First report of acute MERS-CoV infection associated with adverse pregnancy outcome

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1. This report describes the first reported case of acute Middle East Respiratory Syndrome coronavirus (MERS-CoV) associated with a second-trimester stillbirth in a 39-year-old woman

Evidence Rating Level: 4 (Poor)

Study Rundown: Severe respiratory infections during pregnancy can compromise oxygen flow to fetus, which may result in intrauterine growth restriction and spontaneous miscarriages. The authors of this retrospective case present the first published case of a MERS-CoV infection linked to a second-trimester stillbirth. The patient was a 39-year-old G6P6 woman from Jordan who acquired the MERS-CoV infection at 5 months gestation.  She developed acute respiratory symptoms and spontaneously delivered a stillborn newborn in the seventh day of illness. The patient had an uncomplicated pregnancy up until her respiratory symptoms. MERS-CoV antibodies were detected in the mother in serologic testing. This is the first report to describe pregnancy outcomes associated with acute MERS-CoV infection and suggests that MERS-CoV may have similar adverse maternal and birth outcomes as previously observed in SARS-CoV and H1N1 influenza. However, given the fact that fetal remains were not available for pathological analysis and the retrospective methodology, it is difficult to establish a strong causal relationship.

Click to read the study in The Journal of Infectious Diseases

Relevant Reading: H1N1 2009 influenza virus infection during pregnancy in the USA

In-Depth [case series]: The case was identified in a retrospective investigation of a MERS-CoV outbreak that occurred in April 2012 in Zarqa, Jordan. The patient acquired the MERS-CoV infection and experienced symptoms of fever, rhinorrhea and fatigue. She concurrently experienced vaginal bleeding and abdominal pain and delivered a stillborn infant seven days after onset of respiratory symptoms. The patient rejected X-ray imaging and medications during her illness. The patient’s laboratory results were positive for all three MERS-CoV serologic markers: EIA (1:1600), IFA, and MNt (80). The patient also reported unprotected exposure to husband with serologically confirmed MERS-CoV prior to her onset. There is currently no published information on the potential impact of MERS-CoV infections on pregnancy outcomes. This case report prompts addition prospective investigations on pregnancy outcomes associated with MERS-CoV.

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