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Paudyal P, Katuwal N, Rawal S. COVID-19 among Pregnant Women Delivering in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:1-5. [PMID: 35199679 PMCID: PMC9157656 DOI: 10.31729/jnma.6768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/17/2022] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Coronavirus Disease 2019 pandemic is raging across the world and has affected pregnant women as well. There is limited information regarding COVID-19 in pregnant women. The study aimed to find the prevalence of COVID-19 among all pregnant women who delivered during the study period in a tertiary care center. METHODS This was a descriptive cross-sectional study conducted in a tertiary care center from 16th August to 15th November 2020 after obtaining ethical clearance from the Institutional Review Committee of a tertiary care center. All the women who delivered in the hospital during the study period were enrolled and they were subjected to COVID-19 Reverse Transcriptase Polymerase Chain Reaction test. A total of 667 samples were taken using convenience sampling technique. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS Among 667 pregnant women, the prevalence of COVID-19 was 47 (7.05%) (5.10-8.99 at 95% Confidence Interval). Though the majority of women were asymptomatic 40 (85.1%), 5 (10.64%) developed mild disease, 1 (2.12%) each had severe and critical COVID-19 pneumonia. CONCLUSIONS The prevalence of COVID-19 among pregnant women delivering in our center is similar to other studies done in similar settings. In our study, we found that the majority of women had been asymptomatic and were diagnosed on routine testing. Hence, it is important to test all pregnant women before delivery for Coronavirus Disease 2019 irrespective of the presence or absence of symptoms.
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Affiliation(s)
- Pooja Paudyal
- Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Neeta Katuwal
- Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Suniti Rawal
- Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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Algodi M, Wolfe DS, Taub CC. The Utility of Maternal Point of Care Ultrasound on Labor and Delivery Wards. J Cardiovasc Dev Dis 2022; 9:jcdd9010029. [PMID: 35050239 PMCID: PMC8777988 DOI: 10.3390/jcdd9010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to limited bedside ultrasound used to evaluate patients for conditions specific to the scope of their practice. Given the benefits of its application, interest in its use is increasing. We aimed to review the literature and assess the potential feasibility of using POCUS of the heart and lungs in the field of obstetrics. We aim to describe its relevance and value as an adjunctive tool for critically ill obstetric patients on labor and delivery wards.
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Affiliation(s)
- Mohammed Algodi
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Diana S. Wolfe
- Department of Obstetrics and Gynecology and Women’s Health, Division of Maternal Fetal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Cynthia C. Taub
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
- Correspondence:
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Kumar N, Bhatia V. Maternal SARS-CoV-2 Infection, its Vertical Transmission, and Impact on Overall Perinatal Outcomes: A Narrative Review. Curr Pediatr Rev 2022; 18:103-109. [PMID: 34819008 DOI: 10.2174/1573396317666211124095020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND COVID-19 pandemic caused by single-stranded RNA containing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in early December 2019 from the Wuhan city of China and has been affected millions of people, including pregnant women worldwide. Research from all over the world has shown that the SARS-CoV-2 infection can be transmitted vertically from mother to fetus but is very rare. Neonatal infection with COVID-19 accounts for only a small proportion of the total population infected. Furthermore, very few studies have observed the impact of maternal SARS-CoV-2 infection on neonatal outcomes. Thus, the literature about neonatal transmission and outcomes in COVID-19 infected antenatal women is very scattered and limited. The present review briefs on the transmission of SARS-CoV-2 infection from mother to fetus and its impact on perinatal outcomes. METHODOLOGY English language articles from various databases including PubMed, Scopus, EMBASE, Scholar, MedRxiv, and Web of Science and from the World Health Organization site were searched from the beginning of the COVID-19 pandemic up to June 2021. The search terms used were "SARS-CoV-2 and pregnancy outcome, "COVID-19 and neonatal outcome", "Placental changes in COVID-19 infected pregnant women", "Vertical transmission of COVID-19". CONCLUSION Maternal SARS-CoV-2 infection can be transmitted to the fetus, though uncommon, and can lead to adverse perinatal outcomes, including preterm births, intrauterine growth restriction, NICU admission, stillbirths. The data on transmission and the adverse neonatal outcome is sparse, and many more studies are needed to fully understand the mechanism by which maternal COVID-19 infection can affect fetuses and neonates.
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Affiliation(s)
- Naina Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar-508126, Hyderabad Metropolitan Region, Telangana, India
| | - Vikas Bhatia
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bibinagar -508126, Hyderabad Metropolitan Region, Telangana, India
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Matute JD, Finander B, Pepin D, Ai X, Smith NP, Li JZ, Edlow AG, Villani AC, Lerou PH, Kalish BT. Single-cell immunophenotyping of the fetal immune response to maternal SARS-CoV-2 infection in late gestation. Pediatr Res 2022; 91:1090-1098. [PMID: 34750520 PMCID: PMC8573077 DOI: 10.1038/s41390-021-01793-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/31/2021] [Accepted: 09/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, thousands of pregnant women have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The implications of maternal SARS-CoV-2 infection on fetal and childhood well-being need to be characterized. We aimed to characterize the fetal immune response to maternal SARS-CoV-2 infection. METHODS We performed single-cell RNA-sequencing and T cell receptor sequencing on cord blood mononuclear cells (CBMCs) from newborns of mothers infected with SARS-CoV-2 in the third trimester (cases) or without SARS-CoV-2 infection (controls). RESULTS We identified widespread gene expression changes in CBMCs from cases, including upregulation of interferon-stimulated genes and major histocompatibility complex genes in CD14+ monocytes, transcriptional changes suggestive of activation of plasmacytoid dendritic cells, and activation and exhaustion of natural killer cells. Lastly, we observed fetal T cell clonal expansion in cases compared to controls. CONCLUSIONS As none of the infants were infected with SARS-CoV-2, our results suggest that maternal SARS-CoV-2 infection might modulate the fetal immune system in the absence of vertical transmission. IMPACT The implications of maternal SARS-CoV-2 infection in the absence of vertical transmission on fetal and childhood well-being are poorly understood. Maternal SARS-CoV-2 infection might modulate the fetal immune system in the absence of vertical transmission. This study raises important questions about the untoward effects of maternal SARS-CoV-2 on the fetus, even in the absence of vertical transmission.
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Affiliation(s)
- Juan D. Matute
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital (MGH), Boston, MA USA
| | - Benjamin Finander
- grid.2515.30000 0004 0378 8438Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
| | - David Pepin
- grid.32224.350000 0004 0386 9924Department of Pediatric Surgery, MGH, Boston, MA USA
| | - Xingbin Ai
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital (MGH), Boston, MA USA
| | - Neal P. Smith
- grid.32224.350000 0004 0386 9924Department of Medicine, MGH, Boston, MA USA
| | - Jonathan Z. Li
- grid.62560.370000 0004 0378 8294Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Andrea G. Edlow
- grid.32224.350000 0004 0386 9924Department of Obstetrics and Gynecology, MGH, Boston, MA USA
| | | | - Paul H. Lerou
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital (MGH), Boston, MA USA
| | - Brian T. Kalish
- grid.2515.30000 0004 0378 8438Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA ,grid.42327.300000 0004 0473 9646Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Molecular Genetics, University of Toronto, Toronto, ON Canada
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Reproductive and developmental safety of nirmatrelvir (PF-07321332), an oral SARS-CoV-2 Mpro inhibitor in animal models. Reprod Toxicol 2022; 108:56-61. [PMID: 35101563 PMCID: PMC8801796 DOI: 10.1016/j.reprotox.2022.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
Abstract
Nirmatrelvir (PF-07321332; NMV) the antiviral component of PAXLOVID™ is a potent and selective inhibitor of the SARS-CoV-2 main protease (Mpro), which plays a critical role in viral replication. PAXLOVID, comprised of nirmatrelvir and ritonavir (used as a pharmacokinetic enhancer), is an oral therapy currently in development as a therapeutic option for those infected with SARS-CoV-2 to prevent progression to severe disease, hospitalization, and death. PAXLOVID has been shown to be efficacious against hospitalization and death in two Phase 2/3 clinical studies that evaluated non hospitalized patients both with and without high risk factors for progression to severe illness. Given that males and females of reproductive age are included in the intended patient population, we assessed the potential effects of NMV up to the limit dose of 1000 mg/kg/day in ICH guideline embryo-fetal development studies in rats and rabbits, and a fertility and early embryonic development study in rats. There were no effects on male and female fertility or early embryonic development in rats, and no severe manifestations of developmental toxicity in rats or rabbits. The lack of adverse findings reported here in nonclinical species is consistent with the intended therapeutic target of NMV (a virus specific protein not present in mammalian cells), the favorable off-target selectivity profile, and lack of genetic toxicity. The results of these nonclinical studies with NMV along with existing ritonavir safety information indicate that there are no clinically relevant risks associated with PAXLOVID administration during pregnancy and in males and females of reproductive age.
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Hidalgo-Lopezosa P, Cubero-Luna AM, Huertas-Marín J, Hidalgo-Maestre M, De la Torre-González AJ, Rodríguez-Borrego MA, López-Soto PJ. Vaginal birth after caesarean section before and during COVID-19 pandemic. Factors associated with successful vaginal birth. Women Birth 2021; 35:570-575. [PMID: 34972660 PMCID: PMC8702403 DOI: 10.1016/j.wombi.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/25/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Abstract
Background The ratio of caesarean has been increasing considerably in many countries. Planning a vaginal birth after a previous caesarean is considered an important option for women in a subsequent pregnancy. Aims To analyse obstetric and neonatal outcomes in women in labour after caesarean section before and during the COVID-19 pandemic, and to determine factors associated with successful vaginal birth after caesarean (VBAC). Methods Observational cohort study of women in labour with history of caesarean section who gave birth between March 2019 and December 2020 in a tertiary hospital in southern Spain. Consecutive sampling was performed using the maternal birth database and a descriptive and inferential analysis of the study variables was carried out. Socio-demographic, obstetric and neonatal variables were compared between the pre-pandemic and pandemic periods. Multiple logistic regression analysis was performed to determine variables associated with VBAC success. Findings The VBAC success rate was 67.4%. The caesarean section rate was significantly higher during the COVID-19 pandemic period. Factors associated with VBAC success were: birth before the pandemic (OR 0.32) and at night (OR 0.45), use of epidural analgesia (OR 2.14), and having had a previous vaginal birth (OR 1.98). Conclusions The success rate of VBAC was lower during the pandemic. Knowledge of the factors related to VBAC success is critical for practitioners when supporting women in decision-making about mode of birth after a previous caesarean section.
