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Mahyuddin AP, Swa HLF, Weng R, Zhang J, Dhanaraj JP, Sesurajan BP, Rauff M, Dashraath P, Kanneganti A, Lee R, Wang LF, Young BE, Tambyah PA, Lye DC, Chai LYA, Yee S, Choolani M, Mattar CNZ. COVID-19 vaccination before or during pregnancy results in high, sustained maternal neutralizing activity to SARS-CoV-2 wild-type and Delta/Omicron variants of concern, particularly following a booster dose or infection. Int J Infect Dis 2024; 146:107121. [PMID: 38823622 DOI: 10.1016/j.ijid.2024.107121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVES To investigate multi-dose and timings of COVID-19 vaccines in preventing antenatal infection. DESIGN Prospective observational study investigating primary vaccinations, boosters, antenatal COVID-19 infections, neutralizing antibody (Nab) durability, and cross-reactivity to Delta and Omicron variants of concern (VOCs). RESULTS Ninety-eight patients completed primary vaccination prepregnancy (29.6%) and antenatally (63.3%), 24.2% of whom had antenatal COVID-19, while 7.1% were unvaccinated (28.6% had antenatal COVID-19). None had severe COVID-19. Prepregnancy vaccination resulted in vaccination-to-infection delay of 23.3 weeks, which extended to 45.2 weeks with a booster, compared to 16.9 weeks following antenatal vaccination (P < 0.001). Infections occurred at 26.2 weeks gestation in women vaccinated prepregnancy compared to 36.2 weeks gestation in those vaccinated during pregnancy (P < 0.007). The risk of COVID-19 infection was higher without antenatal vaccination (hazard ratio [HR] 14.6, P = 0.05) and after prepregnancy vaccination without a booster (HR 10.4, P = 0.002). Antenatal vaccinations initially led to high Nab levels, with mild waning but subsequent rebound. Significant Nab enhancement occurred with a third-trimester booster. Maternal-neonatal Nab transfer was efficient (transfer ratio >1), and cross-reactivity to VOCs was observed. CONCLUSION Completing vaccination during any trimester delays COVID-19 infection and maintains effective neutralizing activity throughout pregnancy, with robust cross-reactivity to VOCs and efficient maternal-neonatal transfer.
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Affiliation(s)
- Aniza P Mahyuddin
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hannah L F Swa
- Diagnostics Development Hub, Agency for Science, Technology and Research, Singapore, Singapore
| | - Ruifen Weng
- Diagnostics Development Hub, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jingxian Zhang
- Diagnostics Development Hub, Agency for Science, Technology and Research, Singapore, Singapore
| | - Janice P Dhanaraj
- Diagnostics Development Hub, Agency for Science, Technology and Research, Singapore, Singapore
| | - Binny P Sesurajan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mary Rauff
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, National University Health System, Singapore, Singapore
| | - Pradip Dashraath
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, National University Health System, Singapore, Singapore
| | - Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, National University Health System, Singapore, Singapore
| | - Rachel Lee
- Department of Obstetrics and Gynaecology, National University Hospital, National University Health System, Singapore, Singapore
| | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore; The Programme for Research in Epidemic Preparedness and Response (PREPARE), National Centre for Infectious Diseases, Singapore, Singapore
| | - Barnaby E Young
- The Programme for Research in Epidemic Preparedness and Response (PREPARE), National Centre for Infectious Diseases, Singapore, Singapore; National Centre for Infectious Diseases, Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Paul A Tambyah
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - David C Lye
- The Programme for Research in Epidemic Preparedness and Response (PREPARE), National Centre for Infectious Diseases, Singapore, Singapore; National Centre for Infectious Diseases, Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Louis Y A Chai
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Sidney Yee
- Innovation and Enterprise, Agency for Science, Technology and Research, Connexis North Tower, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, National University Health System, Singapore, Singapore
| | - Citra N Z Mattar
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, National University Health System, Singapore, Singapore.
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Marxer CA, Graber SM, Surbek D, Panchaud A, Meier CR, Spoendlin J. Dispensed drugs during pregnancy in outpatient care between 2015 and 2021 in Switzerland: a retrospective analysis of Swiss healthcare claims data. Swiss Med Wkly 2024; 154:3616. [PMID: 39154296 DOI: 10.57187/s.3616] [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: 08/19/2024] Open
Abstract
AIM OF THE STUDY We aimed to evaluate the utilisation of all prescribed drugs during pregnancy dispensed in outpatient care in Switzerland between 2015 and 2021. METHODS We conducted a descriptive study using the Swiss Helsana claims database (2015-2021). We established a cohort of pregnancies by identifying deliveries and estimating the date of the last menstrual period. We analysed the drug burden during a 270-day pre-pregnancy period, during pregnancy (overall and by trimester), and during a 270-day postpartum period. Subsequently, we quantified 1) the median number of drug dispensations (total vs. unique drug claims); and 2) the prevalence of exposure to at least one dispensed drug and the number of dispensed drugs (0, 1, 2, 3, 4, and ≥5); and 3) the 15 most frequently dispensed drugs were identified during each period, overall and stratified by maternal age. RESULTS Among 34,584 pregnant women (5.6% of all successful pregnancies in Switzerland), 87.5% claimed at least one drug (not including vitamins, supplements, and vaccines), and 33.3% claimed at least five drugs during pregnancy. During trimester 1 alone, 8.2% of women claimed at least five distinct drugs. The proportion of women who claimed prescribed drugs was lower pre-pregnancy (69.1%) and similar postpartum (85.6%) when compared to during pregnancy (87.5%). The most frequently claimed drugs during pregnancy were meaningfully different during pregnancy than before and after. CONCLUSIONS This study suggests that 8 of 10 women in Switzerland are exposed to prescribed drugs during pregnancy. Most drugs dispensed during pregnancy are comparatively well investigated and are considered safe. However, the high drug burden in this vulnerable patient population underlines the importance of evidence on the benefit-risk profile of individual drugs taken during pregnancy.
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Affiliation(s)
- Carole A Marxer
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Sereina M Graber
- Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynaecology, University Hospital, University of Bern, Bern, Switzerland
| | - 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
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital Lausanne, Lausanne, Switzerland
| | - Christoph R Meier
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Julia Spoendlin
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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Gou M, Li L, Wang X, Yuan P, Li S, Wei Y, Zhou G. Risk Perception and Maternal Prenatal Depressive Symptoms in the Early Stage of COVID-19 Pandemic in China: Role of Negative Emotions and Family Sense of Coherence. Matern Child Health J 2024:10.1007/s10995-024-03964-w. [PMID: 38856799 DOI: 10.1007/s10995-024-03964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Prenatal depression is associated with adverse health outcomes for both mothers and their children. The worldwide COVID-19 pandemic has presented new risks and challenges for expectant mothers. The aims of the study were to investigate the underlying mechanism between COVID-19 risk perception of Chinese pregnant women and their prenatal depressive symptoms and potential protective factors such as family sense of coherence (FSOC). METHOD A total of 181 Chinese pregnant women (Mage = 31.40 years, SD = 3.67, ranged from 23 to 43) participated in an online survey from April 22 to May 16, 2020. Risk perception and negative emotions (fear and anxiety) related with COVID-19, FSOC, and prenatal depressive symptoms were assessed. RESULTS The experience of maternal COVID-19 related negative emotion fully mediated the positive relationship between COVID-19 risk perception and prenatal depressive symptoms of pregnant women (β = 0.12, 95% CI [0.06, 0.19]). When confronting COVID-19 related fear and anxiety, expectant mothers from higher coherent families experienced a significantly lower level of prenatal depressive symptoms. CONCLUSIONS Contextual negative emotional experience was demonstrated to explain how risk perception impacts depressive symptoms during severe public health crisis for pregnant women. FSOC may be a psychological resource protecting pregnant women from experiencing adverse psychological outcomes during COVID-19 pandemic.
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Affiliation(s)
- Mengke Gou
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behaviour and Mental Health, Peking University, Beijing, 100871, China
| | - Luyao Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Hua yuan north Road, Hai Dian district, Beijing, China
| | - Xi Wang
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behaviour and Mental Health, Peking University, Beijing, 100871, China
| | - Pengbo Yuan
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Hua yuan north Road, Hai Dian district, Beijing, China
| | - Shuang Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Hua yuan north Road, Hai Dian district, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Hua yuan north Road, Hai Dian district, Beijing, China.
| | - Guangyu Zhou
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behaviour and Mental Health, Peking University, Beijing, 100871, China.
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Gibson A, Rand C, Olson-Chen C. Attitudes Toward COVID-19 Vaccination Among Pregnant Persons in Urban Hospital-Affiliated Practices: Exploring Themes in Vaccine Hesitancy. Matern Child Health J 2023; 27:1855-1863. [PMID: 37486448 DOI: 10.1007/s10995-023-03752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To explore beliefs and attitudes toward the COVID-19 vaccine among vaccinated and unvaccinated pregnant persons in order to identify reasons for both vaccine hesitancy and vaccine uptake. METHODS From June-August 2021, we conducted a qualitative study consisting of semi-structured interviews with pregnant persons (n = 30). Participants were recruited from university-owned obstetric practices during prenatal and ultrasound appointments. Interviews were audio recorded and transcribed; transcripts were coded and analyzed to identify themes and subthemes. RESULTS Of the participants, one-third (n = 10) had received the COVID-19 vaccine, while two-thirds (n = 20) were unvaccinated. Primary themes for unvaccinated participants were concern about the paucity of research on the vaccine in pregnancy and potential impact of the vaccine on both fetal development and maternal health. For vaccinated participants, main themes included potential maternal and fetal protection from COVID-19 and anticipated health complications from contracting COVID-19 as their motivations to get vaccinated. While most participants cited healthcare providers as the most trusted source of vaccine information, a majority reported that the internet was their primary source of vaccine information. Many participants wanted to learn more about the COVID-19 vaccine from their obstetric providers, and notably, most vaccinated participants reported the importance of their obstetrician in their vaccine decision-making process. CONCLUSIONS COVID-19 vaccine hesitancy is prevalent among pregnant persons, with concerns for vaccine safety for their fetus, as well as for themselves, being common. Obstetric providers must therefore be prepared to address common concerns with patients during prenatal appointments, taking the time to actively recommend vaccination.
