Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times

Godoi, Ana Paula Nogueira; Bernardes, Gilcelia Correia Santos; Nogueira, Leilismara Sousa; Alpoim, Patrícia Nessralla; Pinheiro, Melina de Barros

doi:10.1055/s-0041-1729145

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Brasil

Español English

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 43 (05) • May 2021 • https://doi.org/10.1055/s-0041-1729145 copy

Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times

Características clínicas e resultados materno-fetais de mulheres grávidas com COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period.

Methods

In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2.

Results

The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission.

Conclusion

Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.

Keywords:
SARS-CoV-2; COVID-19; pregnancy; pregnancy complications; high risk pregnancy

Number of pregnant patients	Delivery route	Maternal symptoms	Maternal/fetal complications	Study	Date of publication
09	Cesarean section	Seven patients had fever, four had cough, and two had malaise	One had flu, one had gestational hypertension, one had pre-eclampsia, two had fetal distress, and three had a ruptured membrane	(Chen et al., 2020)²⁸28 Chen H, Guo J, Wang C, 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;395(10226):809-815. Doi: 10.1016/S0140-6736 (20)30360-3 https://doi.org/10.1016/S0140-6736...	March 07, 2020
17	Cesarean section	Four had fever, four had cough, one had fatigue, two had chest pain, one had dyspnea, and one had diarrhea	Three underwent emergency cesarean section	(Chen et al., 2020)²⁹29 Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020;67(06):655-663. Doi: 10.1007/s12630-020-01630-7 https://doi.org/10.1007/s12630-020-01630...	March 16, 2020
13	Ten cesarean sections, five of which were emergency. Three pregnant women were still pregnant at the end of the study	Ten had fever, three had dyspnea, and one was asymptomatic	Three had fetal distress, one had a ruptured membrane, and one was stillborn	(Liu et al., 2020)³⁰30 Liu Y, Chen H, Tang K, Guo Y. Clinicalmanifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020;•••: S0163-4453(20)30109-2. Doi: 10.1016/j.jinf.2020.02.028 [ahead of print.] https://doi.org/10.1016/j.jinf.2020.02.0...	March 5, 2020
01	Spontaneous vaginal	Fever, cough, headache, and myalgia	Gestational hypertension and hypothyroidism.	(Zambrano et al., 2020)³¹31 Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA, et al. A pregnant woman with COVID-19 in Central America. Travel Med Infect Dis. 2020;36:101639. Doi: 10.1016/j.tmaid.2020.101639 https://doi.org/10.1016/j.tmaid.2020.101...	March 25, 2020
07	Seven cesarean sections, two of which were emergency due to preeclampsia	Six had fever, one had cough, one had shortness of breath, and one had diarrhea.	Two patients had hypertension, blurred vision, and preeclampsia.	(Yang et al., 2020)³²32 Yang P, Wang X, Liu P, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020;127:104356. Doi: 10.1016/j.jcv.2020.104356 https://doi.org/10.1016/j.jcv.2020.10435...	June 2020
01	Vaginal delivery	Fever and dry cough	Premature rupture of the membrane	(Xiong et al., 2020)³³33 Xiong X,Wei H, Zhang Z, et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID-19. J Med Virol. 2020;92(09):1657-1659. Doi: 10.1002/jmv.25857 https://doi.org/10.1002/jmv.25857...	April 10, 2020
01	Emergency cesarean section	Fever	Intermittent fever in the postoperative period.	(Wang et al., 2020)³⁴34 Wang S, Guo L, Chen L, et al. A case report of neonatal 2019 Coronavirus Disease in China. Clin Infect Dis. 2020;71(15): 853-857. Doi: 10.1093/cid/ciaa225 https://doi.org/10.1093/cid/ciaa225...	March 12, 2020
23	Eighteen cesarean sections, two vaginal deliveries and three patients voluntarily terminated the pregnancy in the first trimester	Four patients had fever, six had cough, one had nasal congestion, and 15 patients were asymptomatic	One had fetal intrauterine hypoxia, two had a ruptured membrane, four had gestational hypertension, and three had threat of miscarriage	(Wu et al., 2020)²¹21 WuX, Sun R, Chen J, Xie Y, Zhang S,Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. Int J Gynaecol Obstet. 2020;150(01):58-63. Doi: 10.1002/ijgo.13165 https://doi.org/10.1002/ijgo.13165...	April 8, 2020
03	Vaginal deliveries	Fever, cough, and chest tightness	No complications	(Khan et al., 2020)³⁵35 Khan S, Peng L, Siddique R, et al. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infect Control Hosp Epidemiol. 2020;41(06):748-750. Doi: 10.1017/ice.2020.84 https://doi.org/10.1017/ice.2020.84...	March 19, 2020
