Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

How does COVID-19 affect maternal and neonatal outcomes?

OBJECTIVES

In this article, we aimed to evaluate the most recent information on the impact of the COVID-19 pandemic on the health of mothers and their babies.

METHODS

We conducted a literature search by utilizing online sources. Scientific papers that were written in English on the effects of COVID-19 on both mother and their newborn were assessed.

RESULTS

COVID-19 can be fatal, especially in pregnant women with accompanying chronic diseases. The timing and mode of delivery should be decided by the status of the mother and fetus instead of SARS-CoV-2 positivity in pregnant women. At the nursery, routine separation of SARS-CoV-2 positive mothers and their infants is not recommended. However, it is important to take preventive measures to reduce the risk of transmission. The advantages of breastfeeding seem to outweigh the potential dangers of viral transmission. Neonatal COVID-19 infections may cause different clinical pictures from asymptomatic infections to life-threatening diseases. International health authorities specifically recommend that pregnant and lactating women get vaccinated to diminish the risk of transmission of the virus to the mother and fetus, not giving preference to a certain vaccine. It is prudent to apply universal screening only in populations with a high prevalence of COVID-19.

CONCLUSIONS

Healthcare professionals should carefully manage the perinatal period during the COVID-19 outbreak, using the most up-to-date information to protect and promote maternal and newborn health. Further scientific studies are needed to clarify the early and long-term effects of the COVID-19 pandemic on maternal-neonatal morbidity and mortality.

Insights into the Scenario of SARS-CoV-2 Infection in Male Reproductive Toxicity

COVID-19 has become a significant public health concern that has catastrophic consequences for society. Some preliminary evidence suggests that the male reproductive system may be an infection target for SARS-CoV-2. SARS-CoV-2 may be transmitted sexually, according to preliminary research. Testicular cells exhibit a high level of the angiotensin-converting enzyme 2 (ACE2) receptor, which enhances the entry of the SARS-CoV-2 into host cells. Some instances of COVID-19 have been documented to exhibit hypogonadism during the acute stage. Furthermore, systemic inflammatory reactions triggered by SARS-CoV-2 infection may cause oxidative stress (OS), which has been shown to have profoundly deleterious consequences on testicular functioning. This work gives a clear picture of how COVID-19 may affect male reproductive systems and calls attention to the many unanswered questions about the mechanisms by which this virus can be linked to men's health and fertility.

A Prospective Analysis of Vitamin D Levels in Pregnant Women Diagnosed with Gestational Hypertension after SARS-CoV-2 Infection

The great majority of existing studies suggests that the prognosis and outcomes of SARS-CoV-2 infections are improved with adequate vitamin D levels, with or without supplementation. Simultaneously, whether vitamin D supplementation during pregnancy lessens the chance of developing gestational hypertension is controversial. The objective of the present research was to evaluate whether vitamin D levels during pregnancy differ substantially among pregnant women who develop gestational hypertension following SARS-CoV-2 infection. The current research was designed as a prospective cohort following the pregnant women admitted to our clinic with COVID-19 until 36 weeks of gestation. Total vitamin D (25(OH)D) levels were measured in the three study groups in which pregnant women with COVID-19 during pregnancy and a diagnosis of hypertension after 20 weeks of gestation were considered the group of cases (GH-CoV). The second group (CoV) included those with COVID-19 and no hypertension, while the third group (GH) included those with hypertension and no COVID-19. It was observed that 64.4% of SARS-CoV-2 infections in the group of cases occurred during the first trimester, compared to 29.2% in the first trimester among the controls who did not develop GH. Normal vitamin D levels were measured at admission in a significantly higher proportion of pregnant women without GH (68.8% in the CoV group vs. 47.9% in the GH-CoV group and 45.8% in the GH group). At 36 weeks of gestation, the median values of 25(OH)D in the CoV group was 34.4 (26.9-39.7) ng/mL compared to 27.9 (16.2-32.4) ng/mL in the GH-CoV group and 29.5 ng/mL (18.4-33.2) in the GH group, while the blood pressure measurements remained over 140 mmHg among the groups who developed GH. There was a statistically significant negative association between serum 25(OH)D levels and systolic blood pressure (rho = -0.295; p-value = 0.031); however, the risk of developing GH was not significantly higher among pregnant women with COVID-19 if the vitamin D levels were insufficient (OR = 1.19; p-value = 0.092) or deficient (OR = 1.26; p-value = 0.057). Although insufficient or deficient vitamin D among pregnant women with COVID-19 was not an independent risk factor for the development of GH, it is likely that an association between first-trimester SARS-CoV-2 infection and low vitamin D plays a key role in developing gestational hypertension.

Maternal and Newborn Hospital Outcomes of Perinatal SARS-CoV-2 Infection: A National Registry

OBJECTIVES

The American Academy of Pediatrics National Registry for the Surveillance and Epidemiology of Perinatal coronavirus disease 2019 (COVID-19) (NPC-19) was developed to provide information on the effects of perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

METHODS

National Registry for the Surveillance and Epidemiology of Perinatal COVID-19 participating centers entered maternal and newborn data for pregnant persons who tested positive for SARS-CoV-2 infection between 14 days before and 10 days after delivery. Incidence of and morbidities associated with maternal and newborn SARS-CoV-2 infection were assessed.

RESULTS

From April 6, 2020 to March 19, 2021, 242 centers in the United States centers reported data for 7524 pregnant persons; at the time of delivery, 78.1% of these persons were asymptomatic, 18.2% were symptomatic but not hospitalized specifically for COVID-19, 3.4% were hospitalized for COVID-19 treatment, and 18 (0.2%) died in the hospital of COVID-related complications. Among 7648 newborns, 6486 (84.8%) were tested for SARS-CoV-2, and 144 (2.2%) were positive; the highest rate of newborn infection was observed when mothers first tested positive in the immediate postpartum period (17 of 125, 13.6%). No newborn deaths were attributable to SARS-CoV-2 infection. Overall, 15.6% of newborns were preterm: among tested newborns, 30.1% of polymerase chain reaction-positive and 16.2% of polymerase chain reaction-negative were born preterm (P < .001). Need for mechanical ventilation did not differ by newborn SARS-CoV-2 test result, but those with positive tests were more likely to be admitted to a NICU.

CONCLUSIONS

Early in the pandemic, SARS-CoV-2 infection was acquired by newborns at variable rates and without apparent short-term effects. During a period that preceded widespread availability of vaccines, we observed higher than expected numbers of preterm births and maternal in-hospital deaths.

Evaluation of the effects of COVID-19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes: A retrospective cohort study

AIM

To evaluate the effects of COVID-19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes.

METHODS

This retrospective cohort study was conducted with 358 patients who had or had not been diagnosed with COVID-19 during their pregnancy, had a miscarriage or had given birth.

RESULTS

COVID-19 disease during pregnancy was associated with higher maternal hypertensive disease, preterm birth, low birth weight, low first- and fifth-minute Apgar scores, and need for neonatal intensive care unit. The incidence of preterm birth, low birth weight, low first- and fifth-minute Apgar scores, and need for neonatal intensive care unit in those diagnosed with COVID-19 in the second trimester was significantly higher than those diagnosed with COVID-19 in other trimesters. The frequency of cesarean section was observed most in those diagnosed with COVID-19 in the 3rd trimester, while it was observed in those diagnosed with COVID-19 at least in the first trimester.

CONCLUSION

The presence of COVID-19 during pregnancy may be associated with an increased risk of iatrogenic preterm birth. The frequency of preterm birth in pregnant women diagnosed with COVID-19 in the second trimester is higher than in pregnant women diagnosed with COVID-19 in other trimesters. As the pregnancy trimester at the time of diagnosis progresses, the frequency of cesarean section increases. While the risk of maternal hypertensive disease increases more in pregnant women with COVID-19, the effect of the trimester in which COVID-19 was passed on the risk of maternal hypertensive disease is not observed.

