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Voina VC, Swain S, Kammili N, Mahalakshmi G, Muttineni R, Chander Bingi T, Kondapi AK. Effect of Early pregnancy associated protein-1 on Spike protein and ACE2 interactions: Implications in SARS Cov-2 vertical transmission. Placenta 2024; 152:39-52. [PMID: 38788480 DOI: 10.1016/j.placenta.2024.05.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/24/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Several factors influence transmission of 2019-nCoV from mother to fetus during pregnancy, thus the dynamics of vertical transmission is unclear. The role of cellular protective factors, namely a 90 KDa glycoprotein, Early pregnancy-associated protein (Epap-1), expressed by placental endothelial cells in women during early pregnancy would provide an insight into role of placental factors in virus transmission. Since viral spike protein binding to the ACE2 receptors of the host cells promotes virus invasion in placental tissue, an analysis of effects of Epap-1 on the Spike-ACE2 protein binding was studied. METHODS Epap-1 was isolated from MTP placental tissue. Molecular interaction of Epap-1 and variants of the spike was analyzed in silco. The interaction of Epap-1 with Spike and RBD were analyzed using ELISA and immunofluorescence studies. RESULTS The results in silico showed an interaction of Epap-1 with S-protein at RBD region involving K417, Y449, Y453, Y456, Y473, Q474, F486, Q498, N501 residues of spike with Y61, F287, I302, N303, N305, S334, N465, G467, N468 residues of Epap-1 leading to interference of S-protein and ACE2 interaction [1]. Further, the interaction is conserved among the variants. The studies in vitro confirm that Epap-1 affects S protein-ACE2 and RBD- ACE2 binding, thus suggesting that during early pregnancy, SARS CoV-2 infection may be protected by Epap-1 protein present in placental tissue. The results were further confirmed by pseudovirus expressing Spike and RBD in an infection assay. DISCUSSION Epap-1 interferes with Spike and RBD interaction with ACE2, suggesting a possible mechanism of the antiviral environment during pregnancy.
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Affiliation(s)
- Vidya Chitta Voina
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, 500046, India
| | - Sarita Swain
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, 500046, India
| | - Nagamani Kammili
- Department of Microbiology, Gandhi Medical College and Hospital, Secunderabad, India
| | - G Mahalakshmi
- Department of Obstetrics and Gynecology, Gandhi Medical College and Hospital, Secunderabad, India
| | | | - Thrilok Chander Bingi
- Department of General Medicine, Gandhi Medical College and Hospital, Secunderabad, India
| | - Anand K Kondapi
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, 500046, India.
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Gibson BL, Urbieta D, Sweeney S, Ferguson JA, Glaser D, Marter AY. Pre-Pandemic Versus Early COVID-19 Perinatal Outcomes at a Military Hospital. MCN Am J Matern Child Nurs 2024; 49:219-224. [PMID: 38926920 DOI: 10.1097/nmc.0000000000001023] [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: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to examine the impact of the first year of COVID-19 pandemic on maternal and neonatal outcomes at a large military treatment facility in Southern California. STUDY DESIGN AND METHODS A retrospective review of maternal and neonatal medical records was conducted between January 1, 2019, and December 31, 2020. Outcomes measured included stillbirth rate, neonatal intensive care unit admission, neonatal death, cesarean birth, and postpartum hemorrhage. RESULTS A total of 4,425 records were analyzed. Rates of stillbirth between the years did not vary. The neonatal death rate decreased more than 50% in 2020 (p = .149). Cesarean births rose by 2.7% in 2020 (p = .046). Rates of postpartum hemorrhage did not vary between years. CLINICAL IMPLICATIONS The impact of COVID-19 on maternal and neonatal outcomes at a military treatment facility in the first year of the COVID-19 pandemic provides guidance for optimizing perinatal health care. Vertical transmission of COVID-19 is low and routine testing of asymptomatic neonates of positive mothers may not be necessary. COVID-19 infections should not be an indication for cesarean birth and are not associated with neonatal deaths or NICU admission.
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Turdybekova YG, Kopobayeva IL, Kamyshanskiy YK, Turmukhambetova AA. Comparative clinical and placental pathologic characteristics in pregnancies with and without SARS-CoV-2 infection. J Perinat Med 2023; 51:1179-1188. [PMID: 37475693 DOI: 10.1515/jpm-2022-0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES To compare the clinical and morphological characteristics of the "mother-placenta-fetus" system in high risk pregnant women of three groups: no SARS-CoV-2 infection, mild SARS-CoV-2 infection, and severe SARS-CoV-2 infection. METHODS A case-control study was performed for all deliveries, at 28 weeks' gestation or greater, who had standard indications for placental pathologic examination. Three groups were formed: (1) control group (no SARS-CoV-2 infection), (2) mild SARS-CoV-2 infection, (3) severe SARS-CoV-2 infection. High-risk pregnancies were registered in all cases in the study groups. The examination of the placenta and the selection of fragments of placental tissue were carried out in accordance with the consensus recommendations of the Amsterdam Placental Workshop Group. The sections were subjected to standard processing and stained with hematoxylin and eosin according to the standard protocol. All cases were reviewed by two pathologists, which did not know any information on pregnancy outcome and clinical data. Statistical analysis was performed using SPSS, p<0.05 was considered statistically significant. RESULTS Women with severe SARS-CoV-2 infection had an increased rate of multimorbidity including diabetes, chronic hypertension and obesity (p<0.01) compared with the other groups. Placentas at severe COVID-19 course were damaged by both chronic and acute injuries, in comparison to the mild and control groups (p<0.001). Also an important finding in severe COVID-19 was diffuse necrosis of the villous trophoblast - homogenization, diffuse circular eosinophilic masses surrounding the chorionic villi. CONCLUSIONS Women with multimorbidity are an "at-risk" subgroup for severe SARS-CoV-2 infection and greater likelihood of both placental damage and perinatal hypoxic-ischemic events. These results suggest that patient education, SARS-CoV-2 disease monitoring and preventive measures would be of benefit to this group.
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Hantoushzadeh S, Saeednejad R, Shariat M, Moradi R. Pathological Examination of the Placenta in COVID-19-Positive Mothers: A Short Communication. IRANIAN JOURNAL OF PATHOLOGY 2023; 18:217-220. [PMID: 37600569 PMCID: PMC10439745 DOI: 10.30699/ijp.2023.551018.2860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/25/2023] [Indexed: 08/22/2023]
Abstract
Background & Objective It was declared that COVID-19 might be more severe in symptomatic pregnant patients. This study was conducted to examine the pathological indices of the placenta in pregnant women who were diagnosed with COVID-19. Methods A total of 20 COVID-19-positive mothers were enrolled in this study. Detailed placental pathology findings were compared between subjects based on the history of abortion or occurrence of preterm delivery, hypertension, and diabetes. Results and Conclusion Intervillositis was the most frequent abnormality of the placenta. There was also a significant association between abortion history and maternal vascular malperfusion (MVM; P=0.02). The placental abnormalities were found to be increased in women with COVID-19, regardless of maternal comorbidities. Further studies are needed to compare the placental pathology between COVID-19-positive women and healthy women.
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Affiliation(s)
- Sedigheh Hantoushzadeh
- Maternal, Fetal and Neonatal Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Saeednejad
- Maternal, Fetal and Neonatal Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Maternal, Fetal and Neonatal Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Raheleh Moradi
- Breastfeeding Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran
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Rajanna LB, Raina S, Bhatia R, Tripathi S, Bayad HC, Ranjan R, Srivastava A, Chahar OS. Gestational Mild COVID-19 Infection Associated Neonatal Hearing Loss: A Case-Control Study from North India. Indian J Otolaryngol Head Neck Surg 2023:1-6. [PMID: 37362118 PMCID: PMC10109224 DOI: 10.1007/s12070-023-03786-2] [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: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 06/28/2023] Open
Abstract
COVID-19 infection during pregnancy is potentially dangerous to neonatal hearing, as it is the period of organogenesis, and associated hyperthermia may cause vascular damage, disruption of cell migration, and death of the dividing neuroblasts. To investigate the possible association between neonatal hearing loss and gestational mild COVID-19 infection. A prospective case-control study was conducted at a tertiary healthcare centre in North India from March 2020 to Oct 2022. Cases included the neonates born to COVID-19-positive mothers were subjected to hearing screening at 1, 3 and 6 months using otoacoustic emission (OAE) and automated auditory brainstem response (AABR). Similar protocol was applied to controls, i.e., neonates borne to mothers with no gestational history of COVID infection. Results were analyzed statistically. Our study reported that the statistical difference between groups A (n = 942) and B (n = 942) for gestational COVID-19 infection and neonatal hearing loss was insignificant at 1 month (p-value 0.272 for OAE and p-value 0.634 for AABR) and also insignificant at 3 and 6 months (p-value 0.679 for AABR, for both). The association between gestational mild COVID-19 infection during gestation and neonatal hearing loss is statistically insignificant at initial screening as well as sequential screenings.
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Affiliation(s)
- Lohith Banavara Rajanna
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Sheetal Raina
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Ritika Bhatia
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Shailendra Tripathi
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Himanshu Chhagan Bayad
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Ranjeet Ranjan
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Anchita Srivastava
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
| | - Omvir Singh Chahar
- Department of ENT, Head and Neck Surgery, Command Hospital Central Command, Cariappa Road, Lucknow, Uttar Pradesh 226002 India
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Komine-Aizawa S, Yamada N, Haruyama Y, Deguchi M, Fukuda M, Kawana K, Kobashi G, Miyagi E, Yamada H, Sugiyama T, Hayakawa S. The Factors Influencing Pregnant Women's Selection of Media Sources to Obtain Information on COVID-19 in Japan in 2021. Vaccines (Basel) 2023; 11:vaccines11040805. [PMID: 37112717 PMCID: PMC10143418 DOI: 10.3390/vaccines11040805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Pregnant women presumably gather information about the coronavirus disease 2019 (COVID-19) from various sources. However, it is difficult for pregnant women who are not medical professionals to source the appropriate information because of the infodemic related to the COVID-19 pandemic. Therefore, the objective of our study was to investigate how pregnant women gathered information about COVID-19 and COVID-19 vaccination. To address this issue, we conducted an online questionnaire survey between 5 October and 22 November 2021, which was approved by the Ethics Committee of Nihon University School of Medicine. We received 4962 responses after excluding 1179 insufficient answers. Our study found that age, occupation, and infection-risk anxiety influenced the selection of media for obtaining information. Pregnant women who were older, medical professionals, public servants, or educators tended to rely on specialized medical websites, whereas housewives tended to use mass media, social media, and sources with uncertain scientific evidence. Additionally, the number of weeks of gestation and the method of conception (natural or assisted reproductive conception) affected the selection of media. The accessibility of COVID-19 information for pregnant women was determined by their social background and pregnancy status. We need to continue making efforts to ensure that appropriate information is readily available to pregnant women and their families.