04	Three cesarean sections and one vaginal delivery	Three had fever, two had cough, two had myalgia/fatigue, and two had headache	Two newborns had edema and rash	(Chen et al., 2020)³⁶36 Chen Y, Peng H,Wang L, et al. Infants born tomothers with a New Coronavirus (COVID-19). Front Pediatr. 2020;8:104. Doi: 10.3389/fped.2020.00104 https://doi.org/10.3389/fped.2020.00104...	March 16, 2020
07	Cesarean	Six patients had fever, one had cough, one had shortness of breath, and one had diarrhea	Three patients had uterine scars	(Yu et al., 2020)⁸8 Yu N, Li W, Kang Q, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20(05):559-564. Doi: 10.1016/S1473-3099(20)30176-6 https://doi.org/10.1016/S1473-3099(20)30...	March 24, 2020
15	Ten cesarean sections, a vaginal delivery, and four patients were still pregnant at the end of the study	Thirteen had fever, nine dyspnea, three myalgia, one diarrhea, one cough and one fatigue	Mild clinical manifestations	(Liu et al., 2020)³⁷37 Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with Coronavirus Disease (COVID-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol. 2020;215(01): 127-132. Doi: 10.2214/AJR.20.23072 https://doi.org/10.2214/AJR.20.23072...	July 2020
01	Emergency cesarean section	Fever	No complications	(Wang et al., 2020)³⁸38 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. 2020;71(15):844-846. Doi: 10.1093/cid/ciaa200 https://doi.org/10.1093/cid/ciaa200...	February 28, 2020
09	Seven cesarean sections and two vaginal deliveries	Eight patients had fever, four had cough, one had diarrhea, and one had sore throat	Five neonates were cured, four remained in the hospital until the end of the study, and one died	(Zhu et al., 2020)³⁹39 Zhu H,Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9 (01):51-60. Doi: 10.21037/tp.2020.02.06 https://doi.org/10.21037/tp.2020.02.06...	February 09, 2020
01	Vaginal delivery	Fever, chills, dry cough, and myalgia	No complications	(Iqbal et al., 2020)⁴⁰40 Iqbal SN, Overcash R,Mokhtari N, et al. An uncomplicated delivery in a patient with Covid-19 in the United States. N Engl J Med. 2020;382(16):e34. Doi: 10.1056/NEJMc2007605 https://doi.org/10.1056/NEJMc2007605...	April 01, 2020
05	Three vaginal deliveries, one cesarean section due to gestational diabetes and one emergency cesarean section due to fetal tachycardia	All pregnant women had postpartum fever	Two patients developed gestational diabetes, and one developed preeclampsia	(Chen et al., 2020)⁴¹41 Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol. 2020;92(09):1556-1561. Doi: 10.1002/jmv.25789 https://doi.org/10.1002/jmv.25789...	March 28, 2020
01	Cesarean section	Fever, nasal congestion, and respiratory distress	No complications	(Dong et al., 2020)⁴²42 Dong L, Tian J, He S, et al. Possible vertical transmission of SARSCoV-2 from an infected mother to her newborn. JAMA. 2020;323 (18):1846-1848. Doi: 10.1001/jama.2020.4621 https://doi.org/10.1001/jama.2020.4621...	March 26, 2020
02	Cesarean section	Two patients had fever, two had nasal congestion, and one had chills. One had fever, nasal congestion, sore throat, and a rash	No complications	(Fan et al., 2020)⁴³43 Fan C, Lei D, Fang C, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis. 2020; •••:ciaa226. Doi: 10.1093/cid/ciaa226 [ahead of print] https://doi.org/10.1093/cid/ciaa226...	March 17, 2020
Case: 16 COVID-19 pregnant womenControl: 45 healthy pregnant women	Caesarean section	Fifteen pregnant women with COVID-19 had mild pneumonia, and one of them had severe pneumonia	One patient in the control group was in a more serious condition. No patient in the case group was in critical condition	(Zhang et al., 2020)²⁷27 Zhang L, Jiang Y,WeiM, et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi. 2020;55(03):166-171. Doi: 10.3760/cma.j. cn112141-20200218-00111 Chinese https://doi.org/10.3760/cma.j. cn112141-...	March 25, 2020
8.207	Not informed	1,799 patients had cough, 1,190 had fever, 1,323 had myalgia, 989 chills, 1,409 had headache, 497 had diarrhea, 682 had nausea or vomiting, 350 had abdominal pain, 326 had runny nose, and 587 had new loss of taste or smell	Risk of hospitalization 5.4 times higher than non-pregnant women. Risk of being admitted to the ICU and receiving mechanical ventilation was 1.5 and 1.7, respectively, compared to the group of non-pregnant women	(Ellington et al., 2020)²⁰20 Ellington S, Strid P, Tong VT, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):769-775. Doi: 10.15585/mmwr.mm6925a1 https://doi.org/10.15585/mmwr.mm6925a1...	June 26, 2020