Is Gestational COVID-19 a Risk Factor for Congenital Hearing Loss?

OBJECTIVE

The aim of this study was to investigate whether COVID-19 during pregnancy is a risk factor for congenital hearing loss.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary referral center.

PATIENTS

Hearing screening test results of 60,223 newborns between March 2020 and May 2021 were screened using the national database. Newborn babies of 570 pregnant women with positive COVID-19 PCR test during pregnancy who met the study criteria were included in the gestational COVID-19 group, and 570 healthy newborns born in the same period were included in the control group.

INTERVENTION

Diagnostic.

MAIN OUTCOME MEASURE

Results of up to three automatic auditory brainstem response tests in the first 30 days of life were used for newborn hearing screening.

RESULTS

When the gestational COVID-19 and control groups were compared in terms of demographic data, there was no statistically significant difference for any of the variables (maternal age, gestational age, birth weight, neonate gender, mode of delivery, p > 0.05 for all variables). Of the mothers in the gestational COVID-19 group, 62 (10.9%) had COVID-19 in the first trimester, 181 (31.8%) in the second trimester, and 327 (57.3%) in the third trimester. When the first and second test results of newborn hearing screening were compared between the groups, the number of babies with hearing loss was higher in the gestational COVID-19 group than in the control group (p = 0.025; odds ratio, 1.357; 95% confidence interval, 1.039-1.774; p = 0.006; odds ratio, 4.924; 95% confidence interval, 1.410-17.193, respectively). For the third test results, hearing loss was detected in only one baby in both groups (p = 0.284). When the first, second, and third test results for newborn hearing screening were compared according to the trimesters when COVID-19 positivity was identified, the difference between trimesters was not found to be statistically significant (p > 0.05).

CONCLUSION

To the best of our knowledge, this is the largest study in the literature of the impact of COVID-19 on newborn hearing. The findings in the study suggest that gestational COVID-19 is not a risk factor for permanent congenital hearing loss. However, because the risk of detecting hearing loss is high in the first 15 days, we emphasize the importance of the third screening test.

A Review of Coronavirus Disease 2019 in Pregnancy

Pregnancy is an independent risk factor for morbidity and mortality in coronavirus disease 2019 (COVID-19) with increased rates of operative delivery, intensive care unit admission, and mechanical ventilation as well as a possible increased risk of death, independent of other risk factors, compared with nonpregnant women with COVID-19. Furthermore, pregnancy outcomes are worse in those with COVID-19 with increased risk for preeclampsia, venous thromboembolism, preterm birth, miscarriage, and stillbirth compared with pregnant women without COVID-19. Importantly, pregnant women of nonwhite ethnicity appear to be at greater risk of severe COVID-19, necessitating improved access to care and closer monitoring in these women. The management of COVID-19 in pregnancy is largely similar to that in nonpregnant people; however, there is an important emphasis on multidisciplinary team involvement to ensure favorable outcomes in both mother and baby. Similarly, vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is safe in pregnancy and improves maternal and neonatal outcomes.

Effectiveness of Inexpensive Cloth Facemasks and Their Amendments to Reduce Ambient Particulate Exposures: A Case of Kathmandu, Nepal

Inexpensive cloth masks are widely used to reduce particulate exposures, but their use became ubiquitous after the outbreak of COVID-19. A custom experimental setup (semiactive at 5.1 m/s airflow rate) was fabricated to examine the efficiency of different types of commercial facemasks collected randomly from street vendors. The sample (N = 27) including (n = 16) cloth masks (CMs), (n = 7) surgical masks (SMs), and (n = 4) N95 filtering facepiece respirators (FFRs), of which SMs and N95 FFRs taken as a standard for efficiency comparison were all tested against ambient aerosols (PM2.5 and PM10 μg/m3). The prototype cloth masks (PTCMs) (N = 5) design was tailored, and their performance was assessed and compared with that of standard commercial masks. The filtering efficiency tested against ambient coarse particulates (PM10) ranged from (5% to 34%) for CMs with an average of 16%, (37% to 46%) for SMs with an average of 42%, (59% to 72%) for PTCMs with an average of 65%, and (70% to 75%) for N95 FFRs with an average of 71%, whereas against fine particulates (PM2.5), efficacy ranged from (4% to 29%) for CMs with an average of 13%, (34% to 44%) for SMs with an average of 39%, (53% to 68%) for PTCMs with an average of 60%, and (68% to 73%) for N95 FFRs with an average of 70%, respectively. The efficiency followed the order N95 FFRs > PTCMs > SMs > CMs showing poor exposure reduction potential in CMs and high exposure reduction potential in N95 FFRs and PTCMs. Amendment in existing CMs using eco-friendly cotton fabric with better facial adherence can protect human health from exposure to fine particulates <2.5 μm and can reduce the risk of micro-plastic pollution caused by polypropylene (PP) facemasks.

Severe COVID-19 Infection during Pregnancy Requiring ECMO: Case Report and Review of the Literature

BACKGROUND

The risk of developing severe COVID-19 that requires admission to an intensive care unit (ICU) and invasive ventilation is increased in pregnant women. Extracorporeal membrane oxygenation (ECMO) has been successfully used to manage critical pregnant and peripartum patients.

CASE REPORT

A 40-year-old patient, unvaccinated for COVID-19, presented to a tertiary hospital in January 2021 at 23 weeks of gestation due to respiratory distress, cough, and fever. The patient had a confirmed diagnosis of SARS-CoV-2 with a PCR test in a private center 48 h before. She required admission into the ICU due to respiratory failure. High-flow nasal oxygen therapy, intermittent noninvasive mechanical ventilation (BiPAP), mechanical ventilation, prone positioning, and nitric oxide therapy were administered. Additionally, hypoxemic respiratory failure was diagnosed. Thus, circulatory assistance using ECMO with venovenous access was performed. After 33 days of ICU admission, the patient was transferred to the internal medicine department. She was discharged 45 days after hospital admission. At 37 weeks of gestation, the patient presented active labor and underwent an uneventful vaginal delivery.

CONCLUSIONS

Severe COVID-19 in pregnancy may lead to the requirement for ECMO administration. This therapy should be administered in specialized hospitals using a multidisciplinary approach. COVID-19 vaccination should be strongly recommended to pregnant women to decrease the risk of severe COVID-19.

The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis

BACKGROUND

This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women.

METHODS

All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed.

RESULTS

This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic.

DISCUSSION

It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times.

OTHER

The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.

The Role of Interventional Radiology and Management of an Angiography Suite in the Treatment of COVID-19 Patients: Single-Center, 2-Year Experience

Background and Objectives: Hospital angiography suites with negative-pressure ventilation facilities are challenging to equip. During the COVID-19 pandemic, we aimed to introduce interventional radiology procedures performed on COVID-19 patients and understand management of the angiography suite without a negative-pressure ventilation facility before and after the procedures to prevent the spread of infection. Materials and Methods: Between December 2020 and November 2022, 52 COVID-19 patients underwent interventional radiology procedures in an angiography suite, where no negative-pressure ventilation facility was installed. During the procedure, all staff members wore full personal protection equipment, and after the procedure for the COVID-19-positive patient was completed, the angiography suite was disinfected and entry to the angiography suite was prohibited for 1-3 h. In this angiography suite, procedures for COVID-19 patients and non-COVID-19 patients were performed. Results: A total of 61 interventional radiology procedures were performed in 52 patients with COVID-19. Of 52 patients, 21 underwent procedures under intubation and mechanical ventilation. All procedures were performed according to the guidelines set by the Infection Control Committee of our hospital. No major or minor complications were associated with the procedures. There were no cases of infection among staff members or other non-COVID-19 patients related to procedures on COVID-19 patients. Conclusions: Interventional radiology can play an important role in solving the complications of COVID-19 and the problems caused by patients' underlying diseases. In addition, if accurate guidelines are followed, both COVID-19 and non-COVID-19 patients can undergo procedures in an angiography room without negative-pressure ventilation while preventing infection.

