Abstract
Background
There are limited data on the clinical characteristics and the vertical transmission rate of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their neonates in Korea.
Materials and Methods
Pregnant women who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were retrospectively reviewed in Asan Medical Center from September 1, 2020, to April 26, 2022. All neonates and infected women underwent a polymerase chain reaction test for severe acute respiratory syndrome corona virus 2 within 24 hours of birth and at 48-hour interval if they stayed in the hospital.
Results
A total of 60 pregnant women gave birth by cesarean section (n = 40, 66.7%) or vaginal delivery (n = 20, 33.3%). Among them, 3 women gave birth to twins. Delivery occurred, on average, at 38+2 weeks (± 2+0) of gestational age, and 9 patients (15.0%) had underlying diseases. Of these 60 patients, 9 (15.0%) received coronavirus disease 2019 vaccinations. Pneumonia was confirmed by a chest radiograph in 7 patients (11.7%), and 2 patients (3.3%) required supplemental oxygen therapy, both of whom eventually recovered. The mean birthweight of the neonates was 3,137 g (± 557.6). Further, 8 neonates (12.7%) were of low-birth weight (< 2,500 g), and 11 neonates (17.5%) were preterm (<37 weeks of gestation). Apgar score was median 8 (8 - 9) at 1 minute and 9 (9 – 9.5) at 5 minutes. Four neonates (6.3%) required invasive mechanical ventilation. All neonates had negative SARS-CoV-2 test results. Therefore, there was no vertical transmission in 63 of the neonates (0%, 95% confidence interval [CI]: 0 - 6)
Conclusion
Pregnant Korean women with SARS-CoV-2-infection had favorable obstetric outcomes, and the risk of vertical transmission to their neonates was low. Managing the infection risks of pregnant women and their neonates during the coronavirus disease 2019 pandemic are required.
Keywords: Coronavirus disease 2019, Pregnant women, Delivery, Neonates, Vertical transmission
Graphical Abstract
INTRODUCTION
In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was first reported in Wuhan, China [1]. Since then, the coronavirus disease 2019 (COVID-19) pandemic has affected various vulnerable populations. Given that pregnant women infected with severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have a poor prognosis and there are limited data on their vertical infection [2,3], several previous studies investigated whether pregnant women infected with SARS-CoV-2 had a poor prognosis and whether it could cause vertical transmission [4,5]. A meta-analysis conducted in 2020 reported that pregnant women with SARS-CoV-2 infection had a poor prognosis [4]. A recent multicenter cohort study in 2021 revealed that the prevalence of SARS-CoV-2 infection in neonates born from pregnant women with SARS-CoV-2 infection was approximately 2% [5].
However, there are limited data on the clinical characteristics of pregnant women with SARS-CoV-2 infection and their neonates, and the vertical transmission rate in Korea.
In this study, we investigated the clinical characteristics of pregnant women with SARS-CoV-2 infection and the vertical transmission to their neonates.
MATERIALS AND METHODS
1. Study design, sites, population, Data collections
All pregnant women who were confirmed to have SARS-CoV-2 infection and were admitted for delivery were retrospectively reviewed at Asan Medical Center, Seoul, Korea, from September 1, 2020, to April 26, 2022. All deliveries were performed in a negative pressure facility. All neonates of the SARS-CoV-2-infected women were tested with a nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) test within 24 hours of birth and at 48-hour interval if the neonates in the hospital. During the hospitalization period after delivery, rooming-in system were not applied. Parents and guardians, including SARS-CoV-2 confirmed mothers, were not permitted to visit the newborn. Breastfeeding was not performed, and disposable bottle feeding was performed. All maternal and neonate data were collected from electronic medical records.
Disease severity was determined according to criteria established by the National Institutes of Health (NIH) [6]. (1) Asymptomatic infection: Individuals who have no symptoms. (2) Mild illness: Individuals who have any of the various signs of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell) but who do not have shortness of breath, dyspnea, or abnormal chest imaging. (3) Moderate illness: Individuals who show evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation measured by pulse oximetry (SpO2) ≥94% on room air at sea level. (4) Severe illness: Individuals who have SpO2 <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mm Hg, a respiratory rate >30 breaths/min, or lung infiltrates >50%. (5) Critical illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.
