Screening for COVID-19 in asymptomatic pregnant women: Which is better; rectal or oropharyngeal/nasopharyngeal swab?

Abstract Background The effect of SARS-CoV-2 infection in pregnant women and newborns is incompletely understood. Preliminary data shows a rather fluctuating course of the disease from asymptomatic or mild symptoms to maternal death. However, it is not clear whether the disease increases the risk of pregnancy-related complications. The aim of the study is to describe the maternal and neonatal clinical characteristics and outcome of pregnancies with SARS-CoV-2 infection. Methods In this retrospective national-based study, we analyzed the medical records of all pregnant women infected with SARS-CoV-2 and their neonates who were admitted to New-Jahra Hospital (NJH), Kuwait, between March 15th 2020 and May 31st 2020. During the study period and as part of the public health measures, a total of 185 pregnant women infected with SARS-CoV-2, regardless of symptoms, were hospitalized at NJH, and were included. Maternal and neonatal clinical manifestations, laboratory tests and treatments were collected. The outcomes of pregnancies included miscarriage, intrauterine fetal death (IUFD), preterm birth and live birth were assessed until the end date of the outcomes follow-up (November 10th 2020). Results A total of 185 pregnant women infected with SARS-CoV-2 were enrolled with a median age of 31 years (interquartile range, IQR: 27.5–34), and median gestational age at diagnosis of SARS-CoV2 infection was 29 weeks (IQR: 18–34). The majority (88%) of these women had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). At the time of the analysis, out of the 185, 3 (1.6%) of the pregnant women had a miscarriage, 1 (0.54%) had IUFD which was not related to COVID-19, 16 (8.6%) had ongoing pregnancies and 165 (89%) had a live birth. Only 2 (1.1%) of these women developed severe pneumonia and required intensive care. A total of 167 neonates with two sets of twins were born with median gestational age at birth was 38 (IQR: 36–39) weeks. Most of the neonates were asymptomatic, and only 2 of them tested positive on day 5 by nasopharyngeal swab testing. Conclusions In this national-based study, most of the pregnant women infected with SARS-CoV-2 showed mild symptoms. Although mother-to-child vertical transmission of SARS-CoV-2 is possible, COVID-19 infection during pregnancy may not lead to unfavorable maternal and neonatal outcomes.

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Antibodies to Pneumococcal Proteins PhtD, CbpA, and LytC in Filipino Pregnant Women and Their Infants in Relation to Pneumococcal Carriage

Clinical and Vaccine Immunology ◽

10.1128/cvi.00050-09 ◽

2009 ◽

Vol 16 (6) ◽

pp. 916-923 ◽

Cited By ~ 38

Author(s):

Emma Holmlund ◽

Beatriz Quiambao ◽

Jukka Ollgren ◽

Teija Jaakkola ◽

Cécile Neyt ◽

...

Keyword(s):

Cord Blood ◽

Pregnant Women ◽

Vaccine Candidate ◽

Geometric Mean ◽

Protein A ◽

Nasopharyngeal Swab ◽

Serum Samples ◽

Blood Samples ◽

Clear Cut ◽

Pneumococcal Carriage

ABSTRACTThis study focuses on the immunogenicity of the following three pneumococcal vaccine candidate proteins in Filipino infants, all inducing protection in animal models: pneumococcal histidine triad protein D (PhtD), choline binding protein A (CbpA), and the lysozyme LytC. The immunoglobulin G antibody concentrations to PhtD, its putative, protective, and exposed C-terminal fragment (PhtD C), CbpA, and LytC were measured by enzyme immunoassay in 52 serum samples from pregnant women, 39 cord blood samples, and consecutive serum samples (n= 263) from 52 newborns between 6 weeks and 10 months of age scheduled to be taken at six time points. A nasopharyngeal swab to detect pneumococcal carriage was taken parallel to the serum samples. The antibody concentrations in the cord blood samples were similar to those in the samples from the mothers. In infant sera, the geometric mean antibody concentrations (GMCs) for all three proteins decreased until the age of 18 weeks and started to increase after that age, suggesting that the infants' own antibody production started close to the age of 4 to 5 months. The increase in GMCs by age, most clear-cut for CbpA, was associated with pneumococcal carriage. Anti-PhtD concentrations were higher than anti-PhtD C concentrations but correlated well (rof 0.89 at 10.5 months), suggesting that antibodies are directed to the supposedly exposed and protective C-terminal part of PhtD. Our results show that young children are able to develop an antibody response to PhtD, CbpA, and LytC and encourage the development of pneumococcal protein vaccines for this age group.

