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Raza HA, Sen P, Bhatti OA, Gupta L. Sex hormones, autoimmunity and gender disparity in COVID-19. Rheumatol Int 2021; 41:1375-1386. [PMID: 33903964 PMCID: PMC8075025 DOI: 10.1007/s00296-021-04873-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has majorly contributed to massive and widespread mortality. Epidemiological data strongly indicates a sex-based disparity in COVID-19 clinical outcomes, with women having lower infection and hospitalisation rates, coupled with better prognosis and lesser mortality. This disparity may be explained by several mechanisms including differences in innate and adaptive immune responses, genetic factors, and an interplay between sex hormones and immune effectors, as well as gender-specific behaviour differences. These pathways, particularly the immunological divergence in response to viral infection, could potentially influence not only COVID-19 pathogenesis and disease course, but also the response to antiviral drugs and vaccines. Furthermore, factors that confer a protective advantage against COVID-19 may be exploited to develop therapeutic strategies to improve clinical outcomes in COVID-19.
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Affiliation(s)
- Hussain Ahmed Raza
- Medical College, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
| | - Parikshit Sen
- Maulana Azad Medical College, 2-Bahadur Shah Zafar marg, New Delhi, India
| | - Omaima Anis Bhatti
- Medical College, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
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Sarwal Y, Sarwal T, Sarwal R. Prioritizing pregnant women for COVID-19 vaccination. Int J Gynaecol Obstet 2021; 155:57-63. [PMID: 34227102 PMCID: PMC9347872 DOI: 10.1002/ijgo.13816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022]
Abstract
Despite emerging evidence on safety and efficacy, most countries do not offer COVID‐19 vaccines to pregnant women even though they are at higher risk of complications from COVID‐19. We performed a web search of COVID‐19 vaccination policies for pregnant women under two categories: countries bearing a high burden of COVID‐19 cases and countries with a high burden of maternal and under‐five mortality. Of the top 20 countries affected by COVID‐19, 11 allow vaccination of pregnant women, of which two have deemed it safe to vaccinate pregnant women as a high‐risk group. In contrast, only five of the 20 countries with high under‐five mortality and maternal mortality allow vaccination of pregnant women and none of these countries has included them as part of a high‐risk group that should be vaccinated. India and Indonesia, with one‐fifth of the world's population, fall under both categories but do not include pregnant women as a priority group for COVID‐19 vaccination. To prevent COVID‐19 from further aggravating the already heavy burden of maternal and under‐five mortality, there is a strong case for including pregnant women as a high‐priority group for COVID‐19 vaccination. We recommend including COVID‐19 vaccination in routine antenatal care in all countries, particularly India and Indonesia in view of their high dual burden. COVID‐19 vaccination should be included in routine antenatal care in all countries, particularly India and Indonesia in view of their high dual burden of cases and maternal and under‐five mortality.
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Affiliation(s)
- Yamini Sarwal
- Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Rakesh Sarwal
- National Institution for Transforming India, New Delhi, India
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Ferrer-Oliveras R, Mendoza M, Capote S, Pratcorona L, Esteve-Valverde E, Cabero-Roura L, Alijotas-Reig J. Immunological and physiopathological approach of COVID-19 in pregnancy. Arch Gynecol Obstet 2021; 304:39-57. [PMID: 33945026 PMCID: PMC8093597 DOI: 10.1007/s00404-021-06061-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
Coronavirus disease-2019 (COVID-19) related to Coronavirus-2 (SARS-CoV-2) is a worldwide health concern. Despite the majority of patients will evolve asymptomatic or mild-moderate upper respiratory tract infections, 20% will develop severe disease. Based on current pathogenetic knowledge, a severe COVID-19 form is mainly a hyperinflammatory, immune-mediated disorder, triggered by a viral infection. Due to their particular immunological features, pregnant women are supposed to be particularly susceptible to complicate by intracellular infections as well as immunological disturbances. As an example, immune-thrombosis has been identified as a common immune-mediated and pathogenic phenomenon both in COVID-19, in obstetric diseases and in COVID-19 pregnant women. According to extensive published clinical data, is rationale to expect an interference with the normal development of pregnancy in selected SARS-CoV-2-infected cases, mainly during third trimester.This manuscript provides insights of research to elucidate the potential harmful responses to SARS-CoV-2 and /or other coronavirus infections, as well as bidirectional interactions between COVID-19 and pregnancy to improve their respective management.
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Affiliation(s)
- Raquel Ferrer-Oliveras
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain.
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Sira Capote
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
| | - Laia Pratcorona
- Department of Obstetrics, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Enrique Esteve-Valverde
- Department of Internal Medicine, Althaia Network Health. Manresa, Barcelona, Spain
- Universitat Central de Catalunya, Barcelona, Catalonia, Spain
| | - Lluis Cabero-Roura
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
- Prof. Emeritus of Obsterics and Gynaecology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit. Department of Internal Medicine-1, Vall d' Hebron University Hospital, Barcelona, Spain.
- Systemic Autoimmune Research Unit, Vall d'Hebron Reseacrh Institute, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Mirbeyk M, Saghazadeh A, Rezaei N. A systematic review of pregnant women with COVID-19 and their neonates. Arch Gynecol Obstet 2021; 304:5-38. [PMID: 33797605 PMCID: PMC8017514 DOI: 10.1007/s00404-021-06049-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In December 2019, a novel coronavirus disease (COVID-19) emerged in Wuhan, China, with an incredible contagion rate. However, the vertical transmission of COVID-19 is uncertain. OBJECTIVES This is a systematic review of published studies concerning pregnant women with confirmed COVID-19 and their neonates. SEARCH STRATEGY We carried out a systematic search in multiple databases, including PubMed, Web of Science, Google Scholar, Scopus, and WHO COVID-19 database using the following keywords: (Coronavirus) OR (novel coronavirus) OR (COVID-19) OR (COVID19) OR (COVID 19) OR (SARS-CoV2) OR (2019-nCoV)) and ((pregnancy) OR (pregnant) OR (vertical transmission) OR (neonate) OR (newborn) OR (placenta) OR (fetus) OR (Fetal)). The search took place in April 2020. SELECTION CRITERIA Original articles published in English were eligible if they included pregnant patients infected with COVID-19 and their newborns. DATA COLLECTION AND ANALYSES The outcomes of interest consisted of clinical manifestations of COVID-19 in pregnant patients with COVID-19 and also the effect of COVID-19 on neonatal and pregnancy outcomes. MAIN RESULTS 37 articles involving 364 pregnant women with COVID-19 and 302 neonates were included. The vast majority of pregnant patients were in their third trimester of pregnancy, and only 45 cases were in the first or second trimester (12.4%). Most mothers described mild to moderate manifestations of COVID-19. Of 364 pregnant women, 25 were asymptomatic at the time of admission. The most common symptoms were fever (62.4%) and cough (45.3%). Two maternal deaths occurred. Some pregnant patients (12.1%) had a negative SARS-CoV-2 test but displayed clinical manifestations and abnormalities in computed tomography (CT) scan related to COVID-19. Twenty-two (6.0%) pregnant patients developed severe pneumonia. Two maternal deaths occurred from severe pneumonia and multiple organ dysfunction. Studies included a total of 302 neonates from mothers with COVID-19. Of the studies that provided data on the timing of birth, there were 65 (23.6%) preterm neonates. One baby was born dead from a mother who also died from COVID-19. Of the babies born alive from mothers with COVID-19, five newborns faced critical conditions, and two later died. A total of 219 neonates underwent nasopharyngeal specimen collection for SARS-CoV-2, of which 11 tested positive (5%). Seventeen studies examined samples of the placenta, breast milk, umbilical cord, and amniotic fluid, and all tested negative except one amniotic fluid sample. CONCLUSIONS A systematic review of published studies confirm that the course of COVID-19 in pregnant women resembles that of other populations. However, there is not sufficient evidence to establish an idea that COVID-19 would not complicate pregnancy.
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Affiliation(s)
- Mona Mirbeyk
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Children's Medical Center Hospital, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
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The Deleterious Effects of COVID-19 in the Peripartum Period: A Case Report. Pediatr Rep 2021; 13:334-339. [PMID: 34208425 PMCID: PMC8293368 DOI: 10.3390/pediatric13020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
While the Coronavirus Disease 2019 (COVID-19) pandemic continues to wreak havoc across the nation and the globe as one of the most significant global health crises of our time, recent attention has been turned to the effects of COVID-19 on pregnancy and the puerperium. Although most cases have been asymptomatic, for some patients, the disease may be accompanied by serious complications such as pneumonia, acute respiratory distress, multi organ failure, and death. Several case studies have noted that patients with co-morbidities are at a significant risk of these complications. In a recent systematic review and meta-analysis, authors conclude that cardiovascular disease was associated with increased composite poor outcome in patients with COVID-19. The following case report highlights the multi-system complications and severity of symptoms that can take place after childbirth in a patient with co-morbid obstetric and prenatal conditions and an initially asymptomatic COVID-19 infection.