2. Ethics statement
This cohort study was approved by our Institutional Review Board of the Asan Medical Center (IRB no. AMC-2022-0625). Needs for the written informed consent was waived.
3. Statistical analysis
Categorical and continuous variables are presented as frequencies with percentages and mean with standard deviation (SD) or medians with interquartile range (IQR), respectively. Categorical data were compared using the chi-squared test and continuous variables were analyzed using a t-test. Statistical analyses were conducted using R (version 4.0.4, R Project for Statistical Computing, Vienna, Austria). Vertical transmission rate was analyzed by the modified Wald method and 95% confidence intervals were calculated.
RESULTS
Sixty pregnant women who delivered 63 live newborns (57 singletons and 3 pairs of twins) from September 1, 2020, to April 26, 2022, were included in the study. Maternal demographic and clinical characteristics are presented in Table 1. The women gave birth by cesarean section (n = 40, 66.7%) or vaginal delivery (n = 20, 33.3%). Most patients underwent caesarean sections for high bed turnover due to lack of COVID-19 isolation beds (n = 34, 85.0%). The mean (± standard deviation [SD]) maternal age was 34 (± 4.7) years. Delivery was performed at a mean gestational age of 38+2 weeks (± 2+0), and 9 patients (15.0%) had underlying diseases. Diabetes was the most common underlying disease (n = 4, 13.3%). Among them, three patients were gestational diabetes mellitus and one patient was type 1 diabetes mellitus. The median (interquartile range [IQR]1 – IQR3) number of days from the date of diagnosis of SARS-CoV-2 infection to delivery was 1 (0 – 2.3). Thirty-three of the 60 (55.0%) patients had positive SARS-CoV-2 PCR results before admission, 24 of 60 (40.0%) had positive SARS-CoV-2 PCR test at admission day, and 3 patients had positive SARS-CoV-2 PCR results after admission. The period from the date of diagnosis to the date of delivery (mean (± SD)) was 2.6 (± 1.6) days for cases diagnosed before hospitalization, 0.2 (± 0.4) days for cases diagnosed at the time of admission, and all cases diagnosed after hospitalization gave birth on the day of diagnosis.
Table 1. Maternal characteristics.
| Variables | n (%) | |
|---|---|---|
| Age (year), mean (SD) | 34 (± 4.7) | |
| Period | ||
| Pre-delta (Sep 2020 – May 2021) | 1 (1.7) | |
| Delta dominant (June 2021 – Jan 2022) | 13 (21.7) | |
| Omicron dominant (Feb 2022 – Apr 2022) | 46 (76.7) | |
| Gestational age (weeks), mean (SD) | 38+2 (± 2+0) | |
| Period between first positive SARS-CoV-2 test and delivery (day), median (IQR) | 1 (0 - 2.3) | |
| Birth-related complications | 1 (1.7) | |
| Method of delivery | ||
| Cesarean section | 40 (66.7) | |
| Vaginal delivery | 20 (33.3) | |
| Vaccination | ||
| Yes | 9 (15.0) | |
| No | 33 (55.0) | |
| Unknown | 18 (30.0) | |
| Underlying disease | ||
| Any disease | 9 (15.0) | |
| DM | 4 (13.3) | |
| Solid cancer | 2 (3.3) | |
| Cardiovascular disease | 2 (3.3) | |
| HTN | 1 (1.7) | |
| Pneumonia | ||
| Total | 7 (11.7) | |
| Pre Omicron dominant period | 3 (5.0) | |
| Omicron dominant period | 4 (6.7) | |
