Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know

Late miscarriage and stillbirth in asymptomatic and symptomatic hospitalised pregnant women in Belgium during the first and second waves of COVID-19: a prospective nationwide population-based study

BACKGROUND

Stillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium.

METHODS

Stillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment.

RESULTS

Our cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.5‰ for singleton pregnancies and 83.3‰ for multiple pregnancies, which seems higher than for the background population (respectively 5.6‰ and 13.8‰). The agreement between assessors about the causal relationship with SARS-Cov-2 infection was fair (global weighted kappa value of 0.66). Among these demises, 17.4% (4/23) were "certainly" attributable to SARS-CoV-2 infection, 13.0% (3/23) "probably" and 30.4% (7/23) "possibly". Better agreement in the rating was noticed when pathological examination of the placenta and identification of the virus were available, underlining the importance of a thorough investigation in case of intra-uterine fetal demise.

CONCLUSIONS

SARS-CoV-2 causality assessment of late miscarriage and stillbirth cases in our Belgian nationwide case series has shown that half of the fetal losses could be attributable to SARS-CoV-2. We must consider in future epidemic emergencies to rigorously investigate cases of intra-uterine fetal demise and to store placental tissue and other material for future analyses.

Health and economic implications of the ongoing coronavirus disease (COVID-19) pandemic on women and children in Africa

The coronavirus disease (COVID-19) pandemic continues to pose major health and economic challenges for many countries worldwide. Particularly for countries in the African region, the existing precarious health status resulting from weak health systems have made the impact of the pandemic direr. Although the number of the COVID-19 infections in Africa cannot be compared to that of Europe and other parts of the world, the economic and health ramifications cannot be overstated. Significant impacts of the lockdowns during the onset of the pandemic caused disruptions in the food supply chain, and significant declines in income which decreased the affordability and consumption of healthy diets among the poor and most vulnerable. Access and utilization of essential healthcare services by women and children were also limited because of diversion of resources at the onset of the pandemic, limited healthcare capacity, fear of infection and financial constraint. The rate of domestic violence against children and women also increased, which further deepened the inequalities among these groups. While all African countries are out of lockdown, the pandemic and its consequent impacts on the health and socio-economic well-being of women and children persist. This commentary discusses the health and economic impact of the ongoing pandemic on women and children in Africa, to understand the intersectional gendered implications within socio-economic and health systems and to highlight the need for a more gender-based approach in response to the consequences of the pandemic in the Africa region.

Clinical and laboratory characteristics of COVID-19 in pregnant women

This article discusses the distinct characteristics of COVID-19 in pregnant women and investigates potential early predictors of disease severity in this specific patient population. The study included 116 pregnant women with a confirmed diagnosis of COVID-19 in different trimesters of pregnancy. In addition to clinical features, we evaluated general clinical research methods, biochemical parameters (procalcitonin, C-reactive protein, D-dimer), and the leukocyte index of endogenous intoxication and lymphocytic index to identify potential early predictors of disease severity. All pregnant women were divided into two study groups: Group I - pregnant women with mild course, and Group II - pregnant women with moderate and severe course of COVID-19. Most pregnant women (72.4%) experienced a non-severe course characterized by catarrhal symptoms and moderate intoxication. However, pulmonary manifestations and pregnancy-related complications were detected in pregnant women from Group 2. The levels of C-reactive protein and procalcitonin in both study groups were significantly increased compared to the control group. In pregnant women with moderate and severe COVID-19, indicators of endogenous intoxication were significantly pronounced. Establishing associations between leukocyte indices and biomarkers, such as procalcitonin and C-reactive protein, enables the utilization of routine complete blood counts as a primary screening tool for predicting the severity of COVID-19 in pregnant women.

SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.

To what extent do young chinese elites comply with COVID-19 prevention and control measures?

BACKGROUND

During the COVID-19 pandemic, it is vital for individuals to comply with the government's prevention and control measures. This study aims to explore determinants of college students' compliance behaviour during the COVID-19 pandemic.

METHODS

This study conducted an online survey among 3,122 individuals aged 18 and above from March to November 2022 in China. Individuals' compliance behaviour was divided into protective behaviour (that includes wearing a mask, maintaining a physical distance, and getting vaccinated) and restrictive behaviour (that includes offering health codes and a nucleic acid test certificate). Individuals' compliance motivation was divided into calculated motivation (including the fear of being infected, the fear of being published, and previous experience of pandemic prevention) and normative motivation (including the sense of social responsibility and trust in government). We defined young people aged between 18 and 24 with a college degree as young elites, and constructed ordinary least squares linear regression to compare their compliance behaviour with young people without a college degree (young non-elites), and non-young people with a college degree (non-young elites).

RESULTS

Almost three years after the outbreak of the pandemic, Chinese individuals retained a high degree of compliance with COVID-19 prevention and control policies, particularly with respect to the provision of health codes. Young elites were more compliant with getting vaccinated, wearing a mask, providing health codes and testing results than their counterparts. The sense of social responsibility and trust in government were the major drivers of young elites' compliance behaviour during the pandemic. Young elites who were male, had a rural "hukou", and were not a member of the China Communist Party were more compliant with COVID-19 prevention and control measures.

CONCLUSION

This study found that young elites in China had high policy compliance during the COVID-19 pandemic. These young elites' compliance behaviour was driven by their sense of social responsibility and trust in government rather than the fear of being infected and the fear of being punished as a result of violating the regulations. We suggest that in the context of managing health crises, in stead of introducing punitive measures to enforce citizens to comply with the management measures, promoting citizens' sense of social responsibility and building a trusting relationship with citizens contrite to the enhancement of citizens' policy compliance.

Global knowledge, attitude, and practice towards COVID-19 among pregnant women: a systematic review and meta-analysis

BACKGROUND

Pregnant women form a specially vulnerable group due to unique changes in pregnancy, leading to a higher risk of getting a severe infection. As severe COVID-19 increases the risk of preeclampsia, preterm delivery, gestational diabetes, and low birth weight in pregnancy, there is a need to enhance pregnant women's knowledge, attitudes, and practices to prevent these complications. This systematic review and meta-analysis aimed to determine their levels of knowledge, attitudes, and practice (KAP) regarding COVID-19 at the global level.

METHODS

The systematic literature search was conducted in the English language, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest, from the occurrence of the pandemic until September 2022. We used The Newcastle Ottawa scale for cross-sectional studies checklist to evaluate the risk of bias in the studies. Data were extracted by a Microsoft Excel spreadsheet and analyzed by STATA software version 14. We also employed Cochran Q statistics to assess the heterogeneity of studies and utilized Inverse variance random-effects models to estimate the pooled level of pregnant women's KAP towards COVID-19 infection prevention.

RESULTS

Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 53 qualified studies were acquired from several countries. In total, 51 articles (17,319 participants) for knowledge, 15 articles (6,509 participants) for attitudes, and 24 articles (11,032 participants) for practice were included in this meta-analysis. The pooled good knowledge, positive attitude, and appropriate practice in pregnant women were estimated at 59%(95%CI: 52-66%), 57%(95%CI: 42-72%), and 53%(95%CI: 41-65%), respectively. According to subgroup analysis, the level of knowledge, attitude, and practice were 61%(95%CI: 49-72), 52%(95%CI: 30-74), and 50%(95%CI: 39-60), respectively, in Africa, and 58.8%(95%CI: 49.2-68.4), 60%(95%CI: 41-80) and 60% (95%CI: 41-78), respectively, in Asia.