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de Oliveira KF, de Oliveira JF, Wernet M, Carvalho Paschoini M, Ruiz MT. COVID-19 and pregnancy: A scoping review on pregnancy characteristics and outcomes. Int J Nurs Pract 2021; 27:e12956. [PMID: 33998110 PMCID: PMC8209813 DOI: 10.1111/ijn.12956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/21/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023]
Abstract
Aim The study aim was to map clinical characteristics and the evolution of pregnancies in pregnant women with confirmed diagnosis of SARS‐CoV‐2 infection. Methods Searching four databases, studies were investigated that described the evolution of pregnancies in women diagnosed with SARS‐CoV‐2 infection through laboratory tests. A scoping review was undertaken, including 35 articles published in English. Two pairs of independent researchers synthesized the data. Results Most studies were case studies or case series and had a low risk of bias. A predominance of cases was found in women over the age of 30 years who got infected in the third term of pregnancy and who had comorbidities. The prematurity index varied with the heterogeneity of the samples, and the cases of abortion occurred in combination with severe forms of infection. Caesarean section deliveries predominated, indicated mainly by respiratory decompensation caused by infection. Most women were discharged. Conclusion Based on the reviewed studies, the profile and evolution of pregnant women infected with COVID‐19 could be evaluated. What is already known about this topic? In 2020, the COVID‐19 pandemic was decreed, currently accounting for more than 105 million cases and more than two million deaths. Physiological changes of pregnancy predispose pregnant women to COVID‐19 infection. The characteristics of pregnancy associated with COVID‐19 infection turn obstetric care into a constant challenge.
What this paper adds? The review presents the profile of pregnant women infected by SARS‐CoV‐2, with laboratory confirmation using the diagnostic reference standard (PCR). This review presents the profile of pregnant women infected with SARS‐CoV‐2 and the outcomes of the infection and pregnancy.
The implications of this paper: Based on the knowledge of the profile, public policies can be planned to prevent and manage infection among pregnant and postpartum women. Further studies are suggested, mainly follow‐up studies of cohorts with pregnant women infected with SARS‐CoV‐2 to expand knowledge about the profile and obstetric outcomes.
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Affiliation(s)
| | | | - Monika Wernet
- Department of Nursing, Federal University of Sāo Carlos, Sāo Paulo, Brazil
| | | | - Mariana Torreglosa Ruiz
- Department of Nursing in Hospital Assistance, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Schwartz DA, Dhaliwal A. Coronavirus Diseases in Pregnant Women, the Placenta, Fetus, and Neonate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:223-241. [PMID: 33973182 DOI: 10.1007/978-3-030-63761-3_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the etiological agent of coronavirus disease 2019 (COVID-19), is similar to two other coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), in causing life-threatening respiratory infections and systemic complications in both children and adults. As the COVID-19 pandemic has continued to spread globally, increasing numbers of pregnant women have become infected, raising concern not only for their health but also for the health of their infants. This chapter discusses the effects of coronavirus infections, e.g., MERS, SARS, and COVID 19, on pregnancy and describes the evolving knowledge of COVID 19 among pregnant women. The physiological changes that occur in pregnancy, especially changes in the immune system, are reviewed in terms of their effect on susceptibility to infectious diseases. The effects of COVID-19 on the placenta, fetus, and neonate are also reviewed, including potential clinical outcomes and issues relating to testing and diagnosis. The potential mechanisms of vertical transmission of the virus between pregnant women and their infants are analyzed, including intrauterine, intrapartum, and postpartum infections. Several recent studies have reported the detection of SARS-CoV-2 in tissues from the fetal side of the placenta, permitting the diagnosis of transplacental infection of the fetus by SARS-CoV-2. Placentas from infected mothers in which intrauterine transplacental transmission of SARS-CoV-2 has occurred demonstrate an unusual combination of pathology findings which may represent risk factors for placental as well as fetal infection.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Coronavirus Disease 2019 in Pregnancy and Outcomes Among Pregnant Women and Neonates: A Literature Review. Pediatr Infect Dis J 2021; 40:473-478. [PMID: 33847297 PMCID: PMC8048372 DOI: 10.1097/inf.0000000000003102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Limited data are available about the outcomes of coronavirus disease 2019 (COVID-19) during pregnancy and risk of vertical transmission in exposed neonates. We reviewed studies published February 1, 2020, through August 15, 2020, on outcomes in pregnant women with COVID-19 and neonates with perinatal exposure. Among pregnant women with COVID-19, 181 (11%) required intensive care unit admission and 123 (8%) required mechanical ventilation. There were 22 maternal deaths. Most infections occurred in the third trimester. Among women who delivered, 28% had a preterm birth, and 57% had a Caesarean section. Sixty-one (4%) of 1222 neonates with reported testing had at least 1 positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. The most common symptom among neonates was respiratory distress (n = 126; 21%). There were 14 neonatal deaths, one of which occurred in a neonate with positive testing. Further study of COVID-19 in pregnant women and neonates, including standardized reporting of outcomes, testing and treatment protocols, is essential to optimize maternal and neonatal care.
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Incidence of first trimester pregnancy loss in the infertile population during the first wave of the coronavirus disease 2019 pandemic in New York City. F S Rep 2021; 2:209-214. [PMID: 34278356 PMCID: PMC8267398 DOI: 10.1016/j.xfre.2021.04.005] [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: 01/07/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To describe the incidence of first trimester clinical pregnancy loss in the infertile population during the first wave of the COVID-19 pandemic in New York City. Design Web-based cross-sectional survey. Setting New York City-based academic reproductive medicine practice. Patient(s) A total of 305 infertile patients with a confirmed intrauterine pregnancy in their first trimester between December 1, 2019, and April 1, 2020, were matched by age and treatment type to pregnant patients from the year prior. Intervention(s) None. Main Outcome Measure(s) First trimester clinical pregnancy loss rate. Result(s) In total, the first trimester pregnancy loss rate was lower in the COVID-19 era cohort compared with that in the pre-COVID-19 era cohort (11.9% vs. 20.1%). There was no difference between cohorts in the pregnancy loss rate of women conceiving via fresh embryo transfer (19.6% vs. 24.4%) or via frozen embryo transfer with preimplantation genetic testing (5.4% vs. 9.5%,). In women conceiving via frozen embryo transfer without preimplantation genetic testing, the pregnancy loss rate was statistically lower in the COVID-19 group (12.5% vs. 24.5%). There was no difference in the pregnancy loss rate by treatment type when stratifying by COVID-19 testing or symptom status. Of the 40 (13.1%) patients with a pregnancy loss, there was no difference in self-reported COVID-19 symptoms or symptom type compared with results in those who did not experience a pregnancy loss. Conclusion Despite patients expressing significant worry about COVID-19 and pregnancy, our data provides reassuring information that the first trimester pregnancy loss rate is not elevated for women conceiving via assisted reproductive technology during the global COVID-19 pandemic.
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Qeadan F, Mensah NA, Tingey B, Stanford JB. The risk of clinical complications and death among pregnant women with COVID-19 in the Cerner COVID-19 cohort: a retrospective analysis. BMC Pregnancy Childbirth 2021; 21:305. [PMID: 33863292 PMCID: PMC8051832 DOI: 10.1186/s12884-021-03772-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity. METHODS We used retrospective data from January through June 2020 on female patients aged 18-44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions. RESULTS Out of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%, P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day, P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days, P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%, P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups. CONCLUSIONS Among women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.
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Affiliation(s)
- Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA.
| | - Nana A Mensah
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA
| | - Benjamin Tingey
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA
| | - Joseph B Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA
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Qeadan F, Mensah NA, Tingey B, Stanford JB. The risk of clinical complications and death among pregnant women with COVID-19 in the Cerner COVID-19 cohort: a retrospective analysis. BMC Pregnancy Childbirth 2021; 21:305. [PMID: 33863292 PMCID: PMC8051832 DOI: 10.1186/s12884-021-03772-y#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/05/2021] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Pregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity. METHODS We used retrospective data from January through June 2020 on female patients aged 18-44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions. RESULTS Out of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%, P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day, P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days, P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%, P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups. CONCLUSIONS Among women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.
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Affiliation(s)
- Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA.
| | - Nana A Mensah
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA
| | - Benjamin Tingey
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA
| | - Joseph B Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA
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Patberg ET, Adams T, Rekawek P, Vahanian SA, Akerman M, Hernandez A, Rapkiewicz AV, Ragolia L, Sicuranza G, Chavez MR, Vintzileos AM, Khullar P. Coronavirus disease 2019 infection and placental histopathology in women delivering at term. Am J Obstet Gynecol 2021; 224:382.e1-382.e18. [PMID: 33091406 PMCID: PMC7571377 DOI: 10.1016/j.ajog.2020.10.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/21/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022]
Abstract
Background There is a paucity of data describing the effects of coronavirus disease 2019 on placental pathology, especially in asymptomatic patients. Although the pathophysiology of coronavirus disease 2019 is not completely understood, there is emerging evidence that it causes a severe systemic inflammatory response and results in a hypercoagulable state with widespread microthrombi. We hypothesized that it is plausible that a similar disease process may occur in the fetal-maternal unit. Objective This study aimed to determine whether coronavirus disease 2019 in term patients admitted to labor and delivery, including women without coronavirus disease 2019 symptomatology, is associated with increased placental injury compared with a cohort of coronavirus disease 2019–negative controls. Study Design This was a retrospective cohort study performed at NYU Winthrop Hospital between March 31, 2020, and June 17, 2020. During the study period, all women admitted to labor and delivery were routinely tested for severe acute respiratory syndrome coronavirus 2 regardless of symptomatology. The placental histopathologic findings of patients with coronavirus disease 2019 (n=77) who delivered a singleton gestation at term were compared with a control group of term patients without coronavirus disease 2019 (n=56). Controls were excluded if they had obstetrical or medical complications including fetal growth restriction, oligohydramnios, hypertension, diabetes, coagulopathy, or thrombophilia. Multivariable logistic regression models were performed for variables that were significant (P<.05) in univariable analyses. A subgroup analysis was also performed comparing asymptomatic coronavirus disease 2019 cases with negative controls. Results In univariable analyses, coronavirus disease 2019 cases were more likely to have evidence of fetal vascular malperfusion, that is, presence of avascular villi and mural fibrin deposition (32.5% [25/77] vs 3.6% [2/56], P<.0001) and villitis of unknown etiology (20.8% [16/77] vs 7.1% [4/56], P=.030). These findings persisted in a subgroup analysis of asymptomatic coronavirus disease 2019 cases compared with coronavirus disease 2019–negative controls. In a multivariable model adjusting for maternal age, race and ethnicity, mode of delivery, preeclampsia, fetal growth restriction, and oligohydramnios, the frequency of fetal vascular malperfusion abnormalities remained significantly higher in the coronavirus disease 2019 group (odds ratio, 12.63; 95% confidence interval, 2.40–66.40). Although the frequency of villitis of unknown etiology was more than double in coronavirus disease 2019 cases compared with controls, this did not reach statistical significance in a similar multivariable model (odds ratio, 2.11; 95% confidence interval, 0.50–8.97). All neonates of mothers with coronavirus disease 2019 tested negative for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction. Conclusion Despite the fact that all neonates born to mothers with coronavirus disease 2019 were negative for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction, we found that coronavirus disease 2019 in term patients admitted to labor and delivery is associated with increased rates of placental histopathologic abnormalities, particularly fetal vascular malperfusion and villitis of unknown etiology. These findings seem to occur even among asymptomatic term patients.