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Affiliation(s)
- Shihoko Komine-Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Naotake Yamada
- Institute of Journalism and Media, Nihon University, Tokyo 101-8375, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Masashi Deguchi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Mitsuru Fukuda
- College of Risk Management, Nihon University, Tokyo 154-8513, Japan
| | - Kei Kawana
- Division of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama 236-0004, Japan
| | - Hideto Yamada
- Center for Recurrent Pregnancy Loss, Teine Keijinkai Hospital, Sapporo 006-8555, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon 791-0295, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
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Is intrauterine exposure to COVID-19 infection a risk factor for infant hearing loss? Am J Otolaryngol 2023; 44:103859. [PMID: 36989751 PMCID: PMC10032117 DOI: 10.1016/j.amjoto.2023.103859] [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: 02/15/2023] [Accepted: 03/19/2023] [Indexed: 03/24/2023]
Abstract
Purpose To determine whether exposure to intrauterine COVID-19 infection causes congenital or late-onset hearing loss in infants. Material and method The hearing screening results of infants born in a tertiary hospital between March 2020 and April 2022 with and without a history of intrauterine exposure to COVID-19 infection (36 infants each) were retrospectively analyzed within one month after birth in all infants and additionally at six months after intrauterine COVID-19 infection exposure in the study group. The automated auditory brainstem response (AABR) test was used for the hearing evaluation. Results The polymerase chain reaction test was negative in study group exposed to intrauterine COVID-19 infection. The number of infants admitted to the intensive care unit (ICU), and the length of ICU stay were significantly higher in this group (p < 0.01). Six infants (16.6 %) in the study group failed the first AABR test bilaterally, but five of these infants passed the second AABR test. A bilateral severe sensorineural hearing loss was detected in one infant (2.77 %). All the infants in the study group underwent the AABR test again at six months, and all infants, except this infant, passed the test. In the control group, five infants (13.88 %) failed the first AABR test bilaterally, but they all passed the second test. Conclusions Exposure to COVID-19 infection in the intrauterine period does not cause congenital or late-onset hearing loss (within six months) in infants; therefore, gestational COVID-19 infection is not a risk factor for infant hearing loss.
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De Luca D, Vauloup-Fellous C, Benachi A, Vivanti A. Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do? Semin Fetal Neonatal Med 2023; 28:101429. [PMID: 36935314 PMCID: PMC10010052 DOI: 10.1016/j.siny.2023.101429] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
SARS-CoV-2 can be vertically transmitted from the mother to the fetus and the neonate. This transmission route is rare compared to the environmental or horizontal spread and therefore, the risk can be deemed inconsequential by some medical providers. However, severe, although just as rare, feto-neonatal consequences are possible: fetal demise, severe/critical neonatal COVID-19 and multi-inflammatory syndrome (MIS-N) have been described. Therefore, it is important for the clinicians to know the mechanism of vertical transmission, how to recognize this, and how to deal with neonatal COVID-19 and MIS-N. Our knowledge about this field has significantly increased in the last three years. This is a summary of the pathophysiology, diagnostics, and therapeutics of vertical SARS-CoV-2 transmission that clinicians apply in their clinical practice.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
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Lalor JG, Sheaf G, Mulligan A, Ohaja M, Clive A, Murphy-Tighe S, Ng ED, Shorey S. Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review. Women Birth 2023; 36:e203-e212. [PMID: 35973917 PMCID: PMC9364727 DOI: 10.1016/j.wombi.2022.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic. METHODS A mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design. RESULTS Fifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services. CONCLUSIONS Parental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.
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Affiliation(s)
- Joan Gabrielle Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin 2, Ireland
| | - Andrea Mulligan
- School of Law, Trinity College Dublin, House 39, New Square, Dublin 2, Ireland
| | - Magdalena Ohaja
- School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Ashamole Clive
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland
| | | | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11,10 Medical Drive, 117597, Singapore.
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Asalkar MR, Thakkarwad SM, Bacchewad RP, Sharma NH. Perinatal Outcome in Maternal COVID-19 infection at a Tertiary care Institute- A cross Sectional Study. J Obstet Gynaecol India 2022; 73:123-131. [PMID: 36465798 PMCID: PMC9702842 DOI: 10.1007/s13224-022-01673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract COVID 19 pandemic is one of the biggest challenge to health system of developing as well as developed countries. Because of the novelty of the virus, limited data were available regarding perinatal outcome. The objective of this study is to find out the perinatal outcome in COVID-19 infected mothers who delivered during COVID Pandemic. Methodology A cross sectional study was carried out at PCMC'S Post-Graduate Institute and YCM Hospital Pune (Maharashtra) from 1 May 2020 to 31 October 2021 which was a dedicated COVID hospital during COVID pandemic. A total of 362 maternity patients (including 5 twin pregnancies) having COVID 19 infection who gave birth to 367 Newborns were studied. Maternal COVID -19 infection was diagnosed either by RTPCR test or Rapid Antigen test. Demographic variables, maternal symptoms, labour and neonatal outcome were recorded. RT PCR of neonates at birth was performed. Data was analyzed statistically by using Epi Info Software. Aim To analyze the perinatal outcome among COVID-19 infected mothers who delivered during Covid pandemic. Objectives Study was conducted with the primary objective to analyze the labour outcome, maternal symptoms and secondarily to study maternal demographic profile and to compare disease severity during 1st and 2nd wave of COVID and to detect possibility of vertical transmission of COVID-19 in neonates of covid positive mothers. Results 74.2% patients from young reproductive age (21-30 years age) were affected. All socioeconomic classes were affected. 61% patients were multigravida. Normal BMI was noted in 49.8%. 28.2% deliveries were preterm. Caesarean section rate was 50.5%. Following obstetric high risk factors were noted-anaemia in 34.2% followed by previous LSCS in 26.2% cases and preeclampsia in 18.7%Overall 54.6% patients were asymptomatic while 45.4% were symptomatic. Symptomatology between 1st and 2nd wave showed statistical significance (p value < .05%) for mild, moderate and severe symptoms. Myalgia, cough, fever and fatigue were common presenting symptoms. 14% patients required ICU/HDU care. HDU/ICU requirement showed statistical significance (p value < .05) between 1st and 2nd wave. Overall maternal mortality was 1.1% (4 maternal deaths in 2nd wave) with no mortality in 1st wave.96.4% were live births. Birth weight was more than 2.5 kg in 62% cases and 21.3% cases required NICU. Vertical transmission of COVID was seen in 1.1% cases. Conclusion Pregnant patients with moderate and severe disease are at higher risk of perinatal complications. ICU/HDU management with multidisciplinary management may reduce morbidity and mortality. Neonatal affection due to COVID may not be severe but may increase prematurity due to iatrogenic intervention.
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Affiliation(s)
- M. R. Asalkar
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
| | - S. M. Thakkarwad
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
| | - R. P. Bacchewad
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
| | - N. H. Sharma
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
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The Impact of Coronavirus Disease 2019 on Maternal and Fetal Wellbeing in New Mexico. Diagnostics (Basel) 2022; 12:diagnostics12112856. [PMID: 36428914 PMCID: PMC9689040 DOI: 10.3390/diagnostics12112856] [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: 10/27/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been shown to affect the vasculature, including placental changes. Insults to the placenta, especially in the first and second trimester, can affect placental functionality with a resultant impact on fetal growth and wellbeing. Thus, we explored the relationship between antenatally acquired maternal COVID-19 infection and neonatal birth characteristics. A retrospective chart review was completed using the University of New Mexico electronic medical record system. ICD-10 codes were used to identify individuals that had a positive pregnancy test and positive COVID-19 screening test between 1 March 2020 to 24 March 2021. Chi-square and nonparametric Wilcoxon analyses were used, with p < 0.05 considered significant. A total of 487 dyad charts was analyzed, with 76 (16%) individuals identified as being COVID-19-positive (CovPos) during pregnancy. CovPos mothers were significantly more likely to deliver via a cesarean section compared to CovNeg mothers (33% vs. 20%, p < 0.01). There was a significant difference in gestational age at delivery, with infants born to CovPos individuals born at an earlier gestational age than those born to CovNeg individuals (37.6 vs. 38.5 weeks; p < 0.01). Our findings showed differences in maternal and infant characteristics following COVID-19 infection during pregnancy. Additional investigations are required to further delineate these relationships with a focus on potential long-term impacts on the neonate.
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Al-Kuraishy HM, Al-Gareeb AI, Albezrah NKA, Bahaa HA, El-Bouseary MM, Alexiou A, Al-Ziyadi SH, Batiha GES. Pregnancy and COVID-19: high or low risk of vertical transmission. Clin Exp Med 2022:10.1007/s10238-022-00907-z. [PMID: 36251144 PMCID: PMC9574177 DOI: 10.1007/s10238-022-00907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
Coronavirus disease 19 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). Throughout the pandemic, evidence on the effects of COVID-19 during pregnancy has been inadequate due to the limited number of studies published. Therefore, the objective of this systematic review was to evaluate current literature regarding the effects of COVID-19 during pregnancy and establish pregnancy outcomes and vertical and perinatal transmission during pregnancy. Multiple databases were searched, including Embase, Medline, Web of Science, Scopus, and Cochrane Central Register of Control Clinical Trials, using the following keywords: [Pregnancy] AND [COVID-19 OR SARS-CoV-2 OR nCoV-19] OR [Perinatal transmission, Vertical transmission (VT), Pregnancy complications], [Pregnancy] AND [Hyperinflammation OR Cytokine storm]. We excluded in vitro and experimental studies, but also ex-vivo and animal study methods. To exclude the risk of bias during data collection and interpretation, all included studies were peer-reviewed publications. This review is estimated to tabulate the study intervention characteristics and compare them against the planned groups for each synthesis. Our findings showed that pregnant women are commonly susceptible to respiratory viral infections and severe pneumonia due to physiological immune suppression and pregnancy-induced changes. VT of SARS-CoV-2 infection during pregnancy is associated with a great deal of controversy and conflict. However, there is still no robust clinical evidence of VT. Furthermore, the clinical presentation and management of COVID-19 during pregnancy are nearly identical to those of non-pregnant women. Finally, chloroquine and remdesivir are the only two drugs evaluated as adequate for the management of COVID-19 during pregnancy.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | | | - Haitham Ahmed Bahaa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Maisra M El-Bouseary
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
| | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, Australia.,AFNP Med Austria, Vienna, Austria
| | - Shatha Hallal Al-Ziyadi
- Saudi Board Certified in Obstetrics & Gynecology, Assistant Professor at Taif University, Taif, Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, AlBeheira, Egypt.
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Ahmad SN, Sameen D, Dar MA, Jallu R, Shora TN, Dhingra M. Do SARS-CoV-2-Infected Pregnant Women Have Adverse Pregnancy Outcomes as Compared to Non-Infected Pregnant Women? Int J Womens Health 2022; 14:1201-1210. [PMID: 36081450 PMCID: PMC9447998 DOI: 10.2147/ijwh.s375739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/25/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose To determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies. Patients and Methods A retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups. Results Our hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46–3.34; p<0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72–30.77; p<0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65–203.5; p<0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99–27.23; p<0.001]. Conclusion Significant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.