CONCLUSION

The Knowledge, attitude, and practice towards COVID-19 infection prevention in pregnant women were low. It is suggested that health education programs and empowerment of communities, especially pregnant women, about COVID-19 continue with better planning. For future studies, we propose to investigate the KAP of COVID-19 in pregnant women in countries of other continents and geographical regions.

Inhibition of IL-6 signaling prevents serum-induced umbilical cord artery dysfunction from patients with severe COVID-19

Coronavirus disease 2019 (COVID-19) infection has a negative impact on the cytokine profile of pregnant women. Increased levels of proinflammatory cytokines seem to be correlated with the severity of the disease, in addition to predisposing to miscarriage or premature birth. Proinflammatory cytokines increase the generation of reactive oxygen species (ROS). It is unclear how interleukin-6 (IL-6) found in the circulation of patients with severe COVID-19 might affect gestational health, particularly concerning umbilical cord function. This study tested the hypothesis that IL-6 present in the circulation of women with severe COVID-19 causes umbilical cord artery dysfunction by increasing ROS generation and activating redox-sensitive proteins. Umbilical cord arteries were incubated with serum from healthy women and women with severe COVID-19. Vascular function was assessed using concentration-effect curves to serotonin in the presence or absence of pharmacological agents, such as tocilizumab (antibody against the IL-6 receptor), tiron (ROS scavenger), ML171 (Nox1 inhibitor), and Y27632 (Rho kinase inhibitor). ROS generation was assessed by the dihydroethidine probe and Rho kinase activity by an enzymatic assay. Umbilical arteries exposed to serum from women with severe COVID-19 were hyperreactive to serotonin. This effect was abolished in the presence of tocilizumab, tiron, ML171, and Y27632. In addition, serum from women with severe COVID-19 increased Nox1-dependent ROS generation and Rho kinase activity. Increased Rho kinase activity was abolished by tocilizumab and tiron. Serum cytokines in women with severe COVID-19 promote umbilical artery dysfunction. IL-6 is key to Nox-linked vascular oxidative stress and activation of the Rho kinase pathway.

Gestational complications associated with SARS-CoV-2 infection in pregnant women during 2020-2021: systematic review of longitudinal studies

OBJECTIVES

To identify gestational complications associated with SARS-CoV-2 infection in pregnant women during 2020-2021.

CONTENT

The risk of gestational complications was confirmed during SARS-CoV and MERS-CoV infection. However, this is not robust for COVID-19 because there is still no scientific evidence from longitudinal studies. A systematic review was performed using four databases, and 14 prospective or retrospective cohorts were finally included in the analysis.

SUMMARY

The most frequently associated sociodemographic characteristic or comorbidity was the presence of any previous comorbidity (9 studies, 64.3%), followed by ethnicity and age (6 studies each one, 42.9%). The most frequently associated gestational complications in mothers were the admission to Intensive Care Unit (4 studies, 28.6%) and gestational age at delivery <37 weeks (3 studies, 21.4%). The most frequently associated gestational complications in newborns were preterm birth (4 studies, 28.6%) and the admission to Neonatal Intensive Care Unit (2 studies, 14.3%).

OUTLOOK

Pregnant women infected with SARS-CoV-2 appear to have a higher risk of admission to Intensive Care Unit. Newborns of mothers infected with SARS-CoV-2 appear to have a higher risk of preterm birth and admission to Neonatal Intensive Care Unit.

Symptomatic COVID-19 in Pregnancy: Hospital Cohort Data between May 2020 and April 2021, Risk Factors and Medicolegal Implications

Pregnancy does not appear to increase susceptibility to SARS-CoV-2 infection, but some physiological changes, such as the reduction of residual functional volumes, elevation of the diaphragm, and impaired cellular immunity, may increase the risk of severe disease and result in a higher risk of complications. The article’s primary objective is to evaluate the factors associated with symptomatic COVID-19 disease in pregnancy. The secondary objective is to describe maternal and neonatal outcomes and cases of vertical transmission of the infection. All pregnant women hospitalized with SARS-CoV2 infection were included in a prospective study in the UOC of Obstetrics and Gynecology, AOOR Villa Sofia—Cervello, Palermo, between May 2020 and April 2021. The patients who requested the termination of the pregnancy according to Law 194/78 were excluded. We included 165 pregnancies with a total number of 134 deliveries. Overall, 88.5% of the patients were asymptomatic at the time of admission and 11.5% were symptomatic. Of them, 1.8% of the patients required hospital admission in the intensive care unit. Symptoms occurrences were positively associated with the increase in maternal BMI (OR 1.17; p = 0.002), the prematurity (OR 4.71; p = 0.022), and at a lower birth weight (OR 0.99; p = 0.007). One infant tested positive for SARS-CoV2 nasopharyngeal swab; 11.4% of newborns had IgG anti SARS-CoV2 at birth; IgM was positive in 2.4% of newborns. There was no difference statistically significant difference in the vertical transmission of the infection among the group of symptomatic pregnant women and that of asymptomatic pregnant women.

Fertility Does not Quarantine: Coronavirus Disease 2019 Pandemic Impacts on in Vitro Fertilization Clinical Pregnancy Rates

OBJECTIVE

 To understand the impact of the coronavirus disease 2019 pandemic on in vitro fertilization (IVF) clinical pregnancy rates and analyze factors that may have influenced their outcome.

METHODS

 This was a retrospective observational study conducted at a tertiary-care Brazilian fertility center. All fresh IVF and embryo warming cycles performed from March 11 to December 31, 2018-2021 were analyzed, and their data were used to calculate fertilization, embryo cleavage, cycle cancellation, embryo transfer (ET), and clinical pregnancy rates. Statistical tests were used to evaluate the alterations found. Logistic regression models were used to explore the association of the categorical variables with the observed clinical pregnancy rates. Data from 2018 and 2019 (prepandemic) and 2020 and 2021 (pandemic) were grouped.

RESULTS

 A total of 756 cycles were analyzed (n = 360 prepandemic and n = 396 pandemic). The age group of the patients, fertilization rates, and cleavage rates did not have significant differences (p > 0.05). There was a reduction in the percentage of fresh IVF and an increase in embryo warming cycles (p = 0.005) during the pandemic. There was also an increase in fresh cycle cancellations (p < 0.001) and a reduction in ET rates (p < 0.001). The pandemic had a negative impact on clinical pregnancy rates (p < 0.001) especially due to the increase in fresh cycle cancellations (p < 0.001).

CONCLUSION

 Embryo warming cycles with subsequent frozen-thawed ET were presented as a viable alternative to continue assisted reproductive treatments against pandemic restrictions on fresh cycles, ensuring clinical pregnancy, albeit at a lower rate than that of the prepandemic period.

The investigation of the complex population-drug-drug interaction between ritonavir-boosted lopinavir and chloroquine or ivermectin using physiologically-based pharmacokinetic modeling

OBJECTIVES

Therapy failure caused by complex population-drug-drug (PDDI) interactions including CYP3A4 can be predicted using mechanistic physiologically-based pharmacokinetic (PBPK) modeling. A synergy between ritonavir-boosted lopinavir (LPVr), ivermectin, and chloroquine was suggested to improve COVID-19 treatment. This work aimed to study the PDDI of the two CYP3A4 substrates (ivermectin and chloroquine) with LPVr in mild-to-moderate COVID-19 adults, geriatrics, and pregnancy populations.

METHODS

The PDDI of LPVr with ivermectin or chloroquine was investigated. Pearson's correlations between plasma, saliva, and lung interstitial fluid (ISF) levels were evaluated. Target site (lung epithelial lining fluid [ELF]) levels of ivermectin and chloroquine were estimated.