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Maintaining Maternal-Newborn Safety During the COVID-19 Pandemic. Nurs Womens Health 2021; 25:212-220. [PMID: 33811824 PMCID: PMC7983449 DOI: 10.1016/j.nwh.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Abstract
COVID-19, the disease caused by the SARS-CoV-2 virus, was declared a global pandemic by the World Health Organization on March 11, 2020. In addition to older individuals and those with underlying chronic health conditions, maternal and newborn populations were also identified as being at greater risk. It became critical for hospitals and clinicians to maintain the safety of individuals in the facility and minimize the transmission of COVID-19 while continuing to strive for optimized outcomes by providing family-centered care. Rapid change during the pandemic made it appropriate to use the plan–do–study–act (PDSA) cycle to continually evaluate proposed and standard practices. Our team established an obstetric COVID-19 unit for women and newborns, developed guidelines for visitation and for the use of personal protective equipment, initiated universal COVID-19 testing, and provided health education to emphasize shared decision making.
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Cai J, Tang M, Gao Y, Zhang H, Yang Y, Zhang D, Wang H, Liang H, Zhang R, Wu B. Cesarean Section or Vaginal Delivery to Prevent Possible Vertical Transmission From a Pregnant Mother Confirmed With COVID-19 to a Neonate: A Systematic Review. Front Med (Lausanne) 2021. [PMID: 33681259 DOI: 10.3389/fmed.2021.634949.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The impact of delivery mode on the infection rates of Coronavirus disease 2019 (COVID-19) in the newborn remains unknown. We aimed to summarize the existing literature on COVID-19 infection during pregnancy to evaluate which mode of delivery is better for preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. Methods: We performed a comprehensive literature search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, and the Chinese Biomedical Literature database (CBM) from 31 December 2019 to 18 June 2020. We applied no language restrictions. We screened abstracts for relevance, extracted data, and assessed the risk of bias in duplicate. We rated the certainty of evidence using the GRADE approach. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity in neonates born to mothers with confirmed COVID-19 following different delivery modes. Secondary outcomes were neonatal deaths and maternal deaths. This study is registered with PROSPERO, CRD42020194049. Results: Sixty-eight observational studies meeting inclusion criteria were included in the current study, with no randomized controlled trials. In total, information on the mode of delivery, detailed neonatal outcomes, and SARS-CoV-2 status were available for 1,019 pregnant women and 1,035 neonates. Six hundred and eighteen (59.71%) neonates were born through cesarean section and 417(40.29%) through vaginal delivery. Probable congenital SARS-CoV-2 infections were reported in 34/1,035 (3.29%) neonates. Of babies born vaginally, 9/417 (2.16%) were tested positive compared with 25/618 (4.05%) born by cesarean. Of babies born vaginally, 0/417 (0.00%) neonatal deaths were reported compared with 6/618 (0.97%) born by cesarean. Of women who delivered vaginally, 1/416 (0.24%) maternal deaths were reported compared with 11/603 (1.82%) delivered by cesarean. Two women died before delivery. Sensitivity analyses and subgroup analyses showed similar findings. Conclusions: The rate of neonatal COVID-19 infection, neonatal deaths, and maternal deaths are no greater when the mother gave birth through vaginal delivery. Based on the evidence available, there is no sufficient evidence supporting that the cesarean section is better than vaginal delivery in preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. The mode of birth should be individualized and based on disease severity and obstetric indications. Additional good-quality studies with comprehensive serial tests from multiple specimens are urgently needed. Study registration: PROSPERO CRD42020194049.
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Affiliation(s)
- Jianghui Cai
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mi Tang
- Office of Good Clinical Practice, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Gao
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongxi Zhang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan Zhang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Han Wang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Liang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Zhang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Wu
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Tang G, Luo Y, Lu F, Li W, Liu X, Nan Y, Ren Y, Liao X, Wu S, Jin H, Zomaya AY, Sun Z. Prediction of Sepsis in COVID-19 Using Laboratory Indicators. Front Cell Infect Microbiol 2021; 10:586054. [PMID: 33747973 PMCID: PMC7966961 DOI: 10.3389/fcimb.2020.586054] [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: 09/09/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background The outbreak of coronavirus disease 2019 (COVID-19) has become a global public health concern. Many inpatients with COVID-19 have shown clinical symptoms related to sepsis, which will aggravate the deterioration of patients’ condition. We aim to diagnose Viral Sepsis Caused by SARS-CoV-2 by analyzing laboratory test data of patients with COVID-19 and establish an early predictive model for sepsis risk among patients with COVID-19. Methods This study retrospectively investigated laboratory test data of 2,453 patients with COVID-19 from electronic health records. Extreme gradient boosting (XGBoost) was employed to build four models with different feature subsets of a total of 69 collected indicators. Meanwhile, the explainable Shapley Additive ePlanation (SHAP) method was adopted to interpret predictive results and to analyze the feature importance of risk factors. Findings The model for classifying COVID-19 viral sepsis with seven coagulation function indicators achieved the area under the receiver operating characteristic curve (AUC) 0.9213 (95% CI, 89.94–94.31%), sensitivity 97.17% (95% CI, 94.97–98.46%), and specificity 82.05% (95% CI, 77.24–86.06%). The model for identifying COVID-19 coagulation disorders with eight features provided an average of 3.68 (±) 4.60 days in advance for early warning prediction with 0.9298 AUC (95% CI, 86.91–99.04%), 82.22% sensitivity (95% CI, 67.41–91.49%), and 84.00% specificity (95% CI, 63.08–94.75%). Interpretation We found that an abnormality of the coagulation function was related to the occurrence of sepsis and the other routine laboratory test represented by inflammatory factors had a moderate predictive value on coagulopathy, which indicated that early warning of sepsis in COVID-19 patients could be achieved by our established model to improve the patient’s prognosis and to reduce mortality.
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Affiliation(s)
- Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Lu
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- The Australia-China Joint Research Centre for Energy Informatics and Demand Response Technologies, Centre for Distributed and High Performance Computing, School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Xiongcheng Liu
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Yucen Nan
- The Australia-China Joint Research Centre for Energy Informatics and Demand Response Technologies, Centre for Distributed and High Performance Computing, School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Yufei Ren
- Department of Computer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofei Liao
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Song Wu
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Hai Jin
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Albert Y Zomaya
- The Australia-China Joint Research Centre for Energy Informatics and Demand Response Technologies, Centre for Distributed and High Performance Computing, School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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66
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Debrabandere ML, Farabaugh DC, Giordano C. A Review on Mode of Delivery during COVID-19 between December 2019 and April 2020. Am J Perinatol 2021; 38:332-341. [PMID: 33285608 DOI: 10.1055/s-0040-1721658] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aims to review the published literature to determine mode of delivery in pregnant women with coronavirus disease 2019 (COVID-19) and the indications reported for cesarean section early in the pandemic to add information to the current narrative and raise awareness of trends discovered. STUDY DESIGN A systematic review was conducted by searching PubMed, Scopus, and ScienceDirect databases for articles published between December 2019 and April 29, 2020 using a combination of the keywords such as COVID-19, coronavirus 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pregnancy, vaginal delivery, cesarean section, vertical transmission, management, and guidelines. Peer-reviewed case studies with confirmed SARS-CoV-2 women who delivered were included to determine mode of delivery, indications for cesarean section, and maternal and neonatal characteristics. RESULTS A review of 36 total articles revealed deliveries in 203 SARS-CoV-2 positive pregnant women. A comparable severity of disease in pregnant versus nonpregnant women was noted, as previously determined. Overall, 68.9% of women delivered via cesarean section, with COVID-19 status alone being a common indication. Maternal COVID-19 may also be associated with increased risk of preterm labor, although neonatal outcomes were generally favorable. Despite eight of 206 newborns testing positive for SARS-CoV-2, there remains no definitive evidence of vertical transmission. CONCLUSION COVID-19 status alone became a common indication for cesarean delivery early in the pandemic, despite lack of evidence for vertical transmission. The increase in cesarean rate in this data may reflect obstetricians attempting to serve their patients in the best way possible given the current climate of constantly evolving guidelines on safest mode of delivery for the mother, infant, and provider. Upholding current recommendations from trusted organizations as new data are published, while also providing individualized support to expecting mothers on most appropriate mode of delivery, will reduce the amount of unnecessary, unplanned cesarean sections and could lessen the psychological impact of delivering during the COVID-19 pandemic. KEY POINTS · COVID-19 may result in an increased rate of cesarean delivery for SARS-CoV-2 positive pregnant women.. · COVID-19 is a commonly reported indication for cesarean section, despite management guidelines urging against this.. · Although eight neonates tested positive for SARS-CoV-2, all additional fluid and tissue samples tested negative..
