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Zhu F, Zhao Y, Wu J, Wang M, Zhu Z, Zhang L. Post-COVID-19 Fetal Cardiac Morphology and Systolic Evaluation in Infected Pregnant Women by Fetal Heart Quantification Technology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1199-1209. [PMID: 38465462 DOI: 10.1002/jum.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/03/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Due to the government's liberalization of epidemic control, the current 2019 novel coronavirus disease (COVID-19) has started to spread widely within China. This study aimed to use the fetal heart quantification (fetal HQ) technique to assess the cardiac function and morphology of the fetuses of pregnant women diagnosed with COVID-19 in the early stages of pregnancy. METHODS Exactly 86 pregnant women diagnosed with COVID-19 infection in early pregnancy (COVID-19 group) and 90 healthy pregnant women (control group) who underwent fetal echocardiography were prospectively included in this study. The fetal HQ technique was applied to compare the differences in the global sphericity index (GSI), global strain values (GS), fractional area change (FAC), and 24-segment fractional shortening (FS) of the left and right ventricles, between the COVID-19 group and the control group. RESULTS Compared with the control group, the differences in GS and 24-segment FS of the left ventricle in the COVID-19 group were not statistically significant. However, the COVID-19 group showed lower GSI values compared with the control group (1.24 vs 1.28). FAC (48.12%) of the left ventricle and GS (-23.55%), FAC (41.74%) of the right ventricle in the COVID-19 group were reduced compared with FAC (50.50%) of the left ventricle and GS (-27.63%), FAC (46.01%) of the right ventricle in the control group. Segmental analysis revealed reduced FS in segments 20-24 in the COVID-19 group compared with the control group. Right ventricular GS was an independent predictor of adverse pregnancy outcome with an optimal cutoff value of -18.66%. CONCLUSIONS The results suggest that COVID-19 infection in early pregnancy may have a negative impact on fetal cardiac morphology and function. Fetal HQ may offer a new assessment method for the early identification of fetal cardiac alterations in pregnant women infected with COVID-19.
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Affiliation(s)
- Feihu Zhu
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Yueshu Zhao
- Prenatal Diagnosis Center, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Juan Wu
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Ming Wang
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Ziqi Zhu
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
| | - Lingling Zhang
- Ultrasonic Department, The Third Affiliated Hospital of Zhengzhou University (Maternal and Child Health Hospital of Henan Province), Zhengzhou, China
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K M, Dw K, N A, Km P. Neonatal-perinatal collaboration during the COVID-19 pandemic. Semin Perinatol 2024:151918. [PMID: 38876935 DOI: 10.1016/j.semperi.2024.151918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
The COVID-19 pandemic required perinatal clinicians to address the individual medical needs of the pregnant person and the fetus as well as the interdependent considerations of the maternal/newborn dyad. Regional, national and international collaborative groups utilized existing structures and in some cases, formed new partnerships to rapidly collect perinatal information. The urgent need to care for at-risk and infected pregnant persons required these groups to develop practical approaches to collect the data needed to safely inform practice. Here we will summarize the findings of five collaborative studies that leveraged differing methods to inform perinatal pandemic care.
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Affiliation(s)
- Miller K
- University of Alabama at School of Medicine, Division of Neonatology, Department of Pediatrics, Birmingham, AL, USA
| | - Kimberlin Dw
- University of Alabama at School of Medicine, Division of Pediatric Infectious Disease, Department of Pediatrics, Birmingham, AL, USA
| | - Arora N
- University of Alabama at School of Medicine, Division of Neonatology, Department of Pediatrics, Birmingham, AL, USA
| | - Puopolo Km
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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3
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Joseph L, De Luna G, Bernit E, Cougoul P, Santin A, Faucher B, Habibi A, Garou A, Loko G, Mattioni S, Manceau S, Arlet JB, Lionnet F. A study of 28 pregnant women with sickle cell disease and COVID-19: elevated maternal and fetal morbidity rates. Haematologica 2024; 109:1562-1565. [PMID: 37855041 PMCID: PMC11063858 DOI: 10.3324/haematol.2023.283300] [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: 04/11/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023] Open
Abstract
Not available.
