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Abbasi F, Movahedi M, Seresht LM, Nazari F, Naeiji Z, Arbabzadeh T, Khanjani S. COVID-19's Effect in Pregnancy and Vertical Transmission: A Systematic Review. Int J Prev Med 2024; 15:25. [PMID: 39239304 PMCID: PMC11376542 DOI: 10.4103/ijpvm.ijpvm_245_23] [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: 09/10/2023] [Accepted: 02/20/2024] [Indexed: 09/07/2024] Open
Abstract
The COVID-19 pandemic has significantly impacted public health and the global economy. It has also been found to have potential effects on pregnancy, neonatal outcomes, and mother-to-infant transmission. This systematic review aims to provide an overview of the maternal and perinatal outcomes associated with pregnancy. A systematic review study was conducted by searching the PubMed, MEDLINE, Embase, and Web of Science databases according to PRISMA guidelines from December 1, 2019, to December 23, 2022. The results indicate that there was an increase in the rate of cesarean delivery among mothers infected with SARS-CoV-2. However, the study found that the mode of delivery for pregnant women infected with SARS-CoV-2 did not increase or decrease the risk of infection for newborns. During the COVID-19 pandemic, there has been an increase in maternal and infant mortality rates, as well as stillbirths and ruptured ectopic pregnancies. Research has shown that SARS-CoV-2 can potentially be transmitted during pregnancy, although vertical transmission is rare. However, additional data are needed to investigate this adverse effect, especially regarding reports of disease recurrence in mothers infected with SARS-CoV-2.
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Affiliation(s)
- Fatemeh Abbasi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Minoo Movahedi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Leila Mousavi Seresht
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Farzaneh Nazari
- Department of Obstetrics and Gynecology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Zahra Naeiji
- Department of Obstetrics and Gynecology, School of Medicine, Mahdyieh Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Taraneh Arbabzadeh
- Department of Obstetrics and Gynecology, School of Medicine, Shohada Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Somayeh Khanjani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Ma Y, Zhang Q, Shan Z, Chen Y, Chen Y, Pan X, Huang Y. Pregnancy outcomes in women with severe acute respiratory syndrome coronavirus 2 reinfections compared to those with a single infection: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:459. [PMID: 38961348 PMCID: PMC11223318 DOI: 10.1186/s12884-024-06657-y] [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: 01/26/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND To assess pregnancy outcomes in women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection. METHODS This was a retrospective cohort study that included pregnant women who contracted coronavirus disease 2019 (COVID-19) once or twice during pregnancy and who gave birth between 1 October 2022 and 15 August 2023 in Shanghai First Maternity and Infant Hospital (Shanghai, China). We collected their clinical data and compared the frequency of adverse pregnancy outcomes between the reinfection group and the primary infection group, such as preterm birth, fetal growth restriction (FGR), hypertensive disorders of pregnancy (HDP), common pregnancy-related conditions, birth weight, and neonatal unit admission. RESULTS We observed a 7.7% reinfection rate among the 1,405 women who contracted COVID-19 during pregnancy. There were no significant differences in the frequency of preterm birth, FGR, HDP, other common pregnancy-related conditions, birth weight, or rate of neonatal unit admission between the reinfection and single infection groups. All our participants were unvaccinated, and all had mild symptoms. CONCLUSION Our study showed no significant association between SARS-CoV-2 reinfection and adverse pregnancy outcomes.
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Affiliation(s)
- Yan Ma
- 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, 536 Changle Road, Jingan District, Shanghai, 200040, China
| | - Qingxia Zhang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, 2 Yinghuayuan East Streat, Chaoyang District, 100029, Beijing, China
| | - Zhenli Shan
- 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, 536 Changle Road, Jingan District, Shanghai, 200040, China
| | - Yanting Chen
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, 2 Yinghuayuan East Streat, Chaoyang District, 100029, Beijing, China
| | - Yan Chen
- Department of Obstetrics and Gynecology, North China University of Science And Technology Affiliated Hospital, 063099, Tangshan, Hebei Province, China
| | - Xiaoyu Pan
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, 2 Yinghuayuan East Streat, Chaoyang District, 100029, Beijing, China.
| | - Yiying Huang
- 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, 536 Changle Road, Jingan District, Shanghai, 200040, China.
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dos Santos GG, da Silva ALC, do Nascimento ES, de Andrade LH. Clinical, epidemiological characteristics and mortality of pregnant and postpartum women associated with COVID-19 in Brazil: cohort study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo52. [PMID: 38994462 PMCID: PMC11239213 DOI: 10.61622/rbgo/2024rbgo52] [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: 09/01/2023] [Accepted: 02/20/2024] [Indexed: 07/13/2024] Open
Abstract
Objective To analyze the death of Brazilian pregnant and postpartum women due to COVID-19 or unspecific cause. Methods This is retrospective, descriptive-exploratory, population-based study carried out with the Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) database, with pregnant and postpartum women of reproductive age who died from confirmed COVID-19 between 2020 and 2021. The chosen variables were: age, gestational period, type and number of comorbidities, skin color, using the statistical software R Foundation for Statistical Computing Platform, version 4.0.3 and Statistical Package for Social Science, version 29.0 for analysis. Results A total of 19,333 cases of pregnant and postpartum women aged between 10 and 55 years diagnosed with SARS were identified, whether due to confirmed COVID-19 or unspecific causes. Of these, 1,279 died, these cases were classified into two groups according to the cause of death: deaths from COVID-19 (n= 1,026) and deaths from SARS of unspecific cause (n= 253). Conclusion The risk of death increased among black and brown women, in the postpartum period and with the presence of comorbidities, mainly diabetes, cardiovascular diseases and obesity. The data presented here draw attention to the number of deaths from SARS, especially among sociodemographic profiles, precarious access to health, such as the black population. In addition, limitations in adequate access to health care are reinforced by even lower rates of ICU admissions among women who died from SARS of an unspecified cause.
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Affiliation(s)
- Gustavo Gonçalves dos Santos
- Faculdade de EnfermagemUniversidade Santo AmaroSão PauloSPBrazilFaculdade de Enfermagem, Universidade Santo Amaro, São Paulo, SP, Brazil.
| | - Anderson Lima Cordeiro da Silva
- Escola de Enfermagem de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazilEscola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Edson Silva do Nascimento
- Escola de Enfermagem de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrazilEscola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Luis Henrique de Andrade
- Faculdade de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazilFaculdade de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Dalky A, Quran TO, Abuhammad S, Al-Faraj HM, Bani Hani S, ALBashtawy M, Abu Khader IR, Jallad M, Salameh B. COVID-19 vaccine acceptance and associated factors among pregnant and lactating women attending maternity care clinics in refugee camps in Jordan. PLoS One 2024; 19:e0305314. [PMID: 38861556 PMCID: PMC11166341 DOI: 10.1371/journal.pone.0305314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Despite the advantages of vaccination in preventing maternal and fetal problems, there were many concerns in the medical community regarding vaccine safety for pregnant women, and this has put obstetricians in a challenging situation when it comes to advising their pregnant patients on whether to obtain the vaccine. AIM This study was performed to define the level of acceptance of COVID-19 vaccination and assess the impact of COVID-19 attitudes and knowledge on vaccine acceptance between pregnant and lactating Syrian women who are seeking prenatal care services at the clinics in Azraq refugee camp in Jordan. METHOD A quantitative, cross-sectional study utilizing a non-probability convenience sample. A validated and reliable self-administered questionnaire consisting of four sections was used. RESULTS A total of 412 pregnant/lactating women was recruited The acceptance rate of the COVID-19 vaccine among participants was 86.5%. There was a significant positive moderate association between respondents' attitudes and knowledge around the COVID-19 vaccine and their acceptance of the vaccine (r = .468, p < .001, r = .357, p < .001), respectively. CONCLUSION To effectively mitigate the COVID-19 pandemic and achieve collective protection, decision-makers must intensify the efforts in promoting the importance of maternal vaccination, especially in vulnerable communities that suffer the most from pandemic outcomes.
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Affiliation(s)
- Alaa Dalky
- Faculty of Medicine, Department of Health Management and Policy, Jordan University of Science and Technology, Ar-Ramtha, Jordan
| | | | - Sawsan Abuhammad
- Faculty of Nursing, Department of Maternal and Child Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Haneen Mahyoub Al-Faraj
- Faculty of Medicine, Department of Health Management and Policy, Jordan University of Science and Technology, Irbid, Jordan
| | - Salam Bani Hani
- Faculty of Nursing, Nursing Department, Irbid National University, Irbid, Jordan
| | - Mohammed ALBashtawy
- Princess Salma Faculty of Nursing, Department of Community and Mental Health, Al al-Bayt University, Mafraq, Jordan
| | | | - Mohammed Jallad
- Faculty of Nursing, Arab American University, Jenin, Palestine
| | - Basma Salameh
- Faculty of Nursing, Arab American University, Jenin, Palestine
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Schwartz DA, Mohagheghi P, Moshfegh F, Zafaranloo N, Khalili N, Heidarzadeh M, Habibelahi A, Ghafoury R, Afrashteh F. Epidemiology and Clinical Features of COVID-19 among 4,015 Neonates in Iran: Results of the National Study from the Iranian Maternal and Neonatal Network. Am J Perinatol 2024; 41:e1698-e1708. [PMID: 36990455 PMCID: PMC11136567 DOI: 10.1055/a-2065-4714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on pregnant women and neonates in Iran. This retrospective study describes the national experience among neonates having suspected and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection following hospital admission to examine the epidemiology, demographic, and clinical features. STUDY DESIGN All nationwide cases of suspected and confirmed neonatal SARS-CoV-2 infection were drawn from the Iranian Maternal and Neonatal Network (IMaN) between February 2020 and February 2021. IMaN registers demographic, maternal, and neonatal health data throughout Iran. Statistical analysis of demographic, epidemiological, and clinical data were performed. RESULTS There were 4,015 liveborn neonates having suspected or confirmed SARS-CoV-2 infection that fulfilled the study inclusion criteria identified in the IMaN registry from 187 hospitals throughout Iran. There were 1,392 (34.6%) neonates that were preterm, including 304 (7.6%) less than 32 weeks' gestation. Among the 2,567 newborns admitted to the hospital immediately after birth, the most common clinical problems were respiratory distress (1,095 cases; 42.6%), sepsis-like syndrome (355; 13.8%), and cyanosis (300 cases; 11.6%). Of 683 neonates transferred from another hospital, the most frequent problems were respiratory distress (388; 56.8%), sepsis-like syndrome (152; 22.2%), and cyanosis (134; 19.6%). Among 765 neonates discharged home after birth and subsequently admitted to the hospital, sepsis-like syndrome (244 cases; 31.8%), fever (210; 27.4%), and respiratory distress (185; 24.1%) were most frequent. A total of 2,331 (58%) of neonates required respiratory care, with 2,044 surviving and 287 having a neonatal death. Approximately 55% of surviving neonates received respiratory support, compared with 97% of neonates who expired. Laboratory abnormalities included elevations of white blood cell count, creatine phosphokinase, liver enzymes, and C-reactive protein. CONCLUSION This report adds the national experience of Iran to the list of reports from multiple countries describing their experience with COVID-19 in neonates, demonstrating that newborns are not exempt from COVID-19-morbidity and mortality. KEY POINTS · Most common clinical problem was respiratory distress.. · Sepsis-like syndrome was also frequently present.. · A total of 58% of all neonates required respiratory care..
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Affiliation(s)
| | - Parisa Mohagheghi
- Department of Neonatology, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Moshfegh
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Zafaranloo
- Department of Pediatrics, Omid Hospital, Iran University of Medical and Sciences, Tehran, Iran
| | - Narjes Khalili
- Department of Community and Family Medicine, Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Habibelahi
- Department of Neonatology, Neonatal Health Office, Ministry of Health IR, Tehran, Iran
| | - Roya Ghafoury
- Student Research Committee, School of Medicine, Iran University of Medical and Sciences, Tehran, Iran
| | - Fatemeh Afrashteh
- Student Research Committee, School of Medicine, Iran University of Medical and Sciences, Tehran, Iran
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WANG J, HU L, ZHANG T, LIU J, YU C, ZHAO N, QI J, LIU L. Prevalence and predictors of prenatal depression during the COVID-19 pandemic: A multistage observational study in Beijing, China. PLoS One 2024; 19:e0298314. [PMID: 38662750 PMCID: PMC11045078 DOI: 10.1371/journal.pone.0298314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/19/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE While growing psychological health issues among pregnant women during the COVID-19 pandemic have been clearly validated, most research was conducted in countries with relatively lax quarantine measures. This study aimed to compare the prevalence of prenatal depression among pre-, peak-, and post-COVID-19 in Beijing, the region with a stringent response policy in China. We also explore predictors of prenatal depression throughout the outbreak. METHODS We investigated prenatal depression among 742 pregnant women who received antenatal checkups in Beijing from March 28, 2019 to May 07, 2021 using the Edinburgh Postnatal Depression Scale and associative demographic, pregnancy-related, and psychosocial characteristics were measured. The phase was divided into pre-, peak-, and post-COVID-19 in light of the trajectory of COVID-19. Pearson's Chi-square test was used after the examination of confounders homogeneity. The bivariable and multivariable logistic regression was conducted to explore predictors. RESULTS The pooled prevalence of prenatal depression was 11.9% throughout the COVID-19 pandemic. Rates at different phases were 10.6%, 15.2%, and 11.1% respectively and no significant difference was observed. Multivariable logistic regression revealed that history of mental illness, number of boy-preference from both pregnant women and husband's family, social support, occupation, and living space were independent predictors of prenatal depression in Beijing. CONCLUSION Our data suggested that the impact of this pandemic on prenatal depression in Beijing appears to be not significant, which will strengthen confidence in adhering to current policy for decision-makers and provide important guidance for the development of major outbreak control and management policies in the future. Our findings may also provide a more efficient measure to identify high-risk pregnant women for professionals and help raise gender equity awareness of pregnant women and their husbands' families. Future studies should focus on the value of targeted care and family relations on the mental health of pregnant women.
