1
|
Costa S, Giordano L, Bottoni A, Tiberi E, Fattore S, Pastorino R, Simone ND, Lanzone A, Buonsenso D, Valentini P, Cattani P, Santangelo R, Sanguinetti M, Scambia G, Vento G. Vertical Transmission of SARS-CoV-2 during Pregnancy: A Prospective Italian Cohort Study. Am J Perinatol 2024; 41:1077-1085. [PMID: 35263767 DOI: 10.1055/a-1792-4535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The extent of vertical transmission (VT) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from mothers their fetuses or neonates is still uncertain. We aimed to determine the incidence of VT. STUDY DESIGN In this prospective cohort study. All mother diagnosed with SARS-CoV-2 infection at the time of delivery or up to 1 week prior and their neonates, managed in a tertiary referral hospital for pregnancy complicated by coronavirus disease 2019 (COVID-19) in Rome, from April 2 to December 22, 2020, were included. Maternal infection was defined as nasopharyngeal swab test results positive for SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR). Biological samples were collected before, at, and after delivery to test positivity for SARS-CoV-2 RT-PCR and anti-SARS-CoV-2-specific antibodies. RESULTS The cohort included 95 women and 96 neonates with documented SARS-CoV-2 test results. Four neonates (4.2%) tested positive. The incidence of VT, according to the guidance criteria for diagnosing perinatal SARS-CoV-2 infection, was 5.2%. Neonatal symptoms were due to prematurity or fetal distress: symptomatic infants had lower median (min-max) gestational age, 38.1 (29.3-40.6) versus 39.3 (33.9-41.9) weeks (p = 0.036), and 1-minute and 5-minute Apgar scores, 9 (3-9) versus 9 (7-10) (p = 0.036) and 10 (6-10) versus 10 (8-10) (p = 0.012), respectively, than asymptomatic infants and needed more frequent assistance in the delivery room (22.2 vs 2.5%; p = 0.008). Only six (7.1%) neonates had anti-SARS-CoV-2-specific antibodies, despite the ongoing maternal infection. CONCLUSION The incidence of VT is low as is the detection of specific anti-SARS-CoV-2 antibodies in cord blood when infection is contracted late in pregnancy. This would suggest poor protection of infants against horizontal transmission of the virus. KEY POINTS · VT of SARS-CoV-2 from pregnant mothers to fetuses or neonates can be possible.. · In this prospective cohort study, the incidence of VT is found to be 5.2%.. · VT is low but exists..
Collapse
Affiliation(s)
- Simonetta Costa
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Giordano
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anthea Bottoni
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eloisa Tiberi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Fattore
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Lanzone
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paola Cattani
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosaria Santangelo
- Department of Laboratory and Infectivology Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Maurizio Sanguinetti
- Department of Laboratory and Infectivology Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
2
|
Aouabdi S, Aboalola D, Zakari S, Alwafi S, Nedjadi T, Alsiary R. Protective potential of mesenchymal stem cells against COVID-19 during pregnancy. Future Sci OA 2024; 10:FSO924. [PMID: 38836262 PMCID: PMC11149780 DOI: 10.2144/fsoa-2023-0179] [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: 08/31/2023] [Accepted: 10/17/2023] [Indexed: 06/06/2024] Open
Abstract
SARS-CoV-2 causes COVID-19. COVID-19 has led to severe clinical illnesses and an unprecedented death toll. The virus induces immune inflammatory responses specifically cytokine storm in lungs. Several published reports indicated that pregnant females are less likely to develop severe symptoms compared with non-pregnant. Putative protective role of maternal blood circulating fetal mesenchymal stem cells (MSCs) has emerged and have been put forward as an explanation to alleviated symptoms. MSCs with immune-modulatory, anti-inflammatory and anti-viral roles, hold great potential for the treatment of COVID-19. MSCs could be an alternative to treat infections resulting from the SARS-CoV-2 and potential future outbreaks. This review focuses on the MSCs putative protective roles against COVID-19 in pregnant females.
Collapse
Affiliation(s)
- Sihem Aouabdi
- King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
| | - Doaa Aboalola
- King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
| | - Samer Zakari
- King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
| | - Suliman Alwafi
- King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
| | - Taoufik Nedjadi
- King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
| | - Rawiah Alsiary
- King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia
| |
Collapse
|
3
|
Bajaj M, Romero R, Myers L, Duncan J, Yeo L, Jani S, Natarajan G. Population-Level Study on Fetal Deaths and Preterm Births during SARS-CoV-2 Pandemic in the State of Michigan. Am J Perinatol 2024; 41:e236-e248. [PMID: 35709722 PMCID: PMC10065952 DOI: 10.1055/a-1878-0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to explore the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on preterm birth at different gestational ages and fetal death in the state of Michigan. STUDY DESIGN Data on live births and fetal deaths in the state of Michigan from March to November in the years 2017 through 2020 were obtained from Michigan Department of Health and Human Services (MDHHS). Preterm birth rate, fetal death rate (per 1,000 live births) overall and stratified by race and maternal comorbidities during the period of pandemic (March-November 2020) were compared with the same period (March-November) in the prepandemic years (2017-2019). RESULTS Of 328,879 live births and 1,470 fetal deaths during the study period, 77,983 live births and 242 fetal deaths were reported in 2020. Compared with prepandemic years, fetal death rate per 1,000 live births was significantly lower in 2020 (3.1 vs. 4.7 [2017], 5.2 [2018], 4.4 [2019], p-value <0.001). The adjusted risk for fetal death in 2020 was decreased (odds ratio [OR] = 0.64 [95% confidence interval (CI): 0.56-0.74], p <0.0001), compared with prepandemic years. Fetal death was significantly associated with African-American race, pregnancy hypertension and prepregnancy diabetes. No significant difference in the proportion of preterm births (<37 weeks' gestation) was noted between pandemic and prepandemic years (9.9 vs. 10.0%, p = 0.50). There was no significant difference in the risk of preterm birth across gestational age strata (<28, 28-316/7, 32-366/7, 37-416/7, and >42 weeks) between pandemic and prepandemic years on multinomial analysis. Significant associations with preterm birth across all years included African American race, lower level of maternal education, pregnancy-induced hypertension, chronic hypertension, prepregnancy diabetes, congenital anomalies, previous preterm birth, and prolonged rupture of membranes >12 hours. CONCLUSION Fetal death rate was significantly lower whereas preterm births remained unchanged during pandemic in comparison with prepandemic years in the state of Michigan. KEY POINTS · A decrease in fetal death rate was noted during SARS CoV-2 pandemic in the State of Michigan.. · Overall state-wide rates of preterm birth did not change in 2020, compared to previous years.. · Significant risk factors associated with preterm birth and fetal deaths did not differ between prepandemic and pandemic years..
Collapse
Affiliation(s)
- Monika Bajaj
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
- Detroit Medical Center, Detroit, Michigan
| | - Lindsey Myers
- Division for Vital Records and Health Statistics, Department of Health and Human Services, Lansing, Michigan
| | - Jeffrey Duncan
- Division for Vital Records and Health Statistics, Department of Health and Human Services, Lansing, Michigan
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sanket Jani
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
| | - Girija Natarajan
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
| |
Collapse
|
4
|
Ghosh R, Gutierrez JP, de Jesús Ascencio-Montiel I, Juárez-Flores A, Bertozzi SM. SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study. BMJ Open 2024; 14:e075928. [PMID: 38604636 PMCID: PMC11015228 DOI: 10.1136/bmjopen-2023-075928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection. DESIGN AND SETTING The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021. PARTICIPANTS We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy. OUTCOME MEASURES PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies. RESULTS The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations. CONCLUSIONS In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period.
Collapse
Affiliation(s)
- Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Juan Pablo Gutierrez
- Center for Policy, Population & Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Arturo Juárez-Flores
- Center for Policy, Population & Health Research, National Autonomous University of Mexico, Mexico City, Mexico
| | - Stefano M Bertozzi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
- University of Washington - Seattle Campus, Seattle, Washington, USA
- National Institute of Public Health, Cuernavaca, Mexico
| |
Collapse
|
5
|
Xiao H, Chen C, Huang S, Zhang W, Cai S, Hou X, Luo Y, Lin Y. Effects of novel coronavirus Omicron variant infection on pregnancy outcomes: a retrospective cohort study from Guangzhou. Front Med (Lausanne) 2023; 10:1256080. [PMID: 38170092 PMCID: PMC10759226 DOI: 10.3389/fmed.2023.1256080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Objective Since 2022, Omicron has been circulating in China as a major variant of the novel coronavirus, but the effects of infection with Omicron variants on pregnant women and newborns are unknown. The purpose of this study was to determine the clinical characteristics of Omicron infection during pregnancy and its effect on pregnancy outcomes. Methods This study retrospectively analyzed the data of 93 confirmed cases of novel coronavirus infection and 109 non-infected patients admitted to the isolation ward of Guangdong Maternal and Child Health Hospital from December 1, 2022 to January 31, 2023, and statistically analyzed the clinical features of Omicron variant infection during pregnancy and its impact on pregnancy outcomes. Further effects of underlying diseases on Omicron infection in pregnant women were analyzed. Results The incubation period of COVID-19 infection was 0.99±0.86 days, 94.38% of patients had fever or other respiratory symptoms, the lymphocyte count in the infected group was lower than that in the uninfected group, and the lymphocyte count was further reduced in the patients with pregnancy complications or complications. Compared with the uninfected group, APTT and PT were prolonged, platelet count and fibrinogen were decreased in the infected group, all of which had statistical significance. COVID-19 infection during pregnancy increased the rate of cesarean section compared to uninfected pregnant patients, and COVID-19 infection in gestational diabetes resulted in a 4.19-fold increase in cesarean section rate. There was no statistically significant difference in gestational age between the two groups. The incidence of intrauterine distress, turbidity of amniotic fluid and neonatal respiratory distress were higher in the infection group. No positive cases of neonatal COVID-19 infection have been found. Conclusion The patients infected with omicron during pregnancy often have febrile respiratory symptoms with lymphocyopenia, but the incidence of severe disease is low. Both Omicron infection and gestational diabetes further increase the incidence of cesarean section, and this study found no evidence of vertical transmission of Omicron.
Collapse
Affiliation(s)
- Huanshun Xiao
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Cheng Chen
- Department of Intensive Care Unit, Baiyun Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shan Huang
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wenni Zhang
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shuangming Cai
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiangling Hou
- Faculty of Science and Technology, BNU-HKBU United International College, Zhuhai, China
| | - Yiping Luo
- Department of MICU, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yu Lin
- Department of Intensive Care Unit, Baiyun Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
6
|
Bahado-Singh R, Tarca AL, Hasbini YG, Sokol RJ, Keerthy M, Goyert G, Jones T, Thiel L, Green P, Youssef Y, Townsel C, Vengalil S, Paladino P, Wright A, Ayyash M, Vadlamudi G, Szymanska M, Sajja S, Turkoglu O, Sterenberg G, Mangus AR, Baracy M, Gibbons M, Grace K, Houston K, Norman J, Gudicha DW, Hassan SS. Maternal SARS-COV-2 infection and prematurity: the Southern Michigan COVID-19 collaborative. J Matern Fetal Neonatal Med 2023; 36:2199343. [PMID: 37217448 DOI: 10.1080/14767058.2023.2199343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE COVID-19 has been reported to increase the risk of prematurity, however, due to the frequent absence of unaffected controls as well as inadequate accounting for confounders in many studies, the question requires further investigation. We sought to determine the impact of COVID-19 disease on preterm birth (PTB) overall, as well as related subcategories such as early prematurity, spontaneous, medically indicated preterm birth, and preterm labor (PTL). We assessed the impact of confounders such as COVID-19 risk factors, a-priori risk factors for PTB, symptomatology, and disease severity on rates of prematurity. METHODS This was a retrospective cohort study of pregnant women from March 2020 till October 1st, 2020. The study included patients from 14 obstetric centers in Michigan, USA. Cases were defined as women diagnosed with COVID-19 at any point during their pregnancy. Cases were matched with uninfected women who delivered in the same unit, within 30 d of the delivery of the index case. Outcomes of interest were frequencies of prematurity overall and subcategories of preterm birth (early, spontaneous/medically indicated, preterm labor, and premature preterm rupture of membranes) in cases compared to controls. The impact of modifiers of these outcomes was documented with extensive control for potential confounders. A p value <.05 was used to infer significance. RESULTS The rate of prematurity was 8.9% in controls, 9.4% in asymptomatic cases, 26.5% in symptomatic COVID-19 cases, and 58.8% among cases admitted to the ICU. Gestational age at delivery was noted to decrease with disease severity. Cases were at an increased risk of prematurity overall [adjusted relative risk (aRR) = 1.62 (1.2-2.18)] and of early prematurity (<34 weeks) [aRR = 1.8 (1.02-3.16)] when compared to controls. Medically indicated prematurity related to preeclampsia [aRR = 2.46 (1.47-4.12)] or other indications [aRR = 2.32 (1.12-4.79)], were the primary drivers of overall prematurity risk. Symptomatic cases were at an increased risk of preterm labor [aRR = 1.74 (1.04-2.8)] and spontaneous preterm birth due to premature preterm rupture of membranes [aRR = 2.2(1.05-4.55)] when compared to controls and asymptomatic cases combined. The gestational age at delivery followed a dose-response relation with disease severity, as more severe cases tended to deliver earlier (Wilcoxon p < .05). CONCLUSIONS COVID-19 is an independent risk factor for preterm birth. The increased preterm birth rate in COVID-19 was primarily driven by medically indicated delivery, with preeclampsia as the principal risk factor. Symptomatic status and disease severity were significant drivers of preterm birth.
