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Meamar FZ, Farajkhoda T, Afshani SA, Ardakani TS. Investigating the mode of transmission of COVID-19 through genital secretions, semen, the birth canal, and lactation: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:263. [PMID: 39309991 PMCID: PMC11414867 DOI: 10.4103/jehp.jehp_387_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/14/2023] [Indexed: 09/25/2024]
Abstract
In a global pandemic, the coronavirus has brought new challenges to reproductive and sexual health. This systematic review has been conducted with the aim of investigating a) the transmission of coronavirus disease 2019 (COVID-19) through female-to-male sexual secretions and vice versa, b) vertical transmission to the fetus, c) transmission to the newborn through the birth canal, and d) transmission through breast milk. In this review study, to find related articles, databases were searched using English and Persian keywords from the beginning of 2019 to the end of 2023. Based on the entry and exit criteria and the qualitative evaluation of the studies based on the STROBE criterion, the final studies were summarized. According to the initial search, 5970 articles were reviewed. After removing duplicate articles and the inappropriateness of the title, the abstract of the article was not related to the objectives of the project, there was no relevant study, and retrospective studies were excluded. Finally, 120 articles were selected as final articles. The general results show that transmission of the virus through the vagina to the blood of the fetus causing septicemia, vertical transmission from the mother to the fetus, transmission through the water bag, genital secretions, and ejaculate fluid are considered rare and ruled out. Transmission through rectal secretions during anal or oral sex requires more extensive studies. It is not possible to transmit the virus through breast milk. The long-term reproductive impact of COVID-19 on the reproductive systems of women and men is unclear.
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Affiliation(s)
- Fatemeh Z. Meamar
- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahmineh Farajkhoda
- Research Center for Nursing and Midwifery Care, Non-Communicable Diseases Research Institute, Department of Midwifery, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed A. Afshani
- Department of Sociology, Faculty of Social Science, Yazd University, Yazd, Iran
| | - Tayebeh S. Ardakani
- Department of Midwifery, Maybod Branch, Islamic Azad University, Maybod, Iran
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Martin‐Vicente M, Carrasco I, Muñoz‐Gomez M, Lobo AH, Mas V, Vigil‐Vázquez S, Vázquez M, Manzanares A, Cano O, Alonso R, Sepúlveda‐Crespo D, Tarancón‐Díez L, Muñoz‐Fernández M, Muñoz‐Chapuli M, Resino S, Navarro ML, Martinez I. Antibody levels to SARS-CoV-2 spike protein in mothers and children from delivery to six months later. Birth 2023; 50:418-427. [PMID: 35802776 PMCID: PMC9349436 DOI: 10.1111/birt.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/11/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pregnant women are vulnerable to severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. Neutralizing antibodies against the SARS-CoV-2 spike (S) protein protect from severe disease. This study analyzes the antibody titers to SARS-CoV-2 S protein in pregnant women and their newborns at delivery, and six months later. METHODS We conducted a prospective study on pregnant women with confirmed SARS-CoV-2 infection and newborns. Antibody (IgG, IgM, and IgA) titers were determined using immunoassays in serum and milk samples. An angiotensin-converting enzyme 2 (ACE2) receptor-binding inhibition assay to the S protein was performed on the same serum and milk samples. RESULTS At birth, antibodies to SARS-CoV-2 spike protein were detected in 81.9% of mothers' sera, 78.9% of cord blood samples, and 63.2% of milk samples. Symptomatic women had higher antibody titers (IgG, IgM, and IgA) than the asymptomatic ones (P < 0.05). At six months postpartum, IgG levels decreased drastically in children's serum (P < 0.001) but remained high in mothers' serum. Antibody titers correlated positively with its capacity to inhibit the ACE2-spike protein interaction at baseline in maternal sera (R2 = 0.203; P < 0.001), cord sera (R2 = 0.378; P < 0.001), and milk (R2 = 0.564; P < 0.001), and at six months in maternal sera (R2 = 0.600; P < 0.001). CONCLUSIONS High antibody levels against SARS-CoV-2 spike protein were found in most pregnant women. Due to the efficient transfer of IgG to cord blood and high IgA titers in breast milk, neonates may be passively immunized to SARS-CoV-2 infection. Our findings could guide newborn management and maternal vaccination policies.
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Affiliation(s)
- María Martin‐Vicente
- Unidad de Infección Viral e InmunidadCentro Nacional de Microbiología, Instituto de Salud Carlos III, MajadahondaMadridSpain
| | - Itziar Carrasco
- Grupo de Investigación en Infectología PediátricaInstituto de Investigación Sanitaria Gregorio MarañónMadridSpain
| | - María José Muñoz‐Gomez
- Unidad de Infección Viral e InmunidadCentro Nacional de Microbiología, Instituto de Salud Carlos III, MajadahondaMadridSpain
| | - Alicia Hernanz Lobo
- Grupo de Investigación en Infectología PediátricaInstituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Servicio de PediatríaHospital General Universitario Gregorio MarañónMadridSpain
| | - Vicente Mas
- Unidad de Biología ViralCentro Nacional de Microbiología, Instituto de Salud Carlos IIIMadridSpain
| | - Sara Vigil‐Vázquez
- Sevicio de NeonatologíaHospital General Universitario Gregorio MarañónMadridSpain
| | - Mónica Vázquez
- Unidad de Biología ViralCentro Nacional de Microbiología, Instituto de Salud Carlos IIIMadridSpain
| | - Angela Manzanares
- Servicio de PediatríaHospital General Universitario Gregorio MarañónMadridSpain
| | - Olga Cano