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539. Prevalence of Symptomatic and Asymptomatic COVID-19 Infection in Pregnant Women and Their Infants in an Urban Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.733 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S337-S337

Author(s):

Krystina L Woods ◽

Angela Gabasan ◽

Deborah Schwing ◽

Brian Wagner ◽

Lisa Eiland ◽

...

Keyword(s):

New York ◽

Pregnant Women ◽

Newborn Infants ◽

Nasopharyngeal Swab ◽

Urban Hospital ◽

Birth Parent ◽

Global Pandemic ◽

Increased Risk ◽

Symptomatic Woman ◽

The One

Abstract Background COVID-19 is an emerging pathogen that has caused a global pandemic, with New York City as one of its epicenters. Data are still forthcoming if pregnant women are more vulnerable to COVID-19, as they are with influenza. Additionally, it is not known if infants born to COVID-19 positive women are at risk of being infected at birth. Methods In March 2020, our hospital instituted a policy of testing all pregnant women presenting for active labor and scheduled C-section or induction of labor, with a nasopharyngeal swab that was sent for RT-PCR qualitative SARS-CoV-2 assay (Roche Cobas® 6800). Upon birth, infants were also tested, unless the parent did not give consent. We retrospectively reviewed the COVID-19 test results of all pregnant women and their infants, from March 23 through May 31, 2020 using our infection control surveillance system (VigiLanz®). We also reviewed the electronic medical record (EPIC®) for documentation of any symptoms consistent with COVID-19 infection either prior to hospitalization or during the hospital stay. Results A total of 415 women and 72 infants were tested for SARS-CoV-2. Of the 415 women tested, 41 (9.9%) were positive. Of the 72 infants tested, 2 (2.8%) were positive and concordant with their birth parent. Only 1 (2.4%) of the women who tested positive was symptomatic. The remaining 40 (97.6%) women did not report any symptoms of COVID-19 during labor. Neither of the two positive infants displayed any signs or symptoms of COVID-19. Of the 41 women who were positive, 5 did not consent to have their infant tested. The one symptomatic woman who tested positive for COVID-19 had an infant who tested negative by PCR. Conclusion During the first wave of the COVID-19 pandemic, we found 9.9% (41/415) of pregnant women presenting for labor tested positive for SARS-CoV-2. Among the 41 women who tested positive, only 1 (2.4%) had symptoms on presentation and only 2 newborn infants tested positive. Our data suggests that pregnant women may not be at increased risk for complications from COVID-19 disease and are not likely to transmit the disease to their infants during labor. Disclosures All Authors: No reported disclosures

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COVID-19 related complete blood count changes among asymptomatic pregnant women

Proceedings in Obstetrics and Gynecology ◽

10.17077/2154-4751.1511 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Waleed F Gharib ◽

