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Ghosh R, Gutierrez JP, de Jesús Ascencio-Montiel I, Juárez-Flores A, Bertozzi SM. SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study. BMJ Open 2024; 14:e075928. [PMID: 38604636 PMCID: PMC11015228 DOI: 10.1136/bmjopen-2023-075928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection. DESIGN AND SETTING The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021. PARTICIPANTS We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy. OUTCOME MEASURES PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies. RESULTS The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations. CONCLUSIONS In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period.
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Affiliation(s)
- Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Juan Pablo Gutierrez
- Center for Policy, Population & Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Arturo Juárez-Flores
- Center for Policy, Population & Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Stefano M Bertozzi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
- University of Washington - Seattle Campus, Seattle, Washington, USA
- National Institute of Public Health, Cuernavaca, Mexico
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Yi J, Chen L, Meng X, Chen Y. The impact of gestational weeks of Coronavirus disease 2019 (COVID-19) infection on perinatal outcomes. Reprod Health 2024; 21:31. [PMID: 38433197 PMCID: PMC10910700 DOI: 10.1186/s12978-024-01762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND To evaluate the relationship between coronavirus disease 2019 (COVID-19) infection at different time points during pregnancy and perinatal outcomes. METHODS This retrospective study included 611 women who hospitalized for delivery between December 7 and April 30, 2023. Based on the different pregnancy weeks infected with COVID-19, the participants were divided into four groups: Group 1 (14-27+6 weeks gestation), Group 2 (28-36+6 weeks gestation), Group 3 (37-39+6 weeks gestation), and Group 4 (≥ 40 weeks gestation). Data including maternal demographic characteristics, clinical profiles, and perinatal outcomes were analyzed. RESULTS There were no significant differences in maternal demographic characteristics among the four groups (P > 0.05). Compared to Groups 3 and 4, a higher rate of fever was noted in Groups 1 and 2 (P < 0.05). The frequency of preeclampsia and gestational diabetes mellitus showed a decreasing trend as pregnancy progressing (P < 0.05). Preterm delivery and neonatal intensive care unit admission were more frequently observed in Groups 1 and 2 than in Groups 3 and 4 (P < 0.05). Multivariate logistic regression analysis demonstrated that the timing of gestation in which COVID-19 was infected was not associated with preterm delivery and neonatal intensive care unit admission (P > 0.05), whereas gestational age at COVID-19 infection was negatively associated with the occurrence of preeclampsia and gestational diabetes mellitus (P < 0.05). CONCLUSIONS Gestational age at COVID-19 infection is a simple parameter that predicts adverse perinatal outcomes to aid clinicians in determining to provide early enhanced prenatal care and increased monitoring to reduce maternal complications.
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Affiliation(s)
- Jiao Yi
- Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital Affiliated With Anhui Medical University, Anhui Maternal and Child Health Care Hospital, No 15 Yimin Street, Hefei, 230000, China.
| | - Lei Chen
- Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital Affiliated With Anhui Medical University, Anhui Maternal and Child Health Care Hospital, No 15 Yimin Street, Hefei, 230000, China
| | - Xianglian Meng
- Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital Affiliated With Anhui Medical University, Anhui Maternal and Child Health Care Hospital, No 15 Yimin Street, Hefei, 230000, China
| | - Yi Chen
- Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital Affiliated With Anhui Medical University, Anhui Maternal and Child Health Care Hospital, No 15 Yimin Street, Hefei, 230000, China
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Melo Mendes IC, Martins de Oliveira AL, Martins Pinheiro Trindade P, Mendes da Silva W, Pontes Frankel P, Carvalho Mocarzel C, de Alencar Rosa M, Santos Nascimento AP, de Melo Rodrigues G, Pimentel C, de Moraes Perlingeiro R, Gonçalves Lisbôa Pereira A, Caminha Escosteguy C, Mello Galliez R. Severe Covid-19 in pregnant and postpartum women admitted to an intensive care unit: A retrospective cohort study. PLoS One 2023; 18:e0295444. [PMID: 38096234 PMCID: PMC10721012 DOI: 10.1371/journal.pone.0295444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection is associated with worse maternal and fetal outcomes. This study aims to describe the characteristics of pregnant and postpartum women with severe Covid-19 admitted to ICU. METHODS AND FINDINGS It's a retrospective cohort study evaluating pregnant and postpartum women referenced to a specialized ICU between May 2020 and June 2022. Covid-19 was confirmed with RT-PCR or rapid antigen test on a nasopharyngeal swab. Variables were described by median and IQR when numerical, and by frequency and percentage when categorical. OR with 95% CI were calculated for the evaluation of factors related to death. P-values were calculated using Pearson's ꭓ2-test, Fisher's exact test, Wilcoxon rank sum test, and Kruskall-Wallis test, and statistical significance was established as < 0·05. Missing data were excluded. All statistical analysis were performed using R software version 4.2.2. Of the 101 admissions, 85 (84·2%) were of pregnant women. Obesity (23·0%) and systemic arterial hypertension (13·0%) were the most prevalent medical conditions. Sixty-six (65·3%) were admitted using some type of oxygen support. Forty-seven (46·5%) evolved to mechanical ventilation. There were 61 events considered obstetric complications, with 8 stillbirths/fetal losses. The overall lethality was 15·8%. Pregnancy interruption, need for non-invasive mechanical ventilation, level of oxygen support at admission, prone maneuver, hemodialysis, and healthcare-related infections were factors associated with death. Evaluating the WHO 7-category ordinary scale, there was a trend of increase in the risk of death with higher punctuation, with a statistically significant difference of women with 5 (OR = 7·27; 95% IC = 1·17-194; p = 0·031) or 6 points (OR = 12·0; 95% IC = 1·15-391; p = 0·038) when compared to the ones with 3 points, i.e., of women admitted with a high-flow non-rebreathing mask or invasive mechanical ventilation, compared with the ones admitted at room air, respectively. The main limitations of this study are the relatively small number of participants, and the use of data derived of medical records-which are susceptible to misclassification and variable amounts of missing data. CONCLUSIONS Pregnant and postpartum women with severe Covid-19 have high lethality and a high incidence of clinical and obstetric complications. These findings support that this population should be prioritized in public health strategies that address Covid-19.
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Affiliation(s)
- Isabel Cristina Melo Mendes
- Infectious Diseases Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Estadual de Infectologia São Sebastião, Rio de Janeiro, Brazil
| | | | | | - Wallace Mendes da Silva
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
- Faculty of Medicine, Estácio de Sá University (UNESA/IDOMED), Rio de Janeiro, Brazil
| | | | | | | | | | | | - Clarisse Pimentel
- Instituto Estadual de Infectologia São Sebastião, Rio de Janeiro, Brazil
| | | | | | | | - Rafael Mello Galliez
- Instituto Estadual de Infectologia São Sebastião, Rio de Janeiro, Brazil
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Center for Response and Studies on Emerging and Reemerging Infectious Diseases (NEEDIER), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Vidal MJ, Martínez-Solanas È, Mendoza S, Sala N, Jané M, Mendioroz J, Ciruela P. Impact of SARS-CoV-2 infection in pregnant women and their babies: clinical and epidemiological features. GACETA SANITARIA 2023; 37:102332. [PMID: 38007961 DOI: 10.1016/j.gaceta.2023.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/02/2023] [Accepted: 08/29/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Assess the risk associated with COVID-19 in pregnant women on maternal and neonatal outcomes in Catalonia (Spain) in 2020, before the beginning of COVID-19 vaccination campaign. METHOD Cross-sectional descriptive study with all pregnant women (41,560) and their live newborns (42,097) (1st March to 31st December 2020). Women were classified: positive and negative COVID-19 diagnosis during pregnancy. The outcomes analysed were complications during pregnancy, gestational age, admission of newborns to neonatal intensive care unit (NICU) and birth weight. Associations among positive COVID-19 and maternal and infant variables were measured with logistic regression models. Results were expressed as odds ratios and 95% confidence intervals. Models were adjusted for nationality, maternal age, socioeconomic status, type of pregnancy and type of centre where the delivery occurred (public or private management hospital). RESULTS A total of 696 women (1.7%) were diagnosed with COVID-19 during pregnancy. Women with COVID-19 were 4.37 times more likely to have complications during pregnancy (4.37; 3.52-5.40). A total of 713 newborns (1.7%) were from mothers with COVID-19. A positive diagnosis of COVID-19 increased the risk of preterm birth (1.41; 1.03-1.89), admission to NICU (1.40; 1.06-1.82) and low birth weight (1.35; 0.99-1.80) in babies. CONCLUSIONS Pregnant women with COVID-19 had higher risk of developing complications during pregnancy and their newborns were more likely to be admitted to NICU and had prematurity.
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Affiliation(s)
- María José Vidal
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain.
| | - Èrica Martínez-Solanas
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Sergi Mendoza
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Núria Sala
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Mireia Jané
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jacobo Mendioroz
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Pilar Ciruela
- Public Health Agency of Catalonia, Department of Health, Generalitat de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Dai C, Wang X, Xu C, Bai L, Li Y. A Study on the Psychological Experience and Influential Factors of Pregnant Women Who Decided Elective Caesarean Section After Public Health Emergencies - A Cross-Sectional Survey. Int J Womens Health 2023; 15:1713-1725. [PMID: 37965076 PMCID: PMC10642347 DOI: 10.2147/ijwh.s418959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Background The COVID-19 pandemic used to be a major public health emergency which affected people worldwide, and it affected individuals' body, mood, work and lifestyle to some extent. The pregnant woman affected by the unstable hormone will be more sensitive than normal ones. Long-term depression and anxiety could feedback on their body and lead to a host of pregnancy complications. Because pregnant women who choose cesarean section are awake during the perioperative period, to ensure safety, the degree of cooperation about psychology and behavior is relatively high, so we should know the psychological state of such a group of people. Objective This study aims to explore psychological experience and influential factors of pregnant women who decided elective caesarean section after the COVID-19 pandemic. Methods This is a cross-sectional study carried out in a hospital in Shanghai, according to the inclusion and exclusion criteria, we selected pregnant women who selected elective cesarean section as the study objects, all participants provided informed consent and completed questionnaires, including sociodemographic questionnaire, Generalized Anxiety Disorder scale (GAD-7) and General Well-Being Schedule (GWBS). Software SPSS 23.0 was used to analyze and explore the influencing factors. Results Eligible 595 questionnaires were included in the study, the mean score of GAD-7 was 4.855 ± 3.254 and 90.699 ± 13.807 of GWBS. Generalized linear regression analysis revealed several factors that were statistically significant with the two scales, including birthplace, average monthly income, number of abortion and pregnancy complication (p < 0.01). Conclusion The COVID-19 infection status and symptoms around infection have no statistical difference in anxiety level and general well-being after they experience the COVID-19 pandemic. However, through this study, we found some influencing factors that worth further exploration. In the future, we will expand the sample size to explore the different situation of multi-center, and we hope provide psychological nursing interventions based on existing results to offer a better delivery experience.