Outcome of Newborns with Confirmed or Possible SARS-CoV-2 Vertical Infection-A Scoping Review

Severe acute respiratory syndrome virus 2 (SARS-CoV-2), the virus that causes 2019 coronavirus disease (COVID-19), has been isolated from various tissues and body fluids, including the placenta, amniotic fluid, and umbilical cord of newborns. In the last few years, much scientific effort has been directed toward studying SARS-CoV-2, focusing on the different features of the virus, such as its structure and mechanisms of action. Moreover, much focus has been on developing accurate diagnostic tools and various drugs or vaccines to treat COVID-19. However, the available evidence is still scarce and consistent criteria should be used for diagnosing vertical transmission. Applying the PRISMA ScR guidelines, we conducted a scoping review with the primary objective of identifying the types, and examining the range, of available evidence of vertical transmission of SARS-CoV-2 from mother to newborn. We also aimed to clarify the key concepts and criteria for diagnosis of SARS-CoV-2 vertical infection in neonates and summarize the existing evidence and advance the awareness of SARS-CoV-2 vertical infection in pregnancy. Most studies we identified were case reports or case series (about 30% of poor quality and inconsistent reporting of the findings). Summarizing the existing classification criteria, we propose an algorithm for consistent diagnosis. Registration: INPLASY2022120093.

The perinatal health challenges of emerging and re-emerging infectious diseases: A narrative review

The world has seen numerous infectious disease outbreaks in the past decade. In many cases these outbreaks have had considerable perinatal health consequences including increased risk of preterm delivery (e.g., influenza, measles, and COVID-19), and the delivery of low birth weight or small for gestational age babies (e.g., influenza, COVID-19). Furthermore, severe perinatal outcomes including perinatal and infant death are a known consequence of multiple infectious diseases (e.g., Ebola virus disease, Zika virus disease, pertussis, and measles). In addition to vaccination during pregnancy (where possible), pregnant women, are provided some level of protection from the adverse effects of infection through community-level application of evidence-based transmission-control methods. This review demonstrates that it takes almost 2 years for the perinatal impacts of an infectious disease outbreak to be reported. However, many infectious disease outbreaks between 2010 and 2020 have no associated pregnancy data reported in the scientific literature, or pregnancy data is reported in the form of case-studies only. This lack of systematic data collection and reporting has a negative impact on our understanding of these diseases and the implications they may have for pregnant women and their unborn infants. Monitoring perinatal health is an essential aspect of national and global healthcare strategies as perinatal life has a critical impact on early life mortality as well as possible effects on later life health. The unpredictable nature of emerging infections and the potential for adverse perinatal outcomes necessitate that we thoroughly assess pregnancy and perinatal health implications of disease outbreaks and their public health interventions in tandem with outbreak response efforts. Disease surveillance programs should incorporate perinatal health monitoring and health systems around the world should endeavor to continuously collect perinatal health data in order to quickly update pregnancy care protocols as needed.

Maternal Outcomes Among Pregnant Women Diagnosed With COVID-19

BACKGROUND

COVID-19 has the potential development of negative maternal outcomes for pregnant women. The risk of contracting COVID-19 is high as pregnancy alters the maternal immune system. Therefore, this study aims to assess maternal outcomes among pregnant women with COVID-19 in the Kingdom of Saudi Arabia.

METHODS

A retrospective study was conducted in three hospitals during the pandemic over four months, from the beginning of December 2019 until the end of March 2020. Data was collected using a structured questionnaire filled by the researcher using computers from the medical records of three hospitals. The sampling was all confirmed cases of pregnant women who delivered while being positive for COVID-19.

RESULTS

This study has identified a total of 82 pregnant women with confirmed COVID-19 infection over the study period, with ages ranging from 18 to >40 years. The majority of the pregnant women (84.1%) were symptomatic, with fever (48.8%) being the most frequent COVID-19 symptom, followed by cough (42.7%) and shortness of breath (41.5%). Some women (46.3%) had a spontaneous normal vaginal delivery, and 50.2% had a cesarean delivery. The most common adverse pregnancy outcome was premature delivery (36.5%), followed by fetal distress (20.7%), preeclampsia (2.4%), eclampsia (1.2%), and diabetic ketoacidosis (1.2%), as well as the death of three pregnant women.

CONCLUSION

This study found that infected mothers faced various risks of maternal adverse outcomes. The majority of the pregnant women experienced mild to moderate illness symptoms and were delivered within 14 days of the onset of COVID-19 symptoms. Healthcare providers should provide more attention to pregnant women diagnosed with COVID-19.

Pretesting of Infographic as a Communication Tool on Pregnant Women During Covid-19 Period

Purpose

This study was to analyze the responses of informants about Instagram infographics on Covid-19 prevention for pregnant women.

Methods

This was a qualitative study that used Rapid Assessment Procedure (RAP) and used pretesting communication theory. The informant selection technique was purposive sampling that consist of three pregnant women as main informants, a midwifery lecturer and a visual graphic designer as key informants. One-to-one pretesting communication procedure was selected because the research was conducted at the beginning of the Covid-19 pandemic, so it had a difficulty in recruiting informants. The interview guideline was conducted by the research team and was examined in a field trial. Data collection was by semi-structured interview using voice call WhatsApp application. Data were analysed using thematic analysis.

Results

In attraction aspect, this was considered quite interesting by the informants. In comprehension aspect, the messages were easily understood because of using brief, concise, and simple sentences. Furthermore, the messages were supported by images and comprehensive. In acceptance aspect, all the informants' opinions were identified that the messages of this infographic did not have a conflict with the existing norms. In self-involvement aspect, this infographic was in accordance with the current condition of the informants. In persuasion aspect, it had a good persuasive value as the informants were willing to share the infographic with others.

Conclusion

The infographic still needed improvements from the attraction aspect such as consider using contrasting colour between the background and text, equalize the font size and change icons to become related to the text. As from the comprehension aspect consider using terms that are more popular in the community. There were no need improvements from acceptance, self-involvement, and persuasion aspects. However, evidence-based research is still needed on how this infographic is developed and implemented to optimize transfer of knowledge.

Effects of Biological Sex and Pregnancy on SARS-CoV-2 Pathogenesis and Vaccine Outcomes

SARS-CoV-2 is the causative agent of COVID-19 in humans and has resulted in the death of millions of people worldwide. Similar numbers of infections have been documented in males and females; males, however, are more likely than females to be hospitalized, require intensive care unit, or die from COVID-19. The mechanisms that account for this are multi-factorial and are likely to include differential expression of ACE2 and TMPRSS2 molecules that are required for viral entry into hosts cells and sex differences in the immune response, which are due to modulation of cellular functions by sex hormones and differences in chromosomal gene expression. Furthermore, as comorbidities are also associated with poorer outcomes to SARS-CoV-2 infection and several comorbidities are overrepresented in males, these are also likely to contribute to the observed sex differences. Despite their relative better prognosis following infection with SARS-CoV-2, females do have poorer outcomes during pregnancy. This is likely to be due to pregnancy-induced changes in the immune system that adversely affect viral immunity and disruption of the renin-angiotensin system. Importantly, vaccination reduces the severity of disease in males and females, including pregnant females, and there is no evidence that vaccination has any adverse effects on the outcomes of pregnancy.