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Affiliation(s)
- Laure Joseph
- Biotherapy Department, French National Sickle Cell Disease Referral Center, Clinical Investigation Center, Hopital Necker, Labex GR-Ex, Assistance-Publique Hopitaux de Paris, Paris.
| | - Gonzalo De Luna
- Unite des maladies genetiques du globule rouge and Etablissement Francais du Sang, Hopital Henri Mondor, Assistance-Publique Hopitaux de Paris, Creteil
| | - Emmanuelle Bernit
- Antilles-Guyane Reference Center for Sickle-Cell Disease, Thalassemia and Other Red Blood Cell Disorders, Pointe a Pitre, Guadeloupe
| | - Pierre Cougoul
- Institut Universitaire du Cancer Toulouse Oncopole, Medecine Interne, Toulouse
| | - Aline Santin
- Department of Internal Medicine, Reference Center of Sickle cell Anemia, University Hospital Center of Tenon, Sorbonne University, Assistance-Publique Hopitaux de Paris, Paris
| | - Benoit Faucher
- Department of Internal Medicine, Aix Marseille Universite, Assistance-Publique Hopitaux de Marseille, Hopital de la Timone, Marseille
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine, Henri-Mondor University Hospital, Assistance-Publique Hopitaux de Paris, U-PEC, Creteil
| | - Alain Garou
- Sickle Cell Referral Center, Centre Hospitalier de Mayotte, Mayotte
| | - Gylna Loko
- Sickle Cell Referral Center, Martinique Hospital, Martinique
| | - Sarah Mattioni
- Department of Internal Medicine, Reference Center of Sickle cell Anemia, University Hospital Center of Tenon, Sorbonne University, Assistance-Publique Hopitaux de Paris, Paris
| | - Sandra Manceau
- Biotherapy Department, French National Sickle Cell Disease Referral Center, Clinical Investigation Center, Hopital Necker, Labex GR-Ex, Assistance-Publique Hopitaux de Paris, Paris
| | - Jean Benoit Arlet
- Internal Medicine Department, French National Sickle Cell Disease Referral Center, Georges Pompidou European Hospital, Assistance Publique-Hopitaux de Paris, Paris
| | - François Lionnet
- Department of Internal Medicine, Reference Center of Sickle cell Anemia, University Hospital Center of Tenon, Sorbonne University, Assistance-Publique Hopitaux de Paris, Paris
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4
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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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Gale C, Sharkey D, Fitzpatrick KE, Mactier H, Morelli A, Nakahara M, Hurd M, Placzek A, Knight M, Ladhani SN, Draper ES, Doherty C, Quigley MA, Kurinczuk JJ. Characteristics and outcomes of neonates hospitalised with SARS-CoV-2 infection in the UK by variant: a prospective national cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:279-286. [PMID: 37968087 DOI: 10.1136/archdischild-2023-326167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Neonatal infection with wildtype SARS-CoV-2 is rare and good outcomes predominate. We investigated neonatal outcomes using national population-level data to describe the impact of different SARS-CoV-2 variants. DESIGN Prospective population-based cohort study. SETTING Neonatal, paediatric and paediatric intensive care inpatient care settings in the UK. PATIENTS Neonates (first 28 days after birth) with confirmed SARS-CoV-2 infection who received inpatient care, March 2020 to April 2022. Neonates were identified through active national surveillance with linkage to national SARS-CoV-2 testing data, routinely recorded neonatal data, paediatric intensive care data and obstetric and perinatal mortality surveillance data. OUTCOMES Presenting signs, clinical course, severe disease requiring respiratory support are presented by the dominant SARS-CoV-2 variant in circulation at the time. RESULTS 344 neonates with SARS-CoV-2 infection received inpatient care; breakdown by dominant variant: 146 wildtype, 123 alpha, 57 delta and 18 omicron. Overall, 44.7% (153/342) neonates required respiratory support; short-term outcomes were good with 93.6% (322/344) of neonates discharged home. Eleven neonates died: seven unrelated to SARS-CoV-2 infection, four were attributed to neonatal SARS-CoV-2 infection (case fatality 4/344, 1.2% 95% CI 0.3% to 3.0%) of which three were born preterm due to maternal COVID-19. More neonates were born very preterm (23/54) and required invasive ventilation (27/57) when delta variant was predominant, and all four SARS-CoV-2-related deaths occurred in this period. CONCLUSIONS Inpatient care for neonates with SARS-CoV-2 was uncommon. Although rare, severe neonatal illness was more common during the delta variant period, potentially reflecting more severe maternal disease and associated preterm birth. TRIAL REGISTRATION NUMBER ISRCTN60033461.