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Affiliation(s)
- Chunye Dai
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xuelu Wang
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Chenying Xu
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Lina Bai
- Operating Room, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Yuehong Li
- Nursing Department, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
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Erçelik ZE, Yılmaz HB. Effectiveness of infant massage on babies growth, mother-baby attachment and mothers' self-confidence: A randomized controlled trial. Infant Behav Dev 2023; 73:101897. [PMID: 37939520 DOI: 10.1016/j.infbeh.2023.101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
Infant massage is a unique massage that can be application to babies in the postpartum period for centuries. While baby massage provides contact between the baby and the mother, it supports the growth processes of the baby. This study aimed to investigate the effects of online infant massage training on infant growth, mother-infant attachment, and mothers' self-confidence. This randomized controlled clinical trial included 60 healthy-term infants and mother. The Demographic Data Collection Form, Maternal Attachment Scale, and Pharis Self-Confidence Scale were completed by all the mothers participating in the study. At the end of the 4th week, infant massage training was given to the mothers of the babies in the massage group by the primary investigator. Body weight, height, and head circumference measurements were made at the end of the 4th, 8th, 12th, 16th, and 20th week of both group babies. At the end of the 20th week, the self-confidence of the mothers in both groups was assessed using the Maternal Attachment Scale and Pharis Self-Confidence Scale. Infants in the massage group had significantly higher mean body weight at the end of the 8th week (p = 0.006) and mean height at the end of 20th week (p = 0.05) than the infants in the control group. The Maternal Attachment Scale values were higher for the mothers in the massage group (p = 0.030). Infant massage is an effective method that strengthens maternal attachment and increases body weight and height in infants. The study is registered under the ClinicalTrials.gov identifier NCT05302427.
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Affiliation(s)
- Zübeyde Ezgi Erçelik
- Bandırma Onyedi Eylül University, Faculty of Health Sciences, Nursing Department, Department of Pediatric Nursing, Bandırma, Balıkesir, Turkey.
| | - Hatice Bal Yılmaz
- Ege University, Nursing Faculty, Department of Pediatric Nursing, İzmir, Turkey.
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Yang Y, Dong Y, Li G, Yin B, Tang X, Jia L, Zhang X, Yang W, Wang C, Peng X, Zhang Y, Cao Y, Xu X. Pregnancy outcomes following natural conception and assisted reproduction treatment in women who received COVID-19 vaccination prior to conception: a population-based cohort study in China. Front Med (Lausanne) 2023; 10:1250165. [PMID: 37886353 PMCID: PMC10598612 DOI: 10.3389/fmed.2023.1250165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction The coronavirus disease-2019 (COVID-19) pandemic has swept across the world and continues to exert serious adverse effects on vulnerable populations, including pregnant women and neonates. The vaccines available at present were designed to prevent infection from COVID-19 strains and control viral spread. Although the incidence of pregnancy cycle outcomes are not likely to increase patients vaccinated prior to pregnancy compared with unvaccinated patients based on our knowledge of vaccination safety, there is no specific evidence to support this hypothesis. Therefore, the current study aimed to investigate the association between maternal vaccination prior to conception and pregnancy outcomes. Methods We retrospectively analyzed 2,614 women who received prenatal care and delivered in the Obstetrical Department of The First Affiliated Hospital of Anhui Medical University between February 2022 and November 2022. Of the 1,380 eligible pregnant women, 899 women who had received preconception vaccination were assigned to a vaccine group and 481 women who were not vaccinated were control group. Of the enrolled patients, 291 women received fertility treatment (141 vaccinated women, 150 unvaccinated women). The primary outcomes were pregnancy complications (hypothyroidism, gestational diabetes mellitus, pregnancy-induced hypertension, polyhydramnios, oligohydramnios, premature rupture of membranes and postpartum hemorrhage), obstetric outcomes (preterm birth rate, cesarean section rate) and neonatal outcomes (birth-weight, body length, low-birth-weight rate, rate of congenital defects, neonatal mortality and admission to the neonatal intensive care unit). Results There was no significant difference in the incidence of complications during pregnancy and delivery when compared between the vaccine group and control group in either univariate- or multivariate-models. The type of vaccine was not associated with the odds of adverse pregnancy outcome. Among the women with infertility treatment, the vaccinated group and the unvaccinated group had similar pregnancy outcomes. Conclusion Women who received COVID-19 vaccination prior to conception had similar maternal and neonatal outcomes as women who were unvaccinated. Our findings indicate that COVID-19 vaccinations can be safely administered prior to pregnancy in women who are planning pregnancy or assisted reproductive treatment. During new waves of COVID-19 infection, women who are planning pregnancy should be vaccinated as soon as possible to avoid subsequent infections.
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Affiliation(s)
- Yulu Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Yujie Dong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Guojing Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Biqi Yin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Department of Obstetrics and Gynecology, The Hefei First People’s Hospital, Hefei, China
| | - Xiong Tang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Liangfang Jia
- Department of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Xueke Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Wenjuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, Hefei, China
- Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs, Hefei, China
| | - Chao Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Xiaoqing Peng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
| | - Xiaofeng Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, China
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Brioschi dos Santos AP, Vicente CR, Cola JP, Tanaka LF, Garbin JRT, Dell’Antonio LS, Dell’Antonio CSDS, Miranda AE. The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil. PLoS One 2023; 18:e0290343. [PMID: 37590217 PMCID: PMC10434867 DOI: 10.1371/journal.pone.0290343] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2. METHODS This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (Sistema Nacional de Nascidos Vivos), National Mortality System (Sistema Nacional de Mortalidade), and e-SUS Health Surveillance System (Sistema e-SUS Vigilância em Saúde). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes. RESULTS We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had ≥ 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73-95% confidence interval [95%CI] 11.07-31.69), fetal death/stillbirth (RR 1.96-95%CI 1.18-3.25), preterm birth [RR 1.18-95%CI 1.01-1.39], cesarean delivery (RR 1.07-95%CI 1.02-1.11), and cesarean delivery occurring before the onset of labor (RR 1.33-95%CI 1.23-1.44). CONCLUSION COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.
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Affiliation(s)
| | - Creuza Rachel Vicente
- Departamento de Medicina, Programa de Pós-Graduação em Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - João Paulo Cola
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - Luana Fiengo Tanaka
- Department of Sport and Health Sciences, Technische Universität München, Munich, Germany
| | | | - Larissa Soares Dell’Antonio
- Núcleo Especial de Vigilância Epidemiológica, Secretaria de Estado da Saúde do Espírito Santo, Vitória, ES, Brasil
| | | | - Angelica Espinosa Miranda
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
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Shi X, Liu X, Sun Y. The Pathogenesis of Cytomegalovirus and Other Viruses Associated with Hearing Loss: Recent Updates. Viruses 2023; 15:1385. [PMID: 37376684 DOI: 10.3390/v15061385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Virus infection is one of the most common etiologies of hearing loss. Hearing loss associated with viral infection can be unilateral or bilateral, mild or severe, sudden or progressive, and permanent or recoverable. Many viruses cause hearing loss in adults and children; however, the pathogenesis of hearing loss caused by viral infection is not fully understood. This review describes cytomegalovirus, the most common virus causing hearing loss, and other reported hearing loss-related viruses. We hope to provide a detailed description of pathogenic characteristics and research progress on pathology, hearing phenotypes, possible associated mechanisms, treatment, and prevention measures. This review aims to provide diagnostic and treatment assistance to clinical workers.
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Affiliation(s)
- Xinyu Shi
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaozhou Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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10
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Chilaka VN, Navti O, Opoku A, Okunoye GO, Babarinsa I, Odukoya OA, Bako A, Sulaiman AKP, Mohan M. Managing Labour in Women with COVID-19. J Clin Med 2023; 12:3980. [PMID: 37373674 PMCID: PMC10299190 DOI: 10.3390/jcm12123980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Since first reported in December 2019 in Wuhan, China, COVID-19 caused by Severe Acute Respiratory Syndrome (SARS) Corona virus2 (SARS CoV-2) quickly spread to become a pandemic that has caused significant morbidity and mortality. The rapidity of the spread of the virus and the high mortality at the outset threatened to overwhelm health systems worldwide, and, indeed, this significantly impacted maternal health, especially since there was minimal experience to draw from. Experience with Covid 19 has grown exponentially as the unique needs of pregnant and labouring women with COVID-19 infection have become more evident. Managing COVID-19 parturients requires a multidisciplinary team consisting of anaesthesiologists, obstetricians, neonatologists, nursing staff, critical care staff, infectious disease and infection control experts. There should be a clear policy on triaging patients depending on the severity of their condition and the stage of labour. Those at high risk of respiratory failure should be managed in a tertiary referral centre with facilities for intensive care and assisted respiration. Staff and patients in delivery suites and operating rooms should be protected by enforcing infection protection principles such as offering dedicated rooms and theatres to SARS CoV-2 positive patients and using personal protective equipment. All hospital staff must be trained in infection control measures which should be updated regularly. Breastfeeding and care of the new-born must be part of the healthcare package offered to COVID-19 parturient mothers.
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Affiliation(s)
- Victor Ngozi Chilaka
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Osric Navti
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Albert Opoku
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
| | - Gbemisola O. Okunoye
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
- Sidra Medicine Qatar, Doha P.O. Box 26999, Qatar
- University of Health & Allied Sciences, Ho, Ghana
| | - Isaac Babarinsa
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Qatar University College of Medicine, Doha P.O. Box 2713, Qatar
| | | | - Abdulmalik Bako
- Hamad Medical Corporation Qatar, Doha 3050, Qatar
- Weill Cornell Medicine Doha, Doha P.O. Box 24811, Qatar
- Qatar University College of Medicine, Doha P.O. Box 2713, Qatar
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11
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Falahi S, Abdoli A, Kenarkoohi A. Maternal COVID-19 infection and the fetus: Immunological and neurological perspectives. New Microbes New Infect 2023; 53:101135. [PMID: 37143853 PMCID: PMC10133021 DOI: 10.1016/j.nmni.2023.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/02/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Abstract
Immunoneuropsychiatry is an emerging field about the interaction between the immune and nervous systems. Infection and infection-related inflammation (in addition to genetics and environmental factors) can act as the etiopathogenesis of neuropsychiatric disorders (NPDs). Exposure to COVID-19 in utero may be a risk factor for developing NPDs in offspring in the future. Maternal immune activation (MIA) and subsequent inflammation can affect fetal brain development. Inflammatory mediators, cytokines, and autoantibodies can pass through the placenta and the compromised blood-brain barrier after MIA, leading to neuroinflammation. Neuroinflammation also affects multiple neurobiological pathways; for example, it decreases the production of the neurotransmitter serotonin. Fetal sex may affect the mother's immune response. Pregnant women with male fetuses have been reported to have decreased maternal and placental humoral responses. This suggests that in pregnancies with a male fetus, fewer antibodies may be transferred to the fetus and contribute to males' increased susceptibility/vulnerability to infectious diseases compared to female infants. Here, we want to discuss maternal COVID-19 infection and its consequences for the fetus, particularly the neurological outcomes and the interaction between fetal sex and possible changes in maternal immune responses.