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Affiliation(s)
- P Hidalgo-Lopezosa
- Maimónides Institut of Biomedic Research of Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Department of Nursing, Farmacology and Physiotherapy, University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; University Hospital Reina Sofia, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
| | - A M Cubero-Luna
- Maimónides Institut of Biomedic Research of Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Department of Nursing, Farmacology and Physiotherapy, University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; University Hospital Reina Sofia, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
| | - J Huertas-Marín
- Maimónides Institut of Biomedic Research of Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Department of Nursing, Farmacology and Physiotherapy, University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; University Hospital Reina Sofia, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
| | - M Hidalgo-Maestre
- Department of Nursing, Farmacology and Physiotherapy, University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; University Hospital Reina Sofia, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
| | - A J De la Torre-González
- Department of Nursing, Farmacology and Physiotherapy, University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; University Hospital Reina Sofia, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
| | - M A Rodríguez-Borrego
- Maimónides Institut of Biomedic Research of Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Department of Nursing, Farmacology and Physiotherapy, University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; University Hospital Reina Sofia, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
| | - P J López-Soto
- Maimónides Institut of Biomedic Research of Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; Department of Nursing, Farmacology and Physiotherapy, University of Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain; University Hospital Reina Sofia, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]. Z Geburtshilfe Neonatol 2021; 226:e1-e35. [PMID: 34918334 DOI: 10.1055/a-1688-9398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
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Arthurs AL, Jankovic-Karasoulos T, Roberts CT. COVID-19 in pregnancy: What we know from the first year of the pandemic. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166248. [PMID: 34461257 PMCID: PMC8397492 DOI: 10.1016/j.bbadis.2021.166248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/21/2021] [Accepted: 08/14/2021] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic has infected nearly 178 million people and claimed the lives of over 3.8 million in less than 15 months. This has prompted a flurry of research studies into the mechanisms and effects of SARS-CoV-2 viral infection in humans. However, studies examining the effects of COVID-19 in pregnant women, their placentae and their babies remain limited. Furthermore, reports of safety and efficacy of vaccines for SARS-CoV-2 in pregnancy are limited. This review concisely summarises the case studies and research on COVID-19 in pregnancy, to date. It also reviews the mechanism of infection with SARS-CoV-2, and its reliance and effects upon the renin-angiotensin-aldosterone system. Overall, the data suggest that infection during pregnancy can be dangerous at any time, but this risk to both the mother and fetus, as well as placental damage, increases during the third trimester. The possibility of vertical transmission, which is explored in this review, remains contentious. However, maternal infection with SARS-CoV-2 can increase risk of miscarriage, preterm birth and stillbirth, which is likely due to damage to the placenta.
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Affiliation(s)
- Anya Lara Arthurs
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5042, Australia.
| | | | - Claire Trelford Roberts
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5042, Australia.
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Giesbers S, Goh E, Kew T, Allotey J, Brizuela V, Kara E, Kunst H, Bonet M, Thangaratinam S. Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:120-128. [PMID: 34768118 PMCID: PMC8527829 DOI: 10.1016/j.ejogrb.2021.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022]
Abstract
Objective Clinical trials evaluating
pharmacological and non-pharmacological treatment of COVID-19, either
excluded pregnant women or included very few women. Unlike the numerous
systematic reviews on prevalence, symptoms and adverse outcomes of
COVID-19 in pregnancy, there are very few on the effects of treatment on
maternal and neonatal outcomes in pregnancy. We undertook a systematic
review of all published and unpublished studies on the effects of
pharmacological and non-pharmacological interventions for COVID-19 on
maternal and neonatal pregnancy outcomes. Data sources We performed a systematic literature
search of the following databases: Medline, Embase, Cochrane database,
WHO (World Health Organization) COVID-19 database, China National
Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December
2019 to 1 December 2020. Study eligibility criteria Studies were only included if they
involved pregnant or postnatal women who were exposed to pregnancy
specific interventions like the mode of delivery and type of anaesthesia,
pharmacological or non-pharmacological interventions. Study appraisal and synthesis
methods We first screened the titles and
abstracts of studies and then assessed the full text of the selected
studies in detail for eligibility. Data on study design, population, type
of screening for COVID-19, country, hospital, country status (high or low
and middle income), treatment given (mode of delivery, type of
anaesthesia, type of pharmacological and non-pharmacological treatment
was extracted. The pre-defined maternal outcomes we collected were mode
of delivery (vaginal or by caesarean section), severe or critical
COVID-19 (as defined by the authors), symptomatic COVID-19, maternal
death, maternal hospital admission, ICU admission, mechanical
ventilation, ECMO and maternal pneumonia. The pre-defined neonatal
outcomes we extracted were preterm birth (<37 weeks), stillbirth,
neonatal death, NICU admission, neonatal COVID-19 positive, neonatal
acidosis (pH<7.0) and Apgar scores (<8 after 5 minutes). Study
quality assessment was performed. Results From a total of 342 potential
eligible studies, we included 27 studies in our systematic review,
including 4943 pregnant women (appendix 3). Sixteen studies had a
retrospective cohort design and 11 a prospective cohort design. There
were no randomised controlled trials. There was a significant association
between caesarean section and admission to ICU (OR 4.99, 95% CI 1.24 to
20.12; 4 studies, 153 women, I2=0%), and
diagnosis of maternal COVID-19 pneumonia as defined by study authors (OR
3.09, 95% CI 1.52 to 6.28; 2 studies, 228 women, I2=0%). Women who had a preterm birth were more likely to
have the baby via caesarean section (OR 3.03, 95% CI 1.71 to 5.36, 12
studies; 314 women, I2=0%). For
pharmacological and non-pharmacological we provided estimates of the
expected rates of outcomes in women exposed to various treatment of
COVID-19. Comparative data for pregnant women, in particular for
treatments proven to be effective in the general population, however, is
lacking to provide clinically meaningful interpretation. Conclusions We found associations for pregnancy
specific interventions, like mode of delivery and outcomes of the
disease, but there were too few data on pharmacological and
non-pharmacological treatments in pregnant women with COVID-19. We report
the rates of complications found in the literature. We encourage
researchers to include pregnant women in their trials and report the data
on pregnant women separately.
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Affiliation(s)
- Steven Giesbers
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Edwina Goh
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Tania Kew
- Birmingham Medical School, Birmingham, United Kingdom
| | - John Allotey
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Institute of Applied Health Research, Birmingham, United Kingdom
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health NHS Trust, London, United Kingdom
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
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Harel L, Eliasi E, Jaffe Lifshitz S, Schindler Y, Rosen D, Olteanu I, Rottenstreich A, Tzabari A. Does the presence of symptoms affect pregnancy outcomes in third trimester in women with SARS-CoV-2. J Matern Fetal Neonatal Med 2021; 35:7582-7589. [PMID: 34629031 DOI: 10.1080/14767058.2021.1956895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Parturients with symptoms to COVID-19 have an increased risk for neonatal adverse outcomes and for any adverse outcome compared to the asymptomatic COVID-19 positive parturients and to the COVID-19-negative parturients. The purpose of this study was to determine the effect of COVID-19 on obstetric outcomes based on symptom status of parturients at or near term. METHODS Retrospective cohort study of parturients diagnosed with COVID-19 between 26 March and 30 September 2020. Maternal and neonatal outcomes were assessed by comparing three groups of parturients: COVID-19 negative, asymptomatic COVID-19, and symptomatic COVID-19. RESULTS A total of 2299 COVID-19-negative parturients and 172 patients with confirmed diagnosis of COVID-19 delivered during the study period. The median gestational age at the time of delivery was 39 (interquartile range 39-40) weeks. The most common symptom was cough (28/56, 50%). Gestational diabetes mellitus was significantly less common in COVID-19-negative than in COVID-19-positive patients. There was no significant increase in cesarean delivery in women who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups. Of the 172 cases of COVID-19, only one parturient needed mechanical ventilation, and there were no maternal deaths in this group. There were no cases of severe neonatal asphyxia or neonatal death. Composite maternal adverse outcomes were not significantly different between the three groups. The aOR for composite neonatal adverse outcome and overall composite adverse outcome comparing COVID-19 positive to negative parturients was 2.1 (95% confidence interval [CI], 1.1-3.8; p = .02) and 1.6 (95% CI, 1.1-2.3; p = .02), respectively. CONCLUSIONS An increased risk for neonatal adverse outcomes and for any adverse outcome was found in the symptomatic COVID-19 group compared to the asymptomatic COVID-19-positive parturients and to the COVID-19-negative parturients.
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Affiliation(s)
- Linda Harel
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Sackler School of Medicine, Tel Aviv University, Bnei Brak, Israel
| | - Elior Eliasi
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Sackler School of Medicine, Tel Aviv University, Bnei Brak, Israel
| | - Shirlee Jaffe Lifshitz
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Sackler School of Medicine, Tel Aviv University, Bnei Brak, Israel
| | - Yehudit Schindler
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Sackler School of Medicine, Tel Aviv University, Bnei Brak, Israel.,Laboratory of Microbiology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Doron Rosen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Sackler School of Medicine, Tel Aviv University, Bnei Brak, Israel
| | - Ioana Olteanu
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Sackler School of Medicine, Tel Aviv University, Bnei Brak, Israel
| | - Amichai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Avinoam Tzabari
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Sackler School of Medicine, Tel Aviv University, Bnei Brak, Israel.,The New European Surgical Academy, Berlin, Germany
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Clinical Characteristics of Newborns Born to Mothers with COVID-19. J Clin Med 2021; 10:jcm10194383. [PMID: 34640401 PMCID: PMC8509382 DOI: 10.3390/jcm10194383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/21/2022] Open
Abstract
(1) Background: According to the literature, most outcomes of neonates born to mothers infected with SARS-CoV-2 are favorable. This study aimed to assess the clinical characteristics of newborns born to infected women in a tertiary center in Poznan, Poland. (2) Methods: The study comprised 101 newborns delivered by women infected with SARS-CoV-2. The control group consisted of 101 newborns born before the pandemic. Data were collected retrospectively from the medical records. (3) Results: Most newborns of SARS-CoV-2-positive mothers were delivered by cesarean section-83.17% vs. 40.59% in the control group (p < 0.05). The groups did not differ in Apgar scores and the need for resuscitation. Newborns of SARS-CoV-2-positive mothers were more likely to present with respiratory distress and require respiratory support. The most common diagnosis was transient tachypnea of the newborn, not correlated with the mode of delivery. Newborns of the study group were never exclusively breastfed, 0% vs. 64.36% (p < 0.05). None of the patients in the study group was tested positive for the virus. (4) Conclusions: Infants born to SARS-CoV-2-positive mothers seem to be more at risk of moderate respiratory failure than other newborns. Separation of mother-baby dyads results in a dramatic fall in breastfeeding in the short-term post-partum period.
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The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review. ACTA ACUST UNITED AC 2021; 57:medicina57090977. [PMID: 34577900 PMCID: PMC8468958 DOI: 10.3390/medicina57090977] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022]
Abstract
Background and Objectives: Pregnant women are more likely to develop a more severe course of COVID-19 than their non-pregnant peers. There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnant women. The aim of this study is to conduct a systematic review concerning the approach of pregnant women towards vaccination against COVID-19, with particular regard to determinants of vaccination acceptance. Materials and Methods: Articles were reviewed in which the aim was to evaluate—via a survey or questionnaire—the acceptance and decision to undergo vaccination against COVID-19. The articles were subjected to review according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). Results: In various studies, the percentage of pregnant women accepting the COVID-19 vaccine was between 29.7% and 77.4%. The strongest factors co-existing with the acceptance of the COVID-19 vaccination in pregnancy were trust in the importance and effectiveness of the vaccine, explicit communication about the safety of COVID-19 vaccines for pregnant women, acceptance of other vaccinations such as those for influenza, belief in the importance of vaccines/mass vaccination in one’s own country, anxiety about COVID-19, trust in public health agencies/health science, as well as compliance to mask guidelines. The remaining factors were older age, higher education, and socioeconomic status. Conclusions: This review allowed us to show that geographic factors (Asian, South American countries) and pandemic factors (different threats and risks from infection) significantly influence the acceptance of vaccines. The most significant factors affecting acceptance are those related to public awareness of the risk of infection, vaccine safety, and the way in which reliable information about the need and safety of vaccines is provided. Professional and reliable patient information by obstetricians and qualified medical personnel would significantly increase the level of confidence in vaccination against COVID-19.