RESULTS

Upon LPVr coadministration, while the chloroquine plasma levels were reduced by 30, 40, and 20%, the ivermectin plasma levels were increased by a minimum of 425, 234, and 453% in adults, geriatrics, and pregnancy populations, respectively. The established correlation equations can be useful in therapeutic drug monitoring (TDM) and dosing regimen optimization.

CONCLUSIONS

Neither chloroquine nor ivermectin reached therapeutic ELF levels in the presence of LPVr despite reaching toxic ivermectin plasma levels. PBPK modeling, guided with TDM in saliva, can be advantageous to evaluate the probability of reaching therapeutic ELF levels in the presence of PDDI, especially in home-treated patients.

A COVID Dilemma: How to Manage Pregnancies in Case of Severe Respiratory Failure?

To date, the impact of the COVID-19 pandemic on the world's health, economics and politics is still heavy, and efforts to mitigate virus transmission have caused remarkable disruption. From the early onset of the pandemic, generated by SARS-CoV-2 spread, the scientific community was aware of its impact on vulnerable individuals, including pregnant women. The purpose of this paper is to highlight scientific pitfalls and ethical dilemmas emerging from management of severe respiratory distress in pregnant women in order to add evidence to this topic through an ethical debate. In the here-presented paper, three cases of severe respiratory syndrome are analyzed. No specific therapeutic protocol was available to guide physicians in a cost-benefit balance, and unequivocal conduct was not a priori suggested from scientific evidence. However, vaccines' advent, viral variants lurking on the horizon and other possible pandemic challenges make it necessary to maximize the experience gained through these difficult years. Antenatal management of pregnancies complicated by COVID-19 infection with severe respiratory failure is still heterogeneous and ethical concerns must be pointed out.

Influence of the COVID-19 pandemic on labor and childbirth care practices in Brazil: a cross-sectional study

BACKGROUND

It has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil.

METHODS

This cross-sectional and comparative study analyzed preliminary data from the study "Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2", which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study "Birth in Belo Horizonte: labor and birth survey", conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, "Birth in Belo Horizonte: labor and birth survey", data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson's chi-square test, with a confidence level of 95%, and using Stata statistical program.

RESULTS

We found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001).

CONCLUSION

Our study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

Thrombocytopaenia and COVID-19 infection during pregnancy increases the risk of preeclampsia: a multicentre study

RESEARCH QUESTION

Is a low platelet count related to an increased risk of severe disease in pregnant women with active severe acute respiratory syndrome coronavirus 2 infection?

DESIGN

A cross-sectional multicentre study in pregnant women with COVID-19 confirmed by polymerase chain reaction, antigen test, antibody test, or all.

RESULTS

A total of 153 pregnant women with COVID-19 were included in the study, of whom 12.4% had thrombocytopaenia. Pregnant women with thrombocytopaenia were on average 3.1 years older (95% CI 0.18 to 6.38) than women without thrombocytopaenia. Pregnant smokers had a higher risk of thrombocytopaenia than non-smokers (OR 6.55, CI 95% 1.29 to 33.13). B Rh negative (B Rh-) pregnant women had a much higher risk of thrombocytopaenia than pregnant women with other blood groups (OR 16.83, CI 95% 1.42 to 199.8). Pregnant women with thrombocytopaenia had a much higher risk of suffering from preeclampsia (OR 16.2, CI 95% 1.35 to 193.4).

CONCLUSIONS

COVID-19 infection is not a risk factor for a low platelet count in pregnant women, although the risk is increased by smoking and in women with blood group B Rh-. In case of pregnancy with thrombocytopaenia, COVID-19 infection leads to an increased risk of preeclampsia.

Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study

OBJECTIVE

Our study determined the association of pregnancy with various clinical outcomes among women with COVID-19 infection.

METHODS

We conducted a retrospective, cohort, subgroup analysis of the Philippine CORONA Study datasets comparing the clinical/neurological manifestations and outcomes of pregnant and nonpregnant women admitted in 37 Philippine hospitals for COVID-19 infection.

RESULTS

We included 2448 women in the analyses (322 pregnant and 2.126 nonpregnant). Logistic regression models showed that crude odds ratio (OR) for mortality (OR 0.26 [95% CI 0.11, 0.66]), respiratory failure [OR 0.37 [95% CI 0.17, 0.80]), need for intensive care (OR 0.39 [95% CI 0.19, 0.80]), and prolonged length of hospital stay (OR 1.73 [95% CI 1.36, 2.19]) among pregnant women were significant. After adjusting for age, disease severity, and new-onset neurological symptoms, only the length of hospital stay remained significant (adjusted OR 1.99 [95% CI 1.56,2.54]). Cox regression models revealed that the unadjusted hazard ratio (HR) for mortality (HR 0.22 [95% CI 0.09, 0.55]) among pregnant women was statistically significant; however, after adjustment, the HR for mortality became nonsignificant.

CONCLUSION

We did not find a significantly increased risk of mortality, respiratory failure, and need for ICU admission in pregnant women compared with nonpregnant women with COVID-19. However, the likelihood of hospital confinement beyond 14 days was twice more likely among pregnant women than nonpregnant women with COVID-19.

Decision-making process about prenatal genetic screening: how deeply do moms-to-be want to know from Non-Invasive Prenatal Testing?

BACKGROUND

Prenatal information may be obtained through invasive diagnostic procedures and non-invasive screening procedures. Several psychological factors are involved in the decision to undergo a non-invasive prenatal testing (NIPT) but little is known about the decision-making strategies involved in choosing a specific level of in-depth NIPT, considering the increased availability and complexity of NIPT options. The main aim of this work is to assess the impact of psychological factors (anxiety about pregnancy, perception of risk in pregnancy, intolerance to uncertainty), and COVID-19 pandemic on the type of NIPT chosen, in terms of the number of conditions that are tested.

METHODS

A self-administered survey evaluated the decision-making process about NIPT. The final sample comprised 191 women (M_age = 35.53; SD = 4.79) who underwent a NIPT from one private Italian genetic company. Based on the test date, the sample of women was divided between "NIPT before COVID-19" and "NIPT during COVID-19".

RESULTS

Almost all of the participants reported being aware of the existence of different types of NIPT and more than half reported having been informed by their gynecologist. Results showed no significant association between the period in which women underwent NIPT (before COVID-19 or during COVID-19) and the preferences for more expanded screening panel. Furthermore, regarding psychological variables, results showed a significant difference between perceived risk for the fetus based on the NIPT type groups, revealing that pregnant women who underwent the more expanded panel had a significantly higher level of perceived risk for the fetus than that reported by pregnant women who underwent the basic one. There was no statistically significant difference between the other psychological variables and NIPT type.

CONCLUSIONS

Our findings indicate the paramount role of gynecologist and other health care providers, such as geneticists and psychologists, is to support decision-making process in NIPT, in order to overcome people's deficits in genetic knowledge, promote awareness about their preferences, and control anxiety related to the unborn child. Decision-support strategies are critical during the onset of prenatal care, according to the advances in prenatal genomics and to parent's needs.

