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Revista Española de Salud Pública

versión On-line ISSN 2173-9110versión impresa ISSN 1135-5727

Rev. Esp. Salud Publica vol.94  Madrid  2020  Epub 02-Nov-2020



Maternal and neonatal consequences of coronavirus COVID-19 infection during pregnancy: a scoping review

Rafael A Caparros-Gonzalez1 

1Facultad de Ciencias de la Salud. Departamento de Enfermería. Universidad de Granada. Granada. España.



Coronavirus disease 2019 (COVID-19) is a new pathology, declared a public health emergency by the World Health Organization, which can have negative consequences for pregnant women and their newborns. The aim of this study was to explore the available knowledge on the consequences of developing COVI-19 in pregnant women and their neonates.


Scoping Review, in which the search for articles was conducted using DeCS (“pregnancy”, “coronavirus”, “health”) and MeSH (“pregnan*”, “pregnant women”, “coronavirus”), linking the terms with the Boolean AND operator. Databases used were Web of Science, Scopus, BVS, Scielo and CUIDEN. In addition, the PRISMA methodology was applied.


Ten studies were identified that assessed maternal and neonatal health after maternal COVID-19 infection. Pregnant women seem to had no serious symptoms. Neonates appeared to be affected to a greater extent. A death was reported in a premature newborn whose mother had COVID-19 pneumonia. There did not appear to be vertical transmission from mother to child. Nevertheless, this information was not conclusive.


COVID-19 appears to be more benign with pregnant women than with their neonates.

Key words: SARS-CoV-2; COVID-19; Pregnancy; Neonate; New-born


Coronavirus disease 2019 (COVID-19) is a new pathology with a rapid increase of infections and deaths since it was first identified in Wuhan (China) in December 20191. Available data on its effects on pregnant women and offspring are still sparse. Nevertheless, information regarding its detrimental consequences on the respiratory tract may help discover how it may affect pregnant women and their developing fetuses1.

Coronavirus is a virus that causes infections in humans and animals. More specifically, it is a zoonotic pathology, that is, it can be transmitted from animals to humans2. They can cause several diseases from a common cold to Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS-CoV)2. As a result of COVID-19 disease, the World Health Organization (WHO) stated in late January 2020 that we were (and are) facing a pandemic and an international public health emergency3.

During pregnancy, a variety of environmental circumstances can affect maternal and newborn health4,5,6. Taking this into consideration, it is known how the environment a pregnant woman is exposed to can create a permanent imprint on fetal physiology, which will last a lifetime. Thus, as stated from the Developmental Origin of Health and Disease (DOHaD) theory promulgated by epidemiologist David Barker, fetal programming that occurs during prenatal development will determine the health and illness of that individual throughout his extrauterine life7. Exposure to viruses has been described among the prenatal events that may affect the health of the developing fetus8.

Due to the special care we must give to pregnant women and their newborns9, and the information provided before, the aim of this study was to explore the available knowledge on the consequences of developing COVID-19 in pregnant women and newborns during pregnancy.


In order to perform an initial mapping of the literature, the methodology referring to a scoping review was used10,11. The characteristics of a scoping review are that it is systematic and rigorous. In addition, it allows the possibility of generating hypotheses, as well as proposing which areas of study are partially developed12.

Thus, the search for articles was carried out using the DeCS (“pregnancy”, “coronavirus”, “health”) and MeSH (“pregnan*”, “pregnant women”, “coronavirus”) directories, linking the terms with the Boolean operator AND. The inclusion criteria were: articles in Spanish or English language, published in the last 2 years (due to the novelty of the subject), that included the full text, including pregnant women, and that addressed the maternal and/or neonatal infections consequences of coronavirus infection during pregnancy. In addition, other sources of information were used such as the Spanish Society of Gynecology and Obstetrics (SEGO), the Royal College of Obstetricians and Gynaecologists (UK), The Royal College of Midwives (UK), Royal College of Paediatrics and Child Care (UK) and the WHO final report on the China-WHO joint mission on COVID-19. Exclusion criteria were opinion articles and animal studies.

The databases in which the search was performed were Web of Science, Scopus, BVS, Scielo and CUIDEN. In addition, Google Scholar was used to identify potential articles not indexed in the databases used. The search was carried out between February-March 2020. Figure 1 shows the PRISMA flow diagram13, reflecting the search and selection process for articles according to the inclusion criteria. Finally, 10 studies were selected for further analysis.