Drug	Use in pregnant women	References
Remdesivir	It was not possible to evaluate the effectiveness and/or safety of its use in pregnant women. The Food and Drug Administration (FDA) has authorized its compassionate use for the treatment of severe COVID-19 in children and pregnant women.	(McCoy et al., 2020)⁵¹51 McCoy JA, Short WR, Srinivas SK, Levine LD, Hirshberg A. Compassionate use of remdesivir for treatment of severe coronavirus disease 2019 in pregnant women at a United States academic center. Am J Obstet Gynecol MFM. 2020;2(03):100164. Doi: 10.1016/j.ajogmf.2020.100164 https://doi.org/10.1016/j.ajogmf.2020.10... (Lim et al., 2020)⁵²52 LimS, DeBruin DA, Leider JP, et al. Developing an ethics framework for allocating remdesivir in the COVID-19 pandemic. Mayo Clin Proc. 2020;95(09):1946-1954. Doi: 10.1016/j.mayocp.2020.06.016 https://doi.org/10.1016/j.mayocp.2020.06...
Lopinavir/ritonavir with interferon beta-1	It presented a good safety profile in its use in pregnant women. The results of this study with Interferon beta 1 suggested that there was no increased risk of miscarriage or congenital anomalies.	(Tookey et al., 2016)⁵³53 Tookey PA, Thorne C, van Wyk J, Norton M. Maternal and foetal outcomes among 4118 women with HIV infection treated with lopinavir/ritonavir during pregnancy: analysis of populationbased surveillance data from the national study of HIV in pregnancy and childhood in the United Kingdom and Ireland. BMC Infect Dis. 2016;16:65. Doi: 10.1186/s12879-016-1400-y https://doi.org/10.1186/s12879-016-1400-... (Hellwig et al., 2020)⁵⁴54 Hellwig K, Duarte Caron F, Wicklein EM, Bhatti A, Adamo A. Pregnancy outcomes from the global pharmacovigilance database on interferon beta-1b exposure. Ther Adv Neurol Disorder. 2020; 13:1756286420910310. Doi: 10.1177/1756286420910310 https://doi.org/10.1177/1756286420910310...