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

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

Vertical Transmission of SARS-CoV-2 in a Twin Pregnancy

Description Transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in 2019 and rapidly evolved into the global coronavirus disease 2019 (COVID-19) pandemic. The emergence of a highly morbid disease has posed ongoing challenges in the diagnosis, management, and prevention of COVID-19. The uncertainty underlying medical decision making is further compounded by preexisting conditions, including pregnancy. Here, we report a twin pregnancy complicated by maternal COVID-19 and the vertical transmission of SARS-CoV-2. We hope that our experiences contribute to a better understanding of the disease in pregnancy and, ultimately, guide the development of effective treatment and prevention strategies.

COVID-19 via intrauterine transmission in a critically ill preterm infant: A case report

A preterm infant was born emergently at 29 weeks gestation to a mother with active coronavirus disease 2019 (COVID-19). Clinical presentation and evaluation were consistent with in utero transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The neonate experienced progressive, refractory respiratory failure and catastrophic intracranial hemorrhage which ultimately led to limitation of care.

Development and validation of Health Belief Model based instrument to assess secondary school student's adherence to COVID-19 self-protective practices in Jimma, Oromia, Ethiopia

BACKGROUND

The study aimed in developing and validating a Health Belief Model (HBM) based instrument used for cross-sectional studies among secondary school students in Jimma town, Oromia, Ethiopia.

METHODS

A school-based cross-sectional study was conducted from May 25 to June 10, 2021. The sample size was 634, and students were randomly selected from public and private secondary schools. The 81 items were developed reviewing different literatures based on the constructs of HBM. The constructs were perceived severity, perceived vulnerability, perceived benefit, perceived barrier, self-efficacy, cues to action, perceived school support and self-protective practice. Data were collected using a self-administered questionnaire. The data were cleaned, entered into and analyzed using SPSS 23.0. A principal axis factoring with varimax rotation was carried out to extract items. Items with no loading factor or cross-loaded items were deleted. Items having factor loading coefficient of ≥0.4 were retained. An internal reliability was ensured at Cronbach's alpha >0.70. All items with corrected item-total correlation coefficient below 0.30 were deleted from reliability analysis.

RESULTS

In this study, 576 respondents were participated making a response rate of 90.8%. A total of thirty items were extracted and loaded in to eleven factors with cumulative variance of 56.719%. Percieved social support, percieved benefit, percieved school responsibility, self-efficacy, and practice items were internally consistent. Percieved vurnerability was neither valid nor reliable construct. Similarly, from the extracted factors, attitude towards face mask use and percieved peer influence were not internally consistent. Lastly, percieved benefit, self-efficacy and percieved school responsibility significantly predicted student's adherence to COVID-19 self-protective practices.

CONCLUSIONS

The study found that perceived benefit, perceived school support, social support, self-efficacy, perceived school environment cleanness, perceived school responsibility, perceived school health education, attitude to use face mask, perceived severity, cues to action and perceived peer influence were valid. Finally, perceived benefit, self-efficacy and perceived school responsibility significantly predicted student's adherence to COVID-19 self-protective practices.

Knowledge, Attitudes, and Practices towards COVID-19 among Pregnant Women in Northern Bangladesh: A Community-Based Cross-Sectional Study

Background: COVID-19, caused by SARS-CoV-2, remains a global public health concern despite the availability of effective antiviral treatment against multiple strains. Studies have shown that pregnant women are more susceptible to COVID-19 due to altered physiology and immunological features. Therefore, this study was designed to investigate pregnant women’s knowledge, attitudes, and practice (KAP) to prevent COVID-19 and determine the factors associated with KAP. Methods: A community-based cross-sectional study was conducted among 425 pregnant women in Northern Bangladesh. The samples were obtained using a simple random sampling technique from 5 April to 15 June 2020. The data were collected by face-to-face survey with a structured and pre-tested questionnaire and analyzed using SPSS version 25. Bivariable and multivariable logistic regression analyses were performed, and p-values < 0.05 at 95% CI were considered statistically significant. Results: Overall, the score of KAP among the respondents was 47.76%, 49.41%, and 56.24%, respectively. Participants’ area of residence, educational status of the husband, and antenatal care (ANC) visit were significantly associated with the level of knowledge, whereas age, educational status of the husband, number of living children, and knowledge were significant predictors of attitude. The knowledge of COVID-19 was the only predictor associated with the practice. Conclusion: Our study shows that almost half of the participants had poor knowledge, a negative attitude, and poor practices regarding COVID-19. Additional health education programs by healthcare professionals and different media, coordinated and combined efforts of government and individuals’ participation will be required to fight the spread of the infection.

COVID-19: Impact of Original, Gamma, Delta, and Omicron Variants of SARS-CoV-2 in Vaccinated and Unvaccinated Pregnant and Postpartum Women

This study compares the clinical characteristics and disease progression among vaccinated and unvaccinated pregnant and postpartum women who tested positive for different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using the Brazilian epidemiological data. Data of pregnant or postpartum patients testing positive for SARS-CoV-2 and presenting with coronavirus disease 2019 (COVID-19) from February 2020 to July 2022 were extracted from Brazilian national database. The patients were grouped based on vaccination status and viral variant (original, Gamma, Delta, and Omicron variants), and their demographics, clinical characteristics, comorbidities, symptoms, and outcomes were compared retrospectively. Data of 10,003 pregnant and 2361 postpartum women were extracted from the database. For unvaccinated postpartum women, intensive care unit (ICU) admission was more likely; invasive ventilation need was more probable if they tested positive for the original, Gamma, and Omicron variants; and chances of death were higher when infected with the original and Gamma variants than when infected with other variants. Vaccinated patients had reduced adverse outcome probability, including ICU admission, invasive ventilation requirement, and death. Postpartum women showed worse outcomes, particularly when unvaccinated, than pregnant women. Hence, vaccination of pregnant and postpartum women should be given top priority.

Barriers and enablers of breastfeeding in mother-newborn dyads in institutional settings during the COVID-19 pandemic: A qualitative study across seven government hospitals of Delhi, India

Introduction

The COVID-19 pandemic disrupted newborn care and breastfeeding practices across most healthcare facilities. We undertook this study to explore the barriers and enablers for newborn care and breastfeeding practices in hospitals in Delhi, India for recently delivered mother (RDM)-newborn dyads during the first wave of the COVID-19 pandemic (2020) and inductively design a "pathway of impaction" for informing mitigatory initiatives during the current and future pandemics, at least in the initial months.

Materials and methods

We used an exploratory descriptive design (qualitative research method) and collected information from seven leading public health facilities in Delhi, India. We conducted separate interviews with the head and senior faculty from the Departments of Pediatrics/Neonatology (n = 12) and Obstetrics (n = 7), resident doctors (n = 14), nurses (labor room/maternity ward; n = 13), and RDMs (n = 45) across three profiles: (a) COVID-19-negative RDM with healthy newborn (n = 18), (b) COVID-19-positive RDM with healthy newborn (n = 19), and (c) COVID-19 positive RDM with sick newborn needing intensive care (n = 8) along with their care-giving family members (n = 39). We analyzed the data using grounded theory as the method and phenomenology as the philosophy of our research.

Results

Anxiety among clients and providers, evolving evidence and advisories, separation of the COVID-positive RDM from her newborn at birth, providers' tendency to minimize contact duration and frequency with COVID-positive mothers, compromised counseling on breastfeeding, logistic difficulties in expression and transportation of COVID-positive mother's milk to her baby in the nursery, COVID restrictions, staff shortage and unavailable family support in wards and nursery, and inadequate infrastructure were identified as major barriers. Keeping the RDM-newborn together, harmonization of standard operating procedures between professional associations and within and between departments, strategic mobilization of resources, optimization of human resources, strengthening client-provider interaction, risk triaging, leveraging technology, and leadership-in-crisis-situations were notable enablers.

