Joseph R. Hageman, MD , Mitchell Goldstein, MD, MBA, CML 

Yes, the outcomes out to 6-12 months of age of infants born to pregnant mothers with SARS-CoV-2 infection are very positive based on two studies from Italy by Grazia Capretti from Bologna and 10 United States jurisdictions by Gosdin and colleagues from the Center for Disease Control and Prevention (CDC) (1,2). None of the 106 infants born to pregnant mothers with SARS-CoV-2 infections diagnosed two weeks before delivery were clinically sick or had any evidence of developmental or central nervous system abnormalities, hearing abnormalities, or congenital abnormalities in the Italian cohort study (1). All 106 nasopharyngeal swabs were negative when obtained within 24 hours of postnatal life (1). 

The US CDC study confirmed the same clinical outcomes for 6601 exposed infants (2). IgG levels were present in both studies in the babies and the mothers and were persistent until about six months of age (1, 2). Six months of all-cause hospitalization was 4.1% (2.0-6.2) (2). All-cause mortality was higher in infants born to people with infection < or equal to 14 days (1.0%) than > 14 days (0.3%) prior to delivery (2). None of the infant mortality was secondary to SARS-CoV-2 infection (2). 

In the Italian study, there was evidence of possible in-utero infection in one infant (1) and no recurrent respiratory or SARS-CoV-2 infections in the 12-month follow-up period (1). 

Breastfeeding initiation was lower when maternal infection occurred < or equal to 14 days prior to delivery (77.6 vs. 88.3%) compared with > 14 days in the U.S. study (2). 

It remains to be seen whether maternal infection confers significant protection to their baby or whether the IgG level increases are incidental to maternal infection in association with a protective home environment. 

However, the US CDC study acknowledges that 84.7% were born at term, or 15.3% were born prematurely (2). In light of the recent March of Dimes report card with a grade of D+ given to the United States due to its increased prematurity rate, could this disparity be tracked to widespread SARS-COV-2 infection in pregnancy (3)? 

References: 

1. Grazia Capretti M, Mersico C, Gabrelli L, et al. Infants born following SARS-CoV-2 infection in pregnancy. Pediatrics 2022; 150(5): November 2022 e2022056206. https://doi.org/10.1542/peds.2022-056206
2. Goadin L, Wallace B, Lanzieri T, et al. Six month outcomes of infants born to people with SARS-CoV-2 in pregnancy. Pediatrics 2022; 150(6), December 2022:e2022059009.  https://doi.org/10.1542/peds.2022-059009
3. https://www.marchofdimes.org/sites/default/files/2022-11/March-of-Dimes-2022-Full-Report-Card.pdf 

Disclosures: The author has no disclosures