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Affiliation(s)
- Jin WANG
- Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
- Department of Aviation Psychology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Libin HU
- Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Tianyi ZHANG
- Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Jiajia LIU
- Department of Aviation Psychology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Chuan YU
- Department of Aviation Psychology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Ningxin ZHAO
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Jianlin QI
- Department of Aviation Psychology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Lihua LIU
- Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
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Wright KO, Fagbemi T, Omoera V, Johnson T, Aderibigbe AA, Baruwa B, Oludara F, Ogboye O, Imosemi D, Omololu O, Odugbemi B, Adeyemi O, Omosun A, Akinola I, Akinyinka M, Balogun M, Abe J, Sadiku B, Banke-Thomas A, Fabamwo AO. A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method. BMC Pregnancy Childbirth 2024; 24:314. [PMID: 38664731 PMCID: PMC11044405 DOI: 10.1186/s12884-024-06516-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Pregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria. METHODS A community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15-49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee. RESULTS Most of the respondents (28.7%) were aged 25-29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20-24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45-49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360-510]. CONCLUSION Our findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care.
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Affiliation(s)
- Kikelomo Ololade Wright
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine (LASUCOM), Ikeja, Lagos, Nigeria.
- Centre for Reproductive Health Research and Innovation (CHRHI), LASUCOM, Ikeja, Lagos, Nigeria.
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria.
| | - Temiloluwa Fagbemi
- Centre for Reproductive Health Research and Innovation (CHRHI), LASUCOM, Ikeja, Lagos, Nigeria
| | - Victoria Omoera
- Directorate of Family Health and Nutrition, Lagos State Ministry of Health (LSMoH), Lagos, Nigeria
| | - Taiwo Johnson
- Directorate of Family Health and Nutrition, Lagos State Ministry of Health (LSMoH), Lagos, Nigeria
| | - Adedayo Ayodele Aderibigbe
- Centre for Reproductive Health Research and Innovation (CHRHI), LASUCOM, Ikeja, Lagos, Nigeria
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
| | - Basit Baruwa
- Lagos Bureau of Statistics (LBS), Lagos, Nigeria
| | - Folashade Oludara
- Directorate of Family Health and Nutrition, Lagos State Ministry of Health (LSMoH), Lagos, Nigeria
| | - Olusegun Ogboye
- Directorate of Family Health and Nutrition, Lagos State Ministry of Health (LSMoH), Lagos, Nigeria
| | | | | | - Babatunde Odugbemi
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine (LASUCOM), Ikeja, Lagos, Nigeria
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
| | - Oluwatoni Adeyemi
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
| | - Adenike Omosun
- Department of Planning, Research and Statistics, Lagos State Health Service Commission, Lagos, Nigeria
| | - Ibironke Akinola
- Department of Paediatrics and Child Health, LASUCOM, Lagos, Nigeria
| | - Modupe Akinyinka
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine (LASUCOM), Ikeja, Lagos, Nigeria
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - John Abe
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
| | | | - Aduragbemi Banke-Thomas
- Centre for Reproductive Health Research and Innovation (CHRHI), LASUCOM, Ikeja, Lagos, Nigeria
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Campisciano G, Sorz A, Cason C, Zanotta N, Gionechetti F, Piazza M, Carli P, Uliana FM, Ballaminut L, Ricci G, De Seta F, Maso G, Comar M. Genital Dysbiosis and Different Systemic Immune Responses Based on the Trimester of Pregnancy in SARS-CoV-2 Infection. Int J Mol Sci 2024; 25:4298. [PMID: 38673883 PMCID: PMC11050260 DOI: 10.3390/ijms25084298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory infections are common in pregnancy with conflicting evidence supporting their association with neonatal congenital anomalies, especially during the first trimester. We profiled cytokine and chemokine systemic responses in 242 pregnant women and their newborns after SARS-CoV-2 infection, acquired in different trimesters. Also, we tested transplacental IgG passage and maternal vaginal-rectal microbiomes. IgG transplacental passage was evident, especially with infection acquired in the first trimester. G-CSF concentration-involved in immune cell recruitment-decreased in infected women compared to uninfected ones: a beneficial event for the reduction of inflammation but detrimental to ability to fight infections at birth. The later the infection was acquired, the higher the systemic concentration of IL-8, IP-10, and MCP-1, associated with COVID-19 disease severity. All infected women showed dysbiosis of vaginal and rectal microbiomes, compared to uninfected ones. Two newborns tested positive for SARS-CoV-2 within the first 48 h of life. Notably, their mothers had acute infection at delivery. Although respiratory infections in pregnancy are reported to affect babies' health, with SARS-CoV-2 acquired early during gestation this risk seems low because of the maternal immune response. The observed vaginal and rectal dysbiosis could be relevant for neonatal microbiome establishment, although in our series immediate neonatal outcomes were reassuring.
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Affiliation(s)
- Giuseppina Campisciano
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Alice Sorz
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Carolina Cason
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Nunzia Zanotta
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Fabrizia Gionechetti
- Department of Life Sciences, University of Trieste, Via Licio Giorgieri 5, 34127 Trieste, Italy;
| | - Maria Piazza
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Petra Carli
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Francesca Maria Uliana
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Lisa Ballaminut
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Giuseppe Ricci
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Francesco De Seta
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Gianpaolo Maso
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Manola Comar
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
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9
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Al-Bdairi AA, Makki HA, Shawki O, Alkhudair SH, Al-Hilli NM, Alkhalidi BA, Alkadhim HK, Shweliyya AA. The Multi-faceted Effects of COVID-19 on Female Reproductive Health: An Updated Narrative Review. Cureus 2024; 16:e57944. [PMID: 38738039 PMCID: PMC11082527 DOI: 10.7759/cureus.57944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Concerns about the SARS-CoV-2 pandemic's possible impact on sexual and reproductive health have grown significantly. In this narrative review, the latest research on the effects of SARS-CoV-2 infection on several facets of sexual and reproductive health is reviewed. The review starts initially by going through the possible consequences of SARS-CoV-2 on female menstrual cycles. The virus may interfere with the menstrual cycle, which could affect hormone synthesis and endometrial reactions, according to newly available evidence. Menstrual blood loss may be impacted by COVID-19's potential to influence endothelial cell function and systemic hemostasis. Hypothalamic amenorrhea may be brought on by severe COVID-19 disease. There is little research on this subject, although most women resume their regular menstrual cycles after 1-2 months of recuperation. The review also examines how SARS-CoV-2 infection may affect assisted reproductive technology (ART) treatments. There are few clinical data, although some research points to potential effects on embryo quality. Overall, ART results, however, did not materially change from the time before the epidemic. Obstetric problems are more likely when SARS-CoV-2 infection occurs during pregnancy, especially in the third trimester. Even though the maternal death rate is still low, pregnant women, especially those with comorbidities, are more likely to experience serious sickness. The review emphasizes how the COVID-19 vaccine affects menstrual cycles, showing brief, modest modifications without serious health hazards. Also included are the psychological effects of family planning choices during the pandemic. In conclusion, this narrative review offers a thorough assessment of the complicated and changing effects of SARS-CoV-2 on sexual and reproductive health. The different requirements of people and couples during and after the pandemic are highlighted, underscoring the necessity for ongoing study and specialized healthcare practices.
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Affiliation(s)
- Adnan A Al-Bdairi
- Infertility, Assisted Reproductive Technologies, Teba IVF and Genetic Center, Babylon, IRQ
| | - Hayder A Makki
- Pharmacology and Toxicology, College of Pharmacy, University of Babylon, Babylon, IRQ
| | - Osama Shawki
- Gynecology Surgery, School of Medicine, Cairo University, Cairo, EGY
| | - Sallama H Alkhudair
- Fertility, Assisted Reproductive Technology, Alzaitoon Specialized Fertility Center, Baghdad, IRQ
| | - Nadia M Al-Hilli
- Obstetrics and Gynecology, College of Medicine, University of Babylon, Babylon, IRQ
| | - Batool A Alkhalidi
- Obstetrics and Gynecology, College of Medicine, University of Kufa, Najaf, IRQ
| | - Hanan K Alkadhim
- Obstetrics and Gynecology, Iraqi Fertility Society, College of Medicine, University of Babylon, Babylon, IRQ
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10
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Kazi S, Othman M, Khoury R, Bernstein PS, Thachil J, Ciantar E, Ferrara L, Netto M, Abdul-Kadir R, Malinowski AK. Report of the ISTH registry on pregnancy and COVID-19-associated coagulopathy (COV-PREG-COAG). Obstet Med 2024; 17:13-21. [PMID: 38660318 PMCID: PMC11037201 DOI: 10.1177/1753495x231206931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 04/26/2024] Open
Abstract
Background Concerns about COVID-19-associated coagulopathy (CAC) in pregnant individuals were raised in early pandemic. Methods An ISTH-sponsored COVID-19 coagulopathy in pregnancy (COV-PREG-COAG) international registry was developed to describe incidence of coagulopathy, VTE, and anticoagulation in this group. Results All pregnant patients with COVID-19 from participating centers were entered, providing 430 pregnancies for the first pandemic wave. Isolated abnormal coagulation parameters were seen in 20%; more often with moderate/severe disease than asymptomatic/mild disease (49% vs 15%; p < 0.0001). No one met the ISTH criteria for disseminated intravascular coagulopathy (DIC), though 5/21 (24%) met the pregnancy DIC score. There was no difference in antepartum hemorrhage (APH) with asymptomatic/mild disease versus moderate/severe disease (3.4% vs 7.7%; p = 0.135). More individuals with moderate/severe disease experienced postpartum hemorrhage (PPH) (22.4% vs 9.3%; p = 0.006). There were no arterial thrombotic events. Only one COVID-associated venous thromboembolism (VTE) was reported. Conclusions Low rates of coagulopathy, bleeding, and thrombosis were observed among pregnant people in the first pandemic wave.
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Affiliation(s)
- Sajida Kazi
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Maha Othman
- Queen's University, Kingston, Canada
- St. Lawrence College, School of Baccalaureate Nursing, Kingston, Canada
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha Khoury
- Divisions of Maternal Fetal Medicine and Complex Family Planning, Boston University School of Medicine, Boston, USA
| | - Peter S Bernstein
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA
| | | | - Etienne Ciantar
- Leeds Teaching Hospital NHS Trust, Leeds General Infirmary, Leeds, UK
| | | | | | - Rezan Abdul-Kadir
- The Royal Free NHS Foundation Hospital and Institute for Women's Health, University College London, London, UK
| | - A Kinga Malinowski
- Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- University of Toronto, Toronto, Canada
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11
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Hatamzadeh N, Shakerinejad G, Navak T, Haghi M, Haghighizadeh MH, Baumann SL. The Efficiency of the Health Belief Model in Predicting the Preventive Behaviors of Pregnant Women During the COVID-19 Pandemic in Iran. Nurs Sci Q 2024; 37:76-80. [PMID: 38054312 DOI: 10.1177/08943184231207384] [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] [Indexed: 12/07/2023]
Abstract
This study examined the efficiency of the health belief model in understanding preventive behaviors of pregnant women in Iran. A cross-sectional descriptive-analytical methodology study was conducted of pregnant women who were referred to a healthcare center in 2021. The data were the responses to a questionnaire designed for this study. The data were analyzed with SPSS 24 software, Amos 22 software, correlation tests, regression analysis, and independent t tests. In terms of the health belief model, pregnant women with high perceived susceptibility showed the highest vaccination rate, while those with high perceived barriers had the lowest. The model predicted 20% variance in the preventive behavior from COVID-19, with perceived susceptibility and cues to action being the strongest and weakest predictors of behavior, respectively. The conclusion of the study was that the health belief model was an appropriate model to guide the care of pregnant women.
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Affiliation(s)
- Nasser Hatamzadeh
- Department of Health Promotion and Education, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Tayebeh Navak
- School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Haghi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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12
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Sohn Y, Choi HK, Yun J, Kim EH, Kim YK. Clinical Characteristics and Risk of Hypoxemia Development in Women Infected with SARS-CoV-2 during Pregnancy. Yonsei Med J 2024; 65:27-33. [PMID: 38154477 PMCID: PMC10774648 DOI: 10.3349/ymj.2023.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE There is limited information on the clinical characteristics and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and risk factors for hypoxemia development were investigated in pregnant women with coronavirus disease-2019 (COVID-19). MATERIALS AND METHODS From August 2020 to February 2022, we performed a retrospective cohort study of 410 pregnant women with COVID-19. The clinical characteristics and prognoses were compared between pregnant COVID-19 patients requiring oxygen and those who did not. RESULTS Of 410 patients, 100 (24.4%) required oxygen therapy. Among them, fever [163 (52.6%) vs. 81 (81.0%), p<0.001] and cough [172 (56.4%) vs. 73 (73.0%), p=0.003] were more frequently observed than in non-oxygen group. The proportion of unvaccinated women was higher in oxygen group than in non-oxygen group [264 (85.2%) vs. 98 (98.0%), p=0.003]. During the Omicron wave, patients were more likely to have no oxygen requirement [98 (31.6%) vs. 18 (18.0%), p=0.009]. The risk of hypoxemic respiratory difficulty increased if SARS-CoV-2 infection occurred during the third trimester [adjusted odds ratio (aOR) 5.083, 95% confidence interval (CI): 1.095-23.593, p=0.038] and C-reactive protein (CRP) was elevated (≥1.0 mg/dL) at admission (aOR 5.878, 95% CI: 3.099-11.146, p<0.001). The risk was higher in unvaccinated patients (aOR 5.376, 95% CI: 1.193-24.390, p=0.028). However, the risk was lower in patients during the Omicron wave (aOR 0.498, 95% CI: 0.258-0.961, p=0.038). CONCLUSION A quarter of SARS-CoV-2-infected women developed hypoxemic respiratory difficulty during pregnancy. SARS-CoV-2 infection during the third trimester, CRP elevation at admission, and no vaccination increased the risk of hypoxemia in pregnant women.