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Affiliation(s)
- Chris Gale
- School of Public Health, Faculty of Medicine, Imperial College of Science Technology and Medicine, London, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | - Mariko Nakahara
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Madeleine Hurd
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Anna Placzek
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | | | | | - Cora Doherty
- Neonatology, University Hospital of Wales, Cardiff, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
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Engjom HM, Ramakrishnan R, Vousden N, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Perinatal outcomes after admission with COVID-19 in pregnancy: a UK national cohort study. Nat Commun 2024; 15:3234. [PMID: 38622110 PMCID: PMC11018846 DOI: 10.1038/s41467-024-47181-z] [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: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
There are few population-based studies of sufficient size and follow-up duration to have reliably assessed perinatal outcomes for pregnant women hospitalised with SARS-CoV-2 infection. The United Kingdom Obstetric Surveillance System (UKOSS) covers all 194 consultant-led UK maternity units and included all pregnant women admitted to hospital with an ongoing SARS-CoV-2 infection. Here we show that in this large national cohort comprising two years' active surveillance over four SARS-CoV-2 variant periods and with near complete follow-up of pregnancy outcomes for 16,627 included women, severe perinatal outcomes were more common in women with moderate to severe COVID-19, during the delta dominant period and among unvaccinated women. We provide strong evidence to recommend continuous surveillance of pregnancy outcomes in future pandemics and to continue to recommend SARS-CoV-2 vaccination in pregnancy to protect both mothers and babies.
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Affiliation(s)
- Hilde Marie Engjom
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
- Division of Physical and Mental Health, Norwegian Institute of Public Health, 5015, Bergen, Norway
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Edward Morris
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Nigel Simpson
- Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, London, London, UK, SW7 2BX and Centre for Paediatrics and Child Health, Imperial College, London, SW7 2AZ, UK
| | - Pat O'Brien
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
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Skhvitaridze N, Gamkrelidze A, Manjavidze T, Brenn T, Rylander C. SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study. BMC Pregnancy Childbirth 2024; 24:156. [PMID: 38388360 PMCID: PMC10882809 DOI: 10.1186/s12884-024-06329-x] [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: 04/13/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Georgia experienced an increase in maternal deaths (MD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation. This study aimed to assess associations between timing of SARS-CoV-2 infection during pregnancy and MD, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery. METHODS We performed a national birth registry-based cohort study of pregnant women who had completed 22 weeks of gestation and delivered between February 28, 2020, and August 31, 2022. The data were linked to coronavirus disease 2019 (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery; confirmed infection within 30 days before or at delivery; and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS Among 111,493 pregnant women, 16,751 had confirmed infection during pregnancy, and 7,332 were fully vaccinated against COVID-19 before delivery. Compared to the reference group, those with confirmed infection within 30 days before or at delivery experienced increased odds of MD (aOR: 43.11, 95% CI, 21.99-84.55), post-delivery ICU admission (aOR: 5.20, 95% CI, 4.05-6.67), and CS delivery (aOR: 1.11, 95% CI, 1.03-1.20). CONCLUSIONS Pregnant women in Georgia with confirmed SARS-CoV-2 infection within 30 days before or at delivery experienced a considerably higher risk of MD and post-delivery ICU admission and a slightly higher risk for CS delivery. Additionally, the results highlighted that most pregnant women were not vaccinated against COVID-19. These findings should alert stakeholders that adherence to public health preventive measures needs to be improved.
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Affiliation(s)
- Natia Skhvitaridze
- Department of Community Medicine, UiT The Arctic University of Norway, N-9037, Langnes, Tromsø, PO Box 6050, Norway.
- National Center for Disease Control and Public Health, 99 Kakheti highway, Tbilisi, Georgia.