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Affiliation(s)
- Anastasia Gibson
- School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY, USA.
| | - Cynthia Rand
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
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Favre G, Maisonneuve E, Pomar L, Daire C, Monod C, Martinez de Tejada B, Quibel T, Todesco-Bernasconi M, Sentilhes L, Blume C, Papadia A, Sturm S, Bassler D, Grawe C, Radan AP, Rossier MC, Mathis J, Capoccia-Brugger R, Lepigeon K, Gerbier E, Addor MC, Winterfeld U, Baud D, Panchaud A. Risk of congenital malformation after first trimester mRNA COVID-19 vaccine exposure in pregnancy: the COVI-PREG prospective cohort. Clin Microbiol Infect 2023; 29:1306-1312. [PMID: 37343619 PMCID: PMC10279463 DOI: 10.1016/j.cmi.2023.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES This study aimed to evaluate the risk of congenital malformation among pregnant women exposed to the mRNA COVID-19 vaccines during the first trimester of pregnancy, which is a developmental period where the foetus is at risk of teratogenicity. METHODS Pregnant women were prospectively enrolled from March 2021 to March 2022, at the time of COVID-19 vaccination. Pregnant women exposed to at least one dose of mRNA COVID-19 vaccine from conception to 11 weeks of gestations and 6 days were compared with pregnant women exposed to the vaccine from 12 weeks to the end of pregnancy. The primary outcome was a confirmed congenital malformation at birth. RESULTS A total of 1450 pregnant women were enrolled including 124 in the first trimester and 1326 in the second and third trimester. The overall proportion of congenital malformation was 0.81% (n = 1/124; 95% CI: 0.02-4.41) and 0.83% (n = 11/1326; 95% CI: 0.41-1.48) among pregnant exposed to the COVID-19 vaccine during the first and second/third trimester, respectively. First trimester exposure was not associated with a higher risk of congenital malformation with a relative risk of 0.89 (95% CI: 0.12-6.80) with no significant changes after adjustment through exploratory analysis. CONCLUSIONS Pregnant women exposed to mRNA COVID-19 vaccine before 12 weeks of gestation did not have an increased risk of congenital malformation compared with women exposed outside the teratogenic window. Because vaccination is safe and effective, emphasis must be placed on promoting vaccination during pregnancy.
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Affiliation(s)
- Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Emeline Maisonneuve
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Léo Pomar
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Charlotte Daire
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Cécile Monod
- Department of Obstetrics, Basel, University Hospital, Basel, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Division, Department of Pediatrics, Gynecology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Thibaud Quibel
- Department of Obstetrics, Maternité Poissy Saint Germain, Poissy, France
| | | | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Carolin Blume
- Kantonsspital Graubünden, Frauenklinik Fontana, Chur, Switzerland
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Dirk Bassler
- Neonatal Department, University Hospital Zürich, Zürich, Switzerland
| | - Claudia Grawe
- Department of Obstetrics, Gynecology Stadtspital Triemli Zürich, Zürich, Switzerland
| | - Anda Petronela Radan
- Department of Obstetrics and Feto-maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Marie-Claude Rossier
- Department of Obstetrics and Gynecology, Hospital Riviera Chablais, Rennaz, Switzerland
| | - Jérôme Mathis
- Department of Obstetrics and Gynecology, Centre Hospitalier Bienne, Bienne, Switzerland
| | | | - Karine Lepigeon
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Eva Gerbier
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Marie Claude Addor
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.
| | - 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
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Gonzalez VJ, Li L, Buarpung S, Prahl M, Robinson JF, Gaw SL. Minimal mRNA uptake and inflammatory response to COVID-19 mRNA vaccine exposure in human placental explants. iScience 2023; 26:107549. [PMID: 37664582 PMCID: PMC10470080 DOI: 10.1016/j.isci.2023.107549] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/15/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Despite universal recommendations for COVID-19 mRNA vaccination in pregnancy, uptake has been lower than desired. There have been limited studies of the direct impact of COVID-19 mRNA vaccine exposure in human placental tissue. Using a primary human placental explants model, we investigated the uptake of two common mRNA vaccines (BNT162b2 Pfizer-BioNTech or mRNA-1273 Moderna), and whether exposure altered villous cytokine responses. Explants derived from second or third trimester chorionic villi were incubated with vaccines at supraphysiologic concentrations and analyzed at two time points. We observed minimal uptake of mRNA vaccines in placental explants by in situ hybridization and quantitative RT-PCR. No specific or global cytokine response was elicited by either of the mRNA vaccines in multiplexed immunoassays. Our results suggest that the human placenta does not readily absorb the COVID-19 mRNA vaccines nor generate a significant inflammatory response after exposure.
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Affiliation(s)
- Veronica J. Gonzalez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Lin Li
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, USA
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sirirak Buarpung
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Mary Prahl
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94110, USA
| | - Joshua F. Robinson
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, USA
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
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Ashkir S, Abel T, Khaliq OP, Moodley J. COVID-19 vaccine hesitancy among pregnant women in an antenatal clinic in Durban, South Africa. S Afr J Infect Dis 2023; 38:516. [PMID: 37670934 PMCID: PMC10476234 DOI: 10.4102/sajid.v38i1.516] [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: 02/03/2023] [Accepted: 05/19/2023] [Indexed: 09/07/2023] Open
Abstract
Background Mass administration of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most efficient intervention against the coronavirus disease 2019 (COVID-19) pandemic. Recently, vaccinations were shown to be safe and effective during pregnancy. However, vaccination rates are low in low- and middle-income countries, and vaccine hesitancy is a major limiting factor. Objectives To investigate the rate of COVID-19 vaccine hesitancy among pregnant women. Method A cross-sectional questionnaire-based investigation of 313 unvaccinated pregnant women attending an antenatal clinic in Durban, South Africa (SA). The questionnaire included clinical and socio-demographic data, and reasons for vaccine hesitancy were recorded and evaluated. Results Of 313 women participating, 126 (40.3%) were vaccinated against COVID-19, 21/313 = 6.7%; for those unvaccinated, 21/187 (13.9%) were planning to be vaccinated. However, most unvaccinated women, 174 of 187 (93%), showed COVID-19 vaccine hesitancy. Conclusion The COVID-19 vaccination hesitancy among pregnant women in Durban, SA, is exceptionally high. This requires urgent attention by the relevant health authorities (both professional health organisations and the SA Department of Health) as many countries experience different waves of the variants of SARS-CoV-2 and herd immunity may not have been achieved. Contribution This study showed a high vaccine acceptance hesitancy rate among pregnant women in SA.
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Affiliation(s)
- Sahra Ashkir
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Tashlen Abel
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Olive P. Khaliq
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Jagidesa Moodley
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Maisonneuve E, de Bruin O, Favre G, Goncé A, Donati S, Engjom H, Hurley E, Al-Fadel N, Siiskonen S, Bloemenkamp K, Nordeng H, Sturkenboom M, Baud D, Panchaud A. Evolution of National Guidelines on Medicines Used to Treat COVID-19 in Pregnancy in 2020-2022: A Scoping Review. J Clin Med 2023; 12:4519. [PMID: 37445553 DOI: 10.3390/jcm12134519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The lack of inclusion of pregnant women in clinical trials evaluating the effectiveness of medicines to treat COVID-19 has made it difficult to establish evidence-based treatment guidelines for pregnant women. Our aim was to provide a review of the evolution and updates of the national guidelines on medicines used in pregnant women with COVID-19 published by the obstetrician and gynecologists' societies in thirteen countries in 2020-2022. Based on the results of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, the national societies successively recommended against prescribing hydroxychloroquine, lopinavir-ritonavir and azithromycin. Guidelines for remdesivir differed completely between countries, from compassionate or conditional use to recommendation against. Nirmatrelvir-ritonavir was authorized in Australia and the UK only in research settings and was no longer recommended in the UK at the end of 2022. After initial reluctance to use corticosteroids, the results of the RECOVERY trial have enabled the recommendation of dexamethasone in case of severe COVID-19 since mid-2020. Some societies recommended prescribing tocilizumab to pregnant patients with hypoxia and systemic inflammation from June 2021. Anti-SARS-CoV-2 monoclonal antibodies were authorized at the end of 2021 with conditional use in some countries, and then no longer recommended in Belgium and the USA at the end of 2022. The gradual convergence of the recommendations, although delayed compared to the general population, highlights the importance of the inclusion of pregnant women in clinical trials and of international collaboration to improve the pharmacological treatment of pregnant women with COVID-19.
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Affiliation(s)
- Emeline Maisonneuve
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, 3012 Bern, Switzerland
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Odette de Bruin
- Department of Obstetrics, WKZ Birthcentre, Division Woman and Baby, UMC Utrecht, 3584 CX Utrecht, The Netherlands
- Julius Global Health, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Anna Goncé
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Hilde Engjom
- Department of Health Promotion, Department of Health Registry Research and Development, Norwegian Institute of Public Health, N-5808 Bergen, Norway
| | - Eimir Hurley
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway
| | - Nouf Al-Fadel
- Saudi Food and Drug Authority, Riyadh 13513-7148, Saudi Arabia
| | - Satu Siiskonen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, WKZ Birthcentre, Division Woman and Baby, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway
| | - Miriam Sturkenboom
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
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9
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COVID-19 Vaccination during Pregnancy and Lactation: Attitudes and Uptakes before and after Official Recommendations in Germany. Vaccines (Basel) 2023; 11:vaccines11030627. [PMID: 36992211 DOI: 10.3390/vaccines11030627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Vaccination against COVID-19 is an effective measure to mitigate the pandemic. Pregnant and breastfeeding women were not included in registration studies, so official recommendations to vaccinate this vulnerable group appeared belated. Therefore, our aims were to evaluate vaccination uptake, reasons for and against vaccination, and the changes in these depending on the official national recommendations in Germany. Methods: An anonymous online cross-sectional survey among pregnant and breastfeeding women was conducted prior to and after the publication of the official vaccination recommendation. Results: Data from the convenience sample of 5411 participants (42.9% pregnant; 57% breastfeeding) were analysed. The recommendation was known to 95% of the participants. The information was obtained mainly autonomously (61.6%) and through the media (56.9%). Vaccination uptake increased in pregnant (2.4% before vs. 58.7% after) and breastfeeding women (13.7% vs. 74.7%). As reasons to get vaccinated, pregnant women indicated more fear of the infection than of the side effects of vaccination (52.0% before vs. 66.2% after), intended protection of the baby and oneself (36.0% vs. 62.9%), and limited information about vaccination (53.5% vs. 24.4%). Conclusion: The official national recommendation is widely known and mostly obtained autonomously, thereby showing a high level of awareness and a rise in vaccination uptake. Nonetheless, targeted education campaigns focusing on scientific evidence should be maintained, whereas the engagement of health professionals should be enhanced.
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10
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Gonzalez V, Li L, Buarpung S, Prahl M, Robinson JF, Gaw SL. Minimal mRNA uptake and inflammatory response to COVID-19 mRNA vaccine exposure in human placental explants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.01.23285349. [PMID: 36778281 PMCID: PMC9915836 DOI: 10.1101/2023.02.01.23285349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite universal recommendations for COVID-19 mRNA vaccination in pregnancy, uptake has been lower than desired. There have been limited studies of the direct impact of COVID-19 mRNA vaccine exposure in human placental tissue. Using a primary human villous explant model, we investigated the uptake of two common mRNA vaccines (BNT162b2 Pfizer-BioNTech or mRNA-1273 Moderna), and whether exposure altered villous cytokine responses. Explants derived from second or third trimester chorionic villi were incubated with vaccines at supraphysiologic concentrations and analyzed at two time points. We observed minimal uptake of mRNA vaccines in placental explants by in situ hybridization and quantitative RT-PCR. No specific or global cytokine response was elicited by either of the mRNA vaccines in multiplexed immunoassays. Our results suggest that the human placenta does not readily absorb the COVID-19 mRNA vaccines nor generate a significant inflammatory response after exposure.
