8 April 2021 Episode 126 Update on COVID in pregnancy and children

Thu, 04/08/2021 - 17:45

Dear colleagues,

Upon request, I discuss some evidence related to influence of COVID-19 on pregnancy and children. There is quite an extensive literature, but it often refers to case studies and reviews are about the same studies. Therefore, I selected two reviews that provide most perspective. I also add two papers on vaccination.

Ep 126-1: Oltean at al.  Impact of SARS-CoV-2 on the clinical outcomes and placental pathology of pregnant women and their infants

  • Presenting symptoms of COVID during pregnancy are fever, cough, breathing difficulties, malaise, chills, and rigors with more than half with RX evidence of viral pneumonia.  
  • Admission to ICU is 1.6 %  and associated with pre-existing conditions such as gestational or chronic hypertension, diabetes or obesity.  
  • More frequent complication in COVID pregnancy: gestational diabetes, and pre-ecclampsia (2.5 %).  Also leukocytosis (7 %), lymphopenia (8 %) and thrombocytopenia (1%).
  • More intra-uterine fetal distress (7 %),  premature rupture of membrane (5.7 %)  and preterm birth (21 %).  Elective Caesarian section was done in 80 % (due to fetal distress or out of precaution).
  • Only  8 neonates out of > 300 were PCR positive and had respiratory evidence of COVID and only 1 died.   

Ep 126-2: Siebach on COVID-19 in childhood:

  • Vertical transmission is rare, but maternal infection and inflammation by COVID could affect the developing fetus and even postnatal life. Need for long-term follow-up.
  • No evidence of SARS-CoV-2 transmission via breastfeeding.  Therefore WHO and UNICEF advice breast feeding, while following, hygienic measures and mask use.
  • In households, adult-to-child transmission is more frequent than vice versa.
    • Also in schools staff is more often the source of transmission: “secondary attack rate” (SAR) The overall child‐to‐child SAR was 0.3%,  child to staff SAR was 1.0%), while the staff‐to‐staff SAR was 4.4%  and the staff‐to‐child SAR was 1.5%.
    • Example: School infections peaked in Victoria, Australia, when community transmission was high, but transmission among children was not school driven.48 Controlling community incidence is likely an effective means of controlling transmission within the educational setting.
  • COVID‐19 in children can present with a variety of symptoms, pediatric cases are most often mild or asymptomatic. In rare cases, children can develop severe complications following infection: MISC or Multisystem Inflammatory Syndrome in Children with fever, gastrointestinal complaints, rash, conjunctivitis and sometimes also severe respiratory and cardiac complications.  Remarkably, SARS-CoV-2 PCR is often negative but antibodies positive.  There are conflicting data whether comorbidities (see below) or low socio-economic status favor MISC.  
  • Comorbidities and severity:
    • Some, but not all  studies show significant association between obesity and severe cases requiring mechanical ventilation in children
    • Remarkably, while one would presume that both chronic respiratory illness (incl. asthma) as well as immune deficiency (organ transplant, aplastic anemia, malignancy) and immune suppression (by drugs) would predispose to severe disease, the date are in fact contradictory.
    •  There are also suggestions that co-infections with mycoplasma, RSV or influenza could deteriorate the course of COVID in children, but, here again, the evidence is inconclusive.   

Ep 126-3: Gray on COVID-19 vaccine response in pregnant and lactating women

This small cohort study shows that mRNA vaccines are safe and elicit

  • comparable  neutralizing humoral immune responses to non-pregnant controls,
  • higher antibody titers than those observed following SARS-CoV-2 infection in pregnancy
  • also antibodies present in umbilical cord blood and breast milk after maternal vaccination.

 

Ep 126-4: Oral Milman provides evidence that rapid roll-out of Pfizer mRNA vaccine in adults was associated with a subsequent decline of infection risk in children….

 

Some additional papers are on the website.

 

Best wishes,

 

Guido