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Comment & Response
July 20, 2020

Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From the Mother to the Infant

Author Affiliations
  • 1Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
  • 2Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
  • 3Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
JAMA Pediatr. Published online July 20, 2020. doi:10.1001/jamapediatrics.2020.2150

To the Editor We read with interest the article by Zeng et al1 that reported on 33 neonates of women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy, where 3 of 33 had early-onset SARS-CoV-2 infection. The 3 affected neonates were born 1 to 3 days after their mothers were diagnosed as having SARS-CoV-2, developed symptoms within the first 2 days of life, and had positive SARS-CoV-2 polymerase chain reaction from nasopharyngeal and anal samples on days 2 and 4 of life. It is unclear whether these infants were infected intrauterine or after birth, especially because it is not yet known whether viremia precedes clinical manifestations of SARS-CoV-2 infection. Detection of anti–SARS-CoV-2 IgM in cord and/or early-life neonatal blood could have supported intrauterine infection because neonatal IgM is not transplacentally transferred from the mother and is of fetal origin.2 The distinction between intrauterine vs postnatal infection is critical. With other infections, intrauterine infection can lead to severe consequences in the developing fetus, including blindness, developmental delay, or neurologic manifestations,3 depending on timing of infection during pregnancy and the infectious pathogen (eg, neonatal microcephaly associated with Zika virus during pregnancy). However, postnatal Zika infection is not associated with congenital anomalies and would be expected to cause a primarily mild infection.

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