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Affiliation(s)
- Margot L Debrabandere
- Department of Medical Education, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Dana C Farabaugh
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Carolyn Giordano
- Department of Medical Education, Drexel University College of Medicine, Philadelphia, Pennsylvania
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67
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Cai J, Tang M, Gao Y, Zhang H, Yang Y, Zhang D, Wang H, Liang H, Zhang R, Wu B. Cesarean Section or Vaginal Delivery to Prevent Possible Vertical Transmission From a Pregnant Mother Confirmed With COVID-19 to a Neonate: A Systematic Review. Front Med (Lausanne) 2021; 8:634949. [PMID: 33681259 PMCID: PMC7926203 DOI: 10.3389/fmed.2021.634949] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/22/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The impact of delivery mode on the infection rates of Coronavirus disease 2019 (COVID-19) in the newborn remains unknown. We aimed to summarize the existing literature on COVID-19 infection during pregnancy to evaluate which mode of delivery is better for preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. Methods: We performed a comprehensive literature search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, and the Chinese Biomedical Literature database (CBM) from 31 December 2019 to 18 June 2020. We applied no language restrictions. We screened abstracts for relevance, extracted data, and assessed the risk of bias in duplicate. We rated the certainty of evidence using the GRADE approach. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity in neonates born to mothers with confirmed COVID-19 following different delivery modes. Secondary outcomes were neonatal deaths and maternal deaths. This study is registered with PROSPERO, CRD42020194049. Results: Sixty-eight observational studies meeting inclusion criteria were included in the current study, with no randomized controlled trials. In total, information on the mode of delivery, detailed neonatal outcomes, and SARS-CoV-2 status were available for 1,019 pregnant women and 1,035 neonates. Six hundred and eighteen (59.71%) neonates were born through cesarean section and 417(40.29%) through vaginal delivery. Probable congenital SARS-CoV-2 infections were reported in 34/1,035 (3.29%) neonates. Of babies born vaginally, 9/417 (2.16%) were tested positive compared with 25/618 (4.05%) born by cesarean. Of babies born vaginally, 0/417 (0.00%) neonatal deaths were reported compared with 6/618 (0.97%) born by cesarean. Of women who delivered vaginally, 1/416 (0.24%) maternal deaths were reported compared with 11/603 (1.82%) delivered by cesarean. Two women died before delivery. Sensitivity analyses and subgroup analyses showed similar findings. Conclusions: The rate of neonatal COVID-19 infection, neonatal deaths, and maternal deaths are no greater when the mother gave birth through vaginal delivery. Based on the evidence available, there is no sufficient evidence supporting that the cesarean section is better than vaginal delivery in preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. The mode of birth should be individualized and based on disease severity and obstetric indications. Additional good-quality studies with comprehensive serial tests from multiple specimens are urgently needed. Study registration: PROSPERO CRD42020194049.
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Affiliation(s)
- Jianghui Cai
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Jianghui Cai
| | - Mi Tang
- Office of Good Clinical Practice, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Gao
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongxi Zhang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanfeng Yang
- Department of Pediatric Cardiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan Zhang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Han Wang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Liang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Zhang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Wu
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Servante J, Swallow G, Thornton JG, Myers B, Munireddy S, Malinowski AK, Othman M, Li W, O'Donoghue K, Walker KF. Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: a systematic review and critical analysis. BMC Pregnancy Childbirth 2021; 21:108. [PMID: 33546624 PMCID: PMC7863033 DOI: 10.1186/s12884-021-03568-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. METHODS Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. RESULTS One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. CONCLUSIONS Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.
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Affiliation(s)
- Juliette Servante
- Department of Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Gill Swallow
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Bethan Myers
- Department of Haematology, University Hospitals of Leicester, Leicester, UK
| | - Sandhya Munireddy
- Department of Haematology, University Hospitals of Leicester, Leicester, UK
| | - A Kinga Malinowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University Kingston, Kingston, Ontario, Canada
- School of Baccalaureate Nursing, St Lawrence College, Kingston, Ontario, Canada
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Keelin O'Donoghue
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Kate F Walker
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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69
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Bellos I, Pandita A, Panza R. Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 256:194-204. [PMID: 33246205 PMCID: PMC7664337 DOI: 10.1016/j.ejogrb.2020.11.038] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
Evidence concerning coronavirus disease-19 (covid-19) in pregnancy is still scarce and scattered. This meta-analysis aims to evaluate maternal and neonatal outcomes in covid-19 pregnancies and identify factors associated with perinatal viral transmission. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched to 3 June 2020. Overall, 16 observational studies and 44 case reports/series were included. Fever was the most frequent maternal symptom, followed by cough and shortness of breath, while about 15 % of infected were asymptomatic. Severe disease was estimated to occur in 11 % of women in case reports/series and in 7 % (95 % CI: 4 %-10 %) in observational studies. Two maternal deaths were reported. The rate of neonatal transmission did not differ between women with and without severe disease (OR: 1.94, 95 % CI: 0.50-7.60). Preterm birth occurred in 29.7 % and 16 % (95 % CI: 11 %-21 %) in data obtained from case series and observational studies, respectively. Stillbirth occurred in 3 cases and 2 neonatal deaths were observed. Vertical transmission was suspected in 4 cases. Fever was the most common neonatal symptom (40 %), followed by shortness of breath (28 %) and vomiting (24 %), while 20 % of neonates were totally asymptomatic. In conclusion, the maternal and neonatal clinical course the infection is typically mild, presenting low mortality rates. The risk of vertical transmission is suggested to be low and may not be affected by the severity of maternal disease. Further large-scale studies are needed to clarify the risk factors associated with viral transmission and severe infection in the neonatal population.
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Affiliation(s)
- Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece
| | - Aakash Pandita
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Raffaella Panza
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Section, Policlinico Hospital, University of Bari Aldo Moro, Bari, Italy
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Neef V, Buxmann H, Rabenau HF, Zacharowski K, Raimann FJ. Characterization of neonates born to mothers with SARS-CoV-2 infection: Review and meta-analysis. Pediatr Neonatol 2021; 62:11-20. [PMID: 33334687 PMCID: PMC7585378 DOI: 10.1016/j.pedneo.2020.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022] Open
Abstract
Characterization of neonates born to mothers with SARS-CoV-2 infection has been partially carried out. There has been no systematic review providing a holistic neonatal presentation including possible vertical transmission. A systematic literature search was performed using PubMed, Google Scholar and Web of Science up to June, 6 2020. Studies on neonates born to mothers with SARS-CoV-2 infection were included. A binary random effect model was used for prevalence and 95% confidence interval. 32 studies involving 261 neonates were included in meta-analysis. Most neonates born to infected mothers did not show any clinical abnormalities (80.4%). Clinical features were dyspnea in 11 (42.3%) and fever in 9 newborns (19.1%). Of 261 neonates, 120 neonates were tested for infection, of whom 12 (10.0%) tested positive. Swabs from placenta, cord blood and vaginal secretion were negative. Neonates are mostly non affected by the mother's SARS-CoV-2 infection. The risk of vertical transmission is low.
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Affiliation(s)
- Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Horst Buxmann
- CLinic for Children and Adolescents, Division for Neonatology, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Holger F Rabenau
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany
| | - Florian J Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany.
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Novoa RH, Quintana W, Llancarí P, Urbina-Quispe K, Guevara-Ríos E, Ventura W. Maternal clinical characteristics and perinatal outcomes among pregnant women with coronavirus disease 2019. A systematic review. Travel Med Infect Dis 2021; 39:101919. [PMID: 33220455 PMCID: PMC7674121 DOI: 10.1016/j.tmaid.2020.101919] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the maternal clinical characteristics, maternal and perinatal outcomes in COVID-19-positive pregnant women. METHODS Articles in all languages on the SARS-CoV-2 infection in pregnant women were sought from MEDLINE, EMBASE, Cochrane Library and LILACS; China National Knowledge Infrastructure Database (CNKI), Chinese Science and Technology Periodical Database (VIP) and Wan Fang Data between December 1, 2019 and April 27, 2020. Bulletins and national reports were also searched. RESULTS From 12,168 retrieved articles, 143 were selected for full-text assessment; 33 for descriptive analyses, and 4 case-controls for meta-analysis. In 322 infected pregnant women, aged 20-45 years, the most frequent maternal comorbidity was obesity (24.2%). Forty-two (28.4%) were asymptomatic at admission. Cough (n = 148,59.7%) and fever (n = 147,59.3%) were the most prevalent symptoms. In the meta-analysis, fever (OR: 0.13,95% CI 0.05 to 0.36) and cough (0.26,95% CI 0.11 to 0.59) were lower in pregnant women with COVID-19 than non-pregnant women with COVID-19.195 (60.6%) delivered, and 125 (38.8%) remained pregnant during the study. Cesarean was reported in 99 (50.8%) women and vaginal delivery in 64 (32.8%). The main adverse obstetric outcome was premature birth (n = 37,18.9%). Thirty patients (10.3%) with COVID-19-related complications required intensive care, one (0.3%) died. SARS-CoV-2 was absent in breast milk, amniotic fluid, placenta or umbilical cord blood. CONCLUSIONS The maternal clinical characteristics of COVID-19-positive pregnant include frequently fever and cough; however significantly less frequently than non-pregnant women with COVID-19. Iatrogenic preterm birth is the main adverse obstetric outcome. Current data does not support vertical transmission in the third trimester.