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Affiliation(s)
- Syed Nawaz Ahmad
- Department of Obstetrics and Gynecology, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Duri Sameen
- Department of Obstetrics and Gynecology, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Mansoor Ahmad Dar
- Department of Psychiatry, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
- Correspondence: Mansoor Ahmad Dar, Department of Psychiatry, Government Medical College, Anantnag, Jammu and Kashmir, Tel +919596010111, Email
| | - Romaan Jallu
- Department of Microbiology, Government Medical College Srinagar, Srinagar, Jammu and Kashmir, India
- Romaan Jallu, Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, 190010, India, Tel +916006888061, Email
| | - Tajali Nazir Shora
- Department of Community Medicine, Government Medical College Anantnag, Anantnag, Jammu and Kashmir, India
| | - Mansi Dhingra
- Department of Obstetrics and Gynecology, Vaga Hospital, Lucknow, India
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14
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Słodki M, Respondek-Liberska M. Fetal echocardiography: One of the most important tools in fetal diagnosis and assessing wellbeing. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:636-638. [PMID: 35674056 DOI: 10.1002/jcu.23216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Maciej Słodki
- Faculty of Health Sciences, The Mazovian State University, Plock, Poland
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Diagnosis and Prevention of Fetal Malformations, Medical University of Lodz, Lodz, Poland
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15
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Al-Hussaini TK, EzzEldin AM, Shaaban OM, Abdel-Aleem MA, Kamal DT, Ibrahim MN. The rate of SARS-CoV-2 among asymptomatic non-immunised low-risk parturient women between the two waves. J OBSTET GYNAECOL 2022; 42:1868-1873. [PMID: 35484953 DOI: 10.1080/01443615.2022.2049720] [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]
Abstract
This study was conducted to evaluate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and immunity among asymptomatic non-immunised low-risk parturient women and their newborns. A cross-sectional study conducted in a tertiary hospital during the nadir period of new cases in Egypt. All asymptomatic pregnant, low risk and non-immunised women were included. All eligible participants had been subjected to SARS-CoV-2 nasopharyngeal swabs according to CDC and sampling of maternal and umbilical blood to evaluate the presence of coronavirus disease 2019 (COVID-19) IgM and IgG antibodies by immunochromatographic assay. Two cases out of 171 (1.2%) parturient women were tested positive for PCR swab to COVID-19 infection. Furthermore, COVID-19 IgG and IgM antibodies testing showed that 67.8% of women were negative for both IgG and IGM, 24.6% were positive for IgG only, 4.1% were positive for IgM only, while 3.5% were positive for both IgG and IgM. Regarding neonatal testing for immunity, 28.1% of the neonates were positive to IgG only and none for IgM.The rate of positive PCR patients among asymptomatic low-risk parturient women was 1.2%. About quarter of women had got herd immunity as evident by positive IgG antibodies. IgG antibodies transferred to the neonates in almost all cases.Impact StatementWhat is already known on this subject? Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global public health emergency. Asymptomatic pregnant women with coronavirus disease can transmit their infection to their newborn, family members and the health care providers.What do the results of this study add? The study showed very low (1.2%) prevalence of COVID positive cases among asymptomatic pregnant women admitted to our facility. Only two cases out of 171 parturient women tested PCR positive for COVID-19 infection (1.2%). SARS-Cov-2 IgG and IgM antibodies testing showed, about a quarter (24.6%) were positive for IgG antibodies, 4.1% were positive for IgM antibodies, while 3.5% were positive for both IgG and IgM. On the other hand, 28.1% of the neonates were positive to IgG only and none of the newborns had had IgM antibodies in their cord blood.What are the implications of these findings for clinical practice and/or further research? The first wave of COVID-19 pandemic in Egypt left behind at least a quarter of pregnant women with a positive antibody denoting some immunity. This immunity is usually transmitted to the neonates in almost all cases.
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Affiliation(s)
| | - Azza M EzzEldin
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omar M Shaaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mahmoud A Abdel-Aleem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dalia Tarik Kamal
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa N Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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16
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Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) including Variant Analysis by Mass Spectrometry in Placental Tissue. Viruses 2022; 14:v14030604. [PMID: 35337011 PMCID: PMC8953811 DOI: 10.3390/v14030604] [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: 02/12/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Among neonates, tested positive for SARS-CoV-2, the majority of infections occur through postpartum transmission. Only few reports describe intrauterine or intrapartum SARS-CoV-2 infections in newborns. To understand the route of transmission, detection of the virus or virus nucleic acid in the placenta and amniotic tissue are of special interest. Current methods to detect SARS-CoV-2 in placental tissue are immunohistochemistry, electron microscopy, in-situ hybridization, polymerase chain reaction (PCR) and next-generation sequencing. Recently, we described an alternative method for the detection of viral ribonucleic acid (RNA), by combination of reverse transcriptase-PCR and mass spectrometry (MS) in oropharyngeal and oral swabs. In this report, we could detect SARS-CoV-2 in formal-fixed and paraffin-embedded (FFPE) placental and amniotic tissue by multiplex RT-PCR MS. Additionally, we could identify the British variant (B.1.1.7) of the virus in this tissue by the same methodology. Combination of RT-PCR with MS is a fast and easy method to detect SARS-CoV-2 viral RNA, including specific variants in FFPE tissue.
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17
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Akbarialiabad H, Shidhaye R, Shidhaye P, Cuijpers P, Weaver MR, Bahrololoom M, Kiburi S, Njuguna IN, Taghrir MH, Kumar M. Impact of major disease outbreaks in the third millennium on adolescent and youth sexual and reproductive health and rights in low and/or middle-income countries: a systematic scoping review protocol. BMJ Open 2022; 12:e051216. [PMID: 35277399 PMCID: PMC8919461 DOI: 10.1136/bmjopen-2021-051216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sexual and Reproductive Health and Rights (SRHR) of young people continue to present a high burden and remain underinvested. This is more so in low and middle-income countries (LMICs), where empirical evidence reveals disruption of SRHR maintenance, need for enhancement of programmes, resources and services during pandemics. Despite the importance of the subject, there is no published review yet combining recent disease outbreaks such as (H1N1/09, Zika, Ebola and SARS-COV-2) to assess their impact on adolescents and youth SRHR in LMICs. METHODS AND ANALYSIS We will adopt a four-step search to reach the maximum possible number of studies. In the first step, we will carry out a limitedpreliminary search in databases for getting relevant keywords (appendix 1). Second, we will search in four databases: Pubmed, Cochrane Library, Embase and PsycINFO. The search would begin from the inception of the first major outbreak in 2009 (H1N1/09) up to the date of publication of the protocol in early 2022. We will search databases using related keywords, screen title & abstract and review full texts of the selected titles to arrive at the list of eligible studies. In the third stage, we will check their eligibility to the included article's reference list. In the fourth stage, we will check the citations of included papers in phase 2 to complete our study selection. We will include all types of original studies and without any language restriction in our final synthesis. Our review results will be charted for each pandemic separately and include details pertaining to authors, year, country, region of the study, study design, participants (disaggregated by age and gender), purpose and report associated SRHR outcomes. The review will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR). PATIENT AND PUBLIC INVOLVEMENT Patients or public were not involved in this study. ETHICS AND DISSEMINATION Ethical assessment is not required for this study. The results of the study will be presented in peer-reviewed publications and conferences on adolescent SRHR.
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Affiliation(s)
- Hossein Akbarialiabad
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Pallavi Shidhaye
- Division of Clinical Sciences, ICMR-National AIDS Research Institute, Pune, India
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, VU University Amsterdam, Amsterdam, Netherlands
| | - Marcia R Weaver
- Departments of Health Metrics Sciences and Global Health, University of Washington, Seattle, Washington, USA
| | - Mina Bahrololoom
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sarah Kiburi
- Department of Psychiatry, Mbagathi Hospital, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Irene N Njuguna
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Mohammad Hossein Taghrir
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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18
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Ghiselli S, Laborai A, Biasucci G, Carvelli M, Salsi D, Cuda D. Auditory evaluation of infants born to COVID19 positive mothers. Am J Otolaryngol 2022; 43:103379. [PMID: 35144104 PMCID: PMC8816906 DOI: 10.1016/j.amjoto.2022.103379] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/29/2021] [Accepted: 01/30/2022] [Indexed: 12/11/2022]
Abstract
COVID-19 infection can cause a wide spectrum of symptoms. The audio-vestibular system can also be involved, but there is still debate about this so findings need to be considered carefully. Furthermore, mother to fetus intrauterine transmission of COVID-19 infection in pregnant women is controversial. Few studies are available about the audio-vestibular symptomatology of newborns with intrauterine COVID19 exposure. Objectives This study investigates the possible correlation between the COVID19 gestational infection and hearing impairment onset in newborns. The involvement of hearing in COVID19 is verified so the timing and methodology of audiological evaluation of children can be planned. Methods Children were subject to newborn hearing screening and audiological evaluation. Newborn hearing screening is carried out prior to hospital discharge using the Automatic Transient Evoked Otoacoustic Emissions test. Audiological evaluation is performed within the child age of 4 months by using maternal, pregnancy, and perinatal case history, COVID19 case history, otoscopy, acoustic immittance test, Distortion Product Otoacoustic Emissions test, and the Auditory Brainstem Response test. Results 63 children were included in the study. 82.5% of these children were subjects of the newborn hearing screening program. The remaining 11 newborns were not subjected to hearing screening due to isolation measures and their audiological evaluation was carried out directly. Only one of 52 screened neonates showed a bilateral REFER test result but hearing threshold was normal at audiological evaluation. Audiological evaluation showed normal bilateral ABR thresholds in 59/63 children. Four children (6.3% of the total) had ABR threshold alterations but two showed normal threshold at ABR retest performed within 1 month of the first. The other two infants showed monolateral ABR alterations but one of these had a concomitant middle ear effusion. In conclusion, only one child (1.6% of the sample) had an altered ABR. This child had shown one positive SARS-CoV-2 swab in the absence of risk factors for hearing loss. Conclusion This study finds no evidence that maternal COVID19 infection is a risk factor in the development of congenital hearing loss in newborns.
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19
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Lee D. The impact of COVID-19 on human reproduction and directions for fertility treatment during the pandemic. Clin Exp Reprod Med 2021; 48:273-282. [PMID: 34875734 PMCID: PMC8651760 DOI: 10.5653/cerm.2021.04504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/10/2021] [Indexed: 12/28/2022] Open
Abstract
Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly, resulting in a pandemic. The virus enters host cells through angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine subtype 2 (TMPRSS2). These enzymes are widely expressed in reproductive organs; hence, coronavirus disease 2019 (COVID-19) could also impact human reproduction. Current evidence suggests that sperm cells may provide an inadequate environment for the virus to penetrate and spread. Oocytes within antral follicles are surrounded by cumulus cells, which rarely express ACE2 and TMPRSS2. Thus, the possibility of transmission of the virus through sexual intercourse and assisted reproductive techniques seems unlikely. Early human embryos express coronavirus entry receptors and proteases, implying that human embryos are potentially vulnerable to SARS-CoV-2 in the early stages of development. Data on the expression of ACE2 and TMPRSS2 in the human endometrium are sparse. Moreover, it remains unclear whether SARS-CoV-2 directly affects the embryo and its implantation. A study of the effect of SARS-CoV-2 on pregnancy showed an increase in preterm delivery. Thus, vertical transmission of the virus from mother to fetus in the third trimester is possible, and further data on human reproduction are required to establish this possibility. Based on analyses of existing data, major organizations in this field have published guidelines on the treatment of infertility. Regarding these guidelines, despite the COVID-19 pandemic, reproductive treatment is crucial for the well-being of society and must be continued under suitable regulations and good standard laboratory practice protocols.
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Affiliation(s)
- Dayong Lee
- Department of Obstetrics and Gynecology, Kyungpook National University School of Medicine, Daegu, Korea
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20
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Boelig RC, Aagaard KM, Debbink MP, Shamshirsaz AA. Society for Maternal-Fetal Medicine Special Statement: COVID-19 research in pregnancy: progress and potential. Am J Obstet Gynecol 2021; 225:B19-B31. [PMID: 34481778 PMCID: PMC8413099 DOI: 10.1016/j.ajog.2021.08.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 global pandemic has broad implications for obstetrical care and perinatal outcomes. As we approach the 2-year mark into an unprecedented international pandemic, this review presents the progress and opportunities for research related to COVID-19 and pregnancy. Research is the basis for evidence-based clinical guidelines, and we aim to provide the structure and guidance for framing COVID-19-related obstetrical research. This structure will pertain not only to this pandemic but future ones as well.
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21
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Constantino FB, Cury SS, Nogueira CR, Carvalho RF, Justulin LA. Prediction of Non-canonical Routes for SARS-CoV-2 Infection in Human Placenta Cells. Front Mol Biosci 2021; 8:614728. [PMID: 34820418 PMCID: PMC8606885 DOI: 10.3389/fmolb.2021.614728] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/15/2021] [Indexed: 02/02/2023] Open
Abstract
The SARS-CoV-2 is the causative agent of the COVID-19 pandemic. The data available about COVID-19 during pregnancy have demonstrated placental infection; however, the mechanisms associated with intrauterine transmission of SARS-CoV-2 is still debated. Intriguingly, while canonical SARS-CoV-2 cell entry mediators are expressed at low levels in placental cells, the receptors for viruses that cause congenital infections such as the cytomegalovirus and Zika virus are highly expressed in these cells. Here we analyzed the transcriptional profile (microarray and single-cell RNA-Seq) of proteins potentially interacting with coronaviruses to identify non- canonical mediators of SARS-CoV-2 infection and replication in the placenta. Despite low levels of the canonical cell entry mediators ACE2 and TMPRSS2, we show that cells of the syncytiotrophoblast, villous cytotrophoblast, and extravillous trophoblast co-express high levels of the potential non-canonical cell-entry mediators DPP4 and CTSL. We also found changes in the expression of DAAM1 and PAICS genes during pregnancy, which are translated into proteins also predicted to interact with coronaviruses proteins. These results provide new insight into the interaction between SARS-CoV-2 and host proteins that may act as non-canonical routes for SARS-CoV-2 infection and replication in the placenta cells.
