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Kubrova E, Hallo-Carrasco AJ, Klasova J, Pagan Rosado RD, Prusinski CC, Trofymenko O, Schappell JB, Prokop LJ, Yuh CI, Gupta S, Hunt CL. Persistent chest pain following COVID-19 infection - A scoping review. PM R 2024; 16:605-625. [PMID: 37906499 DOI: 10.1002/pmrj.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/07/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
Persistent chest pain (PCP) following acute COVID-19 infection is a commonly reported symptom with an unclear etiology, making its management challenging. This scoping review aims to address the knowledge gap surrounding the characteristics of PCP following COVID-19, its causes, and potential treatments. This is a scoping review of 64 studies, including observational (prospective, retrospective, cross-sectional, case series, and case-control) and one quasi-experimental study, from databases including Embase, PubMed/MEDLINE, Cochrane CENTRAL, Google Scholar, Cochrane Database of Systematic Reviews, and Scopus. Studies on patients with PCP following mild, moderate, and severe COVID-19 infection were included. Studies with patients of any age, with chest pain that persisted following acute COVID-19 disease, irrespective of etiology or duration were included. A total of 35 studies reported PCP symptoms following COVID-19 (0.24%-76.6%) at an average follow-up of 3 months or longer, 12 studies at 1-3 months and 17 studies at less than 1-month follow-up or not specified. PCP was common following mild-severe COVID-19 infection, and etiology was mostly not reported. Fourteen studies proposed potential etiologies including endothelial dysfunction, cardiac ischemia, vasospasm, myocarditis, cardiac arrhythmia, pneumonia, pulmonary embolism, postural tachycardia syndrome, or noted cardiac MRI (cMRI) changes. Evaluation methods included common cardiopulmonary tests, as well as less common tests such as flow-mediated dilatation, cMRI, single-photon emission computed tomography myocardial perfusion imaging, and cardiopulmonary exercise testing. Only one study reported a specific treatment (sulodexide). PCP is a prevalent symptom following COVID-19 infection, with various proposed etiologies. Further research is needed to establish a better understanding of the causes and to develop targeted treatments for PCP following COVID-19.
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Affiliation(s)
- Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Johana Klasova
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert D Pagan Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Rochester, Minnesota, USA
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | | | - Larry J Prokop
- Library and Public Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Clara I Yuh
- Department of Physical Medicine and Rehabilitation, University of California, Irvine, California, USA
| | - Sahil Gupta
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Christine L Hunt
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Li Y, Wang Y, Wu H, Li Q, Li S, Qiu C, Qiu S, Niu Q, Zhang X, Xiong Y, Tao G. Increased risk of fetal left-right asymmetry disorders associated with maternal SARS-CoV-2 infection during the first trimester. Sci Rep 2024; 14:11422. [PMID: 38763951 PMCID: PMC11102919 DOI: 10.1038/s41598-024-61778-w] [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: 12/10/2023] [Accepted: 05/09/2024] [Indexed: 05/21/2024] Open
Abstract
Our center has observed a substantial increase in the detection rate of fetal left-right(LR) asymmetry disorders between March and May 2023. This finding has raised concerns because these pregnant women experienced the peak outbreak of SARS-CoV-2 in China during their first trimester. To explore the relationship between maternal SARS-CoV-2 infection and fetal LR asymmetry disorders. A retrospective collection of clinical and ultrasound data diagnosed as fetal LR asymmetry disorders was conducted from January 2018 to December 2023. The case-control study involved fetuses with LR asymmetry disorders and normal fetuses in a 1:1 ratio. We evaluated and compared the clinical and fetal ultrasound findings in pregnant women with SARS-CoV-2 infection and pregnant women without infection. The Student t-test was utilized to compare continuous variables, while the chi-squared test was employed for univariable analyses. The incidence rate of LR asymmetry disorders from 2018 to 2023 was as follows: 0.17‰, 0.63‰, 0.61‰, 0.57‰, 0.59‰, and 3.24‰, respectively. A total of 30 fetuses with LR asymmetry disorders and 30 normal fetuses were included. This case-control study found that SARS-CoV-2 infection (96.67% vs 3.33%, P = .026) and infection during the first trimester (96.55% vs 3.45%, P = .008) were identified as risk factors. The odds ratio values were 10.545 (95% CI 1.227, 90.662) and 13.067 (95% CI 1.467, 116.419) respectively. In cases of SARS-CoV-2 infection in the first trimester, the majority of infections (88.1%, 37/42) occurred between 5 and 6 weeks of gestation. We found that 43.7% (66/151) of fetuses with LR asymmetry disorder had associated malformations, 90.9% (60/66) exhibited cardiac malformations. SARS-CoV-2 infection during the first trimester significantly increases the risk of fetal LR asymmetry disorders, particularly when the infection occurs between 5 and 6 gestation weeks. The most common associated malformation is heart malformation.
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Affiliation(s)
- Yang Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, Jinan, China
- The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Yuemei Wang
- Jinan Maternal and Child Health Care Hospital, Jinan, China
| | - Haifang Wu
- Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan City, 250012, China
| | - Qi Li
- Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan City, 250012, China
| | - Shizhen Li
- Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan City, 250012, China
| | - Chunli Qiu
- Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan City, 250012, China
| | - Shuo Qiu
- Jinan Maternal and Child Health Care Hospital, Jinan, China
| | - Qingfang Niu
- Linyi Maternal and Child Health Care Hospital, Shenzhen, China
| | - Xianmei Zhang
- Linyi Maternal and Child Health Care Hospital, Shenzhen, China
| | - Yi Xiong
- Luohu People's Hospital, Third Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Guowei Tao
- Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan City, 250012, China.