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Affiliation(s)
- Shahab Falahi
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Amir Abdoli
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Azra Kenarkoohi
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
- Department of Laboratory Sciences, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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12
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Charuta A, Smuniewska M, Woźniak Z, Paziewska A. Effect of COVID-19 on Pregnancy and Neonate's Vital Parameters: A Systematic Review. J Pregnancy 2023; 2023:3015072. [PMID: 37215313 PMCID: PMC10199793 DOI: 10.1155/2023/3015072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023] Open
Abstract
Background COVID-19 is a new pandemic, which was declared by the World Health Organization in 2019 as a threat to public health. According to numerous reports, it can have negative consequences for pregnant women, labour, and neonates born to infected mothers. The aim of this paper was to gather the evidence and to present a summary of the results of studies concerning COVID-19 in pregnant women and their neonates. Methods Articles from prestigious journals covering the period from 2020 to February 2023, relevant review papers, and original research articles from PubMed were analysed. In order to analyse the available research literature, the Web of Science, Scopus, and PubMed databases were used, in which the search for articles was conducted using terms ("pregnancy," "coronavirus," "SARS-CoV-2," and "newborn") and using PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis) guidelines for clinical trials. Meta-analyses and systematic reviews (2022-2023) on symptoms, neonatal course, and risk of COVID-19 infection have been summarized. Summary of meta-analyses and systematic reviews (2022-2023) on the effect and adverse reaction of the COVID-19 vaccination is presented. Results As a result of the research conducted, it was confirmed that in most pregnant women, no serious signs of the infection were observed, although isolated cases of death related to COVID-19 in pregnant women were reported. Several authors called attention to the more severe course of the infection in pregnant women with obesity. It seemed that no vertical transmission from mother to child was occurring. Nevertheless, the information was not clinching. The condition of the neonates born to mothers with COVID-19 was in most cases described as normal; however, some papers reported deaths of infected neonates. Conclusions Due to insufficient data, further research is necessary. Further studies and follow-up are recommended, which would make possible an assessment of remote effects of COVID-19 on pregnancy and vital parameters of the newborn.
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Affiliation(s)
- Anna Charuta
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Poland
| | - Monika Smuniewska
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Mazowiecki Provincial Hospital in Siedlce Named after Saint John Paul II in Siedlce, Poland
| | - Zofia Woźniak
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Independent Public Health Care Center in Sokołów Podlaski, Poland
| | - Agnieszka Paziewska
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Poland
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13
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Thahir AIA, Nasir S, J Holmes A, Li M, Gordon A. Mothers' and Midwives' Experiences of Maternal and Child Health Services during the COVID-19 Pandemic in Banggai, Indonesia: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:96-109. [PMID: 37114096 PMCID: PMC10126445 DOI: 10.30476/ijcbnm.2023.97114.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 04/29/2023]
Abstract
Background Maternal and child health (MCH) services have been affected by the Coronavirus disease (COVID-19) pandemic in all countries, including Indonesia. Information regarding the impact of COVID-19 on MCH service access and provision is limited, particularly in the context of rural Indonesian communities. This study aimed to explore the experiences of Indonesian mothers and midwives from a rural regency regarding MCH services delivery during the pandemic. Methods This study was a sub-study of a pre-existing cohort study conducted in four sub-districts in Banggai, Indonesia, as the qualitative research. This study was conducted from November 2020 to April 2021, involving 21 mothers and six midwives. We selected the participants using snowball sampling. In-depth interviews were conducted in Bahasa. The study used both deductive and inductive approaches for analysis. Data analysis was performed using NVivo v.12. Results The study identified three themes and eight sub-themes from the analysis incorporating the midwives' and mothers' data. The themes included health service change, perceived barriers to service delivery, and family impact. This study highlights health service changes due to the pandemic, such as relocating the MCH services. Mothers perceived barriers to accessing health services, including distance reasons and fear of COVID-19. Only the shortages of staff affected the midwives in providing optimal services. Conclusion The pandemic triggered health service changes and caused some barriers to service delivery. This study recommends that the local government and stakeholders should pay more attention to the health service changes according to the mothers' experiences and address barriers to optimize access to MCH services during the pandemic.
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Affiliation(s)
- Andi Imam Arundhana Thahir
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Nutrition, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Sudirman Nasir
- Department of Health Promotion, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Andrew J Holmes
- School of Life and Environmental Sciences, Faculty of Science, the University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, NSW, Australia
| | - Mu Li
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, Australia
| | - Adrienne Gordon
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- RPA Newborn Care, Sydney Local Health District, Sydney, NSW, Australia
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14
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Akgül F, Tüzer C, Arslan Y, Sevim B. COVID-19 infection during pregnancy: A retrospective study in a city in the Southeastern region of Turkey. Saudi Med J 2023; 44:268-276. [PMID: 36940972 PMCID: PMC10043889 DOI: 10.15537/smj.2023.44.3.20220729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/10/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES To evaluate the maternal and fetal clinical outcomes in SARS-CoV-2 infected pregnant women during the whole period of the pandemic in a single province in the southeast of Turkey. METHODS This retrospective study included patients who were screened from the medical registration system and found to be infected with SARS-CoV-2 virus during pregnancy. The demographic, clinical, laboratory, and radiological features of all the patients were obtained and compared between groups classified as severe-critical and mild-moderate disease severity. RESULTS The mean age of all the cases was 29.0±5.3 years in the mild-moderate cases, and 30.1±5.5 years in the severe-critical cases. The rates of 3rd trimester, cesarean and premature birth, high body mass index (BMI), symptoms of cough and dyspnea, the presence of comorbidities, and hypothyroidism were significantly higher in the severe-critical cases than in the mild-moderate group. In the univariate analyses, BMI, dyspnea, cough, maternal complication rate, the neutrophil/lymphocyte ratio, the values of white blood cells, procalcitonin, high-sensitive C-reactive protein, D-dimer, ferritin, aspartate aminotransferase, and alanine aminotransferase were detected as significant risk factors. In the multivariate analysis, only procalcitonin was a significant factor. CONCLUSION In the 3rd trimester of pregnancy, obesity and hypothyroidism were found to be risk factors for severe-critical cases of COVID-19 infection, and the clinical course was more severe with a higher rate of mortality in the recent period of the pandemic.
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Affiliation(s)
- Fethiye Akgül
- From the Department of Infectious Diseases and Clinical Microbiology (Akgül, Arslan); from the Department of Allergy and Immunology (Tüzer), Batman Training and Research Hospital, and from the TR Ministry of Health (Sevim), Batman Provincial Health Directorate, Batman, Turkey.
| | - Can Tüzer
- From the Department of Infectious Diseases and Clinical Microbiology (Akgül, Arslan); from the Department of Allergy and Immunology (Tüzer), Batman Training and Research Hospital, and from the TR Ministry of Health (Sevim), Batman Provincial Health Directorate, Batman, Turkey.
| | - Yusuf Arslan
- From the Department of Infectious Diseases and Clinical Microbiology (Akgül, Arslan); from the Department of Allergy and Immunology (Tüzer), Batman Training and Research Hospital, and from the TR Ministry of Health (Sevim), Batman Provincial Health Directorate, Batman, Turkey.
| | - Bünyamin Sevim
- From the Department of Infectious Diseases and Clinical Microbiology (Akgül, Arslan); from the Department of Allergy and Immunology (Tüzer), Batman Training and Research Hospital, and from the TR Ministry of Health (Sevim), Batman Provincial Health Directorate, Batman, Turkey.
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15
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Massimo M, Barelli C, Moreno C, Collesi C, Holloway RK, Crespo B, Zentilin L, Williams A, Miron VE, Giacca M, Long KR. Haemorrhage of human foetal cortex associated with SARS-CoV-2 infection. Brain 2023; 146:1175-1185. [PMID: 36642091 PMCID: PMC9976976 DOI: 10.1093/brain/awac372] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 09/19/2022] [Indexed: 01/17/2023] Open
Abstract
Maternal viral infection and immune response are known to increase the risk of altered development of the foetal brain. Given the ongoing global pandemic of coronavirus disease 2019 (COVID-19), investigating the impact of SARS-CoV-2 on foetal brain health is of critical importance. Here, we report the presence of SARS-CoV-2 in first and second trimester foetal brain tissue in association with cortical haemorrhages. SARS-CoV-2 spike protein was sparsely detected within progenitors and neurons of the cortex itself, but was abundant in the choroid plexus of haemorrhagic samples. SARS-CoV-2 was also sparsely detected in placenta, amnion and umbilical cord tissues. Cortical haemorrhages were linked to a reduction in blood vessel integrity and an increase in immune cell infiltration into the foetal brain. Our findings indicate that SARS-CoV-2 infection may affect the foetal brain during early gestation and highlight the need for further study of its impact on subsequent neurological development.
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Affiliation(s)
- Marco Massimo
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Carlotta Barelli
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Catalina Moreno
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Chiara Collesi
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34139 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Rebecca K Holloway
- Centre for Discovery Brain Sciences, Chancellor’s Building, The University of Edinburgh, Edinburgh, UK
- Dementia Research Institute at The University of Edinburgh, Edinburgh, UK
- Medical Research Council Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Barlo Multiple Sclerosis Centre and Keenan Research Institute for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Berta Crespo
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Lorena Zentilin
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34139 Trieste, Italy
| | - Anna Williams
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK
| | - Veronique E Miron
- Centre for Discovery Brain Sciences, Chancellor’s Building, The University of Edinburgh, Edinburgh, UK
- Dementia Research Institute at The University of Edinburgh, Edinburgh, UK
- Medical Research Council Centre for Reproductive Health, The Queen’s Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Barlo Multiple Sclerosis Centre and Keenan Research Institute for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Mauro Giacca
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34139 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, King’s College London, London, UK
| | - Katherine R Long
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
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16
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Pinheiro FR, Rozza-de-Menezes RE, Blum MC, Pereira RFA, Rocha JA, Guedes Pinto MCF, Penna BA, Riley LW, Aguiar-Alves F. Evaluation of changes in antimicrobial susceptibility in bacteria infecting children and their mothers in pediatric, neonatal-intensive care unit, and gynecology/obstetrics wards of a quaternary referral hospital during the COVID-19 pandemic. Front Microbiol 2023; 14:1096223. [PMID: 36891399 PMCID: PMC9986255 DOI: 10.3389/fmicb.2023.1096223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023] Open
Abstract
The World Health Organization released a statement warning of increased risk for the incidence of multidrug resistant microorganisms and the absence of new drugs to control such infections soon. Since the beginning of the COVID-19 pandemic, the prescription of antimicrobial agents has increased and may have accelerated the emergence of multidrug resistant (MDR) bacteria. This study aimed to evaluate maternal and pediatric infections within a hospital from January 2019 to December 2021. An observational retrospective cohort study was performed at a quaternary referral hospital in a metropolitan area of Niteroi city, Rio de Janeiro state, Brazil. A total of 196 patients' medical records were analyzed. The data from 90 (45.9%) patients were collected before the SARS-CoV-2 pandemic, 29 (14.8%) from the 2020 pandemic period, and 77 (39.3%) from the 2021 pandemic period. A total of 256 microorganisms were identified during this period. Out of those, 101 (39.5%) were isolated in 2019, 51 (19.9%) in 2020, and 104 (40.6%) in 2021. Antimicrobial susceptibility tests were performed on 196 (76.6%) clinical isolates. The exact binomial test showed that the distribution of Gram-negative bacteria was predominant. The most common microorganism was Escherichia coli (23%; n = 45), followed by Staphylococcus aureus (17.9%, n = 35), Klebsiella pneumoniae (12.8%, n = 25), Enterococcus faecalis (7.7%, n = 15), Staphylococcus epidermidis (6.6%, n = 13) and Pseudomonas aeruginosa (5.6%, n = 11). Staphylococcus aureus was the predominant species among resistant bacteria. Among the antimicrobial agents tested, the following were resistant, presented on a descending scale: penicillin (72.7%, p = 0.001, Binomial test), oxacillin (68.3%, p = 0.006, Binomial test), ampicillin (64.3%, p = 0.003, Binomial test), and ampicillin/sulbactam (54.9%, p = 0.57, Binomial test). Infections with S. aureus were 3.1 times greater in pediatrics and maternal units than in other hospital wards. Despite the global reduction in the incidence of MRSA, we observed an increase in MDR S. aureus in this study. No changes were observed in the frequency of resistance profiles of the clinical isolates after the establishment of the global SARS-CoV-2 pandemic. More comprehensive studies are needed to understand the impact of the global SARS-CoV-2 pandemic on the resistance levels of bacteria associated with neonate and pediatric patients.