Figure 1.  PRISMA flow diagram reflecting the search and selection process. 


The novelty of this topic helped that 10 studies met the inclusion criteria and were included in this scoping review14,15,16,17,18,19,20,21,22,23. Table 1 shows the main results of the included empirical studies (n=5)14,15,16,17,18. All empirical studies (n=5) were observational, either single case or case series. The total sample of the 5 empirical studies was 64 pregnant women and 65 neonates (one pregnancy was twin). The 100% (n=5) of empirical studies were conducted in China14,15,16,17,18. A study on recommendations for obstetricians based on the SARS-CoV coronavirus and on the Middle East Respiratory Syndrome (MERS) was included19. In addition, a consensus of experts from China for perinatal and neonatal management in the prevention and control of COVID-19 was added in the review20. Furthermore, among the documents included in this exploratory review were three reports of recommendations for health professionals prepared by the Spanish Society of Gynecology and Obstetrics (SEGO), the Royal College of Obstetricians and Gynaecologists (UK), The Royal College of Midwives (UK), Royal College of Paediatrics and Child Care (UK) and the China-WHO joint mission on COVID-1921,22,23.

Table 1.  Maternal and neonatal outcomes of the empirical studies included in the scoping review. 

Maternal and placental infection by COVID-19

In all 5 empirical studies, pregnant women tested positive for COVID-19 infection14,15,16,17,18.

Although the predominant symptom of pregnant women was fever14,15,16,17,18, in some cases, it did not appear until after delivery or caesarean section14,15,16,17,18. In a case, the pregnant woman debuted with cholecystitis18. The vast majority of pregnant women did not have severe pneumonia, nor did they require intensive care. In addition, none died14,15,16,17,18, being discharged without excessive complications a few days after admission. According to the reviewed studies, only one pregnant woman had to be transferred to a critical care area, but was also discharged with no complications14.

COVID-19 coronavirus was not detected in the analyzed placentas14,16. Nevertheless, a placenta showed chorionic hemangioma morphology14 and a different one had a large area of necrosis14. No placenta showed changes related to chorioamnionitis14. Amniotic fluid, umbilical cord blood, breast milk, and oropharyngeal swab samples from newborns were negative in 6 cases in one study15. Samples of amniotic fluid, umbilical cord blood, placenta blood, and breast milk were also negative in a single case study of a positive pregnant woman to SARS-CoV-216.

Technical consensus reports for professionals and the China-WHO joint mission found that pregnant women were not more likely to become infected with COVID-19 than non-pregnant women19,21,23. The majority of pregnant women only showed mild to moderate symptoms similar to a cold or flu. Only those with some underlying disease, such as diabetes, chronic lung disease, or an immunosuppressed state, were more susceptible to severe symptoms22.

Neonatal consequences of maternal infection to COVID-19

Neonates from mothers who tested positive for COVID-19 were sampled for the SARS-CoV-2 coronavirus, with three infants having a negative test to SARS-Co-2 oropharyngeal samples in one study14, and nine neonates having a negative test to SARS-Co-2 oropharyngeal samples in another study15. A neonate from an unique case study also had a negative test to SARS-Co-2 oropharyngeal samples16. No symptoms of dyspnea or suffocation were found in the neonates14,15,16. Fetal heart rate was only reported in a unique case study with 110 beats per minute16. This neonate was born by caesarean section and no complications were reported. In one of the studies that carried out a clinical analysis of 10 newborns born to mothers with a positive result for COVID-19, it was found that 40% (n=4) of term births and 60% (n=6) of premature births18. Additionally, in this same study, two infants were reported to be small for gestational age (SGA) and one was large for gestational age (LGA)18. Of these infants, a total of 6 had dyspnea, in addition to two who had fever and thrombocytopenia, along with tachycardia, vomiting, and pneumothorax in one case18. To date of one of the studies included in this review18, a total of 5 infants has been discharged from hospital, four remained hospitalized and stable, and one had died due to complications. The Chinese consensus group in relation to neonatal management reported two cases of neonates that were positive for SARS-CoV-2, having the worst prognosis those who also were premature20.