| Lymphocyte count, mean (SD) | 1,208 (± 553.5) | |
| Lymphocytopenia (<1,000/mcL) | ||
| Yes | 16 (26.7) | |
| No | 22 (36.7) | |
| Unchecked | 22 (36.7) | |
| CRP (mg/dL), mean (SD) | 0.94 (± 0.76) | |
| Elevated CRP (>0.6 mg/dL) | ||
| Yes | 30 (50.0) | |
| No | 27 (45.0) | |
| Unchecked | 3 (5.0) | |
| Elevated LD (>250 IU/L) | ||
| Yes | 16 (56.7) | |
| No | 34 (26.7) | |
| Unchecked | 10 (16.7) | |
| Oxygen supply | 2 (3.3) | |
| ICU care | 0 (0.0) | |
| Symptom | ||
| Any symptom | 37 (61.7) | |
| Fever | 18 (70.0) | |
| Chill | 6 (10.0) | |
| Cough | 21 (35.0) | |
| Sputum | 9 (15.0) | |
| Sore throat | 13 (21.7) | |
| Dyspnea | 3 (5.0) | |
| Rhinorrhea | 4 (6.7) | |
| Myalgia | 6 (10.0) | |
| Headache | 7 (11.7) | |
| Nasal congestion | 3 (5.0) | |
| Hyposmia | 1 (1.7) | |
| Hypogeusia | 1 (1.7) | |
| Severity | ||
| Asymptomatic | 23 (38.3) | |
| Mild illness | 25 (41.7) | |
| Moderate illness | 10 (26.1) | |
| Severe illness | 2 (5.2) | |
| Critical illness | 0 (0.0) | |
| Treatment | ||
| Regdanvimab | 10 (16.7) | |
| Dexamethasone | 1 (1.7) | |
| Remdesivir | 1 (1.7) | |
| Mechanical ventilation | 0 (0.0) | |
| In hospital mortality | 0 (0.0) | |
SD, standard deviation; SARS-CoV-2, severe acute respiratory syndrome corona virus 2;
IQR, Interquatile range; DM, diabetes mellitus; HTN, hypertension; CRP, C-Reactive Protein; LD, Lactate Dehydrogenase; ICU, intensive care unit.
Of these 60 patients, 9 (15.0%) received COVID-19 vaccinations. Among them, there were two patients (3.3%) who completed up to the third dose vaccination. There was no statistically significant difference in severity (P = 0.18) and pneumonia occurrence (P = 0.51) depending on vaccination status. But, symptomatic COVID-19 was more common in unvaccinated group than in vaccinated group (P = 0.02). Baseline characteristics of pregnancy patients with COVID-19 according to vaccination status are shown in Supplementary Table 1.
There were 48 (80.0%) women who were asymptomatic or had mild illness. Pneumonia was confirmed by chest radiographs in 7 patients (11.7%), and 2 patients (3.3%) required supplemental oxygen therapy and eventually recovered. During the period before Omicron variant, pneumonia was diagnosed in 3 out of 14 (21.4%) patients, while during the period when the Omicron variant was dominant, 4 out of 46 (8.7%) patients had pneumonia (P = 0.41). (Supplementary Table 2).
Of the clinical symptoms, pregnant women with SARS-CoV-2 infection commonly presented with cough (n = 21, 35.0%) at admission. One woman had a delivery-related complication. After cesarean section, active bleeding was confirmed, and embolization and open surgery were performed. There were 10 (16.7%) women who received monoclonal antibody, such as regdanvimab (Celltrion Inc, Incheon, Korea). Because pregnant women were classified as a high-risk group for COVID-19 complications, regdanvimab was mainly given immediately after delivery to asymptomatic pregnant women from November 2021 to January 2022 when the Delta variant was dominant. There was no further use of regdandimab from February 2022, when the Omicron variant was dominant.
