Clarifying the Consequences of COVID-19 in Pregnant Women, Newborns and Children With Existing Cohorts

Hu, et al. (2020) say that "The sweeping consequences of the coronavirus disease 2019 (COVID-19) pandemic for pregnant women, newborns, and children remain uncharted. The greatest outcomes may not be on those with known infections, who have dominated the early avalanche of literature. Interactions between humans and viruses evolve over time, judging from previous pandemic histories, and we will soon lose the opportunity to understand the current one."

This Viewpoint by Hu, et al. (2020) published in JAMA Pediatrics suggests that the only way to truly capture the long-term consequences of the COVID-19 pandemic for these groups may be in agile reconfiguration of existing, large birth cohort studies.

The researchers observe, "While the broad shapes of pandemics are similar, each has its unique detail. The 2003 severe acute respiratory syndrome coronavirus (SARS-CoV) had higher rates of maternal and neonatal complications and death in younger adults, but SARS-CoV-2 is more prevalent and transmissible. Zika virus can be devastating to the fetus, while the relatively few cases of COVID-19 in fetuses, neonates, and young children have tended to be mild. However, recent reports of a serious, Kawasaki-like illness in young children coincident with the COVID-19 pandemic suggests that its full pediatric story may be yet to emerge. With few pediatric confirmed cases and low rates of severe disease, unknown effects on infants and children at heightened vulnerability in low-income countries, and an unknown extent of subclinical infection, testing children has been deprioritized and their contribution to COVID-19 epidemiology remains something of a mystery. To prepare for the inevitable next pandemic, we need systems designed to help model profiles of transmission, diagnosis, treatment, and prevention. We need to understand the outcome of COVID-19 on pregnant women, infants, and children, including vulnerable and minority groups. Outcomes must cover those with and without infections, who will both bear the burdens of altered health services, psychosocial stress, and economic downturn. We need evidence to strengthen preventive measures and understand the consequences of infection, chemoprophylaxis, vaccination, and treatment. Risks and benefits need to be clarified, including balancing breastfeeding against transmission, physical distancing, and mental health. Infection prevention and control strategies must be developed to minimize the spread of COVID-19 in antenatal settings, the household, and community. We need to document common, rare, and subtle outcomes over time and the genetic and other contributors to their variations."

The researchers say that questions remain around the true incidence, with rates of asymptomatic, minimally symptomatic, and presumptive COVID-19 are unknown; mother-to-child transmission; breastfeeding recommendations; long-term effects on fetal development and child health; and long-term health service outcomes.

Reference: Hu YJ, et al. Clarifying the Sweeping Consequences of COVID-19 in Pregnant Women, Newborns, and Children With Existing Cohorts. JAMA Pediatr. Published online August 10, 2020. doi:10.1001/jamapediatrics.2020.2395

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