- The University of Georgia, 77a Kostava Street, Tbilisi, Georgia.
| | | | - Tinatin Manjavidze
- Department of Community Medicine, UiT The Arctic University of Norway, N-9037, Langnes, Tromsø, PO Box 6050, Norway
- National Center for Disease Control and Public Health, 99 Kakheti highway, Tbilisi, Georgia
- The University of Georgia, 77a Kostava Street, Tbilisi, Georgia
| | - Tormod Brenn
- Department of Community Medicine, UiT The Arctic University of Norway, N-9037, Langnes, Tromsø, PO Box 6050, Norway
| | - Charlotta Rylander
- Department of Community Medicine, UiT The Arctic University of Norway, N-9037, Langnes, Tromsø, PO Box 6050, Norway
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Schaumann N, Suhren JT. An Update on COVID-19-Associated Placental Pathologies. Z Geburtshilfe Neonatol 2024; 228:42-48. [PMID: 38330958 DOI: 10.1055/a-2220-7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
COVID-19 pregnancies are associated with increased rates of premature delivery and stillbirths. It is still a matter of debate whether there is a COVID-19-associated pattern of placenta pathology. We updated our previously published results on a systematic literature review and meta-analysis of COVID-19 pregnancies. In total, 38 reports on 3677 placentas were evaluated regarding histopathological changes. Maternal vascular malperfusion (32%), fetal vascular malperfusion (19%), acute and chronic inflammation (20% and 22%) were frequent pathologies. In non-COVID-19 pregnancies, placentas show similar histologic patterns and mainly similar frequencies of manifestation. It has to be taken into account that there might be an observation bias, because some findings are diagnosed as a "pathology" that might have been classified as minor or unspecific findings in non-COVID-19 placentas. COVID-19 placentitis occurs in 1-2% of cases at the most. In conclusion, this updated meta-analysis indicates that COVID-19 infection during pregnancy does not result in an increased rate of a specific placenta pathology and COVID-19 placentitis is rare.
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Affiliation(s)
- Nora Schaumann
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jan-Theile Suhren
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
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9
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Kleinwechter HJ, Weber KS, Liedtke TP, Schäfer-Graf U, Groten T, Rüdiger M, Pecks U. COVID-19, Pregnancy, and Diabetes Mellitus. Z Geburtshilfe Neonatol 2024; 228:17-31. [PMID: 37918833 DOI: 10.1055/a-2180-7715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
During the severe acute respiratory distress virus coronavirus type 2 (SARS-CoV-2) pandemic, many women were infected during their pregnancies. The SARS-CoV-2-induced coronavirus disease 19 (COVID-19) has an impact on maternal health and pregnancy outcomes; peripartum and perinatal morbidity and mortality are increased. Pregnancy is considered a risk factor for severe COVID-19 course. Additional risk factors during pregnancy are diabetes mellitus, gestational diabetes mellitus (GDM), and obesity. Systemic inflammation can lead to severe metabolic dysregulation with ketoacidosis. The endocrine pancreas is a target organ for SARS-CoV-2 and the fetal risk depends on inflammation of the placenta. Up to now there is no evidence that SARS-CoV-2 infection during pregnancy leads to permanent diabetes in mothers or their offspring via triggering autoimmunity or beta cell destruction. The frequently observed increased prevalence of GDM compared to the years before the pandemic is most likely due to changed lifestyle during lockdown. Furthermore, severe COVID-19 may be associated with the development of GDM due to worsening of glucose tolerance. Vaccination with a mRNA vaccine is safe and highly effective to prevent infection and to reduce hospitalization. Registries support offering evidence-based recommendations on vaccination for pregnant women. Even with the current omicron virus variant, there are increased risks for symptomatic and unvaccinated pregnant women.
