key: cord-0976774-iq6au1go authors: Sahu, Kamal K.; Mishra, Ajay K.; Lal, Amos title: A twin challenge to handle: COVID‐19 with pregnancy date: 2020-04-05 journal: J Med Virol DOI: 10.1002/jmv.25784 sha: a1b8973f30526bc93694853ce28a08be4913ceb2 doc_id: 976774 cord_uid: iq6au1go nan We acknowledge Jiao et al's concern regarding the great need of giving special attention to the pregnant patients during a pandemic period like the current COVID-19 crisis. 1 Although Jiao et al discussed the concept of actively suspecting and monitoring such patients, together with their follow-up starting from early and middle pregnancy, we still believe that recommendations and guidelines of approaching a pregnant patient affected by COVID-19 should be discussed in more detail. The recent outbreak of SARS-CoV-2 has been extremely challenging for all sectors of healthcare. COVID-19 patients with pregnancy are special populations who need excellent care and support. However, very little is known regarding the guidelines on how to approach to pregnant patients suffering from COVID-19. We agree that there is a scarcity of data, but at the same time, patients; hence, it is difficult to comment definitively on the basis of available data, but we expect to have more data on COVID-19 pregnant patients in near future to study such outcomes. Table 1 mentions the three major studies from three major outbreaks-COVID-19, 7 MERS, 11 and SARS 12 -for better understanding. On the basis of these studies, we can conclude that the mortality rate in SARS-infected pregnant patients, as reported by Lam et al (reported mortality rate 30%) and Wong et al (reported mortality rate 25%), was almost two to three times more than in SARS-infected nonpregnant population (reported mortality rate 9%-10%). 7, 11, 12 Last but not the least, we also feel the pain of the Jiao et al when they mentioned about the sorrowful state under which pregnant medical staff, nurses, and doctors, especially from developing nations, have to continue working during the infective crisis, exposing themselves and their in utero babies during a crucial phase of intrauterine growth. To attest the same, we hereby mention a report on two Chinese physicians who had COVID-19 exposure during their pregnancy and had to undergo C-section. 13 Fortunately, baby and the mother in both cases did not suffer from any peripartum complication. Current literature on COVID-19 pandemic is rapidly evolving and hence we expect more revisions. 14, 15 In conclusion, pregnancy with COVID-19 disease is a special scenario that needs a good understanding of the pathophysiology of this disease. Training the obstetricians based on the current recommendations and previous experiences would ensure the appropriate care of this subset of the population. Under the epidemic situation of COVID-19, should special attention to pregnant women be given? Clinical management of severe acute respiratory infection when Novel coronavirus (2019-nCoV) infection is suspected: Interim Guidance Obstetric Subgroup, et al. Proposed management of 2019-novel coronavirus infection during pregnancy and puerperium 2019-nCoV epidemic: what about pregnancies? Novel coronavirus disease (COVID-19) in pregnancy: What clinical recommendations to follow? Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records 1 Description and comparison of various recent studies on COVID-19, MERS, and SARS Parameters COVID-19 SARS Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy Comprehensive update on current outbreak of novel coronavirus infection (2019-nCoV) Novel coronavirus (2019-nCoV): update on 3rd coronavirus outbreak of 21st century QJM A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: report of two cases & review of the literature Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? COVID-2019 and Pregnancy: a plea for transparent reporting of all cases An update on CT chest findings in coronavirus disease-19 (COVID-19) Liu et al 7 Wong et al 12