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Li XF, Zhang YJ, Yao YL, Chen MX, Wang LL, Wang MD, Hu XY, Tang XJ, Zhong ZH, Fu LJ, Luo X, Lv XY, Geng LH, Wan Q, Ding YB. The association of post-embryo transfer SARS-CoV-2 infection with early pregnancy outcomes in in vitro fertilization: a prospective cohort study. Am J Obstet Gynecol 2024; 230:436.e1-436.e12. [PMID: 38135094 DOI: 10.1016/j.ajog.2023.12.022] [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: 08/16/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The influence of SARS-CoV-2 infection after embryo transfer on early pregnancy outcomes in in vitro fertilization or intracytoplasmic sperm injection-embryo transfer treatment remains inadequately understood. This knowledge gap endures despite an abundance of studies investigating the repercussions of preceding SARS-CoV-2 infection on early pregnancy outcomes in spontaneous pregnancies. OBJECTIVE This study aimed to investigate the association between SARS-CoV-2 infection within 10 weeks after embryo transfer and early pregnancy outcomes in patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. STUDY DESIGN This prospective cohort study was conducted at a single public in vitro fertilization center in China. Female patients aged 20 to 39 years, with a body mass index ranging from 18 to 30 kg/m2, undergoing in vitro fertilization/intracytoplasmic sperm injection treatment, were enrolled between September 2022 and December 2022, with follow-up extended until March 2023. The study tracked SARS-CoV-2 infection time (≤14 days, ≤28 days, and ≤10 weeks after embryo transfer), symptoms, vaccination status, the interval between vaccination and embryo transfer, and early pregnancy outcomes, encompassing biochemical pregnancy rate, implantation rate, clinical pregnancy rate, and early miscarriage rate. The study used single-factor analysis and multivariate logistic regression to examine the association between SARS-CoV-2 infection status, along with other relevant factors, and the early pregnancy outcomes. RESULTS A total of 857 female patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment were analyzed. In the first stage, SARS-CoV-2 infection within 14 days after embryo transfer did not have a significant negative association with the biochemical pregnancy rate (adjusted odds ratio, 0.74; 95% confidence interval, 0.51-1.09). In the second stage, SARS-CoV-2 infection within 28 days after embryo transfer had no significant association with the implantation rate (36.6% in infected vs 44.0% in uninfected group; P=.181). No statistically significant association was found with the clinical pregnancy rate after adjusting for confounding factors (adjusted odds ratio, 0.69; 95% confidence interval, 0.56-1.09). In the third stage, SARS-CoV-2 infection within 10 weeks after embryo transfer had no significant association with the early miscarriage rate (adjusted odds ratio, 0.77; 95% confidence interval, 0.35-1.71). CONCLUSION Our study suggests that SARS-CoV-2 infection within 10 weeks after embryo transfer may not be negatively associated with the biochemical pregnancy rate, implantation rate, clinical pregnancy rate, and early miscarriage rate in patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. It is important to note that these findings are specific to the target population of in vitro fertilization/intracytoplasmic sperm injection patients aged 20 to 39 years, without previous SARS-CoV-2 infection, and with a body mass index of 18 to 30 kg/m2. This information offers valuable insights, addressing current concerns and providing a clearer understanding of the actual risk associated with SARS-CoV-2 infection after embryo transfer.
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Affiliation(s)
- Xue-Fei Li
- Reproductive Center, Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, China
| | - Yong-Jia Zhang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ying-Ling Yao
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ming-Xing Chen
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Li-Li Wang
- Reproductive Center, Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, China
| | - Meng-Di Wang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xin-Yue Hu
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xiao-Jun Tang
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Zhao-Hui Zhong
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Li-Juan Fu
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China; Department of Pharmacology, Academician Workstation, Changsha Medical University, Changsha, China
| | - Xin Luo
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xing-Yu Lv
- Reproductive Center, Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, China
| | - Li-Hong Geng
- Reproductive Center, Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, China
| | - Qi Wan
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yu-Bin Ding
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China.
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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.
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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
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Yasa B, Memur S, Ozturk DY, Bagci O, Uslu SI, Cetinkaya M. Neonatal Outcomes of Premature Infants Born to Women with the Novel Coronavirus (SARS-CoV-2) Infection: A Case Control Study. Am J Perinatol 2023; 40:1715-1724. [PMID: 34839474 DOI: 10.1055/s-0041-1740177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Novel coronavirus disease 2019 (COVID-19) is a disease associated with atypical pneumonia caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The first cases of COVID-19 were reported in Wuhan at the end of 2019. Transmission usually occurs via infected droplets and close personal contact; the possibility of vertical transmission is still under debate. This retrospective study aimed to analyze clinical characteristics of premature infants born to mothers with symptomatic COVID-19 disease. STUDY DESIGN This case control study compared the clinical and laboratory data of 20 premature infants born to mothers infected with SARS-CoV-2 with sex and gestational age-matched historical controls. RESULTS The median gestational age and birth weight in both groups were similar. Respiratory distress developed in 11 (55.5%) infants in study group and 19 (47.5%) infants in control group. Mechanical ventilation and endotracheal surfactant administration rates were similar. Median duration of hospitalization was 8.5 (2-76) days in study group and 12 days in historical controls. Real-time reverse-transcription polymerase chain reaction tests (RT-PCR) of nasopharyngeal swab samples for SARS-CoV-2 were found to be negative twice, in the first 24 hours and later at 24 to 48 hours of life. No neutropenia or thrombocytopenia was detected in the study group. Patent ductus arteriosus, bronchopulmonary dysplasia, and necrotizing enterocolitis rates were similar between groups. No mortality was observed in both groups. CONCLUSION To the best of our knowledge, this is one of the few studies evaluating the clinical outcomes of premature infants born to SARS-CoV-2 infected mothers. There was no evidence of vertical transmission of SARS-CoV-2 from symptomatic SARS-CoV-2-infected women to the neonate in our cohort. The neonatal outcomes also seem to be favorable with no mortality in preterm infants. KEY POINTS · SARS-CoV-2 pandemic is a challenge for pregnant women.. · Neonatal outcomes of premature infants born to mothers infected with SARS-CoV-2 not well defined.. · SARS-CoV-2 infection seems to have no adverse effect on mortality and morbidity in premature infants..
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Affiliation(s)
- Beril Yasa
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Seyma Memur
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Dilek Y Ozturk
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Onur Bagci
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Sait I Uslu
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Merih Cetinkaya
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
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Tripathy GS, Rath TS, Behera S, Lekha KS, Kar D, Pendyala S. Effects of Covid-19 Vaccination during Pregnancy on the Obstetric and Neonatal Outcomes in a Tertiary Health Care Center. JOURNAL OF MOTHER AND CHILD 2023; 27:72-78. [PMID: 37409659 PMCID: PMC10323967 DOI: 10.34763/jmotherandchild.20232701.d-22-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Pregnancy is an immuno-compromised state, and pregnant women with COVID-19 are at an increased risk for adverse pregnancy outcomes. Thus, the Center for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization (ACIP) have advocated for COVID-19 vaccination in pregnant women. COVAXIN and COVISHIELD were the vaccines being used in India in the first phase of vaccination, but limited data exist on pregnancy outcomes regarding SARS-CoV-2 vaccines and pregnancy and lactation. MATERIAL AND METHODS A retrospective study was conducted which included only women who delivered after 24 weeks gestation. Women with an unknown vaccination status or with past or active COVID-19 infection were excluded. Demographic characteristics, maternal and obstetric outcomes, and fetal and neonatal outcomes were compared between the unvaccinated and vaccinated groups. Statistical analysis was done with Chi-square testing and the Fisher exact test using SPSS-26 software. RESULTS Deliveries before a gestation of 37 weeks were significantly higher in the unvaccinated group compared to the vaccinated group. Rates of vaginal deliveries and preterm deliveries were found to be higher in the unvaccinated population. Women who had taken COVAXIN had a higher rate of adverse events compared to those who had taken COVISHIELD. CONCLUSION There were no significant differences in adverse obstetric outcomes attributed to vaccine administration between the vaccinated and unvaccinated pregnant women. The beneficial effects of the vaccines in protecting against COVID-19 infection, particularly in pregnancy, outweigh the minor adverse events associated with vaccine administration.