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Affiliation(s)
| | | | | | - Ute Schäfer-Graf
- Department of Obstetrics, Berlin Diabetes Center for Pregnant Women, St. Joseph Hospital, Berlin, Germany
| | - Tanja Groten
- Department of Obstetrics, Competence Center for Diabetic Women, Jena University Hospital, Jena, Germany
| | - Mario Rüdiger
- Saxony Center for Fetal-Neonatal Health, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Obstetrics, University Hospital Würzburg, Maternal Health and Midwifery Science, Würzburg, Germany
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10
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Andescavage N, Lu YC, Wu Y, Kapse K, Keller J, Von Kohorn I, Afifi A, Vezina G, Henderson D, Wessel DL, du Plessis AJ, Limperopoulos C. Intrauterine exposure to SARS-CoV-2 infection and early newborn brain development. Cereb Cortex 2024; 34:bhae041. [PMID: 38385890 PMCID: PMC10883413 DOI: 10.1093/cercor/bhae041] [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: 10/30/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/23/2024] Open
Abstract
Epidemiologic studies suggest that prenatal exposures to certain viruses may influence early neurodevelopment, predisposing offspring to neuropsychiatric conditions later in life. The long-term effects of maternal COVID-19 infection in pregnancy on early brain development, however, remain largely unknown. We prospectively enrolled infants in an observational cohort study for a single-site study in the Washington, DC Metropolitan Area from June 2020 to November 2021 and compared these infants to pre-pandemic controls (studied March 2014-February 2020). The primary outcomes are measures of cortical morphometry (tissue-specific volumes), along with global and regional measures of local gyrification index, and sulcal depth. We studied 210 infants (55 infants of COVID-19 unexposed mothers, 47 infants of COVID-19-positive mothers, and 108 pre-pandemic healthy controls). We found increased cortical gray matter volume (182.45 ± 4.81 vs. 167.29 ± 2.92) and accelerated sulcal depth of the frontal lobe (5.01 ± 0.19 vs. 4.40 ± 0.13) in infants of COVID-19-positive mothers compared to controls. We found additional differences in infants of COVID-19 unexposed mothers, suggesting both maternal viral exposures, as well as non-viral stressors associated with the pandemic, may influence early development and warrant ongoing follow-up.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
- Division of Neonatology, Children’s National Hospital, 111 Michigavn Ave. NW, Washington, DC 20010, United States
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
| | - Yuan-Chiao Lu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Yao Wu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Jennifer Keller
- Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, George Washington University, 2300 Eye Ste. NW, Washington, DC 20052, United States
| | - Isabelle Von Kohorn
- Department of Neonatology, Holy Cross Hospital, 1500 Forest Glen Rd. Silver Spring, MD 20910, United States
| | - Ashraf Afifi
- Department of Hospital-Based Regional Neonatology at Woodbridge, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Gilbert Vezina
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Deidtra Henderson
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - David L Wessel
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
- Critical Care Medicine, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Adre J du Plessis
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
- Prenatal Pediatrics Institute, Children’s National Hospital, 111 Michigan Ave. NW Washington, DC 20010, United States
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
- Prenatal Pediatrics Institute, Children’s National Hospital, 111 Michigan Ave. NW Washington, DC 20010, United States
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11
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Celik IH, Tanacan A, Canpolat FE. Neonatal outcomes of maternal prenatal coronavirus infection. Pediatr Res 2024; 95:445-455. [PMID: 38057579 DOI: 10.1038/s41390-023-02950-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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Affiliation(s)
- Istemi Han Celik
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Türkiye; Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, 06010, Ankara, Türkiye.