Hesham Nasser ◽

Ahmed M.A. Sobh ◽

Rasha E Khamees

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Eosinophil Count ◽

Blood Count ◽

Complete Blood Count ◽

Confirmatory Test ◽

Nasopharyngeal Swab ◽

Care Clinic ◽

Entire Study ◽

Study Population

Objective: To evaluate complete blood count (CBC) changes that suggest coronavirus disease-2019 (COVID-19) among asymptomatic pregnant women attending routine antenatal care Methods: A cross-sectional study included 187 healthy pregnant women who were attending the antenatal care clinic of a tertiary University hospital between March and June 2020. After a thorough history and examinations, a venous blood sample was taken from each participant for complete and differential blood counts. Those who showed CBC findings suggestive of COVID-19 were further scheduled for a nasopharyngeal swab for detection of SARS-CoV-2 specific antigens through polymerase chain reaction (PCR). Results: We found 5.3% (n=10) of the study population showed CBC changes that are suggestive of COVID-19. When they were scheduled for nasopharyngeal swab for a PCR confirmatory test, 30% (n=3) of them were PCR positive (which represented 1.6% of the entire study population). The most frequently encountered COVID-19-suggestive change in peripheral blood leukocyte differential counts was leucopenia (100%), followed by decreased eosinophil count (50%), then neutropenia and lymphocytopenia (30%). Conclusions: Certain differential leucocyte count changes (leucopenia, neutropenia, lymphocytopenia and decreased eosinophil count) among asymptomatic pregnant women might be related to COVID-19 infection and may indicate a need for further testing.

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Severe COVID-19 during Pregnancy and Possible Vertical Transmission

American Journal of Perinatology ◽

10.1055/s-0040-1710050 ◽

2020 ◽

Vol 37 (08) ◽

pp. 861-865 ◽

Cited By ~ 126

Author(s):

Maria Claudia Alzamora ◽

Tania Paredes ◽

David Caceres ◽

Camille M. Webb ◽

Luis M. Valdez ◽

...

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Disease Onset ◽

High Risk Group ◽

Nasopharyngeal Swab ◽

Low Grade ◽

Delayed Cord Clamping ◽

Skin Contact ◽

Cord Clamping ◽

History Of

There are few cases of pregnant women with novel corona virus 2019 (COVID-19) in the literature, most of them with a mild illness course. There is limited evidence about in utero infection and early positive neonatal testing. A 41-year-old G3P2 with a history of previous cesarean deliveries and diabetes mellitus presented with a 4-day history of malaise, low-grade fever, and progressive shortness of breath. A nasopharyngeal swab was positive for COVID-19, COVID-19 serology was negative. The patient developed respiratory failure requiring mechanical ventilation on day 5 of disease onset. The patient underwent a cesarean delivery, and neonatal isolation was implemented immediately after birth, without delayed cord clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 hours after delivery, was positive for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) real-time polymerase chain reaction (RT-PCR), and immunoglobulin (Ig)-M and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive on postpartum day 4 (day 9 after symptom onset). We report a severe presentation of COVID-19 during pregnancy. To our knowledge, this is the earliest reported positive PCR in the neonate, raising the concern for vertical transmission. We suggest pregnant women should be considered as a high-risk group and minimize exposures for these reasons. Key Points

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SARS-CoV-2 in Pregnancy—The First Wave

Medicina ◽

10.3390/medicina57030241 ◽

2021 ◽

Vol 57 (3) ◽

pp. 241

Author(s):

Andreia de Vasconcelos Gaspar ◽

Isabel Santos Silva

Keyword(s):

Pregnant Women ◽

Preterm Labor ◽

Maternity Hospital ◽

Nasopharyngeal Swab ◽

Cesarean Sections ◽

Maternal Deaths ◽

History Of ◽

Threatened Abortion ◽

Severity Of The Disease ◽

Prelabor Rupture Of Membranes

Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.

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COVID-19 in a cohort of pregnant women and their descendants, the MOACC-19 study

BMJ Open ◽

10.1136/bmjopen-2020-044224 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044224

Author(s):

Javier Llorca ◽

Carolina Lechosa-Muñiz ◽

Pilar Gortazar ◽

María Fernández-Ortiz ◽

Yolanda Jubete ◽

...