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Affiliation(s)
- Gargee Suman Tripathy
- Department of Obstetrics and Gynaecology, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
| | - Tanushree Sandipta Rath
- Department of Obstetrics and Gynaecology, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
| | - Saujanya Behera
- Department of Paediatrics, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India
| | - K Shruti Lekha
- AIPH (Asian Institute of Public Health) University, Bhubaneswar, Odisha, India
| | - Dattatreya Kar
- Department of Medical Research, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
| | - Sujata Pendyala
- Department of Obstetrics and Gynaecology, IMS & SUM Hospital, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar - 751003, Odisha, India
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Ivert A, Lindblad Wollmann C, Pettersson K. A Case Series on Pregnant Patients with Mild Covid-19 Infection and Signs of Severe Placental Insufficiency. Case Rep Obstet Gynecol 2023; 2023:2018551. [PMID: 37025388 PMCID: PMC10072962 DOI: 10.1155/2023/2018551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/24/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
In this case series, we present five cases of pregnant women who sought medical attention for reduced fetal movements with an ongoing mild maternal Covid-19 infection at a Stockholm hospital in Spring of 2021. At the time of admission, the patients were in gestational week between
and
. Abdominal ultrasound at the hospital showed no fetal movements, and cardiotocography (CTG) was pathological. All women delivered via cesarean section within 24 hours after admission. Placental pathology in all cases showed massive perivillous fibrin deposition and extensive histiocytic intervillositis. All placentas were Covid-19 polymerase chain reaction (PCR) positive. The infants were Covid-19 PCR negative. Consistent with other published case reports, we hypothesize that Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect the placenta resulting in massive perivillous fibrin deposition and histiocytic intervillositis leading to acute placental insufficiency and fetal hypoxia. The absence of intrauterine growth restriction also augments the theory of an acute onset of placental insufficiency due to the Covid-19 infection.
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Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment. Semin Fetal Neonatal Med 2023; 28:101426. [PMID: 36964118 PMCID: PMC9990893 DOI: 10.1016/j.siny.2023.101426] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Pregnancy-related acute respiratory distress syndrome (ARDS) is fast becoming a growing and clinically relevant subgroup of ARDS amidst global outbreaks of various viral respiratory pathogens that include H1N1-influenza, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS), and the most recent COVID-19 pandemic. Pregnancy is a risk factor for severe viral-induced ARDS and commonly associated with poor maternal and fetal outcomes including fetal growth-restriction, preterm birth, and spontaneous abortion. Physiologic changes of pregnancy further compounded by mechanical and immunologic alterations are theorized to impact the development of ARDS from viral pneumonia. The COVID-19 sub-phenotype of ARDS share overlapping molecular features of maternal pathogenicity of pregnancy with respect to immune-dysregulation and endothelial/microvascular injury (i.e., preeclampsia) that may in part explain a trend toward poor maternal and fetal outcomes seen with severe COVID-19 maternal infections. To date, current ARDS diagnostic criteria and treatment management fail to include and consider physiologic adaptations that are unique to maternal physiology of pregnancy and consideration of maternal-fetal interactions. Treatment focused on lung-protective ventilation strategies have been shown to improve clinical outcomes in adults with ARDS but may have adverse maternal-fetal interactions when applied in pregnancy-related ARDS. No specific pharmacotherapy has been identified to improve outcomes in pregnancy with ARDS. Adjunctive therapies aimed at immune-modulation and anti-viral treatment with COVID-19 infection during pregnancy have been reported but data in regard to its efficacy and safety is currently lacking.
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Affiliation(s)
- Michelle J Lim
- UC Davis School of Medicine, UC Davis Children's Hospital, Department of Pediatrics, Division of Critical Care and Neonatology, Sacramento, CA, USA.
| | - Satyan Lakshminrusimha
- UC Davis School of Medicine, UC Davis Children's Hospital, Department of Pediatrics, Division of Critical Care and Neonatology, Sacramento, CA, USA
| | - Herman Hedriana
- UC Davis School of Medicine, UC Davis Medical Center, Department of Obstetrics and Gynecology, Sacramento, CA, USA
| | - Timothy Albertson
- UC Davis School of Medicine, UC Davis Medical Center, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Sacramento, CA, USA
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Wachman EM, Snyder-Cappione J, Devera J, Boateng J, Dhole Y, Clarke K, Yuen RR, Parker SE, Hunnewell J, Ferraro R, Jean-Sicard S, Woodard E, Cruikshank A, Sinha B, Bartolome R, Barnett ED, Yarrington C, Taglauer ES, Sabharwal V. Maternal, Infant, and Breast Milk Antibody Response Following COVID-19 Infection in Early Versus Late Gestation. Pediatr Infect Dis J 2023; 42:e70-e76. [PMID: 36729773 PMCID: PMC9935237 DOI: 10.1097/inf.0000000000003802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Coronavirus disease 2019 [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] infection at varying time points during the pregnancy can influence antibody levels after delivery. We aimed to examine SARS-CoV-2 IgG, IgM and IgA receptor binding domain of the spike protein and nucleocapsid protein (N-protein) reactive antibody concentrations in maternal blood, infant blood and breastmilk at birth and 6 weeks after SARS-CoV-2 infection in early versus late gestation. METHODS Mothers with SARS-CoV-2 infection during pregnancy were enrolled between July 2020 and May 2021. Maternal blood, infant blood and breast milk samples were collected at delivery and 6 weeks postpartum. Samples were analyzed for SARS-CoV-2 spike and N-protein reactive IgG, IgM and IgA antibodies. Antibody concentrations were compared at the 2 time points and based on trimester of infection ("early" 1st/2nd vs. "late" 3rd). RESULTS Dyads from 20 early and 11 late trimester infections were analyzed. For the entire cohort, there were no significant differences in antibody levels at delivery versus 6 weeks with the exception of breast milk levels which declined over time. Early gestation infections were associated with higher levels of breastmilk IgA to spike protein ( P = 0.04). Infant IgG levels to spike protein were higher at 6 weeks after late infections ( P = 0.04). There were strong correlations between maternal and infant IgG levels at delivery ( P < 0.01), and between breastmilk and infant IgG levels. CONCLUSIONS SARS-CoV-2 infection in early versus late gestation leads to a persistent antibody response in maternal blood, infant blood and breast milk over the first 6 weeks after delivery.
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Affiliation(s)
- Elisha M. Wachman
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Jean Devera
- Boston University School of Medicine, Boston, Massachusetts
| | - Jeffery Boateng
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Yashoda Dhole
- Boston University School of Medicine, Boston, Massachusetts
| | - Katherine Clarke
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts
| | - Rachel R. Yuen
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts
| | - Samantha E. Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jessica Hunnewell
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Renee Ferraro
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Sigride Jean-Sicard
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Elizabeth Woodard
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Alice Cruikshank
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Bharati Sinha
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Ruby Bartolome
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Christina Yarrington
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | | | - Vishakha Sabharwal
- From the Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
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10
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Carvajal J, Casanello P, Toso A, Farías M, Carrasco-Negue K, Araujo K, Valero P, Fuenzalida J, Solari C, Sobrevia L. Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166582. [PMID: 36273675 PMCID: PMC9581789 DOI: 10.1016/j.bbadis.2022.166582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022]
Abstract
The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.
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Affiliation(s)
- Jorge Carvajal
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Paola Casanello
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands
| | - Alberto Toso
- Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Marcelo Farías
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Karina Carrasco-Negue
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Kenny Araujo
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile
| | - Javiera Fuenzalida
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Caterina Solari
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Luis Sobrevia
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland, Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston 4029, Queensland, Australia; Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.