- Unidad de Biología ViralCentro Nacional de Microbiología, Instituto de Salud Carlos IIIMadridSpain
| | - Roberto Alonso
- Departamento de Microbiología Clínica y Enfermedades InfecciosasHospital General Universitario Gregorio MarañónMadridSpain
| | - Daniel Sepúlveda‐Crespo
- Unidad de Infección Viral e InmunidadCentro Nacional de Microbiología, Instituto de Salud Carlos III, MajadahondaMadridSpain
| | - Laura Tarancón‐Díez
- Laboratorio de InmunoBiología Molecular, Sección de InmunologíaHospital General Universitario Gregorio MarañónMadridSpain
| | - María Ángeles Muñoz‐Fernández
- Laboratorio de InmunoBiología Molecular, Sección de InmunologíaHospital General Universitario Gregorio MarañónMadridSpain
- HIV‐HGM BioBankMadridSpain
| | - Mar Muñoz‐Chapuli
- Departamento de Obstetricia y GinecologíaHospital General Universitario Gregorio MarañónMadridSpain
| | - Salvador Resino
- Unidad de Infección Viral e InmunidadCentro Nacional de Microbiología, Instituto de Salud Carlos III, MajadahondaMadridSpain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC)Instituto de Salud Carlos IIIMadridSpain
| | - Maria Luisa Navarro
- Grupo de Investigación en Infectología PediátricaInstituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Servicio de PediatríaHospital General Universitario Gregorio MarañónMadridSpain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC)Instituto de Salud Carlos IIIMadridSpain
| | - Isidoro Martinez
- Unidad de Infección Viral e InmunidadCentro Nacional de Microbiología, Instituto de Salud Carlos III, MajadahondaMadridSpain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC)Instituto de Salud Carlos IIIMadridSpain
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De Luca D, Vauloup-Fellous C, Benachi A, Vivanti A. Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do? Semin Fetal Neonatal Med 2023; 28:101429. [PMID: 36935314 PMCID: PMC10010052 DOI: 10.1016/j.siny.2023.101429] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
SARS-CoV-2 can be vertically transmitted from the mother to the fetus and the neonate. This transmission route is rare compared to the environmental or horizontal spread and therefore, the risk can be deemed inconsequential by some medical providers. However, severe, although just as rare, feto-neonatal consequences are possible: fetal demise, severe/critical neonatal COVID-19 and multi-inflammatory syndrome (MIS-N) have been described. Therefore, it is important for the clinicians to know the mechanism of vertical transmission, how to recognize this, and how to deal with neonatal COVID-19 and MIS-N. Our knowledge about this field has significantly increased in the last three years. This is a summary of the pathophysiology, diagnostics, and therapeutics of vertical SARS-CoV-2 transmission that clinicians apply in their clinical practice.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
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Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review. J Clin Med 2022; 11:jcm11206194. [PMID: 36294520 PMCID: PMC9604883 DOI: 10.3390/jcm11206194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background: COVID-19 is a viral infectious disease leading to a spectrum of clinical complications, especially cardiovascular. Evidence shows that this infection can potentially accompany a worse outcome in pregnant women. Cardiovascular complications in mothers and their fetuses are reported by previous studies. Objective: In this systematic review, we aim to investigate the cardiovascular complications of COVID-19 during pregnancy in the mothers and fetus, according to the published literature. Method: We systematically searched the online databases of PubMed, Scopus, Web of Science, and Google Scholar, using relevant keywords up to April 2022. We included all observational studies reporting cardiovascular complications among COVID-19-affected pregnant women and their fetuses. Results: We included 74 studies containing 47582 pregnant COVID-19 cases. Pre-eclampsia, hypertensive disorders, cardiomyopathy, heart failure, myocardial infarction, thrombosis formation, alterations in maternal–fetal Doppler patterns, and maternal and fetal arrhythmia were reported as cardiovascular complications. The highest incidences of pre-eclampsia/eclampsia among COVID-19 pregnant cases, reported by studies, were 69% and 62%, and the lowest were 0.5% and 3%. The highest and lowest incidences of fetal bradycardia were 20% and 3%, and regarding fetal tachycardia, 5.4% and 1%, respectively. Conclusion: SARS-CoV-2 infection during pregnancy can potentially be associated with cardiovascular complications in the mother, particularly pre-eclampsia and heart failure. Moreover, SARS-CoV-2 infection during pregnancy can potentially cause cardiovascular complications in the fetus, particularly arrhythmia.
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Smith ER, Oakley E, He S, Zavala R, Ferguson K, Miller L, Grandner GW, Abejirinde IOO, Afshar Y, Ahmadzia H, Aldrovandi G, Akelo V, Tippett Barr BA, Bevilacqua E, Brandt JS, Broutet N, Fernández Buhigas I, Carrillo J, Clifton R, Conry J, Cosmi E, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Flaherman V, Gale C, Gil MM, Godwin C, Gottlieb S, Hernandez Bellolio O, Kara E, Khagayi S, Kim CR, Knight M, Kotloff K, Lanzone A, Le Doare K, Lees C, Litman E, Lokken EM, Laurita Longo V, Magee LA, Martinez-Portilla RJ, McClure E, Metz TD, Money D, Mullins E, Nachega JB, Panchaud A, Playle R, Poon LC, Raiten D, Regan L, Rukundo G, Sanin-Blair J, Temmerman M, Thorson A, Thwin S, Tolosa JE, Townson J, Valencia-Prado M, Visentin S, von Dadelszen P, Adams Waldorf K, Whitehead C, Yang H, Thorlund K, Tielsch JM. Protocol for a sequential, prospective meta-analysis to describe coronavirus disease 2019 (COVID-19) in the pregnancy and postpartum periods. PLoS One 2022; 17:e0270150. [PMID: 35709239 PMCID: PMC9202913 DOI: 10.1371/journal.pone.0270150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.