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Affiliation(s)
- Felipe Ramos Pinheiro
- Molecular Epidemiology and Biotechnology Laboratory, School of Pharmacy, Fluminense Federal University, Niteroi, Brazil.,Pathology Post Graduate Program, School of Medicine, Fluminense Federal University, Niteroi, Brazil
| | | | - Marina Camille Blum
- Division of Health and Social Behavior, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Renata Freire Alves Pereira
- Molecular Epidemiology and Biotechnology Laboratory, School of Pharmacy, Fluminense Federal University, Niteroi, Brazil.,Applied Microbiology and Parasitology Post Graduate Programs, Fluminense Federal University, Niteroi, Brazil
| | - Jaqueline Abel Rocha
- Epidemiological Surveillance Unit, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, Brazil
| | - Maria Cristina F Guedes Pinto
- Epidemiological Surveillance Unit, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, Brazil
| | - Bruno A Penna
- Gram-Positive Cocci Laboratory, Biomedical Institute Fluminense Federal University, Niteroi, Brazil
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Fabio Aguiar-Alves
- Pathology Post Graduate Program, School of Medicine, Fluminense Federal University, Niteroi, Brazil.,Applied Microbiology and Parasitology Post Graduate Programs, Fluminense Federal University, Niteroi, Brazil.,Department of Pharmaceutical Sciences, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, United States
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17
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Sobkowski M, Pięta B, Sowińska A, Grabowska M, Koch-Brzozowska K, Wilczak M, Bień A. SARS-CoV-2 in Pregnancy-A Retrospective Analysis of Selected Maternal and Fetal Laboratory Parameters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15307. [PMID: 36430023 PMCID: PMC9690975 DOI: 10.3390/ijerph192215307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Pregnant women and their neonates belong to the group of individuals with elevated risk for COVID-19 infection. Data on the course of the disease and how it affects the pregnancy and neonatal wellbeing remain conflicting. The aim of the study was to evaluate the effect of SARS CoV-2 infection on the mode of delivery, neonatal condition and selected maternal and fetal laboratory parameters. This was a single-center retrospective case-control study. This dataset was generated using electronic medical records collected by medical personnel. Two groups of patients, hospitalized between April, 2020 and February, 2021, were included in the study: study group (304)-pregnant women with SARS-CoV-2 and control group (N = 329)-healthy pregnant women or parturients. Mothers with a severe course of COVID-19 had higher activated partial thromboplastin-APTT (p = 0.02), C-Reactive Protein-CRP (p = 0.00) and procalcitonin (p = 0.032) levels as compared to pregnant women with mild or moderate course of the disease. Neonates born to SARS-CoV-2-infected mothers presented with worse condition at 1 and 5 minutes of life (p = 0.000 and 0.00, respectively) and lower Arterial Blood Gas-ABG pH scores (p = 0.016). Elective cesarean section is the most common mode of delivery for SARS-CoV2-infected mothers. Emergency cesarean sections are performed at earlier gestational age as compared to vaginal delivery and elective cesarean section. Lower Apgar scores were observed in neonates born to SARS-CoV-2-infected mothers who required oxygen therapy and whose procalcitonin levels were elevated. There is a relationship between more severe course of COVID-19 and APTT, as well as CRP and procalcitonin levels.
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Affiliation(s)
- Maciej Sobkowski
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Beata Pięta
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Anna Sowińska
- Department of Informatics and Statistics, University of Medical Sciences, Rokietnicka Street 7, 60-806 Poznań, Poland
| | - Marlena Grabowska
- Gynecological and Obstetric Hospital of the University of Medical Sciences in Poznan, Polna Street 33, 60-535 Poznań, Poland
| | | | - Maciej Wilczak
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4/6 Staszica St., 20-081 Lublin, Poland
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18
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Su X, Lu H, Li X, Luo M, Li F, Zhang Q. COVID-19 vaccine hesitancy in periconceptional and lactating women: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e059514. [PMID: 36343993 PMCID: PMC9644077 DOI: 10.1136/bmjopen-2021-059514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The pandemic of COVID-19 disease has caused severe impact globally. Governments consider vaccination as an effective measure to control pandemic. However, many people have been hesitant to receive COVID-19 vaccine, particularly periconceptional and lactating women. Although research has indicated that pregnant women with COVID-19 are at a higher risk of adverse pregnancy and birth outcomes, as well as severe illness. There appears to be a lack of systematic and comprehensive evidence of the prevalence and determinants of COVID-19 vaccine hesitancy among periconceptional and lactating women. As a result, it has been essential to investigate periconceptional and lactating women's vaccination views and behaviours. This study will review articles on vaccine hesitancy among periconceptional and lactating women to assess the impact of the COVID-19 vaccine hesitancy during the pandemic. METHODS AND ANALYSIS We will systematically search observational studies from 1 November 2019 to 30 October 2021 in the following databases: Web of Science, PubMed, EMBASE, MEDLINE, Cochrane Library, EBSCO, WHO COVID-19 Database, CNKI and WanFang Database. The following medical subject headings and free-text terms will be used: "COVID-19 vaccines" AND "female" AND "vaccine hesitancy". Eligibility criteria are as follows: population (women of reproductive age); exposure (currently pregnant, lactational or trying to get pregnant); comparison (general women who are not in preconception, gestation or lactation) and outcome (the rate of COVID-19 vaccine hesitancy). Article screening and data extraction will be undertaken independently by two reviewers, and any discrepancy will be resolved through discussion. We will use I2 statistics to assess heterogeneity and perform a meta-analysis when sufficiently homogeneous studies are provided. We will explore the potential sources of heterogeneity using subgroup and meta-regression analysis. ETHICS AND DISSEMINATION This study will use published data, so ethical approval is not required. The findings will be disseminated by publication in peer-reviewed journal(s). PROSPERO REGISTRATION NUMBER CRD42021257511.
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Affiliation(s)
- Xianzhi Su
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Hua Lu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Xinyun Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- Student Affairs Department, Sichuan University, Chengdu, People's Republic of China
| | - Mingli Luo
- Chengfei Community Healthcare Center, Genertec Medical Chengfei Hospital, Chengdu, People's Republic of China
| | - Fangyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qi Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- The First Affiliated Hospital of Henan University of CM, Zhengzhou, People's Republic of China
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19
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Patel BM, Khanna D, Khanna S, Hapshy V, Khanna P, Kahar P, Parmar MS. Effects of COVID-19 on Pregnant Women and Newborns: A Review. Cureus 2022; 14:e30555. [DOI: 10.7759/cureus.30555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
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20
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Carneiro ICR, Feronato SG, Silveira GF, Chiavegatto Filho ADP, dos Santos HG. Clusters of Pregnant Women with Severe Acute Respiratory Syndrome Due to COVID-19: An Unsupervised Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13522. [PMID: 36294103 PMCID: PMC9603349 DOI: 10.3390/ijerph192013522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has been widely explored in relation to its symptoms, outcomes, and risk profiles for the severe form of the disease. Our aim was to identify clusters of pregnant and postpartum women with severe acute respiratory syndrome (SARS) due to COVID-19 by analyzing data available in the Influenza Epidemiological Surveillance Information System of Brazil (SIVEP-Gripe) between March 2020 and August 2021. The study's population comprised 16,409 women aged between 10 and 49 years old. Multiple correspondence analyses were performed to summarize information from 28 variables related to symptoms, comorbidities, and hospital characteristics into a set of continuous principal components (PCs). The population was segmented into three clusters based on an agglomerative hierarchical cluster analysis applied to the first 10 PCs. Cluster 1 had a higher frequency of younger women without comorbidities and with flu-like symptoms; cluster 2 was represented by women who reported mainly ageusia and anosmia; cluster 3 grouped older women with the highest frequencies of comorbidities and poor outcomes. The defined clusters revealed different levels of disease severity, which can contribute to the initial risk assessment of the patient, assisting the referral of these women to health services with an appropriate level of complexity.
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21
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Giuliani F, Oros D, Gunier RB, Deantoni S, Rauch S, Casale R, Nieto R, Bertino E, Rego A, Menis C, Gravett MG, Candiani M, Deruelle P, García-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Napolitano R, Liu B, Prefumo F, Savasi V, Do Vale MS, Baafi E, Ariff S, Maiz N, Aminu MB, Cardona-Perez JA, Craik R, Tavchioska G, Bako B, Benski C, Hassan-Hanga F, Savorani M, Sentilhes L, Carola Capelli M, Takahashi K, Vecchiarelli C, Ikenoue S, Thiruvengadam R, Soto Conti CP, Cetin I, Nachinab VB, Ernawati E, Duro EA, Kholin A, Teji JS, Easter SR, Salomon LJ, Ayede AI, Cerbo RM, Agyeman-Duah J, Roggero P, Eskenazi B, Langer A, Bhutta ZA, Kennedy SH, Papageorghiou AT, Villar J. Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study. Am J Obstet Gynecol 2022; 227:488.e1-488.e17. [PMID: 35452653 PMCID: PMC9017081 DOI: 10.1016/j.ajog.2022.04.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. OBJECTIVE To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. STUDY DESIGN In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. RESULTS A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2-9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. CONCLUSION In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.
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Affiliation(s)
- Francesca Giuliani
- Neonatal Special Care Unit, Regina Margherita Children's Hospital, Turin, Italy.
| | - Daniel Oros
- Aragon Institute of Health Research, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Robert B. Gunier
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Sonia Deantoni
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom,Neonatal Care Unit, School of Medicine, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Stephen Rauch
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
| | - Enrico Bertino
- Neonatal Unit of the University, City of Health and Science of Turin, Turin, Italy
| | - Albertina Rego
- Departamento de Pediatria, Faculdade Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camilla Menis
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michael G. Gravett
- Departments of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, WA
| | - Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Sherief Abd-Elsalam
- Faculty of Medicine, Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Becky Liu
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valeria Savasi
- Ospedale Luigi Sacco University Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | | | - Shabina Ariff
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Nerea Maiz
- Department of Obstetrics, Hospital Universitari Vall d’Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Rachel Craik
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Gabriela Tavchioska
- Department of Pediatrics, General Hospital Borka Taleski, Prilep, Republic of North Macedonia
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Caroline Benski
- Hôpitaux Universitaires de Genève, Département de la Femme, de l'Enfant et de l'Adolescent, Geneva, Switzerland
| | - Fatimah Hassan-Hanga
- Bayero University Kano, Nigeria,Aminu Kano Teaching Hospital, Kano State, Nigeria
| | | | - Loïc Sentilhes
- Department of Obstetrics and Gynecology Bordeaux University Hospital, Bordeaux, France
| | - Maria Carola Capelli
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Irene Cetin
- Ospedale Vittore Buzzi Children's Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Ernawati Ernawati
- Department of Obstetrics & Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia,Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eduardo A. Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina,Universidad de Moron, Moron, Argentina
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Jagjit Singh Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine and Division of Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Laurent J. Salomon
- Hôpital Universitaire Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Université de Paris, France
| | - Adejumoke Idowu Ayede
- College of Medicine, University of Ibadan, Ibadan, Nigeria,University College Hospital, Ibadan, Nigeria
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Josephine Agyeman-Duah
- Nuffield Department of Women's & Reproductive Health, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Zulfiqar A. Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom,St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jose Villar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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22
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Vásquez-Procopio J, Espejel-Nuñez A, Torres-Torres J, Martinez-Portilla RJ, Espino Y. Sosa S, Mateu-Rogell P, Ortega-Castillo V, Tolentino-Dolores M, Perichart-Perera O, Franco-Gallardo JO, Carranco-Martínez JA, Prieto-Rodríguez S, Guzmán-Huerta M, Missirlis F, Estrada-Gutierrez G. Inflammatory-Metal Profile as a Hallmark for COVID-19 Severity During Pregnancy. Front Cell Dev Biol 2022; 10:935363. [PMID: 36016660 PMCID: PMC9395991 DOI: 10.3389/fcell.2022.935363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/14/2022] [Indexed: 01/10/2023] Open
Abstract
Pregnancy makes women more susceptible to infectious agents; however, available data on the effect of SARS-CoV-2 on pregnant women are limited. To date, inflammatory responses and changes in serum metal concentration have been reported in COVID-19 patients, but few associations between metal ions and cytokines have been described. The aim of this study was to evaluate correlations between inflammatory markers and serum metal ions in third-trimester pregnant women with varying COVID-19 disease severity. Patients with severe symptoms had increased concentrations of serum magnesium, copper, and calcium ions and decreased concentrations of iron, zinc, and sodium ions. Potassium ions were unaffected. Pro-inflammatory cytokines IL-6, TNF-α, IL-8, IL-1α, anti-inflammatory cytokine IL-4, and the IP-10 chemokine were induced in the severe presentation of COVID-19 during pregnancy. Robust negative correlations between iron/magnesium and zinc/IL-6, and a positive correlation between copper/IP-10 were observed in pregnant women with the severe form of the disease. Thus, coordinated alterations of serum metal ions and inflammatory markers – suggestive of underlying pathophysiological interactions—occur during SARS-CoV-2 infection in pregnancy.