Neonatal demographic and clinical characteristics are shown in Table 2. The mean weight (± SD) of newborns was 3,137 g (± 558), of which 8 neonates (12.7%) were considered to be of a low-birth weight (< 2,500 g), and 11 neonates (17.5%) were born prematurely (<37 weeks of gestation). Eight cases of preterm delivery occurred, on average, at 35+0 weeks (± 2+0) of gestational age. Four patients had premature rupture of membranes, 1 had vaginal bleeding associated with placenta previa totalis, 3 had twin pregnancies, and 1 had early labor pain with unknown etiology. It was not known whether the cause of 5 cases of premature membrane rupture and 1 case of labor pain were related to SARS-CoV-2 infection, but there was no case of premature delivery due to the deterioration of the mother's condition such as respiratory failure due to SARS-CoV-2 infection. Median Apgar score (IQR1 – IQR3) was 8 (8 - 9) at 1 minute and 9 (9 - 9.5) at 5 minutes. 21 of them (33.3%) required oxygen supplement, 1 (1.6%) required neonatal resuscitation with positive pressure ventilation, and 2 (3.2%) required endotracheal intubation in delivery room. Five neonates (7.9%) required mechanical ventilation including Continuous Positive Airway Pressure (CPAP) in neonatal intensive care unit, four of whom eventually recovered. Among them, four neonates (6.3%) required invasive mechanical ventilation. Their gestational age at birth, birthweight, reasons for using mechanical ventilation (including CPAP), period of use of mechanical ventilation, their mother’s severity are summarized in Table 3. All neonates exhibited negative SARS-CoV-2 PCR results within 24 hours of birth. All 45 newborns who underwent the SARS-CoV-2 PCR test at 48 hours after birth were confirmed to be negative. In the case of a long stay of the newborn after 48 hours, SARS-CoV-2 PCR test was performed on the 7th and 14th days, but it was confirmed to be negative. Thus, there was no vertical transmission in any of the 63 neonates (0%, 95% confidence interval [CI]: 0 - 6).
Table 2. Neonatal characteristics.
| Variable | n (%) | |
|---|---|---|
| Sex | ||
| Male | 37 (58.7) | |
| Female | 26 (41.3) | |
| Gestational age (weeks), mean (SD) | 38+2 (± 2+0) | |
| Birthweight (g), mean (SD) | 3,137 (± 557.6) | |
| Low birthweight (<2,500 g) | 8 (12.7) | |
| Preterm birth (<37 weeks) | 11 (17.5) | |
| Small for gestational age | 14 (22.2) | |
| Apgar score median (IQR) | ||
| 1 min | 8 (8 - 9) | |
| 5 min | 9 (9 - 9.5) | |
| Delivery room management | ||
| Oxygen supply | 21 (33.3) | |
| Positive pressure ventilation | 1 (1.6) | |
| Endotracheal intubation | 2 (3.2) | |
| Cardiac compression | 0 (0.0) | |
| Epinephrine administration | 0 (0.0) | |
| SARS-CoV-2 PCR (positive) | ||
| 1st (n = 63) | 0 (0.0) | |
| 2nd (n = 45) | 0 (0.0) | |
| Vertical transmission | 0 (0.0) | |
| Mechanical ventilation | ||
| Invasive | 4 (6.3) | |
| Non-invasive | 1 (1.6) | |
| Mortality | 0 (0.0) | |
SD, standard deviation; IQR, Interquartile range; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; PCR, polymerase chain reaction.
Table 3. Neonatal characteristics.
| Characteristics | Neonate 1 | Neonate 2 | Neonate 3 | Neonate 4 | Neonate 5 |
|---|---|---|---|---|---|
| Gestational age (weeks + days) | 34+4 | 39+0 | 40+1 | 29+2 | 34+1 |
| Birthweight (g) | 2,930 | 3,560 | 2,930 | 1,180 | 2,600 |
| Reasons for using mechanical ventilation | Respiratory distress syndrome | Not breathing at birth | Absent pulmonary valve syndrome, ventricular septal defect | Respiratory distress syndrome | Transient tachypnea of the newborn |
| Period of use of mechanical ventilation including CPAP (day) | 7 | 3 | 29 | 63a | 2 |
| Mother’s severity | Moderate illness | Moderate illness | Moderate illness | Asymptomatic | Asymptomatic |
aCurrently hospitalized and CPAP applied state.
CPAP, Continuous positive airway pressure.
DISCUSSION
In this observational study, none of the pregnant women diagnosed with COVID-19 treated at intensive care unit (ICU) or died. Most of patients (n = 58, 97.0%) were classified as having mild to moderate disease. Also, there was no case where vertical transmission was proven.