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Affiliation(s)
- Flávia Bessi Constantino
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Sarah Santiloni Cury
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Celia Regina Nogueira
- Department of Internal Clinic, Botucatu Medicine School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Robson Francisco Carvalho
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Luis Antonio Justulin
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
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22
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Akyıldız D, Çamur Z. Comparison of early postnatal clinical outcomes of newborns born to pregnant women with COVID-19: a case-control study. J Matern Fetal Neonatal Med 2021; 35:8673-8680. [PMID: 34732087 DOI: 10.1080/14767058.2021.1998440] [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: 10/19/2022]
Abstract
BACKGROUND The ongoing COVID-19 pandemic has infected millions of people, including pregnant women and newborns and caused many deaths. Studies examining the effects of COVID-19 infection in pregnancy have mostly focused on maternal outcomes and there are limited data on neonatal outcomes. OBJECTIVES This study aims to compare the early postnatal period clinical outcomes of newborns born to pregnant women with and without COVID-19. METHODS A retrospective case-control study was used to compare the clinical characteristics of newborns born to pregnant women with and without COVID-19. This study was conducted between 11 March 2020 and 11 March 2021 at Denizli State Hospital, Turkey. This study included 202 newborns selected with a nonprobability method. The clinical records and laboratory results of 202 newborns were reviewed by applying a retrospective questionnaire. Neonatal outcomes were compared between the groups. RESULTS There were 101 newborns born to pregnant women with COVID-19 in the case group and 101 without COVID-19 in the control group in the study. A considerably higher rate of newborns born to pregnant women with COVID-19 had cesarean delivery (79.2 versus 35.6%, p < .001), premature birth (28.7 versus 10.9%, p = .001), low birth weight (15.8 versus 6.9%, p = .046), neonatal respiratory distress syndrome (RDS) (37.6 versus 19.8%, p = .005), oxygen need (19.8 versus 37.6, p = .005), and neonatal intensive care unit admission (10.9 versus 37.6%, p = .001). Breastfeeding (1.0 versus 67.3%, p < .001) and nutrition with breast milk rates (33.7 versus 80.2%, p < .001) of newborns born to pregnant women with COVID-19 were significantly lower. The results of 101 newborns who received nasopharyngeal swab samples for COVID-19 were negative. CONCLUSION Newborns born to pregnant women with COVID-19 were more likely to experience preterm birth, cesarean delivery, low birth weight, neonatal RDS, oxygen demand, need for intensive care, and breastfeeding problems. There was no vertical contamination according to the nasopharyngeal swab samples of the newborns.
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Affiliation(s)
- Deniz Akyıldız
- Division of Midwifery, Kahramanmaras Sutcu Imam University, Faculty of Health Sciences, Kahramanmaras, Turkey
| | - Zühal Çamur
- Denizli State Hospital, Neonatal Intensive Care Unit, Merkezefendi/Denizli, Turkey
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23
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Arinkan SA, Dallı Alper EC, Topcu G, Muhcu M. Perinatal outcomes of pregnant women having SARS-CoV-2 infection. Taiwan J Obstet Gynecol 2021; 60:1043-1046. [PMID: 34794735 PMCID: PMC8426291 DOI: 10.1016/j.tjog.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Aim of this study is to evaluate the prognosis of pregnant women having SARS-CoV-2 infection and investigate whether there was a difference in perinatal outcomes between pregnant women who had SARS-CoV-2 infection and those who did not. MATERIALS AND METHODS This prospective observational study was conducted with 116 singleton pregnancies. Cases enrolling in the study were divided into two groups. While those in the first group had a history of SARS-CoV-2 infection (n = 46) the second group consisted of healthy pregnant women (n = 70). RESULTS Emergency Cesarean section was performed on three SARS-CoV-2 infected pregnancies (30, 33 and 34 gestational weeks). Intensive care unit admission was required for all three cases after delivery and two of them died. Among the pregnancies that had an infection in the third trimester, 71.4% (n = 20) of them had delivery in 14 days after diagnosis and 17.4% (n = 8) of their newborns were followed up at newborn intensive care unit. Overall, only one newborn had a positive swab test result for SARS-CoV-2. There was no statistically significant difference between groups regarding their delivery week (37.02 ± 5.85 vs 38.5 ± 2.33). Similarly, there was no significant difference between groups, concerning mean age, parity, and birth weight (P = 0.707, P = 0.092, P = 0.334; P < 0.05). Furthermore, the difference between SARS-CoV-2 infected pregnancies that were followed up as inpatient or outpatient with respect to the delivery week and birth weight was not significant (p > 0.05). Also, APGAR 5 scores of hospitalized women (9.3 ± 1.1) were found to be lower than the outpatient group (9.8 ± 0.8) (P = 0.043; p < 0.05). CONCLUSION No significant difference was detected between groups in terms of the delivery week, birth weight, and APGAR scores. The inpatient group was found to have lower APGAR 5 scores.
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Affiliation(s)
- Sevcan Arzu Arinkan
- Department of Obstetrics and Gynecology, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Ezgi Ceren Dallı Alper
- Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gunes Topcu
- Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Muhcu
- Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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24
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Okeke EN, Abubakar IS, De Guttry R. In Nigeria, Stillbirths And Newborn Deaths Increased During The COVID-19 Pandemic. Health Aff (Millwood) 2021; 40:1797-1805. [PMID: 34669501 DOI: 10.1377/hlthaff.2021.00659] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The COVID-19 pandemic has put severe pressure on health care systems worldwide. Although attention has been focused on COVID-19 hospitalizations and deaths, some experts have warned about potentially devastating secondary health effects. These effects may be most severe in low- and middle-income countries with already weak health care systems. This study examines the effect of the COVID-19 pandemic on early infant deaths, a question that is currently unsettled. We present new evidence from Nigeria showing that early infant deaths have significantly increased during the pandemic. Using data on the birth outcomes of a large and diverse cohort of pregnant women enrolled in a prospective study and a quasi-experimental difference-in-differences design, we found a 1.1-percentage-point (22 percent) increase and a 0.72-percentage-point (23 percent) increase, respectively, in stillbirths and newborn deaths. Our findings show that the health effects of the pandemic extend beyond counted COVID-19 deaths. If these findings generalize to other low- and middle-income countries, they may indicate that the hard-won gains in child survival made during the past two decades are at risk of being reversed amid the ongoing pandemic. Policies addressing disruptions to health services delivery and providing support to vulnerable groups-specifically to households with pregnant women-will be critical as the pandemic continues.
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Affiliation(s)
- Edward N Okeke
- Edward N. Okeke is a senior policy researcher in the Department of Economics, Sociology, and Statistics, RAND Corporation, in Arlington, Virginia, and a professor of policy analysis in the Pardee RAND Graduate School, in Santa Monica, California
| | - Isa S Abubakar
- Isa S. Abubakar is a professor of community medicine at Bayero University and Aminu Kano Teaching Hospital, both in Kano, Nigeria
| | - Rebecca De Guttry
- Rebecca De Guttry is a doctoral fellow at the Pardee RAND Graduate School
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Yıldız G, Kurt D, Mat E, Yıldız P, Başol G, Gündogdu EC, Kuru B, Topcu B, Kale A. Hearing test results of newborns born from the coronavirus disease 2019 (COVID-19) infected mothers: A tertiary center experience in Turkey. J Obstet Gynaecol Res 2021; 48:113-118. [PMID: 34655257 PMCID: PMC8661853 DOI: 10.1111/jog.15008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/06/2021] [Accepted: 08/26/2021] [Indexed: 01/23/2023]
Abstract
Objective Congenital infections can cause newborn hearing loss. Although vertical transmission of coronavirus disease 2019 (COVID‐19) infection is theoretically possible, this has not been proven yet. To our knowledge, there is no previous report on whether COVID‐19 infection during pregnancy can cause congenital hearing loss. This paper aimed to find an answer to this question. Method This retrospective, single‐center study was performed between April 2020 and May 2021 at a tertiary care referral center in Turkey. A total of 422 pregnant women who had coronavirus infection during pregnancy were followed and 203 of them gave birth in our institution. Results of hearing screening tests of 199 newborns were assessed retrospectively. Results Of patients included in the study, 23 (11.6%) had the disease in the first trimester, 62 (31.2%) in the second trimester, and 114 (57.3%) in the third trimester. In the first hearing test performed on newborns, unilateral hearing loss was observed in 21 babies (10.5%). Hearing tests of these newborns were found to be normal in the second test performed 15 days later. Conclusion Considering the incidence of congenital hearing loss, the absence of hearing loss in our newborn population does not confirm the argument that coronavirus infection does not cause congenital hearing loss. This issue should be evaluated with larger patient series. In addition, it should be kept in mind that hearing loss can occur at later ages as well.
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Affiliation(s)
- Gazi Yıldız
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Didar Kurt
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Emre Mat
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Pınar Yıldız
- Obstetrics and Gynecology Department, Adatıp Kurtköy Hospital, Istanbul, Turkey
| | - Gülfem Başol
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Elif Cansu Gündogdu
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Betül Kuru
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Bahtisen Topcu
- Neonatology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Kale
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
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26
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Ramírez-Rosas A, Benitez-Guerrero T, Corona-Cervantes K, Vélez-Ixta JM, Zavala-Torres NG, Cuenca-Leija J, Martínez-Pichardo S, Landero-Montes-de-Oca ME, Bastida-González FG, Zárate-Segura PB, García-Mena J. Study of perinatal transmission of SARS-CoV-2 in a Mexican public hospital. Int J Infect Dis 2021; 113:225-232. [PMID: 34628021 PMCID: PMC8497953 DOI: 10.1016/j.ijid.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES COVID-19 is a viral transmissible disease and there is limited evidence on vertical transmission and prevalence of SARS-CoV-2 during pregnancy, birth, and the postnatal period. This descriptive cross-sectional study aimed to evaluate the possible perinatal transmission of SARS-CoV-2 in mothers and neonates in a Mexican population. METHODS A total of 133 nasopharyngeal swab samples from mothers, 131 swab samples from neonates, and 140 colostrum samples were obtained, and the presence of SARS-CoV-2 was determined by qPCR. RESULTS One in eight asymptomatic 38-39 weeks' pregnant women were positive for the presence of SARS-CoV-2 in nasopharyngeal swabs taken just before delivery; and one in 12 nasopharyngeal swabs collected from neonates immediately after delivery without breast feeding were also positive. It was also determined that one in 47 colostrum/milk samples were positive for the test. In addition, there was no association between positive results and any collected metadata of mothers or newborns. CONCLUSIONS Asymptomatic women carried the SARS-CoV-2 virus during delivery, with perinatal transmission of SARS-CoV-2 to newborns. Since neonates were sampled immediately after birth, the detection of positive cases might be due to infection by the virus in utero.
