COVID‐19 and Pregnancy: A Case Study - Long - 2021 - Global Challenges - Wiley

The World Health Organization warned that the 2019 novel coronavirus disease (COVID-19) outbreak can be characterized as a "pandemic" given that the virus spreads increasingly worldwide. More than 39 million people have been diagnosed across the world till October 16, 2020, with a death toll surpassing 1,099,000.^[1] Pregnant women and neonates may have a high risk of infecting COVID-19, owing to their special immune states.^[2] Limited studies have reported that pregnant women who were infected by other virus delivered immediately due to deteriorating maternal condition, and observed respiratory complications or stillbirth.^[3] However, for pregnant women with COVID-19, there is no direct evidence to verify whether inducing birth immediately can decrease the risk of adverse outcome.

In this study, we report a confirmed case of pregnant woman who was exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at 34+1 weeks and gave birth at 37+5 weeks to a neonate with positive immunoglobulin G (IgG) for SARS-CoV-2.

A 30-year-old woman (gravida 2, para 1) at 34+1 weeks' gestation developed fever on February 2, 2020. The highest point reached 38.5 °C. Before the onset of the symptom, nuchal translucency (NT), maternal serum markers for Down's Syndrome screening, noninvasive prenatal genetic testing (NIPT), oral glucose tolerance test (OGTT), and fetal ultrasound were performed on the patient, and no abnormity was found. She lived with her husband, her son, and parents-in-law and had no other close contact expect her family members. On the same day, her mother-in-law, who always went to market with nonsurgical mask and eventually diagnosed with COVID-19, developed the same symptom. After developing fever, the patient started to take Ibuprofen suspension (20 mL PO Q8hrs) by herself and relieved after 8 d.

All family members received nucleic acid tests (NATs) for SARS-CoV-2 on throat swab samples on February 8, 2020, and positive result was found only in her mother-in-law. However, abnormal chest computed tomography (CT) was noticed in all members except her son. Ground-glass opacities were found in the patient's right-side lung.

Then the patient was transferred to isolation ward as a close contact with the confirmed case. The nucleic acid test was repeated twice but both were negative. Without obvious symptoms or signs, she did not receive any treatment in the isolation ward and chose to continue expectation till 37+5 weeks without fully maturation treatment. Fetal ultrasound on February 22, 2020, found no abnormality.

Before delivery, her vital signs were normal (body temperature 36.5 °C, blood pressure 130/80 mmHg, respiratory rate 20 breaths min⁻¹, and pulse rate 80 beats min⁻¹), and the pertinent laboratory findings are listed in Table 1. The fetal heart rate (FHR) was 135 bpm and fetal heart monitoring was normal. Due to the history of the scarred uterus, the patient underwent a cesarean section at 37+5 weeks' gestation on February 27, 2020. A 3860 g male infant was delivered without complication. Apgar scores at 1 and 5 min were 8 and 9, respectively. Lung auscultation on neonate revealed no rhonchi over the lung. The mother was given anti-infection, oxytocin, fluid rehydration treatment after surgery. Laboratory examinations revealed elevated leukocyte count, neutrophils, and C-reactive protein level (listed in Table 1). She was afebrile without any discomfort. Her pharyngeal swab sampled for COVID-19 was still negative on two successive examinations and the result of CT was normal on March 2, 2020. The mother was discharged on March 5, 2020, and a high level of IgG and immunoglobulin M (IgM) to SARS-CoV-2 was first found from the peripheral blood on March 10, 2020. Therefore, according to the Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment (7th ed.),^[4] this patient was finally diagnosed as a COVID-19 confirmed case on March 10, 2020.