Conclusion

The separation of the RDM and newborn led to a cascade of disruptions to newborn care and breastfeeding practices in the study institutions. Separating the newborn from the mother should be avoided during public health emergencies unless there is robust evidence favoring the same; routine institutional practices should be family centered.

H, K. P. S, Paul J, R. MK, Rajendran K, Saibannavar AA, Nirali S. An efficacy and safety report based on randomized controlled single-blinded multi-centre clinical trial of ZingiVir-H, a novel herbo-mineral formulation designed as an add-on therapy in adult patients with mild to moderate COVID-19

OBJECTIVE

Coronaviruses, hence named because of the crown-like spikes on the viral envelope, are members of Coronaviridae family and Order Nidovirales. SARS-CoV-2 is the seventh human pathogenic coronavirus identified after HCoV-229E, HCoV-OC43, SARS-CoV (SARS-CoV-1), HCoV-NL63, CoV-HKU1, and MERS-CoV. SARS-Cov-2 is highly similar to SARS-CoV. COVID-19 is the corresponding acute disease caused by SARS-CoV-2 that was initially reported in Wuhan, China towards the end of 2019 and spread to millions of humans globally. Unfortunately, limited studies were available on the efficacy of antiviral drugs to treat COVID-19 at the time of this study. ZingiVir-H is an Ayurvedic formulation for use in early therapy of viral disease. This clinical trial was planned to investigate (1) the efficacy and safety of ZingiVir-H and (2) the efficacy of ZingiVir-H as an add-on therapy to the standard of care in hospitalized adults diagnosed with COVID-19.

METHODS

A total of 123 eligible subjects as per inclusion criteria were randomized within the study. Three subjects later declined to participate in the study and four subjects didn't meet inclusion criteria, which brought the final evaluable subject count to 116 for the efficacy and safety endpoint analysis. Thus, a total of 116 patients were equally randomised into two groups, namely, ZingiVir-H and Placebo for this clinical trial. The study patients were assigned to receive either ZingiVir-H or Placebo along with the standard of care as per the National Indian COVID-19 treatment protocol. The time interval until a negative RT-PCR obtained, was evaluated during treatment with ZingiVir-H or Placebo for ten days. Liver and kidney function tests were regularly assessed to ensure the safety profile of ZingiVir-H.

RESULTS

The study found that patients who were administered ZingiVir-H had a median recovery time of 5 days (95% confidence interval (CI) 5-5) when compared to 6 days (95% CI 5-6) in those who received Placebo. Besides, in Ordinal Scale analysis of all the patients treated with ZingiVir-H demonstrated significant redistribution to a better clinical status from ordinal scale 5 to 6 and 7 within five to seven days when compared to that of placebo treatment. The time required for clinical improvement and the number of days needed for hospitalization was significantly less in the ZingiVir-H treated group when compared to placebo. The absence of liver and kidney function changes affirmed the safety profile of ZingiVir-H. No serious adverse events were reported in ZingiVir-H treated patients.

CONCLUSION

We found that ZingiVir-H is effective and safe in managing COVID-19 infections and delaying the disease progression from mild to moderate and moderate to severe. To the best of our knowledge, this is the first clinical trial report on the efficacy/safety of a herbo-mineral Ayurvedic drug against COVID-19 as of yet.

TRIAL REGISTRATION

Clinical Trial Registry of India CTRI/2020/04/024883. Registered on 28/04/2020.

First-Trimester Influenza Infection Increases the Odds of Non-Chromosomal Birth Defects: A Systematic Review and Meta-Analysis

Viral infections during pregnancy raise several clinical challenges, including birth defects in the offspring. Thus, this systematic review and meta-analysis aims to prove and highlight the risk of birth defects after first-trimester maternal influenza infection. Our systematic search was performed on 21 November 2022. Studies that reported maternal influenza infection in the first trimester and non-chromosomal congenital abnormalities were considered eligible. We used odds ratios (OR) with 95% confidence intervals (CIs) to measure the effect size. Pooled ORs were calculated with a random effects model. Heterogeneity was measured with I² and Cochran's Q tests. We found that first-trimester maternal influenza was associated with increased odds of developing any type of birth defects (OR: 1.5, CI: 1.30-1.70). Moreover, newborns were more than twice as likely to be diagnosed with neural tube defects (OR: 2.48, CI: 1.95-3.14) or cleft lip and palate (OR: 2.48, CI: 1.87-3.28). We also found increased odds of developing congenital heart defects (OR: 1.63, CI: 1.27-2.09). In conclusion, influenza increases the odds of non-chromosomal birth defects in the first trimester. The aim of the present study was to estimate the risk of CAs in the offspring of mothers affected by first-trimester influenza infection.

Correlating the trends of COVID-19 spread and air quality during lockdowns in Tier-I and Tier-II cities of India-lessons learnt and futuristic strategies

The present study focuses on the impact of early imposed lockdowns and following unlocking phases on the status of air quality in six Tier-I and nine Tier-II cities of India as compared to the pre-lockdown measures. Furthermore, the study highlights the possible correlation of air quality index (AQI) with the initial trend of COVID-19 issues including the vaccination cases. Based on the statistical data analysis, we observed that the long-term averages for representing the short-term pre-lockdown conditions can impose a healing effect to the observed anomalies in air pollution data. However, the reduction in air pollution during the imposed lockdown series was only a phenomenal consequence, and the trends started reversing during the later phases of partial unlocking, where the correlation showed reversing trends. Being a yearly averaged parameter, the marginal reductions in the exceedance factor (EF) alone could not dictate air quality compared to the AQI. As there is incoherent variability in the pollutant distributions among the cities during various phases of the study, the trend analysis served as a preferable criterion to choose the preferred sources of variations. Based on the results, the correlation analysis revealed that air quality expressed in terms of AQI can act as an important precursor to estimate the critical phase of COVID-19 spread and the effectiveness of various control measures taken during each phase. Based on our proposed ranking, Kolkata and Patna are ranked first in the Tier-I and Tier-II cities respectively according to their responsiveness to the various institutionalized restrictions in terms of air quality parameters.

COVID-19: what about pregnant women during first lockdown in Italy?

OBJECTIVE

Lombardy was the most affected Italian region by COVID-19. To limit the spread of infection, the government issued a national social lockdown. The obstetrical-gynaecological emergencies and essential services were guaranteed to protect pregnant women's health, and a return to a medicalised childbirth was necessary. This situation could had amplified risk factors on the psychological wellbeing of mothers-to-be. Indeed, the last trimester of pregnancy is a period of increased vulnerability itself.

METHOD

For better support women who experience pregnancy during social lockdown, we explored the impact of COVID-19 on psychic wellbeing of two samples of pregnant women (40 living in Lombardy and 35 in Tuscany).

RESULTS

T-test and correlations analyses revealed that women living in the Lombardy had a higher perception of the centrality of COVID-19. Further, women that considered the pandemic as a significant event, experienced a higher perinatal depressive symptom. Those symptoms also arose in women who presented a higher number of intrusion and hyperarousal symptoms and a lower ability to plan.

CONCLUSION

Pregnant women should be closely monitored and supported, especially those who live in high-risk areas, such as Lombardy Region. The target intervention could be focused on improving resilience to reduce depressive symptomatology.

