- The Washington Times - Tuesday, July 14, 2020

A girl in Texas born prematurely to a mother infected with COVID-19 has tested positive for the coronavirus, providing the strongest evidence so far that the virus can spread in the womb, according to a report published by The Pediatrics Infectious Disease Journal.

The findings suggest that in utero transmission can occur, says the case report published last week.

“Numerous infants have now been delivered to pregnant women diagnosed with SARS-CoV-2, with the majority of these infants without respiratory illness or positive molecular evidence for SARS-CoV-2,” said study author Dr. Amanda Evans, a pediatrics infectious disease professor at the University of Texas Southwestern Medical Center.

“Our study is the first to document intrauterine transmission of the infection during pregnancy, based on immunohistochemical and ultrastructural evidence of SARS-CoV-2 infection in the fetal cells of the placenta,” Dr. Evans told Wolters Kluwer Health.

The mother, who had type 2 diabetes, had been diagnosed with COVID-19 and gave birth to the girl 34 weeks into her pregnancy. The baby was born “large for gestational age” and was treated in the neonatal intensive care unit due to being premature and possibly exposed to the coronavirus.

The baby at first appeared healthy and was breathing normally, but she developed a fever and mild respiratory illness on her second day of life. The researchers said the respiratory distress was unlikely due to prematurity since it did not start until a day after the child’s birth.

The baby tested positive for SARS-CoV-2, the virus that causes COVID-19, 24 and 48 hours after birth. Although she required supplemental oxygen for several days, she did not need mechanical ventilation.

The girl tested positive for the coronavirus for 14 days. After three weeks, the mother and daughter appeared to be in good health and were sent home.

The placenta had signs of tissue inflammation, and tests showed the presence of coronavirus particles and a SARS-CoV-2 protein in the fetal cells of the placenta — evidence that the viral infection spread in the womb instead of during or after birth.

“Overall, intrauterine transmission of SARS-CoV-2 appears to be a rare event,” the authors said in their report, although limited data suggests the virus could spread from a pregnant person to infant.

Researchers at the National Institutes of Health found that placental membranes that contain the fetus and amniotic fluid lack the messenger RNA molecule needed to make the ACE2 receptor, the main cell surface receptor the virus uses to cause infection, according to a statement Monday.

These placental tissues also lack the messenger RNA needed to make an enzyme that the virus uses to invade a cell. Both the receptor and enzyme are present in “only miniscule amounts in the placenta,” possibly explaining why the illness has only rarely been found in fetuses or newborns of women infected with the virus, the study authors said.

The Centers for Disease Control and Prevention warn that pregnant people could be at higher risk for severe illness from COVID-19. The public health agency also says pregnant people with COVID-19 might have an increased risk of adverse pregnancy outcomes such as preterm birth.

Newborns can catch COVID-19 after being in close contact with an infected person. Some babies have tested positive for the virus shortly after birth, but it is unknown when they got the virus, says the CDC. Most newborns diagnosed with COVID-19 had mild or no symptoms and made a full recovery. There are a few reports of newborns who have developed serious illness.

There have been two more case reports that describe “vertical” transmission of the virus from mother to infant, according to a commentary by Dr. George Siberry, associate chief editor of The Pediatrics Infectious Disease Journal, and others cited by Wolters Kluwer Health.

“As these cases illustrate, evaluation for vertical — and especially intrauterine — SARS-CoV-2 infection can be challenging, and assessment is often limited by lack of optimal testing of appropriate specimens obtained at specific timepoints,” Dr. Siberry and the coauthors wrote.

Last week, researchers from Italy said they found signs of the coronavirus in several samples of umbilical cord blood, the placenta and breast milk in one case in a study of 31 women, The Associated Press reported.

But Dr. Claudio Fenizia, the study’s leader and an immunology specialist at the University of Milan, said that doesn’t necessarily imply there is a viable virus in those places.

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