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Affiliation(s)
- Rommy H Novoa
- High-Risk Pregnancy Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Willy Quintana
- High-Risk Pregnancy Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Pedro Llancarí
- Residency Training Program in Obstetrics & Gynecology, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Katherine Urbina-Quispe
- Residency Training Program in Obstetrics & Gynecology, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Enrique Guevara-Ríos
- High-Risk Pregnancy Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Walter Ventura
- Maternal & Fetal Medicine Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Fetal Medicine Unit, Clínica Angloamericana, British Medical Hospital, Lima, Peru.
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Pourafkari L, Mirza-Aghzadeh-Attari M, Zarrintan A, Mousavi-Aghdas SA. Clinical Experience, Pathophysiology, and Considerations in the Prophylaxis and Treatment of Hypercoagulopathy of COVID-19: A Review Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:1-14. [PMID: 33487787 PMCID: PMC7812501 DOI: 10.30476/ijms.2020.87233.1730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023]
Abstract
Since the emergence of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, an increasing number of reports and studies have tried to warn the medical community about the thrombotic complications of coronavirus disease 2019 (COVID-19). It is suggested that the hyperinflammatory response and endothelial injury, especially in patients with severe disease, lead to a hypercoagulable state. Sudden deaths occurring in some patients also point to fulminant arrhythmias and massive pulmonary embolism (PE). Several expert panels have published recommendations regarding the prophylaxis and treatment of such complications. Nonetheless, there are limited high-quality studies for evidence-based decision-making, and most of these recommendations have arisen from descriptive studies, and optimal anticoagulant agents and dosages are yet to be designated. The coagulopathy persists after the acute phase of the illness, and some panels recommend the continuation of deep vein thrombosis prophylaxis for several days after regaining the normal daily activities by the patient. Here, we review the incidence and possible mechanisms of thrombotic complications, and present a summary of the considerations for the prophylaxis and treatment of such complications in the adult population.
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Affiliation(s)
- Leili Pourafkari
- Catholic Health System, SUNY at Buffalo, Buffalo, New York, United States
| | - Mohammad Mirza-Aghzadeh-Attari
- Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Armin Zarrintan
- Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ali Mousavi-Aghdas
- Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Donzelli M, Ippolito M, Catalisano G, Renda B, Tarantino F, Diquattro O, Cortegiani A. Prone positioning and convalescent plasma therapy in a critically ill pregnant woman with COVID-19. Clin Case Rep 2020; 8:3352-3358. [PMID: 33363933 PMCID: PMC7752326 DOI: 10.1002/ccr3.3426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022] Open
Abstract
Prone positioning is feasible in pregnancy and may have contributed to the positive outcome in this case. Doctors should not be reluctant to move a patient to a prone position just because they are pregnant.
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Affiliation(s)
- Massimo Donzelli
- Unità Operativa di Anestesiae RianimazioneAzienda Ospedaliera Ospedali Riuniti (AOOR) P.O. CervelloPalermoItaly
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly
| | - Giulia Catalisano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly
| | - Baldassare Renda
- Unità Operativa di Anestesiae RianimazioneAzienda Ospedaliera Ospedali Riuniti (AOOR) P.O. CervelloPalermoItaly
| | - Francesco Tarantino
- Unità Operativa di Anestesiae RianimazioneAzienda Ospedaliera Ospedali Riuniti (AOOR) P.O. CervelloPalermoItaly
| | - Orazia Diquattro
- Unità Operativa di MicrobiologiaAzienda Ospedaliera Ospedali Riuniti (AOOR)PalermoItaly
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly
- Department of Anesthesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
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Wang MJ, Schapero M, Iverson R, Yarrington CD. Obstetric Hemorrhage Risk Associated with Novel COVID-19 Diagnosis from a Single-Institution Cohort in the United States. Am J Perinatol 2020; 37:1411-1416. [PMID: 32992351 DOI: 10.1055/s-0040-1718403] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The study aimed to compare the quantitative blood loss (QBL) and hemorrhage-related outcomes of pregnant women with and without a coronavirus disease 2019 (COVID-19) diagnosis. STUDY DESIGN This retrospective cohort study of all live deliveries at Boston Medical Center between April 1, 2020 and July 22, 2020 compares the outcomes of pregnant women with a laboratory-confirmed COVID-19 positive diagnosis and pregnant women without COVID-19. The primary outcomes are QBL and obstetric hemorrhage. The secondary outcomes analyzed were a maternal composite outcome that consisted of obstetric hemorrhage, telemetry-level (intermediate care unit) or intensive care unit, transfusion, length of stay greater than 5 days, or intraamniotic infection, and individual components of the maternal composite outcome. Groups were compared using Student's t-test, Chi-squared tests, or Fisher's exact. Logistic regression was used to adjust for confounding variables. RESULTS Of 813 women who delivered a live infant between April 1 and July 22, 2020, 53 women were diagnosed with COVID-19 on admission to the hospital. Women with a COVID-19 diagnosis at their time of delivery were significantly more likely to identify as a race other than white (p = 0.01), to deliver preterm (p = 0.05), to be diagnosed with preeclampsia with severe features (p < 0.01), and to require general anesthesia (p < 0.01). Women diagnosed with COVID-19 did not have a significantly higher QBL (p = 0.64). COVID-19 positive pregnant patients had no increased adjusted odds of obstetric hemorrhage (adjusted odds ratio [aOR]: 0.41, 95% confidence interval [CI]: 0.17-1.04) and no increased adjusted odds of the maternal morbidity composite (aOR: 0.98, 95% CI: 0.50-1.93) when compared with those without a diagnosis of COVID-19. CONCLUSION Pregnant women with COVID-19 diagnosis do not have increased risk for obstetric hemorrhage, increased QBL or risk of maternal morbidity compared with pregnant women without a COVID-19 diagnosis. Further research is needed to describe the impact of a COVID-19 diagnosis on maternal hematologic physiology and pregnancy outcomes. KEY POINTS · Information about blood loss associated with peripartum COVID-19 is limited.. · COVID-19 diagnosis is not associated with increase in obstetric hemorrhage.. · COVID-19 diagnosis is not associated with increase in blood loss..
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Affiliation(s)
- Michelle J Wang
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Melissa Schapero
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Ronald Iverson
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
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Viñuela MC, De León-Luis JA, Alonso R, Catalán P, Lizarraga S, Muñoz P, Bouza E. SARS-CoV-2 screening of asymptomatic women admitted for delivery must be performed with a combination of microbiological techniques: an observational study. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:415-421. [PMID: 32945157 PMCID: PMC7712338 DOI: 10.37201/req/088.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to assess the value of systematic screening in asymptomatic women admitted for spontaneous delivery with a combination of reverse transcription polymerase chain reaction (RT-PCR) and cycle threshold (Ct) and serum antibodies. METHODS Since May 6 all women admitted for spontaneous delivery underwent RT-PCR in nasopharyngeal swabs and specific antibodies IgG of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in serum that were performed as part of routine clinical care in our institution. Ct of the PCR was recorded. We analyzed the first 100 women consecutively admitted for spontaneous delivery at our institution. RESULTS Nine women were positive for SARS-CoV-2 in nasopharyngeal samples (9%) and 13 (13%) presented positive specific antibodies of the coronavirus. Overall, SARS-CoV-2 prior exposure was 15%. The Ct determination (RT-PCR test) of our 9 positive patients ranged from 36 to 41 cycles with a median of 40. Vaginal delivery occurred in 94% of the cases and only 6% underwent a cesarean section, always for obstetric reasons. No fetal transmission was observed and maternal and neonatal prognosis was excellent. CONCLUSIONS During epidemic episodes in asymptomatic women in labor, universal testing with RT-PCR (considering Ct determination), and the detection of antibodies, permits a better interpretation of the results and avoid unnecessary isolation procedures.
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Affiliation(s)
- M C Viñuela
- Maria Carmen Viñuela, Department of Obstetrics and Gynecology. University Hospital Gregorio Marañón, School of Medicine, Complutense University of Madrid. O'Donnell Street 48, 28009 Madrid, Spain.