Consequences of SARS-CoV-2 Infection in Pregnant Women and Their Infants: A Systematic Review

Coronavirus disease 2019 (COVID-19) is a worldwide health problem, particularly for pregnant women. This review assesses the effects of COVID-19 on pregnant women and their infants. A systematic search was performed of studies published on PubMed, Web of Science, Google Scholar, and Embase from January 2020 to January 2021, without restriction by language. This review included 27 studies (22 from China, one from the United States, one from Honduras, one from Italy, one from Iran, and one from Spain), which cumulatively evaluated 386 pregnant women with clinically confirmed COVID-19 and their 334 newborns. Of the 386 pregnant women, 356 had already delivered their infants, four had medical abortions at the time of research, 28 were still pregnant, and two died from COVID-19 before they were able to give birth. Cesarean sections were performed on 71% of pregnant women with COVID-19 to give birth. Fever and cough were common symptoms among women. Premature rupture of membranes, distress, and preterm birth were pregnancy complications. Low birth weight and a short gestational age were common outcomes for newborns. The common laboratory findings among pregnant women were lymphopenia, leukocytosis, and elevated levels of C-reactive protein. Chest computed tomography revealed abnormal viral lung changes in 73.3% of women. Eleven infants tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There was no evidence of vertical transmission. Most infants were observed to have lymphopenia and thrombocytopenia. The clinical features of pregnant women were found to be similar to those of generally infected patients. There is evidence of adverse pregnancy and neonatal outcomes caused by COVID-19.

Clinical course of novel COVID-19 infection in pregnant women

OBJECTIVES

Evaluation of clinical course of COVID-19 during pregnancy and maternal and perinatal outcomes of this pregnancy.

METHODS

66 women with polymerase chain reaction (PCR) - confirmed SARS-CoV-2 and their 42 neonates were included in the prospective observational study. Demographic, epidemiological, clinical, laboratory and instrumental data of pregnancy, delivery, postpartum period, including pharmacotherapy and neonatal outcomes were analyzed.

RESULTS

15 (22.7%) women were asymptomatic, 25 (38%) had mild disease, while moderate and severe forms were detected in 20 (30.2%) and 6 (9.1%) cases, respectively. Additional oxygenation was required in 6 (9%) cases: 4 (6%) received CPAP therapy and 2 (3%) - mechanical ventilation. Main clinical symptoms were cough (51.5%), anosmia (34.9%), and hyperthermia (33.3%). Laboratory changes included increased levels of lactate dehydrogenase (LDH), creatinine, d-dimer, and C-reactive protein (CRP), anemia, and leukopenia. All pregnant women received low molecular weight heparin and interferon alfa-2b according to the National clinical recommendations. Antimicrobial drugs included Amoxicillin/Clavulanic acid (46%) and macrolides (28%) or carbapenems in severe cases of disease. Spontaneous abortion was reported in 6.1% of cases. Eight preterm (19%) and 34 term deliveries (81%) occurred. The mean weight of neonates was (3283 ± 477) g, 1- and 5-min Apgar score was (7.8 ± 0.6) and (8.7 ± 0.5), respectively. No cases of neonatal COVID-19 infection were reported.

CONCLUSIONS

Mostly, the manifestations of COVID-19 were mild. However, 9% of cases were severe, and could contribute to preterm delivery or maternal morbidity. Main predictors of severe COVID-19 course in pregnant women were a decrease in the levels of erythrocytes and lymphocytes and increase in the levels of alanine aminotransferase and CRP. Elimination of the virus in pregnant women required more time due to altered immunity. No evidence of vertical transmission during pregnancy and delivery was found. However, the possibility of this cannot be excluded.

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

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

Can Fetal Heart Lie? Intrapartum CTG Changes in COVID-19 Mothers

BACKGROUND

COVID-19 infection has raised multiple concerns in pregnant mothers; many questioned the risk of vertical transmission and the implication on the feto-maternal outcome. Cardiotocogrm (CTG) is the principal method to observe intrapartum fetal well-being. This paper aims to verify intrapartum CTG changes seen in seropositive COVID-19 mothers versus healthy controls and looks into their relation to subsequent delivery mode and neonatal outcome.

METHODS

A case-control study recruited 90 pregnant women at the labor word of AL Yarmouk Teaching Hospital. All were term pregnancy admitted for delivery. They were grouped into 2: seropositive COVID-19 confirmed by real-time RT-PCR test (30/90) and healthy controls (60/90). We recorded their demographic criteria, laboratory results, CTG changes, delivery mode, and indication.

RESULTS

COVID-19 cases showed significantly higher pulse rate, temperature, and leukocyte counts. Cesarian deliveries (CS) were higher in cases versus healthy controls (70 % vs. 53.3 %) and P = 0.45. Analysis of the CS indications showed that abnormal fetal heart tracing accounts for 33.3 % versus 15.6 % (P-value = 0.015) for cases versus healthy controls. 60 % of COVID-19 cases exhibited abnormal CTG changes versus 19.4 % in healthy controls. These changes were primarily fetal tachycardia and reduced variabilities.

CONCLUSIONS

The higher incidence of abnormal CTG in COVID-19 cases, alongside infection signs and symptoms, underlies the exaggerated inflammatory reactions inside the pregnant mother. These inflammatory reactions are the main causes of CTG changes and higher CS rates. Therefore, obstetricians are advised to optimize the maternal condition to rectify reactive CTG changes rather than proceeding into urgent CS.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13224-022-01663-6.

Observational cohort study of perinatal outcomes of women with COVID-19

BACKGROUND

Understanding the impact of SARS-CoV-2 infection on pregnancy outcomes and of pregnancy on COVID-19 outcomes is critical for ensuring proper prenatal and antenatal care. No similar studies have been published in Saudi Arabia.

METHODS

We performed a prospective cohort study of pregnant women with confirmed SARS-CoV-2 infection who presented at King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Kingdom of Saudi Arabia. COVID-19 staging was performed, pregnancy-related complications were assessed, and neonatal infection was evaluated.

RESULTS

We enrolled 81 patients (mean age 31.75 years, SD 5.25) of which there were 17 cases in the first trimester, 20 in the second trimester, and 34 in the third trimester. The distribution of COVID-19 severity was 40 patients with Stage A, 36 with Stage B, 4 with Stage C, and 1 with Stage D. Complications were pregnancy loss in 2 patients (one in each first and second trimester) and 1 fetal death after 20 weeks of pregnancy, 7 patients with fetal growth restriction, and 8 with pre-term delivery.

CONCLUSIONS

We did not observe an unusual frequency of pregnancy-related complications due to SARS-CoV-2 infection in this high-risk obstetric population and there was no evidence of vertical transmission in newborns from women who delivered while positive for the virus.

'Pregnant women voice their concerns and delivery method preferences during the COVID-19 pandemic in Turkey'

OBJECTIVE

To evaluate pregnant women's voice their concerns and delivery method preferences during the COVID-19 pandemic in Turkey.

Methods: A cross-sectional study is survey based using an online survey platform. Three hundred pregnant women were included between 16 May and 12 June 2020 in Turkey. Sociodemographic features, obstetric features, concerns about COVID-19, delivery method preferences, and Brief Measure of Worry Severity were evaluated.

RESULTS

It was determined that the concerns of pregnant women about the pandemic were moderate (12.73 ± 6.838) and did not alter their delivery method preferences. However, the concerns of the pregnant women who planned to perform their delivery by caesarean section before COVID-19 and whose delivery method preferences changed during the pandemic process were higher (p < 0.05). Additionally, during the COVID-19 period, pregnant women often harbour concerns such as 'not knowing how it would affect my baby if I have to take medications for COVID-19 (90.3%)' 'getting infected by COVID-19 during my pregnancy (89.7%)' 'not having a healthy pregnancy until birth (89%)'.

CONCLUSIONS

Delivery method preferences of pregnant women did not change in the COVID-19 pandemic. On the other hand, COVID-19 pandemic is impacting on the pregnant women experiencing moderate concerns about their pregnancy, delivery, postpartum period, and their baby.