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Affiliation(s)
- Emily R. Smith
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Erin Oakley
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Siran He
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Rebecca Zavala
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Kacey Ferguson
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Lior Miller
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Gargi Wable Grandner
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | | | - Yalda Afshar
- Division of Maternal Fetal Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Homa Ahmadzia
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Grace Aldrovandi
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Victor Akelo
- US Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | - Elisa Bevilacqua
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Justin S. Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America
| | - Natalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Irene Fernández Buhigas
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Jorge Carrillo
- Departmento de Obstetricia y Ginecologia, Clinica Alemana de Santiago, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Rebecca Clifton
- Biostatistics Center, The George Washington University, Washington, DC, United States of America
| | - Jeanne Conry
- OBGYN, The International Federation of Gynecology and Obstetrics, London, United Kingdom
| | - Erich Cosmi
- Department of Woman’s and Child’s Health, Obstetrics and Gynecologic Clinic, University of Padua, Padua, Italy
| | - Camille Delgado-López
- Surveillance for Emerging Threats to Mothers and Babies, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Hema Divakar
- Asian Research and Training Institute for Skill Transfer (ARTIST), Bengaluru, India
| | - Amanda J. Driscoll
- Center for Vaccine Development and Global Health, University of Maryland, School of Medicine, Baltimore, MD, United States of America
| | - Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, University Hospital, Lausanne, Switzerland
| | - Valerie Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States of America
| | - Christopher Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Maria M. Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Christine Godwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Global Health Research, FHI 360, Durham, NC, United States of America
| | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Edna Kara
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sammy Khagayi
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Caron Rahn Kim
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland, School of Medicine, Baltimore, MD, United States of America
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, of London, United Kingdom
| | - Antonio Lanzone
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University of Sacred Hearth, Rome, Italy
| | - Kirsty Le Doare
- Medical Research Council /Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Pediatric Infectious Diseases Research Group, St. George’s University of London, of London, United Kingdom
| | - Christoph Lees
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, of London, United Kingdom
| | - Ethan Litman
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Erica M. Lokken
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Washington, DC, United States of America
- Department of Global Health, School of Public Health, University of Washington, Washington, DC, United States of America
| | | | - Laura A. Magee
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
- Institute of Women and Children’s Health, King’s College Hospital, London, United Kingdom
| | - Raigam Jafet Martinez-Portilla
- Clinical Research Division, National Institute of Perinatology, Mexico City, Mexico
- ABC Medical Center, Fetal Surgery Clinic, Mexico City, Mexico
| | - Elizabeth McClure
- Division of Statistics and Epidemiology, RTI International, Chapel Hill, NC, United States of America
| | - Torri D. Metz
- University of Utah Health, Salt Lake City, UT, United States of America
| | - Deborah Money
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada
| | - Edward Mullins
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, of London, United Kingdom
| | - Jean B. Nachega
- Department of Epidemiology and Center for Global Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rebecca Playle
- Center for Trials Research, Cardiff University, Wales, United Kingdom
| | - Liona C. Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel Raiten
- Pediatric Growth and Nutrition Branch, National Institute of Health, Bethesda, MD, United States of America
| | - Lesley Regan
- Federation International Federation Gynaecology & Obstetrics, Imperial College London, London, United Kingdom
| | - Gordon Rukundo
- PeriCovid (PREPARE)–Uganda Team, Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jose Sanin-Blair
- Maternal Fetal Unit, Universidad Pontificia Bolivariana, RECOGEST Study, Medellín, Colombia
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soe Thwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jorge E. Tolosa
- Maternal Fetal Unit, Universidad Pontificia Bolivariana, RECOGEST Study, Medellín, Colombia
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Oregon Health and Science University, Portland, OR, United States of America
- St. Luke’s University Health Network, Department of Obstetrics & Gynecology, Maternal Fetal Medicine, Bethlehem, PA, United States of America
| | - Julia Townson
- Center for Trials Research, Cardiff University, Wales, United Kingdom
| | - Miguel Valencia-Prado
- Children with Special Medical Needs Division, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Silvia Visentin
- Department of Woman’s and Child’s Health, Obstetrics and Gynecologic Clinic, University of Padua, Padua, Italy
| | - Peter von Dadelszen
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
- Global Health Institute, King’s College London, London, United Kingdom
| | - Kristina Adams Waldorf
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Washington, DC, United States of America
- Department of Global Health, School of Public Health, University of Washington, Washington, DC, United States of America
| | - Clare Whitehead
- Department of Maternal Fetal Medicine, University of Melbourne, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Huixia Yang
- Health Science Center, Peking University, Beijing, China
| | - Kristian Thorlund
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - James M. Tielsch
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
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Abbas‐Hanif A, Rezai H, Ahmed SF, Ahmed A. The impact of COVID-19 on pregnancy and therapeutic drug development. Br J Pharmacol 2022; 179:2108-2120. [PMID: 34085281 PMCID: PMC8239854 DOI: 10.1111/bph.15582] [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: 02/07/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 12/15/2022] Open
Abstract
Emerging data show that pregnant women with COVID-19 are at significantly higher risk of severe outcomes compared with non-pregnant women of similar age. This review discusses the invaluable insight revealed from vaccine clinical trials in women who were vaccinated and inadvertently became pregnant during the trial period. It further explores a number of clinical avenues in their management and proposes a drug development strategy in line with clinical trials for vaccines and drug treatments for the drug development community. Little is known of the long-term effects of COVID-19 on the mother and the baby. Our hypothesis that COVID-19 predisposes pregnant women to pre-eclampsia or hypertensive disorders during pregnancy is supported by a clinical study, and this may also adversely impact a woman's cardiovascular disease risk later in life. It may also increase a woman's risk of pre-eclampsia in subsequent pregnancy. This is an ever-evolving landscape, and early knowledge for healthcare providers and drug innovators is offered to ensure benefits outweigh the risks. COVID-19 mRNA vaccines appear to generate robust humoral immunity in pregnant and lactating women. This novel approach to vaccination also offers new ways to therapeutically tackle disorders of many unmet medical needs. LINKED ARTICLES: This article is part of a themed issue on The second wave: are we any closer to efficacious pharmacotherapy for COVID 19? (BJP 75th Anniversary). To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.10/issuetoc.
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Affiliation(s)
- Allyah Abbas‐Hanif
- Division of Drug DevelopmentMirZyme TherapeuticsBirminghamUK
- Department of CardiologyChelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - Homira Rezai
- Division of Drug DevelopmentMirZyme TherapeuticsBirminghamUK
| | | | - Asif Ahmed
- Division of Drug DevelopmentMirZyme TherapeuticsBirminghamUK
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
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7
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Rolfo A, Cosma S, Nuzzo AM, Salio C, Moretti L, Sassoè-Pognetto M, Carosso AR, Borella F, Cutrin JC, Benedetto C. Increased Placental Anti-Oxidant Response in Asymptomatic and Symptomatic COVID-19 Third-Trimester Pregnancies. Biomedicines 2022; 10:biomedicines10030634. [PMID: 35327436 PMCID: PMC8945802 DOI: 10.3390/biomedicines10030634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022] Open
Abstract
Despite Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) -induced Oxidative Stress (OxS) being well documented in different organs, the molecular pathways underlying placental OxS in late-pregnancy women with SARS-CoV-2 infection are poorly understood. Herein, we performed an observational study to determine whether placentae of women testing positive for SARS-CoV-2 during the third trimester of pregnancy showed redox-related alterations involving Catalase (CAT) and Superoxide Dismutase (SOD) antioxidant enzymes as well as placenta morphological anomalies relative to a cohort of healthy pregnant women. Next, we evaluated if placental redox-related alterations and mitochondria pathological changes were correlated with the presence of maternal symptoms. We observed ultrastructural alterations of placental mitochondria accompanied by increased levels of oxidative stress markers Thiobarbituric Acid Reactive Substances (TBARS) and Hypoxia Inducible Factor-1 α (HIF-1α) in SARS-CoV-2 women during the third trimester of pregnancy. Importantly, we found an increase in placental CAT and SOD antioxidant enzymes accompanied by physiological neonatal outcomes. Our findings strongly suggest a placenta-mediated OxS inhibition in response to SARS-CoV-2 infection, thus contrasting the cytotoxic profile caused by Coronavirus Disease 2019 (COVID-19).