Collapse
Affiliation(s)
- Ray Bahado-Singh
- Department of Obstetrics and Gynecology, William Beaumont Hospital - Royal Oak, Royal Oak, MI, USA
| | - Adi L Tarca
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, USA
- Department of Computer Science, College of Engineering, Wayne State University, Detroit, MI, USA
| | - Yasmin G Hasbini
- Office of Women's Health, Wayne State University, Detroit, MI, USA
| | - Robert J Sokol
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Madhurima Keerthy
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Gregory Goyert
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | | | | | - Pooja Green
- St Joseph Mercy Health System, Ann Arbor, MI, USA
| | | | - Courtney Townsel
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | | | - Paige Paladino
- Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA
| | - Amy Wright
- St. Joseph Mercy Oakland, Trinity Health, Pontiac, MI, USA
| | - Mariam Ayyash
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Gayathri Vadlamudi
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Marta Szymanska
- Department of Obstetrics and Gynecology, William Beaumont Hospital - Royal Oak, Royal Oak, MI, USA
| | - Sonia Sajja
- Department of Obstetrics and Gynecology, William Beaumont Hospital - Royal Oak, Royal Oak, MI, USA
| | - Onur Turkoglu
- Department of Obstetrics and Gynecology, William Beaumont Hospital - Royal Oak, Royal Oak, MI, USA
| | | | - Alexandra R Mangus
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Karlee Grace
- Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA
| | | | - Jessica Norman
- St. Joseph Mercy Oakland, Trinity Health, Pontiac, MI, USA
| | - Dereje W Gudicha
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Sonia S Hassan
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, USA
- Office of Women's Health, Wayne State University, Detroit, MI, USA
- Department of Physiology, School of Medicine, Wayne State University, Detroit, MI, USA
| |
Collapse
|
7
|
McLaren R, London V, Narayanamoorthy S, Atallah F, Silver M, Minkoff H. Cesarean Birth Morbidity among Women with SARS-CoV-2. Am J Perinatol 2023; 40:1367-1372. [PMID: 34775582 DOI: 10.1055/s-0041-1739430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The objective of this study was to compare maternal outcomes of women with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who underwent cesarean births. STUDY DESIGN This was a matched cohort study of pregnant women who had a cesarean birth between March 15, 2020, and May 20, 2020. Cases included women who tested positive for SARS-CoV-2. For every case, two patients who tested negative for SARS-CoV-2 were matched by maternal age, gestational age, body mass index, primary or repeat cesarean birth, and whether the procedure was scheduled or unscheduled. We compared rates of adverse postcesarean complications (intraoperative bladder or bowel injury, estimated blood loss more than or equal to 1,000 mL, hemoglobin drop more than 3 g/dL, hematocrit drop more than 10%, need for blood transfusion, need for hysterectomy, maternal intensive care unit admission, postoperative fever, and development of surgical site infection), with the primary outcome being a composite of those outcomes. We also assessed duration of postoperative stay. Fisher's exact tests were performed to compare the primary outcome between both groups. RESULTS Between March and May 2020, 202 women who subsequently underwent cesarean birth were tested for SARS-CoV-2. Of those 202, 43 (21.3%) patients were positive. They were matched to 86 patients who tested negative. There was no significant difference in the rate of composite adverse surgical outcomes between the groups (SARS-CoV-2 infected 27.9%, SARS-CoV-2 uninfected 25.6%; p = 0.833). There was a higher rate of postoperative fevers (20.9 vs. 5.8%; p = 0.015), but that did not result in a longer length of stay (p = 0.302). CONCLUSION Pregnant women with SARS-CoV-2 who underwent a cesarean birth did not have an increased risk of adverse surgical outcomes, other than fever, compared with pregnant women without SARS-CoV-2. KEY POINTS · Women with SARS-CoV-2 had more postoperative fevers.. · Length of stay did not differ based on SARS-CoV-2 status.. · Composite postoperative outcome did not differ based on SARS-CoV-2 status..
Collapse
Affiliation(s)
- Rodney McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Viktoriya London
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | | | - Fouad Atallah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Michael Silver
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Howard Minkoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
- Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York
| |
Collapse
|
8
|
Reznik SE, Vuguin PM, Cohen A, Khoury R, Loudig O, Balakrishnan R, Fineberg SA, Hughes F, Harigopal M, Charron MJ. SARS-CoV-2 Infection in Unvaccinated High-Risk Pregnant Women in the Bronx, NY, USA Is Associated with Decreased Apgar Scores and Placental Villous Infarcts. Biomolecules 2023; 13:1224. [PMID: 37627289 PMCID: PMC10452574 DOI: 10.3390/biom13081224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Babies born to severe acute respiratory syndrome corona virus-2 (SARS-CoV-2)-infected mothers are at greater risk for perinatal morbidity and more likely to receive a neurodevelopmental diagnosis in the first year of life. However, the effect of maternal infection on placental function and neonatal outcomes varies depending upon the patient population. We set out to test our hypothesis that maternal SARS-CoV-2 infection in our underserved, socioeconomically disadvantaged, mostly unvaccinated, predominantly African American and Latina population in the Bronx, NY would have effects evident at birth. Under IRB approval, 56 SARS-CoV-2-positive patients infected during the "first wave" of the pandemic with alpha and beta strains of the virus, 48 patients infected during the "second wave" of the pandemic with delta and omicron strains and 61 negative third-trimester high-risk patients were randomly selected from Montefiore Medical Center (MMC), Bronx, NY. In addition, two positive cases from Yale New Haven Hospital, CT were included as controls. All 104 placentas delivered by SARS-CoV-2-positive mothers were uninfected by the virus, based on immunohistochemistry, in situ hybridization, and qPCR analysis. However, placental villous infarcts were significantly increased in first-wave cases compared to second-wave cases or negative controls. Significantly lower Apgar scores at 1 min and 5 min were observed in neonates born to infected mothers with severe symptoms. These findings suggest that even without entering the placenta, SARS-CoV-2 can affect various systemic pathways, culminating in altered placental development and function, which may adversely affect the fetus, especially in a high-risk patient population such as ours. These results underline the importance of vaccination among pregnant women, particularly in low-resource areas.
Collapse
Affiliation(s)
- Sandra E. Reznik
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Pharmaceutical Sciences, St. John’s University, Queens, NY 11439, USA
| | - Patricia M. Vuguin
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA
| | - Alexa Cohen
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Rasha Khoury
- Obstetrics and Gynecology and Divisions of Complex Family Planning and Maternal Fetal Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Olivier Loudig
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Ridin Balakrishnan
- Department of Pathology, Louisiana School of Medicine, LSU Health, New Orleans, LA 70112, USA
| | - Susan A. Fineberg
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Francine Hughes
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Malini Harigopal
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Maureen J. Charron
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine and the Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| |
Collapse
|
9
|
Woo EJ, Gee J, Marquez P, Baggs J, Abara WE, McNeil MM, Dimova RB, Su JR. Post-authorization safety surveillance of Ad.26.COV2.S vaccine: Reports to the Vaccine Adverse Event Reporting System and v-safe, February 2021-February 2022. Vaccine 2023; 41:4422-4430. [PMID: 37321898 PMCID: PMC10264169 DOI: 10.1016/j.vaccine.2023.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND On 2/27/2021, FDA authorized Janssen COVID-19 Vaccine (Ad.26.COV2.S) for use in individuals 18 years of age and older. Vaccine safety was monitored using the Vaccine Adverse Event Reporting System (VAERS), a national passive surveillance system, and v-safe, a smartphone-based surveillance system. METHODS VAERS and v-safe data from 2/27/2021 to 2/28/2022 were analyzed. Descriptive analyses included sex, age, race/ethnicity, seriousness, AEs of special interest (AESIs), and cause of death. For prespecified AESIs, reporting rates were calculated using the total number of doses of Ad26.COV2.S administered. For myopericarditis, observed-to-expected (O/E) analysis was performed based on the number verified cases, vaccine administration data, and published background rates. Proportions of v-safe participants reporting local and systemic reactions, as well as health impacts, were calculated. RESULTS During the analytic period, 17,018,042 doses of Ad26.COV2.S were administered in the United States, and VAERS received 67,995 reports of AEs after Ad26.COV2.S vaccination. Most AEs (59,750; 87.9 %) were non-serious and were similar to those observed during clinical trials. Serious AEs included COVID-19 disease, coagulopathy (including thrombosis with thrombocytopenia syndrome; TTS), myocardial infarction, Bell's Palsy, and Guillain-Barré syndrome (GBS). Among AESIs, reporting rates per million doses of Ad26.COV2.S administered ranged from 0.06 for multisystem inflammatory syndrome in children to 263.43 for COVID-19 disease. O/E analysis revealed elevated reporting rate ratios (RRs) for myopericarditis; among adults ages 18-64 years, the RR was 3.19 (95 % CI 2.00, 4.83) within 7 days and 1.79 (95 % CI 1.26, 2.46) within 21 days of vaccination. Of 416,384 Ad26.COV2.S recipients enrolled into v-safe, 60.9 % reported local symptoms (e.g. injection site pain) and 75.9 % reported systemic symptoms (e.g., fatigue, headache). One-third of participants (141,334; 33.9 %) reported a health impact, but only 1.4 % sought medical care. CONCLUSION Our review confirmed previously established safety risks for TTS and GBS and identified a potential safety concern for myocarditis.
Collapse
Affiliation(s)
- Emily Jane Woo
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20903, United States.
| | - Julianne Gee
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - Paige Marquez
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - James Baggs
- Epidemiology Research and Innovations Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States
| | - Winston E Abara
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - Rositsa B Dimova
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20903, United States
| | - John R Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| |
Collapse
|
10
|
Jeong Y, Kim MA. The coronavirus disease 2019 infection in pregnancy and adverse pregnancy outcomes: a systematic review and meta-analysis. Obstet Gynecol Sci 2023; 66:270-289. [PMID: 37194243 PMCID: PMC10375217 DOI: 10.5468/ogs.22323] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak which started in December 2019 rapidly developed into a global health concern. Pregnant women are susceptible to respiratory infections and can experience adverse outcomes. This systematic review and meta-analysis compared pregnancy outcomes according to COVID-19 disease status. The MEDLINE, EMBASE, and Cochrane Library databases were searched for relevant articles published between December 1, 2019, and October 19, 2022. Main inclusion criterion was any population-based, cross-sectional, cohort, or case-control study that assessed pregnancy outcomes in women with or without laboratory-confirmed COVID-19. Sixty-nine studies including 1,606,543 pregnant women (39,716 [2.4%] diagnosed with COVID-19) were retrieved. COVID-19-infected pregnant women had a higher risk of preterm birth (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.42-1.78), preeclampsia (OR, 1.41; 95% CI, 1.30-1.53), low birth weight (OR, 1.52; 95% CI, 1.30-1.79), cesarean delivery (OR, 1.20; 95% CI, 1.10-1.30), stillbirth (OR, 1.71; 95% CI, 1.39-2.10), fetal distress (OR, 2.49; 95% CI, 1.54-4.03), neonatal intensive care unit admission (OR, 2.33; 95% CI, 1.72-3.16), perinatal mortality (OR, 1.96; 95% CI, 1.15-3.34), and maternal mortality (OR, 6.15; 95% CI, 3.74-10.10). There were no significant differences in total miscarriage, preterm premature rupture of membranes, postpartum hemorrhage, cholestasis, or chorioamnionitis according to infection. This review demonstrates that COVID-19 infection during pregnancy can lead to adverse pregnancy outcomes. This information could aid researchers and clinicians in preparing for another pandemic caused by newly discovered respiratory viruses. The findings of this study may assist with evidence-based counseling and help clinicians manage pregnant women with COVID-19.
Collapse
Affiliation(s)
- Yeonsong Jeong
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min-A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Charuta A, Smuniewska M, Woźniak Z, Paziewska A. Effect of COVID-19 on Pregnancy and Neonate's Vital Parameters: A Systematic Review. J Pregnancy 2023; 2023:3015072. [PMID: 37215313 PMCID: PMC10199793 DOI: 10.1155/2023/3015072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023] Open
Abstract
Background COVID-19 is a new pandemic, which was declared by the World Health Organization in 2019 as a threat to public health. According to numerous reports, it can have negative consequences for pregnant women, labour, and neonates born to infected mothers. The aim of this paper was to gather the evidence and to present a summary of the results of studies concerning COVID-19 in pregnant women and their neonates. Methods Articles from prestigious journals covering the period from 2020 to February 2023, relevant review papers, and original research articles from PubMed were analysed. In order to analyse the available research literature, the Web of Science, Scopus, and PubMed databases were used, in which the search for articles was conducted using terms ("pregnancy," "coronavirus," "SARS-CoV-2," and "newborn") and using PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis) guidelines for clinical trials. Meta-analyses and systematic reviews (2022-2023) on symptoms, neonatal course, and risk of COVID-19 infection have been summarized. Summary of meta-analyses and systematic reviews (2022-2023) on the effect and adverse reaction of the COVID-19 vaccination is presented. Results As a result of the research conducted, it was confirmed that in most pregnant women, no serious signs of the infection were observed, although isolated cases of death related to COVID-19 in pregnant women were reported. Several authors called attention to the more severe course of the infection in pregnant women with obesity. It seemed that no vertical transmission from mother to child was occurring. Nevertheless, the information was not clinching. The condition of the neonates born to mothers with COVID-19 was in most cases described as normal; however, some papers reported deaths of infected neonates. Conclusions Due to insufficient data, further research is necessary. Further studies and follow-up are recommended, which would make possible an assessment of remote effects of COVID-19 on pregnancy and vital parameters of the newborn.