Vertical intrauterine transmission of COVID-19 from the pregnant woman to the developing fetus

Vertical transmission refers to microorganisms moving from the mother to the fetus before and after birth, through the cord blood, the placenta, the birth canal or through breastfeeding18. All empirical studies in this review reported an absence of vertical transmission of the coronavirus from the pregnant mother to the developing fetus14,15,16,17,18. However, it should be noted that there was a neonate from one of the studies who was not tested and it is therefore unknown whether or not he was infected with COVID-19 in the perinatal period18. Furthermore, as mentioned, maternal infection with COVID-19 had negative consequences in some of the neonates. The Royal College of Obstetricians and Gynaecologists (UK), The Royal College of Midwives (UK) and Royal College of Paediatrics and Child Care (UK)22 declared in their consensus document for professionals that there was no evidence of vertical transmission (during pregnancy) from mothers to the offspring. Moreover, the group of experts from China, the recommendations of the American Gynaecology Association and the Spanish Society of Gynecology and Obstetrics (SEGO) stated that it is impossible to rule out the circumstance of vertical transmission19,20,21.


The aim of this study was to know the current state regarding the possible negative consequences of maternal COVID-19 infection on the own health of the pregnant woman and the newborn. In addition, it sought to provide clarity on the vertical transmission of COVID-19 from mother to fetus. Studies of COVID-19 during pregnancy are attracting interest, although empirical research has only been conducted in China. This review constitutes the first study in Spain that addressed the health of pregnant women and newborns in relation to COVID-19. The predominant symptom in pregnant women in this review was fever, which did not always appear before birth14,15,16. It should be noted the absence of seriousness of COVID-19 in pregnant women14,15,16,17,18,19,21,23. This contradicts what was previously reported regarding SARS-CoV in Hong Kong in 2003 and in respect to a study stating that SARS was much more severe in pregnant women than among non-pregnant women19. Some cases required admission to an intensive care unit. During the SARS in 2003, the death of some pregnant women was reported as a consequence of the coronavirus that infected them at that time19.

Regarding the neonatal consequences of COVID-19, only one baby was reported to have died possibly due to her/his 2,200 g birth weight and prematurity18. In respect to the rest of the neonates, apparently no lasting complications were observed14,15,16,17,18. It is important to note that almost all newborns screened for COVID-19 tested negative, except in one case where the test was not performed. It is unknown whether that neonate was the deceased baby18. Coronavirus SARS-Cov-2 was not found in any of the analyzed amniotic fluid, breast milk, or cord blood samples14,15,16,17,18.

To date and using the information available, there is insufficient evidence to verify that COVID-19 is transmitted vertically from mother to baby14,15,16,17,18,21.

International professional associations, being aware of the public health problem we are facing, have developed some recommendations for professionals dedicated to the health of pregnant women19,20,21,22,23. These recommendations include the management of those pregnant women during pregnancy, childbirth and postpartum at risk or suffering from an infection by COVID-1919,21,22. In addition, they include a list of recommendations regarding newborns care20. Pregnant women and their neonates health must be a priority24,25,26.

In conclusion, there is no evidence of greater susceptibility to COVID-19 infection in pregnant women than in non-pregnant women19. Furthermore, there is no evidence to support the vertical transmission of SARS-CoV-2 from pregnant women to the fetus14,15,16,21,22. This is supported by the absence of SARS-CoV-2 in breast milk, amniotic fluid and umbilical cord blood samples from newborns of mothers with COVID-1914,15,16. According to the studies included in this review, neonatal infection is quite infrequent. Only one single newborn deceased, possibly due to prematurity and low birth weight18.

This study may have certain limitations. Studies published in Chinese language were not included in the search. Furthermore, pregnant women with a positive result for SARS-CoV-2 and not those with symptoms but without a diagnosis of COVID-19 were included.


Finally, I would like to thank all those people who are trying to respond to this global pandemic.


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Suggested citation: Caparros-Gonzalez RA. Maternal and neonatal consequences of coronavirus Covid-19 infection during pregnancy: a scoping review. Rev Esp Salud Pública. 2020; 94: 17 de abril e202004033

Received: March 17, 2020; Accepted: April 07, 2020; pub: April 17, 2020

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