COVID-19 em gestantes, parto prematuro, peso ao nascer e transmissão vertical: uma revisão sistemática e metanálise

Melo, Géssyca Cavalcante de; Araújo, Karina Conceição Gomes Machado de

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REVIEW • Cad. Saúde Pública 36 (7) • 2020 • https://doi.org/10.1590/0102-311X00087320 copiar

COVID-19 em gestantes, parto prematuro, peso ao nascer e transmissão vertical: uma revisão sistemática e metanálise

Autoria SCIMAGO INSTITUTIONS RANKINGS

O número de casos confirmados de COVID-19 no mundo ultrapassou 1.684.833 em apenas quatro meses. Ainda não há evidências claras sobre os efeitos da COVID-19 em gestantes. Realizamos uma revisão sistemática e meta-análise em gestantes para esclarecer se a COVID-19 tem relação com a prematuridade e o peso ao nascer, além de resumir os resultados diagnósticos em recém-nascidos de mães com COVID-19 para investigar a possibilidade de transmissão vertical. Foram realizadas buscas em PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv e medRxiv. Como medidas de análise, utilizamos a razão de chances (OR) e a diferença média (DM). Foram calculadas estimativas sintéticas com o uso de modelos de efeitos randômicos. Trinta e oito estudos foram incluídos, com análise de dados de 279 mulheres, 60 das quais diagnosticadas com COVID-19. A meta-análise não mostrou associação significativa entre COVID-19 e parto prematuro (OR = 2,25; IC95%: 0,96, 5,31; p = 0,06; I² = 0%). Não houve relação significativa entre peso ao nascer e COVID-19 (DM = -124,16; IC95%: -260,54, 12,22; p = 0,07; I² = 0%). Entre 432 recém-nascidos, 10 testaram positivos para SARS-CoV-2. Devido às características dos estudos, o nível de evidências do estudo foi considerado muito baixo. A COVID-19 em gestantes pode não estar associada à ocorrência de prematuridade ou peso ao nascer, mas as evidências acumuladas até o momento não são conclusivas. Alguns relatos sugerem que a transmissão vertical do SARS-CoV-2 para o feto seja possível, mas as evidências ainda são incompletas.

Palavras-chave:
COVID-19; Gravidez; Transmissão Vertical de Doenças Infecciosas

Study	Local and pregnant COVID-19 +/COVID-19 - (n/n)	Inclusion criteria	Control group	Comorbidities	Type of delivery	Symptoms and complications	Key findings
Li et al. ²¹21. Li N, Han L, Peng M, Lv Y, Ouyang Y, Liu K, et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020; [Online ahead of print].	Maternal and Child Health Hospital of Hubei Province, China (17/121)	Pregnant women who were admitted into the hospital during January 24 to February 29, 2020. Throat swabs were collected from all these patients and realized computed tomography imaging.	Pregnant women without pneumonia during the same period randomly selected from the medical records. Only those aged 25-35 years were selected to match the age range of cases. Considering the potential adverse effects of mental stress caused by city lockdown and severe epidemics, we also included the second control group of 121 women admitted during January 24 - February 11, 2019 (control 2019 group). For this meta-analysis we considered the 2020 group.	Two confirmed cases (12.5%) had chronic conditions of hypertension and polycystic ovary syndrome. Around 31% of the case group had other maternal complications, significantly higher than the control. All these complications were developed before diagnosis of COVID-19.	There were 12 patients who took emergency cesarean section because of active labor at the time of admission, and three had scheduled cesarean section. Two patients had vaginal delivery because neither presented any respiratory symptoms when admitted for full-term labor.	Four cases were admitted with fever for investigation and eight developed fever after childbirth. None presented other respiratory symptoms on admission nor during hospital stay. Seven had typical image of pneumonia in both lungs and eight in single lung. None were admitted into the intensive care unit because of COVID-19 or severe maternal complications	Among three confirmed cases COVID-19 with preterm delivery, two were caused by premature rupture of membranes, and one by placental bleeding. There were 23.5% preterm delivery among the newborns born to mothers with COVID-19 infection, significantly higher than from the control. Low birth weight also occurred more often in infants of case group (17.6%) than in control group (2.5%). However, neonates from the case and control showed no significant differences in key neonatal indicators. No events of deaths and vertical transmission occurred in these newborns.
Liao et al. ²³23. Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150:53-7.	Zhongnan Hospital of Wuhan University, China (10/53)	Pregnant women who delivered vaginally during January 20 to March 2, 2020.	Pregnant women without COVID-19 delivered vaginally on the same period.	No comorbidities were reported.	The delivery methods of the two groups of pregnant women were all by vaginal.	Five women had low fever a few days before the onset of labor; four patients had mild respiratory symptoms, and one patient did not complain of particular discomfort. Data showed nine women had a low lymphocyte ratio. All patients had a chest CT scan that showed typical findings of multiple patchy ground-glass shadows.	There was no statistically difference in premature rupture of membranes, premature delivery, neonatal asphyxia, amniotic fluid pollution, postpartum hemorrhage, or perineal lateral resection rate between the two groups. Three neonates were self-discharged from the hospital owing to family refusal of neonatal treatment. Throat swab tests SARS-CoV-2 performed twice (24 hours apart) in each of the seven neonates were all negative.
Lu et al. ²²22. Lu Z, Yan J, Min W, Ziheng C, Xiaocui Z, Jun L, et al. Analysis of pregnancy results of pregnant women during the epidemic of new coronavirus pneumonia in Hubei. Zhonghua Fu Chan Ke Za Zhi 2020; 55:166-71.	Wuhan University Hospital, China (16/45)	Pregnant women in the third trimester of pregnancy who were admitted into the hospital during January 30 to February 17, 2020.	Pregnant women with no COVID-19 infection and with cesarean section recommendation were recruited to eliminate the possible impact of different methods of delivery when comparing pregnancy outcomes.	One case had pre-eclampsia and three had gestational diabetes.	The delivery methods of the two groups of pregnant women were all by cesarean section.	One case was classified as severe with oxygen saturation in a resting state of 93%, accompanied by reduced fetal movement.	There were 11 cases of labor, marked uterus, premature rupture of membranes and one case of fetal distress in the group with COVID-19 infection. There were no statistically significant differences in gestation time, parity, gestational weeks, preterm delivery, intraoperative blood loss and neonatal birth weight between the two groups of pregnant women. No events of deaths and vertical transmission occurred in these newborns.