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Affiliation(s)
- Alessandro Rolfo
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.R.); (A.M.N.); (L.M.)
| | - Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (S.C.); (A.R.C.); (F.B.)
| | - Anna Maria Nuzzo
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.R.); (A.M.N.); (L.M.)
| | - Chiara Salio
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy;
| | - Laura Moretti
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy; (A.R.); (A.M.N.); (L.M.)
| | - Marco Sassoè-Pognetto
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy;
| | - Andrea Roberto Carosso
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (S.C.); (A.R.C.); (F.B.)
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (S.C.); (A.R.C.); (F.B.)
| | - Juan Carlos Cutrin
- Center of Imaging Molecular, Department of Molecular Biotechnology and Sciences for the Health, University of Turin, 10126 Turin, Italy
- Correspondence: (J.C.C.); (C.B.)
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (S.C.); (A.R.C.); (F.B.)
- Correspondence: (J.C.C.); (C.B.)
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8
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Cosma S, Carosso AR, Cusato J, Borella F, Bertero L, Bovetti M, Bevilacqua F, Mengozzi G, Mazzone R, Ghisetti V, Di Perri G, Benedetto C. Obstetric and neonatal outcomes after SARS-CoV-2 infection in the first trimester of pregnancy: A prospective comparative study. J Obstet Gynaecol Res 2021; 48:393-401. [PMID: 34814234 PMCID: PMC9299461 DOI: 10.1111/jog.15105] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE(S) This prospective observational cohort study aimed to evaluate whether women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the first trimester of pregnancy are at higher risk of adverse obstetric and neonatal outcomes compared to negative patients. STUDY DESIGN Seromolecular testing for SARS-CoV-2 was performed at 12, 16, 21 weeks, and at delivery; the cohort was then subdivided into a first-trimester SARS-CoV-2-positive (case) group and a SARS-CoV-2-negative (control) group. The primary outcome was a composite adverse obstetric outcome, defined as the presence of either abortion, preterm delivery, preterm prelabor rupture of membranes, preeclampsia, intrauterine growth restriction, stillbirth; and a composite measure of adverse neonatal events, including either 1- and 5-min Apgar score ≤ 7, neonatal intensive care unit admission and congenital birth defects. Maternal symptoms and antibody titer were secondarily assessed. RESULTS A total of 17 of 164 women tested positive for SARS-CoV-2 (10.3%) in the first trimester. One SARS-CoV-2-positive patient who gave birth at another hospital was excluded. Composite adverse obstetric outcome was observed in 6.2% (1/16) SARS-CoV-2-positive and 10.5% (11/105) SARS-CoV-2-negative women; composite adverse neonatal outcome in 12.5% (2/16) and 7.6% (8/105), respectively. In the newborns of women who had developed IgG antibodies, the same antibodies were detected in arterial cord blood and the nasopharyngeal swab tested negative for SARS-CoV-2. No maternal pneumonia or hospital admission due to coronavirus disease-19 were recorded. CONCLUSION Asymptomatic or mildly symptomatic women during the first trimester of pregnancy did not experience significantly more adverse events than SARS-CoV-2-negative women.
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Affiliation(s)
- Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Andrea Roberto Carosso
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Marialuisa Bovetti
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Federica Bevilacqua
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Giulio Mengozzi
- Department of Laboratory Medicine, City of Health and Science, Turin, Italy
| | - Raffaela Mazzone
- Department of Laboratory Medicine, City of Health and Science, Turin, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
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Bertero L, Borella F, Botta G, Carosso A, Cosma S, Bovetti M, Carosso M, Abbona G, Collemi G, Papotti M, Cassoni P, Benedetto C. Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts. Virchows Arch 2021; 479:715-728. [PMID: 33934229 PMCID: PMC8088311 DOI: 10.1007/s00428-021-03097-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/14/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
Infection by SARS-CoV-2 has been shown to involve a wide range of organs and tissues, leading to a kaleidoscope of clinical conditions. Within this spectrum, an involvement of the fetal-maternal unit could be expected, but, so far, the histopathological evaluation of placentas delivered by women with SARS-CoV-2 infection did not show distinct hallmarks. A consecutive series of 11 placentas, delivered by 10 women with COVID-19 admitted to our Obstetrics and Gynecology clinic have been investigated and compared to a control cohort of 58 pre-COVID-19 placentas and 28 placentas delivered by women who had a previous cesarean section. Four out of eleven placentas showed changes consistent with chronic villitis/villitis of unknown etiology (VUE), while in one case, chronic histiocytic intervillositis was diagnosed. Thrombo-hemorrhagic alterations were observed in a subset of cases. Compared to the control cohort, chronic villitis/VUE (p < 0.001), chronic deciduitis (p = 0.023), microvascular thrombosis (p = 0.003), presence of infarction areas (p = 0.047) and of accelerated villous maturation (p = 0.005) showed higher frequencies in placentas delivered by women with COVID-19. Chronic villitis/VUE (p = 0.003) and accelerated villous maturation (p = 0.019) remained statistically significant by restricting the analysis to placentas delivered after a previous cesarean section. The observed differences in terms of pathological findings could be consistent with SARS-CoV-2 pathogenesis, but just a subset of alterations remained statistically significant after adjusting for a previous cesarean section. A careful consideration of potential confounders is warranted in future studies exploring the relationship between COVID-19 and pregnancy.
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Affiliation(s)
- Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Fulvio Borella
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giovanni Botta
- Pathology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Andrea Carosso
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Stefano Cosma
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Marialuisa Bovetti
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Marco Carosso
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giancarlo Abbona
- Pathology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giammarco Collemi
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy.