Low Interferon-γ Levels in Cord and Peripheral Blood of Pregnant Women Infected with SARS-CoV-2

COVID-19 is characterized by the immune system's overreaction resulting in a 'cytokine storm', consisting in a massive release of cytokine into the bloodstream, leading to local and systemic inflammatory response. This clinical picture is further complicated in case of infection of patients with a peculiar immunological status, such as pregnancy. In this paper, we focused on Interferon-γ, which plays a pivotal immunomodulatory role in normal pregnancy and fetal development, as well as in defense against pathogens. In this study, we compared the levels of Interferon-γ and the Interferon autoantibodies of the peripheral and cord blood of pregnant women with confirmed mild COVID-19 and healthy pregnant women. The Interferon-γ was significantly lower both in the peripheral and cord blood of SARS-CoV-2-positive mothers, suggesting that infection can affect the fetal microenvironment even without severe maternal symptoms. In conclusion, further studies are needed to clarify whether lower levels of Interferon-γ due to SARS-CoV-2 infection affect the development or infection susceptibility of infants born to SARS-CoV-2-infected mothers.

Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score

BACKGROUND

The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died.

METHODS

This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score.

RESULTS

From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641-0.944) and 0.704 (95% IC: 0.617-0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001).

CONCLUSIONS

The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

Impact of the COVID-19 Pandemic on Obstetric Interventions at a Public Hospital

INTRODUCTION

In response to the COVID-19 pandemic, health systems quickly implemented changes in care delivery with a goal of balancing patient-focused obstetric care with the need to protect pregnant persons and health care providers from infection. Yet, there is no consensus within the scientific community on the impact these measures have on obstetric outcomes in vulnerable populations. We aimed to assess the impact of the COVID-19 pandemic on rates of obstetric procedures and severe maternal morbidity (SMM) among births at an urban safety net institution.

METHODS

We used an interrupted time series design to calculate risk ratios (RRs) and 95% confidence intervals (CIs) comparing monthly rates of labor induction, cesarean births (overall and among nulliparous, term, singleton, vertex births), operative vaginal births, and SMM among births occurring at a public hospital before (March 1, 2016, to February 29, 2020) and during (March 1, 2020, to May 31, 2021) the COVID-19 pandemic.

RESULTS

There were 10,714 and 2,736 births in the prepandemic and postpandemic periods, respectively. Overall, the rates of obstetric interventions and SMM were constant over the two time periods. There were no significant differences in rates of labor induction (42% during prepandemic period vs. 45% during pandemic period; RR, 1.12; 95% CI, 0.93-1.34), operative vaginal births (5% vs. 6%; RR, 1.24; 95% CI, 0.88-1.76), cesarean births (28% vs. 33%; RR, 1.10; 95% CI, 0.94-1.28), or nulliparous, term, singleton, vertex cesarean births (24% vs. 31%; RR, 1.27; 95% CI, 0.92-1.74). Rates of SMM (7% vs. 8%; RR, 1.19; 95% CI, 0.86-1.65) were also unchanged.

CONCLUSIONS

Our findings indicate that the rapid implementation of measures to reduce viral transmission in the labor and delivery setting did not materially affect routine clinical management or rates of serious maternal complications.

"I was having an internal conflict with myself." COVID-19 vaccination decision-making processes among pregnant women

BACKGROUND

Vaccination serves as an efficient primary means of control for infectious diseases. However, in the case of the COVID-19 pandemic, pregnant women within the United States had the lowest rates of COVID-19 vaccination and reported the lowest intent to vaccinate.

OBJECTIVES

To explore the decision-making process for COVID-19 vaccination for people pregnant during the pandemic.

DESIGN

A secondary analysis of data from a mixed-methods study that examined the impact of COVID-19 on experiences of prenatal care, birth support, and delivery in the Southern United States.

METHODS

This study used a descriptive phenomenological approach to thematically analyze in-depth interviews (n = 20) with adult women who were pregnant by January 2020 and had their prenatal care and delivery during the pandemic beginning in March 2020. The transcripts were de-identified, coded, and thematically analyzed to saturation to identify drivers of COVID-19 vaccine decision-making based on COVID-19 vaccination status and timing. Comparative analyses were conducted to assess differences in decision-making processes based on race/ethnicity and parity. Participants also completed a sociodemographic survey that included their COVID-19 vaccination status.

RESULTS

Two themes emerged, the weighing of parallel risks and priorities from different sources resulting in vaccine decisional conflict and the need to reconcile that conflict via multiple strategies. All participants weighed priorities and risks from multiple areas of their lives and described internal conflict around vaccination. Participants described tailoring decisions to household dynamics, reconciling public and private values around vaccination, and the impact of their identities on the decision-making process. While many described concerns over vaccine safety and fetal health, uniquely, many highlighted weighing the impact of prior pregnancy loss history, with some choosing other preventive measures like social distancing or mask-wearing, which they deemed less risky.

CONCLUSION

Pregnant people make complex COVID-19 vaccination decisions, which must be considered in future vaccine messaging and advocacy for this group.

COVID-19 and pregnancy: clinical outcomes; mechanisms, and vaccine efficacy

As the COVID-19 pandemic continues into its third year, emerging data indicates increased risks associated with SARS-CoV-2 infection during pregnancy, including pre-eclampsia, intrauterine growth restriction, preterm birth, stillbirth, and risk of developmental defects in neonates. Here, we review clinical reports to date that address different COVID-19 pregnancy complications. We also document placental pathologies induced by SARS-CoV-2 infection, entry mechanisms in placental cells, and immune responses at the maternal-fetal interface. Since new variants of SARS-CoV-2 are emerging with characteristics of higher transmissibility and more effective immune escape strategies, we also briefly highlight the genomic and proteomic features of SARS-CoV-2 investigated to date. Vector and mRNA-based COVID-19 vaccines continue to be rolled out globally. However, because pregnant individuals were not included in the vaccine clinical trials, some pregnant individuals have safety concerns and are hesitant to take these vaccines. We describe the recent studies that have addressed the effectiveness and safety of the current vaccines during pregnancy. This review also sheds light on important areas that need to be carefully or more fully considered with respect to understanding SARS-CoV-2 disease mechanisms of concern during pregnancy.

Enhanced framework for COVID-19 prediction with computed tomography scan images using dense convolutional neural network and novel loss function

Recent studies have shown that computed tomography (CT) scan images can characterize COVID-19 disease in patients. Several deep learning (DL) methods have been proposed for diagnosis in the literature, including convolutional neural networks (CNN). But, with inefficient patient classification models, the number of 'False Negatives' can put lives at risk. The primary objective is to improve the model so that it does not reveal 'Covid' as 'Non-Covid'. This study uses Dense-CNN to categorize patients efficiently. A novel loss function based on cross-entropy has also been used to improve the CNN algorithm's convergence. The proposed model is built and tested on a recently published large dataset. Extensive study and comparison with well-known models reveal the effectiveness of the proposed method over known methods. The proposed model achieved a prediction accuracy of 93.78%, while false-negative is only 6.5%. This approach's significant advantage is accelerating the diagnosis and treatment of COVID-19.

Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate

The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.

Overlooked sex and gender aspects of emerging infectious disease outbreaks: Lessons learned from COVID-19 to move towards health equity in pandemic response

Sex and gender issues are especially important in emerging infectious diseases (EIDs) but are routinely overlooked despite data and practice. Each of these have an effect either directly, via the effects on vulnerability to infectious diseases, exposures to infectious pathogens, and responses to illness, and indirectly through effects on disease prevention and control programs. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the viral agent of coronavirus disease 2019 (COVID-19) has underscored the importance of understanding the sex and gender impacts on pandemics. This review takes a broader looks at how sex and gender impact vulnerability, exposure risk, and treatment and response that affect incidence, duration, severity, morbidity, mortality, and disability of EIDs. And although EID epidemic and pandemic plans need to be "pro-women", they need to be broader and include all sex and gender factors. Incorporation of these factors are a priority at the local, national, and global policy levels to fulfil the gaps in scientific research, public health intervention programs and pharmaceutical service strengthening to reduce emerging disease inequities in the population during pandemics and epidemics. A failure to do so creates acceptance of the inequities and infringes on fairness and human rights norms.

