Review Article
Volume 10 Issue 5 - 2021
Coronavirus Disease 2019 and the Fetus
Hisham Arab1* and Rola El Rassi2
1Program Director at Maternal and Fetal Health Program at Dr Arab Medical Center, Jeddah, Saudi Arabia
2Research Associate at Maternal and Fetal Health Program at Dr Arab Medical Center, Jeddah, Saudi Arabia
*Corresponding Author: Hisham Arab, Program Director at Maternal and Fetal Health Program, Dr Arab Medical Center, Jeddah, Saudi Arabia.
Received: March 24, 2021; Published: April 06, 2021


The outbreak of COVID-19 and its classification as a pandemic has raised many alarms. The impact of the SARS-CoV-2 virus on the pregnant woman and her unborn child is of utmost concern. Previous viral outbreaks taught us that this population is very vulnerable and among the most affected. Pregnant women infected with COVID-19 were associated with a higher rate of preterm birth, cesarean section, and perinatal death, though it appears that those who are critically ill are at an increased risk of such complications. One major concern is the transmission of this virus from the mother to her fetus during pregnancy. Although rare, review of the literature has indicated that it is possible, with some reporting that 30% of infections were likely due to vertical transmission. The impact of the infection in the neonate however has been reported to be mild and none worrying. A multitude of many circumstantial factors may protect or harm the fetus such as the allogenic rejection of the decidua, the buffering nature of the placenta, the indirect effects of the lockdown and its repercussions, or the possible teratogenic effect of antiviral medications if used. Further studies are needed to assess not only short-term outcomes but also long-term outcomes, and particularly fetal programming.

Keywords: COVID-19; SARS-CoV-2; Maternal Infection; Fetal Infection; Pregnancy; Outcomes; Vertical Transmission; Fetal Programming


  1. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020, World Health Organization (WHO) (2020).
  2. Wang D., et al. “Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus–infected pneumonia in Wuhan, China”. The Journal of the American Medical Association 11 (2020): 1061-1069.
  3. Schwartz DA and A Dhaliwal. “Infections in pregnancy With COVID-19 and other respiratory RNA virus diseases are rarely, if ever, transmitted to the fetus: Experiences with Coronaviruses, Parainfluenza, Metapneumovirus Respiratory Syncytial Virus, and Influenza”. Archives of Pathology and Laboratory Medicine 8 (2020): 920-928.
  4. Kotlyar AM., et al. “Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis”. American Journal of Obstetrics and Gynecology 1 (2021): 35-53.
  5. Chen H., et al. “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records”. Lancet10226 (2020): 809-815.
  6. Shah PS., et al. “Classification system and case definition for SARS-CoV-2 infection in pregnant women”. Fetuses, and Neonates5 (2020): 565-568.
  7. Vivanti AJ., et al. “Transplacental transmission of SARS-CoV-2 infection”. Nature Communications1 (2020): 3572.
  8. Raschetti R., et al. “Synthesis and systematic review of reported neonatal SARS-CoV-2 infections”. Nature Communications1 (2020): 5164.
  9. Kimberlin DW and S Stagno. “Can SARS-CoV-2 infection be acquired in utero?: More definitive evidence is needed”. The Journal of the American Medical Association 18 (2020): 1788-1789.
  10. Yu N., et al. “No SARS-CoV-2 detected in amniotic fluid in mid-pregnancy”. The Lancet Infectious Diseases12 (2020): 1364.
  11. Schaub B., et al. “Analysis of blood from Zika virus-infected fetuses: A prospective case series”. The Lancet Infectious Diseases5 (2017): 520-527.
  12. Weatherbee BAT., et al. “Expression of SARS-CoV-2 receptor ACE2 and the protease TMPRSS2 suggests susceptibility of the human embryo in the first trimester”. Open Biology8 (2020): 200162.
  13. Wastnedge EAN., et al. “Pregnancy and COVID-19”. Physiological Reviews 1 (2021): 303-318.
  14. Costa MAS., et al. “Influence of SARS-COV-2 during pregnancy: A placental view”. Biology of Reproduction (2021).
  15. Chen S., et al. “[Pregnancy with new coronavirus infection: Clinical characteristics and placental pathological analysis of three cases]”. Zhonghua Bing Li Xue Za Zhi5 (2020): 418-423.