| | - Chiara Benedetto
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
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10
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Cosma S, Carosso AR, Cusato J, Borella F, Carosso M, Gervasoni F, Stura I, Preti M, Ghisetti V, Di Perri G, Benedetto C. Preterm birth is not associated with asymptomatic/mild SARS-CoV-2 infection per se: Pre-pregnancy state is what matters. PLoS One 2021; 16:e0254875. [PMID: 34351922 PMCID: PMC8341509 DOI: 10.1371/journal.pone.0254875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 01/10/2023] Open
Abstract
Evidence for the real impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on preterm birth is unclear, as available series report composite pregnancy outcomes and/or do not stratify patients according to disease severity. The purpose of the research was to determine the real impact of asymptomatic/mild SARS-CoV-2 infection on preterm birth not due to maternal respiratory failure. This case-control study involved women admitted to Sant Anna Hospital, Turin, for delivery between 20 September 2020 and 9 January 2021. The cumulative incidence of Coronavirus disease-19 was compared between preterm birth (case group, n = 102) and full-term delivery (control group, n = 127). Only women with spontaneous or medically-indicated preterm birth because of placental vascular malperfusion (pregnancy-related hypertension and its complications) were included. Current or past SARS-CoV-2 infection was determined by nasopharyngeal swab testing and detection of IgM/IgG antibodies in blood samples. A significant difference in the cumulative incidence of Coronavirus disease-19 between the case (21/102, 20.5%) and the control group (32/127, 25.1%) (P= 0.50) was not observed, although the case group was burdened by a higher prevalence of three known risk factors (body mass index > 24.9, asthma, chronic hypertension) for severe Coronavirus disease-19. Logistic regression analysis showed that asymptomatic/mild SARS-CoV-2 infection was not an independent predictor of spontaneous and medically-indicated preterm birth due to pregnancy-related hypertension and its complications (0.77; 95% confidence interval, 0.41-1.43). Pregnant patients without comorbidities need to be reassured that asymptomatic/mild SARS-CoV-2 infection does not increase the risk of preterm delivery. Preterm birth and severe Coronavirus disease-19 share common risk factors (i.e., body mass index > 24.9, asthma, chronic hypertension), which may explain the high rate of indicated preterm birth due to maternal conditions reported in the literature.
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Affiliation(s)
- Stefano Cosma
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Andrea Roberto Carosso
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
- * E-mail:
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Marco Carosso
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Fiammetta Gervasoni
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Mario Preti
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
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11
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Hammad WAB, Al Beloushi M, Ahmed B, Konje JC. Severe acute respiratory syndrome (SARS) coronavirus-2 infection (COVID-19) in pregnancy - An overview. Eur J Obstet Gynecol Reprod Biol 2021; 263:106-116. [PMID: 34225131 PMCID: PMC8205284 DOI: 10.1016/j.ejogrb.2021.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023]
Abstract
The novel severe acute respiratory syndrome (SARS) coronavirus-2 which causes COVID-19 disease results in severe morbidity and mortality especially in vulnerable groups. Pregnancy by virtue of its physiological and anatomical adaptations increases the risk of severe infections especially those of the respiratory tract. This single stranded RNA virus is transmitted by droplets as well as soiled fomites. There are various degrees of disease severity- asymptomatic, mild, moderate severe and critical. Most infections in pregnancy are asymptomatic or mildly symptomatic. For these women, the consequences on the mother or pregnancy are minimal unless they have additional risk factors such as diabetes, hypertension, cardiorespiratory disease, obesity or are of ethnic minority background. Most women with symptoms will present with fever, unproductive cough, sore throat, myalgia, nasal congestion, loss of smell and taste with associated leukocytosis and lymphopenia. Diagnosis is by RT-PCR on nasopharyngeal flocked swabs or saliva and pathognomonic features of ground-glass appearance and pulmonary infiltrates on chest X-ray or CT scans. Management in pregnancy is same as that for non-pregnant women with COVID-19. It is not an indication for elective delivery but assisted delivery in the second stage for those with moderate, severe or critical disease may be required to shorten this stage. COVID-19 is not an indication for interrupting pregnancy or caesarean section but the latter may be performed to facilitate ventilation support or resuscitation in those with severe disease. Pain relief in labour should not be different but regional analgesia is preferred for operative deliveries. Postpartum thromboprophylaxis should be considered and breast feeding encouraged with appropriate precautions to minimize vertical transmission. Pregnant and lactating women should be encouraged to receive the mRNA based vaccines as there is no evidence of adverse outcomes with these.
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Affiliation(s)
- Wafaa Ali Belail Hammad
- Department of Obstetrics and Gynaecology Basildon and Thurrock University Hospitals NHS Foundation Trust Nethermayne, Basildon Essex SS16 5NL, United Kingdom
| | - Mariam Al Beloushi
- Women's Wellness Research Center, Hamad Medical Corporation, Doha, Qatar and Department of Obstetrics and Gynaecology, Qatar University, Doha Qata and Weil Cornell Medicine, Qatar
| | - Badreleden Ahmed
- Feto-Maternal Medicine Center, Doha Qatar and Department of Obstetrics and Gynaecology, Qatar University Doha Qata and Weil Cornell Medicine, Qatar
| | - Justin C Konje
- Department of Health Sciences, University of Leicester, Leicester, UK.
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12
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Sinaci S, Ocal DF, Seven B, Anuk AT, Besimoglu B, Keven MC, Goncu Ayhan S, Akin MS, Tayman C, Keskin HL, Yapar Eyi EG, Dinc B, Moraloglu Tekin O, Sahin D. Vertical transmission of SARS-CoV-2: A prospective cross-sectional study from a tertiary center. J Med Virol 2021; 93:5864-5872. [PMID: 34081331 PMCID: PMC8242620 DOI: 10.1002/jmv.27128] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 12/22/2022]
Abstract
The aim was to investigate the association of the delivery mode and vertical transmission of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) through the samples of vaginal secretions, placenta, cord blood, or amniotic fluid as well as the neonatal outcomes. This cross‐sectional study presents an analysis of prospectively gathered data collected at a single tertiary hospital. Sixty‐three pregnant women with confirmed coronavirus disease 2019 (COVID‐19) participated in the study. Vertical transmission of SARS‐CoV‐2 was analyzed with reverse transcriptase‐polymerase chain reaction (RT‐PCR) tests and blood tests for immunoglobulin G (IgG)–immunoglobulin M (IgM) antibodies. All patients were in the mild or moderate category for COVID‐19. Only one placental sample and two of the vaginal secretion samples were positive for SARS‐CoV‐2. Except for one, all positive samples were obtained from patients who gave birth by cesarean. All cord blood and amniotic fluid samples were negative for SARS‐CoV‐2. Two newborns were screened positive for COVID‐19 IgG–IgM within 24 h after delivery, but the RT‐PCR tests were negative. A positive RT‐PCR result was detected in a neof a mother whose placenta, cord blood, amniotic fluid, and vaginal secretions samples were negative. He died due to pulmonary hemorrhage on the 11th day of life. In conclusion, we demonstrated that SARS‐CoV‐2 can be detectable in the placenta or vaginal secretions of pregnant women. Detection of the virus in the placenta or vaginal secretions may not be associated with neonatal infection. Vaginal delivery may not increase the incidence of neonatal infection, and cesarean may not prevent vertical transmission. The decision regarding the mode of delivery should be based on obstetric indications and COVID‐19 severity.