A Survey on Applications of Artificial Intelligence in Fighting Against COVID-19

The COVID-19 pandemic caused by the SARS-CoV-2 virus has spread rapidly worldwide, leading to a global outbreak. Most governments, enterprises, and scientific research institutions are participating in the COVID-19 struggle to curb the spread of the pandemic. As a powerful tool against COVID-19, artificial intelligence (AI) technologies are widely used in combating this pandemic. In this survey, we investigate the main scope and contributions of AI in combating COVID-19 from the aspects of disease detection and diagnosis, virology and pathogenesis, drug and vaccine development, and epidemic and transmission prediction. In addition, we summarize the available data and resources that can be used for AI-based COVID-19 research. Finally, the main challenges and potential directions of AI in fighting against COVID-19 are discussed. Currently, AI mainly focuses on medical image inspection, genomics, drug development, and transmission prediction, and thus AI still has great potential in this field. This survey presents medical and AI researchers with a comprehensive view of the existing and potential applications of AI technology in combating COVID-19 with the goal of inspiring researchers to continue to maximize the advantages of AI and big data to fight COVID-19.

Treatment of Hydatidiform Mole Suspected to COVID 19

The aim of this study was to report a case of the treatment of hydatidiform mole in Coronavirus pandemic in Iranshahr. A 17-year-old primiparous woman with gestational age of 14 weeks presented with unilateral leg swelling and sudden abdominal distension beginning in the night before referring to the health center. In the abdominal examination of the patient by a healthcare provider, the baby's heartbeat was not heard and a mismatch was observed between gestational age and fundal height, which corresponded to approximately 24 weeks of gestation. She was conscious and pale with hematuria and uterine contractions. After inserting two IV lines, the patient immediately underwent monitoring and was visited by a gynecologist. Complete molar pregnancy was diagnosed with an enlarged heterogeneous uterus 180 cm × 90 cm in size and containing 170 mm × 80 mm cysts. The treatment began with vancomycin AMP, hydrocortisone AMP, oseltamivir CAP 75 mg, kaletra CAP 200 mg, and meropenem AMP.

Sociodemographic characteristics of professional categories most affected by COVID-19 in Mozambique from March to July 2020

Introduction

the risk of a worker becoming ill due to coronavirus disease 2019 (COVID-19) is related to occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the need to restore work activities in Mozambique, the study was conducted with the aim of identifying the occupational categories most affected by COVID-19 in the former in the period from March to July 2020.

Methods

this is a cross-sectional descriptive study, in which data from professions of confirmed cases of COVID-19 from 22 March to 29 July 2020 in Mozambique were analyzed. The professionals' data were reported daily by the National Institute of Health (NIH) and merged into a single database and exported to Excel, the latter categorized according to standard operating procedure (SOP) and descriptive statistics performed for its analysis.

Results

in the period under analysis, 1,127 professionals were diagnosed with COVID-19, divided into 11 categories. Nampula province had the highest frequency of cases with 25.00% (277). The highest frequency of cases was registered in the domestic professional category, which had 16.77% (189/1,127) with the female sex being more frequent, 79.37% (150/189); and defense and security had 14.20% (160/1,127) of cases and male gender with 91.25% (146/160); Health workers had 13.04% (147/1,127), and the maximum number of COVID-19 cases was recorded in June with 58.50% (86/147).

Conclusion

the professional categories most affected by COVID-19 in the period under review correspond to those groups that carry out activities requiring a physical presence at the workplace and from this; it is recommended that professionals reinforce preventive measures.

Innate and adaptive immune response in SARS-CoV-2 infection-Current perspectives

Coronavirus disease 2019 (COVID-19) has been a global pandemic, caused by a novel coronavirus strain with strong infectivity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With the in-depth research, the close relationship between COVID-19 and immune system has been dug out. During the infection, macrophages, dendritic cells, natural killer cells, CD8⁺ T cells, Th1, Th17, Tfh cells and effector B cells are all involved in the anti-SARS-CoV-2 responses, however, the dysfunctional immune responses will ultimately lead to the excessive inflammation, acute lung injury, even other organ failure. Thus, a detailed understanding of pertinent immune response during COVID-19 will provide insights in predicting disease outcomes and developing appropriate therapeutic approaches. In this review, we mainly clarify the role of immune cells in COVID-19 and the target-vaccine development and treatment.

COVID-19 associated liver injury: A general review with special consideration of pregnancy and obstetric outcomes

Liver injury is an increasingly recognized extra-pulmonary manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Coronavirus disease 2019 (COVID-19) associated liver injury (COVALI) is a clinical syndrome encompassing all patients with biochemical liver injury identified in the setting of SARS-CoV-2 infection. Despite profound clinical implications, its pathophysiology is poorly understood. Unfortunately, most information on COVALI is derived from the general population and may not be applicable to individuals under-represented in research, including pregnant individuals. This manuscript reviews: Clinical features of COVALI, leading theories of COVALI, and existing literature on COVALI during pregnancy, a topic not widely explored in the literature. Ultimately, we synthesized data from the general and perinatal populations that demonstrates COVALI to be a hepatocellular transaminitis that is likely induced by systemic inflammation and that is strongly associated with disease severity and poorer clinical outcome, and offered perspective on approaching transaminitis in the potentially COVID-19 positive patient in the obstetric setting.

The Prognostic Value of Lung Injury and Fibrosis Markers, KL-6, TGF-β1, FGF-2 in COVID-19 Patients

Background:

Biomarkers of lung injury and interstitial fibrosis give insight about the extent of involvement and prognosis in well-known interstitial lung diseases (ILD). Serum Krebs von den Lungen-6 (KL-6) reflects direct alveolar injury and, transforming growth factor-beta1 (TGF-β1) and fibroblast growth factor-2 (FGF-2) are principal mediators of fibrosis in ILD and in almost all fibrotic diseases. In this sense, we aimed to assess associations of these biomarkers with traditional inflammatory markers and clinical course of COVID-19.

Methods:

Patients with COVID-19 who had confirmed diagnosis with SARS-CoV-2 nucleic acid RT-PCR were enrolled and followed up prospectively with a standardized approach one month after diagnosis. Patients were divided into severe and non-severe groups according to National Institutes of Health criteria. Outcome was assessed for the requirement of intensive care unit (ICU) admission, long term respiratory support and death. Blood samples were collected at enrollment and serum levels of KL-6, TGF-β1, FGF-2 were determined by ELISA. Association between these markers with other prognostic markers and prognosis were analyzed.

Results:

Overall 31 severe and 28 non-severe COVID-19 patients were enrolled and were compared with healthy control subjects (n = 30). Serum KL-6 levels in COVID-19 patients were significantly higher (median [IQR]; 11.54 [4.86] vs 8.54 [3.98] ng/mL, P = .001] and FGF-2 levels were lower (median [IQR]; 76.84 [98.2] vs 101.62 [210.6] pg/mL) compared to healthy control group. A significant correlation was found between KL-6 values and CRP, fibrinogen, d-dimer and lymphocyte counts. However, we did not find an association between these markers and subsequent severity of COVID-19, mortality and long-term prognosis.

Conclusions:

Serum KL-6 levels were significantly elevated at the diagnosis of COVID-19 and correlated well with the other traditional prognostic inflammatory markers. Serum levels of principal fibrosis mediators, TGF-β1, FGF-2, were not elevated at diagnosis of COVID-19, therefore did not help to anticipate long term prognosis.

Ambient air pollution and COVID-19 in Delhi, India: a time-series evidence

This study aimed to explore the short-term health effects of ambient air pollutants PM2.5, PM10, SO2, NO2, O3, and CO on COVID-19 daily new cases and COVID-19 daily new deaths. A time-series design used in this study. Data were obtained from 1 April 2020 to 31 December 2020 in the National Capital Territory (NCT) of Delhi, India. The generalized additive models (GAMs) were applied to explore the associations of six air pollutants with COVID-19 daily new cases and COVID-19 daily new deaths. The GAMs revealed statistically significant associations of ambient air pollutants with COVID-19 daily new cases and COVID-19 daily new deaths. These findings suggest that governments need to give greater considerations to regions with higher concentrations of PM2.5, PM10, SO2, NO2, O3, and CO, since these areas may experience a more serious COVID-19 pandemic or, in general, any respiratory disease.