  16. Schwartz DA. “An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes”. Archives of Pathology and Laboratory Medicine (2020).
  17. Taglauer E., et al. “Consistent localization of SARS-CoV-2 spike glycoprotein and ACE2 over TMPRSS2 predominance in placental villi of 15 COVID-19 positive maternal-fetal dyads”. Placenta 100 (2020): 69-74.
  18. Yeager A. “Human fetuses can contract SARS-CoV-2, but it’s rare, in”. The Scientist (2021).
  19. Guan WJ., et al. “Clinical characteristics of coronavirus disease 2019 in China”. The New England Journal of Medicine 18 (2020): 1708-1720.
  20. Alserehi H., et al. “Impact of Middle East Respiratory Syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome”. BMC Infectious Diseases 16 (2016): 105.
  21. Wong SF., et al. “Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome”. American Journal of Obstetrics and Gynecology 1 (2004): 292-297.
  22. Samara A and E Herlenius. “Is there an effect of fetal mesenchymal stem cells in the mother-fetus dyad in COVID-19 pregnancies and vertical transmission?” Frontiers in Physiology 11 (2020): 624625.
  23. Di Mascio D., et al. “Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: A systematic review and meta-analysis”. American Journal of Obstetrics and Gynecology MFM 2 (2020): p100107.
  24. Capobianco G., et al. “COVID-19 in pregnant women: A systematic review and meta-analysis”. European Journal of Obstetrics and Gynecology and Reproductive Biology 252 (2020): 543-558.
  25. Metz TD., et al. “Disease severity and perinatal outcomes of pregnant patients with Coronavirus Disease 2019 (COVID-19)”. Obstetrics and Gynecology4 (2021): 571-580.
  26. WAPM (World Association of Perinatal Medicine) Working Group on COVID-19. Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection”. Ultrasound in Obstetrics and Gynecology 2 (2021): 232-241.
  27. Huntley BJF., et al. “Rates of maternal and perinatal mortality and vertical transmission in pregnancies complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A systematic review”. Obstetrics and Gynecology2 (2020): 303-312.
  28. Knight M., et al. “Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: National population based cohort study”. British Medical Journal 369 (2020): m2107.
  29. Hedegaard M., et al. “Do stressful life events affect duration of gestation and risk of preterm delivery?” Epidemiology4 (1996): 339-345.
  30. Najafzadeh A. “Stress and preterm birth: biological and vascular mechanisms affecting the feto-placental circulation and the length of gestation”. Sonography 3 (2016): 95-102.
  31. Ajith S., et al. “Prevalence and risk factors of neonatal COVID-19 Infection: A single-centre observational study”. Journal of obstetrics and gynaecology of India (2021): 1-4.
  32. Cruz-Lemini M., et al. “Obstetric outcomes of SARS-CoV-2 infection in asymptomatic pregnant women”. Viruses 1 (2021): 112.
  33. Erol Koç EM., et al. “Comparison of hematological parameters and perinatal outcomes between COVID-19 pregnancies and healthy pregnancy cohort”. The Journal of Perinatal Medicine 2 (2021): 141-147.
  34. Easterlin MC., et al. “Will prenatal exposure to SARS-CoV-2 define a birth cohort with accelerated aging in the century ahead? Journal of Developmental Origins of Health and Disease (2020): 1-5.
  35. Stowe J., et al. “Stillbirths during the COVID-19 pandemic in England, April-June 2020”. The Journal of the American Medical Association 1 (2021): 86-87.
  36. Khalil A., et al. “Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic”. The Journal of the American Medical Association 7 (2020): 705-706.
  37. Anand P., et al. “Clinical profile, viral load, management and outcome of neonates born to COVID 19 positive mothers: A tertiary care centre experience from India”. European Journal of Pediatrics2 (2021): 547-559.
