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Letter
SARS during Pregnancy, United
States
Lauren J. Stockman,*
Sara A. Lowther,* Karen Coy,† Jenny Saw,‡ and Umesh D. Parashar*
*Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Santa
Clara County Department of Public Health, San Jose, California, USA; and
‡Private pediatric practice, San Jose, California, USA
Suggested
citation for this article
To the Editor: Two of eight persons with laboratory-confirmed
severe acute respiratory syndrome–associated coronavirus (SARS-CoV) infection
in the United States during 2003 were pregnant women. Robertson et al.
(1) reported data describing one pregnant patient who
recovered and delivered a healthy infant. We report data concerning the
second patient, with follow-up 1 month after the child's birth.
The patient, a healthy, 38-year-old woman in the 7th week of pregnancy,
traveled with her husband to Hong Kong. From March 1 to March 6, 2003,
they stayed at the Hong Kong hotel where it is believed a physician from
China spread SARS-CoV to several guests. These guests were the index case-patients
for subsequent outbreaks in Hong Kong, Vietnam, Singapore, and Toronto,
Canada (2). The woman and her husband returned to the
United States on March 6; the husband had onset of SARS illness on March
13. On March 19, the patient had onset of an illness with fever (temperature
37.8–40°C), muscle aches, chills, headache, runny nose, productive
cough, wheezing, and shortness of breath. A chest radiograph showed a
diffuse infiltrate in the left lung. The patient was hospitalized for
9 days and given broad-spectrum antimicrobial drugs. She recovered from
her illness, and enzyme immunoassay and immunofluorescent assays conducted
on serum samples on days 28 and 64 after illness onset were positive for
antibodies to SARS-CoV.
The patient had an uneventful pregnancy until the last trimester, when
her blood glucose levels were elevated. Early spontaneous rupture of membranes
initiated preterm labor, and a cesarean section was performed at 36 weeks'
gestation because of fetal distress. A 5-pound, 7-ounce, healthy boy was
delivered without complications. Apgar scores were 7 at 1 minute and 8
at 5 minutes. The newborn had no illness, abnormalities, or congenital
malformations. Serum samples from the patient at delivery were positive
for antibodies to SARS-CoV, but cord blood and placenta samples were negative.
Breast milk samples on postpartum days 12 and 30 were also negative for
SARS-CoV antibodies. Blood, stool, and nasopharyngeal swab samples from
the patient and cord-blood samples showed no viral RNA by reverse transcription–polymerase
chain reaction. Stool samples from the newborn, collected on days 12 and
30 after delivery, were also negative for viral RNA.
Although other countries have reported cases of severe illness and poor
outcome associated with SARS-CoV infection during pregnancy (3–5),
neither of the two pregnant SARS case-patients in the United States had
serious adverse outcomes. The presence of antibodies to SARS-CoV in breast
milk might be influenced by the time of infection in relation to gestation.
Robertson et al. (1) reported that antibodies to SARS-CoV
were detected in the breast milk of a patient who was infected at 19 weeks'
gestation; however, the patient in this case was infected at 7 weeks'
gestation, and antibodies to the virus were not detected in her breast
milk. No reports have indicated vertical transmission of SARS-CoV, a finding
that is supported by our data. However, too few cases have been studied
to clearly define the risks and provide guidance for treating pregnant
women infected with SARS CoV.
References
- Robertson CA, Lowther SA, Birch T, Tan C, Sorhage
F, Stockman L, et al. SARS
and pregnancy: a case report. Emerg Infect Dis. 2004;10:345–8.
- Centers for Disease Control and Prevention. Update:
outbreak of severe acute respiratory syndrome—worldwide, 2003. MMWR
Morb Mortal Wkly Rep. 2003;52:241–8.
- Shek CC, Ng PC, Fung GP, Cheng FW, Chan PK, Peiris MJ, et al. Infants
born to mothers with severe acute respiratory syndrome. Pediatrics.
2003;112:254–6.
- Zhang JP, Wang YH, Chen LN, Zhang R, Xie YF. Clinical
analysis of pregnancy in second and third trimesters complicated severe
acute respiratory syndrome. Zhonghua Fu Chan Ke Za Zhi. 2003;38:516–20.
- Wong SF, Chow KM, deSwiet M. Severe
acute respiratory syndrome and pregnancy. BJOG. 2003;110:641–2
Suggested citation
for this article:
Stockman LJ, Lowther
SA, Coy K, Saw J, Parashar UD. SARS during pregnancy, United States [letter].
Emerg Infect Dis [serial on the Internet]. 2004 Sep [date cited].
Available from: http://www.cdc.gov/ncidod/EID/vol10no9/04-0244.htm
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