Drug	Use in pregnant women	References
Chloroquine	Chloroquine can induce adverse ophthalmic and cardiac effects on the fetus. It is also genotoxic. Use should be carefully assessed.	(Lacroix et al., 2020)⁵⁵55 Lacroix I, Bénévent J, Damase-Michel C. Chloroquine and hydroxychloroquine during pregnancy: What do we know? Therapie. 2020;75(04):384-385. Doi: 10.1016/j.therap.2020.05.004 https://doi.org/10.1016/j.therap.2020.05...
Hydroxychloroquine	In the treatment of autoimmune diseases, it is not associated with any increased risk of birth defects, spontaneous abortions, fetal death, or prematurity.Hydroxychloroquine can induce adverse ophthalmic and cardiac effects on the fetus. It is also genotoxic. Use should be carefully assessed.	(Lacroix et al., 2020; Sperber et al., 2009)⁵⁵55 Lacroix I, Bénévent J, Damase-Michel C. Chloroquine and hydroxychloroquine during pregnancy: What do we know? Therapie. 2020;75(04):384-385. Doi: 10.1016/j.therap.2020.05.004 https://doi.org/10.1016/j.therap.2020.05... ⁵⁶56 Sperber K, Hom C, Chao CP, Shapiro D, Ash J. Systematic review of hydroxychloroquine use in pregnant patients with autoimmune diseases. Pediatr Rheumatol Online J. 2009;7:9. Doi: 10.1186/1546-0096-7-9 https://doi.org/10.1186/1546-0096-7-9...
Azithromycin	In most studies, there were no significant associations between the use of azithromycin in pregnant women and congenital malformations.	(Keskin-Arslan et al., 2020)⁵⁷57 Keskin-Arslan E, Kaplan YC, Koren G. Use of azithromycin during pregnancy and breastfeeding: a coronavirus pandemic (COVID-19) update. Motherisk Int J.. 2020;1:12