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Affiliation(s)
- Veronica Gonzalez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94158, USA
- These authors contributed equally to this work
| | - Lin Li
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94158, USA
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94143, USA
- These authors contributed equally to this work
| | - Sirirak Buarpung
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94158, USA
| | - Mary Prahl
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, California 94110, USA
| | - Joshua F. Robinson
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94143, USA
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94158, USA
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California 94143, USA
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11
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Li M, Hao J, Jiang T, Deng W, Lu H, Wang S, Wan G, Xie Y, Yi W. Maternal and neonatal safety of COVID-19 vaccination during the peri-pregnancy period: A prospective study. J Med Virol 2023; 95:e28378. [PMID: 36478410 PMCID: PMC9878102 DOI: 10.1002/jmv.28378] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the safety of inactivated COVID-19 vaccine in Chinese pregnant women and their fetuses when inoculated during the peri-pregnancy period. METHODS Eligible pregnant women were prospectively collected and divided into a vaccine group (n = 93) and control group (n = 160) according to whether they had been vaccinated against COVID-19 within 3 months before their last menstruation period (LMP) and after pregnancy. Demographic data of couples, complications during pregnancy and delivery of pregnant women, and data of newborns at birth were collected. RESULTS Sixty-six women were vaccinated with a median time of 35.5 (range = 0-91) days before LMP, and 27 women were vaccinated with a median time of 17 (range = 1-72) days after LMP. The incidence of premature rupture of membrane (PROM) in the vaccine group was significantly higher than that in the control group (16.13% vs. 6.88%, p = 0.019). Multivariate logistic regression analysis revealed that maternal peri-pregnancy COVID-19 vaccination was not an independent risk factor for PROM (odds ratio: 2.407, 95% confidence interval: 0.932-6.216, p = 0.069). There was no difference in the incidence of other complications during pregnancy and delivery between the two groups. A total of 253 neonates were delivered, including two cases with congenital abnormalities in each group. The incidence of congenital abnormalities between the two groups was similar (2.15% vs. 1.25%, p = 0.626). There was no difference in neonatal length, weight, head circumference, and Apgar score between the two groups (p > 0.05), but the incidence of neonatal jaundice in the vaccine group was significantly higher than that in the control group (20.43% vs. 7.5%, p = 0.002). Multivariate logistic regression analysis revealed that maternal peri-pregnancy vaccination, postpartum blood loss, cesarean section, 1-min Apgar score, and paternal smoking were independent risk factors for neonatal jaundice. CONCLUSIONS It is safe for pregnant women and their fetuses to be inoculated the inactivated COVID-19 vaccine during the peri-pregnancy period, but attention should be paid to neonatal jaundice.
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Affiliation(s)
- Minghui Li
- Department of Hepatology Division 2Capital Medical UniversityBeijing Ditan HospitalBeijingChina,Department of Hepatology Division 2Peking University Ditan Teaching HospitalBeijingChina
| | - Jianzhen Hao
- Department of GynecologyMaternal and Children's Healthcare Hospital of Beijing Dongcheng DistrictBeijingChina
| | - Tingting Jiang
- Department of Hepatology Division 2Capital Medical UniversityBeijing Ditan HospitalBeijingChina
| | - Wen Deng
- Department of Hepatology Division 2Capital Medical UniversityBeijing Ditan HospitalBeijingChina
| | - Huihui Lu
- Department of Hepatology Division 2Capital Medical UniversityBeijing Ditan HospitalBeijingChina,Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shiyu Wang
- Department of Hepatology Division 2Capital Medical UniversityBeijing Ditan HospitalBeijingChina
| | - Gang Wan
- Department of Biostatistics, Beijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Yao Xie
- Department of Hepatology Division 2Capital Medical UniversityBeijing Ditan HospitalBeijingChina,Department of Hepatology Division 2Peking University Ditan Teaching HospitalBeijingChina
| | - Wei Yi
- Department of Gynecology and Obstetrics, Beijing Ditan HospitalCapital Medical UniversityBeijingChina
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12
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Moffat MA, Dessie AS, O’Leary K, Lumba R, Rhee DS. Short-term outcomes of infants born to mothers with SARS-CoV-2 infection. J Matern Fetal Neonatal Med 2022; 35:8192-8198. [PMID: 34470140 PMCID: PMC8425428 DOI: 10.1080/14767058.2021.1966412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/06/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The rate of transmission of SARS-CoV-2 from mothers to infants in the peri- and post-natal period remains an area of ongoing investigation. This study aims to determine rates of development of clinically significant COVID-19 disease within 1 month among infants born to symptomatic and asymptomatic SARS-CoV-2 positive mothers. MATERIALS AND METHODS This was a single-center, retrospective cohort study of all infants born to SARS-CoV-2 positive mothers who were admitted to the Well Baby Nursery (WBN) at New York University Langone Hospital-Brooklyn from 23 March-23 September 2020. Infants born to asymptomatic mothers were allowed to room-in, while infants born to mothers with symptoms of SARS-CoV-2 were isolated and discharged home to an alternate primary caregiver. A phone follow-up program contacted mothers at 2 weeks and 1 month post discharge to inquire about newborn symptoms, maternal symptoms, personal protective equipment (PPE) usage, and any presentations to care. Medical records were also reviewed for clinic and hospital visits to determine if exposed infants developed any symptoms following discharge. RESULTS Of 1903 deliveries during the study period, 131 mothers (21 symptomatic, 110 asymptomatic) tested positive for SARS-CoV-2 and had infants admitted to the WBN. 57 infants (21 born to symptomatic mothers, 36 born to asymptomatic mothers) were tested prior to discharge, and none were positive. 121 of 133 infants had at least 1 follow up call in the study period. Of these, 31 had symptoms potentially concerning for SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children, and 19 presented to medical care for these symptoms. 4 infants had SARS- CoV-2 testing after discharge, and none were positive. 2 infants were admitted to the hospital for fever but neither had a positive SARS-CoV-2 result. 65% of mothers reported always adhering to PPE recommendations. CONCLUSION Our results suggest that infants born both to symptomatic and asymptomatic mothers are unlikely to develop clinically significant COVID-19 disease in the peri- and post-natal periods.
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Affiliation(s)
- Michael A. Moffat
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Almaz S. Dessie
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Kathryn O’Leary
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Rishi Lumba
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - David S. Rhee
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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13
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Manca TA, Sadarangani M, Halperin SA, Langley JM, McClymont E, MacDonald SE, Top KA. Vaccine regulation should require and enforce the inclusion of pregnant and breastfeeding women in prelicensure clinical trials. Hum Vaccin Immunother 2022; 18:2104019. [PMID: 35880903 DOI: 10.1080/21645515.2022.2104019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Exclusion of pregnant and breastfeeding women from the pivotal randomized controlled trials for COVID-19 vaccines that led to emergency regulatory approval created gaps in data needed for vaccine policy, healthcare provider recommendations, and women's decisions about vaccination. We argue that such knowledge gaps increase potential for vaccine hesitancy and misinformation relating to the health of women and infants, and that these gaps in evidence are avoidable. Over several decades, ethical and scientific guidance, scholarship, and advocacy in favor of pregnant and breastfeeding women's participation in clinical development of vaccines has accumulated. Guidance on how to include pregnant and breastfeeding women in vaccine trials ethically and safely predates the COVID-19 pandemic but has yet to be routinely incorporated in vaccine development. We highlight the important role regulatory authorities could play in requiring that pregnant and breastfeeding women be eligible as volunteer participants in prelicensure vaccine trials for products that are expected to be used in this population. Inclusion of pregnant and breastfeeding populations in clinical trials leading to market approval or emergency use authorization should be undertaken early or concurrently at the time of trials in the general population.
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Affiliation(s)
- Terra A Manca
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada
| | - Elisabeth McClymont
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada.,School of Public health, University of Alberta, Edmonton, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
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14
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Marín-Cos A, Marbán-Castro E, Nedic I, Ferrari M, Crespo-Mirasol E, Ventura LF, Zamora BN, Fumadó V, Menéndez C, Martínez Bueno C, Llupià A, López M, Goncé A, Bardají A. "Maternal Vaccination Greatly Depends on Your Trust in the Healthcare System": A Qualitative Study on the Acceptability of Maternal Vaccines among Pregnant Women and Healthcare Workers in Barcelona, Spain. Vaccines (Basel) 2022; 10:vaccines10122015. [PMID: 36560425 PMCID: PMC9783547 DOI: 10.3390/vaccines10122015] [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: 10/20/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019. Health promotion and education have been seen to improve knowledge and uptake of vaccinations in pregnancy. This qualitative study was conducted based on phenomenology, a methodological approach to understand first-hand experiences, and grounded theory, an inductive approach to analyse data, where theoretical generalisations emerge. Data were collected through semi-structured interviews with pregnant women attending antenatal care services and healthcare workers (HCWs) in Barcelona, Spain. Interviews were audio-recorded, transcribed, and coded, and notes were taken. Inductive thematic analysis was performed, and data were manually coded. Pertussis was reported as the most trusted vaccine among pregnant women due to its long-standing background as a recommended vaccine in pregnancy. The influenza vaccine was regarded as less important since it was perceived to cause mild disease. The COVID-19 vaccine was the least trustworthy for pregnant women due to uncertainties about effectiveness, health effects in the mid- and long-term, the fast development of the vaccine mRNA technology, and the perceptions of limited data on vaccine safety. However, the necessity to be vaccinated was justified by pregnant women due to the exceptional circumstances of the COVID-19 pandemic. The recommendations provided by HCW and the established relationship between the HCW, particularly midwives, and pregnant women were the main factors affecting decision-making. The role of mass media was perceived as key to helping provide reliable messages about the need for vaccines during pregnancy. Overall, vaccines administered during pregnancy were perceived as great tools associated with better health and improved quality of life. Pregnancy was envisioned as a vulnerable period in women's lives that required risk-benefits assessments for decision-making about maternal vaccinations. A holistic approach involving the community and society was considered crucial for health education regarding maternal vaccines in support of the work conducted by HCWs.