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Affiliation(s)
- Johana Vásquez-Procopio
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Mexico City, Mexico
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
| | - Aurora Espejel-Nuñez
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | | | | | - Paloma Mateu-Rogell
- Clinical Research Division, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | | | - Otilia Perichart-Perera
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | | | | | - Mario Guzmán-Huerta
- Department of Translational Medicine, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Fanis Missirlis
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
- *Correspondence: Guadalupe Estrada-Gutierrez, ; Fanis Missirlis,
| | - Guadalupe Estrada-Gutierrez
- Research Division, Instituto Nacional de Perinatología, Mexico City, Mexico
- *Correspondence: Guadalupe Estrada-Gutierrez, ; Fanis Missirlis,
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23
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Mild or Moderate COVID-19 during Pregnancy Does Not Affect the Content of CD34+ Hematopoietic Stem Cells in Umbilical Cord Blood of Newborns. Bull Exp Biol Med 2022; 173:523-528. [PMID: 36063300 PMCID: PMC9441840 DOI: 10.1007/s10517-022-05575-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Indexed: 11/29/2022]
Abstract
The study included umbilical cord blood samples (n=64) intended for cryogenic storage of hematopoietic stem cells and obtained from patients with a history of mild and moderate forms of COVID-19 during pregnancy. The control group was composed of samples (n=746) obtained from healthy women in labor. A comparative analysis of the volume of cord blood collected, the total leukocyte count, the relative and absolute content of cells with the CD34+/CD45+ phenotype revealed no significant differences between the groups.
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24
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Leung C, Simões e Silva AC, Oliveira EA. Are in-hospital COVID-19-related mortality and morbidity in pregnancy associated with gestational age? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:234-242. [PMID: 35502537 PMCID: PMC9347440 DOI: 10.1002/uog.24931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pregnancy involves dynamic changes in the maternal immune system, thus potentially affecting women's response to infection. The aim of this study was to investigate whether gestational age at the time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with mortality and morbidity related to coronavirus disease 2019 (COVID-19) in hospitalized pregnant women. METHODS This was a cohort study of pregnant women with confirmed SARS-CoV-2 infection at any gestational age (categorized into trimesters) who were hospitalized in Brazil from February 2020 to November 2021. Sociodemographic and epidemiological characteristics, signs and symptoms, comorbidities, interventions, vaccination status and type of healthcare establishment were obtained from a nationwide database. Multivariate logistic and Cox regression analyses were used to identify independent risk factors for in-hospital COVID-19-related mortality and morbidity (defined as time from hospital admission to recovery). RESULTS A total of 7461 SARS-CoV-2-infected pregnant women were included in the study (9.3%, 28.4% and 62.3% in the first, second and third trimesters, respectively). After adjustment for sociodemographic, epidemiological and clinical characteristics, and intervention-related variables, gestational age at infection was found not to be associated with COVID-19-related mortality and morbidity. Women admitted to establishments with an obstetric center, compared to hospitals without, were 38% less likely to die from SARS-CoV-2 infection (adjusted odds ratio, 0.62; 95% CI, 0.48-0.80), while patients who received private not-for-profit healthcare had a 13% shorter time to recovery (adjusted hazard ratio, 1.13; 95% CI, 1.07-1.20) compared to those who received public healthcare. CONCLUSIONS Despite a higher percentage of women being admitted in the third trimester, we found no association between gestational age and COVID-19 mortality and morbidity. The previously reported increase in morbidity and mortality in the third trimester in pregnant women with COVID-19 may be attributable to other gestational-age-affected variables for which adjustment was made in our study. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Leung
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
- Deakin UniversityBurwoodVictoriaAustralia
| | - A. C. Simões e Silva
- Department of Pediatrics, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
| | - E. A. Oliveira
- Department of Pediatrics, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
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25
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Twanow JDE, McCabe C, Ream MA. The COVID-19 Pandemic and Pregnancy: Impact on Mothers and Newborns. Semin Pediatr Neurol 2022; 42:100977. [PMID: 35868726 PMCID: PMC9122838 DOI: 10.1016/j.spen.2022.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has markedly, and likely permanently, changed health care. This includes changing the obstetric and perinatal care of mothers and infants, and by extension, the care of their families. Infection during pregnancy is associated with an increased risk for severe coronavirus disease 2019 illness and related complications that can significantly impact maternal health and the health of the neonate. Viral transmission from mother to fetus is possible, but rare during pregnancy, and current health care policies focusing on maternal masking, and hand washing allows infected mothers to safely care for neonates (including nursing or feeding with expressed breast milk). The newly developed vaccines have been shown to be safe and effective for pregnant and breast-feeding mothers, with measurable antibody levels in cord blood and breast milk potentially providing a level of passive immunity to neonates. While studies looking at short-term outcomes for neonates have been reassuring, it is critical that we continue to work to understand and improve the care of pregnant woman and newborns with coronavirus disease 2019 to optimize long term outcomes. Although the knowledge base continues to evolve, the available evidence influencing the care of pregnant women and their infants is summarized in this focused review.
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Affiliation(s)
- Jaime-Dawn E. Twanow
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH,Address reprint requests to Jaime-Dawn E. Twanow, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Corinne McCabe
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH
| | - Margie A. Ream
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH
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26
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Turgut E, Sakcak B, Uyan Hendem D, Oluklu D, Goncu Ayhan S, Sahin D. Decreased fetal cardiac output in pregnant women with severe SARS-Cov-2 infection. Echocardiography 2022; 39:803-810. [PMID: 35596234 PMCID: PMC9347908 DOI: 10.1111/echo.15367] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/16/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022] Open
Abstract
AIM We aimed to examine fetal cardiac output (CO) in patients who recovered from severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. MATERIALS This prospective study included 48 pregnant women recovered from SARS-CoV-2 infection and 50 control cases. SARS-CoV-2 infection was diagnosed by polymerase chain reaction (PCR) test in patients. Fetal echocardiographic evaluations were performed at 24-37 weeks of gestation in pregnant women who recovered from the infection and control group. RESULTS The median value of ultrasound evaluation was 34 (2.6) weeks of gestation in the recovery from the SARS-CoV-2 infection (RSI) group, and 32 (7.6) weeks in the control group (p = .565). Left cardiac output (LCO) z score was significantly lower in the RSI group than the control group (p = .041). LCO and combine cardiac output (CCO) z score were significantly lower in the severe disease group than mild, moderate disease groups, and controls (p = .019 and p = .013). CCO (ml/min/kg) was decreased in the severe disease group when compared with control and mild disease groups (p = .044). CONCLUSION In the present study, fetal cardiac output in pregnant women who recovered from SARS-CoV-2 infection was found to be significantly reduced in those with severe disease, while there was no significant difference in mild and moderate cases. Placental dysfunction and inflammatory cytokines might cause fetal cardiac changes. Further studies could be clarified on the impact of SARS-CoV-2 infection on fetal cardiac function.
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Affiliation(s)
- Ezgi Turgut
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, ANKARA, Turkey
| | - Bedri Sakcak
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, ANKARA, Turkey
| | - Derya Uyan Hendem
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, ANKARA, Turkey
| | - Deniz Oluklu
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, ANKARA, Turkey
| | - Sule Goncu Ayhan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, ANKARA, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, ANKARA, Turkey
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Hanley S, Raybould G, Baxter E, Gray J, Sharkey D, Walker KF. Maternity services response to the COVID-19 pandemic: how Public Health England guidance was implemented in practice. J Hosp Infect 2022; 129:214-218. [PMID: 35584730 PMCID: PMC9107387 DOI: 10.1016/j.jhin.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
Introduction The rapidly evolving COVID-19 pandemic required systemic change in how healthcare was delivered to minimize virus transmission whilst maintaining safe service delivery. Deemed at ‘moderate-high risk’, maternity patients are an important patient group that require consideration. Public Health England (PHE) issued national guidance on how to adjust these services. Aim To explore how maternity units in England implemented PHE guidance. Methods An online survey of 22 items was distributed to individuals that had worked on an England-based maternity unit during the COVID-19 pandemic. The questionnaire was designed and tested by the multidisciplinary research team. Data was collected from November 2020 to July 2021. Findings Forty-four participants across 33 maternity units responded. Ninety-three percent were able to test all women requiring an overnight stay for COVID-19. Only 27% reported birth partners were tested for COVID-19. Only 73% reported they were able to isolate all COVID-19-positive patients in single rooms. Eighty-four percent stated they were aware of current PHE guidance on personal protective equipment (PPE) and 82% felt ‘confident’ in donning/doffing of PPE. Priorities for the future include rapid testing and a focus on community service provision. Conclusions PHE COVID-19 guidance was implemented differently in maternity units across England due to the varying resources available at each trust leading to variable ability to test and isolate patients as recommended. More specific, tailored guidance for infection control measures against COVID-19 is needed for maternity settings due to their unique position.
