Being Born into a Pandemic: COVID-19 and Pregnancy

Abstract

Case #1: 34yo Asian female G2P1001 presents COVID19+ in 1st trimester. PMH insignificant. Meds: prenatal vitamins. Surg Hx: c/s healthy boy (2017). No h/o GHTN, GDM, or eclampsia. D/t COVID19+ infection, frequent fetal u/s monitoring done at 32w5d, 34w5d, 38w0d. Fetal growth over time: 63.4%, 48.8%, 14.3%. Fluid over time: AFI 8.58cm, MVP 4.52cm; AFI 10.86, MVP 3.52; AFI 2.73, MVP <2. Oligohydramnios diagnosed at 38w0d; emergent repeat c/s performed. Mother and baby healthy s/p delivery, d/c home on PPD#2. Pathology of placental tissue shows increases in villous fibrin accumulation and maternal vascular malperfusion.

Case #2: 29yo Caucasian female G1P0 presents to ED at 18w4d with c/o runny nose, cough, and headache; temp. 100.3*F; tests COVID+. PMH insignificant. Meds: prenatal vitamins. No h/o GHTN, GDM, or eclampsia. 21w0d u/s: growth 71.4%, normal anatomy. 30w0d u/s: growth at 82.3%, AFI 15.10cm, MVP 5.38cm. At 39w1d, healthy infant boy (7lb12oz) via VAVD. Mother and baby healthy s/p delivery, d/c home on PPD#2. Placenta not sent for surgical pathology.

Conclusion Due to the short time course of the COVID19 pandemic, adequate evidence to link maternal-fetal outcomes to infection during pregnancy is just now becoming available. Other coronaviruses, SARS and MERS, are preferentially fatal in pregnant mothers; and, adverse perinatal outcomes in COVID19+ women are appearing. Case reports have associated COVID19 with preterm birth; one study reported 47% preterm deliveries in COVID19+ mothers. Molecular studies have confirmed ACE2 (receptor allowing viral cellular entry) mRNA overexpression in placentas. Placental histopathology has shown maternal-placental interfacing blood vessel anomalies.

Clinical Significance COVID19 represents a monumental threat to public health. Pregnant women and fetuses may be at increased risk for complications compared to the general public. As yet, the relationship between COVID19 and pregnancy remains to be clarified and will require further investigations to understand associations and promote evidence-based treatment practices.