The previous studies suggest that vertical transmission can occur [7,8]. However, most studies on the vertical transmission of SARS-CoV-2 in clinical practice were based on case reports or small case series [9,10,11,12,13,14]. According to a systematic review, no clear evidence for vertical transmission of SARS-CoV-2 has been suggested from the available literature [15]. According to another systematic review study, vertical transmission was possible; however, it was unclear whether SARS-CoV-2 positive neonates were infected in utero, intrapartum or postpartum [16]. A more recent multicenter cohort study investigating 255 neonates, reported SARS-CoV-2 infection in 2.0% of neonates [5]. In contrast, in a recent retrospective study of 101 newborns in New York, no clinical evidence of vertical transmission was identified [17]. The results of this study suggest that the risk of vertical transmission in practice was not high. Our study is also consistent with these New York data. The data on the probability of vertical transmission provide important information for managing the healthcare system during childbirth and newborn care as outbreaks, such as those caused by the omicron variant, exacerbate the pandemic [18]. Although it may be ideal to care for newborns in an appropriate isolation facility and deliver in a negative pressure operating room, when the medical system is overloaded, a lack of resources makes it difficult to provide the appropriate facilities, thus clinicians should consider the risk of vertical transmission while distributing these resources. In this respect, our data provide important scientific evidence for Korea Disease Control and Prevention Agency’s policy to allow childbirth in general obstetric rooms during the omicron pandemic period. However, all deliveries were performed in a negative pressure room in this study, so it is difficult to generalize our findings to the delivery in a non-negative pressure isolation room. Further studies are needed on this area.
According to a systematic review, pregnant women with COVID-19 were less likely to manifest symptoms such as fever, dyspnea, and myalgia, more likely to be admitted to an ICU or need invasive ventilation, more likely to deliver prematurely, have an increased risk of maternal death. And the neonates were more likely to be admitted to the neonatal unit [4]. A recent study of 6,012, SARS-CoV-2 infected pregnant women in Canada also reported that the hospitalization rate, ICU admission rate, and the preterm birth rate were higher in pregnant women with COVID-19 than in non-pregnant women with COVID-19 [19]. In contrast, according to a systematic review, the majority of mothers were discharged without any major complications, while severe maternal morbidity as a result of SARS-CoV-2 infection and perinatal death were reported [17]. Another systematic review also reported that severe and critical disease in pregnant women with COVID-19 were similar to that in general population [16]. Despite of these available data, it is worth to note that there were insufficient study to examine the impact of vaccination status on severity of infection in COVID-19 pregnant women.
In our study, there was no statistically significant difference in severity (P = 0.18) and pneumonia occurrence (P = 0.51) depending on vaccination status. But, symptomatic COVID-19 was more common in unvaccinated group than in vaccinated group (P = 0.02). Interestingly, most pregnant women who were about to give birth experienced mild illness despite low vaccination rate. This discrepancy between studies might stem from the different gestation age and the different stages of the COVID-19 pandemic that could affect COVID-19 treatment, vaccination status, and the dominance of SARS-CoV-2 variants. In our study, only 2 out of 9 patients completed the 3rd dose vaccination. For these reasons, it is difficult to evaluate whether vaccination affects the incidence rate of pneumonia and symptom. Further research is needed on this area. Nevertheless, although most unvaccinated pregnant Korean women who were about to give birth had favorable outcomes during the omicron-dominant period, COVID-19 vaccination in pregnant women cannot be overemphasized because of complications during delivery in SARS-CoV-2-infected pregnant women and the concern of the emergence of new variants.
In delivery, the participation of a health care provider who is sufficiently trained in neonatal resuscitation is essential. A multidisciplinary approach, including a neonatologist, was recommended for neonatal resuscitation according to guidelines early in the COVID-19 pandemic [20]. Wearing all personal protective equipment, they participated in the delivery process of SARS-CoV-2-infected mothers, which may or may not require resuscitation of the newborn. However, the lack of medical resources brought about by the Omicron pandemic has made it laborious to provide adequate resuscitation to newborns born to all COVID-19 mothers. The number of neonates receiving positive pressure ventilation or intubation reported in this study was 3 (4.8%), which was not higher than the 6.0% reported in other literature [21]. Therefore, our report can be influential for efficiently allocating medical resources during a pandemic. In addition, according to the Centers for Disease Control and Prevention (CDC) guideline [22], healthy newborns can room-in with their COVID-19 mothers if they wear masks and follow hand hygiene. None of the patients enrolled in our study were allowed rooming-in or breastfeeding during hospitalization. This policy might minimize postpartum transmission. So, additional research will be needed in the settings of rooming-in or breast feeding. However, until more solid data about the transmission risk of rooming-in or breast feeding are available, the discussion-based decision for the rooming-in or breast feeding with mothers weighting the benefits and potential risk or uncomfortable feelings with this potential risk is reasonable.