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Affiliation(s)
- Yujin Sohn
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Kyoung Choi
- Department of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jisun Yun
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea.
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
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13
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Changizi N, Eshrati B, Salehi M, Beheshtian M, Hadipour Jahromy L, Emami Afshar N, Hejazi S, Hantoushzadeh S, Eslamian L, Savaie M, Raeisi A, Pooransari P. Vaccination effects on reducing COVID-19 complications in pregnancy: A large-scale report from Iran. Int J Gynaecol Obstet 2023; 163:1012-1017. [PMID: 37655467 DOI: 10.1002/ijgo.15077] [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: 04/26/2023] [Revised: 07/29/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of maternal coronavirus disease 2019 (COVID-19) vaccination on preventing severe complications of COVID-19 in pregnant women. METHODS A retrospective study was conducted in pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy and/or for up to 6 weeks postpartum between September 1, 2021, to January 30, 2022. The data was retrieved from a national database. The pregnant women were divided into two groups of vaccinated and unvaccinated. The proposed outcomes (the need for hospitalization, intensive care unit admission, and mechanical ventilation and products of conception complications) were compared between the two groups. RESULTS Approximately 90 000 pregnant women infected with COVID-19 were included in the study. The data of the vaccinated (19 922) and unvaccinated (70 147) groups were analyzed and compared. Pregnant patients in the vaccinated group had a significantly lower rate of hospitalization (21.2% vs 29.4%) (odds ratio [OR], 0.648 [95% confidence interval (CI), 0.625-0.673], P = 0.0001) and intensive care unit admission (3.7% vs 7.8%) (OR, 0.453 [95% CI, 0.382-0.535], P = 0.0001). The need for mechanical ventilation was also lower, although not statistically significant, in the vaccinated group than in the unvaccinated group (30 of 155 [19.4%] vs 418 of 1597 [26.2%]) (OR, 0.677 [95% CI, 0.448-1.024], P = 0.063). Cesarean section (54.3% vs 58.1%) (OR, 0.856 [95% CI, 0.751-0.977], P = 0.021) and stillbirth (0.4% vs 3.6%) (OR, 0.097 [95% CI, 0.026-0.252], P = 0.0001) were also significantly lower in the vaccinated patients. Most pregnant women in the vaccinated group (18 484-96.14%) received Sinopharm BIBP COVID-19 inactivated vaccine. No significant differences were seen in the effect of different types of COVID-19 vaccines on reducing COVID-19 complications in infected pregnant patients. CONCLUSION Maternal COVID-19 immunization is effective in reducing COVID-19 complications in infected pregnant women.
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Affiliation(s)
- Nasrin Changizi
- Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Eshrati
- Department of Community and Family Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Research Center for Antibiotic Stewardship and Anti-microbial Resistance, Imam Khomeini Hospital Complex, Infectious Diseases Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | - Sedigheh Hantoushzadeh
- Department of Obstetrics and Gynecology, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Eslamian
- Department of Obstetrics and Gynecology, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Savaie
- Department of Anesthesiology, School of Medicine, Pain Research Center, Razi Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Raeisi
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parichehr Pooransari
- Department of Obstetrics and Gynecology, School of Medicine, Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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de Andrade LH, dos Santos GG, de Sordi MADP, Nunes HRDC, Parada CMGDL. Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study. Rev Esc Enferm USP 2023; 57:e202320042. [PMID: 38051223 PMCID: PMC10697140 DOI: 10.1590/1980-220x-reeusp-2023-0042en] [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: 02/22/2023] [Accepted: 07/20/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death. METHOD Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05. RESULTS Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death. CONCLUSION Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.
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Affiliation(s)
- Luis Henrique de Andrade
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-graduação. Botucatu, SP, Brasil
| | - Gustavo Gonçalves dos Santos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brasil
| | - Mônica Aparecida de Paula de Sordi
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-graduação. Botucatu, SP, Brasil
| | - Hélio Rubens de Carvalho Nunes
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-graduação. Botucatu, SP, Brasil
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15
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Zerbo O, Ray GT, Fireman B, Layefsky E, Goddard K, Ross P, Greenberg M, Klein NP. Effectiveness of COVID-19 vaccination during pregnancy by circulating viral variant. AJOG GLOBAL REPORTS 2023; 3:100264. [PMID: 37719643 PMCID: PMC10502365 DOI: 10.1016/j.xagr.2023.100264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection in pregnancy can result in a spectrum of asymptomatic to critical COVID-19 outcomes, including hospitalization, admission to the intensive care unit, or death. OBJECTIVE This study aimed to investigate the effectiveness of messenger RNA COVID-19 vaccination during pregnancy against both hospitalization and infection, stratified by different variant circulations and by time since the last vaccine dose. STUDY DESIGN This was a retrospective cohort study among pregnant persons who were members of Kaiser Permanente Northern California and delivered between December 15, 2020, and September 30, 2022. Pregnant persons who received any vaccine dose before the pregnancy onset date were excluded. The primary outcome was hospitalization for COVID-19, and the secondary outcome was polymerase chain reaction-confirmed SARS-CoV-2 infection. Exposure was receipt of a messenger RNA vaccine during pregnancy. Poisson regression was used to estimate the risk ratio of hospitalization by comparing vaccinated pregnant persons with unvaccinated pregnant persons adjusted for sociodemographic factors and calendar time. Cox regression was used to estimate the hazard ratio of infection by comparing vaccinated pregnant persons with unvaccinated pregnant persons. Vaccine effectiveness was estimated as 1 minus the rate ratio or the hazard ratio multiplied by 100. Vaccine effectiveness was estimated overall and by variant periods (before Delta, Delta, Omicron, and subvariants). RESULTS Of 57,688 pregnant persons, 16,153 (28%) received at least 1 dose of a messenger RNA COVID-19 vaccine during pregnancy; moreover, 4404 pregnant persons tested positive for SARS-CoV-2 infection, and 108 pregnant persons were hospitalized during pregnancy. Overall, 2-dose vaccine effectiveness against hospitalization was 91% within <150 days of vaccination and 48% >150 days after vaccination. The 2-dose vaccine effectiveness within <150 days after vaccination was 100% during the original virus strain and Delta variant periods of the virus; vaccine effectiveness was 51% during the Omicron period. Of the hospitalization cases, 97% of pregnant persons were unvaccinated. During hospitalization, none of the vaccinated pregnant persons required ventilation or were admitted to the intensive care unit. Moreover, 2-dose vaccine effectiveness against infection was 54% within <150 days after vaccination and 26% ≥150 days after vaccination. CONCLUSION Messenger RNA COVID-19 vaccination during pregnancy was effective against hospitalization for COVID-19 and SARS-CoV-2 infection. COVID-19 was mild among pregnant persons who were vaccinated compared with those who were unvaccinated. Thus, all pregnant persons should be strongly encouraged to receive messenger RNA COVID-19 vaccines to prevent severe disease.
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Affiliation(s)
- Ousseny Zerbo
- Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA (Dr Zerbo, Mr. Ray, Fireman and Layefsky, Ms. Goddard, and Ross, and Dr Klein)
| | - G. Thomas Ray
- Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA (Dr Zerbo, Mr. Ray, Fireman and Layefsky, Ms. Goddard, and Ross, and Dr Klein)
| | - Bruce Fireman
- Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA (Dr Zerbo, Mr. Ray, Fireman and Layefsky, Ms. Goddard, and Ross, and Dr Klein)
| | - Evan Layefsky
- Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA (Dr Zerbo, Mr. Ray, Fireman and Layefsky, Ms. Goddard, and Ross, and Dr Klein)
| | - Kristin Goddard
- Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA (Dr Zerbo, Mr. Ray, Fireman and Layefsky, Ms. Goddard, and Ross, and Dr Klein)
| | - Pat Ross
- Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA (Dr Zerbo, Mr. Ray, Fireman and Layefsky, Ms. Goddard, and Ross, and Dr Klein)
| | - Mara Greenberg
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, CA (Dr Greenberg)
- Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara, CA (Dr Greenberg)
| | - Nicola P. Klein
- Kaiser Permanente Northern California, Vaccine Study Center, Oakland, CA (Dr Zerbo, Mr. Ray, Fireman and Layefsky, Ms. Goddard, and Ross, and Dr Klein)
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16
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Barrozo ER, Seferovic MD, Castro ECC, Major AM, Moorshead DN, Jochum MD, Rojas RF, Shope CD, Aagaard KM. SARS-CoV-2 niches in human placenta revealed by spatial transcriptomics. MED 2023; 4:612-634.e4. [PMID: 37423216 PMCID: PMC10527005 DOI: 10.1016/j.medj.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/21/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Functional placental niches are presumed to spatially separate maternal-fetal antigens and restrict the vertical transmission of pathogens. We hypothesized a high-resolution map of placental transcription could provide direct evidence for niche microenvironments with unique functions and transcription profiles. METHODS We utilized Visium Spatial Transcriptomics paired with H&E staining to generate 17,927 spatial transcriptomes. By integrating these spatial transcriptomes with 273,944 placental single-cell and single-nuclei transcriptomes, we generated an atlas composed of at least 22 subpopulations in the maternal decidua, fetal chorionic villi, and chorioamniotic membranes. FINDINGS Comparisons of placentae from uninfected healthy controls (n = 4) with COVID-19 asymptomatic (n = 4) and symptomatic (n = 5) infected participants demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection in syncytiotrophoblasts occurred in both the presence and the absence of maternal clinical disease. With spatial transcriptomics, we found that the limit of detection for SARS-CoV-2 was 1/7,000 cells, and placental niches without detectable viral transcripts were unperturbed. In contrast, niches with high SARS-CoV-2 transcript levels were associated with significant upregulation in pro-inflammatory cytokines and interferon-stimulated genes, altered metallopeptidase signaling (TIMP1), with coordinated shifts in macrophage polarization, histiocytic intervillositis, and perivillous fibrin deposition. Fetal sex differences in gene expression responses to SARS-CoV-2 were limited, with confirmed mapping limited to the maternal decidua in males. CONCLUSIONS High-resolution placental transcriptomics with spatial resolution revealed dynamic responses to SARS-CoV-2 in coordinate microenvironments in the absence and presence of clinically evident disease. FUNDING This work was supported by the NIH (R01HD091731 and T32-HD098069), NSF (2208903), the Burroughs Welcome Fund and the March of Dimes Preterm Birth Research Initiatives, and a Career Development Award from the American Society of Gene and Cell Therapy.
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Affiliation(s)
- Enrico R Barrozo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Maxim D Seferovic
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Eumenia C C Castro
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Angela M Major
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - David N Moorshead
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA; Immunology and Microbiology Graduate Program, Baylor College of Medicine, Houston, TX, USA
| | - Michael D Jochum
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Ricardo Ferral Rojas
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Cynthia D Shope
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Kjersti M Aagaard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
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17
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Zerbo O, Ray GT, Fireman B, Layefsky E, Goddard K, Ross P, Greenberg M, Klein NP. Individual and neighborhood factors associated with being unvaccinated against COVID-19 among pregnant persons. Hum Vaccin Immunother 2023; 19:2256042. [PMID: 37697942 PMCID: PMC10498815 DOI: 10.1080/21645515.2023.2256042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/04/2023] [Accepted: 09/02/2023] [Indexed: 09/13/2023] Open
Abstract
We investigated whether unvaccinated pregnant persons cluster geographically and determined factors associated with being unvaccinated using spatial and multivariate logistic regression analyses. Pregnant persons with deliveries from December 15, 2020, through September 30, 2022, at Kaiser Permanente Northern California were included. Of the 85,852 pregnant persons in the study, 46.6% were unvaccinated before and during pregnancy. Spatial analysis identified 5 clusters with high prevalence of unvaccinated pregnant persons. Within these clusters, the proportion of unvaccinated varied from 53% to 62% versus 39% outside the clusters. In covariate-adjusted analyses, residence in a cluster increased the odds of being unvaccinated by 1.64 (95% confidence interval (CI): 1.59,1.69). The odds of being unvaccinated increased among those aged 16-24 years (odds ratio [OR] = 2.69, CI: 2.55, 2.83), aged 25-34 years (OR = 1.59, CI: 1.54, 1.64) compared with age ≥ 35 years, black race (OR = 1.45, CI:1.37, 1.54), and subsidized insurance (OR = 1.32, CI: 1.26, 1.38). The odds of being unvaccinated also increased for pregnant persons living in neighborhoods where the proportion of adults with high school education or less was greater than 20%. Geographic clustering of unvaccinated pregnant persons suggests a need for population-specific-interventions to increase vaccine coverage.
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Affiliation(s)
- Ousseny Zerbo
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - G. Thomas Ray
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Bruce Fireman
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Evan Layefsky
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kristin Goddard
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Pat Ross
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mara Greenberg
- Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, CA, USA
- Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara, CA, USA
| | - Nicola P. Klein
- Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, USA
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Berger DS, Galyean A, Nguyen K, Alshak N, Blumenthal E. A Case of Significant Transaminitis with Liver Biopsy in a Pregnant Patient with COVID-19. AJP Rep 2023; 13:e78-e81. [PMID: 38033600 PMCID: PMC10684339 DOI: 10.1055/s-0043-1777099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/30/2023] [Indexed: 12/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to a global health crisis. The virus can cause varying severity of liver injury, but the mechanism has not yet been elucidated, especially in pregnancy. We present a morbidly obese 30-year-old woman with COVID-19 at 28 weeks' gestation complicated by significant transaminitis with peak liver enzymes levels of 501/1,313 (aspartate aminotransferase/alanine aminotransferase). Liver biopsy showed reactive changes consistent with medication effect and mild steatosis. Significant transaminitis has been found in both pregnant and nonpregnant patients with COVID-19. Our case demonstrates the multifactorial nature of liver injury in COVID-19 patients including mild underlying liver steatosis combined with possible viral potentiation of medication effect.