  38. Stonoga ES., et al. “Intrauterine transmission of SARS-CoV-2”. Emerging Infectious Diseases2 (2021): 638-641.
  39. Baud D., et al. “Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection”. The Journal of the American Medical Association 21 (2020): 2198-2200.
  40. Hedermann G., et al. “Danish premature birth rates during the COVID-19 lockdown”. Archives of Disease in Childhood - Fetal and Neonatal Edition1 (2021): 93-95.
  41. Philip RK., et al. “Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a ‘natural experiment’ allowing analysis of data from the prior two decades”. BMJ Global Health9 (2020): e003075.
  42. Lemon L., et al. “What is driving the decreased incidence of preterm birth during the COVID-19 pandemic?” American Journal of Obstetrics and Gynecology MFM (2020).
  43. Barbosa-Leiker C., et al. “Stressors, coping, and resources needed during the COVID-19 pandemic in a sample of perinatal women”. BMC Pregnancy and Childbirth1 (2021): 171.
  44. Iqbal A., et al. “Generation COVID-19 - Should the foetus be worried? 110.3 (2021): 759-764.
  45. Persson P and M Rossin-Slater. “Family ruptures, stress, and the mental health of the next generation”. American Economic Review4-5 (2018): 1214-1252.
  46. Crespi EJ and RJ Denver. “Ancient origins of human developmental plasticity”. American Journal of Human Biology1 (2005): 44-54.
  47. Buss C., et al. “High pregnancy anxiety during mid-gestation is associated with decreased gray matter density in 6–9-year-old children”. Psychoneuroendocrinology 1 (2010): 141-153.
  48. Bahtiyar MO., et al. “Fetal interventions in the setting of the coronavirus disease 2019 pandemic: statement from the North American Fetal Therapy Network”. American Journal of Obstetrics and Gynecology 2 (2020): 281-284.
  49. Gale C., et al. “Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: A prospective national cohort study using active surveillance”. The Lancet Child and Adolescent Health2 (2021): 113-121.
  50. Gao J., et al. “Disappearance of SARS-CoV-2 antibodies in infants born to women with COVID-19, Wuhan, China”. Emerging Infectious Diseases 10 (2020): 2491-2494.
  51. Mold JE., et al. “Maternal alloantigens promote the development of tolerogenic fetal regulatory T cells in utero”. Science5907 (2008): 1562-1565.
  52. Malek A., et al. “Evolution of maternofetal transport of immunoglobulins during human pregnancy”. American Journal of Reproductive Immunology 5 (1996): 248-255.
  53. Blauvelt CA., et al. “Acute Respiratory Distress Syndrome in a preterm pregnant patient with Coronavirus Disease 2019 (COVID-19)”. Obstetrics and Gynecology 1 (2020).
  54. Al-Haddad BJS., et al. “Long-term risk of neuropsychiatric disease after exposure to infection in utero”. JAMA Psychiatry 6 (2019): 594-602.
  55. Khan MSI., et al. “Risk of congenital birth defects during COVID-19 pandemic: Draw attention to the physicians and policymakers”. Journal of Global Health 2 (2020): 020378.
  56. Roseboom T., et al. “The Dutch famine and its long-term consequences for adult health”. Early Human Development 8 (2006): 485-491.
  57. Bispham J., et al. “Maternal endocrine adaptation throughout pregnancy to nutritional manipulation: consequences for maternal plasma leptin and cortisol and the programming of fetal adipose tissue development”. Endocrinology8 (2003): 3575-3585.
  58. McCurdy CE., et al. “Maternal high-fat diet triggers lipotoxicity in the fetal livers of nonhuman primates”. Journal of Clinical Investigation 2 (2009): 323-335.
  59. Reynolds CM., et al. “Early-life growth hormone treatment to offspring of undernourished mothers alters metabolic parameters in primary adipocytes in adulthood”. Growth Factors1 (2014): 34-40.
Citation: Hisham Arab and Rola El Rassi. “Coronavirus Disease 2019 and the Fetus”. EC Gynaecology 10.5 (2020): 24-36.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

May Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the May issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before May 24, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to