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Affiliation(s)
- Selcan Sinaci
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Doga F Ocal
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Banu Seven
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ali T Anuk
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Berhan Besimoglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Mehmet C Keven
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Mustafa S Akin
- Division of Neonatology, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Cuneyt Tayman
- Division of Neonatology, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey.,Ankara City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Huseyin L Keskin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey.,Ankara City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif G Yapar Eyi
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bedia Dinc
- Ankara City Hospital, University of Health Sciences, Istanbul, Turkey.,Department of Medical Microbiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey.,Ankara City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey.,Ankara City Hospital, University of Health Sciences, Istanbul, Turkey
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13
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Cosma S, Carosso AR, Cusato J, Borella F, Carosso M, Bovetti M, Filippini C, D'Avolio A, Ghisetti V, Di Perri G, Benedetto C. Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients. Am J Obstet Gynecol 2021; 224:391.e1-391.e7. [PMID: 33039396 PMCID: PMC7543983 DOI: 10.1016/j.ajog.2020.10.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022]
Abstract
Background The disease caused by the severe acute respiratory syndrome coronavirus 2 was named coronavirus disease 2019 and classified as a global public health emergency. The evidence related to the impact of coronavirus disease 2019 on pregnancy is limited to the second and third trimester of pregnancy, whereas data on the first trimester are scant. Many viral infections can be harmful to the fetus during the first trimester of pregnancy, and whether severe acute respiratory syndrome coronavirus 2 is one of them is still unknown. Objective With this study, we evaluated severe acute respiratory syndrome coronavirus 2 infection as a risk factor for early pregnancy loss in the first trimester of pregnancy. Furthermore, coronavirus disease 2019 course in the first trimester was assessed. Study Design Between February 22 and May 21, 2020, we conducted a case-control study at S. Anna Hospital, Turin, among pregnant women in their first trimester, paired for last menstruation. The cumulative incidence of coronavirus disease 2019 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by the detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swab and severe acute respiratory syndrome coronavirus 2 immunoglobulin G and immunoglobulin M antibodies in a blood sample. Patient demographics, coronavirus disease 2019–related symptoms, and the main risk factors for abortion were collected. Results Of 225 women, 23 (10.2%) had a positive test result for coronavirus disease 2019. There was no difference in the cumulative incidence of coronavirus disease 2019 between the cases (11/100, 11%) and the controls (12/125, 9.6%) (P=.73). Logistic regression analysis confirmed that coronavirus disease 2019 was not an independent predictor of early pregnancy loss (odds ratio, 1.28; confidence interval, 0.53–3.08). Coronavirus disease 2019–related symptoms in the first trimester were fever, anosmia, ageusia, cough, arthralgia, and diarrhea; no cases of pneumonia or hospital admission owing to coronavirus disease 2019–related symptoms were recorded. No difference in the incidence of symptoms was noted between the 2 groups. Conclusion Severe acute respiratory syndrome coronavirus 2 infection during the first trimester of pregnancy does not seem to predispose to early pregnancy loss; its cumulative incidence did not differ between women with spontaneous abortion and women with ongoing pregnancy. Coronavirus disease 2019 appears to have a favorable maternal course at the beginning of pregnancy, consistent with what has been observed during the second and third trimesters.
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Affiliation(s)
- Stefano Cosma
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Andrea R Carosso
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy.
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Marco Carosso
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Marialuisa Bovetti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
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Cosma S, Carosso AR, Borella F, Cusato J, Bovetti M, Bevilacqua F, Carosso M, Gervasoni F, Sciarrone A, Marozio L, Revelli A, Rolfo A, Filippini C, Ghisetti V, Di Perri G, Benedetto C. Prenatal Biochemical and Ultrasound Markers in COVID-19 Pregnant Patients: A Prospective Case-Control Study. Diagnostics (Basel) 2021; 11:diagnostics11030398. [PMID: 33652805 PMCID: PMC7996827 DOI: 10.3390/diagnostics11030398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
This prospective observational study aimed to evaluate whether women with SARS-CoV-2 infection during the first trimester of pregnancy are at higher risk of noninvasive prenatal screening test alterations and/or of congenital fetal anomalies at the second-trimester fetal anatomy scan. Maternal symptoms were secondly investigated. The study was carried out on 12-week pregnant women admitted for noninvasive prenatal testing (16 April and 22 June 2020). The cohort had seromolecular tests for SARS-CoV-2, after which they were divided into a positive case group and a negative control group. Both groups had 20-week ultrasound screening. Seventeen out of the 164 women tested positive for SARS-CoV-2 (10.3%). There were no significant differences in mean nuchal translucency thickness or biochemical markers (pregnancy-associated plasma protein A, alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol) between cases and controls (p = 0.77, 0.63, 0.30, 0.40, 0.28) or in the fetal incidence of structural anomalies at the second-trimester fetal anatomy scan (p = 0.21). No pneumonia or hospital admission due to COVID-19-related symptoms were observed. Asymptomatic or mildly symptomatic SARS-CoV-2 infection during the first trimester of pregnancy did not predispose affected women to more fetal anomalies than unaffected women. COVID-19 had a favorable maternal course at the beginning of pregnancy in our healthy cohort.
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Affiliation(s)
- Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
- Correspondence:
| | - Andrea Roberto Carosso
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
| | - Marialuisa Bovetti
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Federica Bevilacqua
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Marco Carosso
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Fiammetta Gervasoni
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Andrea Sciarrone
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, City of Health and Science, 10126 Turin, Italy;
| | - Luca Marozio
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Alberto Revelli
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
| | - Alessandro Rolfo
- Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.); (C.F.)
| | - Claudia Filippini
- Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.); (C.F.)
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL ‘Città di Torino’, 10126 Turin, Italy;
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, 10126 Turin, Italy; (A.R.C.); (F.B.); (M.B.); (F.B.); (M.C.); (F.G.); (L.M.); (A.R.); (C.B.)
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15
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Longitudinal analysis of antibody response following SARS-CoV-2 infection in pregnancy: From the first trimester to delivery. J Reprod Immunol 2021; 144:103285. [PMID: 33582489 PMCID: PMC7973007 DOI: 10.1016/j.jri.2021.103285] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 12/31/2022]
Abstract
We report herein the longest-lasting study of SARS-CoV-2 antibody profile in pregnancy, from first trimester-infection to delivery. Seventeen out of 164 pregnant women tested positive for COVID-19. Throughout pregnancy, the neutralizing antibody titer remained stable, whilst a significant decline in the non-neutralizing antibodies was observed after 16 weeks of gestation. All the newborns of women who developed IgG antibodies showed the presence of the same antibodies in arterial cord blood. Knowledge on the longevity and type of SARS-CoV-2 antibody response may help to guide vaccination strategies in pregnancy.