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Ames JL, Ferrara A, Avalos LA, Badon SE, Greenberg MB, Hedderson MM, Kuzniewicz MW, Qian Y, Young-Wolff KC, Zerbo O, Zhu Y, Croen LA. COVID-19 prevalence, symptoms, and sociodemographic disparities in infection among insured pregnant women in Northern California. PLoS One 2021; 16:e0256891. [PMID: 34478463 PMCID: PMC8415576 DOI: 10.1371/journal.pone.0256891] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Research on COVID-19 during pregnancy has mainly focused on women hospitalized for COVID-19 or other reasons during their pregnancy. Little is known about COVID-19 in the general population of pregnant women. OBJECTIVE To describe the prevalence of COVID-19, symptoms, consequent healthcare use, and possible sources of COVID-19 exposure among a population-based sample of pregnant women residing in Northern California. METHODS We analyzed data from 19,458 members of Kaiser Permanente Northern California who were pregnant between January 2020 and April 2021 and responded to an online survey about COVID-19 testing, diagnosis, symptoms, and their experiences during the COVID-19 pandemic. Medical diagnosis of COVID-19 during pregnancy was defined separately by self-report and by documentation in electronic health records (EHR). We examined relationships of COVID-19 with sociodemographic factors, underlying comorbidities, and survey measures of COVID-19-like symptoms, consequent healthcare utilization, and possible COVID-19 exposures. RESULTS Among 19,458 respondents, the crude prevalence of COVID-19 was 2.5% (n = 494) according to self-report and 1.4% (n = 276) according to EHR. After adjustment, the prevalence of self-reported COVID-19 was higher among women aged <25 years compared with women aged ≥35 years (prevalence ratio [PR], 1.75, 95% CI: 1.23, 2.49) and among Hispanic women compared with White women (PR, 1.91, 95% CI: 1.53, 2.37). Prevalence of self-reported COVID-19 was higher among women affected by personal or partner job loss during the pandemic (PR, 1.23, 95% CI: 1.02, 1.47) and among women living in areas of high vs. low neighborhood deprivation (PR, 1.74, 95% CI: 1.33, 2.27). We did not observe differences in self-reported COVID-19 between women with and without underlying comorbidities. Results were similar for EHR-documented COVID-19. Loss of smell or taste was a unique and common symptom reported among women with COVID-19 (42.3% in self-reported; 54.0% in EHR-documented). Among women with symptomatic COVID-19, approximately 2% were hospitalized, 71% had a telehealth visit, and 75% quarantined at home. Over a third of women with COVID-19 reported no known exposure to someone with COVID-19. CONCLUSIONS Observed COVID-19 prevalence differences by sociodemographic and socioeconomic factors underscore social and health inequities among reproductive-aged women. Women with COVID-19 reported unique symptoms and low frequency of hospitalization. Many were not aware of an exposure to someone with COVID-19.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Assiamira Ferrara
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Lyndsay A. Avalos
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Sylvia E. Badon
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Mara B. Greenberg
- Department of Obstetrics and Gynecology, East Bay, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Monique M. Hedderson
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Michael W. Kuzniewicz
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Yinge Qian
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Kelly C. Young-Wolff
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Ousseny Zerbo
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Yeyi Zhu
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Lisa A. Croen
- Division of Research Kaiser Permanente Northern California, Oakland, CA, United States of America
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Jafari M, Pormohammad A, Sheikh Neshin SA, Ghorbani S, Bose D, Alimohammadi S, Basirjafari S, Mohammadi M, Rasmussen‐Ivey C, Razizadeh MH, Nouri‐Vaskeh M, Zarei M. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Rev Med Virol 2021; 31:1-16. [PMID: 33387448 PMCID: PMC7883245 DOI: 10.1002/rmv.2208] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023]
Abstract
In a large-scale study, 128176 non-pregnant patients (228 studies) and 10000 pregnant patients (121 studies) confirmed COVID-19 cases included in this Meta-Analysis. The mean (confidence interval [CI]) of age and gestational age of admission (GA) in pregnant women was 33 (28-37) years old and 36 (34-37) weeks, respectively. Pregnant women show the same manifestations of COVID-19 as non-pregnant adult patients. Fever (pregnant: 75.5%; non-pregnant: 74%) and cough (pregnant: 48.5%; non-pregnant: 53.5%) are the most common symptoms in both groups followed by myalgia (26.5%) and chill (25%) in pregnant and dysgeusia (27%) and fatigue (26.5%) in non-pregnant patients. Pregnant women are less probable to show cough (odds ratio [OR] 0.7; 95% CI 0.67-0.75), fatigue (OR: 0.58; CI: 0.54-0.61), sore throat (OR: 0.66; CI: 0.61-0.7), headache (OR: 0.55; CI: 0.55-0.58) and diarrhea (OR: 0.46; CI: 0.4-0.51) than non-pregnant adult patients. The most common imaging found in pregnant women is ground-glass opacity (57%) and in non-pregnant patients is consolidation (76%). Pregnant women have higher proportion of leukocytosis (27% vs. 14%), thrombocytopenia (18% vs. 12.5%) and have lower proportion of raised C-reactive protein (52% vs. 81%) compared with non-pregnant patients. Leucopenia and lymphopenia are almost the same in both groups. The most common comorbidity in pregnant patients is diabetes (18%) and in non-pregnant patients is hypertension (21%). Case fatality rate (CFR) of non-pregnant hospitalized patients is 6.4% (4.4-8.5), and mortality due to all-cause for pregnant patients is 11.3% (9.6-13.3). Regarding the complications of pregnancy, postpartum hemorrhage (54.5% [7-94]), caesarean delivery (48% [42-54]), preterm labor (25% [4-74]) and preterm birth (21% [12-34]) are in turn the most prevalent complications. Comparing the pregnancy outcomes show that caesarean delivery (OR: 3; CI: 2-5), low birth weight (LBW) (OR: 9; CI: 2.4-30) and preterm birth (OR: 2.5; CI: 1.5-3.5) are more probable in pregnant woman with COVID-19 than pregnant women without COVID-19. The most prevalent neonatal complications are neonatal intensive care unit admission (43% [2-96]), fetal distress (30% [12-58]) and LBW (25% [16-37]). The rate of vertical transmission is 5.3% (1.3-16), and the rate of positive SARS-CoV-2 test for neonates born to mothers with COVID-19 is 8% (4-16). Overall, pregnant patients present with the similar clinical characteristics of COVID-19 when compared with the general population, but they may be more asymptomatic. Higher odds of caesarean delivery, LBW and preterm birth among pregnant patients with COVID-19 suggest a possible association between COVID-19 infection and pregnancy complications. Low risk of vertical transmission is present, and SARS-CoV-2 can be detected in all conception products, particularly placenta and breast milk. Interpretations of these results should be done cautiously due to the heterogeneity between studies; however, we believe our findings can guide the prenatal and postnatal considerations for COVID-19 pregnant patients.
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Affiliation(s)
- Maryamsadat Jafari
- Department of Obstetrics, Gynecology, and PerinatologyHamedan University of Medical ScienceHamedanIran
| | - Ali Pormohammad
- Department of Biological SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Saied Ghorbani
- Department of VirologyFaculty of MedicineIran University of Medical ScienceTehranIran
| | - Deepanwita Bose
- Department of PediatricsDivision of Infectious DiseasesBoston Children's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Shohreh Alimohammadi
- Department of Obstetrics, Gynecology, and PerinatologyHamedan University of Medical ScienceHamedanIran
| | - Sedigheh Basirjafari
- Department of RadiologyHashemi Rafsanjani HospitalNorth Khorasan University of Medical SciencesShirvanIran
| | - Mehdi Mohammadi
- Department of Biological ScienceUniversity of CalgaryCalgaryAlbertaCanada
| | - Cody Rasmussen‐Ivey
- John B. Little Center for Radiation SciencesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | | | | | - Mohammad Zarei
- Center of Mitochondrial and Epigenomic MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Gandhi AM, Ganatra AM, Tank P. Preliminary Results from the FOGSI's National Registry on Pregnancy with COVID-19. J Obstet Gynaecol India 2021; 71:361-368. [PMID: 34483513 PMCID: PMC8405343 DOI: 10.1007/s13224-021-01537-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022] Open
Abstract
Background/purpose of the study The obstetric population is believed to be more susceptible to adverse consequences of coronavirus disease COVID-19 as compared to the general populace. Clinical characteristics and outcomes data related to COVID-19 infection in obstetric cases are limited and evolving. Most importantly, studies reporting Indian data are strikingly few and of single centre. The objective of our study was thus to address these lacunae using data registered in the FOGSI’s National registry on COVID-19 infection in pregnancy (FOGSI COVID registry). Methods We conducted an observational study using data retrieved from the FOGSI COVID registry. Fifty-three hospital departments participating in the registry populated data related to laboratory confirmed and hospitalized COVID-19 obstetric patients. Data for the period of 28 April 2020 to 28 August 2020 were extracted from the registry. A subset of the data was formatted, curated, standardized and harmonized. Descriptive analysis was carried out, and results reported. Results Of the 989 cases analyzed, 956 women were pregnant and 33 women were in the postpartum period. A total of 569 women (61.71%, n = 922) were multi-gravida, and 713 women (72.98%, n = 977) belonged to the 21–30 years age group. A total of 492 cases (52.73%, n = 966) had a gestational age > 37 weeks. A total of 754 women (83.41%, n = 904) were asymptomatic, and 32 cases (3.54%, n = 904) had severe acute respiratory infection (SARI). Fifty-six women (7.19%, n = 779) required critical care and ten women (1.01%, n = 989) died. A total of 771 pregnant women (97.23%, n = 793) gave birth of which 455 cases (59.01%) underwent a lower segment caesarean section (LSCS). There were 749 cases (95.17%, n = 771) of live birth that included eight cases of twin deliveries. 195 infants (28.34%, n = 688) were admitted to the NICU, and 13 infants (2.99%, n = 435) tested COVID-19 positive in the neonatal period. Twelve infants (1.54%, n = 779) died. Conclusion 83.41% pregnant women were asymptomatic. COVID-19 infection in obstetric cases from India led to 59.01% LSCS procedures which are lower than many other countries. COVID-19 infection led to a higher maternal mortality and IUFD rate as compared to pregnant women that did not have COVID-19 infection in India. Vertical transmission rate is 2.99% and at par with other countries.
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Affiliation(s)
- Alpesh Mahendrabhai Gandhi
- Arihant Women’s Hospital, Ambica Anandmayi Society, Near Over Bridge, Chandlodiya, Near Manikaka Chawk, Chandlodiya, Ahmedabad, Gujarat 382481 India
| | - Atul Morarji Ganatra
- Dr.R.J.Ganatra Nursing Home, Omkar Lal Building, Opposite Mulund West Railway Station, Mulund (West), Mumbai, Maharashtra 400080 India
- Fortis Hospital, Mulund (West), Mumbai, Maharashtra 400080 India
| | - Parikshit Tank
- Ashwini Maternity and Surgical Hospital, Mahatma Gandhi Road, Ghatkopar (East), Mumbai, Maharashtra 400086 India
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Principi N, Esposito S. Is the Immunization of Pregnant Women against COVID-19 Justified? Vaccines (Basel) 2021; 9:970. [PMID: 34579207 PMCID: PMC8473171 DOI: 10.3390/vaccines9090970] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Maternal immunization against some infectious diseases can offer significant advantages for women, preventing maternal morbidity and mortality, or for offspring, preventing fetal disease and conferring passive immunity to neonates. Recently, clinical trials specifically to evaluate the immunogenicity, safety, and tolerability of some of the available coronavirus disease 2019 (COVID-19) vaccines in pregnant and lactating women have been planned, initiated and, in some cases, completed. This paper discusses whether the immunization of pregnant women against COVID-19 is justified and presents knowledge about the immunogenicity and safety of mRNA COVID-19 vaccines for these subjects. The results of recent studies indicate that pregnant women are at increased risk of developing severe disease compared with nonpregnant women of the same age. Studies carried out with mRNA vaccines indicate that the immunogenicity, safety and tolerability of these preventive measures in pregnant women are not different from those in nonpregnant women of the same age. Moreover, antibodies are efficiently transferred through the placenta and can be detected in breastmilk, suggesting a potential prevention of infection in the child. All these findings authorize the use of mRNA vaccines in pregnant women to protect both the mother and the child. However, further studies with larger sample size and with follow-up of the pregnant women vaccinated during different periods of pregnancy and their children are needed to better characterize the immune response of pregnant women, to define when these vaccines should be administered to obtain the best protection, and to measure vaccine efficacy against virus variants in both mothers and infants. COVID-19 vaccines based on different technological platforms cannot presently be used, and their role in pregnant women should be clarified.