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Affiliation(s)
- Dana Senderoff Berger
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Anna Galyean
- Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
| | - Kelvin Nguyen
- Department of Gastroenterology, Southern California Permanente Medical Group, Pasadena, California
| | - Najeeb Alshak
- Department of Pathology, Southern California Permanente Medical Group, Pasadena, California
| | - Elizabeth Blumenthal
- Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Pasadena, California
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19
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Afshar M, Ghahramani L, Asadollahi A, Karimi M, Mobasheri N. Predictors of health behavior compliance for the prevention of Covid-19 based on the extended parallel process model in pregnant women in Iran. Health Care Women Int 2023; 44:1019-1035. [PMID: 36854007 DOI: 10.1080/07399332.2023.2181349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 01/21/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
Pregnant women are at higher risk of getting severe Covid-19 disease and consequences on the health status of them and their fetuses. Despite vaccination, all preventive behaviors are emphasized. This study aimed to identify the determinants of Covid-19 preventive health behaviors in pregnant women using Extended Parallel Process Model. This cross-sectional study, was conducted on 175pregnant women. The model fit indices were acceptable. Knowledge had indirect effect on adherence to Covid-19 preventive behaviors trough mediating role of self-efficacy and response efficacy. So, it is suggested that, educational interventions should focus on increasing knowledge.
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Affiliation(s)
- Mohammad Afshar
- Student Research Committee, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ghahramani
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolrahim Asadollahi
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Karimi
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Mobasheri
- Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Ghamri RA, Ghamri KA. Sociodemographic and clinical predictors for COVID-19 preventive measures compliance among pregnant women in Saudi Arabia: a multicenter study. BMC Infect Dis 2023; 23:402. [PMID: 37312041 DOI: 10.1186/s12879-023-08364-z] [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: 01/17/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE To assess the levels of adherence among pregnant women to the basic COVID-19 preventive measures, and to analyze the effect of risk perception and sociodemographic and clinical factors on adherence. METHOD A multicenter, cross-sectional study was conducted at the obstetrics clinics of 50 primary care centers selected using a multistage sampling method. An online-administered, structured questionnaire was used to collect self-reported levels of adherence to four basic preventive measures against COVID-19, along with perceived COVID-19 severity, infectiousness, and harmfulness to the baby, besides sociodemographic and clinical data including obstetrical and other medical history. RESULTS A total of 2460 pregnant women were included with a mean (SD) age of 30.21 (6.11) years. Levels of self-reported compliance were highest for hand hygiene (95.7%), followed by social distancing (92.3%), masking (90.0%), and avoidance of contact with a COVID-19 infected person (70.3%). Perceived COVID-19 severity and infectiousness, and harmfulness to the baby were observed in 89.2%, 70.7%, and 85.0% of the participants, respectively, and were variably associated with compliance to preventive measures. Analysis of sociodemographic factors highlighted the significance of education and economic status in determining adherence to preventive measures, which represents a potential inequity in the risk of COVID-19 infection. CONCLUSION This study highlights the importance of patients' education to enable functional perception of COVID-19 that promotes self-efficacy, besides investigating the specific social determinants of health to tackle inequalities in terms of prevention efficiency and the subsequent health outcomes.
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Affiliation(s)
- Ranya A Ghamri
- Family Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Kholoud A Ghamri
- Internal Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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21
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Steiner ML, Cunha BCR, de Almeida JFM, Carrijo G, Dutra L, Suano F, Giovanelli S, Carneiro M, da Silva MH. Evaluation of Maternal Fetal Outcomes of Pregnant Women and Mothers with Suspected Infection by SARS-CoV-2 Treated at the Municipal Hospital of São Bernardo do Campo (HMU-SBC), Brazil. Matern Child Health J 2023:10.1007/s10995-023-03685-6. [PMID: 37306822 DOI: 10.1007/s10995-023-03685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The impact of Covid-19 infection on pregnancy and perinatal outcomes is not fully known. To describe the risk factors and perinatal outcome of pregnant women with suspected COVID-19 infection. METHODS We evaluated medical records of women with suspected or confirmed SARS-CoV-2 infection who received health care services at the University Hospital of São Bernardo do Campo from March 1 to July 31, 2020, and personal, clinical, and laboratory data of these women and their newborns. RESULTS Of the 219 women identified, 29% were asymptomatic. Considering the total population, 26% and 17% had obesity and hypertensive syndrome, respectively. Fever measured in the emergency room was the main reason for hospitalization. The presence or not of flu-like symptoms did not impact on perinatal outcomes. Pregnant women requiring hospitalization had newborns with lower birth weight (p < 0.01), shorter length (p = 0.02), and smaller head circumference (p = 0.03), and, in these cases, a higher number of cesarean section deliveries was observed. CONCLUSION COVID-19 infection did not affect the prognosis of pregnancy and newborns. However, the worst clinical outcome, requiring hospitalization, had an impact on the anthropometric measurements of newborns.
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Affiliation(s)
- Marcelo Luis Steiner
- Department of Obstetrics and Gynecology, FMABC University Center, Avenida Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil.
| | | | | | | | | | - Fabiola Suano
- Department of Pediatrics, FMABC University Center, Santo André, Brazil
- Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | | | - Mônica Carneiro
- São Bernardo Do Campo City University Hospital, São Bernardo do Campo, Brazil
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22
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Hantoushzadeh S, Eshraghi N, Younesi S, Salehi M, Rezaei N, Hasheminejad MM, Rashidian P, Shirdel S, Asadi F, Ghaemi M. Cord blood antibodies following BBIBP-CorV (Sinopharm) vaccination during pregnancy. Immun Inflamm Dis 2023; 11:e874. [PMID: 37382259 PMCID: PMC10266141 DOI: 10.1002/iid3.874] [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: 12/20/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the maternal and umbilical cord blood antibody levels, after COVID vaccination during pregnancy. METHOD The women who received the COVID-19 vaccine (Sinopharm) during pregnancy were included. Maternal and cord blood samples were tested to detect the severe acute respiratory syndrome coronavirus 2 receptor binding domain (RBD) specific antibodies. In addition, obstetric information and side effects after vaccination were gathered. RESULT A total of 23 women were included. Eleven pregnant women took two doses and 12 cases received a single dose of the vaccine. No IgM antibody was detected in any maternal blood or cord blood samples. The RBD-specific Immunoglobulin G (IgG) antibody was positive in mothers receiving 2 doses of the vaccine and their infants. But the antibody titers were under the positive cut-off threshold for the other 12 women who were vaccinated with a single dose. Women who received both doses of vaccine had significantly higher IgG levels than a single dose of Sinopharm (p = .025). The same result was demonstrated in infants born to these mothers (p = .019). CONCLUSION There was a significant correlation between maternal and neonatal IgG concentrations. Although, receiving both doses of the BBIBP-CorV vaccine (not 1 dose) during pregnancy is highly beneficial for increasing humoral immunity for the mother and fetus.
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Affiliation(s)
- Sedigheh Hantoushzadeh
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Nasim Eshraghi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | | | - Mohammadreza Salehi
- Department of Infectious DiseasesTehran University of Medical SciencesTehranIran
| | - Nima Rezaei
- Department of Immunology, Research Center for Immunodeficiencies, Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Mohammad Mehdi Hasheminejad
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Pegah Rashidian
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Saeedeh Shirdel
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Fatemeh Asadi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Marjan Ghaemi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
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23
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Heeralall C, Ibrahim UH, Lazarus L, Gathiram P, Mackraj I. The effects of COVID-19 on placental morphology. Placenta 2023; 138:88-96. [PMID: 37235921 DOI: 10.1016/j.placenta.2023.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/10/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
The impact of the COVID-19 infection, caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during the pandemic has been considerably more severe in pregnant women than non-pregnant women. Therefore, a review detailing the morphological alterations and physiological changes associated with COVID-19 during pregnancy and the effect that these changes have on the feto-placental unit is of high priority. This knowledge is crucial for these mothers, their babies and clinicians to ensure a healthy life post-pandemic. Hence, we review the placental morphological changes due to COVID-19 to enhance the general understanding of how pregnant mothers, their placentas and unborn children may have been affected by this pandemic. Based on current literature, we deduced that COVID-19 pregnancies were oxygen deficient, which could further result in other pregnancy-related complications like preeclampsia and IUGR. Therefore, we present an up-to-date review of the COVID-19 pathophysiological implications on the placenta, covering the function of the placenta in COVID-19, the effects of this virus on the placenta, its functions and its link to other gestational complications. Furthermore, we highlight the possible effects of COVID-19 therapeutic interventions on pregnant mothers and their unborn children. Based on the literature, we strongly suggest that consistent surveillance for the mothers and infants from COVID-19 pregnancies be prioritised in the future. Though the pandemic is now in the past, its effects are long-term, necessitating the monitoring of clinical manifestations in the near future.
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Affiliation(s)
- C Heeralall
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - U H Ibrahim
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - L Lazarus
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - P Gathiram
- Discipline of Family Medicine, School of Public Health and Nursing, University of KwaZulu-Natal, Durban, South Africa
| | - I Mackraj
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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24
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Țieranu ML, Dragoescu NA, Zorilă GL, Istrate-Ofițeru AM, Rămescu C, Berbecaru EIA, Drăguşin RC, Nagy RD, Căpitănescu RG, Iliescu DG. Addressing Chronic Gynecological Diseases in the SARS-CoV-2 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040802. [PMID: 37109760 PMCID: PMC10145652 DOI: 10.3390/medicina59040802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Introduction: the COVID-19 pandemic has had a considerable impact on healthcare systems worldwide. Since the actual influence of the pandemic on gynecological care is still unclear, we aim to evaluate the effect of the SARS-CoV-2 pandemic on gynecological procedures compared to the pre-pandemic period in Romania. Materials and Methods: this is a single-center retrospective observational study, involving patients hospitalized in the year before the SARS-CoV-2 pandemic (PP), in the first year of the pandemic (P1), and in the second year of the pandemic until February 2022 (P2). The percentages of interventions were analyzed globally but also according to the type of surgery applied on the female genital organs. Results: during pandemic, the number of gynecological surgeries dropped considerably, by more than 50% in some cases, or even decreased by up to 100%, having a major impact on women's health, especially in the first year of the pandemic (P1), before slightly increasing in the post-vaccination period (PV). Surgically treated cancer cases dropped by over 80% during the pandemic, and the consequences of this will be seen in the future. Conclusions: the COVID-19 pandemic played an important part in gynecological care management in the Romanian public health care system, and the effect will have to be investigated in the future.
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Affiliation(s)
- Maria-Loredana Țieranu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 20039 Craiova, Romania
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Nicoleta Alice Dragoescu
- Department of Anesthesiology and Intensive Care, Emergency County Hospital of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - George-Lucian Zorilă
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca-Maria Istrate-Ofițeru
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Cătălina Rămescu
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Elena-Iuliana-Anamaria Berbecaru
- Doctoral School, University of Medicine and Pharmacy of Craiova, 20039 Craiova, Romania
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Roxana Cristina Drăguşin
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Rodica Daniela Nagy
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Răzvan Grigoraș Căpitănescu
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dominic-Gabriel Iliescu
- Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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25
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Lee JJ, Lee SE, Kim Y, Park YJ. Analysis of pregnant women with critically severe COVID-19 in Republic of Korea from February 2020 and December 2021. Osong Public Health Res Perspect 2023; 14:129-137. [PMID: 37183333 PMCID: PMC10211450 DOI: 10.24171/j.phrp.2023.0025] [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: 01/26/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES This study aimed to describe the characteristics and risk factors for severe disease in pregnant women infected with coronavirus disease 2019 (COVID-19) from the early days of the COVID-19 epidemic in Korea to the predominant period of the Delta variant. METHODS A retrospective cohort study was conducted among pregnant women diagnosed with COVID-19 between February 2020 and December 2021. Logistic regression analysis was performed to compare severe and mild cases after adjusting for pregnant women's age, nationality, infection route, outbreak area, infection period, symptoms, underlying disease, smoking status, trimester, and COVID-19 vaccination status. RESULTS In total, 2,233 pregnant women were diagnosed with COVID-19 by December 2021. Among these, 96.7% had mild symptoms, 3.3% had severe symptoms, and 0.04% died. The risk factors for severe disease in pregnant women with confirmed COVID-19 were being in the age group of 35 to 45 years, having hyperlipidemia, being in the second or third trimester of pregnancy at the time of COVID-19 diagnosis, being infected during the Delta-predominant period, and having a fever (≥38 °C) at diagnosis. Furthermore, 47.1% of patients in the mild group and 84.9% of patients in the severe group had 3 or more risk factors. CONCLUSION Pregnant women with COVID-19 mainly experienced mild symptoms, but those with risk factors were at a higher risk of developing severe symptoms. Therefore, treatment and follow-up management should be thoroughly implemented.