Number of pregnant women	Age of pregnant women	Pregnancy period	Premature birth	Average birth weight	1-minute Apgar score	5-minute Apgar score	Vertical transmission signals	Study	Date of publication
1	30 years	35 weeks	One newborn	Not informed	Not informed	Not informed	RT-PCR not detected	(Li et al., 2020)⁶⁸68 Li Y, Zhao R, Zheng S, et al. Lack of vertical transmission of severe acute respiratory syndrome Coronavirus 2, China. Emerg Infect Dis. 2020;26(06):1335-1336. Doi: 10.3201/eid2606.200287 https://doi.org/10.3201/eid2606.200287...	26 de junho de 2020
9	26–40 years	36–39 weeks + 4 days	4 newborns	Two newborns had low birth weight	8–9	9–10	Six newborns had RT-PCR undetected at birth. It was not possible to investigate the other newborns at the time of birth.	(Chen et al., 2020)²⁸28 Chen H, Guo J, Wang C, 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;395(10226):809-815. Doi: 10.1016/S0140-6736 (20)30360-3 https://doi.org/10.1016/S0140-6736...	March 07, 2020
17	28.7–29.5 years	Three pregnant women: < 37 weeks14 pregnant women: ≥ 37 weeks	Three newborns	Not informed	7–9	9–10	RT-PCR not detected	(Chen et al., 2020)²⁹29 Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020;67(06):655-663. Doi: 10.1007/s12630-020-01630-7 https://doi.org/10.1007/s12630-020-01630...	March 16, 2020
13	22–36 years	25–38 weeks	6 newborns	Not informed	Nine newborns had an Apgar score of 10	Not informed	RT-PCR not detected	(Liu et al., 2020)³⁰30 Liu Y, Chen H, Tang K, Guo Y. Clinicalmanifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020;•••: S0163-4453(20)30109-2. Doi: 10.1016/j.jinf.2020.02.028 [ahead of print.] https://doi.org/10.1016/j.jinf.2020.02.0...	March 05, 2020
01	41 years	31 weeks	One newborn	1,500 g	Not informed	Not informed	RT-PCR not detected in nasopharyngeal sample	(Zambrano et al., 2020)³¹31 Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA, et al. A pregnant woman with COVID-19 in Central America. Travel Med Infect Dis. 2020;36:101639. Doi: 10.1016/j.tmaid.2020.101639 https://doi.org/10.1016/j.tmaid.2020.101...	March 25, 2020
07	Not informed	36–37 weeks	Four late preterm infants	2,096 g ± 660 g	8–9	9–10	RT-PCR not detected	(Yang et al., 2020)³²32 Yang P, Wang X, Liu P, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020;127:104356. Doi: 10.1016/j.jcv.2020.104356 https://doi.org/10.1016/j.jcv.2020.10435...	June 2020
01	25 years	38 weeks + 4 days	No	3,070 g	9	10	RT-PCR not detected in samples of amniotic fluid, smear of the newborn's throat and rectum.	(Xiong et al., 2020)³³33 Xiong X,Wei H, Zhang Z, et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID-19. J Med Virol. 2020;92(09):1657-1659. Doi: 10.1002/jmv.25857 https://doi.org/10.1002/jmv.25857...	April 10, 2020
01	34 years	40 weeks	No	3,205 g	8	9	RT-PCR detected from pharynx swab collected 36 hours after birth. Cord and placenta samples were negative.	(Wang et al., 2020)³⁴34 Wang S, Guo L, Chen L, et al. A case report of neonatal 2019 Coronavirus Disease in China. Clin Infect Dis. 2020;71(15): 853-857. Doi: 10.1093/cid/ciaa225 https://doi.org/10.1093/cid/ciaa225...	March 12, 2020
23	21–37 years	Twenty pregnant women: > 28 weeks3 pregnant women: < 12 weeks.	Not informed	Not informed	Not informed	9–10	RT-PCR not detected in 04 newborns. The SARS-CoV-2 infection was ruled out in the others using diagnostic criteria.	(Wu et al., 2020)²¹21 WuX, Sun R, Chen J, Xie Y, Zhang S,Wang X. Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. Int J Gynaecol Obstet. 2020;150(01):58-63. Doi: 10.1002/ijgo.13165 https://doi.org/10.1002/ijgo.13165...	April 08, 2020
03	27–33 years	34 weeks + 6 days39 weeks + 1 day38 weeks + 2 days.	One newborn	3,373 g	8–9	9–10	RT-PCR not detected	(Khan et al., 2020)³⁵35 Khan S, Peng L, Siddique R, et al. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infect Control Hosp Epidemiol. 2020;41(06):748-750. Doi: 10.1017/ice.2020.84 https://doi.org/10.1017/ice.2020.84...	March 19, 2020
