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Can SARS-CoV-2 Infection Be Acquired In Utero?More Definitive Evidence Is Needed

Educational Objective
To understand the original problem of infant infection with COVID-19 that may occur during pregnancy

Two articles reported in this issue of JAMA from separate research teams in China present details of 3 neonates who may have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in utero from mothers with coronavirus disease 2019 (COVID-19).1,2 Evidence for such transmission is based on elevated IgM antibody values in blood drawn from the neonates following birth. All infants also had elevated IgG antibody values and cytokine levels, although these may have crossed the placenta from the mother to the infant. No infant specimen had a positive reverse transcriptase–polymerase chain reaction test result, so there is not virologic evidence for congenital infection in these cases to support the serologic suggestion of in utero transmission. Nevertheless, the serologic data are provocative for a virus that is believed to be spread by respiratory secretions and—given the modeling showing that a significant percentage of the world’s population, many of them pregnant women, will be infected over the next weeks or months—it is one that deserves careful consideration. However, at this time, these data are not conclusive and do not prove in utero transmission.

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Article Information

Corresponding Author: David W. Kimberlin, MD, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, 1600 Seventh Ave S, CHB 303, Birmingham, AL 35233 (dkimberlin@peds.uab.edu).

Published Online: March 26, 2020. doi:10.1001/jama.2020.4868

Conflict of Interest Disclosures: None reported.

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