The rate of respiratory disorders occurring in newborns is known to be about 3.0% [23,24]. In this study, 21 (33.3%) of 63 newborns required oxygenation immediately after birth. Although most of the cases temporarily recovered after oxygenation, it seems like that a significant number of newborns delivered from COVID-19 mothers required oxygenation. In previous studies, SAS-CoV-2 infection can alter oxygen supply of placenta [25,26]. So, this might partially explain the high oxygen requirement rate in the neonates from pregnant women with SARS-CoV-2 infection in this study. Further studies are needed on this area. Five neonates (7.9%) required mechanical ventilation in our study. All of their mothers had a severity between asymptomatic and moderate illness. In one meta-analysis study, compared with mild COVID-19, severe COVID-19 was strongly associated with preeclampsia, preterm birth, gestational diabetes and low birth weight [27,28]. In another study, compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications [29]. Despite of this, it is difficult to draw a firm conclusion about whether the maternal SARS-CoV-2 infection might not affect the poor obstetrical outcome of these 5 neonates because the pregnant women with SARS-CoV-2 infection may affect the pregnancy outcomes regardless of severity.
This study has some limitations. First, due to neonatal discharge, approximately 28.6% of neonates were unable to undergo SARS-CoV-2 PCR testing at 48 hours after birth. So, our estimate of vertical transmission might be underestimated. Second, we could not determine the exact timing of maternal infection, especially in pregnant women with asymptomatic SARS-CoV-2 infection. Since all maternal and neonate data were collected retrospectively through electronic medical records, the prognosis of the mother and the newborn could not be confirmed after discharge. Moreover, our results may not be generalized as it is a single center study. Further, this study could not have a large sample size. It is necessary to investigate with a large sample size whether vertical transmission occurs with SARS-CoV-2 infection. Future studies should analyze prognosis by comparing pregnant women with and without SARS-CoV-2 infection. Additional genetic and pathological studies by collecting placenta and blood samples of the mother with SARS-CoV-2 infection and blood samples of the newborn may also be helpful to study vertical transmission further.
In conclusion, we found that most of pregnant women with SARS-CoV-2 infection experienced mild to moderate severity of COVID-19. There were no cases of vertical transmission in neonates. Based on this, managing the risks associated with infection of pregnant women and their neonates during the COVID-19 pandemic should be considered.
ACKNOWLEDGMENTS
The authors thank A Reum Kim, Somi Park, Sung Woon Kang, Yun Woo Lee, So Yun Lim, Euijin Chang, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, for their technical advice for this study.
Footnotes
Funding: This study was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), which is funded by the National Institute of Infectious Diseases, National Institute of Health, Republic of Korea (grant No. HD22C2045).
Conflict of Interest: No conflict of interest.
- Conceptualization: EJ, SHK.
- Data curation: JL.
- Formal analysis: JL, MYL, JL.
- Funding acquisition: SHK.
- Investigation: JL, MYL, JL.
- Methodology: MYL, JL, EJ, SHK.
- Software: JL.
- Validation: JL.
- Visualization: JL.
- Writing - original draft: JL.
- Writing - review & editing: JL, MYL, JL, EJ, SB, JJ, MJK, YPC, HSW, EJ, SHK.
SUPPLEMENTARY MATERIALS
Baseline characteristics of pregnancy patients with COVID-19 according to vaccination
Baseline characteristics of pregnancy patients with COVID-19 according to COVID-19 variant
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Baseline characteristics of pregnancy patients with COVID-19 according to vaccination
Baseline characteristics of pregnancy patients with COVID-19 according to COVID-19 variant