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Boushra MN, Koyfman A, Long B. COVID-19 in pregnancy and the puerperium: A review for emergency physicians. Am J Emerg Med 2021; 40:193-198. [PMID: 33162266 PMCID: PMC7605788 DOI: 10.1016/j.ajem.2020.10.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a novel virus responsible for causing the novel coronavirus disease of 2019 (COVID-19). OBJECTIVE This article discusses the clinical manifestations of COVID-19 in pregnant patients, the effects of pregnancy on the course of COVID-19 disease, and the impact of COVID-19 on pregnancy outcomes. DISCUSSION The physiological and mechanical changes associated with pregnancy increase maternal susceptibility to infections and complicate intubation and mechanical ventilation. The most common symptoms of COVID-19 in pregnant patients are cough and fever, although many infected individuals are asymptomatic. The majority of pregnant women diagnosed with COVID-19 disease have a mild course of illness and will recover without needing to deliver, but the risks of critical illness and need for mechanical ventilation are increased compared to the general population. Risk factors for death and severe disease include obesity, diabetes, and maternal age > 40 years. Women in their third trimester have the highest risk for critical illness, intensive care unit admission, and need for mechanical ventilation. Adverse fetal outcomes of maternal COVID-19 infection include increased risk of miscarriage, prematurity, and fetal growth restriction. Vertical transmission of SARS-CoV-2 is possible but has not been conclusively proven. CONCLUSIONS COVID-19 is a potentially deadly infection, but data are limited concerning the pregnant population. Pregnant patients appear to present similarly to the general population, with fever and cough being the most reported symptoms in studies. Knowledge of these presentations and outcomes can assist clinicians caring for these patients.
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Affiliation(s)
- Marina N Boushra
- Respiratory Institute at The Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States of America.
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17
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Kurjak A, Jakovljevic M, Masic I, Stanojevic M. Healthy Aging in the Time of Corona Pandemic. Med Arch 2021; 75:4-10. [PMID: 34012191 PMCID: PMC8116115 DOI: 10.5455/medarh.2021.75.4-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/25/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The key considerations for healthy aging are diversity and inequity. Diversity means that there is no typical older person. Policy should be framed to improve the functional ability of all older people, whether they are robust, care dependent or in between. OBJECTIVE The aim of this article is to describe negative influence of Corona pandemic (COVID-19) for realization of the WHO project about Healthy Aging global strategy proposed in the targets "Health for all". METHODS Authors used descriptive model for this cross-sectional study based on facts in analyzed scientific literature deposited in on-line databases about healthy aging concept of the prevention and treatment of the people who will come or already came to the "third trimester of the life". RESULTS AND DISCUSSION Some 80-year-olds have levels of physical and mental capacity that compare favorably with 30-year-olds. Others of the same age may require extensive care and support for basic activities like dressing and eating. Policy should be framed to improve the functional ability of all older people, whether they are robust, care dependent or in between. Inequity reflects a large proportion (approximately 75%) of the diversity in capacity and circumstance observed in older age is the result of the cumulative impact of advantage and disadvantage across people's lives. Importantly, the relationships we have with our environments are shaped by factors such as the family we were born into, our sex, ethnicity, level of education and financial resources. CONCLUSION COVID-19 pandemic "celebrated" one year of existing in almost all countries in the world with very difficult consequences for whole population. But in the first risk group are old people who have in average 6 to 7 co-morbidities. WHO recommended some measures to improve prevention and treatment this category of population, but COVID-19 pandemic stopped full realization of Decade of Healthy Aging project.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
- Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Miro Jakovljevic
- Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
| | - Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Milan Stanojevic
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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18
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Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:232-241. [PMID: 32926494 DOI: 10.1002/uog.23107] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection. METHODS This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory-confirmed SARS-CoV-2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia and Australia, between 1 February 2020 and 30 April 2020. Confirmed SARS-CoV-2 infection was defined as a positive result on real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit (ICU), use of mechanical ventilation and death. RESULTS In total, 388 women with a singleton pregnancy tested positive for SARS-CoV-2 on RT-PCR of a nasopharyngeal swab and were included in the study. Composite adverse maternal outcome was observed in 47/388 (12.1%) women; 43 (11.1%) women were admitted to the ICU, 36 (9.3%) required mechanical ventilation and three (0.8%) died. Of the 388 women included in the study, 122 (31.4%) were still pregnant at the time of data analysis. Among the other 266 women, six (19.4% of the 31 women with first-trimester infection) had miscarriage, three (1.1%) had termination of pregnancy, six (2.3%) had stillbirth and 251 (94.4%) delivered a liveborn infant. The rate of preterm birth before 37 weeks' gestation was 26.3% (70/266). Of the 251 liveborn infants, 69/251 (27.5%) were admitted to the neonatal ICU, and there were five (2.0%) neonatal deaths. The overall rate of perinatal death was 4.1% (11/266). Only one (1/251, 0.4%) infant, born to a mother who tested positive during the third trimester, was found to be positive for SARS-CoV-2 on RT-PCR. CONCLUSIONS SARS-CoV-2 infection in pregnant women is associated with a 0.8% rate of maternal mortality, but an 11.1% rate of admission to the ICU. The risk of vertical transmission seems to be negligible. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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19
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Zimmerman E, Martins NN, Verheijen RHM, Mahmood T. EBCOG position statement - Simulation-based training for obstetrics and gynaecology during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 258:457-458. [PMID: 33518409 DOI: 10.1016/j.ejogrb.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
The specialty of Obstetrics and Gynaecology has been on the forefront of introducing simulation in post graduate education for the past two decades. Simulation training is known to enhance psychomotor skills and is considered an important step in the transition from classroom learning to clinical practice. Training on simulators allows trainees to acquire basic skills before getting involved in day to day care in real life situations. Clinical circumstances around the COVID 19 pandemic have highlighted the key importance of simulation training in delivering post graduate curriculum.
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Affiliation(s)
- Erin Zimmerman
- Product Communication Specialist, VirtaMed, Inc. Lithia, FL, United States.
| | - Nuno N Martins
- EBCOG Standing Committee on Training Recognition, Department of Obstetrics and Gynaecology, Centro Hospitalar Tondela, Viseu, Portugal.
| | - René H M Verheijen
- Formerly Dept. of Gynaecological Oncology, Cancer Centre, University Medical Centre Utrecht, the Netherlands; EBCOG Standards of Care and Position Statements Group, United Kingdom.
| | - Tahir Mahmood
- Victoria Hospital, Kirkcaldy, Scotland, United Kingdom; EBCOG Standards of Care and Position Statements Group, United Kingdom.