Collapse
Affiliation(s)
- Anna Charuta
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Poland
| | - Monika Smuniewska
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Mazowiecki Provincial Hospital in Siedlce Named after Saint John Paul II in Siedlce, Poland
| | - Zofia Woźniak
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Independent Public Health Care Center in Sokołów Podlaski, Poland
| | - Agnieszka Paziewska
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Poland
| |
Collapse
|
12
|
Mihajlovic S, Nikolic D, Milicic B, Santric-Milicevic M, Glushkova N, Nurgalieva Z, Lackovic M. Association of Pre-Pregnancy Obesity and COVID-19 with Poor Pregnancy Outcome. J Clin Med 2023; 12:jcm12082936. [PMID: 37109271 PMCID: PMC10144693 DOI: 10.3390/jcm12082936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index with clinical, laboratory, and radiology diagnostic parameters as well as pregnancy complications and maternal outcomes in pregnant patients with COVID-19. MATERIALS AND METHODS Clinical status, laboratory, and radiology diagnostic parameters and pregnancy outcomes were analyzed for pregnant women hospitalized between March 2020 and November 2021 in one tertiary-level university clinic in Belgrade, Serbia, due to infection with SARS-CoV-2. Pregnant women were divided into the three sub-groups according to their pre-pregnancy body mass index. For testing the differences between groups, a two-sided p-value <0.05 (the Kruskal-Wallis and ANOVA tests) was considered statistically significant. RESULTS Out of 192 hospitalized pregnant women, obese pregnant women had extended hospitalizations, including ICU duration, and they were more likely to develop multi-organ failure, pulmonary embolism, and drug-resistant nosocomial infection. Higher maternal mortality rates, as well as poor pregnancy outcomes, were also more likely to occur in the obese group of pregnant women. Overweight and obese pregnant women were more likely to develop gestational hypertension, and they had a higher grade of placental maturity. CONCLUSIONS Obese pregnant women hospitalized due to COVID-19 infection were more likely to develop severe complications.
Collapse
Affiliation(s)
- Sladjana Mihajlovic
- University Hospital "Dragisa Misovic", Heroja Milana Tepica 1, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children's Hospital, 11000 Belgrade, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milena Santric-Milicevic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Center-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Natalya Glushkova
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty 050044, Kazakhstan
| | - Zhansaya Nurgalieva
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty 050044, Kazakhstan
| | - Milan Lackovic
- University Hospital "Dragisa Misovic", Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| |
Collapse
|
13
|
Maranto M, Zaami S, Restivo V, Termini D, Gangemi A, Tumminello M, Culmone S, Billone V, Cucinella G, Gullo G. Symptomatic COVID-19 in Pregnancy: Hospital Cohort Data between May 2020 and April 2021, Risk Factors and Medicolegal Implications. Diagnostics (Basel) 2023; 13:diagnostics13061009. [PMID: 36980317 PMCID: PMC10047111 DOI: 10.3390/diagnostics13061009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Pregnancy does not appear to increase susceptibility to SARS-CoV-2 infection, but some physiological changes, such as the reduction of residual functional volumes, elevation of the diaphragm, and impaired cellular immunity, may increase the risk of severe disease and result in a higher risk of complications. The article’s primary objective is to evaluate the factors associated with symptomatic COVID-19 disease in pregnancy. The secondary objective is to describe maternal and neonatal outcomes and cases of vertical transmission of the infection. All pregnant women hospitalized with SARS-CoV2 infection were included in a prospective study in the UOC of Obstetrics and Gynecology, AOOR Villa Sofia—Cervello, Palermo, between May 2020 and April 2021. The patients who requested the termination of the pregnancy according to Law 194/78 were excluded. We included 165 pregnancies with a total number of 134 deliveries. Overall, 88.5% of the patients were asymptomatic at the time of admission and 11.5% were symptomatic. Of them, 1.8% of the patients required hospital admission in the intensive care unit. Symptoms occurrences were positively associated with the increase in maternal BMI (OR 1.17; p = 0.002), the prematurity (OR 4.71; p = 0.022), and at a lower birth weight (OR 0.99; p = 0.007). One infant tested positive for SARS-CoV2 nasopharyngeal swab; 11.4% of newborns had IgG anti SARS-CoV2 at birth; IgM was positive in 2.4% of newborns. There was no difference statistically significant difference in the vertical transmission of the infection among the group of symptomatic pregnant women and that of asymptomatic pregnant women.
Collapse
Affiliation(s)
- Marianna Maranto
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Vincenzo Restivo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Donatella Termini
- Neonatal Intensive Care Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy
| | - Antonella Gangemi
- Neonatal Intensive Care Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy
| | - Mario Tumminello
- Neonatal Intensive Care Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy
| | - Silvia Culmone
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Valentina Billone
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
- Correspondence:
| |
Collapse
|
14
|
Attini R, Laudani ME, Versino E, Massaro A, Pagano A, Petey F, Revelli A, Masturzo B. COVID-19 in Pregnancy: Influence of Body Weight and Nutritional Status on Maternal and Pregnancy Outcomes-A Review of Literature and Meta-Analysis. Nutrients 2023; 15:nu15041052. [PMID: 36839410 PMCID: PMC9962478 DOI: 10.3390/nu15041052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
In the last two and a half years, COVID-19 has been one of the most challenging public health issues worldwide. Based on the available evidence, pregnant women do not appear to be more susceptible to infection than the general population but having COVID-19 during pregnancy may increase the risk of major complications for both the mother and the fetus. The aim of this study is to identify the correlation between BMI and nutritional status and the likelihood of contracting COVID-19 infection in pregnancy, its severity, and maternal pregnancy outcomes. We carry out a systematic literature search and a meta-analysis using three databases following the guidelines of the Cochrane Collaboration. We include 45 studies about COVID-19-positive pregnant women. Compared with normal-weight pregnant women with COVID-19, obesity is associated with a more severe infection (OR = 2.32 [1.65-3.25]), increased maternal death (OR = 2.84 [2.01-4.02]), and a higher rate of hospital admission (OR = 2.11 [1.37-3.26]). Obesity may be associated with adverse maternal and pregnancy outcomes by increasing symptom severity and, consequently, hospital and Intensive Care Unit (ICU) admission, and, finally, death rates. For micronutrients, the results are less definite, even if there seems to be a lower level of micronutrients, in particular Vitamin D, in COVID-19-positive pregnant women.
Collapse
Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
- Correspondence:
| | - Maria Elena Laudani
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Elisabetta Versino
- Department of Clinical and Biological Sciences, University of Turin, 10100 Turin, Italy
- Centre for Biostatistics, Epidemiology and Public Health (C-BEPH), 10100 Turin, Italy
| | - Alessio Massaro
- Department of Obstetrics and Gynecology SC1U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Arianna Pagano
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Francesca Petey
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Alberto Revelli
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Bianca Masturzo
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| |
Collapse
|
15
|
Albavera-Hernández C, Rodríguez-Hernández JM, Piñeros-Garzón FS, Montoya-Sanabria SM. The challenge of asymptomatic carriers of COVID-19: A rapid review of literature. Rev Salud Publica (Bogota) 2023; 22:649-657. [PMID: 36753084 DOI: 10.15446/rsap.v22n6.91181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe the epidemiological and sociodemographic characteristics of asymptomatic carriers reported in the literature, and to review the strategies used for diagnosis and control. METHODS Systematic literature review approach. As inclusion criteria, all studies published between January 1 and June 26, 2020, conducted in humans, that reported people who remained asymptomatic of COVID-19. Descriptors were adapted to the interfaces of eight bibliographic databases were configured: PubMed, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos and Embase. RESULTS About 45% of the articles reported adult population, thirteen reported mixed population (adult and pediatric). 3 525 asymptomatic people were reported, with an average of 37,1 years [0.5-82 years]. Although the effectiveness of the control and prevention measures was not reported, the identification, isolation and follow-up of contacts stands out as a potential effective mechanism to prevent the transmission. CONCLUSIONS The use of this information could be relevant to guide evidence-based public health policies and the protection of populations and the improvement of health care that contributes to stopping this pandemic.
Collapse
Affiliation(s)
- Cidronio Albavera-Hernández
- CA: MD. Family Medicine Specialist. M.Sc.; D.Sc. Epidemiology. Mexican Institute of Social Security. Regional General Hospital with Family Medicine No.1. Cuernavaca, Mexico.
| | - Jorge M Rodríguez-Hernández
- JR: MD. M.Sc.; D.Sc. Epidemiology. Institute of Public Health. Pontificia Universidad Javeriana. Bogotá, Colombia.
| | | | - Sandra M Montoya-Sanabria
- SM: RN. M.Sc.; Ph.D.(c). Public Health. Institute of Public Health. Pontificia Universidad Javeriana. Bogotá, Colombia.
| |
Collapse
|
16
|
Muacevic A, Adler JR. A Retrospective Cohort Study on Maternal and Neonatal Clinical Characteristics and Outcomes of COVID-19: Does the Gestational Age Affect the Outcome? Cureus 2023; 15:e35188. [PMID: 36811131 PMCID: PMC9939081 DOI: 10.7759/cureus.35188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
Background To evaluate the maternal and neonatal clinical characteristics and outcomes of COVID-19 during pregnancy and to see whether infection with COVID-19 before or after the 20th gestational week affects these outcomes. Methods We conducted a retrospective study with data from pregnant women who were followed up and delivered at Acibadem Maslak Hospital between April 2020 and December 2021. Their demographics and clinical data were reviewed and compared. Results Among 1223 pregnant women, 42 (3.4%) were diagnosed with COVID-19 (SARS-CoV-2-positive). Approximately 52.4% of the 42 pregnant women with COVID-19 were diagnosed during or before the 20th gestational week, while 47.6% were positive after the 20th gestational week. The preterm birth rate was 11.9% and 5.9% in infected and uninfected pregnant women, respectively (p>0.05). In the infected pregnant women, the rate of preterm rupture of membranes (PROM) was 2.4%, small for gestational age (SGA) was 7.1%, cesarean delivery was 76.2%, and neonatal intensive care unit (NICU) admission was 9.5%. These rates among uninfected women were 0.9%, 9.1%, 61.7%, and 4.1%, respectively (p>0.05). Maternal ICU admission and intrapartum complications were higher in infected pregnant women (p>0.05). Postpartum hemorrhage (PPH), intrauterine growth retardation (IUGR), neonatal infection, and fetal demise were absent in SARS-CoV-2-positive pregnant women. Having a high school or lower education level significantly increased the risk of SARS-CoV-2 infection during pregnancy 10 times. Also, a one-week increase in gestational age significantly reduced the risk of SARS-CoV-2 infection during pregnancy. When SARS-CoV-2-positive pregnant women were compared according to whether or not they were positive before or after the 20th gestational week, there was no statistically significant difference between the two groups in terms of maternal outcomes, neonatal outcomes, and demographic characteristics. Conclusions COVID-19 during pregnancy did not adversely affect maternal and neonatal outcomes. Also, whether pregnant women were infected before or after the 20th gestational week did not have a negative impact on maternal and neonatal outcomes. However, infected pregnant women should be followed closely, and they should be informed in detail about the possible adverse outcomes and the importance of precautions for COVID-19.
Collapse
|
17
|
Delanerolle G, McCauley M, Hirsch M, Zeng Y, Cong X, Cavalini H, Sajid S, Shetty A, Rathod S, Shi JQ, Hapangama DK, Phiri P. The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis. BMC Pregnancy Childbirth 2023; 23:76. [PMID: 36709255 PMCID: PMC9883834 DOI: 10.1186/s12884-022-05243-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women. METHODS All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed. RESULTS This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic. DISCUSSION It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times. OTHER The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.
Collapse
Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Health Care Sciences, Uuniversity of Oxford, Oxford, UK
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Mary McCauley
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Martin Hirsch
- University College London, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Yutian Zeng
- Southern University of Science and Technology, Shenzhen, China
| | - Xu Cong
- Southern University of Science and Technology, Shenzhen, China
| | - Heitor Cavalini
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Sana Sajid
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Ashish Shetty
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Jian Qing Shi
- Southern University of Science and Technology, Shenzhen, China
- National Center for Applied Mathematics, Shenzhen, China
| | | | - Peter Phiri
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK.
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| |
Collapse
|
18
|
Dewi A, Safaria T, Supriyatiningsih S, Dewi DTK. Efforts and expectations of pregnant women against the impact of the COVID-19 pandemic: a phenomenological study. BMC Pregnancy Childbirth 2023; 23:53. [PMID: 36681793 PMCID: PMC9862243 DOI: 10.1186/s12884-023-05383-1] [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: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND COVID-19 is a global threat that directly impacts people's mental health and physical well-being. This study explored the efforts and expectations of pregnant women against the impact of the COVID-19 pandemic. METHODS This study was a qualitative study that used a phenomenological approach. The informants of this study were pregnant women (n = 20). Data analysis used content analysis with software assistance (Nvivo Release 1.5). RESULTS The results of this study identified three themes which were: 1) causative factors of pregnant women's anxiety regarding the impact of COVID-19 including lack of knowledge regarding the impact of the COVID-19 virus and perceived susceptibility; 2) Efforts to reduce anxiety during the COVID-19 pandemic including a spiritual approach, the role of family and COVID-19 prevention; and 3) Expectation regarding healthcare services during COVID-19 including virtual based Antenatal Care (ANC) Services and Private ANC Services. CONCLUSION A spiritual approach, the role of family, and COVID-19 prevention will help pregnant women reduce their anxiety about being infected with the COVID-19 virus. Furthermore, virtual-based ANC Services, and private ANC services, such as home visits and dividing ANC services and general services into two different tracks as a protective mechanism from being infected with the COVID-19 virus, would assist pregnant women feel safer and secure.
