Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis

K F Walker; K O'Donoghue; N Grace; J Dorling; J L Comeau; W Li; J G Thornton

doi:10.1111/1471-0528.16362

Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis

BJOG. 2020 Oct;127(11):1324-1336. doi: 10.1111/1471-0528.16362. Epub 2020 Jul 22.

Authors

K F Walker¹, K O'Donoghue², N Grace³, J Dorling⁴, J L Comeau⁴, W Li⁵, J G Thornton¹

Affiliations

¹ Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK.
² The Irish Centre for Maternal and Child Health, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
³ School of English, University of Nottingham, Nottingham, UK.
⁴ Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
⁵ Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia.

Abstract

Background: Early reports of COVID-19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified?

Objective: To estimate the risk of the neonate becoming infected with SARS-CoV-2 by mode of delivery, type of infant feeding and mother-infant interaction.

Search strategy: Two biomedical databases were searched between September 2019 and June 2020.

Selection criteria: Case reports or case series of pregnant women with confirmed COVID-19, where neonatal outcomes were reported.

Data collection and analysis: Data were extracted on mode of delivery, infant infection status, infant feeding and mother-infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission.

Main results: Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated.

Conclusions: Neonatal COVID-19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother.

Tweetable abstract: Risk of neonatal infection with COVID-19 by delivery route, infant feeding and mother-baby interaction.

Keywords: COVID-19; SARS-COV-2; artificial feeding; birth; breast-feeding; caesarean; disambiguation; duplicate publication; isolation; neonatal infection; pregnancy.

Publication types

Systematic Review

MeSH terms

Betacoronavirus
Bottle Feeding / statistics & numerical data*
Breast Feeding / statistics & numerical data*
Breast Milk Expression
COVID-19
Cesarean Section / statistics & numerical data*
China / epidemiology
Coronavirus Infections / epidemiology*
Coronavirus Infections / transmission*
Delivery, Obstetric / statistics & numerical data
Female
Humans
Infant Formula*
Infant, Newborn
Infectious Disease Transmission, Vertical / statistics & numerical data*
Milk, Human
Mother-Child Relations
Pandemics
Pneumonia, Viral / epidemiology*
Pneumonia, Viral / transmission*
Pregnancy
Pregnancy Complications, Infectious / epidemiology*
Risk Factors
SARS-CoV-2