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Affiliation(s)
- Anna Marín-Cos
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | | | - Ivana Nedic
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - Mara Ferrari
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - Esther Crespo-Mirasol
- BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Department of Maternal-Fetal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Laia Ferrer Ventura
- ASSIR Esquerra, Gerència Territorial de Barcelona, Institut Català de la Salut, 08015 Barcelona, Spain
| | - Berta Noya Zamora
- ASSIR Esquerra, Gerència Territorial de Barcelona, Institut Català de la Salut, 08015 Barcelona, Spain
| | - Victoria Fumadó
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Barcelona, Spain
| | - Cristina Martínez Bueno
- ASSIR Barcelona Ciutat, Gerència Territorial de Barcelona, Institut Català de la Salut i Universitat de Barcelona, 08007 Barcelona, Spain
| | - Anna Llupià
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Department of Preventive Medicine and Epidemiology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Marta López
- BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Department of Maternal-Fetal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Anna Goncé
- BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Department of Maternal-Fetal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Barcelona, Spain
- Correspondence:
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15
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Su X, Lu H, Li X, Luo M, Li F, Zhang Q. COVID-19 vaccine hesitancy in periconceptional and lactating women: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e059514. [PMID: 36343993 PMCID: PMC9644077 DOI: 10.1136/bmjopen-2021-059514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The pandemic of COVID-19 disease has caused severe impact globally. Governments consider vaccination as an effective measure to control pandemic. However, many people have been hesitant to receive COVID-19 vaccine, particularly periconceptional and lactating women. Although research has indicated that pregnant women with COVID-19 are at a higher risk of adverse pregnancy and birth outcomes, as well as severe illness. There appears to be a lack of systematic and comprehensive evidence of the prevalence and determinants of COVID-19 vaccine hesitancy among periconceptional and lactating women. As a result, it has been essential to investigate periconceptional and lactating women's vaccination views and behaviours. This study will review articles on vaccine hesitancy among periconceptional and lactating women to assess the impact of the COVID-19 vaccine hesitancy during the pandemic. METHODS AND ANALYSIS We will systematically search observational studies from 1 November 2019 to 30 October 2021 in the following databases: Web of Science, PubMed, EMBASE, MEDLINE, Cochrane Library, EBSCO, WHO COVID-19 Database, CNKI and WanFang Database. The following medical subject headings and free-text terms will be used: "COVID-19 vaccines" AND "female" AND "vaccine hesitancy". Eligibility criteria are as follows: population (women of reproductive age); exposure (currently pregnant, lactational or trying to get pregnant); comparison (general women who are not in preconception, gestation or lactation) and outcome (the rate of COVID-19 vaccine hesitancy). Article screening and data extraction will be undertaken independently by two reviewers, and any discrepancy will be resolved through discussion. We will use I2 statistics to assess heterogeneity and perform a meta-analysis when sufficiently homogeneous studies are provided. We will explore the potential sources of heterogeneity using subgroup and meta-regression analysis. ETHICS AND DISSEMINATION This study will use published data, so ethical approval is not required. The findings will be disseminated by publication in peer-reviewed journal(s). PROSPERO REGISTRATION NUMBER CRD42021257511.
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Affiliation(s)
- Xianzhi Su
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Hua Lu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Xinyun Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- Student Affairs Department, Sichuan University, Chengdu, People's Republic of China
| | - Mingli Luo
- Chengfei Community Healthcare Center, Genertec Medical Chengfei Hospital, Chengdu, People's Republic of China
| | - Fangyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qi Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
- The First Affiliated Hospital of Henan University of CM, Zhengzhou, People's Republic of China
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16
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Patxot M, Stojanov M, Ojavee SE, Gobert RP, Kutalik Z, Gavillet M, Baud D, Robinson MR. Haematological changes from conception to childbirth: An indicator of major pregnancy complications. Eur J Haematol 2022; 109:566-575. [PMID: 36059200 PMCID: PMC9825915 DOI: 10.1111/ejh.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND About 800 women die every day worldwide from pregnancy-related complications, including excessive blood loss, infections and high-blood pressure (World Health Organization, 2019). To improve screening for high-risk pregnancies, we set out to identify patterns of maternal hematological changes associated with future pregnancy complications. METHODS Using mixed effects models, we established changes in 14 complete blood count (CBC) parameters for 1710 healthy pregnancies and compared them to measurements from 98 pregnancy-induced hypertension, 106 gestational diabetes and 339 postpartum hemorrhage cases. RESULTS Results show interindividual variations, but good individual repeatability in CBC values during physiological pregnancies, allowing the identification of specific alterations in women with obstetric complications. For example, in women with uncomplicated pregnancies, haemoglobin count decreases of 0.12 g/L (95% CI -0.16, -0.09) significantly per gestation week (p value <.001). Interestingly, this decrease is three times more pronounced in women who will develop pregnancy-induced hypertension, with an additional decrease of 0.39 g/L (95% CI -0.51, -0.26). We also confirm that obstetric complications and white CBC predict the likelihood of giving birth earlier during pregnancy. CONCLUSION We provide a comprehensive description of the associations between haematological changes through pregnancy and three major obstetric complications to support strategies for prevention, early-diagnosis and maternal care.
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Affiliation(s)
- Marion Patxot
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland
| | - Miloš Stojanov
- Materno‐fetal and Obstetrics Research Unit, Department of Obstetrics and GynecologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Sven Erik Ojavee
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland
| | | | - Zoltán Kutalik
- Department of Computational BiologyUniversity of LausanneLausanneSwitzerland,Swiss Institute of BioinformaticsLausanneSwitzerland,Statistical GeneticsUniversity Center for Primary Care and Public HealthLausanneSwitzerland
| | - Mathilde Gavillet
- Service and Central Laboratory of Haematology, Department of Oncology and Department of Laboratories and PathologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - David Baud
- Materno‐fetal and Obstetrics Research Unit, Department of Obstetrics and GynecologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Matthew R. Robinson
- Medical GenomicsInstitute of Science and Technology AustriaKlosterneuburgAustria
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17
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Segal D, Arzi YI, Bez M, Cohen M, Rotschield J, Fink N, Karp E. Promoting Compliance to COVID-19 Vaccination in Military Units. Mil Med 2022; 187:e1389-e1395. [PMID: 33959759 PMCID: PMC8135994 DOI: 10.1093/milmed/usab183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND On December 27th, 2020, the Israeli Defense Forces initiated a mass COVID-19 vaccination campaign aiming to vaccinate its personnel. This population upheld specific characteristics in terms of age and sex, lack of significant comorbidities, and a general scarcity of risk factors for sustaining a severe COVID-19 illness. We present the measures taken to increase vaccination compliance, and the vaccination rate that followed these actions. Our secondary goal was to compare between vaccination rates in frontline battalions and highly essential military units (group A) and rear administration and support military units (group B). METHODS This was a retrospective review that included 70 military units that were composed of 18,719 individuals of both sexes, mostly free of significant comorbidities. We divided the challenges of maximizing vaccination rates into two main categories: vaccine compliance (including communication and information) and logistical challenges. We compared the vaccination rates in groups A and B using a multivariable linear regression model. A P-value of .05 was considered significant. RESULTS The mean age in 70 military units was 22.77 ± 1.35 (range 18-50) years, 71.13% males. A total of 726 (3.88%) individuals have been found positive for SARS-CoV-2 between March 1st, 2020 and February 18th, 2021. On February 18th, 2021, 54 days after the vaccination campaign was launched, 15,871 (84.79%) of the study population have been vaccinated by the first dose of Pfizer COVID-19 vaccine, expressing an 88.21% compliance rate (excluding recovered COVID-19 cases who were not prioritized to be vaccinated at this stage). Vaccination compliance in military units from group A was found to be higher when compared to group B (P < .001), leading to a 90.02% of group A population being either previously SARS-CoV-2 positive or COVID-19 vaccinated. CONCLUSIONS A designated army campaign led by a multidisciplinary team could rapidly achieve a high COVID-19 vaccination rate. The information presented can serve organizations worldwide with similar characteristics that plan a mass COVID-19 vaccination campaign.
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Affiliation(s)
- David Segal
- Israeli Defense Forces Medical Corps, Affiliated with the Hebrew University of Jerusalem, Tel Hashomer 526000, Israel
- The Department of Orthopedic Surgery, Meir Medical Center, Affiliated with the School of Medicine, Tel Aviv University, Kfar Saba 4435757, Israel
| | - Yonatan Ilibman Arzi
- Israeli Defense Forces Medical Corps, Affiliated with the Hebrew University of Jerusalem, Tel Hashomer 526000, Israel
| | - Maxim Bez
- Israeli Defense Forces Medical Corps, Affiliated with the Hebrew University of Jerusalem, Tel Hashomer 526000, Israel
| | - Matan Cohen
- Israeli Defense Forces Medical Corps, Affiliated with the Hebrew University of Jerusalem, Tel Hashomer 526000, Israel
| | - Jacob Rotschield
- Israeli Defense Forces Medical Corps, Affiliated with the Hebrew University of Jerusalem, Tel Hashomer 526000, Israel
| | - Noam Fink
- Israeli Defense Forces Medical Corps, Affiliated with the Hebrew University of Jerusalem, Tel Hashomer 526000, Israel
| | - Erez Karp
- Israeli Defense Forces Medical Corps, Affiliated with the Hebrew University of Jerusalem, Tel Hashomer 526000, Israel
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Mascolo A, di Mauro G, Fraenza F, Gaio M, Zinzi A, Pentella C, Rossi F, Capuano A, Sportiello L. Maternal, fetal and neonatal outcomes among pregnant women receiving COVID-19 vaccination: The preg-co-vax study. Front Immunol 2022; 13:965171. [PMID: 36263025 PMCID: PMC9574088 DOI: 10.3389/fimmu.2022.965171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAlthough the European Medicines Agency (EMA) encourage coronavirus disease 2019 (COVID-19) vaccination in pregnant women, the scientific evidence supporting the use of COVID-19 vaccines during pregnancy is still limited.AimWe aimed to investigate adverse events following immunization (AEFI) with COVID-19 vaccines during pregnancy.MethodsWe retrieved Individual Case Safety Reports (ICSRs) related to the use of COVID-19 vaccines during pregnancy from the EudraVigilance database for the year 2021. We analyzed AEFI related to the mother and fetus/newborn. The reporting odds ratio (ROR) was computed to compare the reporting probability of spontaneous abortion between COVID-19 vaccines.ResultsDuring the study period, among 1,315,315 ICSRs related to COVID-19 vaccines, we retrieved 3,252 (0.25%) reports related to the use in pregnancy. More than half (58.24%) of ICSRs were submitted by non-healthcare professionals. Although the majority (87.82%) of ICSRs concerned serious AEFI, their outcomes were mostly favorable. In this study, 85.0% of total ICSRs referred to pregnant women (n = 2,764), while 7.9% referred to fetuses/newborns (n = 258). We identified 16,569 AEFI. Moreover, 55.16% were AEFI not related to pregnancy (mostly headache, pyrexia, and fatigue), while 17.92% were pregnancy-, newborn-, or fetus-related AEFI. Among pregnancy-related AEFI, the most reported was spontaneous abortion. Messenger RNA (mRNA) vaccines had a lower reporting probability of spontaneous abortion than viral vector-based vaccines (ROR 0.80, 95% CI 0.69–0.93). Moderna and Oxford-AstraZeneca vaccines had a higher reporting probability of spontaneous abortion (ROR 1.2, 95% CI 1.05–1.38 and ROR 1.26, 95% CI 1.08–1.47, respectively), while a lower reporting probability was found for Pfizer-BioNTech vaccine compared with all other COVID-19 vaccines (ROR 0.73, 95% CI 0.64–0.84). In addition, 5.8% of ICSRs reported a fatal outcome.ConclusionsNo strong insight of unknown AEFI associated with COVID-19 vaccination in pregnant women was observed. Considering the high risk associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, our analysis suggests that the benefits of COVID-19 vaccines during pregnancy outweigh the possible risks. However, it is important to continue monitoring the safety profile of COVID-19 vaccines in this subpopulation.