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

Introduction

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

Methods

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

Patients population

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

Results

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

Conclusion

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

Guideline

STROCSS 2021.

Correlation between psychiatric impact of COVID-19 during pregnancy and fetal outcomes in Egyptian women

The prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) was examined in 238 pregnant women with (n = 146) and without (n = 92) coronavirus disease 2019 (COVID-19) using the State-Trait Anxiety Inventory (STAI), Edinburgh Postnatal Depression Scale (EPDS), and PTSD Checklist for DSM-5 (PCL-5). Fetal outcomes in the same groups were evaluated using the Apgar score. Anxiety and depression scores were significantly higher in women with COVID-19 but PTSD scores were similar in both groups. Infection with COVID-19 was associated with a higher number of fetal deaths or an Apgar score <7. During the COVID-19 pandemic, approximately 46.6% of pregnant women had depression, 5.5% had PTSD, 64.3% had state anxiety, and 60.9% had trait anxiety. Except for PTSD, psychiatric problems and poor fetal outcomes were higher in women with COVID-19 than in those without COVID-19. Lastly, women with COVID-19 were more prone to have a fetus who died or had an Apgar score of <7.

Mortality in children under five years old in Brazil: evolution from 2017 to 2020 and the influence of COVID-19 in 2020

OBJECTIVE

To analyse the mortality trends in children under five years old in Brazil from 2017 to 2020 and the influence of COVID-19 in 2020.

METHODS

A retrospective study employing secondary data from the Brazilian Mortality Information System. Deaths according to cause were extracted and disaggregated into early, late, postneonatal, and 1 to 4-year-old periods. Corrected mortality rates per 1,000 live births and relative risk ratio for the cause of death were calculated.

RESULTS

There were 34,070 deaths, being 417 (1.2%) from COVID-19 in 2020. COVID-19 mortality was 0.17 per 1000 live births, reaching 0.006 in the early neonatal period, 0.007 in the late neonatal, 0.09 in the postneonatal, and 0.06 in 1 to 4-year-old. Mortality decreased mostly for some diseases that originated in the perinatal period, congenital anomalies, diseases of the respiratory system and external causes, in this order. In 2020, the highest rate was in the early neonatal period, with a fall from 7.2 to 6.5, followed by the postneonatal (3.9 to 3.4) and late neonatal (2.3 to 2.1). Among children aged 1 to 4-year-old, external causes had the highest proportional rate, and diseases of the respiratory system showed the highest decline.

CONCLUSION

The mortality rate declined from 2017 to 2020, and this variation was higher in the early neonatal period. The risk of death from COVID-19 was 14 times higher in the postneonatal period and 10 times higher in children aged 1 to 4 year-old compared to the early neonatal period.

Evaluation of Laboratory Results with Data from Bio-Speedy Respiratory Panel 2 in Nasopharyngeal Swab Specimens of COVID-19-Suspected Patients Having PCR(-) Results

Objective: The distinction between COVID-19 and other respiratory infections can be difficult during the flu and winter seasons. The aim of this study is to detect bacterial/viral microorganisms in nasopharyngeal swab samples and to evaluate routine laboratory results of patients with PCR (-) but suspected covid 19. Methods: Between 1 July 2021 and 31 December 2021, 78 patients who were hospitalized and followed up in the suspected Covid service were included in the study. The patients were divided into two groups as those with and without growth on the respiratory panel. Laboratory, demographic and radiological data were compared between groups. Results: C-reactive protein (CRP) and ferritin levels were found to be statistically significantly higher in the group with growth on the respiratory panel compared to the group without growth (p= .05, p= .041, respectively). Reproduction was detected in nasopharyngeal swab samples taken in 56.4% of the patients. More than half of the patients were radiologically defined as CO-RADS 3. Conclusion: It should not be forgotten that other respiratory viral and bacterial infections that mimic the COVID-19 clinic are also commonly observed during this period.

Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review

Background: COVID-19 is a viral infectious disease leading to a spectrum of clinical complications, especially cardiovascular. Evidence shows that this infection can potentially accompany a worse outcome in pregnant women. Cardiovascular complications in mothers and their fetuses are reported by previous studies. Objective: In this systematic review, we aim to investigate the cardiovascular complications of COVID-19 during pregnancy in the mothers and fetus, according to the published literature. Method: We systematically searched the online databases of PubMed, Scopus, Web of Science, and Google Scholar, using relevant keywords up to April 2022. We included all observational studies reporting cardiovascular complications among COVID-19-affected pregnant women and their fetuses. Results: We included 74 studies containing 47582 pregnant COVID-19 cases. Pre-eclampsia, hypertensive disorders, cardiomyopathy, heart failure, myocardial infarction, thrombosis formation, alterations in maternal–fetal Doppler patterns, and maternal and fetal arrhythmia were reported as cardiovascular complications. The highest incidences of pre-eclampsia/eclampsia among COVID-19 pregnant cases, reported by studies, were 69% and 62%, and the lowest were 0.5% and 3%. The highest and lowest incidences of fetal bradycardia were 20% and 3%, and regarding fetal tachycardia, 5.4% and 1%, respectively. Conclusion: SARS-CoV-2 infection during pregnancy can potentially be associated with cardiovascular complications in the mother, particularly pre-eclampsia and heart failure. Moreover, SARS-CoV-2 infection during pregnancy can potentially cause cardiovascular complications in the fetus, particularly arrhythmia.

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

Purpose of Review

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

Recent Findings

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

Summary

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

A Comprehensive Comparison of COVID-19 Characteristics (Wuhan‎ Strain) Between Children and Adults During Initial Pandemic Phase: A Meta-Analysis Study

Objectives: This systematic review and meta-analysis aimed to compare coronavirus disease 2019 (COVID-19) (Wuhan strain) features in children and adults during the initial pandemic phase. Methods: Until June 4, 2020, a systematic search was conducted on the EMBASE, PubMed, Web of Science, Google Scholar, and Scopus to find and collect studies based on available data among adults and children. The heterogeneity of the studies was assessed using I2 statistics and chi-square testing. The random-effect model was used to pool the effect sizes due to inter-study heterogeneity (chi-square P-value 0.1 and I2 >50%). Results: Fever (65.73%), cough (53.78%), expectoration (37.9%), gastrointestinal symptoms (37.01%), headache (23.41%), shortness of breath (21.65%), and myalgia (20.79%) were the most common symptoms reported in children, according to the pooled estimation analysis. Arthralgia (Effect estimate (ES): adults = 2.15, children = 17.94) and headache (ES: adults = 9.22, children = 23.41) were significantly observed higher in children (P-value = 0.019). Adult patients had a higher rate of abnormal computer tomography (CT)-scan findings, while most children had a normal study. Adults had significantly higher rates of comorbidities, whereas children had significantly higher rates of asthma (ES: 17.94% vs 8.85%; P-value = 0.026) and malignancy (‎ES: 10.36‎% vs ‎5.47‎‎%; P-value = 0.045‎). During initial pandemic phase, hydroxychloroquine (ES: 66.21% vs ‎‎29.01%; P-value = 0.001) and antibiotics (ES: 77.86% vs 38.01%; P-value = 0.001) ‎were used much more frequently in adult patients. Adults used much more antibiotics than children. Nonetheless, antibiotics were given to around 40% of the children studied. ‎ Conclusions: Although children were afflicted less than adults in the early stages of the pandemic and had lower mortality, clinical and radiological findings, as well as prognostic factors, did not differ significantly between adults and children. However, with the advent of novel variants, clinical signs and symptoms, complications, and outcomes changed in children significantly.