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Affiliation(s)
- S Hanley
- University of Nottingham, Nottingham, UK
| | - G Raybould
- University of Nottingham, Nottingham, UK.
| | - E Baxter
- University of Nottingham, Nottingham, UK
| | - J Gray
- University of Nottingham, Nottingham, UK
| | - D Sharkey
- University of Nottingham, Nottingham, UK
| | - K F Walker
- University of Nottingham, Nottingham, UK
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Kosovali BD, Tezcan B, Mutlu NM. Effects of SARS-CoV-2 Variants on Maternal Infection and Severity: A Single-Center Experience. Cureus 2022; 14:e24201. [PMID: 35592191 PMCID: PMC9112371 DOI: 10.7759/cureus.24201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims Pregnant women are one of the vulnerable groups affected by COVID-19. With the mutation of the virus, the severity of the disease in this vulnerable group may vary in different waves of COVID-19 subtypes. The aim of this study is to define the demographic, clinical, laboratory, and mortality results of pregnant COVID-19 patients according to three time frames (March to December 2020, January to June 2021, and July to November 2021). Materials and methods The data of patients admitted to the ICU between March 23, 2020, and November 30, 2021, were retrospectively scanned. Pregnant patients with SARS-CoV-2 PCR test positivity or pregnant patients with COVID-19 who have a negative PCR test but symptoms of COVID-19 and radiological findings consistent with COVID-19 on thorax CT who need intensive care were included in the study. The patients were divided into three groups according to the dates when the Ministry of Health of the Republic of Turkey reported the variants of COVID-19 in Turkey. The nonvariant type was dominant in the first period (March to December 2020), alpha and beta variants were dominant in the second period (January to June 2021), and the delta variant appeared in the last period (July to November 2021). Demographic, clinical, and laboratory findings at the first admission to the ICU and mortality rates of the patients were recorded. Results PCR test was performed in all 109 patients, of whom 101 were PCR test positive. In other eight patients, despite the negative PCR test, thorax CT findings were typical of COVID-19 pneumonia, and other bacterial and viral agents were also excluded. The mean age of the patients was 30.53 years, the mean APACHE II score was 9.68, and the mean gestational age was 28.55 weeks. Around 72.5% of the patients were in the third trimester. Of the 101 PCR-positive patients, 20.2% were delta variants, 16.5% alpha or beta variants, and 63.3% were of unknown variants. Five of the patients were vaccinated. The most common symptom was dyspnea (94.5%), and the most common comorbidity was hypothyroidism (9.17%). Invasive mechanical ventilation (IMV) was needed in 44.95% of pregnant patients. The distribution of pregnant patients admitted to the ICU according to the periods March to December 2020, January to June 2021, and July to November 2021 was 16.5%, 21.1%, and 62.4%, respectively (p<0.001). Two groups of patients were compared: those that survived versus those that deceased. Variables predicting mortality were APACHE score, IMV requirement, length of stay in the ICU, prone positioning, Anakinra treatment, and ECMO (extracorporeal membrane oxygenator) requirement, which were significantly higher in the deceased group than in the living group (p<0.001, p<0.001, p=0.001, p<0.001, p<0.001, and p=0.001, respectively). There was no significant difference between the patients' age, gestational age, variants, treatments other than Anakinra, and the number of patients admitted to the ICU in the three periods (p=0.667, p=0.174, p=0.904, and p=0.605, respectively).In the multiple logistic regression analysis for mortality, high APACHE II score and IMV requirement were found as risk factors for mortality. Conclusion In the last period of delta variant predominance, pregnant COVID-19 patients were admitted to the ICU significantly more frequently than in the first two periods. Mechanical ventilation requirement and high APACHE II score were determined as risk factors for mortality.
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He Y, Wong YWY, Ngeow AJH, Sim EY, Cherng BPZ, Arunachalam S, Ho SKY, Tan WC, Mok US. Preparation and consideration for establishment of an isolation maternity unit in a tertiary hospital during COVID-19 pandemic. BMC Pregnancy Childbirth 2022; 22:317. [PMID: 35418029 PMCID: PMC9007268 DOI: 10.1186/s12884-022-04643-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
The SARS-CoV-2 pandemic is rapidly evolving and remains a major health challenge worldwide. With an increase in pregnant women with COVID-19 infection, we recognized an urgent need to set up a multidisciplinary taskforce to provide safe and holistic care for this group of women. In this review of practice in a tertiary hospital in Singapore, we discuss the key considerations in setting up an isolation maternity unit and our strategies for peripartum and postpartum care. Through teleconsultation, we involve these women and their families in the discussion of timing and mode of birth, disposition of babies after birth and safety of breastfeeding to enable them to make informed decisions and individualize their care.
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Affiliation(s)
- Yingke He
- Department of Anaesthesia, Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Yvonne Wan Yu Wong
- Department of Obstetrics and Gynaecology, Division of Surgery and Surgical Oncology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Alvin Jia Hao Ngeow
- Department of Neonatal and Developmental Medicine, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Eileen Yilin Sim
- Department of Anaesthesia, Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Benjamin Pei Zhi Cherng
- Department of Infectious Disease, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Sridhar Arunachalam
- Department of Neonatal and Developmental Medicine, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Selina Kah Ying Ho
- Department of Neonatal and Developmental Medicine, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Wei Ching Tan
- Department of Obstetrics and Gynaecology, Division of Surgery and Surgical Oncology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Un Sam Mok
- Department of Anaesthesia, Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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Transgenerational epigenetic impacts of parental infection on offspring health and disease susceptibility. Trends Genet 2022; 38:662-675. [PMID: 35410793 PMCID: PMC8992946 DOI: 10.1016/j.tig.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022]
Abstract
Maternal immune activation (MIA) and infection during pregnancy are known to reprogramme offspring phenotypes. However, the epigenetic effects of preconceptual paternal infection and paternal immune activation (PIA) are not currently well understood. Recent reports show that paternal infection and immune activation can affect offspring phenotypes, particularly brain function, behaviour, and immune system functioning, across multiple generations without re-exposure to infection. Evidence from other environmental exposures indicates that epigenetic inheritance also occurs in humans. Given the growing impact of the coronavirus disease 2019 (COVID-19) pandemic, it is imperative that we investigate all of the potential epigenetic mechanisms and multigenerational phenotypes that may arise from both maternal and paternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as well as associated MIA, PIA, and inflammation. This will allow us to understand and, if necessary, mitigate any potential changes in disease susceptibility in the children, and grandchildren, of affected parents.
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Estrada-Chiroque LM, Orostegui-Arenas M, Burgos-Guanilo MDP, Amau-Chiroque JM. Características clínicas y resultado materno perinatal en mujeres con diagnóstico confirmado por COVID-19 en un hospital de Perú. Estudio de cohorte retrospectivo. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2022; 73:28-38. [PMID: 35503299 PMCID: PMC9090281 DOI: 10.18597/rcog.3776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/01/2022] [Indexed: 11/24/2022]
Abstract
Objetivos: describir las características clínicas, sociodemográficas y la frecuencia de complicaciones maternas y perinatales en mujeres gestantes con diagnóstico confirmado de COVID-19 atendidas en un hospital de alta complejidad en Perú. Materiales y métodos: estudio de cohorte retrospectivo descriptivo. Se incluyeron mujeres con 20 semanas o más de gestación con diagnóstico de infección por COVID-19 atendidas en un hospital de referencia nacional del Seguro Social del Perú entre marzo y diciembre del 2020; se excluyeron mujeres cuya gestación no culminó en la institución participante. Las variables medidas fueron: características sociodemográficas y obstétricas de la gestante, nexo epidemiológico, severidad de la infección por COVID-19, síntomas y datos de laboratorio, morbi-mortalidad materna, presencia de anticuerpos en el recién nacido, peso, adaptación y mortalidad perinatal. El análisis fue descriptivo. El protocolo fue aprobado por el comité de ética en investigación del Instituto de Evaluación de Tecnologías en Salud e Investigación de EsSalud. Resultados: los criterios de inclusión y exclusión fueron cumplidos por 322 mujeres. La población de estudio se caracterizó por ser predominantemente mujeres menores de 35 años, con educación superior. El 95% de las gestantes presentó síntomas leves o imperceptibles. Los síntomas predominantes fueron fiebre (85%), tos (52%) y cefalea (18%); se documentó leucocitosis (31%), linfopenia (24%) y trombocitopenia (5%). Se registraron 2 muertes maternas (0,6%) y 22 (7,2%) defunciones perinatales. El 0,9% de los neonatos exhibieron una prueba reactiva positiva para COVID-19. Conclusiones: durante la gestación, la infección producida por el SARS-CoV-2 suele ser asintomática o leve. En las gestantes con infección moderada y severa se presentaron más frecuentemente complicaciones maternas y perinatales. Se requieren más estudios que analicen el impacto materno fetal de la infección por COVID-19 durante la gestación en la región.
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Erten Ö, Biyik İ, Soysal C, Ince O, Keskin N, Tascı Y. Effect of the Covid 19 pandemic on depression and mother-infant bonding in uninfected postpartum women in a rural region. BMC Pregnancy Childbirth 2022; 22:227. [PMID: 35305584 PMCID: PMC8934050 DOI: 10.1186/s12884-022-04580-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Postpartum depression and maternal-infant attachment scores were examined in uninfected women during the COVID 19 pandemic in Kutahya, a rural province in Turkey's North Aegean region. Methods This cohort study was conducted in the Kutahya Health Sciences University Hospital obstetrics unit between April 2021 and August 2021. 178 low-risk term pregnant women who gave birth were given the surveys Edinburgh Postpartum Depression Scale and Mother-to-Infant Bonding Scale (MIBQ) 6 weeks after birth. The Edinburgh Postpartum Depression Scale was used to determine postpartum depression and the Mother-to-Infant Bonding Scale was used to determine maternal attachment. Results In this study, the postpartum depression rate was calculated as 17.4%. When depressed and non-depressed patients were compared, education level, maternal age, BMI, MIBQ score, history of previous pregnancies, route of delivery, previous operation history, economic status, employment status and pregnancy follow-up information were found to be similar (p > 0.05). The ratings on the Mother-to-Infant Bonding Scale were found to be similar in depressed and non-depressed patients (p > 0.05). The odds of maternal depression for patients who received guests at home was 3.068 (95%CI [1.149–8.191]) times the odds of patients who did not receive guests at home. Conclusions Although a relationship has been found between accepting guests in the postpartum period and postpartum depression, it is necessary to investigate in further studies whether there is a causal relationship.
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Pérez-López FR, Savirón-Cornudella R, Chedraui P, López-Baena MT, Pérez-Roncero G, Sanz-Arenal A, Narváez-Salazar M, Dieste-Pérez P, Tajada M. Obstetric and perinatal outcomes of pregnancies with COVID 19: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022; 35:9742-9758. [PMID: 35282784 DOI: 10.1080/14767058.2022.2051008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This meta-analysis aimed at comparing obstetric and perinatal outcomes in laboratory-tested pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before delivering. METHOD We performed a comprehensive systematic review of electronic databases for studies reporting pregnant women with and without SARS-CoV-2 infection, as determined by polymerase chain reaction (PCR) before delivery, during the pandemic period published up to June 25, 2021. Results are reported as mean difference (MD) or odds ratio (OR) and their 95% confidence interval (CI). RESULTS Seventeen observational studies with low to moderate risk of bias, reported on 2,769 pregnant women with a positive SARS-CoV-2 PCR test and 13,807 with a negative test. Pregnant women with a positive PCR test delivered at an earlier gestational age (MD -0.19; 95% CI -0.36 to -0.02 weeks), smoked less (OR 0.75; 95% CI 0.61-0.94) and were associated with higher odds for preeclampsia (OR 1.30; 95% CI 1.09-1.54), NICU admissions (OR 2.37; 95% CI 1.18-4.76), stillbirths (OR 2.70; 95% CI, 1.38-5.29), and perinatal mortality (OR 3.23; 95% CI 1.23-8.52). There were no significant differences between positive and negative tested women in terms of nulliparity, multiple pregnancies, gestational diabetes, route of delivery, labor induction, preterm birth, infant birth weight, 5 min Apgar scores < 7, small-for-gestational-age infants and fetal malformations. Eleven studies included neonatal PCR SARS-CoV-2 testing which was performed on 129 infants, of which 20 were positive. CONCLUSION Positive SARS-CoV-2 tested pregnant women had higher odds for preeclampsia/hypertensive disorders of pregnancy, NICU admissions, stillbirths and perinatal mortality.