Study	Country	Period	Type of study	Pregnant woman with COVID-19/Neonates tested (n/n)	Cesarean (n)	Neonates with SARS-CoV-2 (n)	Neonatal diagnostic method
Chen et al. ⁹9. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, 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; 395:809-15.	China	February 4	Series report	3/3	3	0	RT-PCR: throat swab
Khan et al. ³⁶36. Khan S, Jun L, Nawsherwan Siddique R, Li Y, Han G, et al. Association of COVID-19 with pregnancy outcomes in health-care workers and general women. Clin Microbiol Infect 2020; 26:788-90.	China	January 28 - March 1	Series report	3/3	0	0	RT-PCR: throat swab
Li et al. ²¹21. Li N, Han L, Peng M, Lv Y, Ouyang Y, Liu K, et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020; [Online ahead of print].	China	January 24 - February 29	Case control	34/3	30	0	RT-PCR: throat swab
Lu et al. ²²22. Lu Z, Yan J, Min W, Ziheng C, Xiaocui Z, Jun L, et al. Analysis of pregnancy results of pregnant women during the epidemic of new coronavirus pneumonia in Hubei. Zhonghua Fu Chan Ke Za Zhi 2020; 55:166-71.	China	January 30 - February 17	Case control	16/10	16	0	RT-PCR: throat swab
Liao et al. ²³23. Liao J, He X, Gong Q, Yang L, Zhou C, Li J. Analysis of vaginal delivery outcomes among pregnant women in Wuhan, China during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150:53-7.	China	January 20 - March 2	Case control	10/7	0	0	RT-PCR: throat swab
Yin et al. ²⁴24. Yin MZ, Zhang L, Deng GT, Han CF, Shen MX, Sun HY, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection during pregnancy in china: a retrospective cohort study. medRxiv 2020; 11 apr. https://www.medrxiv.org/content/10.1101/2020.04.07.20053744v1. https://www.medrxiv.org/content/10.1101/...	China	January 28 - February 28	Cohort	31/27	22	0	RT-PCR: amniotic fluid, placenta, throat swab, anal swab, and breast milk
Nie et al. ²⁵25. Nie R, Wang SS, Yang Q, Fan C, Liu Y, He W, et al. Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019. medRxiv 2020; 27 mar. https://www.medrxiv.org/content/10.1101/2020.03.22.20041061v1. https://www.medrxiv.org/content/10.1101/...	China	January 1 - February 20	Cross-sectional	33/26	23	1	RT-PCR: throat, cord blood and placenta
Liu et al. ²⁶26. Liu W, Wang Q, Zhang Q, Chen L, Chen J, Zhang B, et al. Coronavirus disease 2019 (COVID-19) during pregnancy: a case series. Preprints 2020; 25 feb. https://www.preprints.org/manuscript/202002.0373/v1. https://www.preprints.org/manuscript/202...	China	February 2 - February 05	Series report	3/3	2	0	RT-PCR: throat swab
Liu et al. ²⁷27. Liu W, Wang Li W, Zhou ZX, Liu SY, Rong ZH. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med 2020; [Epub ahead of print].	China	January 31 - February 29	Cross-sectional	19/19	18	1: false positive	RT-PCR: throat swab, blood, urine, feces, amniotic fluid and breast milk
Chen et al. ¹³13. Chen D, Yang H, Cao Y, Cheng W, Duan T, Fan C, et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet 2020; 149:130-6.	China	No described	Series report	4/3	3	0	RT-PCR: throat swab
Li et al. ²⁹29. Li Y, Zhao R, Zheng S, Chen X, Wang J, Sheng X, et al. Lack of vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerg Infect Dis 2020; 26:1335-6.	China	February 6	Case report	1/1	1	0	RT-PCR: throat swab