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Affiliation(s)
- Adriana Ramírez-Rosas
- Departamento de Ginecología y Obstetricia, Hospital Gustavo Baz Prada, ISEM, Estado de México, México
| | | | - Karina Corona-Cervantes
- Departamento de Genética y Biología Molecular, Cinvestav Unidad Zacatenco, Ciudad de México, México
| | - Juan Manuel Vélez-Ixta
- Departamento de Genética y Biología Molecular, Cinvestav Unidad Zacatenco, Ciudad de México, México
| | | | - Jazmin Cuenca-Leija
- Departamento de Ginecología y Obstetricia, Hospital Gustavo Baz Prada, ISEM, Estado de México, México
| | - Sarahi Martínez-Pichardo
- Departamento de Ginecología y Obstetricia, Hospital Gustavo Baz Prada, ISEM, Estado de México, México
| | | | | | | | - Jaime García-Mena
- Departamento de Genética y Biología Molecular, Cinvestav Unidad Zacatenco, Ciudad de México, México.
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27
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Rad HS, Röhl J, Stylianou N, Allenby MC, Bazaz SR, Warkiani ME, Guimaraes FSF, Clifton VL, Kulasinghe A. The Effects of COVID-19 on the Placenta During Pregnancy. Front Immunol 2021; 12:743022. [PMID: 34603330 PMCID: PMC8479199 DOI: 10.3389/fimmu.2021.743022] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/26/2021] [Indexed: 12/21/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The virus primarily affects the lungs where it induces respiratory distress syndrome ranging from mild to acute, however, there is a growing body of evidence supporting its negative effects on other system organs that also carry the ACE2 receptor, such as the placenta. The majority of newborns delivered from SARS-CoV-2 positive mothers test negative following delivery, suggesting that there are protective mechanisms within the placenta. There appears to be a higher incidence of pregnancy-related complications in SARS-CoV-2 positive mothers, such as miscarriage, restricted fetal growth, or still-birth. In this review, we discuss the pathobiology of COVID-19 maternal infection and the potential adverse effects associated with viral infection, and the possibility of transplacental transmission.
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Affiliation(s)
- Habib Sadeghi Rad
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joan Röhl
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nataly Stylianou
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark C Allenby
- School of Chemical Engineering, University of Queensland, St Lucia, QLD, Australia.,Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sajad Razavi Bazaz
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Majid E Warkiani
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Vicki L Clifton
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Arutha Kulasinghe
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,The University of Queensland Diamantina Institute (UQDI), Brisbane, QLD, Australia
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28
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Tripathi S, Awasthi S, Singh SN, Kumar M. Vertical Transmission of COVID-19. Indian J Pediatr 2021; 88:1058. [PMID: 34169455 PMCID: PMC8224249 DOI: 10.1007/s12098-021-03833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Shalini Tripathi
- Department of Pediatrics, King George's Medical University (KGMU), Lucknow, UP, 226003, India.
| | - Shally Awasthi
- Department of Pediatrics, King George's Medical University (KGMU), Lucknow, UP, 226003, India
| | - S N Singh
- Department of Pediatrics, King George's Medical University (KGMU), Lucknow, UP, 226003, India
| | - Mala Kumar
- Department of Pediatrics, King George's Medical University (KGMU), Lucknow, UP, 226003, India
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29
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Musa SS, Bello UM, Zhao S, Abdullahi ZU, Lawan MA, He D. Vertical Transmission of SARS-CoV-2: A Systematic Review of Systematic Reviews. Viruses 2021; 13:1877. [PMID: 34578458 PMCID: PMC8471858 DOI: 10.3390/v13091877] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has hugely impacted global public health and economy. The COVID-19 has also shown potential impacts on maternal perinatal and neonatal outcomes. This systematic review aimed to summarize the evidence from existing systematic reviews about the effects of SARS-CoV-2 infections on maternal perinatal and neonatal outcomes. We searched PubMed, MEDLINE, Embase, and Web of Science in accordance with PRISMA guidelines, from 1 December 2019 to 7 July 2021, for published review studies that included case reports, primary studies, clinical practice guidelines, overviews, case-control studies, and observational studies. Systematic reviews that reported the plausibility of mother-to-child transmission of COVID-19 (also known as vertical transmission), maternal perinatal and neonatal outcomes, and review studies that addressed the effect of SARS-CoV-2 infection during pregnancy were also included. We identified 947 citations, of which 69 studies were included for further analysis. Most (>70%) of the mother-to-child infection was likely due to environmental exposure, although a significant proportion (about 20%) was attributable to potential vertical transmission of SARS-CoV-2. Further results of the review indicated that the mode of delivery of pregnant women infected with SARS-CoV-2 could not increase or decrease the risk of infection for the newborns (outcomes), thereby emphasizing the significance of breastfeeding. The issue of maternal perinatal and neonatal outcomes with SARS-CoV-2 infection continues to worsen during the ongoing COVID-19 pandemic, increasing maternal and neonatal mortality, stillbirth, ruptured ectopic pregnancies, and maternal depression. Based on this study, we observed increasing rates of cesarean delivery from mothers with SARS-CoV-2 infection. We also found that SARS-CoV-2 could be potentially transmitted vertically during the gestation period. However, more data are needed to further investigate and follow-up, especially with reports of newborns infected with SARS-CoV-2, in order to examine a possible long-term adverse effect.
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Affiliation(s)
- Salihu S. Musa
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China;
- Department of Mathematics, Kano University of Science and Technology, Wudil 713101, Nigeria;
| | - Umar M. Bello
- Centre for Eye and Vision Research (CEVR) Limited, Hong Kong Science Park, Hong Kong, China;
- Department of Physiotherapy, Yobe State University Teaching Hospital, Damaturu 620101, Nigeria
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China;
- CUHK Shenzhen Research Institute, Chinese University of Hong Kong, Shenzhen 518000, China
| | - Zainab U. Abdullahi
- Department of Biological Sciences, Federal University Dutsinma, Katsina 821101, Nigeria;
| | - Muhammad A. Lawan
- Department of Mathematics, Kano University of Science and Technology, Wudil 713101, Nigeria;
| | - Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China;
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30
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Singh A, Kainth D, Gaur S, Yadav DK, Anand S. Characteristics of Systematic Reviews and Meta-analysis on COVID-19 in the Pediatric Population: A Bibliometric Review With Emphasis on Top 5 Cited Articles. Clin Pediatr (Phila) 2021; 60:392-398. [PMID: 34293948 DOI: 10.1177/00099228211034340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | | | | | - Sachit Anand
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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31
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Arora D, Rajmohan K, Dubey S, Dey M, Singh S, Nair V, Tiwari R, Tiwari S. Assessment of materno-foetal transmission of SARS-CoV-2: A prospective pilot study. Med J Armed Forces India 2021; 77:S398-S403. [PMID: 34334910 PMCID: PMC8313026 DOI: 10.1016/j.mjafi.2021.01.007] [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: 10/19/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The issue of vertical transmission of SARS-CoV-2 infection to the foetus has not yet been resolved. Its main reason is lack of a bigger study to analyse this question. The evidence of the affection of the foetus during antenatal or intrapartum period is limited to some anecdotal reports. To look for the possibility of vertical transmission of Severe Acute Respiratory Syndrome - Corona Virus-2 (SARS-CoV-2) infection to the foetus, this prospective pilot study was conducted at a tertiary health care COVID-19 designated centre of Armed Forces. METHODS This study was conducted during 01 June 2020 and 15 October 2020 and included 54 covid-positive pregnant mothers. During delivery, amniotic fluid and cord blood samples were collected in a sterile manner. Amniotic fluid samples were not collected during vaginal deliveries as chances of contamination was very high. These samples were tested for the presence of SARS-CoV-2 gene by Reverse Transcriptasee Polymerase Chain Reaction (RT-PCR) test, and the results were analysed. Newborns were allowed to room in with mother, and they underwent throat and nasal swab RT-PCR testing of covid within 24-48 h of delivery. RESULTS A total of 1520 pregnant mothers underwent RT-PCR test during the study period. Total positivity rate among our pregnant women was 2.8%. Out of 54 covid-positive women during the study period, amniotic fluid RT-PCR tests were carried out for 43 women, and cord blood was tested for 45 women. CONCLUSION RT-PCR test of amniotic fluid, cord blood and nasal and throat swab of all newborns delivered by SARS-CoV-2-positive pregnant women were negative. Based on our study, the possibility of intrauterine vertical transmission of SARS-CoV-2 infection appears to be unlikely.
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Affiliation(s)
- D. Arora
- Consultant & Head (Obst & Gynae), Trained in Maternal-fetal Medicine, Base Hospital, Delhi Cantt, India
| | - K.S. Rajmohan
- Senior Advisor & Head (Pathology), Base Hospital, Delhi Cantt, India
| | - Sudhir Dubey
- Classified Specialist (Pathology), Base Hospital, Delhi Cantt, India
| | - Madhusudan Dey
- Senior Adviser (Obst & Gynae), Trained in Maternal-Fetal Medicine, Base Hospital, Delhi Cantt, India
| | - Sanjay Singh
- Senior Adviser (Obst & Gynae), Base Hospital, Delhi Cantt, India
| | - V.G. Nair
- Classified Specialist (Obst & Gynae), Base Hospital, Delhi Cantt, India
| | - R.P. Tiwari
- Classified Specialist (Obst & Gynae), Base Hospital, Delhi Cantt, India
| | - Shyamji Tiwari
- Graded Specialist (Obst & Gynae), Base Hospital, Delhi Cantt, India
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Ferrer-Oliveras R, Mendoza M, Capote S, Pratcorona L, Esteve-Valverde E, Cabero-Roura L, Alijotas-Reig J. Immunological and physiopathological approach of COVID-19 in pregnancy. Arch Gynecol Obstet 2021; 304:39-57. [PMID: 33945026 PMCID: PMC8093597 DOI: 10.1007/s00404-021-06061-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
Coronavirus disease-2019 (COVID-19) related to Coronavirus-2 (SARS-CoV-2) is a worldwide health concern. Despite the majority of patients will evolve asymptomatic or mild-moderate upper respiratory tract infections, 20% will develop severe disease. Based on current pathogenetic knowledge, a severe COVID-19 form is mainly a hyperinflammatory, immune-mediated disorder, triggered by a viral infection. Due to their particular immunological features, pregnant women are supposed to be particularly susceptible to complicate by intracellular infections as well as immunological disturbances. As an example, immune-thrombosis has been identified as a common immune-mediated and pathogenic phenomenon both in COVID-19, in obstetric diseases and in COVID-19 pregnant women. According to extensive published clinical data, is rationale to expect an interference with the normal development of pregnancy in selected SARS-CoV-2-infected cases, mainly during third trimester.This manuscript provides insights of research to elucidate the potential harmful responses to SARS-CoV-2 and /or other coronavirus infections, as well as bidirectional interactions between COVID-19 and pregnancy to improve their respective management.
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Affiliation(s)
- Raquel Ferrer-Oliveras
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain.
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Sira Capote
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
| | - Laia Pratcorona
- Department of Obstetrics, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Enrique Esteve-Valverde
- Department of Internal Medicine, Althaia Network Health. Manresa, Barcelona, Spain
- Universitat Central de Catalunya, Barcelona, Catalonia, Spain
| | - Lluis Cabero-Roura
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
- Prof. Emeritus of Obsterics and Gynaecology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit. Department of Internal Medicine-1, Vall d' Hebron University Hospital, Barcelona, Spain.