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Affiliation(s)
- Nicola Principi
- Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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Heydarifard Z, Yavarian J, Malekshahi SS, Zadheidar S, Mokhtari-Azad T, Shafiei-Jandaghi NZ. SARS-CoV-2: an imperative maternal-fetal concern. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:427-433. [PMID: 34557269 PMCID: PMC8421575 DOI: 10.18502/ijm.v13i4.6963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a newly emerged virus which belongs to Coronaviridae family within the betacoronavirus genus. Previous reports demonstrated that other betacoronaviruses were responsible for adverse outcomes during pregnancy in human. Due to inadequate data, the consequences of a SARS-CoV-2 infection during pregnancy is still a public health concern in the second year of SARS-CoV-2 circulation in human population. Herein, we aimed to review the probable risk of intrauterine vertical transmission of SARS-CoV-2 infection to the fetus, its adverse outcomes during pregnancy for both mother and the fetus and maternal risk factors which affect the severity Coronavirus disease 2019 (COVID-19.
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Affiliation(s)
- Zahra Heydarifard
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sevrin Zadheidar
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Zgutka K, Prasanth K, Pinero-Bernardo S, Lew LQ, Cervellione K, Rhythm R, Rahman L, Dolmaian G, Cohen L. Infant outcomes and maternal COVID-19 status at delivery. J Perinat Med 2021; 49:691-696. [PMID: 33713593 DOI: 10.1515/jpm-2020-0481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/24/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare clinical characteristics and outcomes of infants born to COVID-19 to non COVID-19 mothers at delivery in a community hospital in Queens, New York. METHODS Case-control study conducted March 15 to June 15, 2020. Cases were infants born to mothers with laboratory-confirmed COVID-19 infection at delivery. The infant of non COVID-19 mother born before and after each case were selected as controls. RESULTS Of 695 deliveries, 62 (8.9%) infants were born to COVID-19 mothers; 124 controls were selected. Among cases, 18.3% were preterm compared to 8.1% in controls (p=0.04). In preterm cases, birth weight was not significantly different between groups. However, there was a significantly higher proportion of neonatal intensive care unit (NICU) admissions, need for respiratory support, suspected sepsis, hyperbilirubinemia, feeding intolerance and longer length of stay (LOS) in preterm cases. Among term cases, birth weight and adverse outcomes were not significantly different between cases and controls except for more feeding intolerance in cases. All infants born to COVID-19 mothers were COVID-19 negative at 24 and 48 h of life. No infants expired during birth hospitalization. CONCLUSIONS Significantly, more infants of COVID-19 mothers were premature compared to controls. Preterm cases were more likely to have adverse outcomes despite having similar birth weight and gestational age. These differences were not seen among full term infants. Health care providers should anticipate the need for NICU care when a COVID-19 mother presents in labor.
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Affiliation(s)
- Kinga Zgutka
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Kaninghat Prasanth
- Division of Neonatology, Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | | | - Lily Q Lew
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Kelly Cervellione
- Department of Clinical Research, Medisys Health Network, Flushing, NY, USA
| | - Rhythm Rhythm
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Lubna Rahman
- Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Gigliola Dolmaian
- Division of Neonatology, Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
| | - Lourdes Cohen
- Division of Neonatology, Department of Pediatrics, Flushing Hospital Medical Center, Flushing, NY, USA
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Akdemir Y, Haciseyitoglu D, Celebi G, Aydemir C, Bahadır B, Cakir AT, Barut A, Ozmen U. Probable viremia and positive placental swabs for SARS-CoV-2 in a preterm pregnant woman with mild COVID-19. J Med Virol 2021; 93:6788-6793. [PMID: 34260081 PMCID: PMC8426688 DOI: 10.1002/jmv.27202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
This study aimed to report a case of mild novel coronavirus disease (COVID‐19) in a pregnant woman with probable viremia, as reverse transcription‐polymerase chain reaction (RT‐PCR) testing of endometrial and placental swabs for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was positive. A 26‐year‐old multigravida at 35 weeks 2 days of gestation, who had extensive thigh and abdominal cellulitis, tested SARS‐CoV‐2 positive by RT‐PCR performed on samples from the endometrium and maternal side of the placenta. However, other samples (amniotic fluid, fetal side of the placenta, umbilical cord, maternal vagina, and neonatal nasopharynx) tested negative for SARS‐CoV‐2. This is one of the rare reports of probable SARS‐CoV‐2 viremia with the presence of SARS‐CoV‐2 in the endometrium and placenta, but not leading to vertical transmission and neonatal infection. Because knowledge about transplacental transmission and results is very limited, we conclude that more RT‐PCR tests on placental and cord blood samples are needed in order to safely make definite conclusions. Viremia of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) could occur after incubation period and could lead to vertical transmission. Placenta is the main barrier against viral infections as it has an organ specific antiviral mechanism. Not all neonates of infected pregnant women are infected with novel coronavirus disease (COVID‐19). More evidence of placental SARS‐CoV‐2 RNA increases fears about congenital infections that its effects will be in a spectrum between maternal immune activation related neonatal disorders and congenital anomalies or syndromes. Further investigations which will be focusing short and long term effects of SARS‐CoV‐2 infection on neonates in different trimesters of pregnancy are needed.
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Affiliation(s)
- Yesim Akdemir
- Department of Obstetrics and Gynaecology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Demet Haciseyitoglu
- Department of Microbiology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Guven Celebi
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Cumhur Aydemir
- Department of Pediatrics and Neonatal Critical Care, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Burak Bahadır
- Department of Pathology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Anil T Cakir
- Department of Obstetrics and Gynaecology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Aykut Barut
- Department of Obstetrics and Gynaecology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Ulku Ozmen
- Department of Obstetrics and Gynaecology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Mourad M, Jacob T, Sadovsky E, Bejerano S, Simone GSD, Bagalkot TR, Zucker J, Yin MT, Chang JY, Liu L, Debelenko L, Shawber CJ, Firestein M, Ouyang Y, Gyamfi-Bannerman C, Penn A, Sorkin A, Wapner R, Sadovsky Y. Placental response to maternal SARS-CoV-2 infection. Sci Rep 2021; 11:14390. [PMID: 34257394 PMCID: PMC8277865 DOI: 10.1038/s41598-021-93931-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic affected people at all ages. Whereas pregnant women seemed to have a worse course of disease than age-matched non-pregnant women, the risk of feto-placental infection is low. Using a cohort of 66 COVID-19-positive women in late pregnancy, we correlated clinical parameters with disease severity, placental histopathology, and the expression of viral entry and Interferon-induced transmembrane (IFITM) antiviral transcripts. All newborns were negative for SARS-CoV-2. None of the demographic parameters or placental histopathological characteristics were associated with disease severity. The fetal-maternal transfer ratio for IgG against the N or S viral proteins was commonly less than one, as recently reported. We found that the expression level of placental ACE2, but not TMPRSS2 or Furin, was higher in women with severe COVID-19. Placental expression of IFITM1 and IFITM3, which have been implicated in antiviral response, was higher in participants with severe disease. We also showed that IFITM3 protein expression, which localized to early and late endosomes, was enhanced in severe COVID-19. Our data suggest an association between disease severity and placental SARS-CoV-2 processing and antiviral pathways, implying a role for these proteins in placental response to SARS-CoV-2.
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Affiliation(s)
- Mirella Mourad
- Department of Obstetrics, Gynecology and Reproductive Science, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Taylor Jacob
- Department of Obstetrics, Gynecology and Reproductive Science, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Elena Sadovsky
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Shai Bejerano
- Department of Obstetrics, Gynecology and Reproductive Science, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Glicella Salazar-De Simone
- Department of Obstetrics, Gynecology and Reproductive Science, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Jason Zucker
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael T Yin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer Y Chang
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Lihong Liu
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Larisa Debelenko
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Carrie J Shawber
- Department of Obstetrics, Gynecology and Reproductive Science, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Surgery, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Morgan Firestein
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Yingshi Ouyang
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology and Reproductive Science, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Anna Penn
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander Sorkin
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ronald Wapner
- Department of Obstetrics, Gynecology and Reproductive Science, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoel Sadovsky
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 204 Craft Avenue, Pittsburgh, PA, 15213, USA.
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Lassi ZS, Ali A, Das JK, Salam RA, Padhani ZA, Irfan O, Bhutta ZA. A systematic review and meta-analysis of data on pregnant women with confirmed COVID-19: Clinical presentation, and pregnancy and perinatal outcomes based on COVID-19 severity. J Glob Health 2021; 11:05018. [PMID: 34221361 PMCID: PMC8248750 DOI: 10.7189/jogh.11.05018] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We determined the clinical presentation, risk factors, and pregnancy and perinatal outcomes in pregnant women with confirmed COVID-19 and identified if these are different based on COVID-19 severity. METHODS We included all observational studies on pregnant women with confirmed COVID-19 reporting clinical presentation, risk factors, and pregnancy and perinatal outcomes. We included all studies published between Dec/2019-Feb/2021 in Medline, Embase, the WHO COVID-19 databases, and clinicaltrials.gov. The methodological quality of cohort and case-series was assessed using NHLBI criteria. RESULTS 31 016 pregnant women from 62 studies were included. Women were an average of 30.9 years of age, most (77.7%) were in the third trimester, and 16.4% developed severe COVID-19. Nearly half were asymptomatic, while the most commonly reported symptoms were cough, fever, fatigue, and anosmia/ageusia. About 7% were admitted to the intensive care unit (ICU), 8% required mechanical ventilation, and 2% of the women died. Almost 80% of women delivered; 48.4% had cesarean births. Among newborns, 23.4% were preterm (<37 weeks), 16.6% were low birth weight, and 23.7% were admitted to neonatal ICU. A total of 21 stillbirths (1.6%) and 24 neonatal deaths (1.6%) were recorded, while 50 babies (3.5%) were COVID-19 positive. Studies comparing pregnant women with severe and non-severe COVID-19 showed that women with severe COVID-19 were 3.7 years older and the risk of severe COVID-19 was 1.5 times higher among women >35 years. The risk of severe COVID-19 was significantly higher among women who were obese, had smoked, diabetic, and had pre-eclampsia. The risk of preterm birth was almost 2.4 folds among women with severe COVID-19. CONCLUSIONS Our review suggests a heightened risk of COVID-19 severity and adverse pregnancy and perinatal outcomes among women with certain demographic and health profiles. These findings can inform the formation of current guidelines; however, these should be constantly updated as the global COVID-19 scenario unfolds. REGISTRATION PROSPERO: CRD42020182048.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, the University of Adelaide, Adelaide, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
| | - Anna Ali
- Robinson Research Institute, the University of Adelaide, Adelaide, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
| | - Jai K Das
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zahra A Padhani
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Omar Irfan
- Centre for Global Child Health, the Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, the Hospital for Sick Children (SickKids), Toronto, Canada
- Centre of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Lesnic A, Haj Hamoud B, Poenaru MO, Moldovan VT, Chicea R, Sima RM, Popescu M, Ples L. Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?-A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:670. [PMID: 34209533 PMCID: PMC8303955 DOI: 10.3390/medicina57070670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 01/23/2023]
Abstract
We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.
