We greatly appreciate the interest in our work and the opportunity to respond to the issues raised. The letters by Sriwijitalai and Wiwanitkit and by Li and colleagues raise the issue of transplacental transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 , 2 Since the publication of our paper online on February 24, 2020,3 several papers addressing this issue have been published, including a paper by Vivanti et al4 that provides strong evidence for transplacental transmission of SARS-CoV-2. In this case report, the mother presented to the hospital at 35 weeks’ gestation with symptoms of coronavirus disease 2019 (COVID-19), and her nasopharyngeal and vaginal swabs, blood, amniotic fluid, and placenta all tested positive for SARS-CoV-2. She gave birth via cesarean delivery to a neonate who required intubation for 6 hours because of low Apgar scores. The baby’s blood, bronchoalveolar lavage, and nasopharyngeal and rectal swabs were all positive for SARS-CoV-2 on day of life (DOL) 1, with nasopharyngeal and rectal swabs also positive on DOL 3 and DOL 18. The neonate developed neurologic symptoms on DOL 3, and brain magnetic resonance imaging showed white matter gliosis on DOL 11. The test result of the cerebrospinal fluid sample was negative for SARS-CoV-2. Thus, based on recent evidence, it appears that transplacental transmission of SARS-CoV-2 can occur, although it appears to be rare; however, its effects on the newborn remain unclear.
The letter by Liauw and colleagues raises the issue of antenatal corticosteroids.5 Since our paper was published, additional evidence regarding corticosteroids has become available, including a controlled trial in which patients with severe COVID-19 (those receiving respiratory support) who were treated with dexamethasone had significantly lower mortality than those who received usual care.6 Thus, the concern about corticosteroid use in patients with COVID-19 is no longer relevant; consistent with the guidelines developed by the American College of Obstetricians and Gynecologists,7 corticosteroid administration is recommended for pregnant women at risk of preterm delivery to improve neonatal outcomes.
The response to COVID-19 continues to be a rapidly evolving situation, and as we continue to learn more, we anticipate that guidance will continue to change. It is therefore critical that clinicians keep abreast of current developments.
Footnotes
The authors report no conflict of interest.
References
- 1.Sriwijitalai W., Wiwanitkit V. Comparative nanostructure consideration on novel coronavirus and possibility of transplacental transmission. Am J Obstet Gynecol. 2020;223:955. doi: 10.1016/j.ajog.2020.08.061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Li P., Xie M., Zhang W. Clinical characteristics and intrauterine vertical transmission potential of coronavirus disease 2019 infection in 9 pregnant women: a retrospective review of medical records. Am J Obstet Gynecol. 2020;223:955–956. doi: 10.1016/j.ajog.2020.08.059. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Rasmussen S.A., Smulian J.C., Lednicky J.A., Wen T.S., Jamieson D.J. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;222:415–426. doi: 10.1016/j.ajog.2020.02.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Vivanti A.J., Vauloup-Fellous C., Prevot S. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020;11:3572. doi: 10.1038/s41467-020-17436-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Liauw J., Gundy S., Rochwerg B., Hutcheon J.A. Antenatal corticosteroids and COVID-19: balancing benefits and harms. Am J Obstet Gynecol. 2020;223:956–957. doi: 10.1016/j.ajog.2020.08.062. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.RECOVERY Collaborative Group. Horby P., Lim W.S. Dexamethasone in hospitalized patients with Covid-19 - preliminary report. N Engl J Med. 2020 doi: 10.1056/NEJMoa2021436. [Epub ahead of print] [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Committee on Obstetric Practice Committee Opinion no. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2017;130:e102–e109. doi: 10.1097/AOG.0000000000002237. [DOI] [PubMed] [Google Scholar]