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11
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Vásquez-Procopio J, Torres-Torres J, Borboa-Olivares H, Sosa SEY, Martínez-Portilla RJ, Solis-Paredes M, Tolentino-Dolores MC, Helguera-Repetto AC, Marrufo-Gallegos KC, Missirlis F, Perichart-Perera O, Estrada-Gutierrez G. Association between 25-OH Vitamin D Deficiency and COVID-19 Severity in Pregnant Women. Int J Mol Sci 2022; 23:15188. [PMID: 36499537 PMCID: PMC9735729 DOI: 10.3390/ijms232315188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022] Open
Abstract
Evidence from studies in the general population suggests an association between vitamin D insufficiency/deficiency and COVID-19 susceptibility and disease severity. The present study was performed on 165 third-trimester pregnant women at the time of delivery. Seventy-nine women tested negative for SARS-CoV-2. From 86 women testing positive, 32 were asymptomatic, 44 presented a mild form of the disease, and 10 experienced severe symptoms. Serum 25-OH vitamin D levels were measured on blood samples collected on admission. Low vitamin D levels were detected in symptomatic but not asymptomatic COVID-19 patients compared to healthy women (p = 0.0227). In addition, 20 (45.4%) pregnant women in the mild COVID-19 group and 6 (60%) in the severe group were vitamin D deficient (p = 0.030). On the other hand, lasso regression analysis showed that 25-OH vitamin D deficiency is an independent predictor of severe COVID-19 with an odds ratio (OR) of 5.81 (95% CI: 1.108-30.541; p = 0.037). These results show the relationship between vitamin D deficiency in pregnant women and the severity of COVID-19 infection and support the recommendation to supplement with vitamin D to avoid worse COVID-19 outcomes during pregnancy.
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Affiliation(s)
- Johana Vásquez-Procopio
- Department of Immunobiochemistry, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Mexico City 07360, Mexico
| | - Johnatan Torres-Torres
- Clinical Research Division, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
| | - Hector Borboa-Olivares
- Community Interventions Research Branch, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
| | - Salvador Espino Y Sosa
- Clinical Research Division, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
| | | | - Mario Solis-Paredes
- Clinical Research Division, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
| | - Mari-Cruz Tolentino-Dolores
- Coordination of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
| | | | | | - Fanis Missirlis
- Department of Physiology, Biophysics and Neuroscience, Center for Research and Advanced Studies (Cinvestav), Mexico City 07360, Mexico
| | - Otilia Perichart-Perera
- Coordination of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
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12
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Klüßendorf A, Richter MF, Webermann S, Schild RL, Morfeld CA. [COVID-19 in Pregnancy - a Risk for the Unborn Child?]. Z Geburtshilfe Neonatol 2022; 226:343-348. [PMID: 36228609 DOI: 10.1055/a-1915-5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Geburtskliniken werden zunehmend mit an Covid-19 erkrankten Schwangeren konfrontiert. Dies stellt Geburtshelfer vor große Herausforderungen, da einige Fragestellungen noch nicht ausreichend wissenschaftlich erforscht sind. Über Covid-19 während der Schwangerschaft und seine Auswirkungen auf das ungeborene und neugeborene Kind ist nicht viel bekannt.
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Affiliation(s)
| | | | | | - Ralf L Schild
- Perinatalzentrum, DIAKOVERE gGmbH, Hannover, Germany
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13
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Correlation between Pregnancy Outcome and Placental Pathology in COVID-19 Pregnant Women. Infect Dis Obstet Gynecol 2022; 2022:8061112. [PMID: 36046178 PMCID: PMC9420637 DOI: 10.1155/2022/8061112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Vertical transmission of several viruses during pregnancy has been shown to cause adverse fetal outcomes. The question about the possibility of a similar outcome in association with SARS-CoV-2 has been raised in recently published articles. Indeed, the rate of transmission through the placenta to the fetus reported in women with COVID-19 has been shown to form a minority. The aim of this study was to explore the possible histopathological changes in the placenta of pregnant women with COVID-19 after delivery and those changes in the umbilical cord. Methods A case-control study including a total of 50 full-term pregnant women with COVID-19 and 60 control pregnant females. Histopathological evaluation of placental tissues and umbilical cords were reported. Results The main findings in the umbilical cord were increased thickness of vessels, thrombus formation, endothelins, and narrow lumen; except for the increased thickness of blood vessels, these findings were more frequently seen in women with COVID-19, in comparison with control women in a significant manner (p < 0.05). Increased thickness of blood vessels was more significantly observed in the control group compared to the COVID-19 group (p < 0.01). Findings of the placenta included avascular villi, fibrin, thrombosis, and meconium macrophage in various combinations. Except for fibrin as the sole findings, all other findings including combinations were more frequently encountered in the study group in comparison to the control group (p < 0.05). Conclusion Pregnant women with COVID-19 have significant pathological alterations in the placenta and umbilical cord. These findings reflect the capability of SARS-CoV-2 in causing immunological reactions to the placenta, either directly or indirectly, and these pathologies may be linked to the higher rate of adverse neonatal outcomes and maternal admission to the intensive care unit.
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14
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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.
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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,
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15
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Laguila Altoé A, Marques Mambriz AP, Cardozo DM, Valentini Zacarias JM, Laguila Visentainer JE, Bahls-Pinto LD. Vaccine Protection Through Placenta and Breastfeeding: The Unmet Topic in COVID-19 Pandemic. Front Immunol 2022; 13:910138. [PMID: 35720385 PMCID: PMC9203883 DOI: 10.3389/fimmu.2022.910138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/09/2022] [Indexed: 01/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has turned pregnant women's healthcare into a worldwide public health challenge. Although initial data did not demonstrate pregnancy as a more susceptible period to severe outcomes of acute severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infection, there are an increasing number of reports showing that not only pregnant women might be at significantly higher risk than non-pregnant women by COVID-19 but also the fetus. These findings may be related to adaptive changes that occur during pregnancy, such as the reduction in the residual respiratory capacity, the decrease in viral immune responses, and the increased risk for thromboembolic events. Additionally, despite the SARS-CoV-2 vertical transmission evidence being uncommon, maternal illness severity might reflect serious perinatal and neonatal outcomes. Thus, protecting the maternal-fetal dyad against COVID-19 is critical. Even though pregnant women initially were excluded from vaccine trials, several studies have provided safety and efficacy of the overall vaccine COVID-19 platforms. Vaccination during pregnancy becomes a priority and can generate benefits for both the mother and newborn: maternal neutralizing antibodies are transmitted through the placenta and breastfeeding. Moreover, regarding passive immunization, human milk contains other bioactive molecules and cells able to modulate the newborn's immune response, which can be amplified after the vaccine. Nonetheless, many issues remain to be elucidated, considering the magnitude of the protective immunity transferred, the duration of the induced immunity, and the optimal interval for pregnant immunization. In this review, we assessed these unmet topics supported by literature evidence regarding the vaccine's immunogenicity, pregnancy immune heterogeneity, and the unique human milk antiviral features.