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Affiliation(s)
- Anca Lesnic
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.L.); (M.-O.P.); (R.-M.S.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
- Department of PhD Studies, IOSUD, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bashar Haj Hamoud
- Department for Gynaecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany;
| | - Mircea-Octavian Poenaru
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.L.); (M.-O.P.); (R.-M.S.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Valentin-Tiberiu Moldovan
- Department of Pathology “Victor Babeş”, National Institute for Research and Development in Pathology and Biomedical Sciences, 050096 Bucharest, Romania;
| | - Radu Chicea
- Medicine Faculty, Lucian Blaga University, 550024 Sibiu, Romania;
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.L.); (M.-O.P.); (R.-M.S.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Mihai Popescu
- Department of Anaesthesia and Critical Care, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.L.); (M.-O.P.); (R.-M.S.); (L.P.)
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
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74
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Iyengar U, Jaiprakash B, Haitsuka H, Kim S. One Year Into the Pandemic: A Systematic Review of Perinatal Mental Health Outcomes During COVID-19. Front Psychiatry 2021; 12:674194. [PMID: 34248710 PMCID: PMC8264436 DOI: 10.3389/fpsyt.2021.674194] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Obstetric guidelines have rapidly evolved to incorporate new data and research on the novel coronavirus disease (COVID-19), with data on perinatal mental health building over the last year. Our aim in the present manuscript is to provide a systematic review of mental health outcomes in pregnant and postpartum women during the COVID-19 pandemic in the context of neonatal and obstetric guidelines addressing symptoms and complications of COVID-19 during pregnancy, mother-to-neonate transmission, Cesarean-section delivery, neonatal prematurity, maternal/neonate mortalities, maternal-neonatal separation, and breastfeeding. We summarize data from 81 mental health studies of pregnant and postpartum women and underscore protective and risk factors identified for perinatal mental health outcomes amidst the COVID-19 pandemic. Data reviewed here suggest increased psychological symptoms, especially depressive and anxiety symptoms, in pregnant and postpartum women during COVID-19. Our systematic review integrates the most current obstetric and neonate guidelines, along with perinatal mental health outcomes associated with COVID-19, highlighting the best available data for the care of women and their neonates amidst the current COVID-19 pandemic.
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Affiliation(s)
- Udita Iyengar
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), London, United Kingdom
| | - Bhavisha Jaiprakash
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), London, United Kingdom
| | - Hanako Haitsuka
- Yale Child Study Center, Yale University, New Haven, CT, United States
| | - Sohye Kim
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, United States
- Departments of Psychiatry, Pediatrics, and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States
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Sabharwal V, Bartolome R, Hassan SA, Levesque BM, Camelo IY, Wachman EM, Figueira M, Yarrington CD, Cooper ER, Barnett ED, Parker MG. Mother-Infant Dyads with COVID-19 at an Urban, Safety-Net Hospital: Clinical Manifestations and Birth Outcomes. Am J Perinatol 2021; 38:741-746. [PMID: 33853145 DOI: 10.1055/s-0041-1726429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to describe maternal characteristics and clinical outcomes of infants born to mothers with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests during pregnancy at an urban, safety-net hospital in Boston. STUDY DESIGN We abstracted electronic chart data from 75 pregnant women with positive SARS-CoV-2 tests at any stage of gestation until 72 hours after birth who delivered consecutively between March 31 and August 6, 2020 at our center. We collected clinical data on maternal and infant characteristics, including testing, signs, and symptoms of coronavirus disease 2019 (COVID-19), delivery outcomes, newborn care practices (skin-to-skin care, location of care, and breastfeeding) and 30-day postdischarge infant emergency room visits and readmissions. We described categorical characteristics as percentages for this case series. RESULTS Among 75 pregnant women, 47 (63%) were Hispanic, 10 (13%) had hypertension, 23 (30%) had prepregnancy obesity, and 57 (76%) had symptomatic SARS-CoV-2 infection. Regarding birth outcomes, 32 (41%) had cesarean delivery and 14 (19%) had preterm birth. Among 75 infants, 5 (7%) had positive SARS-CoV-2 polymerase chain reaction tests in the first week of life, all of whom were born to Hispanic mothers with symptomatic SARS-CoV-2 infection and had clinical courses consistent with gestational age. Six (8%) infants visited the emergency department within 30 days of discharge; one was admitted with a non-COVID-19 diagnosis. CONCLUSION At our urban, safety-net hospital among pregnant women with positive SARS-CoV-2 tests, 41% had a cesarean delivery and 19% had a preterm birth. Seven percent of infants had one or more positive SARS-CoV-2 tests and all infants had clinical courses expected for gestational age. KEY POINTS · Among 75 pregnant women with SARS-CoV-2 positive testing at our center, five infants (7%) had one or more SARS-CoV-2 positive tests in the first week of life.. · Infants with positive SARS-CoV-2 tests had clinical courses expected for gestational age..
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Affiliation(s)
- Vishakha Sabharwal
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Ruby Bartolome
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sacha Al Hassan
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Bernadette M Levesque
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Ingrid Y Camelo
- Baystate Medical Center, University of Massachusetts, Boston, Massachusetts
| | - Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Marisol Figueira
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | - Ellen R Cooper
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Elizabeth D Barnett
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. Incidence de la COVID-19 sur les issues de grossesse: examen systématique et méta-analyse. CMAJ 2021; 193:E813-E822. [PMID: 34059502 PMCID: PMC8177934 DOI: 10.1503/cmaj.202604-f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
Contexte: La nature exacte des répercussions de la maladie à coronavirus 2019 (COVID-19) sur la santé maternelle et néonatale reste à préciser. Nous avons cherché à évaluer l’association entre l’infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) pendant la grossesse et les issues défavorables de la grossesse. MÉTHODES: Nous avons réalisé une revue systématique et une méta-analyse d’études observationnelles fournissant des données comparatives sur l’infection par le SRAS-CoV-2 et la gravité de la COVID-19 pendant la grossesse. Nous avons sélectionné les études admissibles à partir des bases de données MEDLINE, Embase, ClinicalTrials.gov , medRxiv et Cochrane au 29 janvier 2021, en utilisant les Medical Subject Headings (vedettes matière en médecine) et les expressions clés « severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2 OR coronavirus disease 2019 OR COVID-19 » (coronavirus du syndrome respiratoire aigu sévère 2 ou SRAS-CoV-2 ou maladie à coronavirus 2019 ou COVID-19) AND « pregnancy » (grossesse). Nous avons ensuite évalué la qualité méthodologique de toutes les études retenues avec l’échelle de Newcastle–Ottawa. Les issues primaires étaient la prééclampsie et la naissance prématurée. Les issues secondaires incluaient la mortinaissance et le diabète gestationnel, ainsi que d’autres issues de grossesse. Nous avons calculé des rapports de cotes (RC) sommaires ou des différences moyennes pondérées avec des intervalles de confiance (IC) à 95 % par méta-analyse à effets aléatoires. RÉSULTATS: Nous avons retenu 42 études portant sur 438 548 personnes enceintes. Comparativement à une absence d’infection par le SRAS-CoV-2 pendant la grossesse, le diagnostic de COVID-19 a été associé à la prééclampsie (RC 1,33; IC à 95 % 1,03–1,73), à la naissance prématurée (RC 1,82; IC à 95 % 1,38–2,39) et à la mortinaissance (RC 2,11; IC à 95 % 1,14–3,90). Par rapport à la COVID-19 légère, la COVID-19 grave était fortement associée à la prééclampsie (RC 4,16; IC à 95 % 1,55–11,15), à la naissance prématurée (RC 4,29; IC à 95 % 2,41–7,63), au diabète gestationnel (RC 1,99; IC à 95 % 1,09–3,64) et au faible poids à la naissance (RC 1,89; IC à 95 % 1,14–3,12). INTERPRÉTATION: La COVID-19 pourrait être associée à un risque accru de prééclampsie, de naissance prématurée et d’autres issues défavorables de la grossesse.
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Affiliation(s)
- Shu Qin Wei
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont
| | - Marianne Bilodeau-Bertrand
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont
| | - Shiliang Liu
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont
| | - Nathalie Auger
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont.
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Bowman CJ, Bouressam M, Campion SN, Cappon GD, Catlin NR, Cutler MW, Diekmann J, Rohde CM, Sellers RS, Lindemann C. Lack of effects on female fertility and prenatal and postnatal offspring development in rats with BNT162b2, a mRNA-based COVID-19 vaccine. Reprod Toxicol 2021; 103:28-35. [PMID: 34058573 PMCID: PMC8163337 DOI: 10.1016/j.reprotox.2021.05.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/17/2022]
Abstract
BNT162b2 is a vaccine developed to prevent coronavirus disease 2019 (COVID-19). BNT162b2 is a lipid nanoparticle formulated nucleoside-modified messenger RNA (mRNA) encoding the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein locked in its prefusion conformation. A developmental and reproductive toxicity study was conducted in rats according to international regulatory guidelines. The full human BNT162b2 dose of 30 μg mRNA/dose (>300 times the human dose on a mg/kg basis) was administered intramuscularly to 44 female rats 21 and 14 days prior to mating and on gestation days 9 and 20. Half of the rats were subject to cesarean section and full fetal examination at the end of gestation, and the other half were allowed to deliver and were monitored to the end of lactation. A robust neutralizing antibody response was confirmed prior to mating and at the end of gestation and lactation. The presence of neutralizing antibodies was also confirmed in fetuses and offspring. Nonadverse effects, related to the local injection site reaction, were noted in dams as expected from other animal studies and consistent with observations in humans. There were no effects of BNT162b2 on female mating performance, fertility, or any ovarian or uterine parameters nor on embryo-fetal or postnatal survival, growth, physical development or neurofunctional development in the offspring through the end of lactation. Together with the safety profile in nonpregnant people, this ICH-compliant nonclinical safety data supports study of BNT162b2 in women of childbearing potential and pregnant and lactating women.
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Affiliation(s)
- Christopher J Bowman
- Drug Safety Research and Development, Pfizer Worldwide Research, Development & Medical, Groton, CT, USA.
| | - Marie Bouressam
- Charles River Laboratories France Safety Assessmsent SAS, Lyon, France
| | - Sarah N Campion
- Drug Safety Research and Development, Pfizer Worldwide Research, Development & Medical, Groton, CT, USA
| | - Gregg D Cappon
- Drug Safety Research and Development, Pfizer Worldwide Research, Development & Medical, Groton, CT, USA
| | - Natasha R Catlin
- Drug Safety Research and Development, Pfizer Worldwide Research, Development & Medical, Groton, CT, USA
| | - Mark W Cutler
- Vaccine Research and Development, Pfizer Worldwide Research, Development & Medical, Pearl River, NY, USA
| | - Jan Diekmann
- Non-Clinical Safety, BioNTech SE, Mainz, Germany
| | - Cynthia M Rohde
- Drug Safety Research and Development, Pfizer Worldwide Research, Development & Medical, Pearl River, NY, USA
| | - Rani S Sellers
- Drug Safety Research and Development, Pfizer Worldwide Research, Development & Medical, Pearl River, NY, USA
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78
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Sankaran D, Nakra N, Cheema R, Blumberg D, Lakshminrusimha S. Perinatal SARS-CoV-2 Infection and Neonatal COVID-19: A 2021 Update. Neoreviews 2021; 22:e284-e295. [PMID: 33931474 DOI: 10.1542/neo.22-5-e1001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has swept across the world like an indiscriminating wildfire. Pregnant women and neonates are particularly vulnerable to this infection compared with older children and healthy young adults, with unique challenges in their management. Unfamiliarity with the consequences of this novel virus and lack of high-quality data led to considerable heterogeneity in obstetrical and neonatal management early in the pandemic. The aim of the this review is to summarize the impact of SARS-CoV-2 infection on pregnancy and childbirth and to examine care and possible outcomes for neonates with Covid-19-positive mothers. A brief review of vaccines currently approved by the United States Food and Drug Administration for emergency use and their potential effects on pregnant and lactating women in included.