Yang et al. ³⁰30. Yang P, Wang X, Liu P, Wei C, He B, Zheng J, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol 2020; 127:104356.	China	January 20 - January 29	Cross-sectional	7/7	7	0	RT-PCR: throat swab, amniotic fluid, and umbilical cord blood
Peng et al. ³¹31. Peng Z, Wang J, MoY, Duan W, Xiang G, Yi M, et al. Unlikely SARS-CoV-2 vertical transmission from mother to child: a case report. J Infect Public Health 2020; 13:818-20.	China	No described	Case report	1/1	1	0	RT-PCR: throat swab, anal, serum, bronchoalveolar lavage fluid, urine, amniotic fluid, vaginal secretions, cord blood, placenta, and breast milk
Yu et al. ³²32. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, 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; 20:559-64.	China	January 1 - February 8	Cross-sectional	7/7	7	3	RT-PCR: throat, placenta, and cord blood
Alzamora et al. ³³33. Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; [Online ahead of print].	Peru	March 29	Case report	1/1	1	1	RT-PCR: throat swab + serology
Xiong et al. ³⁴34. Xiong X, Wei H, Zhang Z, Chang J, Ma X, Gao X, et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID-19. J Med Virol 2020; [Online ahead of print].	China	January 29	Case report	1/1	0	0	RT-PCR: throat swab, anal swab, breast milk, amniotic fluid and cervical secretion
Chen et al. ³⁵35. 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; [Online ahead of print].	China	January 20 - January 31	Cross-sectional	9/9	9	0	RT-PCR: amniotic fluid, cord blood, throat swab and breast milk
Khan et al. ³⁶36. Khan S, Jun L, Nawsherwan Siddique R, Li Y, Han G, et al. Association of COVID-19 with pregnancy outcomes in health-care workers and general women. Clin Microbiol Infect 2020; 26:788-90.	China	January 25 - February 15	Series report	17/18	17	2	RT-PCR: throat swab
Yang et al. ³⁷37. Yang H, Sun G. Tang F, Peng M, Gao Y, Peng J, et al. Clinical features and outcomes of pregnant women suspected of coronavirus disease 2019. J Infect 2020; 81:e40-e44.	China	January 20 - March 5	Case control	13/14	9	0	RT-PCR: throat swab
Zeng et al. ³⁸38. Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal early-onset Infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; [Online ahead of print].	China	January - February	Cohort	33/33	26	3	RT-PCR: throat and anal swab
Liu et al. ³⁹39. Liu Y, Haihong C, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020; [Online ahead of print].	China	January 31 - February 29	Cross-sectional	16/16	10	0	Not described
Dong et al. ⁴⁰40. Dong L, Tian J, He S. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323:1846-8.	China	February 22	Case report	1/1	1	1	RT-PCR: throat swab, vaginal secretions of the mother + serology
Schnettler et al. ⁴¹41. Schnettler WT, Al Ahwel Y, Suhag A. Severe ARDS in COVID-19-infected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM 2020; [Online ahead of print].	USA	March 23	Case report	1/1	1	0	RT-PCR: throat swab and amniotic fluid
Hantoushzadeh et al. ⁴²42. Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, et al. Maternal death due to COVID-19 disease. Am J Obstet Gynecol 2020; [Online ahead of print].	Iran	February - March	Series report	9/4	4	1	RT-PCR: throat swab
Qiancheng et al. ⁴³43. Qiancheng X, Jian S, Lingling P, Lei H, Xiaogan J, Weihua L, et al. Coronavirus disease 2019 in pregnancy. Int J Infect Dis 2020; 95:376-83.	China	January 15 - March 15	Cross-sectional	28/23	17	0	RT-PCR: throat swab