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Affiliation(s)
- Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella di Mauro
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- UOC Pharmacy, AORN Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Federica Fraenza
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- *Correspondence: Federica Fraenza,
| | - Mario Gaio
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alessia Zinzi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ciro Pentella
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Monkeypox in pregnancy: virology, clinical presentation, and obstetric management. Am J Obstet Gynecol 2022; 227:849-861.e7. [PMID: 35985514 PMCID: PMC9534101 DOI: 10.1016/j.ajog.2022.08.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 01/26/2023]
Abstract
The 2022 monkeypox outbreak, caused by the zoonotic monkeypox virus, has spread across 6 World Health Organization regions (the Americas, Africa, Europe, Eastern Mediterranean, Western Pacific, and South-East Asia) and was declared a public health emergency of international concern on July 23, 2022. The global situation is especially concerning given the atypically high rate of person-to-person transmission, which suggests viral evolution to an established human pathogen. Pregnant women are at heightened risk of vertical transmission of the monkeypox virus because of immune vulnerability and natural depletion of population immunity to smallpox among reproductive-age women, and because orthopoxviral cell entry mechanisms can overcome the typically viral-resistant syncytiotrophoblast barrier within the placenta. Data on pregnancy outcomes following monkeypox infection are scarce but include reports of miscarriage, intrauterine demise, preterm birth, and congenital infection. This article forecasts the issues that maternity units might face and proposes guidelines to protect the health of pregnant women and fetuses exposed to the monkeypox virus. We review the pathophysiology and clinical features of monkeypox infection and discuss the obstetrical implications of the unusually high prevalence of anogenital lesions. We describe the use of real-time polymerase chain reaction tests from mucocutaneous and oropharyngeal sites to confirm infection, and share an algorithm for the antenatal management of pregnant women with monkeypox virus exposure. On the basis of the best available knowledge from prenatal orthopoxvirus infections, we discuss the sonographic features of congenital monkeypox and the role of invasive testing in establishing fetal infection. We suggest a protocol for cesarean delivery to avoid the horizontal transmission of the monkeypox virus at birth and address the controversy of mother-infant separation in the postpartum period. Obstetrical concerns related to antiviral therapy with tecovirimat and vaccinia immune globulin are highlighted, including the risks of heart rate-corrected QT-interval prolongation, inaccuracies in blood glucose monitoring, and the predisposition to iatrogenic venous thromboembolism. The possibility of monkeypox vaccine hesitancy during pregnancy is discussed, and strategies are offered to mitigate these risks. Finally, we conclude with a research proposal to address knowledge gaps related to the impact of monkeypox infection on maternal, fetal, and neonatal health.
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20
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COVID-19 mRNA vaccine in pregnancy: Results of the Swiss COVI-PREG registry, an observational prospective cohort study. Lancet Reg Health Eur 2022; 18:100410. [PMID: 35651954 PMCID: PMC9148537 DOI: 10.1016/j.lanepe.2022.100410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Pregnant individuals with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, prematurity, and stillbirth. In March 2021, vaccination for at risk pregnant women was recommended in Switzerland, expanding this to all pregnant women in May 2021. Our aim was to assess the safety of mRNA COVID-19 vaccines in pregnancy. Methods This multicentre prospective cohort study describes early adverse events and perinatal outcomes in pregnant women who received at least one dose of mRNA vaccine between March 1st and December 27th, 2021 in Switzerland, using the COVI-PREG registry. Early adverse events were collected at least one month following vaccine administration. Pregnancy and neonatal outcomes were extracted from medical records using the maternity discharge letters providing follow-up information up to 5 days after birth. Findings Of 1012 vaccinated women, 894 (88·3%) received both injections during pregnancy, with BNT162b2 (n = 271) or mRNA-1273 (n = 623) vaccines. Local events (mainly local pain) were reported in 81·3% and 80·5% after the first and second doses. Rates of systemic reactions (mainly fatigue and headache) were similar after the first dose and most frequent after the second dose of mRNA-1273. Of the 1012 women, four (0·4%; 95%CI [0·1-1·0]) severe early adverse events occurred: pulmonary embolism, preterm premature rupture of membranes, isolated fever with hospitalisation, and herpes zoster. Of 107 patients vaccinated before 14 weeks, one (0·9%; 95%CI [0·0-5·1]) early spontaneous abortions was reported (8 weeks). Of 228 vaccinated before 20 weeks one (0·4%; 95%CI [0·0-2·4]) late spontaneous abortion was reported (16 weeks). Of 513 women exposed before 37 weeks, 33 (6·4%; 95%CI [4·5-8·9]) delivered preterm. Among 530 patients exposed in pregnancy, no stillbirth was reported and 25 (4·7%; 95%CI [3·0-6·8]) neonates were admitted to intensive care unit. Interpretation Frequent local and systemic effects were described after exposure to mRNA COVID-19 vaccines during pregnancy but severe events were rare. Women vaccinated during pregnancy did not experience higher adverse pregnancy or neonatal outcomes when compared to historical data on background risks in the obstetric population. Funding This research was funded by a grant from the Swiss Federal Office of Public Health and the CHUV Foundation.
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21
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Taubman-Ben-Ari O, Weiss E, Abu-Sharkia S, Khalaf E. A comparison of COVID-19 vaccination status among pregnant Israeli Jewish and Arab women and psychological distress among the Arab women. Nurs Health Sci 2022; 24:360-367. [PMID: 35150201 PMCID: PMC9115497 DOI: 10.1111/nhs.12929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
The public debate surrounding the COVID-19 vaccine is especially intense regarding pregnant women, who are concerned with its effects on themselves and their fetus, and a vulnerable at-risk population for psychological distress. We aimed at describing differences in vaccination status between pregnant Jewish and Arab women and understanding factors contributing to psychological distress among Arab women. Pregnant women (n = 860) aged 19-46 completed self-report questionnaires during the national vaccination program (March-April 2021). The questionnaires related to background, COVID-19-related vaccination status and intentions in this regard, COVID-19-related anxiety, and the Mental Health Inventory-Short Form. Data were analyzed using descriptive statistics, t- and chi-square tests, Pearson correlations, and a hierarchical regression. Considerably fewer Jewish women had been infected and more were vaccinated than Arab women. Poorer health, lower economic status, being a mother, not being vaccinated, higher anxiety over economic damage, a family member being infected, delivery, and raising the baby contributed to higher distress. Findings offer novel insights for nurses in their efforts to encourage vaccination, highlighting the need to understand women's concerns during the vulnerable period of pregnancy.
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Affiliation(s)
- Orit Taubman-Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Efrat Weiss
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Salam Abu-Sharkia
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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22
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Nikpour M, Sepidarkish M, Omidvar S, Firouzbakht M. Global prevalence of acceptance of COVID-19 vaccines and associated factors in pregnant women: a systematic review and meta-analysis. Expert Rev Vaccines 2022; 21:843-851. [PMID: 35285374 DOI: 10.1080/14760584.2022.2053677] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pregnant women have a difficult choice about the COVID- 19 vaccination. We performed a systematic review and meta-analysis to evaluate the acceptance of a coronavirus disease 2019 (COVID-19) vaccine among pregnant women and its determinants. METHOD We searched the bibliographic databases (Scopus, Medline, and Web of Science) for the relevant studies from 1 January 2020 to 11 July 2021. We pooled the prevalence of vaccine acceptance among pregnant women using a random-effects model and conducted subgroup analyses to explore its determinants. The result was expressed as a prevalence percentage with 95% CIs. RESULTS We found ten studies that were suitable, with 16696 participants from 32 countries. COVID-19 vaccination acceptability in pregnant women was 54 percent globally (95 percent CI, 45 percent, 62 percent), with significant heterogeneity (I2= 99.05 percent, p <0.001). The pooled adjusted OR of COVID-19 vaccine acceptance in pregnant women with age >35 years, high education and income levels, and knowledge scores on COVID-19 infection were 1.17, 1.03, 1.18, and 2.55, respectively. CONCLUSION About half of pregnant women accepted the COVID-19 vaccine. A high knowledge score on COVID-19 infection had an effective role to increase this acceptance. To promote vaccine knowledge, appropriate planning should be done by the health policy-makers.
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Affiliation(s)
- Maryam Nikpour
- Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Shabnam Omidvar
- Department of Nursing- Midwifery, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Mojgan Firouzbakht
- Department of Nursing- Midwifery, Comprehensive Health Research Center, Babol Branch, Isalamic Azad University, Babol Iran
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23
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Casella C, Lo Giudice M, Niola M, DI Lorenzo P, Adamo M, Bianco C, Gragnano E, Saccone G, Guida M. Need for fair inclusion of pregnant women in clinical trials: scientific and ethical considerations about the lesson from the COVID-19 vaccines development. Minerva Obstet Gynecol 2022; 74:112-113. [PMID: 35196854 DOI: 10.23736/s2724-606x.21.04922-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Claudia Casella
- School of Medicine, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marco Lo Giudice
- School of Medicine, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Massimo Niola
- School of Medicine, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pierpaolo DI Lorenzo
- School of Medicine, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mauro Adamo
- School of Medicine, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Cristina Bianco
- Department of Law, University of Naples Federico II, Naples, Italy
| | - Elisabetta Gragnano
- School of Medicine, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy -
| | - Gabriele Saccone
- School of Medicine, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- School of Medicine, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Zhang Y, Wu G, Chen S, Ju X, Yimaer W, Zhang W, Lin S, Hao Y, Gu J, Li J. A review on COVID-19 transmission, epidemiological features, prevention and vaccination. MEDICAL REVIEW 2022; 2:23-49. [PMID: 35658107 PMCID: PMC9047653 DOI: 10.1515/mr-2021-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused hundreds of millions of infections and millions of deaths over past two years. Currently, many countries have still not been able to take the pandemic under control. In this review, we systematically summarized what we have done to mitigate the COVID-19 pandemic, from the perspectives of virus transmission, public health control measures, to the development and vaccination of COVID-19 vaccines. As a virus most likely coming from bats, the SARS-CoV-2 may transmit among people via airborne, faecal-oral, vertical or foodborne routes. Our meta-analysis suggested that the R0 of COVID-19 was 2.9 (95% CI: 2.7–3.1), and the estimates in Africa and Europe could be higher. The median Rt could decrease by 23–96% following the nonpharmacological interventions, including lockdown, isolation, social distance, and face mask, etc. Comprehensive intervention and lockdown were the most effective measures to control the pandemic. According to the pooled R0 in our meta-analysis, there should be at least 93.3% (95% CI: 89.9–96.2%) people being vaccinated around the world. Limited amount of vaccines and the inequity issues in vaccine allocation call for more international cooperation to achieve the anti-epidemic goals and vaccination fairness.