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Affiliation(s)
| | - Natasha Nakra
- Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, CA
| | - Ritu Cheema
- Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, CA
| | - Dean Blumberg
- Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, CA
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Grudlewska-Buda K, Wiktorczyk-Kapischke N, Wałecka-Zacharska E, Kwiecińska-Piróg J, Buszko K, Leis K, Juszczuk K, Gospodarek-Komkowska E, Skowron K. SARS-CoV-2-Morphology, Transmission and Diagnosis during Pandemic, Review with Element of Meta-Analysis. J Clin Med 2021; 10:1962. [PMID: 34063654 PMCID: PMC8125301 DOI: 10.3390/jcm10091962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
The outbreak of Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2). Thus far, the virus has killed over 2,782,112 people and infected over 126,842,694 in the world (state 27 March 2021), resulting in a pandemic for humans. Based on the present data, SARS-CoV-2 transmission from animals to humans cannot be excluded. If mutations allowing breaking of the species barrier and enhancing transmissibility occurred, next changes in the SARS-CoV-2 genome, leading to easier spreading and greater pathogenicity, could happen. The environment and saliva might play an important role in virus transmission. Therefore, there is a need for strict regimes in terms of personal hygiene, including hand washing and surface disinfection. The presence of viral RNA is not an equivalent of active viral infection. The positive result of the RT-PCR method may represent either viral residues or infectious virus particles. RNA-based tests should not be used in patients after the decline of disease symptoms to confirm convalescence. It has been proposed to use the test based on viral, sub-genomic mRNA, or serological methods to find the immune response to infection. Vertical transmission of SARS-CoV-2 is still a little-known issue. In our review, we have prepared a meta-analysis of the transmission of SARS-CoV-2 from mother to child depending on the type of delivery. Our study indicated that the transmission of the virus from mother to child is rare, and the infection rate is not higher in the case of natural childbirth, breastfeeding, or contact with the mother. We hope that this review and meta-analysis will help to systemize knowledge about SARS-CoV-2 with an emphasis on diagnostic implications and transmission routes, in particular, mother-to-child transmission.
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Affiliation(s)
- Katarzyna Grudlewska-Buda
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Natalia Wiktorczyk-Kapischke
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Ewa Wałecka-Zacharska
- Department of Food Hygiene and Consumer Health, Wrocław University of Environmental and Life Sciences, 50-375 Wrocław, Poland;
| | - Joanna Kwiecińska-Piróg
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Katarzyna Buszko
- Department of Theoretical Foundations of Biomedical Science and Medical Informatics, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-067 Bydgoszcz, Poland;
| | - Kamil Leis
- Faculty of Medicile, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-067 Bydgoszcz, Poland;
| | - Klaudia Juszczuk
- Clinic of General, Colorectal and Oncological Surgery, Dr. Jana Biziel University Hospital, No. 2 in Bydgoszcz, 75 Ujejskiego St., 85-168 Bydgoszcz, Poland;
| | - Eugenia Gospodarek-Komkowska
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Krzysztof Skowron
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
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80
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Sankaran D, Nakra N, Cheema R, Blumberg D, Lakshminrusimha S. Perinatal SARS-CoV-2 Infection and Neonatal COVID-19: A 2021 Update. Neoreviews 2021. [PMID: 33931474 DOI: 10.1542/neo.22-5-e284] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The coronavirus disease 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has swept across the world like an indiscriminating wildfire. Pregnant women and neonates are particularly vulnerable to this infection compared with older children and healthy young adults, with unique challenges in their management. Unfamiliarity with the consequences of this novel virus and lack of high-quality data led to considerable heterogeneity in obstetrical and neonatal management early in the pandemic. The aim of the this review is to summarize the impact of SARS-CoV-2 infection on pregnancy and childbirth and to examine care and possible outcomes for neonates with Covid-19-positive mothers. A brief review of vaccines currently approved by the United States Food and Drug Administration for emergency use and their potential effects on pregnant and lactating women in included.
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Affiliation(s)
| | - Natasha Nakra
- Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, CA
| | - Ritu Cheema
- Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, CA
| | - Dean Blumberg
- Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, CA
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81
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DeBolt CA, Bianco A, Limaye MA, Silverstein J, Penfield CA, Roman AS, Rosenberg HM, Ferrara L, Lambert C, Khoury R, Bernstein PS, Burd J, Berghella V, Kaplowitz E, Overbey JR, Stone J. Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls. Am J Obstet Gynecol 2021; 224:510.e1-510.e12. [PMID: 33221292 PMCID: PMC7677036 DOI: 10.1016/j.ajog.2020.11.022] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
Background In March 2020, as community spread of severe acute respiratory syndrome coronavirus 2 became increasingly prevalent, pregnant women seemed to be equally susceptible to developing coronavirus disease 2019. Although the disease course usually appears mild, severe and critical cases of coronavirus disease 2019 seem to lead to substantial morbidity, including intensive care unit admission with prolonged hospital stay, intubation, mechanical ventilation, and even death. Although there are recent reports regarding the impact of coronavirus disease 2019 on pregnancy, there is a lack of information regarding the severity of coronavirus disease 2019 in pregnant vs nonpregnant women. Objective We aimed to describe the outcomes of severe and critical cases of coronavirus disease 2019 in pregnant vs nonpregnant, reproductive-aged women. Study Design This is a multicenter, retrospective, case-control study of women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection hospitalized with severe or critical coronavirus disease 2019 in 4 academic medical centers in New York City and 1 in Philadelphia between March 12, 2020, and May 5, 2020. The cases consisted of pregnant women admitted specifically for severe or critical coronavirus disease 2019 and not for obstetrical indications. The controls consisted of reproductive-aged, nonpregnant women admitted for severe or critical coronavirus disease 2019. The primary outcome was a composite morbidity that includes the following: death, a need for intubation, extracorporeal membrane oxygenation, noninvasive positive pressure ventilation, or a need for high-flow nasal cannula O2 supplementation. The secondary outcomes included intensive care unit admission, length of stay, a need for discharge to long-term acute care facilities, and discharge with a home O2 requirement. Results A total of 38 pregnant women with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction-confirmed infections were admitted to 5 institutions specifically for coronavirus disease 2019, 29 (76.3%) meeting the criteria for severe disease status and 9 (23.7%) meeting the criteria for critical disease status. The mean age and body mass index were markedly higher in the nonpregnant control group. The nonpregnant cohort also had an increased frequency of preexisting medical comorbidities, including diabetes, hypertension, and coronary artery disease. The pregnant women were more likely to experience the primary outcome when compared with the nonpregnant control group (34.2% vs 14.9%; P=.03; adjusted odds ratio, 4.6; 95% confidence interval, 1.2–18.2). The pregnant patients experienced higher rates of intensive care unit admission (39.5% vs 17.0%; P<.01; adjusted odds ratio, 5.2; 95% confidence interval, 1.5–17.5). Among the pregnant women who underwent delivery, 72.7% occurred through cesarean delivery and the mean gestational age at delivery was 33.8±5.5 weeks in patients with severe disease status and 35±3.5 weeks in patients with critical coronavirus disease 2019 status. Conclusion Pregnant women with severe and critical coronavirus disease 2019 are at an increased risk for certain morbidities when compared with nonpregnant controls. Despite the higher comorbidities of diabetes and hypertension in the nonpregnant controls, the pregnant cases were at an increased risk for composite morbidity, intubation, mechanical ventilation, and intensive care unit admission. These findings suggest that pregnancy may be associated with a worse outcome in women with severe and critical cases of coronavirus disease 2019. Our study suggests that similar to other viral infections such as severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, pregnant women may be at risk for greater morbidity and disease severity.
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82
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Riley LE, Jamieson DJ. Inclusion of Pregnant and Lactating Persons in COVID-19 Vaccination Efforts. Ann Intern Med 2021; 174:701-702. [PMID: 33493013 PMCID: PMC7875205 DOI: 10.7326/m21-0173] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This commentary discusses the interplay of pregnancy and SARS-CoV-2 infection. The authors explain why COVID-19 vaccination efforts should not exclude pregnant women.
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Affiliation(s)
- Laura E Riley
- Weill Cornell School of Medicine, New York, New York (L.E.R.)
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83
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Steffen HA, Swartz SR, Jackson JB, Kenne KA, Ten Eyck P, Merryman AS, Castaneda C, Marsden K, Maxwell T, Merrill AE, Krasowski MD, Rysavy MB. SARS-CoV-2 Infection during Pregnancy in a Rural Midwest All-delivery Cohort and Associated Maternal and Neonatal Outcomes. Am J Perinatol 2021; 38:614-621. [PMID: 33611783 PMCID: PMC11071687 DOI: 10.1055/s-0041-1723938] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. STUDY DESIGN This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. RESULTS In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26-33 years) and body mass index was 31.75 kg/m2 (IQR 27.7-37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. CONCLUSION In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. KEY POINTS · SARS-CoV-2 seroprevalence rate in pregnant population in Iowa is 5.8%.. · Infections are higher among minorities, non-English speakers, and patients without private insurance.. · No increased adverse maternal/neonatal outcomes observed for SARS-CoV-2 infected mothers..
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Affiliation(s)
| | | | | | - Kimberly A. Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA
| | - Abbey S. Merryman
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
| | | | | | - Timothy Maxwell
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | - Mary B. Rysavy
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
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84
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Carrasco I, Muñoz-Chapuli M, Vigil-Vázquez S, Aguilera-Alonso D, Hernández C, Sánchez-Sánchez C, Oliver C, Riaza M, Pareja M, Sanz O, Pérez-Seoane B, López J, Márquez E, Domínguez-Rodríguez S, Hernanz-Lobo A, De León-Luis JA, Sánchez-Luna M, Navarro ML. SARS-COV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave. BMC Pregnancy Childbirth 2021; 21:326. [PMID: 33902483 PMCID: PMC8072086 DOI: 10.1186/s12884-021-03784-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.