- Systemic Autoimmune Research Unit, Vall d'Hebron Reseacrh Institute, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Sule GA, Aysegul A, Selcan S, Atakan T, Eda OT, Deniz O, Filiz HO, Ozlem MT, Dilek S. Effects of SARS-COV-2 infection on fetal pulmonary artery Doppler parameters. Echocardiography 2021; 38:1314-1318. [PMID: 34184313 PMCID: PMC8444886 DOI: 10.1111/echo.15146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 01/18/2023] Open
Abstract
Purpose To determine the effect of SARS‐CoV‐2 infection on the fetal pulmonary system using the acceleration time (AT), ejection time (ET), and acceleration/ejection time ratio (PATET) of the fetal main pulmonary artery Doppler waveform. Methods We prospectively studied pregnant women attending our hospital with confirmed SARS‐CoV‐2 infection by RT‐PCR test and an age‐matched control group who admitted for routine prenatal care. An ultrasound examination that included measurements of the AT, ET, and AT/ET ratio (PATET) were performed and the results were compared. Results Fifty‐five SARS‐CoV‐2‐infected and 93 control group pregnant women were included in this study. AT found higher in the COVID‐19 positive group when compared with controls. When the ET and PATET parameters were compared, no differences were detected between the groups. Eleven neonates had Neonatal Intensive Care Unit (NICU) requirement in the COVID‐19 positive group while there were none in the control group. All fetal pulmonary artery Doppler values were decreased in NICU admitted fetuses. The mean gestational week of this group was lower than non‐NICU COVID‐19 positive group and the control group. Conclusion COVID‐19 infection increases fetal pulmonary blood flow, which appears high AT values on Doppler parameters. NICU admission only occurred in the COVID‐19 group and their Doppler values were found significantly lower than non‐NICU COVID‐19 group. The clinical significance of this result must be evaluated with further studies.
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Affiliation(s)
- Goncu Ayhan Sule
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atalay Aysegul
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sinaci Selcan
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Tanacan Atakan
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozden Tokalioglu Eda
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Oluklu Deniz
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Halici Ozturk Filiz
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Moraloglu Tekin Ozlem
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey.,Department of Obstetrics and Gynecology, University of Health Sciences, Istanbul, Turkey
| | - Sahin Dilek
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey.,Department of Obstetrics and Gynecology, University of Health Sciences, Istanbul, Turkey
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Ciapponi A, Bardach A, Comandé D, Berrueta M, Argento FJ, Rodriguez Cairoli F, Zamora N, Santa María V, Xiong X, Zaraa S, Mazzoni A, Buekens P. COVID-19 and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes. PLoS One 2021; 16:e0253974. [PMID: 34185807 PMCID: PMC8241118 DOI: 10.1371/journal.pone.0253974] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783). METHODS We searched literature databases and COVID-19 research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR's results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables. RESULTS We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had "critically low" overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 clinical findings during pregnancy were fever (28-100%), mild respiratory symptoms (20-79%), raised C-reactive protein (28-96%), lymphopenia (34-80%), and pneumonia signs in diagnostic imaging (7-99%). The most frequent maternal outcomes were C-section (23-96%) and preterm delivery (14-64%). Most of their babies were asymptomatic (16-93%) or presented fever (0-50%), low birth weight (5-43%) or preterm delivery (2-69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 versus non-COVID-19 pregnant women was 1.88 (95% Confidence Interval [CI] 1.36-2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05-4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks. CONCLUSION This comprehensive overview supports that pregnant women with COVID-19 may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.
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Affiliation(s)
- Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Fernando J. Argento
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | | | - Natalia Zamora
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Victoria Santa María
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
| | - Sabra Zaraa
- School of Pharmacy, University of Washington, Seattle, WA, United States of America
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
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35
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Skin-to-Skin Contact (Kangaroo Care) During the COVID-19 Pandemic. Neonatal Netw 2021; 40:161-174. [PMID: 34088862 DOI: 10.1891/11-t-748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
Early recommendations to separate mothers from their newborns during the coronavirus disease 2019 (COVID-19) pandemic have created a detrimental separation practice. This article presents a review of the latest information regarding the (1) 3 modes of transmission of the virus to the neonate; (2) incidence, clinical signs, and severity of COVID-19 in the neonate; (3) factors to be considered to balance risk and benefits of separation and skin-to-skin contact (SSC) when conducting shared decision making; and (4) compendium of published SSC guidelines; and concludes with recommendations for safe practice of SSC to prevent and/or restrict COVID-19 infection in neonates.
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Maeda MDFY, Brizot MDL, Gibelli MABC, Ibidi SM, Carvalho WBD, Hoshida MS, Machado CM, Sabino EC, Oliveira da Silva LCD, Jaenisch T, Mendes-Correa MCJ, Mayaud P, Francisco RPV. Vertical transmission of SARS-CoV2 during pregnancy: A high-risk cohort. Prenat Diagn 2021; 41:998-1008. [PMID: 34101871 PMCID: PMC8242902 DOI: 10.1002/pd.5980] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/13/2021] [Accepted: 05/28/2021] [Indexed: 12/14/2022]
Abstract
Objective Identify the potential for and risk factors of SARS‐CoV‐2 vertical transmission. Methods Symptomatic pregnant women with COVID‐19 diagnosis in whom PCR for SARS‐CoV‐2 was performed at delivery using maternal serum and at least one of the biological samples: cord blood (CB), amniotic fluid (AF), colostrum and/or oropharyngeal swab (OPS) of the neonate. The association of parameters with maternal, AF and/or CB positivity and the influence of SARS‐CoV‐2 positivity in AF and/or CB on neonatal outcomes were investigated. Results Overall 73.4% (80/109) were admitted in hospital due to COVID‐19, 22.9% needed intensive care and there were four maternal deaths. Positive RT‐PCR for SARS‐CoV‐2 was observed in 14.7% of maternal blood, 13.9% of AF, 6.7% of CB, 2.1% of colostrum and 3.7% of OPS samples. The interval between COVID‐19 symptoms and delivery was inversely associated with SARS‐CoV‐2 positivity in the maternal blood (p = 0.002) and in the AF and/or CB (p = 0.049). Maternal viremia was associated with positivity for SARS‐CoV‐2 in AF and/or CB (p = 0.001). SARS‐CoV‐2 positivity in the compartments was not associated with neonatal outcomes. Conclusion Vertical transmission is possible in pregnant women with COVID‐19 and a shorter interval between maternal symptoms and delivery is an influencing factor. What is already known about this topic?Few studies systematically evaluated the presence of SARS‐CoV‐2 in biological samples such as amniotic fluid, cord blood, placenta and colostrum Vertical transmission is still uncertain in pregnant women with COVID‐19
What this study add?Vertical transmission is possible in pregnant women with COVID‐19 Maternal viremia is associated with positivity in amniotic fluid and/or cord blood A shorter interval between symptoms and delivery is an influential factor for vertical transmission
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Affiliation(s)
| | - Maria de Lourdes Brizot
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da FMUSP, São Paulo, Brazil
| | | | - Silvia Maria Ibidi
- Disciplina de Neonatologia, Departamento de Pediatria da FMUSP, São Paulo, Brazil.,Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
| | - Werther Brunow de Carvalho
- Disciplina de Neonatologia, Departamento de Pediatria da FMUSP, São Paulo, Brazil.,Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
| | - Mara Sandra Hoshida
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da FMUSP, São Paulo, Brazil
| | | | - Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical da FMUSP, São Paulo, Brazil
| | | | - Thomas Jaenisch
- Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA.,Heidelberg Institute for Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | | | - Philippe Mayaud
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Rossana Pulcinelli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia da FMUSP, São Paulo, Brazil.,Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
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Leal CRV, Maciel RAM, Corrêa Júnior MD. SARS-CoV-2 Infection and Placental Pathology. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:474-479. [PMID: 34077991 PMCID: PMC10411154 DOI: 10.1055/s-0041-1730291] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/18/2021] [Indexed: 01/25/2023] Open
Abstract
Placental pathophysiology in SARS-CoV-2 infection can help researchers understand more about the infection and its impact on the maternal/neonatal outcomes. This brief review provides an overview about some aspects of the placental pathology in SARS-CoV-2 infection. In total, 11 papers were included. The current literature suggests that there are no specific histopathological characteristics in the placenta related to SARS-CoV-2 infection, but placentas from infected women are more likely to show findings of maternal and/or fetal malperfusion. The most common findings in placentas from infected women were fibrin deposition and intense recruitment of inflammatory infiltrates. The transplacental transmission of this virus is unlikely to occur, probably due to low expression of the receptor for SARS-CoV-2 in placental cell types. Further studies are needed to improve our knowledge about the interaction between the virus and the mother-fetus dyad and the impact on maternal and neonatal/fetal outcomes.
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Affiliation(s)
- Caio Ribeiro Vieira Leal
- Department of Gynecology and Obstetrics, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, MG, Brazil
| | - Rayra Amana Macêdo Maciel
- Department of Gynecology and Obstetrics, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, MG, Brazil
| | - Mário Dias Corrêa Júnior
- Department of Gynecology and Obstetrics, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, MG, Brazil
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Tasca C, Rossi RS, Corti S, Anelli GM, Savasi V, Brunetti F, Cardellicchio M, Caselli E, Tonello C, Vergani P, Nebuloni M, Cetin I. Placental pathology in COVID-19 affected pregnant women: A prospective case-control study. Placenta 2021; 110:9-15. [PMID: 34058611 PMCID: PMC8096756 DOI: 10.1016/j.placenta.2021.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/23/2023]
Abstract
Introduction During pregnancy, SARS-CoV-2 infection may cause an abnormal development of the placenta, thus influencing maternal and fetal outcomes. Few studies have reported data on placental morphology and histology in infected pregnant patients, although not compared with carefully matched controls. The aim of this study is to compare placental morphology and histology of pregnant women affected by SARS-CoV-2 to non-infected controls. Methods This is a prospective multicenter case-control study on 64 pregnant women affected by SARS-CoV-2 who delivered at term or late-preterm. Data were collected about pregnancy course, maternal and fetal outcomes, placental biometry and macro- and microscopical morphology. 64 not-infected women were identified as controls, matched by age, body mass index and ethnicity. Results Cases and controls had similar fetal and maternal outcomes. No significant differences were observed in placental macro- or microscopical morphology between the two groups. In the cases treated with antivirals, chloroquine, LMWH or antibiotics, placentas were heavier but not more efficient than the non-treated, since the fetal/placental weight ratio did not differ. Moreover, delayed villous maturation was more frequent in treated women, although not significantly. The newborns whose mothers received oxygen therapy as treatment had higher levels of umbilical cord pO₂ at birth. Discussion In this prospective case-control study, SARS-CoV-2 infection during the third trimester did not influence placental histological pattern. Pharmacological and oxygen therapy administered to women affected by this viral infection could impact maternal and fetal outcomes and be associated to placental histological alterations.
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Affiliation(s)
- Chiara Tasca
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Roberta Simona Rossi
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Silvia Corti
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Gaia Maria Anelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Federica Brunetti
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Manuela Cardellicchio
- Unit of Obstetrics and Gynecology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Emilio Caselli
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Cristina Tonello
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Manuela Nebuloni
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Irene Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy.
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Carrasco I, Muñoz-Chapuli M, Vigil-Vázquez S, Aguilera-Alonso D, Hernández C, Sánchez-Sánchez C, Oliver C, Riaza M, Pareja M, Sanz O, Pérez-Seoane B, López J, Márquez E, Domínguez-Rodríguez S, Hernanz-Lobo A, De León-Luis JA, Sánchez-Luna M, Navarro ML. SARS-COV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave. BMC Pregnancy Childbirth 2021; 21:326. [PMID: 33902483 PMCID: PMC8072086 DOI: 10.1186/s12884-021-03784-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.