Inflammatory and coagulation marker profiles in severe pediatric COVID-19 patients: a systematic review

Background Children are susceptible to SARS-CoV-2 infection and often present mild manifestations. However, severe and critical cases have also been reported. The inflammation and coagulation marker profile pattern in these patients along with the white blood cell differential count in critical PICU cases with non-COVID-19 etiology is not entirely clear. Objective To evaluate the inflammation and coagulation profiles in children presenting with severe/critical SARS-CoV-2 infection. Methods A systematic search and review of scientific literature was conducted following the PRISMA guidelines using ProQuest, SCOPUS, EBSCOHost, ScienceDirect, Cochrane, EMBASE, and Pubmed databases. All relevant original studies until March 11, 2021, were included. The risk of bias was appraised using the Modified Newcastle Ottawa Scale and JBI Critical Appraisal Checklist tools. Results We identified 14 studies across 6 countries, including a total sample of 159 severe and critically ill pediatric COVID-19 patients. Most of the subjects showed normal leukocytes, but increased CRP, procalcitonin, ferritin, and IL-6. Studies on coagulation profiles showed normal thrombocytes, PT, aPTT, and inconsistent D-dimer results.  Conclusion Inflammation and coagulation parameters in severe/critically ill children with COVID-19 are atypical. Several inflammatory markers were elevated, including CRP, ferritin, procalcitonin, and IL-6. However, the elevated marker values are still lower compared to non-COVID infection patients. Further investigation of the parameters need to be done in serial examination multicenter studies, which include control subjects.

Comparison of Maternal-Fetal Outcomes among Unvaccinated and Vaccinated Pregnant Women with COVID-19

Background: This study sought to elucidate whether COVID-19 vaccination, during gestation or before conception, entails a decreased incidence of severe COVID-19 disease during pregnancy. Methods: This retrospective cohort study included all pregnant women that were followed up at a tertiary University Hospital with SARS-CoV-2 infection diagnosed between 1 March 2020 and 30 July 2022. The primary outcome of the study was to compare maternal and perinatal outcomes in unvaccinated and vaccinated pregnant patients with SARS-CoV-2 infection. Results: A total of 487 pregnant women with SARS-CoV-2 infection were included. SARS-CoV-2 infection during the third trimester of pregnancy was associated with an 89% lower probability of positive cord-blood SARS-CoV-2 IgG antibodies (OR 0.112; 95% CI 0.039-0.316), compared with infection during the first or the second trimester. Vaccinated pregnant women (201 (41.27%)) with COVID-19 had an 80% lower risk for developing pneumonia and requiring hospital admission due to COVID-19 than unvaccinated patients (aOR 0.209; 95% CI 0.044-0.985). Noticeably, pregnant patients with SARS-CoV-2 infection with at least two doses of the COVID-19 vaccine did not develop severe COVID-19. Conclusion: Vaccinated women with SARS-CoV-2 infection during pregnancy are associated with decreased hospital admission due to COVID-19 as well as reduced progression to severe COVID-19.

Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal-newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. KEY POINTS: · COVID-19 in pregnancy can cause perinatal morbidities.. · Breastfeeding and breast milk are safe for newborns.. · COVID-19 vaccination reduces the risk for morbidities..

PERINATAL ASPECTS OF SARS-CoV-2 INFECTION DURING PREGNANCY: A POTENTIAL CAUSE FOR CONCERN

Ever since the beginning of COVID-19 pandemic, uncertainty regarding clinical presentation and differences among various subpopulations exist. With more than 209,870,000 confirmed cases and more than 4,400,000 deaths worldwide, we are facing the new era of health crisis which will undoubtedly impair global health, economic and social circumstances. In the past year, numerous genetic mutations which code SARS-CoV-2 proteins led to the occurrence of new viral strains, with higher transmission rates. Apart from the implementation of vaccination, the effect of SARS-CoV-2 on pregnancy outcome and maternal fetal transmission remains an important concern. Although neonates diagnosed with COVID-19 were mostly asymptomatic or presented with mild disease, the effect on early pregnancy is yet to be evident. While positive finding of SARS-CoV-2 RNA in some samples such as amniotic fluid, placental tissue, cord blood and breast milk exists, additional research should confirm its association with transplacental transmission.

COVID-19 vaccine and pregnancy outcomes: A systematic review and meta-analysis

OBJECTIVES

To explore perinatal outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-vaccinated pregnant women compared with unvaccinated counterparts.

METHODS

Search was conducted using Web of Science, Scopus, ClinicalTrial.gov, MEDLINE, Embase, OVID, and Cochrane Library as electronic databases. We included observational studies evaluating pregnant women undergoing SARS-CoV-2 vaccination and compared pregnancy and perinatal outcomes with those in unvaccinated women. Categorical variables were assessed using odds ratio (OR) with 95% confidence interval (CI), whereas for continuous variables, the results were expressed as mean difference with their 95% CI. All analyses were performed by adopting the random effect model of DerSimonian and Laird.

RESULTS

There was no difference in the probability of having a small-for-gestational-age fetus (OR 0.97, 95% CI 0.85-1.09; P = 0.570), but we observed a reduced probability of a non-reassuring fetal monitoring, a reduced gestational age at delivery, and a reduced probability of premature delivery in vaccinated pregnant women versus unvaccinated ones.

CONCLUSION

The probability of small for gestational age is similar between vaccinated and unvaccinated pregnant women, and the former also had a slightly reduced rate of premature delivery.

The Significance of COVID-19 Diseases in Lipid Metabolism Pregnancy Women and Newborns

Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2. Elderly people, people with immunodeficiency, autoimmune and malignant diseases, as well as people with chronic diseases have a higher risk of developing more severe forms of the disease. Pregnant women and children can becomesick, although more often they are only the carriers of the virus. Recent studies have indicated that infants can also be infected by SARS-CoV-2 and develop a severe form of the disease with a fatal outcome. Acute Respiratory Distress Syndrome (ARDS) ina pregnant woman can affect the supply of oxygen to the fetus and initiate the mechanism of metabolic disorders of the fetus and newborn caused by asphyxia. The initial metabolic response of the newborn to the lack of oxygen in the tissues is the activation of anaerobic glycolysis in the tissues and an increase in the concentration of lactate and ketones. Lipid peroxidation, especially in nerve cells, is catalyzed by iron released from hemoglobin, transferrin and ferritin, whose release is induced by tissue acidosis and free oxygen radicals. Ferroptosis-inducing factors can directly or indirectly affect glutathione peroxidase through various pathways, resulting in a decrease in the antioxidant capacity and accumulation of lipid reactive oxygen species (ROS) in the cells, ultimately leading to oxidative cell stress, and finally, death. Conclusion: damage to the mitochondria as a result of lipid peroxidation caused by the COVID-19 disease can cause the death of a newborn and pregnant women as well as short time and long-time sequelae.

COVID-19 and Pregnancy: Have We Gotten through the Darkest Hour?

On December 2019, a new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) was isolated and identified in Wuhan (China) [...].