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Rodrigues C, Baía I, Domingues R, Barros H. Pregnancy and Breastfeeding During COVID-19 Pandemic: A Systematic Review of Published Pregnancy Cases. Front Public Health 2020; 8:558144. [PMID: 33330308 PMCID: PMC7719788 DOI: 10.3389/fpubh.2020.558144] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023] Open
Abstract
Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19. Methods: Searches were conducted in PubMed®, Scopus®, Web of Science®, and MedRxiv® up to 26th June 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality. Results: We identified 161 original studies reporting 3,985 cases of pregnant women with COVID-19 (1,007 discharged while pregnant). The 2,059 published cases with pregnancy outcomes resulted in 42 abortions, 21 stillbirths, and 2,015 live births. Preterm birth occurred in 23% of cases. Around 6% of pregnant women required admission to an intensive care unit and 28 died. There were 10 neonatal deaths. From the 163 cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus, 10 were positive. Sixty-one newborns were positive for SARS-CoV-2. Four breast milk samples from 92 cases showed evidence of SARS-CoV-2. Conclusion: Emerging evidence suggests that vertical transmission is possible, however, there is still a limited number of reported cases with intrapartum samples. Information, counseling and adequate monitoring are essential to prevent and manage adverse effects of SARS-CoV-2 infection during pregnancy.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal,*Correspondence: Carina Rodrigues
| | - Inês Baía
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Rosa Domingues
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Henrique Barros
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Kirtsman M, Diambomba Y, Poutanen SM, Malinowski AK, Vlachodimitropoulou E, Parks WT, Erdman L, Morris SK, Shah PS. Infection congénitale probable au SRAS-CoV-2 chez le nouveau-né d’une femme atteinte de COVID-19 active. CMAJ 2020; 192:E1419-E1422. [PMID: 33168768 PMCID: PMC7669294 DOI: 10.1503/cmaj.200821-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Maksim Kirtsman
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - Yenge Diambomba
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - Susan M Poutanen
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - Ann K Malinowski
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - Evangelia Vlachodimitropoulou
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - W Tony Parks
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - Laura Erdman
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - Shaun K Morris
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont
| | - Prakesh S Shah
- Services de pédiatrie (Kirtsman, Diambomba, Shah), d'obstétrique et gynécologie Malinowski, Vlachodimitropoulou) et de pathologie et médecine de laboratoire (Parks), Hôpital du Mont-Sinaï; Services de microbiologie (Poutanen) et de médecine (Infectiologie) (Poutanen), Réseau universitaire de santé (Hôpital du Mont-Sinaï); Départements de pédiatrie (Kirtsman, Diambomba, Erdman, Morris, Shah), de médecine de laboratoire et pathobiologie (Poutanen, Parks), de médecine (Poutanen) et d'obstétrique et gynécologie (Malinowski, Vlachodimitropoulou), Université de Toronto; Division d'infectiologie (Erdman, Morris), Service de pédiatrie, Hôpital pour enfants malades de Toronto, Toronto, Ont.
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Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, Woodworth KR, Nahabedian JF, Azziz-Baumgartner E, Gilboa SM, Meaney-Delman D. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1641-1647. [PMID: 33151921 PMCID: PMC7643892 DOI: 10.15585/mmwr.mm6944e3] [Citation(s) in RCA: 807] [Impact Index Per Article: 201.8] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Kadir RA, Kobayashi T, Iba T, Erez O, Thachil J, Kazi S, Malinowski AK, Othman M. COVID-19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry-Communication from the ISTH SSC for Women's Health. J Thromb Haemost 2020; 18:3086-3098. [PMID: 32846051 PMCID: PMC7461532 DOI: 10.1111/jth.15072] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Novel coronavirus (SARS-CoV-2), which causes COVID-19, has thus far affected more than 15 million individuals, resulting in more than 600 000 deaths worldwide, and the number continues to rise. In a large systematic review and meta-analysis of the literature including 2567 pregnant women, 7% required intensive care admission, with a maternal mortality ~1% and perinatal mortality below 1%. There has been a rapid increase in publications on COVID-19-associated coagulopathy, including disseminated intravascular coagulopathy and venous thromboembolism, in the non-pregnant population, but very few reports of COVID-19 coagulopathy during pregnancy; leaving us with no guidance for care of this specific population. METHODS This is a collaborative effort conducted by a group of experts that was reviewed, critiqued, and approved by the International Society on Thrombosis and Haemostasis Subcommittee for Women's Health Issues in Thrombosis and Hemostasis. A structured literature search was conducted, and the quality of current and emerging evidence was evaluated. Based on the published studies in the non-pregnant and pregnant population with a moderate to high risk of bias as assessed by Newcastle-Ottawa scale and acknowledging the absence of data from randomized clinical trials for management of pregnant women infected with SARS-CoV-2, a consensus in support of a guidance document for COVID-19 coagulopathy in pregnancy was identified. RESULTS AND CONCLUSIONS Specific hemostatic issues during pregnancy were highlighted, and preliminary recommendations to assist in the care of COVID-19-affected pregnant women with coagulopathy or thrombotic complications were developed. An international registry to gather data to support the management of COVID-19 and associated coagulopathy in pregnancy was established.
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Affiliation(s)
- Rezan Abdul Kadir
- Katharine Dormandy Haemophilia and Thrombosis Centre and Department of Obstetrics and Gynaecology, The Royal Free NHS Foundation Hospital, London, UK
- University College, London, UK
| | - Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Shizuoka, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | | | - Ann Kinga Malinowski
- Division of Maternal Fetal Medicine Mount Sinai Hospital, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Maha Othman
- Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
- School of Baccalaureate Nursing, St Lawrence College, Kingston, ON, Canada
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Preeclampsia and the crucial postpartum period for Covid-19 infected mothers: A case report. Pregnancy Hypertens 2020; 23:136-139. [PMID: 33388729 PMCID: PMC7604163 DOI: 10.1016/j.preghy.2020.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/10/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022]
Abstract
The early postpartum period is crucial for mothers who have a complicated delivery due to preeclampsia. In mothers with symptoms of COVID-19, there may be severe and sometimes fatal consequences. We report the first maternal death in Balouchestan (Iran) due to complicated delivery with preeclampsia concomitant with COVID-19 postpartum. The patient was asymptomatic for COVID-19 during the delivery and rapidly progressed to severe respiratory distress and coagulopathy in the early postpartum period. Mothers with preeclampsia features may be at risk for severe COVID-19, and detailed assessments are essential for these patients during the COVID-19 pandemic.
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81
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Chamseddine RS, Wahbeh F, Chervenak F, Salomon LJ, Ahmed B, Rafii A. Pregnancy and Neonatal Outcomes in SARS-CoV-2 Infection: A Systematic Review. J Pregnancy 2020; 2020:4592450. [PMID: 33062333 PMCID: PMC7542507 DOI: 10.1155/2020/4592450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Abstract
With the emergence of SARS-CoV-2 and its rapid spread, concerns regarding its effects on pregnancy outcomes have been growing. We reviewed 245 pregnancies complicated by maternal SARS-CoV-2 infection across 48 studies listed on PubMed and MedRxiv. The most common clinical presentations were fever (55.9%), cough (36.3%), fatigue (11.4%), and dyspnea (12.7%). Only 4.1% of patients developed respiratory distress. Of all patients, 89.0% delivered via cesarean section (n = 201), with a 33.3% rate of gestational complications, a 35.3% rate of preterm delivery, and a concerning 2.5% rate of stillbirth delivery or neonatal death. Among those tested, 6.45% of newborns were reported positive for SARS-CoV-2 infection. Relative to known viral infections, the prognosis for pregnant women with SARS-CoV-2 is good, even in the absence of specific antiviral treatment. However, neonates and acute patients, especially those with gestational or preexisting comorbidities, must be actively managed to prevent the severe outcomes being increasingly reported in the literature.
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Affiliation(s)
| | - Farah Wahbeh
- Genetic Intelligence Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Frank Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell-Lenox Hill Hospital, New York, USA
| | - Laurent J. Salomon
- Maternité, Médecine, Chirurgie et Imagerie Fœtales, Hôpital Universitaire Necker Enfants Malades, Université de Paris and EA FETUS, Affiliate of Institute Imagine, Paris, France
| | | | - Arash Rafii
- Genetic Intelligence Laboratory, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medicine, New York, USA
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82
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Kucirka LM, Norton A, Sheffield JS. Severity of COVID-19 in pregnancy: A review of current evidence. Am J Reprod Immunol 2020; 84:e13332. [PMID: 32865300 DOI: 10.1111/aji.13332] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/06/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) has recently emerged as a major threat to human health. Infections range from asymptomatic to severe (increased respiratory rate, hypoxia, significant lung involvement on imaging) or critical (multi-organ failure or dysfunction or respiratory failure requiring mechanical ventilation or high-flow nasal cannula). Current evidence suggests that pregnancy women are at increased risk of severe disease, specifically the need for hospitalization, ICU admission, and mechanical ventilation, and the already complex management of infection with an emerging pathogen may be further complicated by pregnancy. The goal of this review is to provide an overview of what is known about the clinical course of COVID-19 in pregnancy, drawing on (a) experience with other coronaviruses such as SARS and MERS, (b) knowledge of immunologic and physiologic changes in pregnancy and how these might impact infection with SARS-CoV-2, and (c) the current literature reporting outcomes in pregnant women with SARS-CoV-2. We also briefly summarize considerations in management of severe COVID-19 in pregnancy.
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Affiliation(s)
- Lauren M Kucirka
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Alexandra Norton
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jeanne S Sheffield
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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83
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Stanworth SJ, New HV, Apelseth TO, Brunskill S, Cardigan R, Doree C, Germain M, Goldman M, Massey E, Prati D, Shehata N, So-Osman C, Thachil J. Effects of the COVID-19 pandemic on supply and use of blood for transfusion. Lancet Haematol 2020; 7:e756-e764. [PMID: 32628911 PMCID: PMC7333996 DOI: 10.1016/s2352-3026(20)30186-1] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/28/2023]
Abstract
The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. We systematically searched for relevant studies addressing the transfusion chain-from donor, through collection and processing, to patients-to provide a synthesis of the published literature and guidance during times of potential or actual shortage. A reduction in donor numbers has largely been matched by reductions in demand for transfusion. Contingency planning includes prioritisation policies for patients in the event of predicted shortage. A range of strategies maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. Sharing experience and developing expert consensus on the basis of evolving publications will help transfusion services and hospitals in countries at different stages in the pandemic.