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Affiliation(s)
- Ariane Laguila Altoé
- Department of Basic Health Science, Laboratory of Immunogenetics, State University of Maringa, Maringa, Brazil
- Department of Medicine, State University of Maringa, Maringa, Brazil
| | - Anna Paula Marques Mambriz
- Department of Clinical Analysis and Biomedicine, Postgraduate Program in Biosciences and Physiopathology, State University of Maringa, Maringa, Brazil
| | | | - Joana Maira Valentini Zacarias
- Department of Basic Health Science, Laboratory of Immunogenetics, State University of Maringa, Maringa, Brazil
- Department of Clinical Analysis and Biomedicine, Postgraduate Program in Biosciences and Physiopathology, State University of Maringa, Maringa, Brazil
| | - Jeane Eliete Laguila Visentainer
- Department of Basic Health Science, Laboratory of Immunogenetics, State University of Maringa, Maringa, Brazil
- Department of Clinical Analysis and Biomedicine, Postgraduate Program in Biosciences and Physiopathology, State University of Maringa, Maringa, Brazil
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16
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Cao H, Abd Aziz NH, Xavier JR, Shafiee MN, Kalok A, Jee B, Salker MS, Singh Y. Dysregulated Exosomes Result in Suppression of the Immune Response of Pregnant COVID-19 Convalescent Women. Front Mol Biosci 2022; 9:869192. [PMID: 35647028 PMCID: PMC9136085 DOI: 10.3389/fmolb.2022.869192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 12/28/2022] Open
Abstract
A successful pregnancy outcome is dependent on a delicate balance between inflammatory and anti-inflammatory processes throughout the different trimesters. Interruption in this balance can lead to an adverse outcome resulting in pregnancy loss. Since late 2019, the emergence of the new SARS-CoV-2 virus has affected lives worldwide, including pregnant women; therefore, there is an urgent need to address different approaches in relation to prevention, diagnostics, and therapeutics. Early pregnancy is affected by SARS-CoV-2 infection leading to fetal demise. Available evidence also suggests that 90% of pregnant women infected with the SARS-CoV-2 virus seem to be asymptomatic. Nonetheless, it is still unclear how COVID-19 affects exosome production in pregnant women recovered from COVID-19 and how these exosomes regulate the adaptive immune response. In this study, we found several exosomes including CD9, CD31, CD40, CD45, CD41b, CD42a, CD62P, CD69, CD81, CD105, and HLA-DRDPDQ in the plasma of COVID-19-recovered pregnant women were significantly less abundant than the control group. Furthermore, to understand how these exosomes affect the adaptive immune response, we co-cultured the peripheral blood mononuclear cells (PBMCs) from healthy control (HC) pregnant women with exosomes of either Preg-HC or Preg-recovered COVID-19 women. We identified that Preg-recovered COVID-19 women have reduced capacity for the inflammatory cytokine TNF-α from cytotoxic CD8+ T cells. In summary, our study highlights that pregnant recovered COVID-19 women have reduced production of several exosomes and possess fewer immunogenic properties. Our study implicates that exosomes can control inflammation and antigen presentation capacity of immune cells, thus limiting the infection in pregnant women.
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Affiliation(s)
- Hang Cao
- Department of Women’s Health, Research Institute for Women’s Health, University of Tübingen, Tübingen, Germany
| | - Nor Haslinda Abd Aziz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Janet Raja Xavier
- Department of Women’s Health, Research Institute for Women’s Health, University of Tübingen, Tübingen, Germany
| | - Mohamad Nasir Shafiee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Aida Kalok
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Babban Jee
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Madhuri S. Salker
- Department of Women’s Health, Research Institute for Women’s Health, University of Tübingen, Tübingen, Germany
| | - Yogesh Singh
- Department of Women’s Health, Research Institute for Women’s Health, University of Tübingen, Tübingen, Germany
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- NGS Competence Centre Tübingen (NCCT), University of Tübingen, Tübingen, Germany
- *Correspondence: Yogesh Singh,
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17
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Ghafoor H, Abdus Samad A, Bel Khair AOM, Ahmed O, Khan MNA. Critical Care Management of Severe COVID-19 in Pregnant Patients. Cureus 2022; 14:e24885. [PMID: 35572463 PMCID: PMC9097928 DOI: 10.7759/cureus.24885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 12/15/2022] Open
Abstract
Since December 2019, the coronavirus disease (COVID-19) pandemic has had a disastrous impact worldwide. COVID-19 is caused by the SARS-CoV-2 virus and was declared a pandemic by the WHO on March 11, 2020. The virus has been linked to a wide range of respiratory illnesses, ranging from mild symptoms to acute pneumonia and severe respiratory distress syndrome. Pregnant women are more vulnerable to COVID-19 complications owing to the physiological and immunological changes caused by pregnancy. According to the CDC, pregnant patients with COVID-19 are commonly hospitalized and often require admission to ICUs and ventilator support. Therefore, it is especially important for pregnant women to adhere to disease prevention measures to lower the risk of contracting the disease. In addition, the guidelines of several clinical societies and local health authorities should be followed when caring for pregnant women with suspected or confirmed COVID-19. In this review article, we discuss the epidemiology of COVID-19 during delivery, its effect on the physiological and immunological changes during pregnancy, the classification of COVID-19 severity, maternal and fetal risks, antenatal care, respiratory management, treatment/medication safety, timing and mode of delivery, anesthetic considerations, and the outcome of critically ill pregnant patients with COVID-19, as well as their post-delivery care and weaning from mechanical ventilation.
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Affiliation(s)
- Hashsaam Ghafoor
- Department of Anaesthesiology, Hamad Medical Corporation, Al Khor, QAT
| | - Aijaz Abdus Samad
- Department of Anaesthesiology, Latifa Women and Children Hospital, Dubai, ARE
| | | | - Osman Ahmed
- Department of Anaesthesiology, Hamad Medical Corporation, Al Khor, QAT
| | - Muhammad Nasir Ayub Khan
- Department of Anaesthesiology and Critical Care, Shifa International Hospital Islamabad, Islamabad, PAK
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18
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Nakhaei M, Fakhar M, Sharifpour A, Banimostafavi ES, Zakariaei Z, Mehravaran H, Saberi R, Safanavaei S, Abedi S, Aliyali M, Soleimani M. First Co-morbidity of Lophomonas blattarum and COVID-19 Infections: Confirmed Using Molecular Approach. Acta Parasitol 2022; 67:535-538. [PMID: 34677797 PMCID: PMC8531884 DOI: 10.1007/s11686-021-00468-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022]
Abstract
Introduction Lophomoniasis is caused by Lophomonas spp., a new emerging protozoan, which commonly affects the human lower respiratory tract. The Lophomonas parasite mostly lives commensally in the hindgut of cockroaches. Case Presentation We present the case of a 33-year-old woman, 30 weeks pregnant, who had severe COVID-19. She was intubated upon admission and began the routine COVID-19 treatment. To rule out possible super infection dual with COVID-19, microscopic examination of the patient's mini-bronchoalveolar lavage (mini-BAL) specimen, revealed L. blattarum, which was identified by the SSU rRNA-PCR and sequencing approaches (accession number: MZ093069). According to that, the patient was treated successfully with metronidazole. Conclusion To prevent serious complications, lophomoniasis should be listed in co-morbidity cases of COVID-19 infection during the COVID-19 pandemic worldwide. To the best of our knowledge, this is the first co-infection of Lophomonas blattarum and COVID-19 in the world which has been confirmed using a molecular approach.