Keyword(s):

Pregnant Women ◽

Pcr Analysis ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Third Trimester ◽

Rna Detection ◽

Preliminary Results ◽

Mother And Child ◽

North Of Spain ◽

Future Plans

PurposeThe Mother and Child COVID-19 study is a cohort recruiting pregnant women and their children in Cantabria, North of Spain, during COVID-19 pandemic in order to ascertain consequences of SARS-CoV-2 infection on pregnant women and their descendants. This article reports the cohort profile and preliminary results as recruitment is still open.ParticipantsThree subcohorts can be identified at recruitment. Subcohort 1 includes women giving birth between 23 March and 25 May 2020; they have been retrospectively recruited and could have been exposed to COVID-19 only in their third trimester of pregnancy. Subcohort 2 includes women giving birth from 26 May 2020 on; they are being prospectively recruited and could have been exposed to COVID-19 in both their second and third trimesters of pregnancy. Subcohort 3 includes women in their 12 week of pregnancy prospectively recruited from 26 May 2020 on; they could have been exposed to COVID-19 anytime in their pregnancy. All women are being tested for SARS-CoV-2 infection using both RT-PCR for RNA detection and ELISA for anti-SARS-CoV-2 antibodies. All neonates are being tested for antibodies using immunochemoluminiscency tests; if the mother is tested positive for SARS-CoV-2 RNA, a nasopharyngeal swab is also obtained from the child for RT-PCR analysis.Findings to dateAs of 22 October, 1167 women have been recruited (266, 354 and 547 for subcohorts 1, 2 and 3, respectively). Fourteen women tested positive to SARS-CoV-2 RNA by the day of delivery. All 14 children born from these women tested negative for SARS-CoV-2 RNA.Future plansChildren from women included in subcohort 3 are expected to be recruited by the end of 2020. Children will be followed-up for 1 year in order to ascertain the effect that COVID-19 on their development.

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Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait

10.1101/2020.07.10.20150623 ◽

2020 ◽

Cited By ~ 1

Author(s):

Amal Ayed ◽

Alia Embaireeg ◽

Asmaa Benawadth ◽

Wadha Al-Fouzan ◽

Majeda Hammoud ◽

...

Keyword(s):

General Population ◽

Pregnant Women ◽

Clinical Features ◽

Severe Pneumonia ◽

Intrauterine Fetal Death ◽

Nasopharyngeal Swab ◽

Disease Manifestation ◽

Maternal And Neonatal Outcomes ◽

Novel Coronavirus

Background: In late December of 2019, a novel coronavirus (SARS-CoV-2) was identified in the Chinese city Wuhan among a cluster of pneumonia patients. While it is known that pregnant women have reduced immunity and they are at risk for COVID-19 infection during the current pandemic, it is not clear if the disease manifestation would be different in pregnant women from non-pregnant women. Objectives: To describe the maternal and neonatal clinical features as well as outcome of pregnancies complicated with SARS-CoV-2 infection. Methods: In this retrospective national-based study, we analyzed the medical records of all SARS-CoV-2 positive pregnant patients and their neonates who were admitted to New-Jahra Hospital, Kuwait, between March 15th 2020 and May 31st 2020. The outcomes of pregnancies were assessed until the end date of follow-up (June 15th 2020). Results: A total of 185 pregnant women were enrolled with a median age of 31 years (interquartile range, IQR: 27.5-34), and median gestational age at diagnosis was 29 weeks (IQR: 18-34). The majority (88%) of the patients had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). During the study period, 141 (76.2%) patients continued their pregnancy, 3 (1.6%) had a miscarriage, 1 (0.5%) had intrauterine fetal death and only 2 (1.1%) patients developed severe pneumonia and required intensive care. Most of the neonates were asymptomatic, and only 2 (5%) of them tested positive on day 5 by nasopharyngeal swab testing. Conclusion: Pregnant women do not appear to be at higher risk to the COVID-19 than the general population. The clinical features of pregnant women with SARS-CoV-2 infection were similar to those of the general population having SARS-CoV-2 infection. Favorable maternal and neonatal outcomes reinforce the existing evidence and may guide healthcare professionals in the management of pregnancies complicated with SARS-CoV-2 infection.