Kadına Yönelik Artan Şiddet Olaylarının Koronavirüs Pandemisi Özelinde İncelenmesi ve Şiddeti Önlemek İçin Yapılabileceklere Dair Öneriler Geliştirilmesi

Kadına yönelik şiddet fiziksel, psikolojik, cinsel ve ekonomik başta olmak üzere birçok anlamda etkileri olan çok boyutlu bir sorundur. Günümüzde küresel olarak yaşadığımız koronavirüs pandemisinin kadına yönelik artan şiddet olaylarının bir nedeni olduğu, pandemi sürecinde çeşitli nedenlerle kadınların eşi ya da birlikte yaşadığı erkeğin şiddetine daha fazla maruz kaldığı bildirilmektedir. Kadına yönelik şiddetin önlenmesi ve kadın sağlığının yükseltilmesi adına, kadınlara gereksinim duydukları acil destek hizmetlerinin sunulması, pandemi sürecinde tıbbi, psikolojik ve ekonomik başta olmak üzere bazı desteklerin sağlanması ve konu ile ilgili toplum duyarlılığının geliştirilmesi gerekmektedir. Kadın sağlığı önce aile sağlığı, sonra toplum sağlığı demektir. Bu nedenle, kadına yönelik artan şiddet olaylarının koronavirüs pandemisi özelinde incelenmesi, kadına yönelik şiddeti önlemek için yapılabileceklere dair öneriler geliştirilmesi ve kadınlara verilecek destek ve koruyucu hizmetlerin planlanması önem arz etmektedir. Ebe ve hemşireler şiddete maruz kalan veya karantinada şiddete maruz kalma riski bulunanlar kadınlar başta olmak üzere tüm kadınların ve kız çocuklarının şiddet riskini değerlendirmeli, psiko-sosyal destek hizmetleri de dâhil sağlık hizmetlerine erişebilmelerini sağlamalıdır. Bu derlemenin amacı; kadına yönelik artan şiddet olaylarını koronavirüs pandemisi özelinde incelenmesi ve şiddeti önlemeye yönelik önerilerin geliştirilmesidir.

Perinatal Outcome in Maternal COVID-19 infection at a Tertiary care Institute- A cross Sectional Study

Abstract

COVID 19 pandemic is one of the biggest challenge to health system of developing as well as developed countries. Because of the novelty of the virus, limited data were available regarding perinatal outcome. The objective of this study is to find out the perinatal outcome in COVID-19 infected mothers who delivered during COVID Pandemic.

Methodology

A cross sectional study was carried out at PCMC'S Post-Graduate Institute and YCM Hospital Pune (Maharashtra) from 1 May 2020 to 31 October 2021 which was a dedicated COVID hospital during COVID pandemic. A total of 362 maternity patients (including 5 twin pregnancies) having COVID 19 infection who gave birth to 367 Newborns were studied. Maternal COVID -19 infection was diagnosed either by RTPCR test or Rapid Antigen test. Demographic variables, maternal symptoms, labour and neonatal outcome were recorded. RT PCR of neonates at birth was performed. Data was analyzed statistically by using Epi Info Software.

Aim

To analyze the perinatal outcome among COVID-19 infected mothers who delivered during Covid pandemic.

Objectives

Study was conducted with the primary objective to analyze the labour outcome, maternal symptoms and secondarily to study maternal demographic profile and to compare disease severity during 1^st and 2^nd wave of COVID and to detect possibility of vertical transmission of COVID-19 in neonates of covid positive mothers.

Results

74.2% patients from young reproductive age (21-30 years age) were affected. All socioeconomic classes were affected. 61% patients were multigravida. Normal BMI was noted in 49.8%. 28.2% deliveries were preterm. Caesarean section rate was 50.5%. Following obstetric high risk factors were noted-anaemia in 34.2% followed by previous LSCS in 26.2% cases and preeclampsia in 18.7%Overall 54.6% patients were asymptomatic while 45.4% were symptomatic. Symptomatology between 1^st and 2^nd wave showed statistical significance (p value < .05%) for mild, moderate and severe symptoms. Myalgia, cough, fever and fatigue were common presenting symptoms. 14% patients required ICU/HDU care. HDU/ICU requirement showed statistical significance (p value < .05) between 1^st and 2^nd wave. Overall maternal mortality was 1.1% (4 maternal deaths in 2^nd wave) with no mortality in 1^st wave.96.4% were live births. Birth weight was more than 2.5 kg in 62% cases and 21.3% cases required NICU. Vertical transmission of COVID was seen in 1.1% cases.

Conclusion

Pregnant patients with moderate and severe disease are at higher risk of perinatal complications. ICU/HDU management with multidisciplinary management may reduce morbidity and mortality. Neonatal affection due to COVID may not be severe but may increase prematurity due to iatrogenic intervention.

Obstetric complications in mothers with ADHD

BACKGROUND

There is currently limited research on the intersection of pregnancy and ADHD and the unique pregnancy risk factors for mothers with an ADHD diagnosis. With an increased population of patients with ADHD in the recent decades and an increase in ADHD medication use during pregnancy it is important to consider what unique risks mothers with ADHD face during the perinatal period.

OBJECTIVE

Investigate a variety of outcomes in maternal ADHD.

METHODS

We identified female patients with a diagnosis of pregnancy and ADHD diagnosis. We also further separated the ADHD cohort for separate sub-analyses based on medication type. Odds ratios and relative risk were calculated from outcome incidence within each cohort. Cohorts were balanced on age, sex, and race.

RESULTS

We identified 45,737 pregnant females with ADHD. We matched these patients to pregnant females without ADHD, for a total of 42,916 pairs. Compared to the group without ADHD, mothers with ADHD had higher rates of every outcome except for HPV infection, which was statistically insignificant (P = 0.768). The odds ratios ranged from 1.08 for anemia complicating pregnancy to 2.63 for depressive episodes. Most outcomes were between 1.2 and 1.8 times more likely to occur in the cohort with ADHD.

CONCLUSION

This study presents substantial advancements in our knowledge of pregnancy-related ADHD care. Armed with an increased awareness of these potential complications and their relationship with ADHD, obstetricians, psychiatrists, and providers of all specialties may be able to reduce the rate of complications within this specific patient population.

A retrospective study of COVID during pregnancy and the outcome of vaginal delivery

Introduction

SARS-CoV, MERS-CoV, and SARS-CoV-2, later named coronavirus disease 2019 (COVID-19), are three highly pathogenic and lethal human coronaviruses that have arisen in the last two decades. Pregnant women have a higher risk due to a special state of immunosuppression. However, there is no proof that pregnant women and their babies are more vulnerable to infection, as data is limited.The primary goal of this retrospective study is to examine the effects of early COVID-19 diagnosis and to address the best method of delivery based on medical records of neonatal and maternal outcomes observed at Nepal's Paropakar Maternity Hospital. This retrospective research will determine whether vaginal delivery is healthy compared to cesarean delivery and whether the outcome of a COVID-19 pregnancy in both mother and the baby is independent of the disease's status of the mother.

Methods

Study design: The proposed study is a retrospective cross-sectional study.

Patients population

104 cases of COVID positive pregnancy with vaginal delivery or caesarean section.

Results

The neonatal outcomes of COVID pregnancy revealed at least 51% baby born with Low APGAR score, 18% born prematurely, 19% with low birth weight, 7% requiring NICU admission, 3% Neonatal asphyxia, and 2% Neonatal death. Furthermore, when normal vaginal delivery and Cesarean section were compared there was no significant between the differences found in the outcomes

Conclusion

The COVID positive status had no association with the perinatal outcomes. Moreover, COVID status rarely affected the course of pregnancy.

Guideline

STROCSS 2021.