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Affiliation(s)
- Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK; Radcliffe Department of Medicine and NIHR Oxford Biomedical Research Centre-Haematology Theme, University of Oxford, Oxford, UK.
| | - Helen V New
- NHS Blood and Transplant, London, UK; Department of Haematology, Imperial College London, London, UK
| | - Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway; Norwegian Armed Forces Medical Services, Oslo, Norway
| | - Susan Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Rebecca Cardigan
- NHS Blood and Transplant, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Québec, QC, Canada
| | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | | | - Daniele Prati
- Department of Transfusion Medicine and Hematology, IRCCS Ca 'Granda Hospital Maggiore Policlinico Foundation, Milan, Italy
| | - Nadine Shehata
- Department of Medicine, Division of Haematology, Mount Sinai Hospital, ON, Canada; Department of Medicine, and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; University Health Network, Department of Medicine, Division of Medical Oncology and Haematology, Toronto, ON, Canada
| | - Cynthia So-Osman
- Department of Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, Netherlands; Department of Haematology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jecko Thachil
- Manchester University NHS Foundation Trust, Manchester, UK
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84
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Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul‐Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. Int J Gynaecol Obstet 2020; 151:7-16. [PMID: 32816307 PMCID: PMC9087651 DOI: 10.1002/ijgo.13329] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women represent a potentially high-risk population in the COVID-19 pandemic. OBJECTIVE To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID-19. SEARCH STRATEGY Relevant databases were searched up until May 29, 2020. SELECTION CRITERIA Case series/reports of hospitalized pregnant women with laboratory-confirmed COVID-19. DATA COLLECTION AND ANALYSIS PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools. MAIN RESULTS Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory-confirmed SARS-CoV-2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D-dimer and interleukin-6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID-19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. CONCLUSIONS Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D-dimer and interleukin-6 levels are predictive of poor pregnancy outcomes in COVID-19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.
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Affiliation(s)
- Ozlem Turan
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
| | - Amir Hakim
- National Heart and Lung InstituteImperial College LondonLondonUK
- Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Pradip Dashraath
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Wong Jing Lin Jeslyn
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Alison Wright
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
| | - Rezan Abdul‐Kadir
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
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85
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Czeresnia RM, Trad ATA, Britto ISW, Negrini R, Nomura ML, Pires P, Costa FDS, Nomura RMY, Ruano R. SARS-CoV-2 and Pregnancy: A Review of the Facts. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:562-568. [PMID: 32992359 PMCID: PMC10309239 DOI: 10.1055/s-0040-1715137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy. METHODS Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID-19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included. CONCLUSION The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of preterm birth and C-section. Vertical transmission is still a possibility, due to a few reported cases of neonatal positive real-time polymerase chain reaction (RT-PCR) in nasal swab, amniotic fluid, and positive immunoglobulin M (IgM) in neonatal blood. Treatments must be weighed in with caution due to the lack of quality trials that prove their effectiveness and safety during pregnancy. Medical staff must use personal protective equipment in handling SARS-CoV2 suspected or positive patients and be alert for respiratory decompensations.
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Affiliation(s)
| | - Ayssa Teles Abrao Trad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | | | - Romulo Negrini
- Faculty of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil.,Department of Obstetrics & Gynecology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcelo Luís Nomura
- Department of Obstetrics and Gynecology, School of Medical Sciences, Universidade de Campinas, Campinas, SP, Brazil
| | - Pedro Pires
- Department of Gynecology and Obstetrics, School of Medical Sciences, Universidade de Pernambuco, Recife, PE, Brazil.,Ministério da Saúde, Brasília, DF, Brazil
| | - Fabricio da Silva Costa
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.,Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia
| | | | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, United States
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86
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Vivanti AJ, Mattern J, Vauloup-Fellous C, Jani J, Rigonnot L, El Hachem L, Le Gouez A, Desconclois C, Ben M'Barek I, Sibiude J, Benachi A, Picone O, Cordier AG. Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France. Emerg Infect Dis 2020; 26:2069-2076. [PMID: 32633712 PMCID: PMC7454086 DOI: 10.3201/eid2609.202144] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Fix data are available on the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a retrospective study of 100 pregnant women with SARS-CoV-2 infection in 4 obstetric units in the Paris metropolitan area of France during March 12-April 13, 2020. Among patients, 52 (52%) were hospitalized, 10 (10%) in intensive care units (ICUs). Women with higher body mass indexes (BMIs; median 30.7 kg/m2) were more likely to be hospitalized in ICUs than other women (median BMI 26.2 kg/m2). Women hospitalized in ICUs had lower lymphocyte count at diagnosis (median 0.77 × 109 cells/L) than women not hospitalized in ICUs (median lymphocyte count 1.15 × 109 cells/L). All women requiring oxygen >5 L/min were intubated. Clinical and laboratory evaluation of SARS-CoV-2-positive pregnant women at the time of diagnosis can identify patients at risk for ICU hospitalization.
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87
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Khalil A, Kalafat E, Benlioglu C, O'Brien P, Morris E, Draycott T, Thangaratinam S, Le Doare K, Heath P, Ladhani S, von Dadelszen P, Magee LA. SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes. EClinicalMedicine 2020; 25:100446. [PMID: 32838230 PMCID: PMC7334039 DOI: 10.1016/j.eclinm.2020.100446] [Citation(s) in RCA: 206] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Perform a systematic review and meta-analysis of SARS-CoV-2 infection and pregnancy. METHODS Databases (Medline, Embase, Clinicaltrials.gov, Cochrane Library) were searched electronically on 6th April and updated regularly until 8th June 2020. Reports of pregnant women with reverse transcription PCR (RT-PCR) confirmed COVID-19 were included. Meta-analytical proportion summaries and meta-regression analyses for key clinical outcomes are provided. FINDINGS 86 studies were included, 17 studies (2567 pregnancies) in the quantitative synthesis; other small case series and case reports were used to extract rarely-reported events and outcome. Most women (73.9%) were in the third trimester; 52.4% have delivered, half by caesarean section (48.3%). The proportion of Black, Asian or minority ethnic group membership (50.8%); obesity (38.2%), and chronic co-morbidities (32.5%) were high. The most commonly reported clinical symptoms were fever (63.3%), cough (71.4%) and dyspnoea (34.4%). The commonest laboratory abnormalities were raised CRP or procalcitonin (54.0%), lymphopenia (34.2%) and elevated transaminases (16.0%). Preterm birth before 37 weeks' gestation was common (21.8%), usually medically-indicated (18.4%). Maternal intensive care unit admission was required in 7.0%, with intubation in 3.4%. Maternal mortality was uncommon (~1%). Maternal intensive care admission was higher in cohorts with higher rates of co-morbidities (beta=0.007, p<0.05) and maternal age over 35 years (beta=0.007, p<0.01). Maternal mortality was higher in cohorts with higher rates of antiviral drug use (beta=0.03, p<0.001), likely due to residual confounding. Neonatal nasopharyngeal swab RT-PCR was positive in 1.4%. INTERPRETATION The risk of iatrogenic preterm birth and caesarean delivery was increased. The available evidence is reassuring, suggesting that maternal morbidity is similar to that of women of reproductive age. Vertical transmission of the virus probably occurs, albeit in a small proportion of cases. FUNDING N/A.
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Affiliation(s)
- Asma Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, UK
| | - Erkan Kalafat
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK
- Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey
| | - Can Benlioglu
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK
| | - Pat O'Brien
- The Royal College of Obstetricians and Gynaecologists, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Tim Draycott
- The Royal College of Obstetricians and Gynaecologists, London, UK
- North Bristol NHS Trust Department of Women's Health, Westbury on Trym, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
| | - Paul Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, UK
- British Paediatric Surveillance Unit, Royal College of Pediatrics and Child Health, UK
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Laura A. Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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88
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Galang RR, Chang K, Strid P, Snead MC, Woodworth KR, House LD, Perez M, Barfield WD, Meaney-Delman D, Jamieson DJ, Shapiro-Mendoza CK, Ellington SR. Severe Coronavirus Infections in Pregnancy: A Systematic Review. Obstet Gynecol 2020; 136:262-272. [PMID: 32544146 PMCID: PMC7942856 DOI: 10.1097/aog.0000000000004011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To inform the current coronavirus disease 2019 (COVID-19) outbreak, we conducted a systematic literature review of case reports of Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, during pregnancy and summarized clinical presentation, course of illness, and pregnancy and neonatal outcomes. DATA SOURCES We searched MEDLINE and ClinicalTrials.gov from inception to April 23, 2020. METHODS OF STUDY SELECTION We included articles reporting case-level data on MERS-CoV, SARS-CoV, and SARS-CoV-2 infection in pregnant women. Course of illness, indicators of severe illness, maternal health outcomes, and pregnancy outcomes were abstracted from included articles. TABULATION, INTEGRATION, AND RESULTS We identified 1,328 unique articles, and 1,253 articles were excluded by title and abstract review. We completed full-text review on 75, and 29 articles were excluded by full-text review. Among 46 publications reporting case-level data, eight described 12 cases of MERS-CoV infection, seven described 17 cases of SARS-CoV infection, and 31 described 98 cases of SARS-CoV-2 infection. Clinical presentation and course of illness ranged from asymptomatic to severe fatal disease, similar to the general population of patients. Severe morbidity and mortality among women with MERS-CoV, SARS-CoV, or SARS-CoV-2 infection in pregnancy and adverse pregnancy outcomes, including pregnancy loss, preterm delivery, and laboratory evidence of vertical transmission, were reported. CONCLUSION Understanding whether pregnant women may be at risk for adverse maternal and neonatal outcomes from severe coronavirus infections is imperative. Data from case reports of SARS-CoV, MERS-CoV, and SAR-CoV-2 infections during pregnancy are limited, but they may guide early public health actions and clinical decision-making for COVID-19 until more rigorous and systematically collected data are available. The capture of critical data is needed to better define how this infection affects pregnant women and neonates. This review was not registered with PROSPERO.