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MESH Headings
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- COVID-19/epidemiology
- COVID-19/physiopathology
- COVID-19/therapy
- COVID-19 Nucleic Acid Testing
- Carrier State/epidemiology
- Cesarean Section/statistics & numerical data
- Cohort Studies
- Comorbidity
- Cough/physiopathology
- Diabetes, Gestational/epidemiology
- Dyspnea/physiopathology
- Female
- Fever/physiopathology
- Gestational Age
- Humans
- Hypertension/epidemiology
- Hypothyroidism/epidemiology
- Immunologic Factors/therapeutic use
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Intensive Care Units/statistics & numerical data
- Lung/diagnostic imaging
- Male
- Obesity, Maternal/epidemiology
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pregnancy
- Pregnancy Complications/epidemiology
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Premature Birth/epidemiology
- Radiography, Thoracic
- Respiration, Artificial
- Risk Factors
- SARS-CoV-2
- Severity of Illness Index
- Spain/epidemiology
- COVID-19 Drug Treatment
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Affiliation(s)
- Itzíar Carrasco
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain.
| | - Mar Muñoz-Chapuli
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Hernández
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - César Sánchez-Sánchez
- Department of Paediatric Gastroenterology Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Oliver
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mónica Riaza
- Department of Paediatrics, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Marta Pareja
- Department of Paediatrics, Hospital General de Albace, Castilla La Mancha, Spain
| | - Olga Sanz
- Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Juan López
- Department of Paediatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Elena Márquez
- Department of Paediatrics, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Infectious Diseases Unit, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Alicia Hernanz-Lobo
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Antonio De León-Luis
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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85
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Cardona-Pérez JA, Villegas-Mota I, Helguera-Repetto AC, Acevedo-Gallegos S, Rodríguez-Bosch M, Aguinaga-Ríos M, Coronado-Zarco I, León-Juárez M, Aguilar-Ayala D, Valdespino-Vázquez MY, Moreno-Verduzco ER, Rivera MA, Valencia-Contreras C, Gómez-Sousa MDL, Solis-Paredes M, Frías-Madrid B, Velasco-Téllez C, Rodriguez-Aldama JC, Avila-Sosa V, Galván-Contreras R, Figueroa-Damian R, Cortés-Bonilla M, Estrada-Gutierrez G, Espino-y-Sosa S, Irles C. Prevalence, clinical features, and outcomes of SARS-CoV-2 infection in pregnant women with or without mild/moderate symptoms: Results from universal screening in a tertiary care center in Mexico City, Mexico. PLoS One 2021; 16:e0249584. [PMID: 33886590 PMCID: PMC8062012 DOI: 10.1371/journal.pone.0249584] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/20/2021] [Indexed: 12/23/2022] Open
Abstract
The perinatal consequences of SARS-CoV-2 infection are still largely unknown. This study aimed to describe the features and outcomes of pregnant women with or without SARS-CoV-2 infection after the universal screening was established in a large tertiary care center admitting only obstetric related conditions without severe COVID-19 in Mexico City. This retrospective case-control study integrates data between April 22 and May 25, 2020, during active community transmission in Mexico, with one of the highest COVID-19 test positivity percentages worldwide. Only pregnant women and neonates with a SARS-CoV-2 result by quantitative RT-PCR were included in this study. Among 240 pregnant women, the prevalence of COVID-19 was 29% (95% CI, 24% to 35%); 86% of the patients were asymptomatic (95% CI, 76%-92%), nine women presented mild symptoms, and one patient moderate disease. No pregnancy baseline features or risk factors associated with severity of infection, including maternal age > 35 years, Body Mass Index >30 kg/m2, and pre-existing diseases, differed between positive and negative women. The median gestational age at admission for both groups was 38 weeks. All women were discharged at home without complications, and no maternal death was reported. The proportion of preeclampsia was higher in positive women than negative women (18%, 95% CI, 10%-29% vs. 9%, 95% CI, 5%-14%, P<0.05). No differences were found for other perinatal outcomes. SARS-CoV-2 test result was positive for nine infants of positive mothers detected within 24h of birth. An increased number of infected neonates were admitted to the NICU, compared to negative neonates (44% vs. 22%, P<0.05) and had a longer length of hospitalization (2 [2-18] days vs. 2 [2-3] days, P<0.001); these are potential proxies for illness severity. This report highlights the importance of COVID-19 detection at delivery in pregnant women living in high transmission areas.
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Affiliation(s)
- J. Arturo Cardona-Pérez
- Dirección General, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Isabel Villegas-Mota
- Unidad de Enfermedades Infecciosas y Epidemiología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - A. Cecilia Helguera-Repetto
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Sandra Acevedo-Gallegos
- Departamento de Medicina Materno-Fetal, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Mario Rodríguez-Bosch
- Subdirección de Ginecología y Obstetricia, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Mónica Aguinaga-Ríos
- Departamento de Genética y Genómica Humana, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Irma Coronado-Zarco
- Subdirección de Neonatología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Moisés León-Juárez
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Diana Aguilar-Ayala
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | | | - Elsa Romelia Moreno-Verduzco
- Subdirección de Servicios auxiliares de Diagnóstico, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - María Antonieta Rivera
- Unidad de Cuidados Intensivos del Recién Nacido, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Carolina Valencia-Contreras
- Unidad de Cuidados Inmediatos al Recién Nacido, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - María de Lourdes Gómez-Sousa
- Departamento de Posgrado e Investigación, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Mario Solis-Paredes
- Departamento de Genética y Genómica Humana, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Brenda Frías-Madrid
- Unidad de Cuidados Intensivos del Recién Nacido, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - César Velasco-Téllez
- Departamento de Salud Mental, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Juan Carlos Rodriguez-Aldama
- Unidad de Enfermedades Infecciosas y Epidemiología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Valeria Avila-Sosa
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Rafael Galván-Contreras
- Unidad de Enfermedades Infecciosas y Epidemiología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Ricardo Figueroa-Damian
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Manuel Cortés-Bonilla
- Dirección Médica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe Estrada-Gutierrez
- Dirección de Investigación, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Salvador Espino-y-Sosa
- Subdirección de Investigación Clínica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Claudine Irles
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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Hapshy V, Aziz D, Kahar P, Khanna D, Johnson KE, Parmar MS. COVID-19 and Pregnancy: Risk, Symptoms, Diagnosis, and Treatment. ACTA ACUST UNITED AC 2021; 3:1477-1483. [PMID: 33898924 PMCID: PMC8057857 DOI: 10.1007/s42399-021-00915-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 12/17/2022]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel virus responsible for causing an infection known as COVID-19. Several pulmonary and systemic manifestations of the illness have been described since the discovery of this virus. However, there have been higher-risk populations in which this infection has not been well studied nor documented. One of these populations includes the pregnant cohort. The purpose of this article is to describe the clinical manifestations of COVID-19 infection in the pregnant population and review the implications and sequelae of the infection throughout pregnancy and outcomes of live births. Also, we summarize the understanding and safety of current treatments and vaccination in pregnancy. This comprehensive review article comprises several case reports, case series, cohort studies, retrospective studies, and randomized clinical trials. Findings regarding maternal morbidity included an increased risk of acquiring severe COVID-19 infection requiring a higher level of inpatient hospital care along with an increased risk of preterm labor and cesarean delivery. Neonatal COVID-19 vertical transmission was shown to have conflicting data as there was a presence of transmission in certain retrospective studies and absence in others. There was also no evidence of teratogenicity from maternal COVID-19 infection. In conclusion, in part due to the unique physiologic state of pregnancy and part due to unknown factors, pregnant patients are at increased risk for negative outcomes of COVID-19 infection and must be classified as a high-risk population.
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Affiliation(s)
- Vera Hapshy
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa Bay Campus, Clearwater, FL USA
| | - Daniel Aziz
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Payal Kahar
- Department of Health Sciences, Florida Gulf Coast University, Fort Myers, FL USA
| | - Deepesh Khanna
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa Bay Campus, Clearwater, FL USA
| | - Kenneth E Johnson
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa Bay Campus, Clearwater, FL USA
| | - Mayur S Parmar
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Tampa Bay Campus, Clearwater, FL USA
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87
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Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 2021; 193:E540-E548. [PMID: 33741725 PMCID: PMC8084555 DOI: 10.1503/cmaj.202604] [Citation(s) in RCA: 412] [Impact Index Per Article: 137.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) on maternal and newborn health is unclear. We aimed to evaluate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and adverse pregnancy outcomes. METHODS We conducted a systematic review and meta-analysis of observational studies with comparison data on SARS-CoV-2 infection and severity of COVID-19 during pregnancy. We searched for eligible studies in MEDLINE, Embase, ClinicalTrials.gov, medRxiv and Cochrane databases up to Jan. 29, 2021, using Medical Subject Headings terms and keywords for "severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2 OR coronavirus disease 2019 OR COVID-19" AND "pregnancy." We evaluated the methodologic quality of all included studies using the Newcastle-Ottawa Scale. Our primary outcomes were preeclampsia and preterm birth. Secondary outcomes included stillbirth, gestational diabetes and other pregnancy outcomes. We calculated summary odds ratios (ORs) or weighted mean differences with 95% confidence intervals (CI) using random-effects meta-analysis. RESULTS We included 42 studies involving 438 548 people who were pregnant. Compared with no SARS-CoV-2 infection in pregnancy, COVID-19 was associated with preeclampsia (OR 1.33, 95% CI 1.03 to 1.73), preterm birth (OR 1.82, 95% CI 1.38 to 2.39) and stillbirth (OR 2.11, 95% CI 1.14 to 3.90). Compared with mild COVID-19, severe COVID-19 was strongly associated with preeclampsia (OR 4.16, 95% CI 1.55 to 11.15), preterm birth (OR 4.29, 95% CI 2.41 to 7.63), gestational diabetes (OR 1.99, 95% CI 1.09 to 3.64) and low birth weight (OR 1.89, 95% CI 1.14 to 3.12). INTERPRETATION COVID-19 may be associated with increased risks of preeclampsia, preterm birth and other adverse pregnancy outcomes.
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Affiliation(s)
- Shu Qin Wei
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont
| | - Marianne Bilodeau-Bertrand
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont
| | - Shiliang Liu
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont
| | - Nathalie Auger
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont.
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88
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Effect of SARS-CoV-2 Infection on Pregnancy Outcomes in an Inner-City Black Patient Population. J Community Health 2021; 46:1029-1035. [PMID: 33855649 PMCID: PMC8046575 DOI: 10.1007/s10900-021-00988-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 12/20/2022]
Abstract
While data have shown that Black populations are disproportionately affected by COVID-19, few studies have evaluated birth outcomes in these understudied populations. This study hypothesized that SARS-CoV-2 infection would confer worse maternal and neonatal outcomes in a predominantly Black and underserved population in Brooklyn, New York City. In particular, SARS-CoV-2 is associated with higher rates of preterm birth, cesarean delivery, postpartum hemorrhage, lower APGAR scores, and neonatal resuscitation. Demographic factors and comorbidities were compared between the SARS-CoV-2 positive and negative groups. A retrospective cohort study was conducted in hospitalized patients who gave birth at Kings County Hospital from April 10 through June 10, 2020. Demographic and clinical data were obtained from the electronic medical record. Patients were categorized based on SARS-CoV-2 infection status and peripartum outcomes were analyzed. We used the Fisher exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. P < 0.05 was considered significant. There were no differences in obstetric or neonatal outcomes between the SARS-CoV-2 positive and negative cohorts. Most SARS-CoV-2 positive patients were asymptomatic on admission. The rates of maternal comorbidities were similar in the SARS-CoV-2 positive and negative groups. In this predominantly Black population in Brooklyn, SARS-CoV-2 infection did not confer increased risk of adverse obstetric or neonatal outcomes, despite the prevalence of comorbidities. The impact of SARS-CoV-2 infection on pregnancy outcomes is complex and may differ on a community level. Determining how COVID-19 is associated with perinatal outcomes in this minoritized patient population will augment our understanding of health disparities in order to improve care.