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MESH Headings
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- COVID-19/epidemiology
- COVID-19/physiopathology
- COVID-19/therapy
- COVID-19 Nucleic Acid Testing
- Carrier State/epidemiology
- Cesarean Section/statistics & numerical data
- Cohort Studies
- Comorbidity
- Cough/physiopathology
- Diabetes, Gestational/epidemiology
- Dyspnea/physiopathology
- Female
- Fever/physiopathology
- Gestational Age
- Humans
- Hypertension/epidemiology
- Hypothyroidism/epidemiology
- Immunologic Factors/therapeutic use
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Intensive Care Units/statistics & numerical data
- Lung/diagnostic imaging
- Male
- Obesity, Maternal/epidemiology
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pregnancy
- Pregnancy Complications/epidemiology
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Premature Birth/epidemiology
- Radiography, Thoracic
- Respiration, Artificial
- Risk Factors
- SARS-CoV-2
- Severity of Illness Index
- Spain/epidemiology
- COVID-19 Drug Treatment
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Affiliation(s)
- Itzíar Carrasco
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain.
| | - Mar Muñoz-Chapuli
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Hernández
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - César Sánchez-Sánchez
- Department of Paediatric Gastroenterology Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Oliver
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mónica Riaza
- Department of Paediatrics, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Marta Pareja
- Department of Paediatrics, Hospital General de Albace, Castilla La Mancha, Spain
| | - Olga Sanz
- Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Juan López
- Department of Paediatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Elena Márquez
- Department of Paediatrics, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Infectious Diseases Unit, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Alicia Hernanz-Lobo
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Antonio De León-Luis
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Tolu LB, Ezeh A, Feyissa GT. Vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2: A scoping review. PLoS One 2021; 16:e0250196. [PMID: 33886645 PMCID: PMC8062014 DOI: 10.1371/journal.pone.0250196] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/30/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The evidence for vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not well established. Therefore, the objective of this review is to summarize emerging evidence on the vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2. METHODS We conducted a systematic search in PubMed, CINAHL, Web of Science, SCOPUS, and CENTRAL. Likewise, a search for preprint publications was conducted using MedRxiv and Research Square. Studies that addressed vertical transmission of SARS-CoV-2 (concept) among pregnant women infected by Covid-19 (population) in any setting (community, hospital, or home) in any country or context were considered for inclusion. Any types of studies or reports published between December 2019 and September 2020 addressing the effects of SARS-CoV-2 on pregnant women and their newborn babies were included. Studies were screened for eligibility against the inclusion criteria for the review by two reviewers. RESULTS We identified 51 studies reporting 336 newborns screened for COVID-19. From the 336 newborns screened for COVID-19, only 15 (4.4%) were positive for throat swab RT-PCR. All neonates with positive throat swab RT-PCR were delivered by cesarean section. Among neonates with throat swab SARS-CoV-2 positive only five (33.3%) had concomitant placenta, amniotic fluid, and cord blood samples tested, of which only one amniotic fluid sample is positive for RT PCR. Five neonates had elevated IgG and IgM but without intrauterine tissue tested. Four neonates had chest imaging suggestive of COVID-19 pneumonia. CONCLUSION Currently there is not enough evidence on vertical virologic transmission of COVID-19 infection during the third trimester of pregnancy. Additionally, there is no evidence to support cesarean delivery, abstaining from breast feeding nor mother and infant separation. Further research involving an adequate sample size of breast milk, placenta, amniotic fluid, and cord blood to ascertain the possibility of vertical transmission and breast milk transfer is needed.
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Affiliation(s)
- Lemi Belay Tolu
- Saint Paul’s Hospital Millennium Medical College, Department of Obstetrics and Gynaecology, Addis Ababa, Ethiopia
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Garumma Tolu Feyissa
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
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Barcelos IDES, Penna IADA, Soligo ADG, Costa ZB, Martins WP. Vertical Transmission of SARS-CoV-2: A Systematic Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:207-215. [PMID: 33860504 PMCID: PMC10183886 DOI: 10.1055/s-0040-1722256] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The evaluation of the available evidence on vertical transmission by severe acute respiratory syndrome coronavirus 2 (SARS-CoV)-2. DATA SOURCES An electronic search was performed on June 13, 2020 on the Embase, PubMed and Scopus databases using the following search terms: (Coronavirus OR COVID-19 OR COVID19 OR SARS-CoV-2 OR SARS-CoV2 OR SARSCoV2) AND (vertical OR pregnancy OR fetal). SELECTION OF STUDIES The electronic search resulted in a total of 2,073 records. Titles and abstracts were reviewed by two authors (WPM, IDESB), who checked for duplicates using the pre-established criteria for screening (studies published in English without limitation regarding the date or the status of the publication). DATA COLLECTION Data extraction was performed in a standardized way, and the final eligibility was assessed by reading the full text of the articles. We retrieved data regarding the delivery of the potential cases of vertical transmission, as well as the main findings and conclusions of systematic reviews. DATA SYNTHESIS The 2,073 records were reviewed; 1,000 duplicates and 896 clearly not eligible records were excluded. We evaluated the full text of 177 records, and identified only 9 suspected cases of possible vertical transmission. The only case with sufficient evidence of vertical transmission was reported in France. CONCLUSION The risk of vertical transmission by SARS-CoV-2 is probably very low. Despite several thousands of affected pregnant women, we have identified only one case that has fulfilled sufficient criteria to be confirmed as a case of vertical transmission. Well-designed observational studies evaluating large samples are still necessary to determine the risk of vertical transmission depending on the gestational age at infection.
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Affiliation(s)
| | | | | | - Zelma Bernardes Costa
- Department of Obstetrics and Gynecology, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Vergara-Merino L, Meza N, Couve-Pérez C, Carrasco C, Ortiz-Muñoz L, Madrid E, Bohorquez-Blanco S, Pérez-Bracchiglione J. Maternal and perinatal outcomes related to COVID-19 and pregnancy: An overview of systematic reviews. Acta Obstet Gynecol Scand 2021; 100:1200-1218. [PMID: 33560530 PMCID: PMC8014248 DOI: 10.1111/aogs.14118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
Introduction Evidence about coronavirus disease 2019 (COVID‐19) and pregnancy has rapidly increased since December 2019, making it difficult to make rigorous evidence‐based decisions. The objective of this overview of systematic reviews is to conduct a comprehensive analysis of the current evidence on prognosis of COVID‐19 in pregnant women. Material and methods We used the Living OVerview of Evidence (L·OVE) platform for COVID‐19, which continually retrieves studies from 46 data sources (including PubMed/MEDLINE, Embase, other electronic databases, clinical trials registries, and preprint repositories, among other sources relevant to COVID‐19), mapping them into PICO (population, intervention, control, and outcomes) questions. The search covered the period from the inception date of each database to 13 September 2020. We included systematic reviews assessing outcomes of pregnant women with COVID‐19 and/or their newborns. Two authors independently screened the titles and abstracts, assessed full texts to select the studies that met the inclusion criteria, extracted data, and appraised the risk of bias of each included systematic review. We measured the overlap of primary studies included among the selected systematic reviews by building a matrix of evidence, calculating the corrected covered area, and assessing the level of overlap for every pair of systematic reviews. Results Our search yielded 1132 references. 52 systematic reviews met inclusion criteria and were included in this overview. Only one review had a low risk of bias, three had an unclear risk of bias, and 48 had a high risk of bias. Most of the included reviews were highly overlapped among each other. In the included reviews, rates of maternal death varied from 0% to 11.1%, admission to intensive care from 2.1% to 28.5%, preterm deliveries before 37 weeks from 14.3% to 61.2%, and cesarean delivery from 48.3% to 100%. Regarding neonatal outcomes, neonatal death varied from 0% to 11.7% and the estimated infection status of the newborn varied between 0% and 11.5%. Conclusions Only one of 52 systematic reviews had a low risk of bias. Results were heterogeneous and the overlap of primary studies was frequently very high between pairs of systematic reviews. High‐quality evidence syntheses of comparative studies are needed to guide future clinical decisions.
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Affiliation(s)
- Laura Vergara-Merino
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | - Nicolás Meza
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | - Constanza Couve-Pérez
- Department of Gynecology and Obstetrics, Division of Maternal and Fetal Medicine, Faculty of Medicine, Universidad de Valparaíso, Hospital Dr. Gustavo Fricke, Viña del Mar, Chile
| | - Cynthia Carrasco
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | - Luis Ortiz-Muñoz
- UC Evidence Center, Cochrane Chile Associate Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eva Madrid
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
| | | | - Javier Pérez-Bracchiglione
- Interdisciplinary Center for Health Studies (CIESAL, Universidad de Valparaíso, Cochrane Chile Associate Center, Valparaíso, Chile
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Forestieri S, Pintus R, Marcialis MA, Pintus MC, Fanos V. COVID-19 and developmental origins of health and disease. Early Hum Dev 2021; 155:105322. [PMID: 33571742 PMCID: PMC7837628 DOI: 10.1016/j.earlhumdev.2021.105322] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022]
Abstract
From the moment of the identification of SARS-CoV-2 as an etiological agent of the severe clinical pictures of pneumonia that were being slowly observed all over the world, numerous studies have been conducted to increase the knowledge about what was an unknown virus until then. The efforts were mainly aimed to acquire epidemiological, microbiological, pathogenetic, clinical, diagnostic, therapeutic and preventive information in order to increase the available weapons to fight an infection which was rapidly taking on the characteristics of the pandemic. Given the topicality of the problem, not everything has yet been fully understood and clarified, especially in the maternal-fetal‑neonatal field, where we are beginning to question what could be the outcomes of newborn babies born to mothers who contracted SARS-CoV-2 infection during pregnancy. Thus, the aim of this review is to analyze the long-term outcomes of this infection that could affect the offspring, regardless of a possible maternal-fetal transmission, focusing on, above all, the role of maternal immune activation and the expression of the Angiotensin-converting enzyme 2 (ACE2) in particular at the placental level.
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Affiliation(s)
| | - Roberta Pintus
- Department of Surgery, Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy.
| | | | | | - Vassilios Fanos
- Department of Surgery, Neonatal Intensive Care Unit, University of Cagliari, Cagliari, Italy,Neonatal Intensive Care Unit, AOU, Cagliari, Cagliari, Italy
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Vertical Transmission of SARS-CoV-2 in Second Trimester Associated with Severe Neonatal Pathology. Viruses 2021; 13:v13030447. [PMID: 33801923 PMCID: PMC7999228 DOI: 10.3390/v13030447] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
The effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in women on the gestation course and the health of the fetus, particularly in the first and second trimesters, remain very poorly explored. This report describes a case in which the normal development of pregnancy was complicated immediately after the patient had experienced Coronavirus disease 2019 (COVID-19) at the 21st week of gestation. Specific conditions included critical blood flow in the fetal umbilical artery, fetal growth restriction (1st percentile), right ventricular hypertrophy, hydropericardium, echo-characteristics of hypoxic-ischemic brain injury (leukomalacia in periventricular area) and intraventricular hemorrhage at the 25th week of gestation. Premature male neonate delivered at the 26th week of gestation died after 1 day 18 h due to asystole. The results of independent polymerase chain reaction (PCR), mass spectrometry and immunohistochemistry analyses of placenta tissue, umbilical cord blood and child blood jointly indicated vertical transmission of SARS-CoV-2 from mother to the fetus, which we conclude to be the major cause for the development of maternal vascular malperfusion in the studied case.
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Porpora MG, Merlino L, Masciullo L, D’Alisa R, Brandolino G, Galli C, De Luca C, Pecorini F, Fonsi GB, Mingoli A, Franchi C, Oliva A, Manganaro L, Mastroianni CM, Piccioni MG. Does Lung Ultrasound Have a Role in the Clinical Management of Pregnant Women with SARS COV2 Infection? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052762. [PMID: 33803223 PMCID: PMC7967479 DOI: 10.3390/ijerph18052762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is a major health threat. Pregnancy can lead to an increased susceptibility to viral infections. Although chest computed tomography (CT) represents the gold standard for the diagnosis of SARS-CoV-2 pneumonia, lung ultrasound (LUS) could be a valid alternative in pregnancy. The objectives of this prospective study were to assess the role of LUS in the diagnosis of lung involvement and in helping the physicians in the management of affected patients. Thirty pregnant women with SARS-CoV-2 infection were admitted at the obstetrical ward of our Hospital. Mean age was 31.2 years, mean gestational age 33.8 weeks. Several LUS were performed during hospitalization. The management of the patients was decided according to the LUS score and the clinical conditions. Mean gestational age at delivery was at 37.7 weeks, preterm birth was induced in 20% of cases for a worsening of the clinical conditions. No neonatal complications occurred. In 9 cases with a high LUS score, a chest CT was performed after delivery. CT confirmed the results of LUS, showing a significant positive correlation between the two techniques. LUS seems a safe alternative to CT in pregnancy and may help in the management of these patients.