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20
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Kurjak A, Api O, Masic I. Why Not Lose Faith in Science in the Fight Against Coronavirus. Mater Sociomed 2020; 32:252-257. [PMID: 33628125 PMCID: PMC7879456 DOI: 10.5455/msm.2020.32.252-257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND One of the most vulnerable group to cope with the consequences of COVID-19 pandemic are women, particularly pregnant ones. OBJECTIVE The aim of this article was to make review of the scientific literature to show clearly that pandemic is not so dangerous neither for mother nor her unborn and newborn children. RESULTS AND DISCUSSION It should be stated that most of the scientific papers on COVID-19 are currently being conducted in a way that would probably be completely unacceptable to serious science in any other circumstances. Taking into account everything we have learned about the SARS-CoV-2 virus so far it comes as a surprise that there has not been a more intense scientific debate on whether the blind lockdown model, implemented by most national governments, was truly an appropriate response to the challenges posed by the pandemic. CONCLUSION Deep analysis what science in perinatal medicine did assess and what it recommended to perinatal world it may be followed by principles that the research of the members of the Academy will not be the first to be published, but we certainly aim that the scientific evidence published by Academy is fast, reliable and implementable.
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Affiliation(s)
- Asim Kurjak
- International Academy of Perinatal Medicine, Zagreb, Croatia
| | - Olus Api
- VKV American Hospital, Istanbul, Perinatal Medicine Foundation, Istanbul, Turkey
| | - Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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21
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Carosso AR, Cosma S, Benedetto C. Vaginal delivery in COVID-19 pregnant women: anorectum as a potential alternative route of SARS-CoV-2 transmission. Am J Obstet Gynecol 2020; 223:612. [PMID: 32531218 PMCID: PMC7283067 DOI: 10.1016/j.ajog.2020.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/05/2020] [Indexed: 01/13/2023]
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22
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SARS-COV-2 Maternal-Child Transmission: Can It Occur Before Delivery and How Do We Prove It? Pediatr Infect Dis J 2020; 39:e263-e264. [PMID: 32658094 DOI: 10.1097/inf.0000000000002820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Cosma S, Borella F, Carosso A, Sciarrone A, Cusato J, Corcione S, Mengozzi G, Preti M, Katsaros D, Di Perri G, Benedetto C. The "scar" of a pandemic: Cumulative incidence of COVID-19 during the first trimester of pregnancy. J Med Virol 2020; 93:537-540. [PMID: 32633869 PMCID: PMC7361535 DOI: 10.1002/jmv.26267] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 01/01/2023]
Abstract
Congenitally‐ or perinatally‐acquired viral infections can be harmful to the fetus but data are limited about prevalence and outcomes of coronavirus disease 2019 (COVID‐19) disease during the first trimester of pregnancy. We report epidemiologic data from a study investigating a cohort of women who became pregnant just before or during the COVID‐19 pandemic. We recruited 138 consecutive pregnant women attending for first trimester screening (11‐13 weeks of gestation) at Sant'Anna Hospital, Turin, Piedmont, Italy, during the plateau and the falling phase of the COVID‐19 epidemic curve. Patients were tested for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) immunoglobulin M/immunoglobulin G antibody levels and SARS‐CoV‐2 detection in sera and nasopharyngeal swab samples. COVID‐19 cumulative incidence during the first trimester was of 10.1% with high prevalence of asymptomatic patients (42.8%). Similar to the course of the disease in non pregnant adults, 80% to 90% of infections were not severe.The prevalence of reported symptoms was four‐fold higher in SARS‐CoV‐2 positive patients (57%) than in those negative (13%) (P < .001), suggesting that direct self‐testing should open doors to confirmatory testing for COVID‐19. Our findings support the need for COVID‐19 screening in early pregnancy in epidemic areas to plan materno‐fetal health surveillance programs. 1‐ In a COVID‐19 endemic area, we found a cumulative incidence during the first trimester of pregnancy of 10.1% 2‐ Among positive patients, 42.8% were asymptomatic 3‐ In the COVID‐19 endemic area, a screening test for SARS‐CoV‐2 should be offered to all pregnant women in the first trimester.
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Affiliation(s)
- Stefano Cosma
- Gynecology and Obstetrics 1, Department of Surgical Sciences, School of Health and Science, University of Turin, Turin, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, School of Health and Science, University of Turin, Turin, Italy
| | - Andrea Carosso
- Gynecology and Obstetrics 1, Department of Surgical Sciences, School of Health and Science, University of Turin, Turin, Italy
| | - Andrea Sciarrone
- Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, School of Health and Science, Turin, Italy
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Silvia Corcione
- Division of Infectious Diseases, Department of Medical Sciences, School of Health and Science, University of Turin, Turin, Italy.,Division of Geographic Medicine and Infectious Diseases, Tufts School of Medicine, Boston, Massachusetts
| | - Giulio Mengozzi
- Department of Public Health and Pediatric Sciences, Diagnostic Hemostasis Laboratories, School of Health and Science, Turin, Italy
| | - Mario Preti
- Gynecology and Obstetrics 1, Department of Surgical Sciences, School of Health and Science, University of Turin, Turin, Italy
| | - Dionyssios Katsaros
- Gynecology and Obstetrics 1, Department of Surgical Sciences, School of Health and Science, University of Turin, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, School of Health and Science, University of Turin, Turin, Italy
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24
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Hagenbeck C, Pecks U, Fehm T, Borgmeier F, Schleußner E, Zöllkau J. [Pregnancy, birth, and puerperium with SARS-CoV-2 and COVID-19]. DER GYNAKOLOGE 2020; 53:614-623. [PMID: 32836333 PMCID: PMC7357434 DOI: 10.1007/s00129-020-04637-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- C. Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - U. Pecks
- Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - T. Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - F. Borgmeier
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - E. Schleußner
- Klinik für Geburtsmedizin, Universität Jena, Jena, Deutschland
| | - J. Zöllkau
- Klinik für Geburtsmedizin, Universität Jena, Jena, Deutschland
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25
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Carbone IF, Conforti A, Farina A, Alviggi C. A practical approach for the management of obstetric and infertile women during the phase two of the novel coronavirus disease 2019 (COVID -19) pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 251:266-267. [PMID: 32536467 PMCID: PMC7278634 DOI: 10.1016/j.ejogrb.2020.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/06/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ilma Floriana Carbone
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy; Istituto per l'Endocrinologia e l'Oncologia Sperimentale (IEOS), Consiglio Nazionale delle Ricerche, Naples, Italy
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