To determine the pregnancy and neonatal outcomes of women who recovered from coronavirus disease 2019 (COVID-19) that developed in early pregnancy.
We report a cases series of five pregnant women (26–33 years) who recovered from COVID-19 that developed in early pregnancy (6–27 weeks) and who were admitted at the Union Hospital from January 15, 2020 to April 30, 2020. The clinical manifestation, laboratory examinations, treatment, pregnancy outcomes, maternal and neonatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throat swab reverse transcription polymerase chain reaction test results, and SARS-CoV-2 antibody test results in neonates were reviewed. The placental pathology, placental angiotensin-converting enzyme 2 expression were studied by hematoxylin-eosin and immunohistochemistry staining, SARS-CoV-2 presence was examined by QT-PCR.
Three pregnant women were diagnosed with COVID-19 in early pregnancy (Cases 1–3), and two cases were serum immunoglobulin G positive asymptomatic cases (Cases 4 and 5). Cases 1–3 showed complete recovery after severe COVID-19. Case 3 was infected at 6 weeks of gestation during the first trimester and had induced medical abortion at 12 weeks of gestation. All neonates had no pneumonia, SARS-CoV-2 mRNA reverse transcription polymerase chain reaction and serum immunoglobulin M were negative, and immunoglobulin G were positive. All placental samples were negative for SARS-CoV-2 in the nucleic acid test. Infants followed up at 3–6 months were healthy and asymptomatic. Placental pathology showed chronic ischemia changes. ACE-2 expressed in both placenta and decidua.
No adverse outcomes were observed in our case series. However, systemic inflammatory responses to SARS-CoV-2 infection may cause placental injury. At the time of delivery after recovery from COVID-19, no SARS-CoV-2 positive results were found in the placenta in this case series.