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Affiliation(s)
- Yuqin Zhang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Gonghua Wu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Shirui Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xu Ju
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | | | - Wangjian Zhang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Yuantao Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-Sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
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Repercussions of the COVID-19 pandemic on preventive health services in Brazil. Prev Med 2022; 155:106914. [PMID: 34953811 PMCID: PMC8716082 DOI: 10.1016/j.ypmed.2021.106914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/12/2021] [Accepted: 12/12/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The increasing burden of non-communicable diseases and limited public financing are major challenges facing health care systems in Latin America. Although COVID-19 severely impacted the Brazilian health care system, it is crucial to further characterize the degree of disruption caused to public health efforts, in order to address and manage long term effects of this pandemic. We therefore quantified the demand for preventive and treatment services from the Brazilian Unified Health System (Sistema Único de Saúde/SUS) in 2020 to evaluate potential repercussions of COVID-19 in this setting. METHODS Using the SUS database, we compared preventative and treatment services rendered in 2020 to the same services rendered from 2017 to 19. We also evaluated the frequency of respiratory infection (RI) diagnoses during the pandemic, relative to the preceding years. RESULTS Compared to 2017-19, in 2020 non-urgent medical appointments decreased 1.4-fold (p = 0.0017), dental consultations 2.8-fold (p = 0.05), and immunization coverage 1.5 fold (p = 0.0005). The number of RI visits to SUS ambulatory care units in 2020 was 4.2 times higher than in preceding years (p = 0.0014), with a peak of 280,898 diagnoses in July 2020. CONCLUSION The COVID-19 pandemic appears to have led to a dramatic decline in preventative and treatment services provided by SUS to the Brazilian population. Our findings may aid decision-makers in formulating policies to increase the availability of outpatient services in the aftermath of the pandemic. Counter measures will be critical to avoid a resurgence in vaccine-preventable diseases and complications stemming from non-communicable, chronic health conditions.
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Gerbier E, Graber SM, Rauch M, Marxer CA, Meier CR, Baud D, Winterfeld U, Blozik E, Surbek D, Spoendlin J, Panchaud A. Use of Prescribed Drugs to Treat Chronic Diseases during Pregnancy in Outpatient Care in Switzerland between 2014 and 2018: Descriptive Analysis of Swiss Health Care Claims Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1456. [PMID: 35162474 PMCID: PMC8835338 DOI: 10.3390/ijerph19031456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
Evidence on the use of drugs during pregnancy in Switzerland is lacking. We aimed to evaluate the utilisation of drugs to treat chronic diseases during pregnancy in Switzerland. We identified all pregnancies (excluding abortions) in Swiss Helsana claims data (2014-2018). In those, we identified all claims for drugs to treat a chronic disease, which typically affects women of childbearing age. Potentially teratogenic/fetotoxic drugs were evaluated during specific risk periods. Results were demographically weighted relative to the Swiss population. We identified claims for ≥1 drug of interest during 22% of 369,371 weighted pregnancies. Levothyroxine was most frequently claimed (6.6%). Antihypertensives were claimed during 5.3% (3.9% nifedipine in T3). Renin-Angiotensin-Aldosterone System (RAAS) inhibitors were dispensed to 0.3/10,000 pregnancies during trimester 2 (T2) or trimester 3 (T3). Insulin was claimed during 3.5% of pregnancies, most frequently in T3 (3.3%). Exposure to psychotropic drugs was 3.8% (mostly Selective serotonin reuptake inhibitors (SSRIs)) and to drugs for obstructive airway diseases 3.6%. Traditional immunosuppressants (excluding corticosteroids) were claimed during 0.5% (mainly azathioprine and hydroxychloroquine), biologic immunosuppressants (Tumour necrosis factor-alpha (TNF-alpha) inhibitors and interleukin inhibitors) during 0.2%, and drugs to treat multiple sclerosis during 0.09% of pregnancies. Antiretrovirals were claimed during 0.15% of pregnancies. Patterns of drug claims were in line with treatment recommendations, but relatively rare events of in utero exposure to teratogenic drugs may have had severe implications for those involved.
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Affiliation(s)
- Eva Gerbier
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Sereina M. Graber
- Department of Health Sciences, Helsana Insurance Group, 8001 Zurich, Switzerland; (S.M.G.); (E.B.)
| | - Marlene Rauch
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - Carole A. Marxer
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - Christoph R. Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department “Woman-Mother-Child”, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Ursula Winterfeld
- Swiss Teratogen Information Service and Clinical Pharmacology Service, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, 8001 Zurich, Switzerland; (S.M.G.); (E.B.)
- Institute of Primary Care, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynaecology, Bern University Hospital, Insel Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Julia Spoendlin
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland; (M.R.); (C.A.M.); (C.R.M.); (J.S.)
- Hospital Pharmacy, University Hospital Basel, 4056 Basel, Switzerland
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
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Pant P, Rani M, Aqib Khan M, Ahmad S, Maroof M, Awasthi S. Study of clinico- epidemiological profile of COVID-19 positive pregnant females in a tertiary care hospital of Kumaon region. J Family Med Prim Care 2022; 11:336-339. [PMID: 35309664 PMCID: PMC8930133 DOI: 10.4103/jfmpc.jfmpc_1762_21] [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: 09/03/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Pregnant females are considered as a high-risk group for the prevention and control of various communicable diseases. Therefore, this research was undertaken to study the clinic-epidemiological profile and biochemical parameters of COVID-19-positive pregnant females in a tertiary care hospital. Methods: This hospital-based retrospective study was done on COVID-19-positive pregnant females admitted during April 2020–March 2021. A total of 139 patients were included in the study. Clinical, epidemiological, hematological, and biochemical profiles were described using frequency, percentages, mean, standard deviation using Microsoft Excel software. Results: The mean age of study participants was 25.36 ± 3.79 years, mean duration of pregnancy was 37.53 ± 3.31 weeks. The majority of the patients were asymptomatic (89.2%). Abdominal pain was the most common symptom (66.7%) among symptomatic. All patients were managed conservatively. Conclusion: The study showed the mild nature of COVID-19 among pregnant females as the majority of them pregnant were asymptomatic and few presented with mild symptoms.
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The Potential of Mesenchymal Stem Cells for the Treatment of Cytokine Storm due to COVID-19. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3178796. [PMID: 34840969 PMCID: PMC8626179 DOI: 10.1155/2021/3178796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has seriously affected public health and social stability. The main route of the transmission is droplet transmission, where the oral cavity is the most important entry point to the body. Due to both the direct harmful effects of SARS-CoV-2 and disordered immune responses, some COVID-19 patients may progress to acute respiratory distress syndrome or even multiple organ failure. Genetic variants of SARS-CoV-2 have been emerging and circulating around the world. Currently, there is no internationally approved precise treatment for COVID-19. Mesenchymal stem cells (MSCs) can traffic and migrate towards the affected tissue, regulate both the innate and acquired immune systems, and participate in the process of healing. Here, we will discuss and investigate the mechanisms of immune disorder in COVID-19 and the therapeutic activity of MSCs, in particular human gingiva mesenchymal stem cells.
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Abstract
As the world clamored to respond to the rapidly evolving coronavirus 2019 (COVID-19) pandemic, health care systems reacted swiftly to provide uninterrupted care for patients. Within obstetrics and gynecology, nearly every facet of care was influenced. Rescheduling of office visits, safety of labor and delivery and in the operating room, and implementation of telemedicine are examples. Social distancing has impacted academic centers in the education of trainees. COVID-19 vaccine trials have increased awareness of including pregnant and lactating women. Last, the pandemic has reminded us of issues related to ethics, diversity and inclusiveness, marginalized communities, and the women's health workforce.
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Affiliation(s)
- Denisse S Holcomb
- Department of Obstetrics and Gynecology, University of Texas Southwestern Center, Dallas, TX, USA.
| | - William F Rayburn
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study. Am J Obstet Gynecol 2021; 225:522.e1-522.e11. [PMID: 34023315 PMCID: PMC8135190 DOI: 10.1016/j.ajog.2021.05.016] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Some studies have suggested that women with SARS-CoV-2 infection during pregnancy are at increased risk of adverse pregnancy and neonatal outcomes, but these associations are still not clear. OBJECTIVE This study aimed to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes. STUDY DESIGN This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between May 29, 2020, and January 31, 2021, in a national database of hospital admissions. Maternal and perinatal outcomes were compared between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks' gestation (stillbirth), preterm birth (<37 weeks' gestation), small for gestational age infant (small for gestational age; birthweight at the <tenth centile), preeclampsia or eclampsia, induction of labor, mode of birth, specialist neonatal care, composite neonatal adverse outcome indicator, maternal and neonatal length of hospital stay after birth (3 days or more), and 28-day neonatal and 42-day maternal hospital readmission. Adjusted odds ratios and their 95% confidence interval for the association between SARS-CoV-2 infection status and outcomes were calculated using logistic regression, adjusting for maternal age, ethnicity, parity, preexisting diabetes mellitus, preexisting hypertension, and socioeconomic deprivation measured using the Index of Multiple Deprivation 2019. Models were fitted with robust standard errors to account for hospital-level clustering. The analysis of the neonatal outcomes was repeated for those born at term (≥37 weeks' gestation) because preterm birth has been reported to be more common in pregnant women with SARS-CoV-2 infection. RESULTS The analysis included 342,080 women, of whom 3527 had laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 infection was more common in women who were younger, of non-White ethnicity, primiparous, or residing in the most deprived areas or had comorbidities. Fetal death (adjusted odds ratio, 2.21; 95% confidence interval, 1.58-3.11; P<.001) and preterm birth (adjusted odds ratio, 2.17; 95% confidence interval, 1.96-2.42; P<.001) occurred more frequently in women with SARS-CoV-2 infection than those without. The risk of preeclampsia or eclampsia (adjusted odds ratio, 1.55; 95% confidence interval, 1.29-1.85; P<.001), birth by emergency cesarean delivery (adjusted odds ratio, 1.63; 95% confidence interval, 1.51-1.76; P<.001), and prolonged admission after birth (adjusted odds ratio, 1.57; 95% confidence interval, 1.44-1.72; P<.001) were significantly higher for women with SARS-CoV-2 infection than those without. There were no significant differences (P>.05) in the rate of other maternal outcomes. The risk of neonatal adverse outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.27-1.66; P<.001), need for specialist neonatal care (adjusted odds ratio, 1.24; 95% confidence interval, 1.02-1.51; P=.03), and prolonged neonatal admission after birth (adjusted odds ratio, 1.61; 95% confidence interval, 1.49-1.75; P<.001) were all significantly higher for infants with mothers with laboratory-confirmed SARS-CoV-2 infection. When the analysis was restricted to pregnancies delivered at term (≥37 weeks), there were no significant differences in neonatal adverse outcome (P=.78), need for specialist neonatal care after birth (P=.22), or neonatal readmission within 4 weeks of birth (P=.05). Neonates born at term to mothers with laboratory-confirmed SARS-CoV-2 infection were more likely to have prolonged admission after birth (21.1% compared with 14.6%; adjusted odds ratio, 1.61; 95% confidence interval, 1.49-1.75; P<.001). CONCLUSION SARS-CoV-2 infection at the time of birth is associated with higher rates of fetal death, preterm birth, preeclampsia, and emergency cesarean delivery. There were no additional adverse neonatal outcomes, other than those related to preterm delivery. Pregnant women should be counseled regarding risks of SARS-CoV-2 infection and should be considered a priority for vaccination.