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Perinatology Clinic, University of Health Sciences Turkiye, Ankara Bilkent City Hospital, 06800, Ankara, Türkiye
| | - Fuat Emre Canpolat
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Türkiye, Ankara Bilkent City Hospital, 06800, Ankara, Türkiye
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12
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Magawa S, Nii M, Enomoto N, Tamaishi Y, Takakura S, Maki S, Ishida M, Osato K, Kondo E, Sakuma H, Ikeda T. COVID-19 during pregnancy could potentially affect placental function. J Matern Fetal Neonatal Med 2023; 36:2265021. [PMID: 37806776 DOI: 10.1080/14767058.2023.2265021] [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: 03/23/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE COVID-19 is an ongoing pandemic and has been extensively studied. However, the effects of COVID-19 during pregnancy, particularly on placental function, have not been verified. In this study, we used blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) to evaluate whether COVID-19 incidence during pregnancy has any lasting effects with respect to placental oxygenation. METHODS This is a case-control study, in which eight cases of singleton pregnancies before 30 weeks gestation with COVID-19 mothers were included. Placental oxygenation was evaluated using BOLD-MRI after 32 weeks of gestation. BOLD-MRI was consecutively performed under normoxia (21% O2), hyperoxia (100% O2), and normoxia for 4 min each. Individual placental time-activity curves were evaluated to calculate the peak score (peakΔR2*) and the time from the start of maternal oxygen administration to the time of peakΔR2* (time to peakΔR2*). Eighteen COVID-19-free normal pregnancies from a previous study were used as the control group. RESULTS No significant differences were found between the two groups regarding maternal background, number of days of delivery, birth weight, and placental weight. The parameter peakΔR2* was significantly decreased in the COVID-19 group (8 ± 3 vs. 5 ± 1, p < .001); however, there was no significant difference in time to peakΔR2* (458 ± 74 s vs. 471 ± 33 s, p = .644). CONCLUSIONS In this study, BOLD-MRI was used to evaluate placental oxygenation during pregnancy in COVID-19-affected patients. COVID-19 during pregnancy decreased placental oxygenation even post-illness, but had no effect on fetal growth; further investigation of the possible effects of COVID-19 on the fetus and mother is warranted.
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Affiliation(s)
- Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Yuya Tamaishi
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Faculty of Medicine, Tsu, Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology, Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Faculty of Medicine, Tsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty of Medicine, Tsu, Japan
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Abstract
PURPOSE OF REVIEW Congenital infections are a major cause of childhood multidomain neurodevelopmental disabilities. They contribute to a range of structural brain abnormalities that can cause severe neurodevelopmental impairment, cerebral palsy, epilepsy, and neurosensory impairments. New congenital infections and global viral pandemics have emerged, with some affecting the developing brain and causing neurodevelopmental concerns. This review aims to provide current understanding of fetal infections and their impact on neurodevelopment. RECENT FINDINGS There are a growing list of congenital infections causing neurodevelopmental issues, including cytomegalovirus, Zika virus, syphilis, rubella, lymphocytic choriomeningitis virus, and toxoplasmosis. Fetal exposure to maternal SARS-CoV-2 may also pose risk to the developing brain and impact neurodevelopmental outcomes, although studies have conflicting results. As Zika virus was a recently identified congenital infection, there are several new reports on child neurodevelopment in the Caribbean and Central and South America. For many congenital infections, children with in-utero exposure, even if asymptomatic at birth, may have neurodevelopmental concerns manifest over time. SUMMARY Congenital infections should be considered in the differential diagnosis of a child with neurodevelopmental impairments. Detailed pregnancy history, exposure risk, and testing should guide diagnosis and multidisciplinary evaluation. Children with congenital infections should have long-term follow-up to assess for neurodevelopmental delays and other neurosensory impairments. Children with confirmed delays or high-risk should be referred for rehabilitation therapies.
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Affiliation(s)
- Olivier Fortin
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
| | - Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
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14
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Crispino P, Marocco R, Di Trento D, Guarisco G, Kertusha B, Carraro A, Corazza S, Pane C, Di Troia L, del Borgo C, Lichtner M. Use of Monoclonal Antibodies in Pregnant Women Infected by COVID-19: A Case Series. Microorganisms 2023; 11:1953. [PMID: 37630512 PMCID: PMC10459383 DOI: 10.3390/microorganisms11081953] [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: 07/07/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Monoclonal antibodies are designed to target specific proteins of COVID-19 and can be used as a treatment for people with mild to moderate infection and at a high risk of severe disease. Casirivimab/imdevimab, sotrovimab, and Bamlanivimab/etesevimab have been authorized for emergency use in the treatment of COVID-19. However, during pregnancy, these drugs have not been extensively studied. METHODS A total of 22 pregnant women with mild to moderate infection were treated with three different monoclonal antibodies, and efficacy and safety were evaluated in the first period and until six months of follow-up. RESULTS No infusion/allergic reactions occurred. No fatal or adverse events were observed in the pregnant women or fetus. The time of negativization with sotrovimab was shorter in comparison to Imdevimav/casirivimab (p = 0.0187) and Bamlanivimab/etesevimab (p < 0.00001). The time of negativization with sotrovimab was earlier in comparison to Imdevimav/casirivimab (t-value: 2.92; p = 0.0052) in vaccinated patients and similar in comparison to Imdevimav/casirivimab (t-value: 1.48; p = 0.08). In unvaccinated patients, sotrovimab was faster to achieve negativization in comparison to Bamlanivimab/etesevimab (t-value: 10.75; p < 0.0005). CONCLUSIONS Pregnant COVID-19 patients receiving sotrovimab obtained better clinical outcomes. Pregnancy or neonatal complications were not observed after monoclonal treatment, confirming the safety and tolerability of these drugs in pregnant women.