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Affiliation(s)
- Faustino R Pérez-López
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | | | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral & Laboratorio de Biomedicina, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | | | | | - Ana Sanz-Arenal
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marta Narváez-Salazar
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Peña Dieste-Pérez
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Mauricio Tajada
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Faculty of Medicine, University of Zaragoza, Zaragoza, Spain.,Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Liu A, Raja xavier J, Singh Y, Brucker SY, Salker MS. Molecular and Physiological Aspects of SARS-CoV-2 Infection in Women and Pregnancy. Front Glob Womens Health 2022; 3:756362. [PMID: 35284910 PMCID: PMC8908006 DOI: 10.3389/fgwh.2022.756362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/01/2022] [Indexed: 01/08/2023] Open
Abstract
Whilst scientific knowledge about SARS-CoV-2 and COVID-19 is rapidly increasing, much of the effects on pregnant women is still unknown. To accommodate pregnancy, the human endometrium must undergo a physiological transformation called decidualization. These changes encompass the remodeling of endometrial immune cells leading to immunotolerance of the semi-allogenic conceptus as well as defense against pathogens. The angiotensin converting enzyme 2 (ACE2) plays an important regulatory role in the renin-angiotensin-system (RAS) and has been shown to be protective against comorbidities known to worsen COVID-19 outcomes. Furthermore, ACE2 is also crucial for decidualization and thus for early gestation. An astounding gender difference has been found in COVID-19 with male patients presenting with more severe cases and higher mortality rates. This could be attributed to differences in sex chromosomes, hormone levels and behavior patterns. Despite profound changes in the female body during pregnancy, expectant mothers do not face worse outcomes compared with non-pregnant women. Whereas mother-to-child transmission through respiratory droplets during labor or in the postnatal period is known, another question of in utero transmission remains unanswered. Evidence of placental SARS-CoV-2 infection and expression of viral entry receptors at the maternal-fetal interface suggests the possibility of in utero transmission. SARS-CoV-2 can cause further harm through placental damage, maternal systemic inflammation, and hindered access to health care during the pandemic. More research on the effects of COVID-19 during early pregnancy as well as vaccination and treatment options for gravid patients is urgently needed.
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Affiliation(s)
- Anna Liu
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
| | - Janet Raja xavier
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
| | - Yogesh Singh
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
- Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, Tübingen, Germany
| | - Sara Y. Brucker
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
| | - Madhuri S. Salker
- Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany
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Tolerability of the BNT162b2 COVID-19 Vaccine during Pregnancy among Polish Healthcare Professionals. Vaccines (Basel) 2022; 10:vaccines10020200. [PMID: 35214659 PMCID: PMC8876673 DOI: 10.3390/vaccines10020200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 01/18/2023] Open
Abstract
The tolerance and safety of vaccination in pregnancy should be assessed in local populations based on ethnic differences across countries. Therefore, this study aimed to determine the tolerability of the BNT162b2 mRNA vaccination in pregnancy in a Polish population. An online questionnaire enquiring about the safety and tolerability of the BNT162b2 mRNA vaccine was distributed to pregnant and non-pregnant female healthcare professionals who had voluntarily received one or two doses of the COVID-19 vaccine in Poland. The two groups were compared simultaneously considering the COVID-19 infection status before vaccination. Compared with that noted in the control group, pregnant women in the COVID-19-free group were less likely to have fever (p = 0.002) or gastrointestinal symptoms (p = 0.009) after the second dose. In the COVID-19-exposed group, pregnant women were less likely to experience local skin reactions (p = 0.009), and myalgia (p = 0.003) after the first dose. After the second dose, the only noticeable difference was a lower incidence of myalgia (p = 0.001) in pregnant women. The tolerability of the BNT162b2 mRNA COVID-19 vaccine was similar in both the groups. No severe local, generalised, or pregnancy complications related to mother or foetus were observed. Good tolerability of the BNT162b2 mRNA COVID-19 vaccine in pregnancy in the Polish population may facilitate the decision to vaccinate pregnant women against COVID-19.
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Shrivastava S, Shrivastava P. Sustaining essential health services for maternal, newborn, child, adolescent, and elderly people amid the ongoing coronavirus disease-2019 pandemic. ENVIRONMENTAL DISEASE 2022. [DOI: 10.4103/ed.ed_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Carter M, Casey S, O'Keeffe GW, Gibson L, Gallagher L, Murray DM. Maternal Immune Activation and Interleukin 17A in the Pathogenesis of Autistic Spectrum Disorder and Why It Matters in the COVID-19 Era. Front Psychiatry 2022; 13:823096. [PMID: 35250672 PMCID: PMC8891512 DOI: 10.3389/fpsyt.2022.823096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/21/2022] [Indexed: 11/30/2022] Open
Abstract
Autism spectrum disorder (ASD) is the commonest neurodevelopmental disability. It is a highly complex disorder with an increasing prevalence and an unclear etiology. Consensus indicates that ASD arises as a genetically modulated, and environmentally influenced condition. Although pathogenic rare genetic variants are detected in around 20% of cases of ASD, no single factor is responsible for the vast majority of ASD cases or that explains their characteristic clinical heterogeneity. However, a growing body of evidence suggests that ASD susceptibility involves an interplay between genetic factors and environmental exposures. One such environmental exposure which has received significant attention in this regard is maternal immune activation (MIA) resulting from bacterial or viral infection during pregnancy. Reproducible rodent models of ASD are well-established whereby induction of MIA in pregnant dams, leads to offspring displaying neuroanatomical, functional, and behavioral changes analogous to those seen in ASD. Blockade of specific inflammatory cytokines such as interleukin-17A during gestation remediates many of these observed behavioral effects, suggesting a causative or contributory role. Here, we review the growing body of animal and human-based evidence indicating that interleukin-17A may mediate the observed effects of MIA on neurodevelopmental outcomes in the offspring. This is particularly important given the current corona virus disease-2019 (COVID-19) pandemic as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is a potent stimulator of the maternal immune response, however the long-term effects of maternal SARS-CoV-2 infection on neurodevelopmental outcomes is unclear. This underscores the importance of monitoring neurodevelopmental outcomes in children exposed to SARS-CoV-2-induced MIA during gestation.
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Affiliation(s)
- Michael Carter
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - Sophie Casey
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Gerard W O'Keeffe
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Louise Gibson
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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Characteristics and Outcomes of COVID-19 in Reproductive-Aged Pregnant and Non-Pregnant Women in Osaka, Japan. Int J Infect Dis 2022; 117:195-200. [PMID: 35104668 PMCID: PMC8800534 DOI: 10.1016/j.ijid.2022.01.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To describe the clinical characteristics and outcomes of reproductive-aged female patients with coronavirus disease 2019 (COVID-19). Methods We conducted a retrospective study of female patients aged 10–49 years, diagnosed with COVID-19 in Osaka, Japan, between January and November 2020. We assessed their epidemiological and clinical characteristics according to their pregnancy status. Results A total of 4,156 patients were enrolled, of whom 29 (0.7%) were pregnant. Most patients exhibited mild symptoms, and 10.8% of the cases were asymptomatic. No moderate or severe cases were observed in pregnant women, whereas only 0.1% of the nonpregnant women had severe disease at diagnosis. No clusters were observed in the pregnant patients; however, most acquired the infection from a family member. Of the 29 pregnant women, 22 (75.9%) were hospitalized; whereas among the nonpregnant women, 579 (14.0%) were hospitalized (p < 0.001). No patients were admitted to the intensive care unit, and there were no deaths among women aged 10–49 years. Conclusions Pregnant women accounted for 0.7% of the total cases of COVID-19 among women aged 10–49 years. Pregnant women were more likely to be hospitalized but generally had mild disease.
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Mao XD, Liu KS, Yao YP, Xu ZR. Potential effects of COVID-19 on reproductive health: a mini review. Am J Transl Res 2021; 13:13321-13327. [PMID: 35035678 PMCID: PMC8748173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/16/2021] [Indexed: 06/14/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is now a major public health problem worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity is extremely strong. One major target of the virus is the lung, which can lead to death due to the development of respiratory distress syndrome and even multiple system organ failure. The possible pathophysiology by which SARS-CoV-2 affects the object is by way of the receptor, angiotensin-converting enzyme 2 (ACE2). From the study of the viral structure and infection mechanisms, researchers have discovered that the ACE2 acts as a receptor for SARS-CoV-2. According to previous studies, ACE2 is one of the key enzymes in the RAS system. Physiological functions can be found in angiosarcomas and in the kidney, liver, intestine and so on. Whether SARS-CoV-2 infection leads to male fertility impairment has recently received attention. Nevertheless, the association between SARS-CoV-2 infection and reproductive health is currently poorly understood. Using key words including "SARS-CoV-2", "reproductive health", "ACE2" and "2019-nCoV", we retrieved original articles and reviews from the PubMed and WEB OF SCI databases published before December 16, 2020 and performed a thorough review of them. Compared with females, we discovered that infected person with SARS-CoV-2 was higher in males. Men who were infected with SARS-CoV-2 may be easy to suffer from impaired reproductive health. These investigations would help for a comprehensive grasp of the relationship between SARS-CoV-2 infection and reproductive health.
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Affiliation(s)
- Xiao-Dong Mao
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese MedicineNanjing 210028, Jiangsu, China
| | - Kang-Sheng Liu
- Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care HospitalNanjing 210029, Jiangsu, China
| | - Yan-Ping Yao
- Department of Pharmacy, Suzhou Xiangcheng People’s HospitalSuzhou 215006, Jiangsu, China
| | - Zhi-Rong Xu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow UniversitySuzhou 215006, Jiangsu, China
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Larcade R, DeShea L, Lang GA, Caballero MT, Ferretti A, Beasley WH, Tipple TE, Vain N, Prudent L, Lang ML, Polack F, Ofman G. Maternal-fetal immunologic response to SARS-CoV-2 infection in a symptomatic vulnerable population: A prospective cohort. J Infect Dis 2021; 225:800-809. [PMID: 34865064 DOI: 10.1093/infdis/jiab591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND COVID-19 disproportionally affects pregnant women and their newborn, yet little is known about the variables that modulate the maternal-fetal immune response to infection. METHODS We prospectively studied socioeconomic, biologic and clinical factors affecting humoral immunity in 87 unvaccinated pregnant women admitted to hospital in the Buenos Aires metropolitan area for symptoms consistent with COVID-19 disease. RESULTS The number of days between symptom onset and childbirth predicted maternal and newborn virus Spike protein Receptor Binding Domain (RBD)-specific IgG. These findings suggest newborns may benefit less when mothers deliver soon after COVID-19 infection. Similarly, a longer time between symptom onset and birth predicted higher in utero transfer of maternal IgG and its concentration in cord blood. Older gestational ages at birth were associated with lower maternal IgG: cord blood IgG ratios. Eighty seven percent of women with confirmed SARS-CoV-2 infection developed RBD-specific IgA responses in breast milk within 96 h of childbirth. IgA was not significantly associated with time from infection but correlated with maternal serum IgG and placental transfer. CONCLUSIONS These results demonstrate the combined role of biologic, clinical and socioeconomic variables associated with maternal SARS-CoV-2 RBD-specific antibodies and supports early vaccination strategies for COVID-19 in socioeconomically vulnerable pregnant women.
