Low Rate of Ocular Abnormalities Seen Among Newborns Exposed to SARS-CoV-2 In Utero

April 19, 2021
Skylar Jeremias

A study of newborns exposed to SARS-CoV-2, the virus that causes COVID-19, during gestation found few instances of ocular abnormalities, with none detected in exposed infants who testing positive.

Among the infants gestationally exposed to SARS-CoV-2, the virus that causes COVID-19, and who tested positive after birth, none had ocular abnormalities, according to an uncontrolled case series. Additionally, few ocular irregularities were observed among exposed newborns who tested negative.

The report, published in JAMA Ophthalmology, likely rules out a moderate to high increased risk of ocular effects in newborns of mothers who experienced SARS-CoV-2 infection, regardless of what point during gestation the exposure occurred.

“Additional controlled and larger-sized studies with standardized imaging (fundus images and optical coherence tomography imaging) and standardization of ophthalmologists would be needed to rule out a low increased risk,” wrote the investigators.

Viruses that cause diseases similar to COVID-19 are known to cause ocular complications in newborns. A previous study evaluating 38 pregnant women with COVID-19 found no association with increased mortality, morbidity, or maternal transmission in newborns. However, no studies have analyzed the ophthalmological impacts of infection with SARS-CoV-2 during pregnancy.

From April to November 2020, the investigators enrolled newborns of mother with COVID-19 admitted to 3 maternity hospitals in São Paulo, Brazil. All the infants underwent an external ocular examination and binocular indirect ophthalmoscopy.

The study enrolled 165 newborns with maternal COVID-19 infection. The age of the newborns at the time of examination ranged from 1 to 18 days. The mean (SD) weight of the newborns was 2931 (702) g, 74.5% (n = 123) were born full term, and 25.4% (n = 42) were born preterm. Twenty-nine (17.6%) infants were born weighing less than 1500 g and 2 were classified as having an extremely low birth weight, or weighing less than 1000 g. The mean (SD) length of the infants was 47.3 (3.9) cm.

Diagnosis of COVID-19 in the mothers was reported between the first and 40th gestational weeks, and 6 newborns tested positive for SARS-CoV-2 via polymerase chain reaction. One infant tested positive within its first 18 days, suggesting horizontal viral transmission, and the remaining 5 tested positive on their first day of life, suggesting vertical viral transmission. No infants testing positive had ocular abnormalities.

“Although more data are needed, vertical transmission of SARS-CoV-2 seems to be possible and should be a concern, especially in a condition that could be asymptomatic, that is so wide- spread in the population, and that could bring a substantial burden to patients and to the health care system even at low rates of congenital infection,” wrote the investigators.

Of the 5 infants who tested positive on the first day of life, 4 were infected during the third trimester and 1 during the first trimester.

Despite all positive infants presenting with no ocular abnormalities, some who tested negative showed fundus abnormalities that may or may not be associated with COVID-19 exposure during gestation.

“Considering the noninvasive nature of fundus examination, retinal changes should be further investigated in prospective studies to understand their possible applications in the diagnosis and management of COVID-19,” the investigators suggested.

Additionally, 1 infant testing negative presented with retinal vascular tortuosity and venous engorgement, 7 infants presented with retinal hemorrhages, and 2 had retinopathy of prematurity. One COVID-19–negative infant also had to be treated with antivascular endothelial growth factor injection for an aggressive posterior form.

The investigators noted the lack of control group and standardized imaging as study limitations.


Kiappe OP, Santos da Cruz NF, Rose PAC, Arrais L, Bueno de Moraes NS. Ocular assessments of a series of newborns gestationally exposed to maternal COVID-19 infection. Published online April 7, 2021. Accessed on April 14, 2021. doi: 10.1001/jamaophthalmol.2021.1088