Collapse
Affiliation(s)
- Arlina Dewi
- grid.444658.f0000 0004 0375 2195Department of Public Health, Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Triantoro Safaria
- grid.444626.60000 0000 9226 1101Department of Psychology, Faculty of Psychology, Ahmad Dahlan University, Yogyakarta, Indonesia
| | - Supriyatiningsih Supriyatiningsih
- grid.444658.f0000 0004 0375 2195Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Dyah Tri Kusuma Dewi
- grid.444658.f0000 0004 0375 2195Department of Public Health, Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia ,grid.412896.00000 0000 9337 0481School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
19
|
COVID-19 not Hypertension or Diabetes increases the risk of Preeclampsia among a high-risk population. Pregnancy Hypertens 2023. [PMCID: PMC9829436 DOI: 10.1016/j.preghy.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
20
|
Muacevic A, Adler JR, Gupta P, Sood AK. COVID-19 Vaccine Acceptance During Pregnancy, Women's Views, and Influencing Factors. Cureus 2023; 15:e34039. [PMID: 36814747 PMCID: PMC9940663 DOI: 10.7759/cureus.34039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND COVID-19 vaccination is advised for pregnant women all over the world; however, vaccine acceptance is variable across the globe. METHODS This study was conducted by enrolling 292 antenatal women attending the outpatient department (OPD) in a tertiary care hospital in Delhi, India, between August 1, 2022 and October 31, 2022, with the aim to determine the acceptability of vaccination against COVID-19 disease in pregnancy, women's views regarding the vaccine and to ascertain reasons for acceptance or denial during pregnancy. RESULT Of the 292 pregnant women who completed the questionnaire, 39.73% had received both doses of vaccination against COVID-19 disease before pregnancy, and 39.04% had received a single dose. Twenty-one percent of women did not receive any vaccine. Eighty-four percent of the unvaccinated and 35% of the women with a single dose of the vaccine refused further doses during pregnancy. The most common concern was the fear that the vaccine might cause harm to the fetus (35.3%), followed by the fear of vaccine-related reactions (25.4%). Also, 14.6% of women feared that the vaccine might cause them to abort the ongoing pregnancy. Thirteen percent of women stated their intent to receive the vaccine after they were informed regarding its safety and requirement. No difference was found in the acceptability of the vaccine based on the educational status of women or on the monthly income of the families. CONCLUSION Adequate communication regarding safety information on COVID-19 vaccines is a must for pregnant women and their families to provide reassurance about the need and safety of the vaccines. It would facilitate making informed decisions and is likely to be helpful in increasing vaccine acceptance.
Collapse
|
21
|
Fernandes GM, Sasaki LMP, Jardim-Santos GP, Schulte HL, Motta F, da Silva ÂP, de Carvalho AO, Pereira YR, Alves CDO, de Araújo Júnior DA, Mendonça-Silva DL, Costa KN, de Castro MEC, Lauand L, Nery RDR, Tristão R, Kurizky PS, Nóbrega ODT, Espindola LS, de Castro LCG, Alpoim PN, Godoi LC, Dusse LMSA, Coelho-dos-Reis JGA, do Amaral LR, Gomes MDS, Bertarini PLL, Brito-de-Sousa JP, da Costa-Rocha IA, Campi-Azevedo AC, Peruhype-Magalhães V, Teixeira-Carvalho A, Zaconeta AM, Soares AADSM, Valim V, Gomes CM, de Albuquerque CP, Martins-Filho OA, da Mota LMH. Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study. Front Immunol 2023; 14:1176898. [PMID: 37122732 PMCID: PMC10130456 DOI: 10.3389/fimmu.2023.1176898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction SARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators. Methods A sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array. Results In the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester. Discussion and conclusion From an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women.
Collapse
Affiliation(s)
- Geraldo Magela Fernandes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- *Correspondence: Geraldo Magela Fernandes, ; Olindo Assis Martins-Filho,
| | - Lizandra Moura Paravidine Sasaki
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Heidi Luise Schulte
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | - Felipe Motta
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | | | | | | | | | | | | | | | - Maria Eduarda Canellas de Castro
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | - Lucas Lauand
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Rosana Tristão
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | - Patricia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Laila Salmen Espindola
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
| | - Luiz Cláudio Gonçalves de Castro
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | | | - Lara Carvalho Godoi
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Laurence Rodrigues do Amaral
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Matheus de Souza Gomes
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | - Pedro Luiz Lima Bertarini
- Laboratório de Bioinformática e Análises Moleculares, Universidade Federal de Uberlândia, Patos de Minas, Brazil
| | | | | | | | | | | | | | - Alexandre Anderson de Sousa Munhoz Soares
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
| | - Valéria Valim
- Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo (HUCAM-UFES), Vitória, Brazil
- Programa de Pós-Graduação em Saúde Coletiva (PPGSC), Centro de Ciências Médicas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília (UnB), Brasília, Brazil
| | - Cleandro Pires de Albuquerque
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
| | - Olindo Assis Martins-Filho
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Brazil
- *Correspondence: Geraldo Magela Fernandes, ; Olindo Assis Martins-Filho,
| | - Licia Maria Henrique da Mota
- Programa de Pós-Graduação em Ciências Médicas, Universidade de Brasília (UnB), Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Brazil
- Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília (UnB), Brasília, Brazil
| |
Collapse
|
22
|
Morris R, Moustafa ASZ, Kassahun-Yimer W, Novotny S, Billsby B, Abbas A, Wallace K. COVID-19 Not Hypertension or Diabetes Increases the Risk of Preeclampsia among a High-Risk Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16631. [PMID: 36554511 PMCID: PMC9779111 DOI: 10.3390/ijerph192416631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has been associated with greater morbidity and increased mortality in certain populations, such as those with chronic medical conditions, the elderly, and pregnant women. Our goal was to determine if COVID-19 infection during pregnancy increased the risk of preeclampsia in a population of women with increased risk factors for preeclampsia. We present a prospective observational matched case-control study of 100 deliveries with confirmed SARS-CoV2. Specifically, we investigated the maternal and neonatal outcomes in a high-risk population of pregnant women. Among women with COVID-19, the severity of symptoms was associated with the incidence of preeclampsia, but not with pre-existing diabetes or hypertension. Women with more severe symptoms were more likely to delivery pre-term with smaller babies. After adjusting for diabetes, hypertensive women with COVID-19 had an increased risk of preeclampsia aOR4.3 [1.5,12.4] compared to non-hypertensive women with COVID-19. After adjusting for hypertension, women with diabetes and COVID-19 had an increased risk of preeclampsia aOR3.9 [1.2,12.5]. This relationship was not seen among women without COVID-19. For women who had pre-existing diabetes or hypertension, the risk of developing preeclampsia was only increased if they were also diagnosed with COVID-19, suggesting that in our population of women the risk of preeclampsia is not associated with pre-existing diabetes or hypertension.
Collapse
Affiliation(s)
- Rachael Morris
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Ahmed S. Z. Moustafa
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | - Sarah Novotny
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Brittney Billsby
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Amira Abbas
- School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kedra Wallace
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Pharmacology & Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Myrlie Evers-Williams Institute for Elimination of Health Disparities, Jackson, MS 39213, USA
| |
Collapse
|
23
|
Sobkowski M, Pięta B, Sowińska A, Grabowska M, Koch-Brzozowska K, Wilczak M, Bień A. SARS-CoV-2 in Pregnancy-A Retrospective Analysis of Selected Maternal and Fetal Laboratory Parameters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15307. [PMID: 36430023 PMCID: PMC9690975 DOI: 10.3390/ijerph192215307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Pregnant women and their neonates belong to the group of individuals with elevated risk for COVID-19 infection. Data on the course of the disease and how it affects the pregnancy and neonatal wellbeing remain conflicting. The aim of the study was to evaluate the effect of SARS CoV-2 infection on the mode of delivery, neonatal condition and selected maternal and fetal laboratory parameters. This was a single-center retrospective case-control study. This dataset was generated using electronic medical records collected by medical personnel. Two groups of patients, hospitalized between April, 2020 and February, 2021, were included in the study: study group (304)-pregnant women with SARS-CoV-2 and control group (N = 329)-healthy pregnant women or parturients. Mothers with a severe course of COVID-19 had higher activated partial thromboplastin-APTT (p = 0.02), C-Reactive Protein-CRP (p = 0.00) and procalcitonin (p = 0.032) levels as compared to pregnant women with mild or moderate course of the disease. Neonates born to SARS-CoV-2-infected mothers presented with worse condition at 1 and 5 minutes of life (p = 0.000 and 0.00, respectively) and lower Arterial Blood Gas-ABG pH scores (p = 0.016). Elective cesarean section is the most common mode of delivery for SARS-CoV2-infected mothers. Emergency cesarean sections are performed at earlier gestational age as compared to vaginal delivery and elective cesarean section. Lower Apgar scores were observed in neonates born to SARS-CoV-2-infected mothers who required oxygen therapy and whose procalcitonin levels were elevated. There is a relationship between more severe course of COVID-19 and APTT, as well as CRP and procalcitonin levels.
Collapse
Affiliation(s)
- Maciej Sobkowski
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Beata Pięta
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Anna Sowińska
- Department of Informatics and Statistics, University of Medical Sciences, Rokietnicka Street 7, 60-806 Poznań, Poland
| | - Marlena Grabowska
- Gynecological and Obstetric Hospital of the University of Medical Sciences in Poznan, Polna Street 33, 60-535 Poznań, Poland
| | | | - Maciej Wilczak
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4/6 Staszica St., 20-081 Lublin, Poland
| |
Collapse
|
24
|
Zöllkau J, Bohlmann M, Mingers N, Pecks U, Weschenfelder F, Groten T. Hypertensive Schwangerschaftserkrankungen und
SARS-CoV-2/COVID-19: Auswertung des nationalen
CRONOS-Registers. Z Geburtshilfe Neonatol 2022; 227:120-126. [PMID: 36368683 DOI: 10.1055/a-1962-6964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ZusammenfassungSARS-CoV-2-Infektion und COVID-19-Erkrankung sind in internationalen
Registerstudien mit einem erhöhten Risiko für hypertensive
Schwangerschaftserkrankungen assoziiert. Hypertensive Erkrankungen stellen zudem
einen Risikofaktor eines schweren COVID-19-Verlaufes in der Schwangerschaft dar.
Als pathophysiologische Gemeinsamkeit beider Erkrankungen wird die
Schädigung des Endothels angesehen.Daten des nationalen CRONOS-Registers (Datenstand 05/2021; 1104
schwangere Frauen mit SARS-CoV-2-Infektion) wurden hinsichtlich des
Zusammenhangs zu hypertensiven Schwangerschaftserkrankungen und dem Outcome von
Mutter, Schwangerschaft, Neugeborenen und COVID-19-Erkrankung analysiert. Bei
Vorliegen einer hypertensiven Schwangerschaftserkrankung war signifikant
häufiger ein schweres kombiniertes Outcome der Schwangerschaft (17,3 vs.
4,3%, p=0,001), der Mutter (25,0 vs. 9,4%,
p=0,001) und des Neugeborenen (28,8 vs. 9,1%, p<0,0005)
zu verzeichnen. Das Outcome der COVID-19-Erkrankung unterschied sich hingegen
nicht (3,8 vs. 7,5%, p=0,424). Hypertensive
Schwangerschaftserkrankungen sollten im Management einer SARS-CoV-2-Infektion in
der Schwangerschaft als Risikofaktor angesehen werden. Dies kann Implikationen
auf die Therapie haben, wie zum Beispiel mit monoklonalen Antikörpern
haben.
Collapse
Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena,
Jena, Germany
| | - Michael Bohlmann
- Frauenheilkunde und Geburtshilfe, St Elisabethen-Krankenhaus
Lörrach gGmbH, Lörrach, Germany
| | - Nina Mingers
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Jena,
Germany
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Jena,
Germany
| | | | - Tanja Groten
- Klinik für Geburtsmedizin, Universitätsklinikum Jena,
Jena, Germany
| |
Collapse
|
25
|
Smith LH, Dollinger CY, VanderWeele TJ, Wyszynski DF, Hernández-Díaz S. Timing and severity of COVID-19 during pregnancy and risk of preterm birth in the International Registry of Coronavirus Exposure in Pregnancy. BMC Pregnancy Childbirth 2022; 22:775. [PMID: 36258186 PMCID: PMC9578260 DOI: 10.1186/s12884-022-05101-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background Studies of preterm delivery after COVID-19 are often subject to selection bias and do not distinguish between early vs. late infection in pregnancy, nor between spontaneous vs. medically indicated preterm delivery. This study aimed to estimate the risk of preterm birth (overall, spontaneous, and indicated) after COVID-19 during pregnancy, while considering different levels of disease severity and timing. Methods Pregnant and recently pregnant people who were tested for or clinically diagnosed with COVID-19 during pregnancy enrolled in an international internet-based cohort study between June 2020 and July 2021. We used several analytic approaches to minimize confounding and immortal time bias, including multivariable regression, time-to-delivery models, and a case-time-control design. Results Among 14,264 eligible participants from 70 countries who did not report a pregnancy loss before 20 gestational weeks, 5893 had completed their pregnancies and reported delivery information; others were censored at time of their last follow-up. Participants with symptomatic COVID-19 before 20 weeks’ gestation had no increased risk of preterm delivery compared to those testing negative, with adjusted risks of 10.0% (95% CI 7.8, 12.0) vs. 9.8% (9.1, 10.5). Mild COVID-19 later in pregnancy was not clearly associated with preterm delivery. In contrast, severe COVID-19 after 20 weeks’ gestation led to an increase in preterm delivery compared to milder disease. For example, the risk ratio for preterm delivery comparing severe to mild/moderate COVID-19 at 35 weeks was 2.8 (2.0, 4.0); corresponding risk ratios for indicated and spontaneous preterm delivery were 3.7 (2.0, 7.0) and 2.3 (1.2, 3.9), respectively. Conclusions Severe COVID-19 late in pregnancy sharply increased the risk of preterm delivery compared to no COVID-19. This elevated risk was primarily due to an increase in medically indicated preterm deliveries, included preterm cesarean sections, although an increase in spontaneous preterm delivery was also observed. In contrast, mild or moderate COVID-19 conferred minimal risk, as did severe disease early in pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05101-3.
