What Effect Does Maternal COVID-19 Infection in the First Trimester Have on Fetal Lung Development?

Background: Current evidence suggests that infants born to mothers with COVID-19 are more likely to be admitted to neonatal intensive care than those born to uninfected mothers1. However, the majority of these cases involve maternal infection at or around time of delivery with few studies separating cases by trimester. There have been several reported cases of placental infection with the SARS-CoV-2 virus and there is growing evidence to suggest that even in the absence of fetal infection, placental infection can lead to a fetal pro-inflammatory state impacting on fetal development2. Case: A 33-year-old primigravida acquired COVID-19 at 6-week gestation via community transmission from an infected co-worker. She suffered only mild symptoms. She subsequently had an unremarkable pregnancy with normal antenatal ultrasounds. Her daughter was delivered via elective caesarean section at 38+6/40 with APGARS of 9 and 9. Within 1 hour of delivery the infant experienced acute respiratory distress thought to be secondary to mild hyaline membrane disease, requiring 12 hours of continuous positive airway pressure (CPAP). Twenty-two hours after cessation of CPAP the infant developed a large right-sided pneumothorax requiring active management. The infant and placenta were not tested for COVID-19. Discussion: This case raises the question of whether maternal infection with COVID-19 in the first trimester might impact on fetal lung development. Further trimester-specific evidence is required to fully understand the impact of infection on fetal outcomes.