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Future vaccines in pregnancy. Best Pract Res Clin Obstet Gynaecol 2021; 76:96-106. [PMID: 33893037 PMCID: PMC7987580 DOI: 10.1016/j.bpobgyn.2021.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 01/04/2023]
Abstract
Vaccination in pregnancy provides an important opportunity to target illnesses that are known to impact pregnant women, fetal development, and newborns in particular. The ability to create antibodies through safe vaccination that cross the placenta can provide protection against maternal, congenital, and newborn infections. At present, multiple vaccines are being developed which have direct benefits for pregnant women and their newborns. Group B streptococcus, Respiratory Syncytial Virus, Cytomegalovirus, Zika, Ebola, Malaria, and Coronavirus SARS-CoV-2 are all being researched with the view to develop a safe vaccine available for pregnant women. There is also an increased movement towards the inclusion of pregnant women in vaccine development and trials - challenging the historical, ethical, and medicolegal arguments against their involvement in such research.
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Garg I, Shekhar R, Sheikh AB, Pal S. COVID-19 Vaccine in Pregnant and Lactating Women: A Review of Existing Evidence and Practice Guidelines. Infect Dis Rep 2021; 13:685-699. [PMID: 34449637 PMCID: PMC8395843 DOI: 10.3390/idr13030064] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 01/21/2023] Open
Abstract
Coronavirus 2019 (COVID-19) has created a global pandemic that is devastating human lives, public healthcare systems, and global economies. Multiple effective and safe COVID-19 vaccines have been developed at an unprecedented speed due to the efforts of the scientific community, and collaboration between the federal government and pharmaceutical companies. However, the continued exclusion of pregnant and lactating women from the COVID anti-viral and vaccine trials has created the paradox of a lack of empirical evidence in a high-risk population. Based on the experience of similar prior vaccines, animal developmental and reproductive toxicology studies, and preliminary findings from human studies, various healthcare professional advisory committees (Advisory Committee on Immunization Practices, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and Academy of Breastfeeding Medicine) have issued guidance supporting COVID-19 vaccination in pregnant and lactating women. In this article, we summarize the available data on the efficacy and safety profile of COVID-19 vaccination in pregnant and lactating women, review the challenges of vaccine hesitancy, and include recommendations for healthcare providers.
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Affiliation(s)
- Ishan Garg
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55902, USA;
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (R.S.); (A.B.S.)
| | - Abu B. Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (R.S.); (A.B.S.)
| | - Suman Pal
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA; (R.S.); (A.B.S.)
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Kumar R, Yeni CM, Utami NA, Masand R, Asrani RK, Patel SK, Kumar A, Yatoo MI, Tiwari R, Natesan S, Vora KS, Nainu F, Bilal M, Dhawan M, Emran TB, Ahmad T, Harapan H, Dhama K. SARS-CoV-2 infection during pregnancy and pregnancy-related conditions: Concerns, challenges, management and mitigation strategies-a narrative review. J Infect Public Health 2021; 14:863-875. [PMID: 34118736 PMCID: PMC8062420 DOI: 10.1016/j.jiph.2021.04.005] [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: 02/09/2021] [Revised: 04/10/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health problem. The SARS-CoV-2 triggers hyper-activation of inflammatory and immune responses resulting in cytokine storm and increased inflammatory responses on several organs like lungs, kidneys, intestine, and placenta. Although SARS-CoV-2 affects individuals of all age groups and physiological statuses, immune-compromised individuals such as pregnant women are considered as a highly vulnerable group. This review aims to raise the concerns of high risk of infection, morbidity and mortality of COVID-19 in pregnant women and provides critical reviews of pathophysiology and pathobiology of how SARS-CoV-2 infection potentially increases the severity and fatality during pregnancy. This article also provides a discussion of current evidence on vertical transmission of SARS-CoV-2 during pregnancy and breastfeeding. Lastly, guidelines on management, treatment, preventive, and mitigation strategies of SARS-CoV-2 infection during pregnancy and pregnancy-related conditions such as delivery and breastfeeding are discussed.
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Affiliation(s)
- Rakesh Kumar
- Department of Veterinary Pathology, Dr. G.C Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur, 176062, Himachal Pradesh, India.
| | - Cut Meurah Yeni
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, 23111, Banda Aceh, Indonesia; Department of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, 24415, Indonesia.
| | - Niken Asri Utami
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, 23111, Banda Aceh, Indonesia; Department of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, 24415, Indonesia.
| | - Rupali Masand
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
| | - Rajesh Kumar Asrani
- Department of Veterinary Pathology, Dr. G.C Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur, 176062, Himachal Pradesh, India.
| | - Shailesh Kumar Patel
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, Medanta Hospital, Gurgaon, 122001, India.
| | - Mohd Iqbal Yatoo
- Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, Alusteng Srinagar, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shalimar, Srinagar, 190006, Jammu and Kashmir, India.
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan (DUVASU), Mathura, 281001, India.
| | - Senthilkumar Natesan
- Indian Institute of Public Health Gandhinagar, Lekawada, Gandhinagar, Gujarat, 382042, India.
| | - Kranti Suresh Vora
- Indian Institute of Public Health Gandhinagar, Lekawada, Gandhinagar, Gujarat, 382042, India; Institute of Health Research, University of Canberra, ACT 2617, Australia.
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia.
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China.
| | - Manish Dhawan
- Department of Microbiology, Punjab Agricultural University, Ludhiana, 141004, India; The Trafford Group of Colleges, Manchester, WA14 5PQ, United Kingdom.
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
| | - Tauseef Ahmad
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China.
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia.
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
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Carbone L, Mappa I, Sirico A, Di Girolamo R, Saccone G, Di Mascio D, Donadono V, Cuomo L, Gabrielli O, Migliorini S, Luviso M, D'antonio F, Rizzo G, Maruotti GM. Pregnant women's perspectives on severe acute respiratory syndrome coronavirus 2 vaccine. Am J Obstet Gynecol MFM 2021; 3:100352. [PMID: 33771762 PMCID: PMC7985679 DOI: 10.1016/j.ajogmf.2021.100352] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since coronavirus disease 2019 vaccines have been distributed, a debate has raised on whether pregnant women should get the vaccine. No available data exist so far regarding the safety, efficacy, and toxicology of these vaccines when administered during pregnancy. Most of the Obstetrics and Gynecology societies suggested that pregnant could agree to be vaccinated, after a thorough counseling of risks and benefits with their gynecologists, thus leading to an autonomous decision. OBJECTIVE This study aimed to evaluate the attitude to coronavirus disease 2019 vaccination in pregnant and breastfeeding women in Italy. STUDY DESIGN A survey was made at the University of Naples Federico II and the Ospedale Cristo Re, Tor Vergata University of Rome, on pregnant and breastfeeding women asking their perspectives on the available vaccines after reading the recommendations issued by our national Obstetrics, Gynecology, and Neonatology societies. The questionnaire included 12 items finalized to evaluate general features of the women and 6 items specifically correlated to their attitudes toward the severe acute respiratory syndrome coronavirus 2 vaccination. Chi-square or Fisher's exact tests were used to compare group differences of categorical variables and Wilcoxon signed rank or Mann-Whitney U test for continuous variables. The study was approved by the institutional review boards of the University of Naples Federico II (ref. no. 409/2020) and the Ospedale Cristo Re, Tor Vergata University of Rome (ref. #Ost4-2020). RESULTS Most of the included women did not agree to eventually receive severe acute respiratory syndrome coronavirus 2 vaccine during pregnancy (40 [28.2%] vs 102 [71.8%]). Being pregnant was considered a determinant factor to refuse the vaccine prophylaxis (99 [69.7%] vs 43 [30.3%]; chi-square test=24.187; P<.001), even if a very large percentage declared to be generally in favor of vaccines (128 [90.1%] vs 14 [9.9%]; chi-square test=6.091; P=.014) and most of them confirmed they received or would receive other recommended vaccines during pregnancy (75 [52.8%] vs 67 [47.2%]; chi-square test=10.996; P=.001). CONCLUSION Urgent data are needed on the safety, efficacy, and toxicology of severe acute respiratory syndrome coronavirus 2 vaccines during pregnancy to modify this trend and to help obstetricians during the counseling. Furthermore, pregnant women should be included in future vaccine development trials to not incur again in such uncertainty.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti).
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Tor Vergata University of Rome, Rome, Italy (Drs Mappa, Luviso, and Prof Rizzo)
| | - Angelo Sirico
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti)
| | - Raffaella Di Girolamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti); Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr Di Girolamo and Prof D'antonio)
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti)
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Dr Di Mascio)
| | - Vera Donadono
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti)
| | - Lara Cuomo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti)
| | - Olimpia Gabrielli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti)
| | - Sonia Migliorini
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti)
| | - Maria Luviso
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Tor Vergata University of Rome, Rome, Italy (Drs Mappa, Luviso, and Prof Rizzo)
| | - Francesco D'antonio
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr Di Girolamo and Prof D'antonio)
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Tor Vergata University of Rome, Rome, Italy (Drs Mappa, Luviso, and Prof Rizzo); Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia (Prof Rizzo)
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs Carbone, Sirico, Di Girolamo, Saccone, Donadono, Cuomo, Gabrielli, Migliorini, and Prof Maruotti)
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Geoghegan S, Stephens LC, Feemster KA, Drew RJ, Eogan M, Butler KM. "This choice does not just affect me." Attitudes of pregnant women toward COVID-19 vaccines: a mixed-methods study. Hum Vaccin Immunother 2021; 17:3371-3376. [PMID: 34009096 DOI: 10.1080/21645515.2021.1924018] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Public health experts agree that pregnant women who fall into priority groups may be offered a Coronavirus Disease 2019 (COVID-19) vaccine. However, little is known about attitudes of pregnant women toward COVID-19 vaccination. We surveyed 300 pregnant women during the roll out of the Pfizer-BioNTech vaccine in Ireland. Women rated likelihood of receipt of a vaccine during pregnancy, on a 1-10 scale (1 = very unlikely, 10 = very likely). One hundred and thirteen (38%) women responded with a score of ≥8, while a similar proportion (36%) selected a score of ≤2. Safety of their unborn infant was the primary driver of decision making among survey participants, but specific safety concerns differed according to likely acceptance of a vaccine. Communication about COVID-19 vaccines to pregnant women must explicitly address safety. Pregnant women and their health-care providers should be supported with accessible interpretations of data so that they can make the best choice for their individual risk profile.