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Affiliation(s)
- Romeo R Galang
- Division of Reproductive Health and the Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, and the Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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89
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Kazi S, Malinowski AK, Othman M. The delights and perils of publishing, knowledge-sharing and critique during a pandemic: Observations from COVID-19 coagulopathies. Thromb Res 2020; 192:37-39. [PMID: 32425263 PMCID: PMC7229916 DOI: 10.1016/j.thromres.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Sajida Kazi
- MSc Clinical Education Student, University of Edinburgh, Edinburgh, UK
| | - A Kinga Malinowski
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Canada; School of Baccalaureate Nursing, St. Lawrence College, Kingston, Canada.
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90
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Melo GCD, Araújo KCGMD. COVID-19 infection in pregnant women, preterm delivery, birth weight, and vertical transmission: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2020; 36:e00087320. [PMID: 32696830 DOI: 10.1590/0102-311x00087320] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
In less than four months, the total of confirmed cases of COVID-19 was 1,684,833 worldwide. Outcomes among the public of pregnant women with COVID-19 are still unclear. We performed a systematic review and meta-analysis to analyze whether COVID-19 in pregnant women is related to premature birth and birth weight, and to summarize the diagnostic results of neonates born to mothers with COVID-19 for investigating the possibility of vertical transmission. Searches were performed in PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv, and medRxiv. We used the odds ratio (OR) and mean difference (MD) as measure of analysis. Summary estimates were calculated using random effects models. 38 studies were included; data from 279 women were analyzed; 60 patients were diagnosed with COVID-19. The meta-analysis showed no significant association between COVID-19 and preterm delivery (OR = 2.25; 95%CI: 0.96, 5.31; p = 0.06; I² = 0%). No significant relationship was found between birth weight and COVID-19 (MD = -124.16; 95%CI: -260.54, 12.22; p = 0.07; I² = 0%). Among 432 newborns, 10 were reported with positive results for early SARS-CoV-2. Due to the characteristics of the studies, the level of evidence of this meta-analysis was considered very low. COVID-19 in pregnant women may not be associated with the occurrence of preterm deliveries or the birth weight of the newborn children, however the evidence to date is very uncertain. A few reports suggest vertical transmission of SARS-CoV-2 to newborn is possible, but evidence is still uncertain.
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91
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Lou‐Mercadé AC, Gavín O, Oros D, Paules C, Savirón‐Cornudella R, Mateo P, Páramo JA, Ruiz‐Martinez S. Prevention of thrombosis in pregnant women with suspected SARS-CoV-2 infection: clinical management algorithm. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:111-112. [PMID: 32449242 PMCID: PMC7280740 DOI: 10.1002/uog.22096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/11/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A. C. Lou‐Mercadé
- Aragon Institute of Health Research (IIS Aragon)Obstetrics Department, Hospital Clínico Universitario Lozano BlesaZaragozaSpain
| | - O. Gavín
- Hematology and Hematotherapy DepartmentHospital Clínico Universitario Lozano BlesaZaragozaSpain
| | - D. Oros
- Aragon Institute of Health Research (IIS Aragon)Obstetrics Department, Hospital Clínico Universitario Lozano BlesaZaragozaSpain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII)Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER)Spain
| | - C. Paules
- Aragon Institute of Health Research (IIS Aragon)Obstetrics Department, Hospital Clínico Universitario Lozano BlesaZaragozaSpain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII)Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER)Spain
| | | | - P. Mateo
- Aragon Institute of Health Research (IIS Aragon)Obstetrics Department, Hospital Clínico Universitario Lozano BlesaZaragozaSpain
| | - J. A. Páramo
- Hematology Service, Clinica Universidad de NavarraCIBERCV, IdiSNaPamplonaSpain
| | - S. Ruiz‐Martinez
- Aragon Institute of Health Research (IIS Aragon)Obstetrics Department, Hospital Clínico Universitario Lozano BlesaZaragozaSpain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII)Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER)Spain
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Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:15-27. [PMID: 32430957 PMCID: PMC7276742 DOI: 10.1002/uog.22088] [Citation(s) in RCA: 335] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate the effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome by performing a systematic review of available published literature on pregnancies affected by COVID-19. METHODS We performed a systematic review to evaluate the effect of COVID-19 on pregnancy, perinatal and neonatal outcome. We conducted a comprehensive literature search using PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure Database and Wan Fang Data up to and including 20 April 2020 (studies were identified through PubMed alert after that date). For the search strategy, combinations of the following keywords and medical subject heading (MeSH) terms were used: 'SARS-CoV-2', 'COVID-19', 'coronavirus disease 2019', 'pregnancy', 'gestation', 'maternal', 'mother', 'vertical transmission', 'maternal-fetal transmission', 'intrauterine transmission', 'neonate', 'infant' and 'delivery'. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient being pregnant on admission and availability of clinical characteristics, including at least one maternal, perinatal or neonatal outcome. Exclusion criteria were non-peer-reviewed or unpublished reports, unspecified date and location of the study, suspicion of duplicate reporting and unreported maternal or perinatal outcomes. No language restrictions were applied. RESULTS We identified a high number of relevant case reports and case series, but only 24 studies, including a total of 324 pregnant women with COVID-19, met the eligibility criteria and were included in the systematic review. These comprised nine case series (eight consecutive) and 15 case reports. A total of 20 pregnant patients with laboratory-confirmed COVID-19 were included in the case reports. In the combined data from the eight consecutive case series, including 211 (71.5%) cases of laboratory-confirmed and 84 (28.5%) of clinically diagnosed COVID-19, the maternal age ranged from 20 to 44 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath, fatigue and myalgia. The rate of severe pneumonia reported amongst the case series ranged from 0% to 14%, with the majority of the cases requiring admission to the intensive care unit. Almost all cases from the case series had positive computed tomography chest findings. All six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Only four cases of spontaneous miscarriage or termination were reported. In the consecutive case series, 219/295 women had delivered at the time of reporting and 78% of them had Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at both 1 and 5 min ranged from 7 to 10. Only eight neonates had birth weight < 2500 g and nearly one-third of neonates were transferred to the neonatal intensive care unit. There was one case of neonatal asphyxia and death. In 155 neonates that had nucleic-acid testing in throat swab, all, except three cases, were negative for SARS-CoV-2. There were no cases of maternal death in the eight consecutive case series. Seven maternal deaths, four intrauterine fetal deaths (one with twin pregnancy) and two neonatal deaths (twin pregnancy) were reported in a non-consecutive case series of nine cases with severe COVID-19. In the case reports, two maternal deaths, one neonatal death and two cases of neonatal SARS-CoV-2 infection were reported. CONCLUSIONS Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good-quality data to draw unbiased conclusions with regard to the severity of the disease or specific complications of COVID-19 in pregnant women, as well as vertical transmission, perinatal and neonatal complications. In order to answer specific questions in relation to the impact of COVID-19 on pregnant women and their fetuses, through meaningful good-quality research, we urge researchers and investigators to present complete outcome data and reference previously published cases in their publications, and to record such reporting when the data of a case are entered into one or several registries. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. Juan
- Department of Obstetrics and GynaecologyPeking University First HospitalBeijingChina
| | - M. M. Gil
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
- School of MedicineUniversidad Francisco de Vitoria (UFV), Pozuelo de AlarcónMadridSpain
| | - Z. Rong
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina
| | - Y. Zhang
- Department of Gynaecology and ObstetricsZhongnan Hospital of Wuhan UniversityWuhanChina
- Clinical Medicine Research Center of Prenatal Diagnosis and Birth Health in Hubei ProvinceWuhanChina
| | - H. Yang
- Department of Obstetrics and GynaecologyPeking University First HospitalBeijingChina
| | - L. C. Poon
- Department of Obstetrics and Gynaecology, Prince of Wales HospitalThe Chinese University of Hong KongHong Kong SAR
- Harris Birthright CentreFetal Medicine Research Institute, King's College Hospital, King's College LondonLondonUK
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93
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Westgren M, Pettersson K, Hagberg H, Acharya G. Severe maternal morbidity and mortality associated with COVID-19: The risk should not be downplayed. Acta Obstet Gynecol Scand 2020; 99:815-816. [PMID: 32386440 PMCID: PMC7273078 DOI: 10.1111/aogs.13900] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Magnus Westgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karin Pettersson
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Hagberg
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ganesh Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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94
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Kirtsman M, Diambomba Y, Poutanen SM, Malinowski AK, Vlachodimitropoulou E, Parks WT, Erdman L, Morris SK, Shah PS. Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection. CMAJ 2020; 192:E647-E650. [PMID: 32409520 DOI: 10.1503/cmaj.200821] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Maksim Kirtsman
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - Yenge Diambomba
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - Susan M Poutanen
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - Ann K Malinowski
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - Evangelia Vlachodimitropoulou
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - W Tony Parks
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - Laura Erdman
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - Shaun K Morris
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont
| | - Prakesh S Shah
- Departments of Pediatrics (Kirtsman, Diambomba, Shah), Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), and Pathology and Laboratory Medicine (Parks), Mount Sinai Hospital; Departments of Microbiology (Poutanen) and Medicine (Infectious Diseases) (Poutanen), University Health Network/Sinai Health; Departments of Pediatrics (Kirtsman, Diambomba, Erdman, Morris, Shah), Laboratory Medicine and Pathobiology (Poutanen, Parks), Medicine (Poutanen), and Obstetrics and Gynecology (Malinowski, Vlachodimitropoulou), University of Toronto; Division of Infectious Diseases (Erdman, Morris), Department of Pediatrics, The Hospital for Sick Children, Toronto, Ont.
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