Lyra et al. ⁴⁴44. Lyra J, Valente R, Rosário M, Guimarães M. Cesarean section in a pregnant woman with covid-19: first case in Portugal. Acta Med Port 2020; 33:429-31.	Portugal	No described	Case report	1/1	1	0	RT-PCR: throat swab
Kelly et al. ⁴⁵45. Kelly JC, Dombrowksi M, O'neil-Callahan M, Kernberg AS, Frolova AI, Stout MJ. False-negative COVID-19 testing: considerations in obstetrical care. Am J Obstet Gynecol MFM 2020; [Online ahead of print].	USA	No described	Case report	1/1	1	0	RT-PCR: throat swab
Xu et al. ⁴⁶46. Xu L, Yang Q, Shi H, Lei S, Liu X, Zhu Y, et al. Clinical presentations and outcomes of SARS-CoV-2 infected pneumonia in pregnant women and health status of their neonates. Sci Bull (Beijing) 2020; [Epub ahead of print].	China	January 21 - February 9	Series report	9/5	4	0	RT-PCR: throat swab
Hu et al. ⁴⁷47. Hu X, Gao J, Luo X, Feng L, Liu W, Chen J, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vertical transmission in neonates born to mothers with Coronavirus Disease 2019 (COVID-19) pneumonia. Obstet Gynecol 2020; [Online ahead of print].	China	January 20 - February 2	Series report	7/7	6	1	RT-PCR: throat, blood, feces and urine
Lu et al. ⁴⁸48. Lu D, Sang L, Du S, Li T, Chang Y, Yang XA. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol 2020; [Epub ahead of print].	China	February 13	Case report	1/1	1	0	RT-PCR: throat swab and blood
Yan et al. ⁴⁹49. Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases. Am J Obstet Gynecol 2020; [Epub ahead of print].	China	January 20 - March 24	Cross-sectional	99/100	85	0	RT-PCR: throat swab, amniotic fluid and umbilical cord blood
Ferrazzi et al. ⁵⁰50. Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG 2020; [Online ahead of print].	Italy	March 1 - March 20	Cross-sectional	42/42	18	2	RT-PCR: throat swab
Lee et al. ⁵¹51. Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean J Anesthesiol 2020; [Online ahead of print].	South Korea	March	Case report	1/1	1	0	RT-PCR: throat swab, placenta, amniotic fluid and cord blood
Breslin et al. ⁵²52. Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; [Online ahead of print].	EUA	March 13 - March 27	Cross-sectional	43/18	8	0	RT-PCR: throat swab + serology
Sharma et al. ⁵³53. Sharma KA, Kumari R, Kachhawa G, Chhabra A, Agarwal R, Sharma A, et al. Management of the first patient with confirmed COVID-19 in pregnancy in India: from guidelines to frontlines. Int J Gynaecol Obstet 2020; 150:116-8.	India	No described	Case report	1/1	1	0	Not described
Chen et al. ⁵⁴54. Chen S, Huang B, Luo DJ, Li X, Yang F, Zhao Y, et al. Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases. Zhonghua Bing Li Xue Za Zhi 2020; 49:E005.	China	January 20 - February 10	Cross-sectional	3/3	3	0	RT-PCR: throat swab and placenta
Zhu et al. ⁵⁵55. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9:51-60.	China	January 20 - February 5	Series report	9/9	7	0	RT-PCR: throat swab
Fan et al. ⁵⁶56. Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis 2020; [Online ahead of print].	China	January 31	Series report	2/2	2	0	RT-PCR: throat swab, maternal serum, placenta tissues, umbilical cord blood, amniotic fluid, vaginal swabs, breast milk