Table 1. Laboratory results for the mother and neonate

Date	Days after birth	Laboratory test	Value	Reference rangea)
Mother
February 8, 2020	–	NAT of throat swab	−	−
February 26, 2020	–	Leucocyte count [× 109 L−1]	8.11	3.5–9.5
		Lymphocyte count [× 109 L−1]	1.56	1.1–3.2
		Neutrophil ratio [%]	75.7	40–75
		Hb [g L−1]	124	>110
		PLT [× 109 L−1]	181	150–400
		Fibrinogen [mg L−1]	4.24	2–4
		D-dimer [µg mL−1]	1.7	<0.4
		CRP [mg L−1]	0.7	<1
February 27, 2020	–	Leucocyte count [× 109 L−1]	11.37	3.5–9.5
		Lymphocyte count [× 109 L−1]	1.46	1.1–3.2
		Neutrophil ratio [%]	83	40–75
		Hb [g L−1]	112	>110
		PLT [× 109 L−1]	147	150–400
		Fibrinogen [mg L−1]	5.99	2–4
		D-dimer [µg mL−1]	4.14	<0.4
		CRP [mg L−1]	13	<1
Neonate
February 27, 2020	0	NAT of amniotic fluid	−	−
		NAT of throat swab	−	−
		SARS-CoV-2 IgG [AU mL−1]	134.13	≤10
		SARS-CoV-2 IgM [AU mL−1]	3.52	≤10
		Urine leucocyte	+	−
		Specific gravity	1.009	1.001–1.020
		Leucocyte count [µL−1]	20.7	0–4 per low-power field
		Leucocyte count [× 109 L−1]	16.48	9–30
		Neutrophil count [× 109 L−1]	11.15	2.5–8
		Neutrophil ratio [%]	67.7	55–70
		Lymphocyte ratio [%]	20.8	20–40
		RBC [× 1012 L−1]	3.74	4.8–7.1
		Hb [g L−1]	140	140–240
		PLT [× 109 L−1]	369	150–300
		β2 microglobulin [mg L−1]	1.55	1–2
		Urine creatinine [µmol L−1]	2677	88–176 µmol kg−1 d−1
		Cystatin C [mg L−1]	1.87	0.6–2.5
		hs-CRP [mg L−1]	0.5	<10
		cTnI [pg mL−1]	8.1	<20
		NT-proBNP [pg mL−1]	1342	<125 (adult)
		TBil [µmol L−1]	76.4	17.1–205
		DBil [µmol L−1]	7.5	1.7–5.1
		ALT [U L−1]	6	4–36
		AST [U L−1]	26	35–140
		TP [g L−1]	51.4	46–74
		ALB [g L−1]	35.3	35–54
March 4, 2020	6	SARS-CoV-2 IgG [AU mL−1]	215.04	≤10
		SARS-CoV-2 IgM [AU mL−1]	2.38	≤10
		NAT of throat swab	−	−
		Stool routine	−	−
		Urinalysis	−	−
March 8, 2020	10	SARS-CoV-2 IgG [AU mL−1]	119	≤10
		SARS-CoV-2 IgM [AU mL−1]	2.79	≤10
		NAT of throat swab	−	−
		NAT of anal swab	−	−
		NAT of urine	−	−
		NAT of excrement	−	−
		TBil [µmol L−1]	128.4	17.1–205
		DBil [µmol L−1]	14	1.7–5.1
		ALT [U L−1]	6	4–36
		AST [U L−1]	18	15–60
		TP [g L−1]	49	46–74
		ALB [g L−1]	32.8	35–54
		LDH [U L−1]	295	160–450
		hsCRP [mg L−1]	0.3	<10
		Leucocyte count [× 109 L−1]	9.87	9–30
		Neutrophil count [× 109 L−1]	4.44	2.5–8
		Neutrophil ratio [%]	45	55–70
		Lymphocyte count [× 109 L−1]	3.94	1–4
		Lymphocyte ratio [%]	39.9	20–40
		RBC [× 1012 L−1]	3.15	4.8–7.1
		Hb [g L−1]	112	140–240
		PLT [× 109 L−1]	546	150–300
		IL-1β [pg mL−1]	<5	<5
		IL-2R [U mL−1]	1374	223–710
		IL-6 [pg mL−1]	<1.5	<8.5
		IL-8 [pg mL−1]	12.7	<62
		IL-10 [pg mL−1]	<5	<7
		TNF-α [pg mL−1]	14.4	<3.5

• Notes: NAT, nucleic acid test; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; RBC, red blood cell; Hb, hemoglobin; PLT, platelet; CRP, C reaction protein; hsCRP, hypersensitivity C reaction protein; cTnI, cardiac troponin I; NT-proBNP, N-terminal pronatriuretic peptide; TBiL, total bilirubin; DBiL, direct bilirubin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TP, total protein; ALB, albumin; IL, interleukin; TNF, tumor necrosis factor; −, negative; +, positive.
• ^a) Pagana K. Mosby's Manual of Diagnostic and Laboratory Tests, Mosby, 2017.

The throat swabs, peripheral blood samples, and amniotic fluid of the neonate were collected and tested for nucleic acid and antibodies of SARS-CoV-2 immediately at birth. The only positive result was high IgG level in peripheral blood (134.13 AU mL⁻¹). Most of the laboratory findings were normal except an elevated leukocyte count and an alleviated lymphocyte (listed in Table 1). The antibodies in neonate peripheral blood were tested twice on March 4 and March 8, 2020, and the IgG...