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Affiliation(s)
| | - Lise DeShea
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | - Gillian A Lang
- The University of Oklahoma Health Sciences Center, Oklahoma City, USA, Department of Microbiology and Immunology, Oklahoma City; USA
| | - Mauricio T Caballero
- Fundación INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - William H Beasley
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | - Trent E Tipple
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | | | | | - Mark L Lang
- The University of Oklahoma Health Sciences Center, Oklahoma City, USA, Department of Microbiology and Immunology, Oklahoma City; USA
| | | | - Gaston Ofman
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA.,Fundación INFANT, Buenos Aires, Argentina
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Thapa K, Verma N, Singh TG, Kaur Grewal A, Kanojia N, Rani L. COVID-19-Associated acute respiratory distress syndrome (CARDS): Mechanistic insights on therapeutic intervention and emerging trends. Int Immunopharmacol 2021; 101:108328. [PMID: 34768236 PMCID: PMC8563344 DOI: 10.1016/j.intimp.2021.108328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023]
Abstract
AIMS The novel Coronavirus disease 2019 (COVID-19) has caused great distress worldwide. Acute respiratory distress syndrome (ARDS) is well familiar but when it happens as part of COVID-19 it has discrete features which are unmanageable. Numerous pharmacological treatments have been evaluated in clinical trials to control the clinical effects of CARDS, but there is no assurance of their effectiveness. MATERIALS AND METHODS A systematic review of the literature of the Medline, Scopus, Bentham, PubMed, and EMBASE (Elsevier) databases was examined to understand the novel therapeutic approaches used in COVID-19-Associated Acute Respiratory Distress Syndrome and their outcomes. KEY FINDINGS Current therapeutic options may not be enough to manage COVID-19-associated ARDS complications in group of patients and therefore, the current review has discussed the pathophysiological mechanism of COVID-19-associated ARDS, potential pharmacological treatment and the emerging molecular drug targets. SIGNIFICANCE The rationale of this review is to talk about the pathophysiology of CARDS, potential pharmacological treatment and the emerging molecular drug targets. Currently accessible treatment focuses on modulating immune responses, rendering antiviral effects, anti-thrombosis or anti-coagulant effects. It is expected that considerable number of studies conducting globally may help to discover effective therapies to decrease mortality and morbidity occurring due to CARDS. Attention should be also given on molecular drug targets that possibly will help to develop efficient cure for COVID-19-associated ARDS.
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Affiliation(s)
- Komal Thapa
- Chitkara School of Pharmacy, Chitkara University, Himachal Pradesh, India; Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Nitin Verma
- Chitkara School of Pharmacy, Chitkara University, Himachal Pradesh, India
| | | | | | - Neha Kanojia
- Chitkara School of Pharmacy, Chitkara University, Himachal Pradesh, India
| | - Lata Rani
- Chitkara School of Pharmacy, Chitkara University, Himachal Pradesh, India
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Rathberger K, Häusler S, Wellmann S, Weigl M, Langhammer F, Bazzano MV, Ambrosch A, Fill Malfertheiner S. SARS-CoV-2 in pregnancy and possible transfer of immunity: assessment of peripartal maternal and neonatal antibody levels and a longitudinal follow-up. J Perinat Med 2021; 49:702-708. [PMID: 34116588 DOI: 10.1515/jpm-2021-0166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In the current Severe Acute Respiratory Distress Coronavirus 2 (SARS-CoV-2) pandemic there is still great uncertainty about the effects of an infection in pregnancy especially regarding a possible fetal transmission of antibodies to SARS-CoV-2 and the longevity of this immunity. METHODS Sixteen women who were infected with SARS-CoV-2 during pregnancy and their offspring were included. The antibody response to SARS-CoV-2 was measured in mother and umbilical cord blood peripartum and in a follow-up examination 6-11 weeks after birth. Medical history, symptoms regarding SARS-CoV-2, obstetric and neonatal information were queried following recommendations by the WHO. RESULTS A total of 73% of the women and one third of the infants developed antibodies to SARS-CoV-2 spike (S) protein receptor binding domain (RBD), with a long interval between infection and birth proving favorable for a transplacentar transfer of antibodies to the neonates. All infants showed declining or vanishing antibody-titers in the follow-up examination, while the titers of their mothers were stable or even increased. CONCLUSIONS Our results demonstrate that transplacental transfer of SARS-CoV-2-specific antibodies is possible, but also indicate that the immunity that may be gained as a result might decrease in newborns postpartum. This provides important evidence that could be useful for further studies covering vaccination during pregnancy.
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Affiliation(s)
- Katharina Rathberger
- University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Sebastian Häusler
- University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- Department of Obstetrics and Gynecology, School of Medicine, University of Würzburg, Würzburg, Germany
| | - Sven Wellmann
- Department of Neonatology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Marco Weigl
- University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Florian Langhammer
- Department of Neonatology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Maria Victoria Bazzano
- Laboratory of Translational Perinatology, University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Hygiene, Hospital of the Order of St. John, Regensburg, Germany
| | - Sara Fill Malfertheiner
- University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
- WECARE Research and Development Campus Regensburg at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
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Franchini M, Prefumo F, Grisolia G, Bergamini V, Glingani C, Pisello M, Presti F, Zaffanello M. Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review. Viruses 2021; 13:1194. [PMID: 34206468 PMCID: PMC8310344 DOI: 10.3390/v13071194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 12/23/2022] Open
Abstract
The treatment of COVID-19 is particularly critical in pregnant women, considering the potential teratogenic effects of antiviral agents and the immune-depression related with pregnancy. The aim of this review is to systematically examine the current evidence on the clinical use of convalescent plasma during pregnancy. The electronic databases Medline PubMed Advanced Search Builder, Scopus, Web Of Science and Google Scholar were searched (until 1 January 2021). Inclusion criteria were pregnant women with COVID-19 (or SARS-CoV-2 infection), in whom convalescent plasma (or hyperimmune plasma) was used as treatment. We searched clinical trial registries (censored 5 January 2021) for eligible studies under way. After elimination of duplications, the initial search yielded 79 potentially relevant records, of which 67 were subsequently excluded. The 12 remaining records were case reports involving 12 pregnancies. Six of the mothers were reported to be well, two were reported to have preeclampsia, and in one case each the maternal outcome was described as survival, clinical improvement, discharged with oxygen and rehabilitation. With regard to the neonates, two were declared to be well, four had transient morbidity, two were critically ill and one died; normal ongoing pregnancies, but no post-delivery information, were reported for the remaining three cases. Clinical trials under way or planned to investigate the use of convalescent plasma for COVID-19 during pregnancy are lacking. This is the first systematic review of the literature regarding the treatment of COVID-19 in pregnancy. The published literature data seem to indicate that convalescent plasma administered to pregnant women with severe COVID-19 provides benefits for both the mother and the fetus. The quality of the available studies is, however, very limited since they are all case reports and thus suffer from relevant reporting bias.
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, I-46100 Mantova, Italy; (M.F.); (C.G.)
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, I-25123 Brescia, Italy;
| | - Gianpaolo Grisolia
- Obstetrics and Gynecology Unit, Carlo Poma Hospital, I-46100 Mantova, Italy; (G.G.); (M.P.)
| | - Valentino Bergamini
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, I-37126 Verona, Italy; (V.B.); (F.P.)
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, I-46100 Mantova, Italy; (M.F.); (C.G.)
| | - Marlene Pisello
- Obstetrics and Gynecology Unit, Carlo Poma Hospital, I-46100 Mantova, Italy; (G.G.); (M.P.)
| | - Francesca Presti
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, I-37126 Verona, Italy; (V.B.); (F.P.)
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, I-37126 Verona, Italy
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Elsaddig M, Khalil A. Effects of the COVID pandemic on pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol 2021; 73:125-136. [PMID: 33832868 PMCID: PMC7969862 DOI: 10.1016/j.bpobgyn.2021.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022]
Abstract
Pregnant women and neonates are often categorised as being at high risk during the coronavirus disease-2019 (COVID-19) pandemic. Numerous studies have demonstrated that the characteristics of COVID-19 disease in pregnant women and non-pregnant women are very similar. However, pregnant women with COVID-19 in the third trimester are more likely than their non-pregnant counterparts to require intensive care, though this may reflect a lower threshold for intervention in pregnant women rather than more serious disease. Compared with pregnant women without COVID-19, pregnant women with symptomatic COVID-19 requiring admission to hospital have worse maternal outcomes, including death, although the absolute risk remains very low. Outcomes of neonates born to women positive for COVID-19 are generally very good, though iatrogenic preterm birth is more common. Findings from these studies highlight the need for further monitoring of the outcomes of pregnant and post-partum women according to trimester during this pandemic.
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Affiliation(s)
- Maab Elsaddig
- Fetal Medicine Unit, St George's Hospital, St George's University of London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, UK.
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Bukowska-Ośko I, Popiel M, Kowalczyk P. The Immunological Role of the Placenta in SARS-CoV-2 Infection-Viral Transmission, Immune Regulation, and Lactoferrin Activity. Int J Mol Sci 2021; 22:5799. [PMID: 34071527 PMCID: PMC8198160 DOI: 10.3390/ijms22115799] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
A pandemic of acute respiratory infections, due to a new type of coronavirus, can cause Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) and has created the need for a better understanding of the clinical, epidemiological, and pathological features of COVID-19, especially in high-risk groups, such as pregnant women. Viral infections in pregnant women may have a much more severe course, and result in an increase in the rate of complications, including spontaneous abortion, stillbirth, and premature birth-which may cause long-term consequences in the offspring. In this review, we focus on the mother-fetal-placenta interface and its role in the potential transmission of SARS-CoV-2, including expression of viral receptors and proteases, placental pathology, and the presence of the virus in neonatal tissues and fluids. This review summarizes the current knowledge on the anti-viral activity of lactoferrin during viral infection in pregnant women, analyzes its role in the pathogenicity of pandemic virus particles, and describes the potential evidence for placental blocking/limiting of the transmission of the virus.
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Affiliation(s)
- Iwona Bukowska-Ośko
- Department of Immunopathology of Infectious and Parasitic Diseases, Medical University of Warsaw, 02-091Warsaw, Poland;
| | - Marta Popiel
- Department of Animal Nutrition, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110 Jabłonna, Poland;
| | - Paweł Kowalczyk
- Department of Animal Nutrition, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110 Jabłonna, Poland;
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Maprayil S, Goggins A, Harris F, Johnson TRB, Adanu R, Geary M. The COVID-19 pandemic: A first-year review through the lens of IJGO. Int J Gynaecol Obstet 2021; 153:183-185. [PMID: 33742686 PMCID: PMC9087567 DOI: 10.1002/ijgo.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Wali AA, Abd-El-Fatah SM. Prognosis and Outcomes of COVID-19 infection During Pregnancy. COVID-19 INFECTIONS AND PREGNANCY 2021. [PMCID: PMC8298323 DOI: 10.1016/b978-0-323-90595-4.00003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The pathophysiology of COVID-19 and pregnancy physiology intertwine in mysterious ways; thus, studying outcomes and prognosis in pregnant women with this new disease is an emerging concern. In this chapter, two main parts are presented; the first part discusses the effect of pregnancy on COVID-19, whether pregnant women are more susceptible to the disease, the different course of the disease and its severity in the pregnant population compared with the general population, and specific reference to COVID-19 complications in pregnant women. Also, the need for hospitalization, intensive care, and mechanical ventilation is reviewed. On the other hand, the second part of the chapter presents the effect of COVID-19 on pregnancy and discusses different maternal, fetal, and neonatal morbidities, including the possibility of vertical transmission, which could be caused by COVID-19 in this vulnerable group. Furthermore, maternal and perinatal mortality rates are discussed.
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