Study	Local	Gestational age/Birth weight/Delivery	Apgar 1’/5'	Diagnostic method	Results and preventive measures
Nie et al. ²⁵25. Nie R, Wang SS, Yang Q, Fan C, Liu Y, He W, et al. Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019. medRxiv 2020; 27 mar. https://www.medrxiv.org/content/10.1101/2020.03.22.20041061v1. https://www.medrxiv.org/content/10.1101/...	China n = 1	- Cesarean	8-10/9-10	RT-PCR: throat swab, cord blood and placenta	The mother wore N95 mask during delivery. Newborn was immediately isolated after birth. He tested positive; imaging 53 hours (h) after was consistent with pulmonary infection. Cord blood and placental samples were both negative. He had no clinical symptoms and found negative for SARS-CoV-2 on days 4/8/15. Pulmonary infection had resolved. He did not receive treatment; discharged on day 16.
Alzamora et al. ³³33. Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; [Online ahead of print].	Peru n = 1	33 weeks 2,970g Cesarean	6/8	RT-PCR: throat swab + serology	Neonate was immediately isolated and intubated due to sedation of the mother. Delayed cord clamping, skin-to-skin contact and breastfeeding was not performed. Baseline and follow-up neonatal serology obtained at birth: negative IgG/IgM. RT-PCR of 16h/48h: positives. Maternal serology on postpartum day 1: negative IgG/IgM levels. IgG/IgM on repeat testing on day 4 (day 9 after symptom onset): positives. The newborn required ventilatory support for 12h, after which he was extubated and placed on continuous positive airway pressure; not requiring antibiotic. On day 6, he presented mild respiratory difficulty and sporadic cough requiring supplemental oxygen. Chest X-ray showed no abnormalities.
Khan et al. ³⁶36. Khan S, Jun L, Nawsherwan Siddique R, Li Y, Han G, et al. Association of COVID-19 with pregnancy outcomes in health-care workers and general women. Clin Microbiol Infect 2020; 26:788-90.	China n = 2	- 3,360g/3,570g Cesarean	9/10 9/10	RT-PCR: throat swab	The testing within 24 hours after the delivery were positive in two neonates. Intrauterine tissue samples such as placenta, cord blood or amniotic fluid were not tested.
Zeng et al. ³⁸38. Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal early-onset Infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; [Online ahead of print].	China n = 3	40/40/31 weeks 3,250g/3,360g /1,580g Cesarean	- - 3/4	RT-PCR: throat and anal swab	Neonates 1/2: On day 2 of life, they experienced lethargy and fever. Imaging showed pneumonia. RT-PCR was positive on days 2/4 of life and negative on day 6. Neonate 3: Resuscitation was required after birth. Neonatal respiratory distress syndrome and pneumonia confirmed by imaging were resolved on day 14 of life after noninvasive ventilation, caffeine, and antibiotics. RT-PCR was positive on days 2/4 of life and negative on day 7. Strict infection control procedures were implemented during the deliveries.
Dong et al. ⁴⁰40. Dong L, Tian J, He S. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323:1846-8.	China n = 1	- 3,120g Cesarean	9/10	RT-PCR: throat swab, vaginal secretions of the mother + serology	Neonate was born in a negative-pressure isolation room; had no symptoms and was immediately quarantined. The mother wore an N95 mask. At 2h of age, IgG (140.32 AU/mL) and IgM (45.83 AU/mL) were positives. Results from five RT-PCR tests on throat swabs taken from 2 h to 16 days were negative. IgM (11.75 AU/mL) and IgG (69.94 AU/mL) levels were still elevated on day 15. The results of test of the mother’s vaginal secretions were negative. On day 7 the breastmilk had a negative test result. Laboratory results displaying inflammation and liver injury. Newborn was discharged on day 26.
Hantoushzadeh et al. ⁴²42. Hantoushzadeh S, Shamshirsaz AA, Aleyasin A, Seferovic MD, Aski SK, et al. Maternal death due to COVID-19 disease. Am J Obstet Gynecol 2020; [Online ahead of print].	Iran n = 1	30 weeks 2,100g Cesarean	9/10	RT-PCR: throat swab	The premature neonate initially tested negative and tested positive on day-of-life seven while intubated.
Hu et al. ⁴⁷47. Hu X, Gao J, Luo X, Feng L, Liu W, Chen J, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vertical transmission in neonates born to mothers with Coronavirus Disease 2019 (COVID-19) pneumonia. Obstet Gynecol 2020; [Online ahead of print].	China n = 1	40 weeks 3,250g Cesarean	8/9	RT-PCR: throat, blood, feces and urine	The neonate had no clinical symptoms. Chest X-rays performed on the first day of life were also normal.

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[1] Correspondence
G. C. Melo Universidade Estadual de Ciências da Saúde de Alagoas. Rua Dr. Jorge de Lima 113, Maceió, AL 57010-300, Brasil. gessyca.melo@uncisal.edu.br