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Affiliation(s)
- Maryam Nakhaei
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran.
| | - Ali Sharifpour
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran.
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, PO Box 48166-33131, Sari, Iran.
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
- Department of Radiology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
- Toxicology and Forensic Medicine Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mehravaran
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, PO Box 48166-33131, Sari, Iran
| | - Reza Saberi
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
| | - Sepideh Safanavaei
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, PO Box 48166-33131, Sari, Iran
| | - Siavash Abedi
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, PO Box 48166-33131, Sari, Iran
| | - Masoud Aliyali
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, PO Box 48166-33131, Sari, Iran
| | - Mostafa Soleimani
- Toxoplasmosis Research Center, School of Medicine, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Km 18, Farah-Abad Road, PO Box 48471-91971, Sari, Iran
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19
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Chang EE, Cordoba M, Vellanki S, Trikannad Ashwini Kumar AK, Segura E. Critical Care Management of a Severe Acute Respiratory Distress Syndrome COVID-19 Patient With Control Cesarean Section. Cureus 2022; 14:e22660. [PMID: 35371736 PMCID: PMC8964022 DOI: 10.7759/cureus.22660] [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] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
Abstract
We share our experience of one 29-year-old female, G2 P1, with acute respiratory distress syndrome (ARDS) and at 30 weeks of pregnancy. The 30-week gravid uterus in combination with a poor ventilation-perfusion ratio creates a restrictive lung pattern that may prove to be lethal for both the mother and baby. Due to her rapid deterioration and increased hemodynamic instability we opted for controlled delivery in the operating room with an ICU physician, a Neonatologist, and an Obstetric team. At 3.27 minutes from induction, the baby was born with Apgar scores of 7 and 8. The mother was placed on a RotoProne® bed, treated with remdesivir, steroids, and was subsequently extubated seven days later. The newborn was admitted to the Neonatal Intensive Care Unit (NICU) after delivery. We have reviewed the literature and provided a concise set of recommendations based on our field experience and current world literature review. Prompt delivery in a controlled environment with multiple resuscitating teams provided expeditious treatment of both patients, maintaining oxygenation and perfusion while keeping hemodynamic stability. The controlled environment and the proximity of all teams avoided deleterious consequences to the unborn baby. This is an example where the risk of keeping the baby in the womb outweighs the premature delivery into a NICU. Both mother and baby were downgraded from their respective Intensive Care Units (ICUs) and discharged home in one month.
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20
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Cardoso JP, Calazans MIP, Carneiro ALFC, Costa CM, Monteiro ELO, Aristizábal LYG, Oliveira JDS, dos Santos AM. Association between multimorbidity, intensive care unit admission, and death in patients with COVID-19 in Brazil: a cross-section study, 2020. SAO PAULO MED J 2022; 141:e2022226. [PMID: 36197353 PMCID: PMC10065096 DOI: 10.1590/1516-3180.2022.0226.r1.21072022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multimorbidity can influence intensive care unit (ICU) admissions and deaths due to coronavirus disease (COVID-19). OBJECTIVE To analyze the association between multimorbidity, ICU admissions, and deaths due to COVID-19 in Brazil. DESIGN AND SETTING This cross-sectional study was conducted using data from patients with severe acute respiratory syndrome (SARS) due to COVID-19 recorded in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) in 2020. METHODS Descriptive and stratified analyses of multimorbidity were performed based on sociodemographic, ventilatory support, and diagnostic variables. Poisson regression was used to estimate the prevalence ratios. RESULTS We identified 671,593 cases of SARS caused by COVID-19, of which 62.4% had at least one morbidity. Multimorbidity was associated with male sex, age 60-70 and ≥ 80 years, brown and black skin color, elementary education and high school, ventilatory support, and altered radiologic exams. Moreover, all regions of the country and altered computed tomography due to COVID-19 or other diseases were associated with death; only the northeast region and higher education were associated with ICU admission. CONCLUSION Our results showed an association between multimorbidity, ICU admission, and death in COVID-19 patients in Brazil.
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Affiliation(s)
- Jefferson Paixão Cardoso
- PhD. Physiotherapist and Full Professor, Department of Health
II, Núcleo de Estudos em Saúde da População (NESP), Universidade Estadual do
Sudoeste da Bahia (UESB), Jequié (BA), Brazil
| | - Maria Inês Pardo Calazans
- MSc. Physiotherapist and Doctoral Student, Postgraduate Program
in Nursing and Health, Núcleo de Estudos em Saúde da População (NESP),
Universidade Estadual do Sudoeste da Bahia (UESB), Jequié (BA), Brazil
| | | | - Cayara Mattos Costa
- MSc. Dental Surgeon, Doctoral Student, Postgraduate Program in
Dentistry, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil
| | - Edna Luisa Oliveira Monteiro
- MSc. Dental Surgeon, Postgraduate Program in Dentistry,
Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil
| | - Liliana Yanet Gómez Aristizábal
- PhD. Health Administrator, Postgraduate Program in Public
Health, Universidade Federal do Maranhão (UFMA), São Luís (MA), Brazil
| | - Juliana da Silva Oliveira
- PhD. Nurse and Full Professor, Department of Health II, Núcleo
de Estudos em Saúde da População (NESP), Universidade Estadual do Sudoeste da
Bahia, (UESB), Jequié (BA), Brazil
| | - Alcione Miranda dos Santos
- PhD. Statistician and Full Professor, Postgraduate Program in
Public Health, Universidade Federal do Maranhão (UFMA), São Luís (MA),
Brazil
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21
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Zaky S, Hosny H, Elassal G, Asem N, Baki AA, Kamal E, Abdelbary A, Said A, Ibrahim H, Taema K, Amin W, Abd-Elsalam S, Soliman S, Abdelmenam HS, Mohamed AS, Elnady M, Hassany M, Zaid H. Clinical evaluation of pregnant women with SARS-COV2 pneumonia: a real-life study from Egypt. J Egypt Public Health Assoc 2021; 96:29. [PMID: 34735655 PMCID: PMC8567119 DOI: 10.1186/s42506-021-00092-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 10/18/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Knowledge about the outcome of COVID-19 on pregnant women is so important. The published literature on the outcomes of pregnant women with COVID-19 is confusing. The aim of this study was to report our clinical experience about the effect of COVID-19 on pregnant women and to determine whether it was associated with increased mortality or an increase in the need for mechanical ventilation in this special category of patients. METHODS This was a cohort study from some isolation hospitals of the Ministry of Health and Population, in eleven governorates, Egypt. The clinical data from the first 64 pregnant women with COVID-19 whose care was managed at some of the Egyptian hospitals from 14 March to 14 June 2020 as well as 114 non-pregnant women with COVID-19 was reviewed. RESULTS The two groups did not show any significant difference regarding the main outcomes of the disease. Two cases in each group needed mechanical ventilation (p 0.617). Three cases (4.7%) died among the pregnant women and two (1.8%) died among the non-pregnant women (p 0.352). CONCLUSIONS The main clinical outcomes of COVID-19 were not different between pregnant and non-pregnant women with COVID-19. Based on our findings, pregnancy did not exacerbate the course or mortality of COVID-19 pneumonia.