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Affiliation(s)
- Sarah Geoghegan
- School of Medicine, University College Dublin, Dublin, Ireland.,Division of Paediatric Infectious Diseases, Children's Health Ireland at Crumlin & Temple Street, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
| | - Laura C Stephens
- Department of Medicine, Mater Misericordiae Hospital, Dublin, Ireland
| | - Kristen A Feemster
- Division of Paediatric Infectious Diseases, Children's Health Ireland at Crumlin & Temple Street, Dublin, Ireland.,Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc, Upper Gwynedd, PA, USA
| | - Richard J Drew
- Clinical Innovation Unit, The Rotunda Hospital, Dublin, Ireland
| | - Maeve Eogan
- Division of Obstetrics & Gynaecology, The Rotunda Hospital, Dublin, Ireland
| | - Karina M Butler
- School of Medicine, University College Dublin, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
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Kalafat E, O'Brien P, Heath PT, Le Doare K, von Dadelszen P, Magee L, Ladhani S, Khalil A. Benefits and potential harms of COVID-19 vaccination during pregnancy: evidence summary for patient counseling. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:681-686. [PMID: 33734524 PMCID: PMC8250523 DOI: 10.1002/uog.23631] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 05/05/2023]
Affiliation(s)
- E. Kalafat
- Koc University, School of MedicineDepartment of Obstetrics and GynaecologyIstanbulTurkey
| | - P. O'Brien
- University College London Hospitals NHS Foundation TrustLondonUK
- The Royal College of Obstetricians and GynaecologistsLondonUK
| | - P. T. Heath
- Paediatric Infectious Diseases Research Group and Vaccine InstituteInstitute of Infection and Immunity, St George's University of LondonLondonUK
| | - K. Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine InstituteInstitute of Infection and Immunity, St George's University of LondonLondonUK
| | - P. von Dadelszen
- Department of Women and Children's HealthSchool of Life Course Sciences, King's College LondonLondonUK
| | - L. Magee
- Department of Women and Children's HealthSchool of Life Course Sciences, King's College LondonLondonUK
| | - S. Ladhani
- Immunisation and Countermeasures Division, Public HealthEnglandUK
- British Paediatric Surveillance UnitRoyal College of Paediatrics and Child HealthLondonUK
| | - A. Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation TrustUniversity of LondonLondonUK
- Vascular Biology Research CentreMolecular and Clinical Sciences Research Institute, St George's University of LondonLondonUK
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Practical Recommendations for the Management of Patients with ITP During the COVID-19 Pandemic. Mediterr J Hematol Infect Dis 2021; 13:e2021032. [PMID: 34007420 PMCID: PMC8114883 DOI: 10.4084/mjhid.2021.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/10/2021] [Indexed: 01/08/2023] Open
Abstract
The current COVID-19 pandemic requires revisiting our current approach to major blood disorders, including ITP (Immune Thrombocytopenia), stirring up the production of several disease-specific practical guidelines. This report describes an updated version of consensus-based practical guidelines on the management of ITP, adapted to the Italian health system and social context. It highlights the role of the hematologist in offering guidance for choosing differentiated approaches in relation to specific circumstances and is intended to provide them with a useful tool for sharing the decision-making process with their patients. Probably, the greatest risk to avoid for a patient with suspected, ongoing or relapsed ITP - that is not severe enough to place him or her at risk for major bleeding - is to be infected in non-hospital and hospital healthcare settings. This risk must be carefully considered when adapting the diagnostic and therapeutic approach. More in detail, the document first addresses the appropriate management for COVID-19 negative patients with newly diagnosed ITP or who experience a relapse of previous ITP, according to first and second lines of treatment and then the management of COVID-19 positive patients according to their severity, from paucisymptomatic to those requiring admission to Intensive Cure Units (ICU). The pros and cons of the different treatments required to correct platelet count are discussed, as are some specific situations, including chronic ITP, splenectomy, thromboembolic complication and anti COVID-19 vaccination.
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Wang EW, Parchem JG, Atmar RL, Clark EH. SARS-CoV-2 Vaccination During Pregnancy: A Complex Decision. Open Forum Infect Dis 2021; 8:ofab180. [PMID: 34056031 PMCID: PMC8083262 DOI: 10.1093/ofid/ofab180] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
As the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines passed UK and US regulatory milestones in late 2020 and early 2021, multiple professional societies offered recommendations to assist pregnant and breastfeeding people as they choose whether to undergo vaccination. Despite such guidance, the lack of data describing vaccine safety, immunogenicity, and efficacy in pregnant and breastfeeding people has made this decision challenging for many. However, even considering the paucity of data, the known risks of coronavirus disease 2019 during pregnancy likely outweigh the not yet fully elucidated risks of SARS-CoV-2 vaccines, which have reassuring safety and efficacy profiles among nonpregnant people.
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Affiliation(s)
- Elizabeth Wenqian Wang
- Department of Infectious Diseases, University of Maryland St. Joseph Medical Center, Towson, Maryland, USA
| | - Jacqueline G Parchem
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Robert L Atmar
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Eva H Clark
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Safety, and Effectiveness (IQuESt), Section of Health Services Research, Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Appropriateness for SARS-CoV-2 vaccination for otolaryngologist and head and neck surgeons in case of pregnancy, breastfeeding, or childbearing potential: Yo-IFOS and CEORL-HNS joint clinical consensus statement. Eur Arch Otorhinolaryngol 2021; 278:4091-4099. [PMID: 33855628 PMCID: PMC8046580 DOI: 10.1007/s00405-021-06794-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022]
Abstract
Purpose SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available. Methods A multidisciplinary international panel of 33 specialists judged statements through a two-round modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience. Results Of the 13 statements, 7 reached consensus or strong consensus, 2 reached no consensus, and 2 reached near-consensus. According to the statements with strong consensus otorhinolaryngologists—head and neck surgeons who are pregnant, breastfeeding, or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination. Conclusion Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06794-6.
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Manca TA, Graham JE, MacDonald NE, Top KA. Healthcare providers' interpretations of product labelling information developed through a consensus stakeholder approach. Vaccine 2021; 39:2652-2659. [PMID: 33849724 DOI: 10.1016/j.vaccine.2021.03.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 11/05/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The World Health Organization recommends immunization with inactivated influenza vaccine (IIV) and tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy. Yet, product labelling information for IIV and Tdap sends a different message. In a previous study, we developed evidence-based statements about vaccination in pregnancy that could be included in product information. This study compares healthcare providers' perceptions of the revised statements to those currently used in vaccine product labelling information. METHODS A 30-item online survey with qualitative and quantitative components was distributed to Canadian maternal healthcare providers via professional organizations and public health. Participants read excerpts from revised and existing IIV and Tdap product labelling information and answered questions about how they perceived the safety and effectiveness of the vaccines, whether they would recommend each vaccine during pregnancy, and which statements they preferred. RESULTS From June to August 2018, 449 healthcare providers completed the survey, including physicians (45%), nurses (24%), midwives (27%) and others (5%). Most participants perceived the vaccines to be safe and effective based on the revised statements. Over twice as many participants said they would recommend the IIV and Tdap vaccines in pregnancy based on the revised rather than the existing statements (64% versus 21% for IIV and 63% versus 27% for Tdap). Most participants selected that the revised statements better explained the risks and benefits of vaccination in pregnancy (65% versus 21% for IIV; 51% versus 27% for Tdap). Qualitative comments highlighted the strengths of the revised statements and areas for improvement. CONCLUSIONS The majority of participants demonstrated preferences for the revised IIV and Tdap product label statements over the existing statements. Comments suggested the revised statements include improvements to the evidence-base and readability. Involving stakeholders improved the development of product labelling information, but further improvement is needed to support the evidence-based use of vaccines in pregnancy.
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Affiliation(s)
- Terra A Manca
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, B3K 6R8 Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University IWK Health Centre, 5850 University Avenue, P. O. Box 9700, B3K 6R8 Halifax, Nova Scotia, Canada.
| | - Janice E Graham
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, B3K 6R8 Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University IWK Health Centre, 5850 University Avenue, P. O. Box 9700, B3K 6R8 Halifax, Nova Scotia, Canada.
| | - Noni E MacDonald
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, B3K 6R8 Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University IWK Health Centre, 5850 University Avenue, P. O. Box 9700, B3K 6R8 Halifax, Nova Scotia, Canada.
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, B3K 6R8 Halifax, Nova Scotia, Canada; Department of Pediatrics, Dalhousie University IWK Health Centre, 5850 University Avenue, P. O. Box 9700, B3K 6R8 Halifax, Nova Scotia, Canada.
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Fesler MC, Stricker RB. Pre-Exposure Prophylaxis for COVID-19 in Pregnant Women. Int J Gen Med 2021; 14:279-284. [PMID: 33542646 PMCID: PMC7851576 DOI: 10.2147/ijgm.s295627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Pregnant women are at higher risk for developing severe complications of COVID-19 including preterm delivery, respiratory failure, and death. Although vaccines to prevent COVID-19 are being developed, pregnant women are not included in the current COVID-19 vaccine trials and initially this population may not be eligible for COVID-19 vaccines due to lack of safety testing in pregnancy. As an alternate approach, we discuss the concept of pre-exposure prophylaxis (PrEP) using medications that are approved for use in pregnant women to prevent gestational problems and severe illness in this high-risk population. In particular, the use of hydroxychloroquine PrEP affords a safe and readily available means to avoid COVID-19 complications in pregnancy.
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Affiliation(s)
- Melissa C Fesler
- Alan E. Beer Medical Center for Reproductive Immunology, Los Gatos, CA, USA.,Union Square Medical Associates, San Francisco, CA, USA
| | - Raphael B Stricker
- Alan E. Beer Medical Center for Reproductive Immunology, Los Gatos, CA, USA.,Union Square Medical Associates, San Francisco, CA, USA
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