04	28–34 years	37 weeks + 2 days39 weeks37 weeks + 3 days38 weeks + 4 days	None	3,400 g	7–8	8–9	RT-PCR not detected in three newborns. The other parents did not authorize.	(Chen et al., 2020)³⁶36 Chen Y, Peng H,Wang L, et al. Infants born tomothers with a New Coronavirus (COVID-19). Front Pediatr. 2020;8:104. Doi: 10.3389/fped.2020.00104 https://doi.org/10.3389/fped.2020.00104...	March 16, 2020
07	29–34 years	37–41 weeks	None	3,264 g	8–9	9–10	Four newborns have not been tested. Of the three who were tested, one tested positive 36 hours after birth	(Yu et al., 2020)⁸8 Yu N, Li W, Kang Q, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20(05):559-564. Doi: 10.1016/S1473-3099(20)30176-6 https://doi.org/10.1016/S1473-3099(20)30...	March 24, 2020
15	23–40 years	12–38 weeks	None	Not informed	8	9	RT-PCR not detected	(Liu et al., 2020)³⁷37 Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with Coronavirus Disease (COVID-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol. 2020;215(01): 127-132. Doi: 10.2214/AJR.20.23072 https://doi.org/10.2214/AJR.20.23072...	July 2020
01	28 years	30 weeks	One newborn	1,830 g	9	10	RT-PCR not detected	(Wang et al., 2020)³⁸38 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. 2020;71(15):844-846. Doi: 10.1093/cid/ciaa200 https://doi.org/10.1093/cid/ciaa200...	February 28, 2020
09	average age 30 years	31–39 weeks	Six newborns	2,423 g	7–10	8–10	RT-PCR not detected	(Zhu et al., 2020)³⁹39 Zhu H,Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9 (01):51-60. Doi: 10.21037/tp.2020.02.06 https://doi.org/10.21037/tp.2020.02.06...	February 09, 2020
01	34 years	39 weeks	None	Not informed	8	9	RT-PCR not detected	(Iqbal et al., 2020)⁴⁰40 Iqbal SN, Overcash R,Mokhtari N, et al. An uncomplicated delivery in a patient with Covid-19 in the United States. N Engl J Med. 2020;382(16):e34. Doi: 10.1056/NEJMc2007605 https://doi.org/10.1056/NEJMc2007605...	April 1, 2020
05	25 to years	38 to 41 weeks	None	3,691 g	10	10	RT-PCR not detected	(Chen et al., 2020)⁴¹41 Chen S, Liao E, Cao D, Gao Y, Sun G, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol. 2020;92(09):1556-1561. Doi: 10.1002/jmv.25789 https://doi.org/10.1002/jmv.25789...	March 28, 2020
01	29 years	34 weeks + two days	Not informed	3,120 g	9	10	RT-PCR not detected, High IgM and IgG	(Dong et al., 2020)⁴²42 Dong L, Tian J, He S, et al. Possible vertical transmission of SARSCoV-2 from an infected mother to her newborn. JAMA. 2020;323 (18):1846-1848. Doi: 10.1001/jama.2020.4621 https://doi.org/10.1001/jama.2020.4621...	March 26, 2020
02	29 and 34 years	36 weeks + five days37 weeks	Not informed	3,145 g	9	10	RT-PCR not detected	(Fan et al., 2020)⁴³43 Fan C, Lei D, Fang C, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis. 2020; •••:ciaa226. Doi: 10.1093/cid/ciaa226 [ahead of print] https://doi.org/10.1093/cid/ciaa226...	March 17, 2020
06	Not informed	Not informed	Not informed	Not informed	8–9	9–10	RT-PCR not detected. In two newborns high levels of IgM and IgG. And in three newborns normal IgM and elevated IgG.	(Zeng et al., 2020)⁶⁹69 Zeng H, Xu C, Fan J, et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020;323(18):1848-1849. Doi: 10.1001/jama.2020.4861 https://doi.org/10.1001/jama.2020.4861...	March 26, 2020
Case: 16 COVID-19 pregnant womenControl: 45 healthy pregnant women	Case: 24–34 yearsControl: 24–40 years	Not informed	One newborn from the case group	Case: 2,300–3,750 gControl: 2,180–4,100g	Not informed	Not informed	RT-PCR not detected in 10 newborns.	(Zhang et al., 2020)²⁷27 Zhang L, Jiang Y,WeiM, et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi. 2020;55(03):166-171. Doi: 10.3760/cma.j. cn112141-20200218-00111 Chinese https://doi.org/10.3760/cma.j. cn112141-...	March 25, 2020

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[1] Address for correspondence Melina de Barros Pinheiro, PhD, Rua Sebastião Gonçalves Coelho, 400, Bloco D, sala 308.1, Bairro Chanadour, 35501-296 Divinópolis, MG, Brazil (e-mail: melinapinheiro@ufsj.edu.br).