Effects of COVID-19 Pandemic on Nutritional Status, Feeding Practices, and Access to Food Among Infants and Children in Lower and Middle-Income Countries: a Narrative Review

Purpose of Review

The COVID-19 pandemic has affected children across the planet and the consequences on their health, nutritional status, and social structure have been more pronounced in low- and middle-income countries (LMICs). This review will focus on the effects of the COVID-19 pandemic on infant growth and feeding practices and access to food and obesity prevalence among children in LMICs. An electronic search was performed on MEDLINE and Embase to identify relevant articles in the English language.

Recent Findings

A higher prevalence of infections by the SARS-CoV-2 virus and a lower mortality rate were found in children in LMICs compared to western countries. In 2020, 22% and 52% of the wasting and deaths in children under 5 years of age in LMICS came from the sub-Saharan Africa region, respectively. Despite the decrease in stunting from 40% in 1990 to 24.2% in 2019, the prevalence remains above 30% in LMICs. Regarding breastfeeding practices in LMICs, many organizations recommend breastfeeding for infants and children born to infected mothers with SARS-CoV-2. This pandemic has resulted in higher food insecurity and disruption to access to health care and nutrition-related programs from schools; this situation has been more detrimental for younger children from LMICs.

Summary

Given the devastating effects of the COVID-19 pandemic on the nutritional status, higher food insecurity, and lack of access to health care for infants and children in LMICs, efforts from government, world organizations, and non-for-profit institutions should be implemented to ameliorate the effects of this pandemic.

The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines

INTRODUCTION

Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice.

MAIN RECOMMENDATIONS

As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au).

CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES

The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.

Analysis of YouTube Videos on Pregnant COVID-19 Patients During the Pandemic Period

OBJECTIVE

Pregnant women often refer to YouTube videos when they are worried about themselves and/or their baby. This study aims to evaluate COVID-19 and pregnancy-related content on YouTube, the platform that comes to mind first when social media is mentioned.

METHODS

YouTube videos were evaluated between September 7-10, 2022. "COVID-19 pregnancy" videos with more than 100.000 views were included in the study. The content and technical data of 45 videos were recorded. The videos were scored using the DISCERN score, Video Power Index (VPI), and Global Quality Scale (GQS).

RESULTS

Of the 45 videos with a mean duration of 432 seconds, 32 (71.1%) of them originated in the USA, 38 (84.4%) of them were presented by healthcare workers, and 36 (80.0%) of them recommended vaccination. Accounts producing the videos had a mean of 3,037,619 subscribers. The videos we analyzed were viewed a mean of 522836 times. These videos had 9287 likes and 1891 comments. The DISCERN, VPI, and GQS mean scores of the videos were 32.36, 74.76, and 3.82, respectively.

CONCLUSION

In order to correctly inform society about health problems, healthcare workers must make presentations on YouTube with a controlled mechanism. There is confusion about information on the internet, and people must acquire information selectively.

Syndemic aspects between COVID-19 pandemic and social inequalities

Although the coronavirus disease 2019 (COVID-19) pandemic has reached all over the world population, it has demonstrated a heterogeneous impact on different populations. The most vulnerable communities which coexist daily with the social inequalities like low access to hygiene and personal protection products, crowded residences, and higher levels of chronic diseases have a higher risk of contact and the spread of infection, beyond unfavorable clinical outcomes. The elevation of the risk of infection exposure can be related to gender due to the presence of a larger contingent of women in essential services, as well as frontline and cleaning professionals who regardless of gender have the greatest exposure to the virus. Such exposures can contribute to the development of fear of contaminating themselves or their family members associated also with the work stress, both of which are related to the emergence of mental disturbances in these populations. Furthermore, conditions of unsanitary living and low socioeconomic status, populations at war, pre-existing social barriers, and ethnicity have contributed to more impact of the pandemic both in the exposure to the virus and access to health services, COVID-19 management, and management of other pathologies. At the same time, factors such as the closing of non-essential services, the loss of jobs, and the increase in household spending aggravated the social vulnerabilities and impacted the family economy. Lastly, the COVID-19 pandemic contributed still more to the impact on women's health since it propitiated a favorable environment for increasing domestic violence rates, through the segregation of women from social life, and increasing the time of the victims with their aggressors.

Neonatal Outcome Associated With Maternal COVID-19 Infection in Adolescent Patients

Background

Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with high rates of preeclampsia, stillbirth, and preterm birth. Adolescent pregnancy has also been associated with various adverse maternal and neonatal outcomes, including preeclampsia, stillbirth, preterm birth, congenital anomalies, and low birth weight. Therefore, this study aimed to determine whether COVID-19 infection associated with adolescent pregnancy represents an additional risk factor.

Methods

We performed a study that included 17 adolescent COVID-19- positive patients, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital, Bucharest, between 01.04.2020 and 15.04.2022, and a control group of 17 patients who were COVID-19-negative and delivered in the same period in the same unit. In the control group, additional risk factors that could affect neonatal outcomes were excluded. The COVID-19 infection was confirmed using a polymerase chain reaction (PCR) test. The analysis of neonatal outcomes included preterm birth, low birth weight, stillbirth, congenital anomalies, and Apgar score calculated at one minute.

Results

The data from this study showed that COVID-19 infection does not influence the newborn's weight or Apgar score in adolescent patients. Also, in our study, COVID-19 infection was not statistically significant according to preterm delivery in adolescents.

Conclusion

Adolescent pregnancy represents an important health problem associated with a high risk of maternal and neonatal complications. However, COVID-19 infection does not influence neonatal outcomes in this population.

Clinical Manifestation and Obstetric Outcomes in Pregnant Women with SARS-CoV-2 Infection at Delivery: A Retrospective Cohort Analysis

This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women.

Do SARS-CoV-2-Infected Pregnant Women Have Adverse Pregnancy Outcomes as Compared to Non-Infected Pregnant Women?

Purpose

To determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies.

Patients and Methods

A retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups.

Results

Our hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46-3.34; p<0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72-30.77; p<0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65-203.5; p<0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99-27.23; p<0.001].

Conclusion

Significant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.

Pregnancy outcomes among pregnant women infected with COVID-19 with and without underlying disease: A case-control study

Emerging infections have many effects on the health of pregnant mothers and their fetuses. Given the importance of coronavirus disease (COVID-19) during pregnancy, this study aims to evaluate the pregnancy and fetal outcomes in pregnant women with COVID-19 by using previous studies. To conduct this study, all studies related to the subject under discussion during the years 2000-2021 were checked out by systematic search in internationally available databases, including Web of Science, Science Direct, Scopus, PubMed, and Google Scholar. Finally, 21 closely related studies were selected to investigate the main objective. The results showed that common symptoms of COVID-19 in pregnant women included fever, cough, and muscle aches. The most common laboratory results included decreased blood lymphocytes and increased blood CRP. Consequences of pregnancy and childbirth in pregnant women included increased preterm delivery and increased cesarean section. Based on the results of the reviewed study, it can be concluded that newborns of mothers with COVID-19 were negative for COVID-19. However, the most common outcome for infants born to mothers with COVID-19 was low birth weight. Clinical signs, laboratory results, and radiographic criteria in pregnant women with COVID-19 are similar to those in non-infected adults. However, it is recommended that precautions be taken to prevent transmission of the virus, as well as preventive health instructions, particularly masking.