Collapse
Affiliation(s)
- Louisa H Smith
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA. .,Roux Institute at Northeastern University, 100 Fore St, Portland, ME, 04101, USA.
| | - Camille Y Dollinger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA
| | | | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA
| |
Collapse
|
26
|
COVID-19 Vaccine Acceptance during Pregnancy and Influencing Factors in South Korea. J Clin Med 2022; 11:jcm11195733. [PMID: 36233601 PMCID: PMC9573627 DOI: 10.3390/jcm11195733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/16/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Pregnant women were excluded from vaccination against Coronavirus 2019 (COVID-19) until September 2021 in South Korea. Although vaccination for pregnant women started in October 2021, vaccine acceptance in pregnant women is yet unknown. This cross-sectional study aimed to investigate COVID-19 vaccine acceptance during pregnancy and influencing factors. An anonymous survey was distributed in obstetrics departments to all pregnant or postpartum women, during the prenatal or postpartum visit. The proportion of self-reported COVID-19 vaccination during pregnancy among 436 women was 26.6%. Pregnancy-related independent factors influencing maternal COVID-19 vaccination were “received vaccine information about from obstetrics and gynecology (OBGYN) doctors” (OR 3.41, 95% CI 2.05–5.65), “cohabitant COVID-19 vaccination” (OR 2.43, 95% CI 1.06–5.59), and “second trimester” (OR 7.35, 95% CI 1.54–35.15). In women who did not want to get vaccinated, the most common reason for COVID-19 vaccination hesitancy was concern that COVID-19 vaccine might affect the fetus (91.7%, 243/266), followed by distrust in COVID-19 vaccine effectiveness (42.6%, 113/266). This study showed that providing information about maternal COVID-19 vaccination, especially by OBGYN doctors, is crucial for increasing vaccination coverage in pregnant women. Providing updated evidence of COVID-19 vaccine efficacy and safety in pregnant women may be also helpful for increasing vaccine acceptance.
Collapse
|
27
|
Azami M, Nasirkandy MP, Esmaeili Gouvarchin Ghaleh H, Ranjbar R. COVID-19 vaccine acceptance among pregnant women worldwide: A systematic review and meta-analysis. PLoS One 2022; 17:e0272273. [PMID: 36170334 PMCID: PMC9518917 DOI: 10.1371/journal.pone.0272273] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to the death of many people worldwide. The World Health Organization (WHO) has declared vaccine resistance as one of the greatest health threats in the world even before the COVID-19 epidemic. The aim of this study was to evaluate the acceptance of COVID-19 vaccine in pregnant women. METHOD We performed this systematic review and meta-analysis in accordance with the PRISMA guidelines. We applied the standard search strategy to the PubMed/Medline, Web of Science (ISI), Scopus, Science Direct, Cochrane Library, EMBASE, and EBSCO databases, and the Google Scholar search engine. Heterogeneity between studies was relatively high and therefore meta-analyses were performed based on random effects model with 95% CI using STATA version 16. RESULTS In 16 articles with a sample size of 19219 pregnant women, the acceptance of COVID-19 vaccine was estimated 53.46% (95%CI: 47.64%-59.24%). Subgroup analysis was performed based on continent (p = 0.796), data collection method (p = 0.450) and meta-regression based on the month of the study (P<0.001), and only meta-regression was significant based on the month of the study. The effect of some variables such as graviad (OR = 1.02 [95%CI: 0.90-1.16]), maternal age was (OR = 1.02 [95%CI: 0.93-1.11]) and history of influenza vaccination (OR = 0.87 [95%CI: 0.71-1.06]) on COVID-19 vaccine acceptance was evaluated, which was not significant. CONCLUSION The prevalence of COVID-19 vaccine acceptance in pregnant women was 53.46%, which was much lower than the general COVID-19 vaccination. Therefore, necessary interventions should be taken to increase the acceptance of the vaccine, address safety concerns and educate about it.
Collapse
Affiliation(s)
- Milad Azami
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Marzieh Parizad Nasirkandy
- Department of Obstetrics and Gynecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
28
|
Barriers and facilitators to vaccination for COVID-19, pertussis, and influenza during pregnancy: Protocol for an umbrella review. PLoS One 2022; 17:e0275105. [PMID: 36156084 PMCID: PMC9512206 DOI: 10.1371/journal.pone.0275105] [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: 07/26/2022] [Accepted: 09/11/2022] [Indexed: 11/19/2022] Open
Abstract
Pregnant women are particularly vulnerable to infection. Furthermore, infection from pertussis, influenza and COVID-19 increases the likelihood of adverse consequences to the mother and developing baby such as stillbirth, ICU admission, and pre-term caesarean birth. Increased rates of transmission and risk of adverse consequences from infection justifies the provision of national maternal vaccination programmes. Additionally, maternal vaccination helps protect the infant until they are able to receive their own vaccinations; a time when they are most at risk of mortality from influenza and pertussis. Vaccination during pregnancy has been repeatedly demonstrated as safe and effective in reducing harm, although rates of uptake remain low compared to the general population. The current protocol describes the methodology for an umbrella review aiming to explore the barriers and facilitators of vaccination during pregnancy for pertussis, influenza, and COVID-19. Systematic reviews that investigate the barriers and facilitators of at least one of either pertussis, influenza, or COVID-19 will be included in this review. Multiple databases will be searched, and included reviews assessed for quality (using the Joanna Briggs Institute (JBI) quality assessment for systematic reviews) and degree of overlap of included primary studies. Included reviews will be analysed according to the WHO SAGE model of determinants of vaccine hesitancy and separated by whether these explore influenza and pertussis, or COVID-19. The outcomes of this review will help inform the development of interventions to increase uptake of vaccination during pregnancy, and on whether interventions need to be tailored depending on the infectious disease. The key findings will identify the specific barriers and facilitators of vaccination hesitancy by considering contextual influences (e.g. sociodemographic variables), individual/social group influences (e.g. trust in the institutions), and vaccine-specific issues (e.g. safety and recommendations).
Collapse
|
29
|
Futterman ID, McLaren R, Friedmann H, Musleh N, Haberman S. Use of Machine Learning to Identify Clinical Variables in Pregnant and Non-pregnant Women with SARS-CoV-2 Infection. Methods Inf Med 2022; 61:61-67. [PMID: 36096142 DOI: 10.1055/s-0042-1756282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of the study is to identify the important clinical variables found in both pregnant and non-pregnant women who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, using an artificial intelligence (AI) platform. MATERIALS AND METHODS This was a retrospective cohort study of all women between the ages of 18 to 45, who were admitted to Maimonides Medical Center between March 10, 2020 and December 20, 2021. Patients were included if they had nasopharyngeal PCR swab positive for SARS-CoV-2. Safe People Artificial Intelligence (SPAI) platform, developed by Gynisus, Inc., was used to identify key clinical variables predicting a positive test in pregnant and non-pregnant women. A list of mathematically important clinical variables was generated for both non-pregnant and pregnant women. RESULTS Positive results were obtained in 1,935 non-pregnant women and 1,909 non-pregnant women tested negative for SARS-CoV-2 infection. Among pregnant women, 280 tested positive, and 1,000 tested negative. The most important clinical variable to predict a positive swab result in non-pregnant women was age, while elevated D-dimer levels and presence of an abnormal fetal heart rate pattern were the most important clinical variable in pregnant women to predict a positive test. CONCLUSION In an attempt to better understand the natural history of the SARS-CoV-2 infection we present a side-by-side analysis of clinical variables found in pregnant and non-pregnant women who tested positive for COVID-19. These clinical variables can help stratify and highlight those at risk for SARS-CoV-2 infection and shed light on the individual patient risk for testing positive.
Collapse
Affiliation(s)
- Itamar D Futterman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Rodney McLaren
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Thomas Jefferson University Hospital - Jefferson Health, Philadelphia, Pennsylvania
| | | | | | - Shoshana Haberman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maimonides Medical Center, Brooklyn, New York
| |
Collapse
|
30
|
Khoury RS, Fazzari M, Lambert C, Debolt C, Stone J, Bianco A, Nathan L, Dolan SM, Bernstein PS. Characteristics and Outcomes of Pregnant Women with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in New York City: A Matched Cohort Study. Am J Perinatol 2022; 39:1261-1268. [PMID: 35240711 DOI: 10.1055/a-1787-3673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preterm birth, cesarean birth, and composite severe maternal morbidity by studying women with and without SARS-CoV-2 infection at the time of delivery hospitalization from similar residential catchment areas in New York City. STUDY DESIGN This was a retrospective cohort study of pregnant women with laboratory-confirmed or laboratory-denied SARS-CoV-2 on nasopharyngeal swab under universal testing policies at the time of admission who gave birth between March 13 and May 15, 2020, at two New York City medical centers. Demographic and clinical data were collected and follow-up was completed on May 30, 2020. Groups were compared for the primary outcome and preterm birth, in adjusted (for age, race/ethnicity, nulliparity, body mass index) and unadjusted analyses. RESULTS Among this age-matched cohort, 164 women were positive and 247 were negative for SARS-CoV-2. Of the positive group, 52.4% were asymptomatic and 1.2% had critical coronavirus disease 2019 (COVID-19). The groups did not differ by race and ethnicity, body mass index, or acute or chronic comorbidities. Women with SARS-CoV-2 were more likely to be publicly insured. Preterm birth, cesarean birth, and severe maternal morbidity did not differ between groups. Babies born to women with SARS-CoV-2 were more likely to have complications of prematurity or low birth weight (7.7 vs. 2%, p = 0.01). CONCLUSION Preterm and cesarean birth did not differ between women with and without SARS-CoV-2 across disease severity in adjusted and unadjusted analysis among this cohort during the pandemic peak in New York City.
Collapse
Affiliation(s)
- Rasha S Khoury
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| | - Melissa Fazzari
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Calvin Lambert
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| | - Chelsea Debolt
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joanne Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angela Bianco
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lisa Nathan
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| | - Siobhan M Dolan
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, New York
| | - Peter S Bernstein
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
31
|
Tanna R, Dugarte HJN, Kurakula S, Muralidharan V, Das A, Kanigalpula SPR, Mendez IE, Afaq M, Bassi R, Shah K, Saddiq Z. Review of Impact of COVID-19 on Maternal, Neonatal Outcomes, and Placental Changes. Cureus 2022; 14:e28631. [PMID: 36106265 PMCID: PMC9450993 DOI: 10.7759/cureus.28631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Coronavirus disease (COVID-19), caused by SARS-CoV-2, is a disease that has caused a global impact. COVID-19 is transmitted through airborne droplets, respiratory secretions, and direct contact. The pandemic has affected individuals of different ages, and studying the impact of COVID-19 on maternal and newborn outcomes is critical. In this review, we highlight the impact of COVID-19 infection in pregnancy and its repercussion in the maternal-fetal binomial. Physiological changes that occur during pregnancy have significant effects on the immune system, cardiopulmonary system, and coagulation, and these changes can result in an altered response to COVID-19 infection. The symptoms, risk factors, and maternal health consequences of COVID-19 were discussed. In addition, the impact of newborns born to mothers with COVID-19 was reviewed. Finally, placental changes and vertical transmission of COVID-19 during pregnancy were also discussed in this review.
Collapse
|
32
|
Vásquez-Procopio J, Espejel-Nuñez A, Torres-Torres J, Martinez-Portilla RJ, Espino Y. Sosa S, Mateu-Rogell P, Ortega-Castillo V, Tolentino-Dolores M, Perichart-Perera O, Franco-Gallardo JO, Carranco-Martínez JA, Prieto-Rodríguez S, Guzmán-Huerta M, Missirlis F, Estrada-Gutierrez G. Inflammatory-Metal Profile as a Hallmark for COVID-19 Severity During Pregnancy. Front Cell Dev Biol 2022; 10:935363. [PMID: 36016660 PMCID: PMC9395991 DOI: 10.3389/fcell.2022.935363] [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: 05/03/2022] [Accepted: 06/14/2022] [Indexed: 01/10/2023] Open
Abstract
Pregnancy makes women more susceptible to infectious agents; however, available data on the effect of SARS-CoV-2 on pregnant women are limited. To date, inflammatory responses and changes in serum metal concentration have been reported in COVID-19 patients, but few associations between metal ions and cytokines have been described. The aim of this study was to evaluate correlations between inflammatory markers and serum metal ions in third-trimester pregnant women with varying COVID-19 disease severity. Patients with severe symptoms had increased concentrations of serum magnesium, copper, and calcium ions and decreased concentrations of iron, zinc, and sodium ions. Potassium ions were unaffected. Pro-inflammatory cytokines IL-6, TNF-α, IL-8, IL-1α, anti-inflammatory cytokine IL-4, and the IP-10 chemokine were induced in the severe presentation of COVID-19 during pregnancy. Robust negative correlations between iron/magnesium and zinc/IL-6, and a positive correlation between copper/IP-10 were observed in pregnant women with the severe form of the disease. Thus, coordinated alterations of serum metal ions and inflammatory markers – suggestive of underlying pathophysiological interactions—occur during SARS-CoV-2 infection in pregnancy.
