Vertical Transmission of SARS-CoV-2 is Plausible During Pregnancy and
Vaginal Delivery: A Prospective Cohort Study
Abstract
Objective: To evaluate if SARS-CoV-2 is detectable in vaginal swabs and
whether antibodies against SARS-CoV-2 are present in maternal and
umbilical cord blood of pregnant women with COVID-19. Design:
Prospective cohort study. Setting: Department of Obstetrics and
Gynaecology, Copenhagen University Hospital – North Zealand, Denmark.
Population: Pregnant women tested positive for SARS-CoV-2 in a
pharyngeal swab between August 20th, 2020 and March 1st, 2021 who gave
birth during the same period. Methods: Maternal blood sample and vaginal
swabs were collected at inclusion. If included during pregnancy, these
samples were repeated at delivery in addition to an umbilical cord blood
sample. Swabs were analysed for SARS-CoV-2 and blood samples for
SARS-CoV-2 total antibodies. Placental and neonatal swabs were performed
on clinical indications. Main outcome measures: SARS-CoV-2 in vaginal
swabs and SARS-CoV-2 total antibodies in maternal and umbilical cord
blood. Results: We included 28 women, hereof 4 serious maternal or fetal
outcomes including 1 neonatal death. Within the first eight days after a
maternal positive pharyngeal swab, SARS-CoV-2 was detectable in two
vaginal (2/28) and two placental swabs (2/4), whereas SARS-CoV-2
antibodies were detected in 1/13 women. After eight days, SARS-CoV-2 was
not detectable in vaginal swabs and SARS-CoV-2 antibodies were observed
in 19/21 of women. Antibodies in cord blood of seropositive mothers
appeared after 16 days. Conclusion: Vertical transmission of SARS-CoV-2
seems plausible since SARS-CoV-2 is detectable in the vagina up to eight
days after a positive pharyngeal swab at which time the neonate is not
yet protected by antibodies.