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COMPARATIVE STUDY –FETOMATERNAL OUTCOME IN COVID 19 PREGNANCIES BETWEEN FIRST AND SECOND WAVE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i9.2210 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Aarthi Rajendran ◽

Rajni Parikh ◽

Payal Patel

Keyword(s):

Comparative Study ◽

Maternal Mortality ◽

Pregnant Women ◽

Wave Pattern ◽

Tertiary Hospital ◽

Outcome Data ◽

Nasopharyngeal Swab ◽

Severity Of The Disease ◽

Age Range ◽

Second Wave

Background: Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. This study helps in the comparison between the characteristics and severity between first and second wave. Methods: This study is prospective and comparative study based on compiled clinical and outcome data for pregnant women infected with COVID-19 between April 2020 to October 2020 and March 2021 to July 2021 at our tertiary level hospital. A laboratory confirmed case of COVID-19 is defined as a positive result by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) assay of maternal pharyngeal and nasopharyngeal swab specimen. Results: In our hospital, a total of 89 pregnant women were admitted in our tertiary hospital, out of which 53 of the patients were antenatal women of which 15 of the women died, 32 patients were admitted during third trimester and labour and 4 patients were delivered outside and referred here. This study, the most common age group affected was only between 20-30 years same as that of the first wave, preterm deliveries was found to be higher. The second wave had higher incidence and severity of cough (40%), fever (43%), diarrhea (28.12%) and dyspnea (38%).It also suggests that the caesarian rates(62%) were found to be higher in covid 19 patients and maternal mortality rate(25%) was also found to be higher thereby indicating the need for vaccination to reduce the severity and mortality in the upcoming waves. Conclusion: The result of the present study suggests that the second wave among the pregnant women was found to be more severe when compared to the first wave because of the new variants. Because of this we as obstetricians and health care workers has to insist upon the vaccination during pregnancy thereby preventing the severity of the disease and reducing the maternal mortality. Key words: covid 19, fetomaternal outcome, maternal mortality.

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Covid-19 and pregnancy: the experience of a tertiary maternity hospital

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0070 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Panagiotis Antsaklis ◽

Konstantinos Tasias ◽

Alexandros Psarris ◽

Marianna Theodora ◽

George Daskalakis ◽

...

Keyword(s):

Pregnant Women ◽

Medical Records ◽

Clinical Status ◽

Maternity Hospital ◽

Neonatal Outcomes ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Neonatal Deaths ◽

Maternal And Neonatal Outcomes ◽

Polymerase Chain

Abstract Objectives The aim of our study is to present the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and evaluate its impact on maternal and neonatal outcomes. Methods We retrospectively reviewed the medical records of all COVID-19 positive pregnant women who were admitted to “Alexandra” maternity hospital from March to December 2020 (n=40). The infection status was determined via real-time polymerase chain reaction (RT-PCR) of nasopharyngeal swab specimen. We documented the demographic features, clinical status, pregnancy characteristics and maternal and fetal outcomes. Results Forty COVID-19 positive pregnant women were admitted to our clinic during the study period. Mean maternal age was 27.6 years. Gestational age (GA) ranged from 10–42 weeks of pregnancy with mean GA calculated at 38+3 weeks. Associated comorbidities included hypertension, hypothyroidism, epilepsy, hepatitis B and asthma. Thirty-five out of 40 women delivered within the study period. Cesarean section was performed in 57.1% of the cases. Most of the cases (87.5%) were asymptomatic while ventilation was required for only one patient. All neonates tested negative for SARS-CoV-2. Neither maternal nor neonatal deaths occurred. Conclusions In alignment to other studies, our data show that the course of coronavirus disease 2019 (COVID-19) during pregnancy in the majority of cases is mild and neonatal outcomes also appear favorable.

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