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Affiliation(s)
- Ji Joo Lee
- Division of Epidemiological Investigation Analysis, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Sang-Eun Lee
- Division of Epidemiological Investigation Analysis, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Yeonjung Kim
- Division of Infectious Disease Response, Gyeongnam Regional Center for Disease Control and Prevention, Korea Disease Control and Prevention Agency, Busan, Republic of Korea
| | - Young-Joon Park
- Division of Epidemiological Investigation Analysis, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
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26
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Surekha MV, Suneetha N, Balakrishna N, Putcha UK, Satyanarayana K, Geddam JJB, Sreenu P, Tulja B, Mamidi RS, Rutter GA, Meur G. Impact of COVID-19 during pregnancy on placental pathology, maternal and neonatal outcome - A cross-sectional study on anemic term pregnant women from a tertiary care hospital in southern India. Front Endocrinol (Lausanne) 2023; 14:1092104. [PMID: 37025411 PMCID: PMC10070875 DOI: 10.3389/fendo.2023.1092104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Background SARS-CoV-2 infection during pregnancy may cause adverse maternal, neonatal and placental outcomes. While tissue hypoxia is often reported in COVID-19 patients, pregnant women with anemia are suspected to be more prone to placental hypoxia-related injuries. Methods This hospital-based cross-sectional study was conducted between August-November 2021, during COVID-19 second wave in India. Term pregnant women (N=212) admitted to hospital for delivery were enrolled consecutively. Since hospital admission mandated negative RT-PCR test for SARS-CoV-2 virus, none had active infection. Data on socio-demography, COVID-19 history, maternal, obstetric, and neonatal outcomes were recorded. Pre-delivery maternal and post-delivery cord blood samples were tested for hematological parameters and SARS-CoV-2 IgG. Placentae were studied for histology. Results Of 212 women, 122 (58%) were seropositive for SARS-CoV-2 IgG, but none reported COVID-19 history; 134 (63.2%) were anemic. In seropositive women, hemoglobin (p=0.04), total WBC (p=0.009), lymphocytes (p=0.005) and neutrophils (p=0.02) were significantly higher, while ferritin was high, but not significant and neutrophils to lymphocytes (p=0.12) and platelets to lymphocytes ratios (p=0.03) were lower. Neonatal outcomes were similar. All RBC parameters and serum ferritin were significantly lower in anemic mothers but not in cord blood, except RDW that was significantly higher in both, maternal (p=0.007) and cord (p=0.008) blood from seropositive anemic group compared to other groups. Placental histology showed significant increase in villous hypervascularity (p=0.000), dilated villous capillaries (p=0.000), and syncytiotrophoblasts (p=0.02) in seropositive group, typically suggesting placental hypoxia. Maternal anemia was not associated with any histological parameters. Univariate and multivariate logistic regression analyses of placental histopathological adverse outcomes showed strong association with SARS-CoV-2 seropositivity but not with maternal anemia. When adjusted for several covariates, including anemia, SARS-CoV-2 seropositivity emerged as independent risk factor for severe chorangiosis (AOR 8.74, 95% CI 3.51-21.76, p<0.000), dilated blood vessels (AOR 12.74, 95% CI 5.46-29.75, p<0.000), syncytiotrophoblasts (AOR 2.86, 95% CI 1.36-5.99, p=0.005) and villus agglutination (AOR 9.27, 95% CI 3.68-23.32, p<0.000). Conclusion Asymptomatic COVID-19 during pregnancy seemed to be associated with various abnormal placental histopathologic changes related to placental hypoxia independent of maternal anemia status. Our data supports an independent role of SARS-CoV-2 in causing placental hypoxia in pregnant women.
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Affiliation(s)
- M. V. Surekha
- Pathology and Microbiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - N. Suneetha
- Obstetrics & Gynecology Department, Government Area Hospital, Nampally, Hyderabad, India
| | - N. Balakrishna
- Department of Statistics, Apollo Hospitals Educational and Research Foundation (AHERF), Hyderabad, India
| | - Uday Kumar Putcha
- Pathology and Microbiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - K. Satyanarayana
- Pathology and Microbiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - J. J. Babu Geddam
- Clinical Epidemiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - Pagidoju Sreenu
- Clinical Epidemiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - B. Tulja
- Clinical Epidemiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - Raja Sriswan Mamidi
- Clinical Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - Guy A. Rutter
- Centre of Research of Centre Hospitalier de l'Université de Montréal (CRCHUM), Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Section of Cell Biology and Functional Genomics, Imperial College London, London, United Kingdom
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gargi Meur
- Cell Biology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
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27
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Vasquez DN, Giannoni R, Salvatierra A, Cisneros K, Lafosse D, Escobar MF, Montenegro M, Juárez P, Visani L, Mandich V, Barrozo E, Kirschbaum M, Das Neves AV, Valenti MF, Canseco MC, Romero I, Macharé P, Marquez AK, Rodriguez E, Palacio C, Rapela L, Amillategui Scenna JM, Nuñez R, Torres S, González MA, Franconieri L, Nasner D, Okurzaty P, Plotnikow GA, Intile AD. Ventilatory Parameters in Obstetric Patients With COVID-19 and Impact of Delivery: A Multicenter Prospective Cohort Study. Chest 2023; 163:554-566. [PMID: 36257474 PMCID: PMC9573860 DOI: 10.1016/j.chest.2022.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Current evidence on obstetric patients requiring advanced ventilatory support and impact of delivery on ventilatory parameters is retrospective, scarce, and controversial. RESEARCH QUESTION What are the ventilatory parameters for obstetric patients with COVID-19 and how does delivery impact them? What are the risk factors for invasive mechanical ventilation (IMV) and for maternal, fetal, and neonatal mortality? STUDY DESIGN AND METHODS Prospective, multicenter, cohort study including pregnant and postpartum patients with COVID-19 requiring advanced ventilatory support in the ICU. RESULTS Ninety-one patients were admitted to 21 ICUs at 29.2 ± 4.9 weeks; 63 patients (69%) delivered in ICU. Maximal ventilatory support was as follows: IMV, 69 patients (76%); high-flow nasal cannula, 20 patients (22%); and noninvasive mechanical ventilation, 2 patients (2%). Sequential Organ Failure Assessment during the first 24 h (SOFA24) score was the only risk factor for IMV (OR, 1.97; 95% CI, 1.29-2.99; P = .001). Respiratory parameters at IMV onset for pregnant patients were: mean ± SD plateau pressure (PP), 24.3 ± 4.5 cm H2O; mean ± SD driving pressure (DP), 12.5 ± 3.3 cm H2O; median static compliance (SC), 31 mL/cm H2O (interquartile range [IQR], 26-40 mL/cm H2O); and median Pao2 to Fio2 ratio, 142 (IQR, 110-176). Respiratory parameters before (< 2 h) and after (≤ 2 h and 24 h) delivery were, respectively: mean ± SD PP, 25.6 ± 6.6 cm H2O, 24 ± 6.7 cm H2O, and 24.6 ± 5.2 cm H2O (P = .59); mean ± SD DP, 13.6 ± 4.2 cm H2O, 12.9 ± 3.9 cm H2O, and 13 ± 4.4 cm H2O (P = .69); median SC, 28 mL/cm H2O (IQR, 22.5-39 mL/cm H2O), 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O), and 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O; P = .058); and Pao2 to Fio2 ratio, 134 (IQR, 100-230), 168 (IQR, 136-185), and 192 (IQR, 132-232.5; P = .022). Reasons for induced delivery were as follows: maternal, 43 of 71 patients (60.5%); maternal and fetal, 21 of 71 patients (29.5%); and fetal, 7 of 71 patients (9.9%). Fourteen patients (22.2%) continued pregnancy after ICU discharge. Risk factors for maternal mortality were BMI (OR, 1.10; 95% CI, 1.006-1.204; P = .037) and comorbidities (OR, 4.15; 95% CI, 1.212-14.20; P = .023). Risk factors for fetal or neonatal mortality were gestational age at delivery (OR, 0.67; 95% CI, 0.52-0.86; P = .002) and SOFA24 score (OR, 1.53; 95% CI, 1.13-2.08; P = .006). INTERPRETATION Contrary to expectations, pregnant patient lung mechanics were similar to those of the general population with COVID-19 in the ICU. Delivery was induced mainly for maternal reasons, but did not change ventilatory parameters other than Pao2 to Fio2 ratio. SOFA24 score was the only risk factor for IMV. Maternal mortality was associated independently with BMI and comorbidities. Risk factors for fetal and neonatal mortality were SOFA24 score and gestational age at delivery.
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Affiliation(s)
| | - Roberto Giannoni
- Hospital Regional Ramón Carrillo, Santiago del Estero, Argentina
| | | | | | - Diego Lafosse
- Hospital Materno Infantil Dr. F Escardó, Tigre, Buenos Aires, Argentina
| | | | - Martín Montenegro
- Hospital Materno Infantil Ramón Sardá, City of Buenos Aires, Argentina
| | - Paula Juárez
- Hospital de la Madre y el Niño, La Rioja, Argentina
| | - Lucía Visani
- Hospital Cuenca Alta Néstor Kirchner, Cañuelas, Buenos Aires, Argentina
| | | | - Erika Barrozo
- Maternidad Provincial Teresita Baigorria, San Luis, Argentina
| | | | - Andrea V Das Neves
- Hospital Interzonal General de Agudos Gral. San Martín, La Plata, Buenos Aires, Argentina
| | - María F Valenti
- Argentine Society of Critical Care Medicine, City of Buenos Aires, Argentina
| | - María C Canseco
- Instituto de Maternidad y Ginecología nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán, Argentina
| | | | - Pedro Macharé
- Hospital Mi Pueblo, Florencio Varela, Buenos Aires, Argentina
| | - Ana K Marquez
- Hospital Municipal de Morón, Morón, Buenos Aires, Argentina
| | - Eva Rodriguez
- Hospital Simplemente Evita, González Catán, Buenos Aires, Argentina
| | | | - Laura Rapela
- Hospital Municipal del Carmen, Chacabuco, Buenos Aires, Argentina
| | | | - Rosshanna Nuñez
- Hospital Mariano y Luciano de la Vega, Moreno, Buenos Aires, Argentina
| | - Sebastián Torres
- Sanatorio Anchorena San Martín, San Martín, Buenos Aires, Argentina
| | - Miguel A González
- Hospital del Este "Eva Perón", San Miguel de Tucumán, Tucumán, Argentina
| | | | | | - Patricia Okurzaty
- Hospital Materno Infantil Ramón Sardá, City of Buenos Aires, Argentina
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Soni M, Kumari M, Grover N, Taneja R, Parashar L. Perioperative Outcome of COVID-19-Positive Parturient Posted for Cesarean Section—Our Experience in a Tertiary Care Hospital in Northern India. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1761606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Abstract
Introduction There is insufficient data regarding the severity of coronavirus disease 2019 (COVID-19) infections in pregnant women. This study assessed the outcome of COVID-19-positive parturient after cesarean section, correlation of maternal mortality with COVID-19 severity, association of comorbid parturients with severe COVID-19, and number of patients requiring general anesthesia.
Materials and Methods This single-center, retrospective observational study was performed on reverse transcriptase polymerase chain reaction confirmed COVID-19-positive 89 parturients posted for elective or emergency cesarean section. Data was collected from medical records of our hospital regarding COVID-19 severity, maternal mortality, need for admission in intensive care unit, gestational age, maternal comorbidities, indication for cesarean section, type of anesthesia, duration of surgery, neonatal birth weight, neonatal mortality, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, and neonatal intensive care unit (NICU) admission. Assessment of maternal outcome was the primary objective. Secondary objectives of this study were to correlate maternal outcome with COVID-19 severity, to find association of comorbid parturients with severe COVID-19 and to estimate number of patients requiring general anesthesia.
Results Out of 89 patients, 79 patients had mild COVID-19 disease were on room air and 6 patients required preoperative oxygen supplementation, and 4 patients diagnosed to have severe COVID-19 pneumonia were on mechanical ventilator preoperatively. Four cases were operated under general anesthesia and remaining 85 parturients were operated under regional anesthesia. Out of four parturients with severe COVID-19 pneumonia, three patients did not survive in postoperative period due to refractory hypoxemia. In eight patients, spinal anesthesia was repeated due to inadequate effect. Fourteen neonates (16.09%) required NICU stay after cesarean delivery.
Conclusions Parturients with severe COVID-19 disease had higher mortality. No statistically significant association was found between number of comorbidities and severity of COVID-19. The results of this study will guide us regarding further management and prognostication of COVID-19-positive parturients posted for cesarean section.
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Affiliation(s)
- Megha Soni
- Department of Anaesthesia, ESIC Medical College, Faridabad, Haryana, India
| | - Mamta Kumari
- Department of Anaesthesia, ESIC Medical College, Faridabad, Haryana, India
| | - Niharika Grover
- Department of Anaesthesia, ESIC Medical College, Faridabad, Haryana, India
| | - Rashmi Taneja
- Department of Anaesthesia, ESIC Medical College, Faridabad, Haryana, India
| | - Lokesh Parashar
- Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India
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Koç E, Dilli D. How does COVID-19 affect maternal and neonatal outcomes? J Perinat Med 2023; 51:277-283. [PMID: 36580338 DOI: 10.1515/jpm-2022-0509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES In this article, we aimed to evaluate the most recent information on the impact of the COVID-19 pandemic on the health of mothers and their babies. METHODS We conducted a literature search by utilizing online sources. Scientific papers that were written in English on the effects of COVID-19 on both mother and their newborn were assessed. RESULTS COVID-19 can be fatal, especially in pregnant women with accompanying chronic diseases. The timing and mode of delivery should be decided by the status of the mother and fetus instead of SARS-CoV-2 positivity in pregnant women. At the nursery, routine separation of SARS-CoV-2 positive mothers and their infants is not recommended. However, it is important to take preventive measures to reduce the risk of transmission. The advantages of breastfeeding seem to outweigh the potential dangers of viral transmission. Neonatal COVID-19 infections may cause different clinical pictures from asymptomatic infections to life-threatening diseases. International health authorities specifically recommend that pregnant and lactating women get vaccinated to diminish the risk of transmission of the virus to the mother and fetus, not giving preference to a certain vaccine. It is prudent to apply universal screening only in populations with a high prevalence of COVID-19. CONCLUSIONS Healthcare professionals should carefully manage the perinatal period during the COVID-19 outbreak, using the most up-to-date information to protect and promote maternal and newborn health. Further scientific studies are needed to clarify the early and long-term effects of the COVID-19 pandemic on maternal-neonatal morbidity and mortality.