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Affiliation(s)
- Samy Zaky
- Hepatogastroenterology and Infectious Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hossam Hosny
- Chest Diseases Department, Head of Pulmonary Hypertension Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehan Elassal
- Pulmonary Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Noha Asem
- Public Health Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amin Abdel Baki
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt
| | - Ehab Kamal
- Tropical Medicine Department. Medical Division, National Research Center, Cairo, Egypt
| | - Akram Abdelbary
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad Said
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hamdy Ibrahim
- Fever Hospitals, Ministry of Health and Population (MOHP), Cairo, Egypt
| | - Khaled Taema
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Shaimaa Soliman
- Public Health and Community Medicine Department, Menoufia University, Menoufia, Egypt
| | | | - Ahmed S Mohamed
- Chest Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Elnady
- Pulmonology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt
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22
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Stephansson O, Pasternak B, Ahlberg M, Hervius Askling H, Aronsson B, Appelqvist E, Jonsson J, Sengpiel V, Söderling J, Norman M, Ludvigsson JF, Neovius M. SARS-CoV-2 and pregnancy outcomes under universal and non-universal testing in Sweden: register-based nationwide cohort study. BJOG 2021; 129:282-290. [PMID: 34706148 PMCID: PMC8652549 DOI: 10.1111/1471-0528.16990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/13/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval. DESIGN Nationwide cohort study. SETTING Sweden. POPULATION From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval. MAIN OUTCOME MEASURES Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. RESULTS During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02). CONCLUSIONS Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. TWEETABLE ABSTRACT Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.
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Affiliation(s)
- O Stephansson
- The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - B Pasternak
- The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Statens Serum Institut, Copenhagen, Denmark
| | - M Ahlberg
- The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - H Hervius Askling
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - B Aronsson
- The Public Health Agency of Sweden, Solna, Sweden
| | - E Appelqvist
- The Public Health Agency of Sweden, Solna, Sweden
| | - J Jonsson
- The Public Health Agency of Sweden, Solna, Sweden
| | - V Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Söderling
- The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - J F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
| | - M Neovius
- The Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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23
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Machluf Y, Rosenfeld S, Ben Shlomo I, Chaiter Y, Dekel Y. The Misattributed and Silent Causes of Poor COVID-19 Outcomes Among Pregnant Women. Front Med (Lausanne) 2021; 8:745797. [PMID: 34765620 PMCID: PMC8575767 DOI: 10.3389/fmed.2021.745797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023] Open
Abstract
Abundant evidence strongly suggests that the condition of pregnancy makes women and their fetuses highly vulnerable to severe Corona-virus 2019 (COVID-19) complications. Here, two novel hypoxia-related conditions are proposed to play a pivotal role in better understanding the relationship between COVID-19, pregnancy and poor health outcomes. The first condition, "misattributed dyspnea (shortness of breath)" refers to respiratory symptoms common to both advanced pregnancy and COVID-19, which are mistakenly perceived as related to the former rather than to the latter; as a result, pregnant women with this condition receive no medical attention until the disease is in an advanced stage. The second condition, "silent hypoxia", refers to abnormally low blood oxygen saturation levels in COVID-19 patients, which occur in the absence of typical respiratory distress symptoms, such as dyspnea, thereby also leading to delayed diagnosis and treatment. The delay in diagnosis and referral to treatment, due to either "misattributed dypsnea" or "silent hypoxia", may lead to rapid deterioration and poor health outcome to both the mothers and their fetuses. This is particularly valid among women during advanced stages of pregnancy as the altered respiratory features make the consequences of the disease more challenging to cope with. Studies have demonstrated the importance of monitoring blood oxygen saturation by pulse oximetry as a reliable predictor of disease severity and outcome among COVID-19 patients. We propose the use of home pulse oximetry during pregnancy as a diagnostic measure that, together with proper medical guidance, may allow early diagnosis of hypoxia and better health outcomes.
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Affiliation(s)
- Yossy Machluf
- Unit of Agrigenomics, Shamir Research Institute, Haifa University, Kazerin, Israel
| | - Sherman Rosenfeld
- The Department of Science Teaching, Weizmann Institute of Science, Rehovot, Israel
| | - Izhar Ben Shlomo
- Emergency Medicine Program, Zefat Academic College, Safed, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-Based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Yaron Dekel
- Unit of Agrigenomics, Shamir Research Institute, Haifa University, Kazerin, Israel
- Department of Medical Laboratory Sciences, Zefat Academic College, Safed, Israel
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24
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Rodríguez-Díaz M, Alonso-Molero J, Cabero-Perez MJ, Llorca J, Dierssen-Sotos T, Gómez-Acebo I. Pregnancy and Birth Outcomes during the Early Months of the COVID-19 Pandemic: The MOACC-19 Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10931. [PMID: 34682679 PMCID: PMC8535818 DOI: 10.3390/ijerph182010931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
The new coronavirus, SARS-CoV-2, is devastating for specific groups of patients, but currently there is not enough information concerning its effects on pregnant women. The purpose of this study is to identify the impact of SARS-CoV-2 infection on pregnancy and the consequences that it could cause. We studied a cohort of pregnant ladies who were tested for SARS-CoV-2 infection by RT-PCR and classified as infected or not infected. The recruitment was carried out in the HUMV hospital, a third-level hospital located in Santander, northern Spain. It started on 23 March 2020 and ended on 14 October 2020. Data from our cohort were compared to another cohort recruited in 2018 at the same hospital. We found that gestational hypertension, placental abruptio, and home exposure to an infected person, among other variables, could be associated with SARS-CoV-2 infection. In conclusion, we consider pregnant women a high-risk group of patients towards a possible SARS-CoV-2 infection, especially those who present with conditions such as gestational hypertension or obesity; moreover, we think that SARS-CoV-2 infection could increase the possibilities of having an abruptio placentae, although this result was found in only a few women, so it requires further confirmation.
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Affiliation(s)
- Marta Rodríguez-Díaz
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
| | - Jéssica Alonso-Molero
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
| | - María J. Cabero-Perez
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Javier Llorca
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Trinidad Dierssen-Sotos
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Inés Gómez-Acebo
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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25
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Zolezzi M, Paravattil B, El-Gaili T. Using motivational interviewing techniques to inform decision-making for COVID-19 vaccination. Int J Clin Pharm 2021; 43:1728-1734. [PMID: 34599721 PMCID: PMC8486954 DOI: 10.1007/s11096-021-01334-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
Motivational interviewing is a patient-centered communication style used to enhance a person’s internal motivation for attitudinal change by exploring and solving inherent ambivalences. In the face of rising COVID-19 vaccine hesitancy, pharmacists and other health care professionals may use motivational interviewing to enable individuals making informed decisions with regards to the COVID-19 vaccines. The purpose of this article is to integrate theory with practice by describing a scenario that illustrates how motivational interviewing skills and strategies can be used to reduce COVID-19 vaccine hesitancy.