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89
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Berlin, im Februar 2021 – COVID-19-Schutzimpfung von Schwangeren und Frauen mit Kinderwunsch. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1401-4901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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90
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Abstract
PURPOSE OF REVIEW The aim of this review was to describe the process of and challenges in developing national guidance for management of infants born to mothers with COVID-19. RECENT FINDINGS Beginning in January 2020, infection with the novel coronavirus SARS-CoV-2 spread across the USA, causing the illness COVID-19. As pregnant women began to present for delivery while sick with COVID-19, the American Academy of Pediatrics (AAP) convened a writing group in March 2020 to develop guidance for the management of their newborns. The initial guidance was developed emergently and was forced to rely on extremely limited data from China. The initial guidance advocated for a conservative approach that included temporary physical separation of infected mother and newborn. To address the knowledge deficit, the AAP sponsored a volunteer registry to collect data on perinatal infection and management. As data have emerged informing the natural history of COVID-19, the performance of PCR-based diagnostics, the value of infection control measures and the risk of infant disease, AAP has issued serial updates to newborn guidance. SUMMARY Evolving knowledge on the epidemiology of perinatal COVID-19 has informed newborn guidance. The most recent guidance focuses on the use of infection control measures to support maternal-newborn contact and breastfeeding.
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Affiliation(s)
- Dustin D. Flannery
- Division of Neonatology, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen M. Puopolo
- Division of Neonatology, Children's Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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91
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Berry M, Wang A, Clark SM, Harirah HM, Jain S, Olson GL, Pacheco LD, Saade GR, Saad AF. Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience. Am J Perinatol 2021; 38:515-522. [PMID: 33548937 DOI: 10.1055/s-0041-1723761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. STUDY DESIGN This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. RESULTS Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. CONCLUSION Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. KEY POINTS · The majority of pregnant patients with COVID-19 are asymptomatic and <1 in 20 require oxygen support.. · Women in the later stages of pregnancy may be at increased risk for severe infection.. · Anemia, leukopenia, CRP, ferritin, and procalcitonin are associated with increasing severity..
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Affiliation(s)
- Marissa Berry
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Amanda Wang
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Shannon M Clark
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Hassan M Harirah
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Sangeeta Jain
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Gayle L Olson
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Luis D Pacheco
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - George R Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Antonio F Saad
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
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Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, Manuck TA, Miodovnik M, Sowles A, Clark K, Gyamfi-Bannerman C, Mendez-Figueroa H, Sehdev HM, Rouse DJ, Tita AT, Bailit J, Costantine MM, Simhan HN, Macones GA. Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2021; 137:571-580. [PMID: 33560778 PMCID: PMC7984765 DOI: 10.1097/aog.0000000000004339] [Citation(s) in RCA: 258] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/29/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes. METHODS We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling. RESULTS A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients. CONCLUSION Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.
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93
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Elsaddig M, Khalil A. Effects of the COVID pandemic on pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol 2021; 73:125-136. [PMID: 33832868 PMCID: PMC7969862 DOI: 10.1016/j.bpobgyn.2021.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022]
Abstract
Pregnant women and neonates are often categorised as being at high risk during the coronavirus disease-2019 (COVID-19) pandemic. Numerous studies have demonstrated that the characteristics of COVID-19 disease in pregnant women and non-pregnant women are very similar. However, pregnant women with COVID-19 in the third trimester are more likely than their non-pregnant counterparts to require intensive care, though this may reflect a lower threshold for intervention in pregnant women rather than more serious disease. Compared with pregnant women without COVID-19, pregnant women with symptomatic COVID-19 requiring admission to hospital have worse maternal outcomes, including death, although the absolute risk remains very low. Outcomes of neonates born to women positive for COVID-19 are generally very good, though iatrogenic preterm birth is more common. Findings from these studies highlight the need for further monitoring of the outcomes of pregnant and post-partum women according to trimester during this pandemic.
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Affiliation(s)
- Maab Elsaddig
- Fetal Medicine Unit, St George's Hospital, St George's University of London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, UK.
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94
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A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19. ACTA ACUST UNITED AC 2021; 3:1272-1294. [PMID: 33754135 PMCID: PMC7968576 DOI: 10.1007/s42399-021-00836-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
The maternal-fetal/newborn unit is established at risk for COVID-19 infection. This narrative review summarizes the contemporary and cumulative publications which detail maternal infection, antenatal and newborn infections, and maternal/fetal/newborn management and prevention. There is a wide spectrum of maternal disease, but the potential for severe disease albeit in a minority is confirmed. COVID-19 carries risk for preterm delivery. Pregnant females can suffer multisystem disease, and co-morbidities play a significant role in risk. Congenital infection has been supported by several anecdotal reports, but strong confirmatory data are few. No typical congenital dysmorphisms are evident. Nevertheless, placental vascular compromise must be considered a risk for the fetus during advanced maternal infections. Clinical manifestations of newborn infection have been mild to moderate and relatively uncommon. Proven antiviral therapy is of yet lacking. The mode of delivery is a medical decision that must include patient risk assessment and patient directives. Both presymptomatic and asymptomatic mothers and offspring can complicate infection control management with the potential for spread to others in several regards. In the interim, infections of the maternal-fetal-newborn unit must be taken seriously both for the disease so caused and the potential for further dissemination of disease.
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95
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Matute J, Finander B, Pepin D, Ai X, Smith N, Li J, Edlow A, Villani A, Lerou P, Kalish B. Single-cell immunophenotyping of the fetal immune response to maternal SARS-CoV-2 infection in late gestation. RESEARCH SQUARE 2021:rs.3.rs-311000. [PMID: 33758834 PMCID: PMC7987103 DOI: 10.21203/rs.3.rs-311000/v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During the COVID-19 pandemic, thousands of pregnant women have been infected with SARS-CoV-2. The implications of maternal SARS-CoV-2 infection on fetal and childhood well-being are unknown. We aimed to characterize the fetal immune response to maternal SARS-CoV-2 infection. We performed single-cell RNA sequencing and T-cell receptor (TCR) sequencing on cord blood mononuclear cells (CBMC) from newborns of mothers infected with SARS-CoV-2 in the third-trimester (cases) or without SARS-CoV-2 infection. We identified widespread gene expression changes in CBMC from cases, including upregulation of interferon-stimulated genes and Major Histocompatibility Complex genes in CD14 + monocytes; transcriptional changes suggestive of activation of plasmacytoid dendritic cells, and activation and exhaustion of NK cells and CD8 + T-cells. Lastly, we observed fetal TCR repertoire expansion in cases. As none of the infants were infected with SARS-CoV-2, our results suggest that SARS-CoV-2 maternal infection might modulate the fetal immune system in the absence of vertical transmission.
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Affiliation(s)
- Juan Matute
- Massachusetts General Hospital and Harvard Medical School
| | | | | | - Xinbin Ai
- Massachusetts General Hospital and Harvard Medical School
| | - Neal Smith
- Massachusetts General Hospital and Harvard Medical School
| | | | - Andrea Edlow
- Massachusetts General Hospital and Harvard Medical School
| | | | - Paul Lerou
- Massachusetts General Hospital and Harvard Medical School
| | - Brian Kalish
- The Hospital for Sick Children and University of Toronto
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Karimi L, Makvandi S, Vahedian-Azimi A, Sathyapalan T, Sahebkar A. Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis. J Pregnancy 2021; 2021:8870129. [PMID: 33728066 PMCID: PMC7938334 DOI: 10.1155/2021/8870129] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/12/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. METHODS Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. RESULTS 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. CONCLUSION COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.
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Affiliation(s)
- Leila Karimi
- Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Somayeh Makvandi
- Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, UK
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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97
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Erol Koç EM, Fındık RB, Akkaya H, Karadağ I, Tokalıoğlu EÖ, Tekin ÖM. Comparison of hematological parameters and perinatal outcomes between COVID-19 pregnancies and healthy pregnancy cohort. J Perinat Med 2021; 49:141-147. [PMID: 33544531 DOI: 10.1515/jpm-2020-0403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the relationship between Coronavirus Disease 2019 (COVID-19) in pregnancy and adverse perinatal outcomes. The secondary aim is to analyze the diagnostic value of hematologic parameters in COVID-19 complicated pregnancies. METHODS The current study is conducted in a high volume tertiary obstetrics center burdened by COVID-19 pandemics, in Turkey. In this cohort study, perinatal outcomes and complete blood count indices performed at the time of admission of 39 pregnancies (Study group) complicated by COVID-19 were compared with 69 uncomplicated pregnancies (Control group). RESULTS There was no significant difference between the obstetric and neonatal outcomes of pregnancies with COVID-19 compared to data of healthy pregnancies, except the increased C-section rate (p=0.026). Monocyte count, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) were significantly increased (p<0.0001, p=0.009, p=0.043, p<0.0001, respectively) whereas the MPV and plateletcrit were significantly decreased (p=0.001, p=0.008) in pregnants with COVID-19. ROC analysis revealed that the optimal cut-off value for MLR was 0.354 which indicated 96.7% specificity and 59.5% sensitivity in diagnosis of pregnant women with COVID-19. A strong positive correlation was found between the MLR and the presence of cough symptom (r=41.4, p=<0.0001). CONCLUSIONS The study revealed that, pregnancies complicated by COVID-19 is not related with adverse perinatal outcomes. MLR may serve as a supportive diagnostic parameter together with the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in assessment of COVID-19 in pregnant cohort.
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Affiliation(s)
- Esin Merve Erol Koç
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Rahime Bedir Fındık
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Hatice Akkaya
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
| | - Işılay Karadağ
- Department of Obstetrics and Gynecology, Ankara City Hospital, Ankara, Turkey
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Management of Viral Complications of Pregnancy: Pharmacotherapy to Reduce Vertical Transmission. Obstet Gynecol Clin North Am 2021; 48:53-74. [PMID: 33573790 DOI: 10.1016/j.ogc.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Viral infections are common complications of pregnancy. Although some infections have maternal sequelae, many viral infections can be perinatally transmitted to cause congenital or chronic infection in fetuses or infants. Treatments of such infections are geared toward reducing maternal symptoms and complications and toward preventing maternal-to-child transmission of viruses. The authors review updates in the treatment of herpes simplex virus, cytomegalovirus, hepatitis B and C viruses, human immunodeficiency virus, and COVID-19 during pregnancy.
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Samara A, Herlenius E. Is There an Effect of Fetal Mesenchymal Stem Cells in the Mother-Fetus Dyad in COVID-19 Pregnancies and Vertical Transmission? Front Physiol 2021; 11:624625. [PMID: 33679426 PMCID: PMC7928412 DOI: 10.3389/fphys.2020.624625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
Because of the polysystemic nature of coronavirus disease 2019 (COVID-19), during the present pandemic, there have been serious concerns regarding pregnancy, vertical transmission, and intrapartum risk. The majority of pregnant patients with COVID-19 infection present with mild or asymptomatic course of the disease. Some cases were hospitalized, and few needed intensive care unit admission, or mechanical ventilation. There have also been scarce case reports where neonates required mechanical ventilation post COVID-19 pregnancies. Without approved therapies other than dexamethasone, advanced mesenchymal cell therapy is one immunomodulatory therapeutic approach that is currently explored and might hold great promise. We suggest that the circulating fetal stem cells might have an immune-protective effect to mothers and contribute to the often mild and even asymptomatic post-COVID-19 pregnancies. Thus, COVID-19 pregnancies come forth as a paradigm to be further and more comprehensively approached, to understand both the mechanism and action of circulating stem cells in immunoprotection and hypoxia in microcirculation.
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Affiliation(s)
- Athina Samara
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children′s Hospital Karolinska University Hospital, Stockholm, Sweden
| | - Eric Herlenius
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children′s Hospital Karolinska University Hospital, Stockholm, Sweden
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Affiliation(s)
- David W Kimberlin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham
| | - Karen M Puopolo
- Section of Newborn Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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