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COVID-19 Pandemic, Pregnancy and Cord Blood Banking

FREQUENTLY ASKED QUESTIONS

COVID-19, Pregnancy and Cord Blood Banking

As the new coronavirus disease (COVID-19) continues to spread around the world, new clinical analyses are providing more information about the pandemic. Some of the findings are about pregnancy, the blood in the umbilical cord, and the tissues around the birth canal.

To help expectant families make informed choices, we have gathered existing information from recent clinical studies and prepared known answers to address some commonly asked questions about stem cell banking.

Are pregnant mothers more susceptible to contracting COVID-19?

According to the American College of Obstetricians and Gynecologists (ACOG) as well as the Centres for Disease Control and Prevention (CDC) of the United States, there is no evidence to suggest that pregnant mothers are more at risk of getting infected with COVID-19.1,2

However, pregnant mothers who have viral respiratory infections may be at greater risk of developing severe symptoms. 2 Given that the symptoms of COVID-19 are similar to those of many respiratory infections, see a doctor immediately if you are experiencing symptoms such as cough and fever.

If you are pregnant during the COVID-19 pandemic, it is absolutely crucial to observe personal hygiene by washing your hands with soap frequently and also avoid travelling to crowded places. If travelling is essential, always wear a face mask.

Can the COVID-19 virus be transmitted to the unborn baby during pregnancy?

Evidence suggests that COVID-19 is mostly spread from person to person through close contact with air droplets that carry the virus and are released when an infected person coughs or sneezes. According to the CDC, mother-to-child transmission of COVID-19 during pregnancy is unlikely.1

In a recent case study of nine pregnant women with COVID-19 who had caesarean deliveries, none of the babies tested positive for COVID-19. In addition, the virus was not detected in cord blood, throat swabs, amniotic fluid, or other maternal samples collected.3

However, early research from China suggests that the COVID-19 virus could be passed from mother to child after the baby is born. According to a widely cited and shared research letter from Wuhan, China, COVID-19 was found in three out of 33 babies born to COVID-19-positive mothers through caesarean delivery. Even though the three newborns showed symptoms of fever and pneumonia right after birth, all of them have recovered and were tested negative for COVID-19 within a span of one week.4

Hence, it can't be ruled out that COVID-19 could be passed on to the baby through close contact. In this case, the mother may want to consider getting additional help to care for the baby until she is fully recovered.

Will my baby’s cord blood contain the COVID-19 virus?

As far as we know, your baby’s cord blood will not contain the COVID-19 strain, even if the mother is a carrier. Typically, when a mother is sick with a respiratory virus, it is very rare for the virus to be present in the cord blood.5,6,7

A retrospective study conducted in Wuhan, China, on nine pregnant women in their third trimester who all had a history of epidemiological exposure to COVID-19 has also provided further reassurance that the virus is unlikely to be present in cord blood and birth tissues. The study's nine livebirths were all COVID-19 negative, with no severe perinatal asphyxia. 3 Perinatal asphyxia is defined as a lack of blood flow or oxygen to or from the foetus in the period immediately before, during, or after the birth process.8 Furthermore, amniotic fluid, cord blood, and neonatal throat swab samples of the newborns were also COVID-19 negative at the point of birth.3

A recent study on 38 pregnant women and their newborns in China assessed the effects of COVID-19 and the virus's transmissibility from mother to foetus. The findings also revealed that the COVID-19 virus did not cause maternal death and that there were no cases of COVID-19 intrauterine transmission from mothers to their foetuses. Furthermore, neonatal specimens and placentas were tested negative for the virus in some cases. 9

Is it safe to have cord blood, cord lining and cord tissue collected during this pandemic?

As cord blood will be collected by your caregiver immediately after the delivery of your baby, the collection of cord blood, cord lining, and cord tissue remains safe even during this pandemic period.

Emerging evidence is now suggesting that the risk of direct transmission at the point of delivery is low, and there was no detection of the COVID-19 virus strain within the maternal and neonatal samples that can be transmitted to the umbilical cord blood and cord tissue.9

In most, if not all, cases of COVID-19 human-to-human transmission globally, the virus is spread mainly through close interaction with an infected person, where respiratory secretions can enter the eyes, mouth, nose, or airways, and via the touching of a surface or an object that is contaminated with the respiratory droplets.10

Cordlife is listed as an essential service provider during this pandemic. Our laboratory operations remain unaffected, and we will adhere to the most stringent protocols to ensure that your baby’s cord blood, cord lining and cord tissue are safely collected, processed, and cryopreserved.

Can Mesenchymal Stem Cells be used to treat COVID-19?

