种冠状病毒——严重急性呼吸综合征冠状病毒（SARS-CoV）和中东呼吸综合征冠状病毒（MERS-CoV）相似，可引发危及生命的孕产妇呼吸道感染和全身并发症。鉴于全球对SARS-CoV-2可能在子宫内由孕妇传播给胎儿的关注，本报告分析了SARS-CoV-2及其他呼吸道RNA病毒感染对妊娠的影响，并研究了SARS-CoV-2、严重急性呼吸综合征（SARS）、中东呼吸综合征（MERS）、流感、呼吸道合胞病毒（RSV）、副流感病毒（HPIV）和偏肺病毒（hMPV）母婴传播的频率。目前尚无COVID-19或任何其他冠状病毒感染的子宫内传播确诊病例报告。流感病毒尽管在全球每年导致约10亿例感染，但仅有少数确诊或疑似子宫内胎儿感染病例报告。RSV在孕妇中是一种不常见的致病原因，除了1例患有先天性肺炎的早产儿外，未描述其他母婴感染病例。副流感病毒和人偏肺病毒可导致有症状的孕产妇感染，但不会引起子宫内胎儿感染。总之，在COVID-19大流行期间，SARS-CoV-2病毒迄今未出现母婴传播，这似乎与其他冠状病毒情况相似，也与其他呼吸道RNA病毒子宫内传播的疑似或确诊病例极为罕见相一致。这一观察结果对孕妇具有重要意义，因为如果SARS-CoV-2最终确实发生子宫内传播，将是罕见事件。本文还讨论了胎儿免受母体病毒感染的潜在机制。