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Affiliation(s)
- Pietro Crispino
- Medicine, Santa Maria Goretti Hospital, Via Scaravelli Snc, 04100 Latina, Italy
| | - Raffaella Marocco
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Daniela Di Trento
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Gloria Guarisco
- Unit of Diabetology, Santa Maria Goretti Hospital, 04100 Latina, Italy;
| | - Blerta Kertusha
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Anna Carraro
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Sara Corazza
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Cristina Pane
- Unit of Gynecology, Santa Maria Goretti Hospital, 04100 Latina, Italy; (C.P.); (L.D.T.)
| | - Luciano Di Troia
- Unit of Gynecology, Santa Maria Goretti Hospital, 04100 Latina, Italy; (C.P.); (L.D.T.)
| | - Cosimo del Borgo
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Miriam Lichtner
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
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15
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Boettcher LB, Metz TD. Maternal and neonatal outcomes following SARS-CoV-2 infection. Semin Fetal Neonatal Med 2023; 28:101428. [PMID: 37105860 PMCID: PMC10005973 DOI: 10.1016/j.siny.2023.101428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Infection with SARS-CoV-2 causing COVID-19 in pregnancy is known to confer risks to both the pregnant patient and fetus. A review of the current literature demonstrates that pregnant individuals with SARS-CoV-2 infection are at risk for higher composite morbidity, intensive care unit admission, ventilatory support, pre-eclampsia, preterm birth, and neonatal intensive care unit admissions compared to pregnant individuals without SARS-CoV-2. Worse obstetric morbidity and mortality generally correlate with the severity of COVID-19. Comorbidities such as diabetes increase the risk of severe COVID-19. An increased risk of stillbirth appears to be predominantly confined to pregnancies affected in the Delta variant time period. Further, vaccination against SARS-CoV-2 has been demonstrated to be safe and effective in pregnancy and while breastfeeding. Therefore, continued counseling encouraging vaccination remains imperative. The long-term maternal and neonatal consequences of pregnancies affected by SARS-CoV-2 remain unknown, and therefore continued research in this regard is warranted.
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Affiliation(s)
- Lillian B Boettcher
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, #2B200, Salt Lake City, UT, 84132, USA.
| | - Torri D Metz
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, #2B200, Salt Lake City, UT, 84132, USA.
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16
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Abstract
Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disability and cardiovascular and metabolic disease later in life. Pre-eclampsia is a complex multisystem disease, diagnosed by sudden-onset hypertension (>20 weeks of gestation) and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction. Pre-eclampsia is found only when a placenta is or was recently present and is classified as preterm (delivery <37 weeks of gestation), term (delivery ≥37 weeks of gestation) and postpartum pre-eclampsia. The maternal syndrome of pre-eclampsia is driven by a dysfunctional placenta, which releases factors into maternal blood causing systemic inflammation and widespread maternal endothelial dysfunction. Available treatments target maternal hypertension and seizures, but the only 'cure' for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. Despite decades of research, the aetiology of pre-eclampsia, particularly of term and postpartum pre-eclampsia, remains poorly defined. Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials.
