In-Utero Maternal-to-Fetal Transmission of COVID-19: An Immunological and Virological Study in the Eastern Province of Saudi Arabia

Hibah A Alzayer,1,2 Basavaraja C Hunasemarada,1 Arwa Alumran,3 Shaikha Aldossary,4 Reem A Al Dossary1 1Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia; 2Clinical Laboratory Services, Dammam Medical Complex, Dammam, Saudi Arabia; 3Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia; 4Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi ArabiaCorrespondence: Reem A Al Dossary, Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), P.O.Box 1982, Dammam, 31441, Saudi Arabia, Email [email protected]: Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The pandemic potential of the virus along with its severity posed a threat to all individuals particularly pregnant women. Multiple studies suggested the possibility of vertical transmission of COVID-19 with variable findings.Aim: This study aims to assess the frequency of COVID-19 vertical transmission and identify maternal and neonatal complications.Materials and Methods: A retrospective study of 17 months for all pregnant women attending for delivery who tested positive using SARS-CoV-2 polymerase chain reaction (PCR) (n = 80) and their neonates (n = 81) who were tested by both SARS-CoV2 PCR and viral IgG and IgM antibodies detection using immunochromatography. A matched control group of PCR negative mothers (n = 51) was included. All testing was done within 24– 48 hours, and the neonates of positive mothers were immediately and completely separated from their mothers as per the hospital policy.Results: A total of 263 individuals were included in the study. Out of 80 SARS-CoV2 PCR positive mothers, 4 (5%) had PCR positive neonates and one (1.3%) had SARS-CoV2 IgM positive neonates. The commonest presentation of COVID-19 in mothers were cough (11.4%) and dyspnea (10%). In addition, the need for ICU admission and antibiotics usage was significantly higher in SARS-CoV2 PCR positive mothers (p value 0.042, 0.003 respectively). On the other hand, neonates of SARS-CoV2 PCR positive mothers had a higher risk of low birth weight and NICU admission (p value < 0.001).Conclusion: This study, with its unique infection control protocol for managing SARS-CoV2 PCR-positive mothers and the use of immunological testing for neonates, provides evidence for in-utero SARS-CoV2 transmission, and interpretation of the results should be in conjunction with the WHO categorization of the timing of mother-to-fetal transmission. Further studies are needed to assess the impact of viral genetic evolution on the risk of maternal–fetal transmission.Keywords: SARS-CoV-2, in-utero, transmission, IgM, PCR