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Affiliation(s)
- Esin Koç
- Department of Neonatology, Chief of Neonatology Division, Gazi University, Gazi School of Medicine, Chief of Turkish Neonatal Society, Ankara, Türkiye
| | - Dilek Dilli
- Department of Neonatology, Dr Sami Ulus Maternity and Children Research and Training Hospital, University of Health Sciences of Türkiye, Ankara, Türkiye
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Pregnancy Outcomes in SARS-CoV-2-Positive Patients: A 20-Month Retrospective Analysis of Delivery Cases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020341. [PMID: 36837541 PMCID: PMC9968024 DOI: 10.3390/medicina59020341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023]
Abstract
Background and Objectives: The SARS-CoV-2 infection brings supplemental risks for pregnant women. Due to controversial hesitancy, their vaccination rate was lower in 2021 compared to the general population. In addition, access to maternal care was reduced during the pandemic. We conducted a retrospective cross-sectional analysis of the health records data over 20 months (1 April 2020 to 20 November 2021) aiming to explore the outcomes in SARS-CoV-2-positive cases referred for delivery to a tertiary public hospital in Western Romania. Materials and Methods: Women with SARS-CoV-2 infection diagnosed for the first time at the moment of birth who delivered singletons after 24 weeks of gestation, and had a clear immunization status were included in the analysis. Results: Out of the 97 patients included in the study, 35 (36%) had undergone ARN-based vaccination. Five cases of maternal death were recorded (all unvaccinated). Our retrospective exploratory analysis showed that the presence of COVID-19 symptoms in the SARS-CoV-2-positive patients made a significant impact on the delivery hospitalization, with a median hospital stay increase from 5 to 9 days (Mann-Whitney test, p = 0.014): longer hospitalization was recorded in the symptomatic cases irrespective of their vaccination status. No other adverse outcomes, such as gestational age at delivery, C-section rate, 5 min Apgar index, or birth weight were associated with the presence of symptoms. Conclusions: Our clinic maintained safe maternal care for the COVID-19 patients during the analyzed period. Vaccination of the expectant women was beneficial in SARS-CoV-2-positive patients by lowering the risk of COVID-19 symptoms, with subsequent implications on the newborns' health and maternal attachment.
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Zamparini J, Saggers R, Buga CE. A Review of Coronavirus Disease 2019 in Pregnancy. Semin Respir Crit Care Med 2023; 44:50-65. [PMID: 36646085 DOI: 10.1055/s-0042-1758853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Pregnancy is an independent risk factor for morbidity and mortality in coronavirus disease 2019 (COVID-19) with increased rates of operative delivery, intensive care unit admission, and mechanical ventilation as well as a possible increased risk of death, independent of other risk factors, compared with nonpregnant women with COVID-19. Furthermore, pregnancy outcomes are worse in those with COVID-19 with increased risk for preeclampsia, venous thromboembolism, preterm birth, miscarriage, and stillbirth compared with pregnant women without COVID-19. Importantly, pregnant women of nonwhite ethnicity appear to be at greater risk of severe COVID-19, necessitating improved access to care and closer monitoring in these women. The management of COVID-19 in pregnancy is largely similar to that in nonpregnant people; however, there is an important emphasis on multidisciplinary team involvement to ensure favorable outcomes in both mother and baby. Similarly, vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is safe in pregnancy and improves maternal and neonatal outcomes.
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Affiliation(s)
- Jarrod Zamparini
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Robin Saggers
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Chandia Edward Buga
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Obstetrics and Gynaecology, Thelle Mogoerane Regional Hospital, Vosloorus, South Africa
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Wainstock T, Sergienko R, Orenshtein S, Sheiner E. Factors associated with COVID-19 vaccination likelihood during pregnancy. Int J Gynaecol Obstet 2023; 161:478-484. [PMID: 36651802 DOI: 10.1002/ijgo.14680] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 11/12/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify maternal background, medical and gynecological characteristics associated with COVID-19 vaccination likelihood, in the context where COVID-19 vaccination rates among pregnant women are significantly lower than the general population. METHODS In a retrospective cohort study, including all women who delivered between January and September 2021, background and medical history, including current and previous pregnancies diagnoses, were compared between vaccinated and unvaccinated women. Multivariable logistic models were used to identify factors associated with vaccination for the entire population, and for the two distinctive populations included in the study (Bedouin Arabs and Jewish women). RESULTS The study population included 7017 women, of whom 1925 (27.4%) were vaccinated during pregnancy. According to the multivariable analysis, unvaccinated mothers were younger with lower socioeconomic score. They were more likely to be Bedouin Arabs, have a poor obstetrical history or recurrent pregnancy loss, and insufficient prenatal care. Additional risk factors were inconsistent between the two ethnicities included in the study. CONCLUSIONS Ethnicity, insufficient prenatal care, and having a poor obstetric history were consistently associated with lower vaccination among pregnant women. These factors should be considered in future plans aimed at increasing vaccination among pregnant women.
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Affiliation(s)
- Tamar Wainstock
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shani Orenshtein
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Cahen-Peretz A, Tsaitlin-Mor L, Allouche Kam H, Frenkel R, Kabessa M, Cohen SM, Lipschuetz M, Oiknine-Djian E, Lianski S, Goldman-Wohl D, Walfisch A, Kovo M, Neeman M, Wolf DG, Yagel S, Beharier O. Boosting maternal and neonatal anti-SARS-CoV-2 humoral immunity using a third mRNA vaccine dose. JCI Insight 2023; 8:158646. [PMID: 36625348 PMCID: PMC9870074 DOI: 10.1172/jci.insight.158646] [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: 01/19/2022] [Accepted: 11/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To minimize COVID-19 pandemic burden and spread, 3-dose vaccination campaigns commenced worldwide. Since patients who are pregnant are at increased risk for severe disease, they were recently included in that policy, despite the lack of available evidence regarding the impact of a third boosting dose during pregnancy, underscoring the urgent need for relevant data. We aimed to characterize the effect of the third boosting dose of mRNA Pfizer BNT162b2 vaccine in pregnancy. METHODS We performed a prospective cohort study of anti-SARS-CoV-2 antibody titers (n = 213) upon delivery in maternal and cord blood of naive fully vaccinated parturients who received a third dose (n = 86) as compared with 2-dose recipients (n = 127). RESULTS We found a robust surge in maternal and cord blood levels of anti-SARS-CoV-2 titers at the time of delivery, when comparing pregnancies in which the mother received a third boosting dose with 2-dose recipients. The effect of the third boosting dose remained significant when controlling for the trimester of last exposure, suggesting additive immunity extends beyond that obtained after the second dose. Milder side effects were reported following the third dose, as compared with the second vaccine dose, among the fully vaccinated group. CONCLUSION The third boosting dose of mRNA Pfizer BNT162b2 vaccine augmented maternal and neonatal immunity with mild side effects. These data provide evidence to bolster clinical and public health guidance, reassure patients, and increase vaccine uptake among patients who are pregnant. FUNDING Israel Science Foundation KillCorona grant 3777/19; Research grant from the "Ofek" Program of the Hadassah Medical Center.
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Affiliation(s)
- Adva Cahen-Peretz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Lilah Tsaitlin-Mor
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hadas Allouche Kam
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Racheli Frenkel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Maor Kabessa
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sarah M. Cohen
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sapir Lianski
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Dana G. Wolf
- Clinical Virology Unit, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.,Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Muacevic A, Adler JR, Thabet H, Alenezi F. Maternal Outcomes Among Pregnant Women Diagnosed With COVID-19. Cureus 2023; 15:e33887. [PMID: 36819426 PMCID: PMC9934465 DOI: 10.7759/cureus.33887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COVID-19 has the potential development of negative maternal outcomes for pregnant women. The risk of contracting COVID-19 is high as pregnancy alters the maternal immune system. Therefore, this study aims to assess maternal outcomes among pregnant women with COVID-19 in the Kingdom of Saudi Arabia. METHODS A retrospective study was conducted in three hospitals during the pandemic over four months, from the beginning of December 2019 until the end of March 2020. Data was collected using a structured questionnaire filled by the researcher using computers from the medical records of three hospitals. The sampling was all confirmed cases of pregnant women who delivered while being positive for COVID-19. RESULTS This study has identified a total of 82 pregnant women with confirmed COVID-19 infection over the study period, with ages ranging from 18 to >40 years. The majority of the pregnant women (84.1%) were symptomatic, with fever (48.8%) being the most frequent COVID-19 symptom, followed by cough (42.7%) and shortness of breath (41.5%). Some women (46.3%) had a spontaneous normal vaginal delivery, and 50.2% had a cesarean delivery. The most common adverse pregnancy outcome was premature delivery (36.5%), followed by fetal distress (20.7%), preeclampsia (2.4%), eclampsia (1.2%), and diabetic ketoacidosis (1.2%), as well as the death of three pregnant women. CONCLUSION This study found that infected mothers faced various risks of maternal adverse outcomes. The majority of the pregnant women experienced mild to moderate illness symptoms and were delivered within 14 days of the onset of COVID-19 symptoms. Healthcare providers should provide more attention to pregnant women diagnosed with COVID-19.
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Carvajal J, Casanello P, Toso A, Farías M, Carrasco-Negue K, Araujo K, Valero P, Fuenzalida J, Solari C, Sobrevia L. Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166582. [PMID: 36273675 PMCID: PMC9581789 DOI: 10.1016/j.bbadis.2022.166582] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022]
Abstract
The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.
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Affiliation(s)
- Jorge Carvajal
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Paola Casanello
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands
| | - Alberto Toso
- Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Marcelo Farías
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Karina Carrasco-Negue
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Kenny Araujo
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile
| | - Javiera Fuenzalida
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Caterina Solari
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Luis Sobrevia
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland, Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston 4029, Queensland, Australia; Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.
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36
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Serra FE, Rosa Junior ER, de Rossi P, Francisco RPV, Rodrigues AS. COVID-19: Impact of Original, Gamma, Delta, and Omicron Variants of SARS-CoV-2 in Vaccinated and Unvaccinated Pregnant and Postpartum Women. Vaccines (Basel) 2022; 10:2172. [PMID: 36560582 PMCID: PMC9786095 DOI: 10.3390/vaccines10122172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
This study compares the clinical characteristics and disease progression among vaccinated and unvaccinated pregnant and postpartum women who tested positive for different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using the Brazilian epidemiological data. Data of pregnant or postpartum patients testing positive for SARS-CoV-2 and presenting with coronavirus disease 2019 (COVID-19) from February 2020 to July 2022 were extracted from Brazilian national database. The patients were grouped based on vaccination status and viral variant (original, Gamma, Delta, and Omicron variants), and their demographics, clinical characteristics, comorbidities, symptoms, and outcomes were compared retrospectively. Data of 10,003 pregnant and 2361 postpartum women were extracted from the database. For unvaccinated postpartum women, intensive care unit (ICU) admission was more likely; invasive ventilation need was more probable if they tested positive for the original, Gamma, and Omicron variants; and chances of death were higher when infected with the original and Gamma variants than when infected with other variants. Vaccinated patients had reduced adverse outcome probability, including ICU admission, invasive ventilation requirement, and death. Postpartum women showed worse outcomes, particularly when unvaccinated, than pregnant women. Hence, vaccination of pregnant and postpartum women should be given top priority.
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Affiliation(s)
- Fabiano Elisei Serra
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 05508-070, Brazil
- Faculdade de Medicina, Universidade de Santo Amaro (UNISA), São Paulo 04743-030, Brazil
- Gerência de Obstetrícia, Hospital Maternidade Interlagos, São Paulo 04802-190, Brazil
| | - Elias Ribeiro Rosa Junior
- Departamento de Estatística, Universidade Federal do Espírito Santo, 514 Fernando Ferrari Avenue, Vitória 29075-910, Brazil
| | - Patricia de Rossi
- Faculdade de Medicina, Universidade de Santo Amaro (UNISA), São Paulo 04743-030, Brazil
- Department of Perinatology and Gynecology, Mandaqui Hospital, São Paulo 02401-400, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 05508-070, Brazil
| | - Agatha Sacramento Rodrigues
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo 05508-070, Brazil
- Departamento de Estatística, Universidade Federal do Espírito Santo, 514 Fernando Ferrari Avenue, Vitória 29075-910, Brazil
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Barbosa RN, Braga MA, Costa BB, Peret FJA. Treatment of pregnant and early postpartum women with severe and critical COVID-19: experience at a tertiary center. Eur J Med Res 2022; 27:269. [PMID: 36461042 PMCID: PMC9716514 DOI: 10.1186/s40001-022-00907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The management of acute respiratory failure during pregnancy is a poorly defined issue in the literature, especially regarding the use of the prone position and the appropriate time for delivery. This study describes our experience in treating pregnant and postpartum women with severe or critical coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS This descriptive retrospective study included 25 pregnant and 4 postpartum women admitted to an ICU due to respiratory complications from COVID-19 from June 2020 to August 2021. RESULTS The mean maternal age was 33.6 years, and the median gestational age (GA) at admission was 33 weeks. Obesity was the most common comorbidity. The median time between symptom onset and ICU admission was 10 days, while the median length of ICU stay was 14 days. Invasive mechanical ventilation (IMV) was required in 16 (55.2%) patients for a median time of 16.5 days. Prone positioning (PP) was performed in 68.7% of the patients on IMV, and resulted in an expressive increase in arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio). Eleven (44%) pregnant women delivered during their ICU stay for obstetric or fetal reasons: of these, 2 (18%) developed postpartum hemorrhagic shock and 1 (9%) developed abdominal wall infection. None of the 25 pregnant women underwent delivery due to acute respiratory failure or in an attempt to avoid intubation. There were 2 fetal deaths, but no maternal or neonatal deaths. CONCLUSION We observed favorable outcomes in pregnant and postpartum women with severe and critical COVID-19 admitted to our institution. This finding reinforces the effectiveness of PP in the treatment of hypoxemic respiratory failure secondary to COVID-19 in pregnant women undergoing IMV, and suggests that gestation should only be interrupted in cases of obstetric and fetal complications, provided the patient is stable, or when hypoxemia is refractory to PP.