Collapse
Affiliation(s)
- Johana Vásquez-Procopio
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Mexico City, Mexico
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
| | - Aurora Espejel-Nuñez
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | | | | | - Paloma Mateu-Rogell
- Clinical Research Division, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | | | - Otilia Perichart-Perera
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | | | | | - Mario Guzmán-Huerta
- Department of Translational Medicine, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Fanis Missirlis
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
- *Correspondence: Guadalupe Estrada-Gutierrez, ; Fanis Missirlis,
| | - Guadalupe Estrada-Gutierrez
- Research Division, Instituto Nacional de Perinatología, Mexico City, Mexico
- *Correspondence: Guadalupe Estrada-Gutierrez, ; Fanis Missirlis,
| |
Collapse
|
33
|
Mupanomunda M, Fakih MG, Miller C, Ottenbacher A, Winegar AL, Roberts P, Kimathi M, Gianopoulos JG, Cahill AG, Cacchione JG, Fogel RI, Aloia TA, Masoudi FA. Comparison of Severe Maternal Morbidities Associated With Delivery During Periods of Circulation of Specific SARS-CoV-2 Variants. JAMA Netw Open 2022; 5:e2226436. [PMID: 35960519 PMCID: PMC9375165 DOI: 10.1001/jamanetworkopen.2022.26436] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Infection with SARS-CoV-2, which causes COVID-19, is associated with adverse maternal outcomes. While it is known that severity of COVID-19 varies by viral strain, the extent to which this variation is reflected in adverse maternal outcomes, including nonpulmonary maternal outcomes, is not well characterized. OBJECTIVE To evaluate the associations of SARS-CoV-2 infection with severe maternal morbidities (SMM) in pregnant patients delivering during 4 pandemic periods characterized by predominant viral strains. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients delivering in a multicenter, geographically diverse US health system between March 2020 and January 2022. Individuals with SARS-CoV-2 infection were propensity-matched with as many as 4 individuals without evidence of infection based on demographic and clinical variables during 4 time periods based on the dominant strain of SARS-CoV-2: March to December 2020 (wild type); January to June 2021 (Alpha [B.1.1.7]); July to November 2021 (Delta [B.1.617.2]); and December 2021 to January 2022 (Omicron [B.1.1.529]). Data were analyzed from October 2021 to June 2022. EXPOSURES Positive SARS-CoV-2 nucleic acid amplification test result during the delivery encounter. MAIN OUTCOMES AND MEASURES The primary outcome was any SMM event, as defined by the US Centers for Disease Control and Prevention, during hospitalization for delivery. Secondary outcomes were number of SMM, respiratory SMM, nonrespiratory SMM, and nontransfusion SMM events. RESULTS Over all time periods, there were 3129 patients with SARS-CoV-2, with a median (IQR) age of 29.1 (24.6-33.2) years. They were propensity matched with a total of 12 504 patients without SARS-CoV-2, with a median (IQR) age of 29.2 (24.7-33.2) years. Patients with SARS-CoV-2 infection had significantly higher rates of SMM events than those without in all time periods, except during Omicron. While the risk of any SMM associated with SARS-CoV-2 infection was increased for the wild-type strain (odds ratio [OR], 2.74 [95% CI, 1.85-4.03]) and Alpha variant (OR, 2.57 [95% CI, 1.69-4.01]), the risk during the Delta period was higher (OR, 7.69 [95% CI, 5.19-11.54]; P for trend < .001). The findings were similar for respiratory complications, nonrespiratory complications, and nontransfusion outcomes. For example, the risk of nonrespiratory SMM events for patients with vs without SARS-CoV-2 infection were similar for the wild-type strain (OR, 2.16 [95% CI, 1.40-3.27]) and Alpha variant (OR, 1.96 [95% CI, 1.20-3.12]), highest for the Delta variant (OR, 4.65 [95% CI, 2.97-7.29]), and not significantly higher in the Omicron period (OR, 1.21 [95% CI, 0.67-2.08]; P for trend < .001). CONCLUSIONS AND RELEVANCE This cohort study found that the SARS-CoV-2 Delta variant was associated with higher rates of SMM events compared with other strains. Given the potential of new strains, these findings underscore the importance of preventive measures.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Frederick A. Masoudi
- Ascension Health, St Louis, Missouri
- Dell Medical School, University of Texas, Austin
| |
Collapse
|
34
|
Hirakata VN, Oppermann MLR, Genro VK, Reichelt AJ. Exploring the Gantt chart as a tool to highlight double report in case series published during the first wave of the COVID-19 pandemic. Syst Rev 2022; 11:155. [PMID: 35908036 PMCID: PMC9338517 DOI: 10.1186/s13643-022-02024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, some studies describing different aspects of the infection included very similar participants, rising suspicion about double reporting. We aimed to evaluate the Gantt chart as a tool to highlight possible double reporting. The chart is routinely used in business applications to depict tasks of a project, by plotting horizontal bars against time, showing their time span and overlaps. METHODS All case reports and case series of pregnant women with COVID-19, published by July 15, 2020, were included. Initial and final dates of participants' enrollment, country, city, hospital, and number of pregnancies were plotted in the Gantt chart. Bars stand for enrollment dates of each study, according to hospital and city, thus allowing comparisons. RESULTS We included 116 articles in the present analysis. The Gantt chart highlighted papers in which some participants were likely the same, thus allowing easier identification of double reporting of cases. Combining all information and pregnancy characteristics and outcomes helped to recognize duplications when the authors did not acknowledged the previous publication. CONCLUSIONS Unintended double reporting may occur, especially in exceptional times. The Gantt chart may help researchers to visually identify potential duplications, thus avoiding biased estimates in systematic reviews or meta-analysis.
Collapse
Affiliation(s)
- Vânia N Hirakata
- Unidade de Bioestatística, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Lúcia R Oppermann
- Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa K Genro
- Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Angela J Reichelt
- Serviço de Endocrinologia e Metabologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035-903, Brazil.
| |
Collapse
|
35
|
Biasi MF, Amorim MMR, Katz L. What is the role of the scientific community in the fight against COVID-19 pandemic? Observations concerning fake news, predatory journals and public policies. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200030001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira, Brazil
| |
Collapse
|
36
|
Depression in pregnant and postpartum women during COVID-19 pandemic: systematic review and meta-analysis. Obstet Gynecol Sci 2022; 65:287-302. [PMID: 35754363 PMCID: PMC9304439 DOI: 10.5468/ogs.21265] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 05/19/2022] [Indexed: 11/08/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) emerged as a global pandemic in March 2020 and caused a big crisis, especially the health crisis. Pregnant and postpartum women experienced significant physical, social, and mental changes that put them at higher risk for several conditions during the pandemic. This study aimed to report the prevalence of depression in pregnant and postpartum women during the COVID-19 pandemic. Eligible studies were identified using several databases. Prevalence analysis was conducted using MedCalc ver. 19.5.1. This systematic review and meta-analysis was registered in PROSPERO on July 12, 2021 with registration number CRD42021266976. We included 54 studies with 95.326 participants. The overall prevalence of depression was 32.60% among pregnant and postpartum women during the COVID-19 pandemic. The rate was higher among pregnant women (31.49%) compared to postpartum women (27.64%). The prevalence of depression among pregnant and postpartum women increased during the COVID-19 pandemic.
Collapse
|
37
|
Hernandez-Diaz S, Smith LH, Dollinger C, Rasmussen SA, Schisterman EF, Bellocco R, Wyszynski DF. International Registry of Coronavirus Exposure in Pregnancy (IRCEP): Cohort Description and Methodological Considerations. Am J Epidemiol 2022; 191:967-979. [PMID: 35259213 PMCID: PMC8992307 DOI: 10.1093/aje/kwac046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 12/21/2022] Open
Abstract
Limited data are available about the potential health effects of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnant women and their developing offspring. We developed the International Registry of Coronavirus Exposure in Pregnancy (IRCEP) to provide data on the risk of major adverse obstetric and neonatal outcomes among women with varying degrees of severity and timing of COVID-19 exposure during pregnancy. We describe here the cohort and share the lessons learned. The IRCEP enrolls women tested for SARS-CoV-2 or with a clinical diagnosis of COVID-19 during pregnancy and obtains information using an online data collection system. By March 2021, 17,532 participants from 77 countries had enrolled; 54% enrolled during pregnancy and 46% afterwards. Among women with symptomatic COVID-19 with a positive SARS-CoV-2 test (N=4,934), symptoms were mild in 41%, moderate in 52% and severe in 7%; 7.7% were hospitalized for COVID-19 and 1.7% were admitted to an intensive care unit. The biggest challenges were retention of participants enrolled during pregnancy, and the potential bias introduced when participants enroll after pregnancy outcomes are known. Multiple biases need to be considered and addressed when estimating and interpreting the effects of COVID-19 in pregnancy in these types of cohorts.
Collapse
Affiliation(s)
- Sonia Hernandez-Diaz
- Correspondence Address: Dr. Sonia Hernandez-Diaz, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue. Boston, MA 02115 (e-mail: )
| | - Louisa H Smith
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Camille Dollinger
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Sonja A Rasmussen
- Department of Pediatrics, Obstetrics and Gynecology, & Epidemiology, University of Florida, United States
| | | | - Rino Bellocco
- Karolinska Institutet, Stockholm, Sweden and University of Milano-Bicocca, Milan, Italy
| | | |
Collapse
|
38
|
de Moraes FM, de Souza JWPS, Alves LP, de Siqueira MFR, dos Santos APA, de Carvalho Berardo MM, Granja MG, de Castro-Faria-Neto HC. SARS-CoV-2 Infection and Possible Neonatal Neurological Outcomes: A Literature Review. Viruses 2022; 14:1037. [PMID: 35632778 PMCID: PMC9143946 DOI: 10.3390/v14051037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
The virus responsible for COVID-19 is designated "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), a highly transmissible and pathogenic coronavirus. Although people of all ages are susceptible to SARS-CoV-2 infection, clinical manifestations may vary with age. The response of neonates to SARS-CoV-2 infection or exposure differs from that of children and adults. Encephalitis due to viral infections in the central nervous system (CNS) and childhood multisystem inflammatory syndrome (MIS-C) are some of the possible neonatal consequences of SARS-CoV-2 infection. This review aims to verify possible neonatal neurological outcomes after SARS-CoV-2 infection. Overall, the cellular and molecular basis of the neurological sequelae of SARS-CoV-2 in neonates remains unclear, and attempts to elucidate the pathophysiology of COVID-19 involve a comparison with the mechanism of other viral diseases. There are a considerable number of case reports in the literature exploring neurological outcomes in the neonatal period. In this review, we present possible effects of SARS-CoV-2 in neonates, emphasizing the importance of monitoring this group. The mechanisms of SARS-CoV-2 entry into the CNS have not yet been fully elucidated, and the potential severity of SARS-CoV-2 infection in neonates, as well as the possible short- and long-term neurological sequelae, remain unclear.
Collapse
Affiliation(s)
- Flávia Maciel de Moraes
- Programa de Pós-Graduação em Biologia Molecular e Celular, Universidade Federal do Estado do Rio de Janeiro—UNIRIO, Rua Frei Caneca, 94-Centro, Rio de Janeiro 20211-010, Brazil; (F.M.d.M.); (L.P.A.)
| | - Julia Werneck Paulino Soares de Souza
- Instituto de Educação Médica—IDOMED, Escola de Medicina, Universidade Estácio de Sá, Avenida Presidente Vargas, 1121-Centro, Rio de Janeiro 20071-004, Brazil; (J.W.P.S.d.S.); (M.M.d.C.B.)
| | - Letícia Pires Alves
- Programa de Pós-Graduação em Biologia Molecular e Celular, Universidade Federal do Estado do Rio de Janeiro—UNIRIO, Rua Frei Caneca, 94-Centro, Rio de Janeiro 20211-010, Brazil; (F.M.d.M.); (L.P.A.)
| | - Milena Ferreira Ribeiro de Siqueira
- Faculdade de Biomedicina, Instituto Biomédico, Universidade Federal Fluminense, Rua Ernani Melo, 101-São Domingos, Niterói 24210-130, Brazil;
| | - Ana Paula Aguiar dos Santos
- Escola de Medicina, Fundação Técnico-Educacional Souza Marques, Avenida Ernani Cardoso, 335-Cascadura, Rio de Janeiro 20020-080, Brazil;
| | - Mariana Monteiro de Carvalho Berardo
- Instituto de Educação Médica—IDOMED, Escola de Medicina, Universidade Estácio de Sá, Avenida Presidente Vargas, 1121-Centro, Rio de Janeiro 20071-004, Brazil; (J.W.P.S.d.S.); (M.M.d.C.B.)
| | - Marcelo Gomes Granja
- Laboratório de Imunofarmacologia, Fundação Oswaldo Cruz-Fiocruz, Avenida Brasil, 4365-Manguinhos, Rio de Janeiro 21045-900, Brazil;
| | - Hugo Caire de Castro-Faria-Neto
- Laboratório de Imunofarmacologia, Fundação Oswaldo Cruz-Fiocruz, Avenida Brasil, 4365-Manguinhos, Rio de Janeiro 21045-900, Brazil;
| |
Collapse
|
39
|
Sessa R, Anastasi E, Brandolino G, Brunelli R, Di Pietro M, Filardo S, Masciullo L, Terrin G, Viscardi MF, Porpora MG. What is the Hidden Biological Mechanism Underlying the Possible SARS-CoV-2 Vertical Transmission? A Mini Review. Front Physiol 2022; 13:875806. [PMID: 35600312 PMCID: PMC9117645 DOI: 10.3389/fphys.2022.875806] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2) represents an emerging infection that is spreading around the world. Among susceptible patients, pregnant women are more likely to develop serious complications and negative obstetric outcomes. Vertical transmission constitutes a debating issue which has not been completely understood. This review aims at describing the currently available evidence on SARS-CoV2 vertical transmission. We carried out a computerized literature search in the Cochrane Library, PubMed, Scopus and Web of Science, selecting the most relevant studies on vertical transmission from the outbreak onset until February 2022. The analysis of the available literature identifies the presence of SARS-CoV2 genome in different biological specimens, confirming the hypothesis that a transplacental infection can occur. In spite of the high number of infected people around the world, mother-to-child infections have been infrequently reported but it can be observed under certain biologic conditions. A deep knowledge of the underlying mechanisms of SARS-CoV2 vertical transmission is of paramount importance for planning an adequate management for the affected mothers and newborns.