Clinical, Laboratory, and Imaging Findings of Pregnant Women with Possible Vertical Transmission of SARS-CoV-2-Case Series

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic significantly impacted the general population's health. At times, the infection has unfavorably influenced pregnancy evolution and the result of birth. However, vertical transmission of the virus is rare and generates controversial discussions. The study aimed to highlight the clinical, laboratory, and imaging findings of pregnant women with confirmed Coronavirus Disease 2019 (COVID-19) with possible vertical transmission and identify possible factors that encourage vertical transmission. Between 1 April 2020 and 31 December 2021, 281 pregnant women diagnosed with COVID-19 gave birth in the Obstetrics and Gynecology Departments of the tertiary unit of County Emergency Clinical Hospital from Timisoara. Three newborns (1.06%) tested positive. The characteristic of these three cases was described as a short series. In two cases, the patients were asymptomatic. In one case, the patient developed a mild form of COVID-19 with a favorable evolution in all cases. We did not identify the presence of smoking history, vaccine before admission, atypical presentation, fever, or chest X-ray abnormalities. We note possible factors that encourage vertical transmission: Pregnancy-induced hypertension, thrombophilia, asymptomatic cough, an asymptomatic or mild form of the disease, a ruptured membrane, and cesarean. The laboratory results highlight the inconstant presence of some changes found in the list of potential predictors of the severity of the infection: Lymphopenia, high values of C-reactive protein, D-dimer, fibrinogen, platelets, Aspartate Aminotransferase, Lactate dehydrogenase, and ferritin. The study's conclusion of this small group suggests that there may have been an intrauterine infection in late pregnancy and described characteristics of the pregnant women. Possible risk factors that could encourage vertical transmission have been identified.

Examining the relationship between perinatal anxiety, COVID-19 phobia and birth type preferences: A cross-sectional study

AIM

To examine the relationship between the COVID-19 phobia and perinatal anxiety levels and birth type preferences of pregnant women in the third trimester.

DESIGN

This was designed a cross-sectional study using the non-random convenience sampling method following the STROBE checklist.

METHODS

The research was conducted with 315 pregnant women from April to May 2021. Data were collected using a personal information form, the COVID-19 Phobia Scale, and the Perinatal Anxiety Screening Scale (PASS).

RESULTS

We found a positive and moderate correlation between the total scores for perinatal anxiety and COVID-19 phobia. During the COVID-19 pandemic, 4.1% of the participants changed their birth type preferences and this change was statistically significant according to McNemar's test. During the COVID-19 pandemic, the women changed their birth type preferences in favour of caesarean section. However, there was no statistically significant difference between those who changed their birth type preferences and those who did not in terms of perinatal anxiety or COVID-19 phobia levels. Women with no access to prenatal follow-up visits due to the COVID-19 pandemic had higher mean PASS scores and higher mean scores for the perfectionism, control and trauma subscale. The scores for general worry and specific fears were lower among individuals who had obtained information about birth types in prenatal follow-up visits. Also, perinatal anxiety and COVID-19 phobia levels were higher among pregnant women who were worried about giving birth in hospital compared to those who were not worried.

CONCLUSION

We conclude that COVID-19 phobia has increased women's perinatal anxiety, causing them to change their birth type preferences in favour of caesarean section.

RELEVANCE TO CLINICAL PRACTICE

We recommended that healthcare professionals take COVID-19 phobia and perinatal anxiety into account when counselling pregnant women about birth types to improve prenatal care.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection. Data were obtained from pregnant women in the third trimester, who came to a regional hospital-affiliated obstetrics polyclinic for routine prenatal follow-up visits.

Pregnant women and infants against the infection risk of COVID-19: a review of prenatal and postnatal symptoms, clinical diagnosis, adverse maternal and neonatal outcomes, and available treatments

BACKGROUND

The establishment of a risk-appropriate care approach for pregnant women and newborn infants under the COVID-19 pneumonia is vital to prevent the main pregnancy complications.

OBJECTIVES AND DESIGN

This study reviewed the vertical transmission (VT) potential of COVID-19 pneumonia in pregnant women. Key-related symptoms and adverse clinical outcomes for mothers and infants before and after childbirth were summarized. Some practical therapies and preventive health solutions were also proposed.

RESULTS

There was a high susceptibility in pregnant women to COVID-19 infection, especially in the third trimester of pregnancy. The most common symptoms in 22-40-year-old patients infected with COVID-19 were fever (87.6%), cough (52.3%), dyspnea (27.6%), fatigue (22.4%), sore throat (13.5%), malaise (9.4%), and diarrhea (3.4%), respectively. The viral infection led to an increase in preterm labor and cesarean delivery without any intrauterine infection and severe neonatal asphyxia. No infection in the newborn infants was reported despite a high risk of the VT phenomenon. The most important therapies were the reception of antiviral and antibiotic drugs, oxygenation therapy, psychological interventions, and food supplements with health-promoting effects. The best proposed medical strategies to control the COVID-19 infection were bi-monthly screening and following-up the mothers' and fetuses' health, not using the potent broad-spectrum antibiotics and corticosteroids, providing the delivery room with negative pressure for emergency cesarean section, and the immediate isolation of newborns after childbirth without direct breastfeeding.

CONCLUSION

Babies with respiratory problems may be born to some mothers with COVID-19, who have weak immune systems. Thus, the virus transmission cycle should be disrupted to prevent adverse maternal and fetal outcomes by integrating individual health guidelines, efficient medical care therapies, and hospital preventive practices.

CT Imaging Features and Clinical Characteristics of 2019 Novel Coronavirus Pneumonia (COVID-19) During Rehabilitation

This study aims to explore the clinical characteristics of the patients with novel coronavirus pneumonia (COVID-19) during rehabilitation. One hundred and twelve confirmed patients were enrolled, while 72 were females (64.3%) and 40 were males (35.7%). The age of the patients was 51.63 ± 4.07 years old. Those patients were divided into mild group, moderate group and severe group based on lesion volume and proportion of total lesion on CT images. The age, gender, past medical history, finger pulse oxygen (SPO2), heart rate (HR) and body temperature and other clinical characteristics of patients were collected. Lesion volume was measured by CT. Compared with mild group, age, lesion volume and total lesion proportion in moderate group were significantly higher. Age, lesion volume and total lesion proportion in severe group were also higher than those in moderate group. Age and past medical history were the risk factors for the lesion volume of COVID-19. Older the patient has larger CT lesion range (R = 0.232, P = 0.045). Without past medical history or combination of post-medical history, the COVID-19 patients had smaller CT lesion ranges, and the history of previous cardiovascular disease and pulmonary disease was important risk factors for the larger CT lesion ranges. The patients who were older or combined with chronic diseases, especially cardiovascular diseases, respiratory disease and diabetes, tended to have the larger lesions. Age and past medical history of patients with COVID-19 period are significantly related to the lesion volume and total lesion proportion on CT images.

Knowledge, Attitude, and Practices of Pregnant Women Towards COVID-19: An On-site Cross-sectional Survey

Objective: To assess the knowledge, attitude, and practices (KAP) of pregnant women towards coronavirus disease 2019 (COVID-19).

Methods: This on-site cross-sectional survey was conducted in the antenatal and fetal medicine clinics in a tertiary care hospital in North India. Pregnant women attending the maternal-fetal unit filled out a 31-item questionnaire assessing their KAP towards COVID-19. Correlation between KAP was assessed by using Spearman’s rank correlation.

Results: Some 302 questionnaires were analyzed: more than 90% of women had correct general knowledge of COVID, but only 12.3% scored 50% or more for pregnancy-related knowledge. Some 67% of women reported more than usual anxiety, and 7.7% reported severe anxiety levels. General knowledge improved with age, education, and occupation but pregnancy-related knowledge and anxiety score were unaffected by these variables.

Conclusions: Pregnant women's knowledge of COVID-19 infection, in general, is excellent and they have the correct attitude towards preventive strategies. However, knowledge and attitude towards its effect on pregnancy are limited.