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Affiliation(s)
- Maria Grazia Porpora
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Lucia Merlino
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Luisa Masciullo
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Rossella D’Alisa
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Gabriella Brandolino
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Cecilia Galli
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
- Correspondence:
| | - Casimiro De Luca
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Francesco Pecorini
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Giovanni Battista Fonsi
- Department of Surgery, “Pietro Valdoni”, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.F.); (A.M.)
| | - Andrea Mingoli
- Department of Surgery, “Pietro Valdoni”, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.F.); (A.M.)
| | - Cristiana Franchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (C.F.); (A.O.); (C.M.M.)
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (C.F.); (A.O.); (C.M.M.)
| | - Lucia Manganaro
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy;
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (C.F.); (A.O.); (C.M.M.)
| | - Maria Grazia Piccioni
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
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Ronchi A, Pietrasanta C, Zavattoni M, Saruggia M, Schena F, Sinelli MT, Agosti M, Tzialla C, Varsalone FF, Testa L, Ballerini C, Ferrari S, Mangili G, Ventura ML, Perniciaro S, Spada E, Lunghi G, Piralla A, Baldanti F, Mosca F, Pugni L. Evaluation of Rooming-in Practice for Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italy. JAMA Pediatr 2021; 175:260-266. [PMID: 33284345 PMCID: PMC7921895 DOI: 10.1001/jamapediatrics.2020.5086] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The management of mother-infant dyads during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic constitutes a major issue for neonatologists. In mothers with SARS-CoV-2 infection, current recommendations suggest either to separate the dyad or encourage protected rooming-in under appropriate precautions. No data are available regarding the risk of mother-to-infant transmission of SARS-CoV-2 during rooming-in. OBJECTIVE To evaluate the risk of postnatal transmission of SARS-CoV-2 from infected mothers to their neonates following rooming-in and breastfeeding. DESIGN, SETTING, AND PARTICIPANTS A prospective, multicenter study enrolling mother-infant dyads from March 19 to May 2, 2020, followed up for 20 days of life (range, 18-22 days), was performed. The study was conducted at 6 coronavirus disease 2019 maternity centers in Lombardy, Northern Italy. Participants included 62 neonates born to 61 mothers with SARS-CoV-2 infection who were eligible for rooming-in practice based on the clinical condition of the mother and infants whose results of nasopharyngeal swabs were negative at birth. EXPOSURES Mothers with SARS-CoV-2 infection were encouraged to practice rooming-in and breastfeeding under a standardized protocol to minimize the risk of viral transmission. MAIN OUTCOMES AND MEASURES Clinical characteristics and real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 on neonatal nasopharyngeal swabs at 0, 7, and 20 days of life. RESULTS Of the 62 neonates enrolled (25 boys), born to 61 mothers (median age, 32 years; interquartile range, 28-36 years), only 1 infant (1.6%; 95% CI, 0%-8.7%) was diagnosed as having SARS-CoV-2 infection at postbirth checks. In that case, rooming-in was interrupted on day 5 of life because of severe worsening of the mother's clinical condition. The neonate became positive for the virus on day 7 of life and developed transient mild dyspnea. Ninety-five percent of the neonates enrolled were breastfed. CONCLUSIONS AND RELEVANCE The findings of this cohort study provide evidence-based information on the management of mother-infant dyads in case of SARS-CoV-2 maternal infection suggesting that rooming-in and breastfeeding can be practiced in women who are able to care for their infants.
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Affiliation(s)
- Andrea Ronchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy
| | - Carlo Pietrasanta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy,University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Maurizio Zavattoni
- Fondazione IRCCS Policlinico San Matteo, Microbiology and Virology Department, Molecular Virology Unit, Pavia, Italy
| | | | - Federico Schena
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy
| | | | - Massimo Agosti
- Del Ponte Hospital, Neonatology and NICU, Varese, Italy,University of Insubria, Department of Pediatrics, Varese, Italy
| | - Chryssoula Tzialla
- Fondazione IRCCS Policlinico San Matteo, Neonatology and NICU, Pavia, Italy
| | | | - Lea Testa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy
| | - Claudia Ballerini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy
| | | | | | | | | | - Elena Spada
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy
| | - Giovanna Lunghi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Microbiology and Virology Unit, Milan, Italy
| | - Antonio Piralla
- Fondazione IRCCS Policlinico San Matteo, Microbiology and Virology Department, Molecular Virology Unit, Pavia, Italy
| | - Fausto Baldanti
- Fondazione IRCCS Policlinico San Matteo, Microbiology and Virology Department, Molecular Virology Unit, Pavia, Italy,University of Pavia. Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pavia, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy,University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Lorenza Pugni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatology and NICU, Milan, Italy
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Abstract
Despite the worldwide spread of SARS-CoV-2 infection (COVID-19), knowledge of the different clinical presentations, ways of transmission, severity and prognosis in children and adolescents is limited. An increasing number of reports describe some of these characteristics in this age range. A non-systematic review was undertaken using MEDLINE (PubMed), LILACS (VHL), Scopus, Web of Science, Cochrane and CAPES Portal databases from 1 January until 30 September 2020 [103] with the search terms SARS-CoV-2, COVID-19, child, children, youth, adolescent and newborn to identify the more recent clinical aspects of SARS-CoV-2 infection in children. In general, SARS-CoV-2 infection in children tends to be asymptomatic or to have mild or moderate signs, and most young ones are infected by family members. Recent reports offer new insights into the disease. Current evidence on SARS-CoV-2 infection in children and adolescents is presented, especially concerning the clinical presentation, imaging and uncommon severe forms of the disease, particularly the COVID-19-associated multisystem inflammatory syndrome. The impact of COVID-19 infection in the perinatal period is described in detail. Knowledge of the various clinical presentations of SARS-CoV-2 in children and adolescents allows the paediatrician to diagnose earlier, monitor warnings signs, implement treatment and, especially, establish preventive measures.Abbreviations : ACE-2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; ARF, acute rheumatic fever; CAA, coronary artery aneurysms; CK-MB, creatine kinase-MB; COVID-19, coronavirus disease-2019; HLA, specific human leucocyte antigen; IPC, infection prevention and control; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; MIS-C, COVID-19-associated multisystem inflammatory syndrome; RNA, ribonucleic acid; RT-PCR, reserve transcription-polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; TCT, thoracic computed tomography; TSS, toxic shock syndrome; WHO, World Health Organization.
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Affiliation(s)
- Marlos Melo Martins
- Department of Pediatrics, Institute of Childcare and Pediatrics Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio De Janeiro, Brazil
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, Intituto d'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
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48
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Abstract
Medical care is predicated on 'do no harm', yet the urgency to find drugs and vaccines to treat or prevent COVID-19 has led to an extraordinary effort to develop and test new therapies. Whilst this is an essential cornerstone of a united global response to the COVID-19 pandemic, the absolute requirements for meticulous efficacy and safety data remain. This is especially pertinent to the needs of pregnant women; a group traditionally poorly represented in drug trials, yet a group at heightened risk of unintended adverse materno-fetal consequences due to the unique physiology of pregnancy and the life course implications of fetal or neonatal drug exposure. However, due to the complexities of drug trial participation when pregnant (be they vaccines or therapeutics for acute disease), many clinical drug trials will exclude them. Clinicians must determine the best course of drug treatment with a dearth of evidence from either clinical or preclinical studies, where at least in the short term they may be more focused on the outcome of the mother than of her offspring.
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49
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Papapanou M, Papaioannou M, Petta A, Routsi E, Farmaki M, Vlahos N, Siristatidis C. Maternal and Neonatal Characteristics and Outcomes of COVID-19 in Pregnancy: An Overview of Systematic Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E596. [PMID: 33445657 PMCID: PMC7828126 DOI: 10.3390/ijerph18020596] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022]
Abstract
(1) Background: A considerable number of systematic reviews, with substantial heterogeneity regarding their methods and included populations, on the impact of COVID-19 on infected pregnant women and their neonates, has emerged. The aim was to describe the obstetric-perinatal and neonatal outcome of infected pregnant women and their newborns during the COVID-19 pandemic; (2) Methods: Three bibliographical databases were searched (last search: September 10, 2020). Quality assessment was performed using the AMSTAR-2 tool. Primary outcomes included mode of delivery, preterm delivery/labor, premature rupture of membranes (PROM/pPROM) and abortions/miscarriages. Outcomes were mainly presented as ranges. A separate analysis, including only moderate and high-quality systematic reviews, was also conducted. The protocol was registered with PROSPERO (CRD42020214447); (3) Results: Thirty-nine reviews were analyzed. Reported rates, regarding both preterm and term gestations, varied between 52.3 and 95.8% for cesarean sections; 4.2-44.7% for vaginal deliveries; 14.3-63.8% specifically for preterm deliveries and 22.7-32.2% for preterm labor; 5.3-12.7% for PROM and 6.4-16.1% for pPROM. Maternal anxiety for potential fetal infection contributed to abortion decisions, while SARS-CoV-2-related miscarriages could not be excluded. Maternal ICU admission and mechanical ventilation rates were 3-28.5% and 1.4-12%, respectively. Maternal mortality rate was <2%, while stillbirth, neonatal ICU admission and mortality rates were <2.5%, 3.1-76.9% and <3%, respectively. Neonatal PCR positivity rates ranged between 1.6% and 10%. After accounting for quality of studies, ranges of our primary outcomes remained almost unchanged, while among our secondary outcomes, maternal ICU admission (3-10%) and mechanical ventilation rates (1.4-5.5%) were found to be relatively lower; (4) Conclusions: Increased rates of cesarean sections and preterm birth rates were found, with iatrogenic reasons potentially involved. In cases of symptomatic women with confirmed infection, high maternal and neonatal ICU admission rates should raise some concerns. The probability of vertical transmission cannot be excluded. Further original studies on women from all trimesters are warranted.
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Affiliation(s)
- Michail Papapanou
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Maria Papaioannou
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Aikaterini Petta
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Eleni Routsi
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Maria Farmaki
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece
| | - Charalampos Siristatidis
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece
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Patil UP, Krishnan P, Abudinen-Vasquez S, Maru S, Noble L. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positive Newborns of COVID-19 Mothers After Dyad-Care: A Case Series. Cureus 2021; 13:e12528. [PMID: 33569259 PMCID: PMC7864286 DOI: 10.7759/cureus.12528] [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] [Indexed: 11/23/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in newborns is extremely rare, and there is a scarcity of research pertaining to epidemiology, clinical presentation, transmission, and prognosis in this population. We present five newborns who tested positive while colocating with their SARS-CoV-2 positive mothers from March 19 to May 15, 2020, at a large public hospital in Queens, New York that was severely affected by the coronavirus disease 2019 (COVID-19) pandemic. All the newborns subsequently tested negative and remained asymptomatic, including through median outpatient follow-up of three weeks.
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Affiliation(s)
- Uday P Patil
- Pediatrics / Neonatal-Perinatal Medicine, Icahn School of Medicine at Mt. Sinai and New York City Health + Hospitals/Elmhurst, Elmhurst, USA
| | - Parvathy Krishnan
- Pediatrics, Icahn School of Medicine at Mt. Sinai and New York City Health + Hospitals/Elmhurst, Elmhurst, USA
| | - Samira Abudinen-Vasquez
- Pediatrics, Icahn School of Medicine at Mt. Sinai and New York City Health + Hospitals/Elmhurst, Elmhurst, USA
| | - Sheela Maru
- Obstetrics, Gynecology and Reproductive Science, New York City Health + Hospitals/Elmhurst, New York City, USA.,Health System Design and Global Health and Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Lawrence Noble
- Pediatrics / Neonatal-Perinatal Medicine, Icahn School of Medicine at Mt. Sinai and New York City Health + Hospitals/Elmhurst, Elmhurst, USA
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