Collapse
Affiliation(s)
- Rosa Sessa
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, Rome, Italy
| | - Emanuela Anastasi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Gabriella Brandolino
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Marisa Di Pietro
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, Rome, Italy
| | - Simone Filardo
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, Rome, Italy
| | - Luisa Masciullo
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Maria Federica Viscardi
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
- *Correspondence: Maria Grazia Porpora,
| |
Collapse
|
40
|
Vila-Candel R, González-Chordá VM, Soriano-Vidal FJ, Castro-Sánchez E, Rodríguez-Blanco N, Gómez-Seguí A, Andreu-Pejó L, Martínez-Porcar C, Rodríguez Gonzálvez C, Torrent-Ramos P, Asensio-Tomás N, Herraiz-Soler Y, Escuriet R, Mena-Tudela D. Obstetric-Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095482. [PMID: 35564880 PMCID: PMC9103978 DOI: 10.3390/ijerph19095482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023]
Abstract
This study analyses the obstetric−neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric−neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother−infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother−infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions.
Collapse
Affiliation(s)
- Rafael Vila-Candel
- Department of Nursing, Faculty of Nursing and Podiatry, Universitat de València, 46010 Valencia, Spain; or
- Department of Obstetrics and Gynaecology, Hospital Universitario de la Ribera, 46600 Alcira, Spain;
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
| | - Víctor M. González-Chordá
- GIENF-281 Nursing Research Group, Nursing Department, Univesitat Jaume I, 12006 Castelló de la Plana, Spain; (L.A.-P.); (D.M.-T.)
- Correspondence:
| | - Francisco Javier Soriano-Vidal
- Department of Obstetrics and Gynaecology, Hospital Universitario de la Ribera, 46600 Alcira, Spain;
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
- Department of Obstetrics and Gynaecology, Hospital Lluis Alcanyís, 46800 Xàtiva, Spain
| | - Enrique Castro-Sánchez
- College of Nursing, Midwifery and Healthcare, University of West London, London TW8 9GB, UK;
- Health Protection Research Unit, Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London SW7 2BX, UK
| | - Noelia Rodríguez-Blanco
- Department of Nursing, Universidad CEU Cardenal Herrera, Plaza Reyes Católicos, 19, 03204 Elche, Spain;
- Department of Obstetrics and Gynaecology, Hospital Marina Baixa, 03570 Villajoyosa, Spain
| | - Ana Gómez-Seguí
- Department of Obstetrics and Gynaecology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (A.G.-S.); (N.A.-T.)
| | - Laura Andreu-Pejó
- GIENF-281 Nursing Research Group, Nursing Department, Univesitat Jaume I, 12006 Castelló de la Plana, Spain; (L.A.-P.); (D.M.-T.)
| | | | | | - Patricia Torrent-Ramos
- Preventive Medicine Service, Hospital General de Castellón, 12071 Castelló de la Plana, Spain;
- Nursing Department, Univesitat Jaume I, 12006 Castelló de la Plana, Spain
| | - Nieves Asensio-Tomás
- Department of Obstetrics and Gynaecology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (A.G.-S.); (N.A.-T.)
| | - Yolanda Herraiz-Soler
- Department of Obstetrics and Gynaecology, Consorcio Hospital General Universitario Valencia, 46014 Valencia, Spain;
- Facultat d’Infermeria i Podologia, Universitat de València, 46100 Valencia, Spain
| | - Ramon Escuriet
- Ghenders Research Group, School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain;
- Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain
| | - Desirée Mena-Tudela
- GIENF-281 Nursing Research Group, Nursing Department, Univesitat Jaume I, 12006 Castelló de la Plana, Spain; (L.A.-P.); (D.M.-T.)
| |
Collapse
|
41
|
Raeisi T, Mozaffari H, Sepehri N, Darand M, Razi B, Garousi N, Alizadeh M, Alizadeh S. The negative impact of obesity on the occurrence and prognosis of the 2019 novel coronavirus (COVID-19) disease: a systematic review and meta-analysis. Eat Weight Disord 2022; 27:893-911. [PMID: 34247342 PMCID: PMC8272688 DOI: 10.1007/s40519-021-01269-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The 2019 novel coronavirus (COVID-19) is an emerging pandemic, with a disease course varying from asymptomatic infection to critical disease resulting to death. Recognition of prognostic factors is essential because of its growing prevalence and high clinical costs. This meta-analysis aimed to evaluate the global prevalence of obesity in COVID-19 patients and to investigate whether obesity is a risk factor for the COVID-19, COVID-19 severity, and its poor clinical outcomes including hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, and mortality. METHODS The study protocol was registered in PROSPERO (CRD42020203386). A systematic search of Scopus, Medline, and Web of Sciences was conducted from 31 December 2019 to 1 June 2020 to find pertinent studies. After selection, 54 studies from 10 different countries were included in the quantitative analyses. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated to assess the associations. RESULTS The prevalence of obesity was 33% (95% CI 30.0%-35.0%) among patients with COVID-19. Obesity was significantly associated with susceptibility to COVID-19 (OR = 2.42, 95% CI 1.58-3.70; moderate certainty) and COVID-19 severity (OR = 1.62, 95% CI 1.48-1.76; low certainty). Furthermore, obesity was a significant risk factor for hospitalization (OR = 1.75, 95% CI 1.47-2.09; very low certainty), mechanical ventilation (OR = 2.24, 95% CI 1.70-2.94; low certainty), intensive care unit (ICU) admission (OR = 1.75, 95% CI 1.38-2.22; low certainty), and death (OR = 1.23, 95% CI 1.06-1.41; low certainty) in COVID-19 patients. In the subgroup analyses, these associations were supported by the majority of subgroups. CONCLUSION Obesity is associated with COVID-19, need for hospitalization, mechanical ventilation, ICU admission, and death due to COVID-19. LEVEL OF EVIDENCE Level I, systematic reviews and meta-analyses.
Collapse
Affiliation(s)
- Tahereh Raeisi
- Department of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hadis Mozaffari
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, Canada
| | | | - Mina Darand
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahman Razi
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Nazila Garousi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Alizadeh
- Department of Medical Surgical Nursing, Nasibeh Nursing and Midwifery School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| |
Collapse
|
42
|
Manti S, Leonardi S, Rezaee F, Harford TJ, Perez MK, Piedimonte G. Effects of Vertical Transmission of Respiratory Viruses to the Offspring. Front Immunol 2022; 13:853009. [PMID: 35359954 PMCID: PMC8963917 DOI: 10.3389/fimmu.2022.853009] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.
Collapse
Affiliation(s)
- Sara Manti
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Fariba Rezaee
- Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
- Center for Pediatric Pulmonology, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Terri J. Harford
- Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Miriam K. Perez
- Department of General Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Giovanni Piedimonte
- Department of Pediatrics, Biochemistry and Molecular Biology, Tulane University, New Orleans, LA, United States
- *Correspondence: Giovanni Piedimonte,
| |
Collapse
|
43
|
SARS- CoV-2 infection and oxidative stress in early-onset preeclampsia. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166321. [PMID: 34920081 PMCID: PMC8668602 DOI: 10.1016/j.bbadis.2021.166321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/23/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 causes coronavirus disease 2019 (COVID-19) also in pregnant women. Infection in pregnancy leads to maternal and placental functional alterations. Pregnant women with vascular defects such as preeclampsia show high susceptibility to SARS-CoV-2 infection by undefined mechanisms. Pregnant women infected with SARS-CoV-2 show higher rates of preterm birth and caesarean delivery, and their placentas show signs of vasculopathy and inflammation. It is still unclear whether the foetus is affected by the maternal infection with this virus and whether maternal infection associates with postnatal affections. The SARS-CoV-2 infection causes oxidative stress and activation of the immune system leading to cytokine storm and next tissue damage as seen in the lung. The angiotensin-converting-enzyme 2 expression is determinant for these alterations in the lung. Since this enzyme is expressed in the human placenta, SARS-CoV-2 could infect the placenta tissue, although reported to be of low frequency compared with maternal lung tissue. Early-onset preeclampsia (eoPE) shows higher expression of ADAM17 (a disintegrin and metalloproteinase 17) causing an imbalanced renin-angiotensin system and endothelial dysfunction. A similar mechanism seems to potentially account for SARS-CoV-2 infection. This review highlights the potentially common characteristics of pregnant women with eoPE with those with COVID-19. A better understanding of the mechanisms of SARS-CoV-2 infection and its impact on the placenta function is determinant since eoPE/COVID-19 association may result in maternal metabolic alterations that might lead to a potential worsening of the foetal programming of diseases in the neonate, young, and adult.
Collapse
|
44
|
Nindrea RD, Djanas D, Warsiti, Darma IY, Hendriyani H, Sari NP. The risk factors and pregnant women's willingness toward the SARS-CoV-2 vaccination in various countries: A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 14:100982. [PMID: 35169659 PMCID: PMC8830147 DOI: 10.1016/j.cegh.2022.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Pregnant women will benefit from research on immunization during pregnancy because they will have more accurate information on the SARS-CoV-2 vaccine. The purpose of this study was to determine the risk factors and pregnant women's desire to get the SARS-CoV-2 vaccine in various countries. Methods A search of PubMed, ProQuest, and EBSCO for related publications published (January and December 2021) on risk factors and pregnant women's desire to get the SARS-CoV-2 vaccine in various countries. The Pooled Odds Ratio (POR) were calculated using fixed and random-effect analysis. The I-squared formula was used to calculate the heterogeneity. Egger's and Begg's tests were used to identify study bias. STATA 16.0 was used for data analysis. Results This study revealed good practice has the highest POR (8.99), followed by received influenza vaccine last year (2.72), high perception of SARS-CoV-2 vaccine (2.70), >35 years (2.01), sufficient information about the SARS-COV-2 vaccine (1.94), higher school education (1.84), and third trimester (1.35) with pregnant women's desire toward the SARS-CoV-2 vaccination. The heterogeneity analysis revealed homogenous among risk factors in >35 years, high perception of SARS-CoV-2 vaccine, good practice, and third trimester (I2 ≤ 50%). In the articles combined in this study, there was no indication of study bias. Conclusion The insights of this study might help the authorities in determining the most effective strategy to deploy SARS-CoV-2 mass immunization campaigns for pregnant women.
Collapse
|
45
|
Abstract
As of November, 2021 there have been more than 250 million coronavirus disease-2019 (COVID-19) cases worldwide and more than 5 million deaths. Obstetric patients have been a population of interest given that they may be at risk of more severe infection and adverse pregnancy outcomes. The purpose of this review is to assess current epidemiology and outcomes research related to COVID-19 for the obstetric population. This review covers the epidemiology of COVID-19, symptomatology, transmission, and current knowledge gaps related to outcomes for the obstetric population.