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Affiliation(s)
- Rodrigo Nacif Barbosa
- Unidade de Tratamento Intensivo, Maternidade Unimed-Unidade Grajaú, Belo Horizonte, Brazil ,Rua Viamão, 1171, UTI adulto. Bairro Grajaú, Belo Horizonte, Minas Gerais CEP 30431-253 Brazil
| | - Maria Aparecida Braga
- Unidade de Tratamento Intensivo, Maternidade Unimed-Unidade Grajaú, Belo Horizonte, Brazil
| | - Bárbara Braga Costa
- Unidade de Tratamento Intensivo, Maternidade Unimed-Unidade Grajaú, Belo Horizonte, Brazil
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Aljohani MA, Albalawi FM, Albalawi BM, Alghamdi SS, Alghamdi EH, Almahl AA, Alagoul HA, Alamori AM, Mobarki AY, Hadi IM, Asiri MA, Dighriri IM. Consequences of SARS-CoV-2 Infection in Pregnant Women and Their Infants: A Systematic Review. Cureus 2022; 14:e32787. [PMID: 36694500 PMCID: PMC9857045 DOI: 10.7759/cureus.32787] [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] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a worldwide health problem, particularly for pregnant women. This review assesses the effects of COVID-19 on pregnant women and their infants. A systematic search was performed of studies published on PubMed, Web of Science, Google Scholar, and Embase from January 2020 to January 2021, without restriction by language. This review included 27 studies (22 from China, one from the United States, one from Honduras, one from Italy, one from Iran, and one from Spain), which cumulatively evaluated 386 pregnant women with clinically confirmed COVID-19 and their 334 newborns. Of the 386 pregnant women, 356 had already delivered their infants, four had medical abortions at the time of research, 28 were still pregnant, and two died from COVID-19 before they were able to give birth. Cesarean sections were performed on 71% of pregnant women with COVID-19 to give birth. Fever and cough were common symptoms among women. Premature rupture of membranes, distress, and preterm birth were pregnancy complications. Low birth weight and a short gestational age were common outcomes for newborns. The common laboratory findings among pregnant women were lymphopenia, leukocytosis, and elevated levels of C-reactive protein. Chest computed tomography revealed abnormal viral lung changes in 73.3% of women. Eleven infants tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There was no evidence of vertical transmission. Most infants were observed to have lymphopenia and thrombocytopenia. The clinical features of pregnant women were found to be similar to those of generally infected patients. There is evidence of adverse pregnancy and neonatal outcomes caused by COVID-19.
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Affiliation(s)
- Mohammed A Aljohani
- Department of Laboratory and Blood Bank, Alwajh General Hospital, Tabuk, SAU
| | - Fahad M Albalawi
- Department of Laboratory and Blood Bank, Alwajh General Hospital, Tabuk, SAU
| | - Bader M Albalawi
- Department of Laboratory and Blood Bank, Alwajh General Hospital, Tabuk, SAU
| | - Sameer S Alghamdi
- Department of Laboratory, Laboratories and Blood Bank Administration, Taif, SAU
| | - Essam H Alghamdi
- Department of Laboratory, Laboratories and Blood Bank Administration, Taif, SAU
| | - Ali A Almahl
- Department of Laboratory, Dammam Regional Laboratory and Blood Bank, Dammam, SAU
| | - Hassan A Alagoul
- Department of Laboratory, Dammam Regional Laboratory and Blood Bank, Dammam, SAU
| | - Ahmed M Alamori
- Department of Laboratory and Blood Bank, King Fahad Hospital, Jeddah, SAU
| | - Ahmed Y Mobarki
- Department of Molecular Biology, Regional Laboratory and Central Blood Bank, Abha, SAU
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Naz S, Dur e Shawar S, Saleem S, Malik A, Raza A. Knowledge, attitudes, and practices (KAP) towards COVID-19 pandemic among pregnant women in a tertiary hospital in Karachi, Pakistan. PLoS One 2022; 17:e0274252. [PMID: 36449555 PMCID: PMC9710773 DOI: 10.1371/journal.pone.0274252] [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: 06/14/2021] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the knowledge, attitude, and practices (KAP) of the pregnant population during the COVID-19 pandemic in a tertiary care hospital. METHODS This cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. KAP towards COVID-19 was assessed using 21-item questionnaires. A score for each category was calculated and points were summed. The outcome variables of KAP were compared with demographic characteristics. Data were analyzed by using SPSS 19. RESULTS A total of 377 patients participated in the study. The majority of the patients were multiparous (36.8%) in the age group of 30-40years (42.4%). More than 90% of patients were aware of COVID-19 symptoms and mode of transmission. They were aware of no cure for disease and optimum social distance. Although < 50% of patients truly answered the questions regarding the impact of COVID-19 on the risk of congenital malformation, vertical transmission, and the effect of infection on the mode of delivery. Regarding attitude and practices,> 90% of patients were anxious about fetal and personal safety, they are using a facemask, sanitizing their hands regularly, and avoiding social gatherings. Univariate and multivariable linear regression analysis showed statistically significant results among demographic variables (age, parity, family members, occupational status, and source of information). CONCLUSION Pregnant patients demonstrated inadequate knowledge regarding the impact of COVID-19 on pregnancy. However positive attitude and practices on preventive measures were good. This highlights the need for health education for pregnant women for COVID-19 to improve knowledge on a constant basis.
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Affiliation(s)
- Sumaira Naz
- Department of Obstetrics & Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Syeda Dur e Shawar
- Department of Obstetrics & Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Shamila Saleem
- Department of Obstetrics & Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayesha Malik
- Department of Obstetrics & Gynecology, Aga Khan University Hospital, Karachi, Pakistan
- * E-mail:
| | - Amir Raza
- Department of Obstetrics & Gynecology, Aga Khan University Hospital, Karachi, Pakistan
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Guedalia J, Lipschuetz M, Calderon-Margalit R, Cohen SM, Goldman-Wohl D, Kaminer T, Melul E, Shefer G, Sompolinsky Y, Walfisch A, Yagel S, Beharier O. Effectiveness of a third BNT162b2 mRNA COVID-19 vaccination during pregnancy: a national observational study in Israel. Nat Commun 2022; 13:6961. [PMID: 36379951 PMCID: PMC9664047 DOI: 10.1038/s41467-022-34605-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
The Centers for Disease Control (CDC) recommend a third dose of COVID-19 vaccine for pregnant women, although data regarding effectiveness during pregnancy are lacking. This national, population-based, historical cohort study of pregnant women in Israel, delivering between August 1, 2021 and March 22, 2022, aims to analyze and compare the third and second doses' vaccine effectiveness in preventing COVID-19-related hospitalizations during pregnancy during two COVID-19 waves (Delta variant in the summer of 2021 and Omicron, BA.1, variant in the winter of 2022). Time-dependent Cox proportional-hazards regression models estimate the hazard ratios (HR) and 95% confidence intervals (CI) for COVID-related outcomes according to vaccine dose, and vaccine effectiveness as 1-HR. Study includes 82,659 and 33,303 pregnant women from the Delta and Omicron waves, respectively. Compared with the second dose, the third dose effectively prevents overall hospitalizations with SARS-CoV-2 infections, with estimated effectiveness of 92% (95% CI 83-96%) during Delta, and enhances protection against significant disease during Omicron, with effectiveness of 92% (95% CI 26-99%), and 48% (95% CI 37-57%) effectiveness against hospitalization overall. A third dose of the BNT162b2 mRNA COVID-19 vaccine during pregnancy, given at least 5 months after the second vaccine dose, enhances protection against adverse COVID-19-related outcomes.
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Affiliation(s)
- Joshua Guedalia
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- grid.9619.70000 0004 1937 0538Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M. Cohen
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Kaminer
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Galit Shefer
- grid.414840.d0000 0004 1937 052XTIMNA-Israel Ministry of Health’s Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Yishai Sompolinsky
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asnat Walfisch
- grid.12136.370000 0004 1937 0546Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Simcha Yagel
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- grid.9619.70000 0004 1937 0538Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
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Ghaemi M, Hantoushzadeh S, Ghanbari R, Heidary Z. Reporting 12 Cases of Maternal Mortality Due to COVID-19; the Role of Termination of Pregnancy as a Double-Edged Sword. ARCHIVES OF IRANIAN MEDICINE 2022; 25:765-766. [PMID: 37543903 PMCID: PMC10685858 DOI: 10.34172/aim.2022.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/20/2022] [Indexed: 08/08/2023]
Affiliation(s)
- Marjan Ghaemi
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghanbari
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Heidary
- Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Kiefer MK, Mehl R, Rood KM, Germann K, Mallampati D, Manuck T, Costantine MM, Lynch CD, Grobman WA, Venkatesh KK. Association between social vulnerability and COVID-19 vaccination hesitancy and vaccination in pregnant and postpartum individuals. Vaccine 2022; 40:6344-6351. [PMID: 36167695 PMCID: PMC9489982 DOI: 10.1016/j.vaccine.2022.09.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the association of community-level social vulnerability with COVID-19 vaccine hesitancy and vaccination among pregnant and postpartum individuals. METHODS Prospective cohort study assessing COVID-19 vaccine hesitancy among pregnant and postpartum individuals. We performed a baseline survey on COVID-19 vaccine hesitancy from 03/22/21 to 04/02/21, and a follow-up survey on COVD-19 vaccination status 3- to 6-months later. The primary exposure was the Centers for Disease Control and Prevention SVI (Social Vulnerability Index), measured in quartiles. Higher SVI quartiles indicated greater community-level social vulnerability with the lowest quartile (quartile 1) as the referent group. The primary outcome was COVID-19 vaccine hesitancy on the baseline survey (uncertainty or refusal of the vaccine), and the secondary outcome was self-report of not being vaccinated (unvaccinated) for COVID-19 on the follow-up survey. RESULTS Of 456 assessed individuals, 46% reported COVID-19 vaccine hesitancy on the baseline survey; and of 290 individuals (290/456, 64%) who completed the follow-up survey, 48% (140/290) were unvaccinated. The frequency of baseline vaccine hesitancy ranged from 25% in quartile 1 (low SVI) to 68% in quartile 4 (high SVI), and being unvaccinated at follow-up ranged from 29% in quartile 1 to 77% in quartile 4. As social vulnerability increased, the risk of COVID-19 vaccine hesitancy at baseline increased (quartile 2 aRR (adjusted relative risk): 1.46; 95% CI:0.98 to 2.19; quartile 3 aRR: 1.86; 95% CI:1.28 to 2.71; and quartile 4 aRR: 2.24; 95% CI:1.56 to 3.21), as did the risk of being unvaccinated at follow-up (quartile 2 aRR: 1.00; 95% CI:0.66 to 1.51; quartile 3 aRR: 1.68; 95% CI:1.17 to 2.41; and quartile 4 aRR: 1.82; 95% CI:1.30 to 2.56). CONCLUSIONS Pregnant and postpartum individuals living in an area with higher community-level social vulnerability were more likely to report COVID-19 vaccine hesitancy and subsequently to be unvaccinated at follow-up.
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Affiliation(s)
- Miranda K. Kiefer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States,Corresponding author: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, 395, West 12, Avenue, Floor 5, Columbus, OH 43210
| | - Rebecca Mehl
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kara M. Rood
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Katherine Germann
- College of Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Divya Mallampati
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Tracy Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Maged M. Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Courtney D. Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kartik K. Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
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Hessami K, Norooznezhad AH, Monteiro S, Barrozo ER, Abdolmaleki AS, Arian SE, Zargarzadeh N, Shekerdemian LS, Aagaard KM, Shamshirsaz AA. COVID-19 Pandemic and Infant Neurodevelopmental Impairment: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2238941. [PMID: 36306133 PMCID: PMC9617178 DOI: 10.1001/jamanetworkopen.2022.38941] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Primary studies proposed that aberrant maternal antiviral immunity and/or giving birth in quarantine, such as during the ongoing COVID-19 pandemic, may be associated with the risk of neurodevelopmental impairment (NDI) in offspring. OBJECTIVES To evaluate the associations of birth and being raised during the COVID-19 pandemic with risk of NDI among infants and to assess the association of gestational exposure to SARS-CoV-2 with risk of NDI. DATA SOURCES PubMed, Web of Science, Scopus, Embase, and preprint servers were systematically searched from inception to March 25, 2022. STUDY SELECTION Studies evaluating the neurodevelopment of infants born during the SARS-CoV-2 pandemic were included in this systematic review and meta-analysis. Studies using Ages and Stages Questionnaires, Third Edition (ASQ-3), were used for quantitative meta-analysis. DATA EXTRACTION AND SYNTHESIS Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, a random-effects model meta-analysis was used to pool the proportion and odds ratios (ORs) of overall NDI, as well as each developmental domain on ASQ-3 with the corresponding 95% CI. MAIN OUTCOMES AND MEASURES The primary outcome was the risk of overall NDI among infants screened during the pandemic vs prepandemic. The secondary outcome was the comparison of NDI by ASQ-3 domain among infants born to women with known gestational exposure to SARS-CoV-2 vs no exposure. RESULTS A total of 8 studies were included, including 21 419 infants (11 438 screened in pandemic and 9981 in prepandemic period). NDI was present in 330 of 8992 infants (7%; 95% CI, 4%-10%) screened during the COVID-19 pandemic from January 2020 to January 2021. Among the pandemic cohort, the prevalence of NDI among infants with gestational exposure to SARS-CoV-2 was 77 of 691 (12%; 95% CI, 6%-18%). Compared with the prepandemic cohort (2015-2019), the pandemic cohort was more likely to have communication impairment (OR, 1.70; 95% CI, 1.37-2.11; P < .001), without significant differences in other ASQ-3 domains (eg, gross motor, fine motor, personal-social, and problem-solving). In contrast, maternal SARS-CoV-2 infection was not associated with significant differences in any neurodevelopment domain in offspring, except for increasing the odds of fine motor impairment (OR, 3.46; 95% CI, 1.43-8.38; P < .001). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis examining the association between COVID-19 pandemic and the risk of NDI, findings suggest that overall neurodevelopment in the first year of life was not changed by either being born or raised during the SARS-CoV-2 pandemic or by gestational exposure to SARS-CoV-2. Interestingly, the first year of life during the COVID-19 pandemic, regardless of maternal infection, was significantly associated with the risk of communication delay among the offspring.