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17
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Wołejszo S, Genowska A, Motkowski R, Strukcinskiene B, Klukowski M, Konstantynowicz J. Insights into Prevention of Health Complications in Small for Gestational Age (SGA) Births in Relation to Maternal Characteristics: A Narrative Review. J Clin Med 2023; 12:jcm12020531. [PMID: 36675464 PMCID: PMC9862121 DOI: 10.3390/jcm12020531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Small for gestational age (SGA) births are a significant clinical and public health issue. The objective of this review was to summarize maternal biological and socio-demographic factors and preventive strategies used to reduce the risk of SGA births. A literature search encompassing data from the last 15 years was conducted using electronic databases MEDLINE/PubMed, Google Scholar and Scopus to review risk factors and preventive strategies for SGA. Current evidence shows that primiparity, previous stillbirths, maternal age ≤24 and ≥35 years, single motherhood, low socio-economic status, smoking and cannabis use during pregnancy confer a significant risk of SGA births. Studies on alcohol consumption during pregnancy and SGA birth weight are inconclusive. Beneficial and preventive factors include the "Mediterranean diet" and dietary intake of vegetables. Periconceptional folic acid supplementation, maternal 25-hydroxyvitamin D, zinc and iron levels are partly associated with birth weight. No significant associations between COVID-19 vaccinations and birthweight are reported. A midwifery-led model based on early and extensive prenatal care reduces the risk of SGA births in women with low socio-economic status. Major preventive measures relate to the awareness of modifiable and non-modifiable risk factors of SGA, leading to changes in parents' lifestyles. These data support that education, monitoring during pregnancy, and implementing preventive strategies are as important as biological determinants in risk reduction of SGA births.
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Affiliation(s)
- Sebastian Wołejszo
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
- Correspondence: (S.W.); (A.G.)
| | - Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, 15-295 Bialystok, Poland
- Correspondence: (S.W.); (A.G.)
| | - Radosław Motkowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
| | | | - Mark Klukowski
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children′s Hospital, 15-274 Bialystok, Poland
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18
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Fernandes GM, Sasaki LMP, Jardim-Santos GP, Schulte HL, Motta F, da Silva ÂP, de Carvalho AO, Pereira YR, Alves CDO, de Araújo Júnior DA, Mendonça-Silva DL, Costa KN, de Castro MEC, Lauand L, Nery RDR, Tristão R, Kurizky PS, Nóbrega ODT, Espindola LS, de Castro LCG, Alpoim PN, Godoi LC, Dusse LMSA, Coelho-dos-Reis JGA, do Amaral LR, Gomes MDS, Bertarini PLL, Brito-de-Sousa JP, da Costa-Rocha IA, Campi-Azevedo AC, Peruhype-Magalhães V, Teixeira-Carvalho A, Zaconeta AM, Soares AADSM, Valim V, Gomes CM, de Albuquerque CP, Martins-Filho OA, da Mota LMH. Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study. Front Immunol 2023; 14:1176898. [PMID: 37122732 PMCID: PMC10130456 DOI: 10.3389/fimmu.2023.1176898] [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: 03/01/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction SARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators. Methods A sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array. Results In the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester. Discussion and conclusion From an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women.
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Affiliation(s)
- Geraldo Magela Fernandes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- *Correspondence: Geraldo Magela Fernandes, ; Olindo Assis Martins-Filho,
| | - Lizandra Moura Paravidine Sasaki
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Heidi Luise Schulte
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | - Felipe Motta
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | | | | | | | | | | | | | | | - Maria Eduarda Canellas de Castro
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | - Lucas Lauand
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Rosana Tristão
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | - Patricia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Laila Salmen Espindola
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | - Luiz Cláudio Gonçalves de Castro
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Lara Carvalho Godoi
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Laurence Rodrigues do Amaral
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Matheus de Souza Gomes
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Pedro Luiz Lima Bertarini
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | | | | | | | | | | | | | - Alexandre Anderson de Sousa Munhoz Soares
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | - Valéria Valim
- Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, Brazil
- Programa de Pós-Graduação em Saúde Coletiva (PPGSC), Centro de Ciências Médicas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília (UnB), Brasília, Brazil
| | - Cleandro Pires de Albuquerque
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | - Olindo Assis Martins-Filho
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Brazil
- *Correspondence: Geraldo Magela Fernandes, ; Olindo Assis Martins-Filho,
| | - Licia Maria Henrique da Mota
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília (UnB), Brasília, Brazil
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19
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Schwangerschaftsverlauf bei SARS-CoV-2-Infektion. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1902-8089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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20
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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: 0] [Impact Index Per Article: 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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