Collapse
|
46
|
Wang X, Chen X, Zhang K. Maternal infection with COVID-19 and increased risk of adverse pregnancy outcomes: a meta-analysis. J Matern Fetal Neonatal Med 2022; 35:9368-9375. [PMID: 35156521 DOI: 10.1080/14767058.2022.2033722] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The Coronavirus disease 2019 (COVID-19) pandemic has become worldwide, posing particularly severe challenges. Pregnancy brings changes that might make individuals more vulnerable to this viral infection. To date, the impact of COVID-19 infection on pregnancy outcomes remains controversial.Method: We performed a meta-analysis to address the impact of COVID-19 infection on pregnancy outcomes. We searched the PubMed and China National Knowledge infrastructure (CNKI) databases for related articles. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to define the impact of INFECTION and severity of COVID-19 on pregnancy outcomes. The statistical heterogeneity among studies was batched with the Q-test and I2 statistics.Results: We collected 38 studies including 127,805 pregnancy women. Our meta-analysis revealed that pregnant women with COVID-19 have been linked to an increased risk of premature birth (OR = 1.66, 95% CI = 1.41-1.96), stillbirth (OR = 1.98, 95% CI = 1.22-3.21), pre-eclampsia (OR = 1.46, 95% CI = 1.18-1.80), and PROM (OR = 1.39, 95% CI = 1.07-1.81).Conclusions: Our meta-analysis showed that infection with COVID-19 increases the risk of preterm birth, stillbirth, pre-eclampsia, and PROM. Screening and early care for pregnant women to intervene with COVID-19 is important, given the increased risk of adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Xin Wang
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, PR China
| | - Xiameng Chen
- Department of Forensic Pathology and Forensic Clinical Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, PR China
| | - Kui Zhang
- Department of Forensic Pathology and Forensic Clinical Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, PR China
| |
Collapse
|
47
|
Hsu AL, Ohler AM, Goldstein A, Truong S, Tang CY, Wan XF, McElroy JA. Coronavirus Disease 2019 (COVID-19) Disease Severity: Pregnant vs Nonpregnant Women at 82 Facilities. Clin Infect Dis 2022; 74:467-471. [DOI: 10.1093/cid/ciab441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 01/05/2023] Open
Abstract
Abstract
Background
Pregnancy has been reported to be a risk factor for severe COVID-19. We evaluated the impact of pregnancy on severe COVID-19 and mortality in an electronic medical record (EMR) database that enabled exclusion of labor and delivery (L&D) encounters.
Methods
In this retrospective cohort study, EMRs from 82 healthcare facilities in the Cerner COVID-19 Datamart were analyzed. The study comprised 38 106 individuals aged 18–45 years old with COVID-19 who had emergency department, urgent care, or inpatient encounters from December 2019 to September 2020. Subgroups were balanced through propensity score weights for age, race, smoking status, and number of comorbidities. The primary outcome was COVID-19–related mortality; secondary outcomes were markers of severe COVID-19: intubations, mechanical ventilation, use of vasopressors, diagnosis of sepsis, and diagnosis of acute respiratory distress syndrome.
Results
In comparing pregnant and nonpregnant women, no statistical differences were found for markers of severe COVID-19, after adjusting for age, smoking, race, and comorbidities. The adjusted odds of an inpatient encounter were higher for pregnant vs nonpregnant women (adjusted odds ratio [aOR], 13.2; 95% confidence interval [CI], 11.6–15.3; P < .001), but notably lower after excluding L&D encounters (aOR, 2.3; 95% CI, 1.89–2.88; P < .001). In comparison to women without L&D encounters, hospitalization was significantly more likely for men.
Conclusions
We did not find an increased risk of severe COVID-19 or mortality in pregnancy. Hospitalization does not necessarily indicate severe COVID-19 in pregnancy, as half of pregnant patients with COVID-19 were admitted for L&D encounters in this study.
Collapse
Affiliation(s)
- Albert L Hsu
- Department of Obstetrics, Gynecology, and Women’s Health, University of Missouri–Columbia School of Medicine, Columbia, Missouri, USA
| | - Adrienne M Ohler
- Child Health Research Institute, Department of Child Health, University of Missouri–Columbia School of Medicine, Columbia, Missouri, USA
| | - Andrea Goldstein
- University of Missouri–Columbia School of Medicine, Columbia, Missouri, USA
| | - Sarah Truong
- Department of Obstetrics, Gynecology, and Women’s Health, University of Missouri–Columbia School of Medicine, Columbia, Missouri, USA
| | - Cynthia Y Tang
- University of Missouri–Columbia School of Medicine, Columbia, Missouri, USA
- MU Center for Influenza and Emerging Infectious Diseases, University of Missouri, Columbia, Missouri, USA
- University of Missouri Institute for Data Science and Informatics, Columbia, Missouri, USA
- Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Xiu-Feng Wan
- MU Center for Influenza and Emerging Infectious Diseases, University of Missouri, Columbia, Missouri, USA
- University of Missouri Institute for Data Science and Informatics, Columbia, Missouri, USA
- Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Department of Electrical Engineering and Computer Science, College of Engineering, University of Missouri, Columbia, Missouri, USA
| | - Jane A McElroy
- University of Missouri Department of Family and Community Medicine, Columbia, Missouri, USA
| |
Collapse
|
48
|
Januszek S, Siwiec N, Januszek R, Kluz M, Lebed R, Toś P, Góra T, Plens K, Dąbrowski K, Sidorowicz M, Szcześniewska A, Barnaś E, Kalandyk-Osinko K, Darmochwal-Kolarz D, Kluz T. Approach of Pregnant Women from Poland and the Ukraine to COVID-19 Vaccination—The Role of Medical Consultation. Vaccines (Basel) 2022; 10:vaccines10020255. [PMID: 35214718 PMCID: PMC8880363 DOI: 10.3390/vaccines10020255] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 12/14/2022] Open
Abstract
There are many arguments for the safety and efficacy of COVID-19 vaccines in pregnancy. The aim of this study is to describe the level of vaccination acceptance, to find the factors that most influence the decision to vaccinate, and to describe the scale of changes in vaccination acceptance influenced by medical information on the safety, efficacy, and benefits of vaccination among pregnant women. A total of 300 patients completed the questionnaire, including 150 in Poland and 150 in the Ukraine. The level of vaccination acceptance was assessed before and after medical consultation. There were 53 (35.3%) patients with the intention to get vaccinated in Poland and 25 (16.7%) in the Ukraine. After consultation with a physician, this increased to 109 (72.6%) in Poland and 69 (46%) in the Ukraine. The main factors influencing the acceptance of vaccinations were the fear of harming the foetus (OR-0.119, CI-0.039–0.324 p < 0.001), complications in pregnancy (OR-0.073 CI-0.023–0.197 p < 0.001), and limitations in the vaccination programme (OR-0.026 CI-0.001–0.207 p < 0.001). Medical information about the safety, effectiveness and benefits of vaccinations among pregnant women, provided during a medical visit, may increase the acceptance of vaccinations by 105.6%, as among Polish patients, and by 176%, as among pregnant women from the Ukraine.
Collapse
Affiliation(s)
- Sławomir Januszek
- Department of Gynecology, Oncology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (N.S.); (K.K.-O.); (T.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszów University, 35-316 Rzeszów, Poland; (E.B.); (D.D.-K.)
- Correspondence: ; Tel.: +48-535860429
| | - Natalia Siwiec
- Department of Gynecology, Oncology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (N.S.); (K.K.-O.); (T.K.)
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland;
| | - Marta Kluz
- Department of Pathology, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland;
| | - Roman Lebed
- Khmelnytsky Regional Perinatal Centre, 29-016 Khmelnytskyi, Ukraine;
| | - Paweł Toś
- Department of Gynecology and Obstetrics, University Hospital No. 2, 35-301 Rzeszów, Poland;
| | - Tomasz Góra
- Department of Gynecology and Obstetrics, Jan Paweł II Hospital, 35-241 Rzeszów, Poland;
- Department of Obstetrics and Perinatology, Medical College, Jagiellonian University, 31-501 Kraków, Poland
| | | | - Krzysztof Dąbrowski
- Department of Perinatology, City Hospital in Ruda Śląska, Gynecology and Obstetrics, 41-717 Ruda Śląska, Poland; (K.D.); (M.S.)
| | - Marcin Sidorowicz
- Department of Perinatology, City Hospital in Ruda Śląska, Gynecology and Obstetrics, 41-717 Ruda Śląska, Poland; (K.D.); (M.S.)
| | - Aleksandra Szcześniewska
- Departament of Perinatology and Gynecology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Łodź, Poland;
| | - Edyta Barnaś
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszów University, 35-316 Rzeszów, Poland; (E.B.); (D.D.-K.)
| | - Katarzyna Kalandyk-Osinko
- Department of Gynecology, Oncology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (N.S.); (K.K.-O.); (T.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszów University, 35-316 Rzeszów, Poland; (E.B.); (D.D.-K.)
| | - Dorota Darmochwal-Kolarz
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszów University, 35-316 Rzeszów, Poland; (E.B.); (D.D.-K.)
- Department of Gynecology and Obstetrics, University Hospital No. 2, 35-301 Rzeszów, Poland;
| | - Tomasz Kluz
- Department of Gynecology, Oncology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (N.S.); (K.K.-O.); (T.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszów University, 35-316 Rzeszów, Poland; (E.B.); (D.D.-K.)
| |
Collapse
|
49
|
Ungar SP, Solomon S, Stachel A, Demarco K, Roman AS, Lighter J. Impact of Prenatal SARS-CoV-2 Infection on Infant Emergency Department Visits and Hospitalization. Clin Pediatr (Phila) 2022; 61:206-211. [PMID: 34903074 DOI: 10.1177/00099228211065898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To better understand the impact of prenatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on infants, this study sought to compare the risk of hospital visits and of postnatal SARS-CoV-2 infection between infants born to mothers with and without prenatal SARS-CoV-2 infection. In this retrospective observational cohort study of 6871 mothers and their infants, overall rates of emergency department (ED) visits and hospital admissions in the first 90 days of life were similar for infants born to mothers with and without prenatal SARS-CoV-2 infection. Infants born to negative mothers were more likely than infants of positive mothers to be hospitalized after ED visit (relative risk: 3.76; 95% confidence interval: 1.27-11.13, P = .003). Five infants tested positive; all were born to negative mothers, suggesting that maternal prenatal SARS-CoV-2 infection may protect infants from postnatal infection. The lower acuity ED visits for infants born to mothers with prenatal SARS-CoV-2 infection may reflect a heightened level of concern among these mothers.
Collapse
|
50
|
Marchand G, Patil AS, Masoud AT, Ware K, King A, Ruther S, Brazil G, Calteux N, Ulibarri H, Parise J, Arroyo A, Coriell C, Cook C, Ruuska A, Nourelden AZ, Sainz K. Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021. AJOG GLOBAL REPORTS 2022; 2:100049. [PMID: 35005663 PMCID: PMC8720679 DOI: 10.1016/j.xagr.2021.100049] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE COVID-19 is a rapidly changing and developing emergency that requires constant re-evaluation of available data. We report a systematic review and meta-analysis based on all published high-quality data up to and including June 3, 2021 on the maternal and neonatal outcomes in pregnant women infected with COVID-19. DATA SOURCES PubMed, SCOPUS, MEDLINE, ClinicalTrials.gov, and Web of Science databases were queried from inception up to June 3, 2021. STUDY ELIGIBILITY CRITERIA We included all clinical studies (prospective and retrospective cohort studies, case-control studies, case series, and rapid communications) that reported data on any maternal and neonatal outcomes of pregnant women with COVID-19. METHODS The data were analyzed as pooled proportions or odds ratios and 95% confidence intervals in meta-analysis models. RESULTS We included 111 studies enrolling 42,754 COVID-19-positive pregnant women. From COVID-19-positive pregnant women, the incidence rates were 53.2% (95% confidence interval, 48-58.4) for cesarean delivery, 41.5% (95% confidence interval, 36.3-46.8) for spontaneous vaginal delivery, and 6.4% (95% confidence interval, 4.5-9.2) for operative delivery. The rates of some adverse neonatal events, including premature delivery (16.7%; 95% confidence interval, 12.8-21.5) and low birthweight (16.7%; 95% confidence interval, 12.8-21.5) were relatively high in mothers infected with COVID-19. Vertical transmission (3.5%; 95% confidence interval, 2.7-4.7), neonatal death (3%; 95% confidence interval, 2-4), stillbirth (1.9%; 95% confidence interval, 1.5-2.4), and maternal mortality (0.012%; 95% confidence interval, 0.010-0.014) were rare adverse events. The mean birthweight was 3069.7 g (95% confidence interval, 3009.7-3129.8 g). In the comparative analysis, COVID-19 significantly increased the risk of premature delivery (odds ratio, 1. 48 [95% confidence interval, 1.22-1.8]), preeclampsia (odds ratio, 1.6 [95% confidence interval, 1.2-2.1]), stillbirth (odds ratio, 2.36 [95% confidence interval, 1.24-4.462]), neonatal mortality (odds ratio, 3.35 [95% confidence interval, 1.07-10.5]), and maternal mortality (odds ratio, 3.08 [95% confidence interval, 1.5-6.3]). The pooled analyses were homogenous, with mild heterogeneity in premature delivery and preeclampsia outcomes. CONCLUSION The data must be interpreted with caution as limited data are available, and no complete assessment of bias is possible at this time. Our data suggest that pregnant women who test positive for COVID-19 seem to be at a higher risk of lower birth weights and premature delivery. There is no evidence at this time of the sharply increased maternal mortality that was seen previously with both the 2003 SARS and 2012 MERS pandemics.
Collapse
Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Avinash S. Patil
- Department of Obstetrics and Gynecology, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ (Dr Patil)
- Valley Perinatal Services, Phoenix, AZ (Dr Patil)
| | - Ahmed T. Masoud
- Faculty of Medicine, Fayoum University, Fayoum, Egypt (Dr Masoud)
| | - Kelly Ware
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Catherine Coriell
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Dr Marchand, Mses Ware, King, Ruther, and Brazil, Mr Calteux, Mses Ulibarri, Parise, Arroyo, and Coriell)
| | - Chelsea Cook
- Midwestern School of Osteopathic Medicine, Glendale, AZ (Mses Cook and Ruuska)
| | - Alexandra Ruuska
- Midwestern School of Osteopathic Medicine, Glendale, AZ (Mses Cook and Ruuska)
| | | | - Katelyn Sainz
- Department of Pediatrics, Tucson Medical Center, Tucson, AZ (Dr Sainz)
| |
Collapse
|