At this juncture, there is little or no conclusive evidence to prove that Mesenchymal Stem Cells (MSCs) can help treat COVID-19. It is important to note that the major risk factor in COVID-19 mortality is the development of acute respiratory distress syndrome (ARDS) in critically ill patients, among other considerations such as age and pre-existing medical conditions.11 According to the European Respiratory Journal, MSC treatment was given to ARDS patients who had respiratory infections caused by the influenza virus (H7N1) and was found to be a viable treatment that resulted in a shorter ICU stay and faster recovery in patients11

A recent pilot study was conducted in Wuhan, China, in which seven COVID-19 patients received allogeneic Mesenchymal Stem Cells (MSC) infusions. Among the seven patients, three (two moderate and one severe) had recovered and were discharged 10 days after the treatment. The results may suggest that MSCs could be used to treat or significantly improve the patients' conditions. 12

The World Health Organization (WHO) and several U.S. agencies, led by the Centres for Disease Control and Prevention (CDC), are looking into using expanded MSCs as a possible treatment for COVID-19. 13 The limited but emerging evidence regarding MSCs in managing COVID-19 suggests an urgent mandate for more clinical trials to determine the direct impact these regenerative cells have on patient recovery, which may point in favour of uncovering the potential applications of MSCs to treat COVID-19.

LINKS TO RESOURCES

REFERENCES

  1. CDC/Coronavirus Disease 2019 (COVID-19). Centers forDisease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/need-extra precautions/pregnancy-breastfeeding.html. Accessed April 27, 2020.
  2. ACOG/Coronavirus Disease 2019 (COVID-19) Practice Advisory. The American College of Obstetricians and Gynecologists website. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019. Accessed April 27, 2020.
  3. ChenH, GuoJJ, WangC, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19infection in nine pregnant women: a retrospective review of medical records. THE LANCET. 2020; 395(10226): 809 –815.
  4. ZengLK, XiaSW, YuanWH, et al. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatrics. 2020; https://jamanetwork.com/journals/jamapediatrics/fullarticle/2763787. Accessed April 27, 2020. doi:10.1001/jamapediatrics.2020.0878.
  5. Irving WL, James DK, Stephenson T, et al. Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study [Abstract]. BJOG. 2000; 107(10): 1282-9. https://www.ncbi.nlm.nih.gov/pubmed/11028582. Accessed April 27, 2020. PMID: 11028582.
  6. Robertson CA, Lowther SA, Birch T, et al. SARS and Pregnancy: A Case Report. Emerg Infect Dis. 2004;10(2):345–348. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322896/. Accessed April 27, 2020. PMID: 11028582.
  7. Zou S. Potential Impact of Pandemic Influenza on Blood Safety and Availability. Transfus Med Rev. 2006;20(3):181–189. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134961/. Accessed April 27, 2020. PMID: 16787826.
  8. Gillam-Krakauer M, Gowen Jr CW. Birth Asphyxia. [Updated 2019 Nov 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK430782/. Accessed April 27, 2020.
  9. Schwartz DA. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2:Maternal Coronavirus Infections and Pregnancy Outcomes [Abstract]. Arch Pathol Lab Med. 2020; https://www.ncbi.nlm.nih.gov/pubmed/32180426. Accessed April 27, 2020. PMID: 32180426.
  10. Royal College of Obstetricians and Gynaecologists:Coronavirus (COVID-19) Infection in Pregnancy-Information for healthcare professionals. Ver 7; 2020: 1-53. Info
  11. Khoury M, Cuenca J, Cruz FF, et al. Current Status of Cell-Based Therapies for Respiratory Virus Infections: Applicability to COVID-19. Eur Respir J. 2020; in press (https://doi.org/10.1183/13993003.00858-2020). Accessed April 27, 2020.
  12. LengZK, ZhuRJ, HouW, et al. Transplantation of ACE2-Mesenchymal Stem Cells Improves the Outcome of Patients with COVID-19 Pneumonia. Aging and disease. 2020; 11(2): 216-228. http://www.aginganddisease.org/EN/10.14336/AD.2020.0228. Accessed April 27, 2020. DOI: 10.14336/AD.2020.0228.
  13. Atluri S, ManchikantiL, Hirsch JA. Expanded Umbilical Cord Mesenchymal Stem Cells (UC-MSCs) as a Therapeutic Strategy in Managing Critically Ill COVID-19 Patients: The Case for Compassionate Use [Abstract]. Pain Physician. 2020; 23(2):E71-E83. https://www.ncbi.nlm.nih.gov/pubmed/32214286. Accessed April 27, 2020. PMID: 32214286.

DCR No. 4071, June 2020, Version A