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Affiliation(s)
- Kamran Hessami
- Maternal Fetal Care Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amir Hossein Norooznezhad
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sonia Monteiro
- Meyer Center for Developmental Pediatrics and Autism, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Enrico R. Barrozo
- Division of Maternal Fetal Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | | | - Sara E. Arian
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Nikan Zargarzadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Lara S. Shekerdemian
- Division of Critical Care, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Kjersti M. Aagaard
- Division of Maternal Fetal Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Alireza A. Shamshirsaz
- Maternal Fetal Care Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Takahashi K, Kobayashi Y, Sato M, Nagae S, Kondo I, Funaki S, Sato T, Konishi A, Ito Y, Kamide T, Hoshina T, Kanuka H, Kobayashi M, Sakurai Y, Iwamoto M, Takahashi H, Samura O, Okamoto A. Clinical outcomes in pregnant women with coronavirus disease 2019 in a perinatal medical centre in Japan: a retrospective study of the first 1 year of the pandemic. J OBSTET GYNAECOL 2022; 42:2684-2692. [PMID: 35678738 DOI: 10.1080/01443615.2022.2082277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this retrospective study, we analysed clinical and demographic data from the medical records of 31 pregnant women with coronavirus disease 2019 (COVID-19) who were treated at our hospital between April 2020 and April 2021. The most common symptom was a fever; ∼10% of patients were asymptomatic. One patient with rapidly worsening pneumonia needed a Caesarean Section at 30 weeks and was admitted for intensive care. Twelve patients received perinatal care in our hospital (10 live births, one stillbirth, and one artificial abortion). Six patients delivered vaginally; the others delivered via caesarean section. Two patients had complications, including severe hypertensive disorders and preeclampsia. All patients recovered from COVID-19. Severe acute respiratory syndrome coronavirus 2 was not detected in the placenta, umbilical cord, cord blood, amniotic fluid, vaginal fluid, or breast milk in any patient. There were no neonatal adverse outcomes. The possibility of transmitting the coronavirus to pregnancy-related samples was low.IMPACT STATEMENTWhat is already known on the subject? COVID-19 has been affecting different countries in diverse ways, and the incidence, mortality, and morbidity rates of patients with COVID-19 vary widely by country or region and race. These differences in results may reflect racial differences and differences in national health care systems. Moreover, the information about the perinatal outcomes of pregnant women with COVID-19 and their newborns from Japan is limited.What do the results of this study add to what is known? We described the perinatal outcomes of 31 Japanese pregnant women with COVID-19 who were managed safely in a perinatal medical centre in Tokyo Japan, during the first 1 year of the pandemic.What are the implications of these findings for clinical practice and/or further research? Severe pneumonia and perinatal complications may occur, although no maternal and neonatal deaths were observed for COVID-19-positive pregnant women in our facility. Therefore, it is important to prevent this infection during pregnancy with the provision of effective medical care.
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Affiliation(s)
- Ken Takahashi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukari Kobayashi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mariko Sato
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Seika Nagae
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ibuki Kondo
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoru Funaki
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taisuke Sato
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akiko Konishi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Ito
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taizan Kamide
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tokio Hoshina
- Department of Infectious Diseases and Control, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirotaka Kanuka
- Department of Tropical Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahisa Kobayashi
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyoshi Sakurai
- Department of Anesthesia, The Jikei University School of Medicine, Tokyo, Japan
| | - Masami Iwamoto
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Ahmad SN, Sameen D, Dar MA, Jallu R, Shora TN, Dhingra M. Do SARS-CoV-2-Infected Pregnant Women Have Adverse Pregnancy Outcomes as Compared to Non-Infected Pregnant Women? Int J Womens Health 2022; 14:1201-1210. [PMID: 36081450 PMCID: PMC9447998 DOI: 10.2147/ijwh.s375739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/25/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose To determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies. Patients and Methods A retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups. Results Our hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46-3.34; p<0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72-30.77; p<0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65-203.5; p<0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99-27.23; p<0.001]. Conclusion Significant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.
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Affiliation(s)
- Syed Nawaz Ahmad
- Department of Obstetrics and Gynecology, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Duri Sameen
- Department of Obstetrics and Gynecology, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Mansoor Ahmad Dar
- Department of Psychiatry, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Romaan Jallu
- Department of Microbiology, Government Medical College Srinagar, Srinagar, Jammu and Kashmir, India
| | - Tajali Nazir Shora
- Department of Community Medicine, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Mansi Dhingra
- Department of Obstetrics and Gynecology, Vaga Hospital, Lucknow, India
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46
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Nevo L, Cahen-Peretz A, Vorontsov O, Frenkel R, Kabessa M, Cohen SM, Hamrani A, Oiknine-Djian E, Lipschuetz M, Goldman-Wohl D, Walfisch A, Kovo M, Neeman M, Yagel S, Wolf DG, Beharier O. Boosting maternal and neonatal humoral immunity following SARS-CoV-2 infection using a single messenger RNA vaccine dose. Am J Obstet Gynecol 2022; 227:486.e1-486.e10. [PMID: 35430228 PMCID: PMC9008977 DOI: 10.1016/j.ajog.2022.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Post-COVID-19 vaccine boosting is a potent tool in the ongoing pandemic. Relevant data regarding this approach during pregnancy are lacking, which affects vaccination policy guidance, public acceptance, and vaccine uptake during pregnancy. We aimed to investigate the dynamics of anti-SARS-CoV-2 antibody levels following SARS-CoV-2 infection during pregnancy and to characterize the effect of a single postinfection vaccine booster dose on the anti-SARS-CoV-2 antibody levels in parturients in comparison with the levels in naïve vaccinated and convalescent, nonboosted parturients. STUDY DESIGN Serum samples prospectively collected from parturients and umbilical cords at delivery at our university-affiliated urban medical center in Jerusalem, Israel, from May to October 2021, were selected and analyzed in a case-control manner. Study groups comprised the following participants: a consecutive sample of parturients with a polymerase chain reaction-confirmed history of COVID-19 during any stage of pregnancy; and comparison groups selected according to time of exposure comprising (1) convalescent, nonboosted parturients with polymerase chain reaction-confirmed COVID-19; (2) convalescent parturients with polymerase chain reaction-confirmed COVID-19 who received a single booster dose of the BNT162b2 messenger RNA vaccine; and (3) infection-naïve, fully vaccinated parturients who received 2 doses of the BNT162b2 messenger RNA vaccine. Outcomes that were determined included maternal and umbilical cord blood anti-SARS-CoV-2 antibody levels detected at delivery, the reported side effects, and pregnancy outcomes. RESULTS A total of 228 parturients aged 18 to 45 years were included. Of those, samples from 64 were studied to characterize the titer dynamics following COVID-19 at all stages of pregnancy. The boosting effect was determined by comparing (1) convalescent (n=54), (2) boosted convalescent (n=60), and (3) naïve, fully vaccinated (n=114) parturients. Anti-SARS-CoV-2 antibody levels detected on delivery showed a gradual and significant decline over time from infection to delivery (r=0.4371; P=.0003). Of the gravidae infected during the first trimester, 34.6% (9/26) tested negative at delivery, compared with 9.1% (3/33) of those infected during the second trimester (P=.023). Significantly higher anti-SARS-CoV-2 antibody levels were observed among boosted convalescent than among nonboosted convalescent (17.6-fold; P<.001) and naïve vaccinated parturients (3.2-fold; P<.001). Similar patterns were observed in umbilical cord blood. Side effects in convalescent gravidae resembled those in previous reports of mild symptoms following COVID-19 vaccination during pregnancy. CONCLUSION Postinfection maternal humoral immunity wanes during pregnancy, leading to low or undetectable protective titers for a marked proportion of patients. A single boosting dose of the BNT162b2 messenger RNA vaccine induced a robust increase in protective titers for both the mother and newborn with moderate reported side effects.
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Affiliation(s)
- Lea Nevo
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adva Cahen-Peretz
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Olesya Vorontsov
- Clinical Virology Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachelli Frenkel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maor Kabessa
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adar Hamrani
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Kovo
- Department Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel
| | - Michal Neeman
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Tanna R, Dugarte HJN, Kurakula S, Muralidharan V, Das A, Kanigalpula SPR, Mendez IE, Afaq M, Bassi R, Shah K, Saddiq Z. Review of Impact of COVID-19 on Maternal, Neonatal Outcomes, and Placental Changes. Cureus 2022; 14:e28631. [PMID: 36106265 PMCID: PMC9450993 DOI: 10.7759/cureus.28631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Coronavirus disease (COVID-19), caused by SARS-CoV-2, is a disease that has caused a global impact. COVID-19 is transmitted through airborne droplets, respiratory secretions, and direct contact. The pandemic has affected individuals of different ages, and studying the impact of COVID-19 on maternal and newborn outcomes is critical. In this review, we highlight the impact of COVID-19 infection in pregnancy and its repercussion in the maternal-fetal binomial. Physiological changes that occur during pregnancy have significant effects on the immune system, cardiopulmonary system, and coagulation, and these changes can result in an altered response to COVID-19 infection. The symptoms, risk factors, and maternal health consequences of COVID-19 were discussed. In addition, the impact of newborns born to mothers with COVID-19 was reviewed. Finally, placental changes and vertical transmission of COVID-19 during pregnancy were also discussed in this review.
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Dandachi I, Aljabr W. Prognosis of COVID-19 in the middle eastern population, knowns and unknowns. Front Microbiol 2022; 13:974205. [PMID: 36118201 PMCID: PMC9471247 DOI: 10.3389/fmicb.2022.974205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/09/2022] [Indexed: 01/08/2023] Open
Abstract
Since its emergence in China in 2019, the SARS-CoV-2 virus has affected all countries worldwide. The virus is easily transmitted from one person to another via infected aerosols or contaminated surfaces. Unlike its counterparts, the prognosis of COVID-19 ranges from asymptomatic to critical disease or death. Several factors play a role in determining the severity of the disease in infected patients. Among others, is the pre-existence of an underlying medical condition such as diabetes, cancer, and others. Furthermore, although children are less prone to the severe form of the COVID-19 disease, they require attention due to the report of many atypical presentations of the infection, post-asymptomatic exposure. In the Middle East, little is known about the prognosis of the SARS-CoV-2 infection in high-risk categories, notably patients with diabetes, cancer, and pregnant women. The aim of this review is to summarize the current knowledge about this group of population in the middle eastern region as well as to highlight the gap in the literature. We have found that the majority of the papers were from the Gulf countries. Although, few studies were conducted; high-risk patients appear to have an increased risk of morbidity and mortality from COVID-19 compared to their counterparts. Higher levels of inflammatory markers, C-reactive protein, erythrocyte sedimentation rate, D-dimer, and ferritin levels were also observed. Children are often asymptomatic or present with atypical presentations. More studies should be conducted to determine the clinical biomarkers of COVID-19 in high-risk categories to help in patient risk stratification and management in the middle eastern population.
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Affiliation(s)
| | - Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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49
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Tefera Z, Assefaw M. A Mixed-Methods Study of COVID-19 Vaccine Acceptance and Its Determinants Among Pregnant Women in Northeast Ethiopia. Patient Prefer Adherence 2022; 16:2287-2299. [PMID: 36039366 PMCID: PMC9419903 DOI: 10.2147/ppa.s374217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background The World Health Organization recommends that pregnant women should receive a vaccine against COVID-19. However, COVID-19 vaccine hesitance was one of the barriers to delivering the vaccine, and this issue was not well addressed in Ethiopia. Therefore, we aimed to determine the prevalence of COVID-19 vaccination acceptability and the factors that influence it among pregnant women in Northeast Ethiopia. Methods A mixed-methods approach comprising both qualitative interviews and a quantitative survey was conducted from January 1-30, 2022. For the quantitative part, a multi-stage sampling technique was used to recruit the study participants (n=702). Data was collected through face-to-face interviews using pretested and structured questionnaires. Bivariate and multivariable logistic regression analyses were employed. The statistical difference was considered at P-0.05, and the strength of association was assessed by the odds ratio and respective 95% confidence intervals. For the qualitative part, 18 participants were selected purposively for in-depth interviews, an interviewer guide was used for data collection and thematic content analysis was performed. Results In this study, a total of 702 pregnant women were included with the response rate of 100%. The rate of COVID-19 vaccine acceptance was 22.6% (95% CI: 19.6%, 25.9%). The husbands' educational level (AOR = 1.99, 95% CI: 1.09, 3.64), chronic medical illness (AOR = 2.41, 95% CI: 1.28, 4.54), positive attitude (AOR = 1.59, 95% CI: 1.09, 2.31), and good practice of COVID-19 preventive measures (AOR = 1.59, 95% CI: 1.09, 2.31) were determinant factors of COVID-19 vaccine acceptance. According to the qualitative findings, the most common reasons for COVID-19 vaccine hesitancy were fear of fetal side effects, misconceptions about the vaccine, and religious beliefs. Conclusion In this study, the acceptability of the COVID-19 vaccine was low. Therefore, health professionals should disseminate accurate vaccination information and address misinformation to boost vaccine acceptance among pregnant women.
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Affiliation(s)
- Zenebe Tefera
- Department of Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mandefro Assefaw
- Department of Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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50
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Khoiwal K, Ravi AK, Mittal A, Pallapothu B, Priyadarshi M, Gaurav A, Mundhra R, Chawla L, Bahadur A, Chaturvedi J. Maternal-Fetal Characteristics of Pregnant Women With Severe COVID Disease and Maternal-Neonatal Characteristics of Neonates With Early-Onset SARS-CoV-2 Infection: A Prospective Data Analysis. Cureus 2022; 14:e27995. [PMID: 36134091 PMCID: PMC9469780 DOI: 10.7759/cureus.27995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
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