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Affiliation(s)
- Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
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26
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Azinheira Nobrega Cruz N, Stoll D, Casarini D, Bertagnolli M. Role of ACE2 in pregnancy and potential implications for COVID-19 susceptibility. Clin Sci (Lond) 2021; 135:1805-1824. [PMID: 34338772 PMCID: PMC8329853 DOI: 10.1042/cs20210284] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
In times of coronavirus disease 2019 (COVID-19), the impact of severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 infection on pregnancy is still unclear. The presence of angiotensin-converting enzyme (ACE) 2 (ACE2), the main receptor for SARS-CoV-2, in human placentas indicates that this organ can be vulnerable for viral infection during pregnancy. However, for this to happen, additional molecular processes are critical to allow viral entry in cells, its replication and disease manifestation, particularly in the placenta and/or feto-maternal circulation. Beyond the risk of vertical transmission, COVID-19 is also proposed to deplete ACE2 protein and its biological actions in the placenta. It is postulated that such effects may impair essential processes during placentation and maternal hemodynamic adaptations in COVID-19 pregnancy, features also observed in several disorders of pregnancy. This review gathers information indicating risks and protective features related to ACE2 changes in COVID-19 pregnancies. First, we describe the mechanisms of SARS-CoV-2 infection having ACE2 as a main entry door and current evidence of viral infection in the placenta. Further, we discuss the central role of ACE2 in physiological systems such as the renin-angiotensin system (RAS) and the kallikrein-kinin system (KKS), both active during placentation and hemodynamic adaptations of pregnancy. Significant knowledge gaps are also identified and should be urgently filled to better understand the fate of ACE2 in COVID-19 pregnancies and the potential associated risks. Emerging knowledge will be able to improve the early stratification of high-risk pregnancies with COVID-19 exposure as well as to guide better management and follow-up of these mothers and their children.
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Affiliation(s)
- Nayara Azinheira Nobrega Cruz
- Department of Medicine, Discipline of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil
- Research Center of the Hospital Sacré-Coeur, CIUSSS Nord-de-l’Île-de-Montréal, Montréal, Canada
| | - Danielle Stoll
- Department of Medicine, Discipline of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil
| | - Dulce Elena Casarini
- Department of Medicine, Discipline of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil
| | - Mariane Bertagnolli
- Research Center of the Hospital Sacré-Coeur, CIUSSS Nord-de-l’Île-de-Montréal, Montréal, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Canada
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27
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Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Pregnancy: Measures of Immunity and Placental Histopathology. Obstet Gynecol 2021; 138:281-283. [PMID: 33975329 PMCID: PMC8288194 DOI: 10.1097/aog.0000000000004457] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022]
Abstract
Receipt of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination was not associated with placental histopathologic lesions.
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28
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Yasa B, Memur S, Ozturk DY, Bagci O, Uslu SI, Polat I, Cetinkaya M. Severity of Maternal SARS-CoV-2 Infection in Pregnancy Predicts Neonatal Outcomes. Am J Perinatol 2021; 40:688-696. [PMID: 34320680 DOI: 10.1055/s-0041-1733783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak had an enormous global impact. Pregnant women with SARS-CoV-2 appear to have higher morbidity and mortality. This study aimed to evaluate the effect of the severity of maternal SARS-CoV-2 infection on neonatal outcomes. STUDY DESIGN The clinical and laboratory data of 40 women and neonates evaluated retrospectively. RESULTS This retrospective study showed that SARS-CoV-2 infection had an adverse impact on neonatal outcomes proportionally with the maternal disease severity including increased prematurity rates, postnatal resuscitation need, prolonged hospital stay and longer ventilatory support requirement in infants born to mothers with moderate or severe disease. CONCLUSION Maternal disease severity had adverse effects on neonatal outcomes. The severity of maternal disease was found to be associated with increased rates of prematurity, requirement of postnatal resuscitation, prolonged hospital stay, and longer ventilatory support. KEY POINTS · SARS-CoV-2 pandemic is a problem for pregnant women.. · Vertical transmission has been shown in limited studies.. · Maternal disease severity may have impact on neonatal outcomes..
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Affiliation(s)
- Beril Yasa
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Seyma Memur
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Dilek Yavuzcan Ozturk
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Onur Bagci
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Sait Ilker Uslu
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ibrahim Polat
- Perinatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Merih Cetinkaya
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Samadi P, Alipour Z, Ghaedrahmati M, Ahangari R. The severity of COVID-19 among pregnant women and the risk of adverse maternal outcomes. Int J Gynaecol Obstet 2021; 154:92-99. [PMID: 33834499 PMCID: PMC9087550 DOI: 10.1002/ijgo.13700] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 12/31/2022]
Abstract
Objective To evaluate the relationship between the severity of coronavirus disease 2019 (COVID‐19) during pregnancy and the risk of adverse maternal outcomes. Methods A descriptive‐analytical cross‐sectional study conducted on 258 pregnant women who were hospitalized due to confirmed COVID‐19 from March 2020 to January 2021 at the Forghani Hospital in Qom, Iran. Demographic and obstetric characteristics, laboratory findings, and adverse maternal outcomes were recorded from the patients’ medical records. The Fisher exact test, one‐way analysis of variance, and regression logistics were used to assess the relationship between variables. Results Of the total study population, 206 (79.8%) pregnant women had mild to moderate disease, 43 (16.7%) had severe disease, and 9 (3.5%) were in the critical stage of the disease. Eight women (3.1%) died and 33 (12.8%) were admitted to the intensive care unit (ICU). The most important demographic factors associated with the severity of the disease were ethnicity, underlying conditions, maternal age, and parity. The severity of the disease was significantly associated with increased cesarean delivery and admission to the ICU. Conclusion Pregnant women with severe and critical disease had a high rate of cesarean delivery and admission to the ICU. There were eight cases of maternal mortality. Factors related to severity of COVID‐19 were ethnicity, underlying conditions, age, and parity. Women with severe disease had a high rate of cesarean delivery and admission to the ICU.
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Affiliation(s)
- Parisa Samadi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, University of Medical Sciences Tehran, Tehran, Iran
| | - Zahra Alipour
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | | | - Roghayeh Ahangari
- Department of Obstetrics & Gynecology, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
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Jaffe EF, Karron RA, Krubiner CB, Wonodi CB, Beigi RH, Sheffield JS, Faden RR. Global equity in protection of pregnant frontline workers. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16548.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vaccination of frontline workers against COVID-19 is underway in some countries. With women comprising a majority of health, education, and other essential workforces, many on the front lines of the pandemic response will be pregnant at the time that they are offered COVID-19 vaccines. However, pregnant people were not included in any of the COVID-19 vaccine trials that regulatory agencies evaluated when considering authorization. Without pregnancy-specific data, pregnant frontline workers in some settings are being denied COVID-19 vaccines. In other settings, pregnant frontline workers are able to access these same vaccines, but are faced with the burden of decision-making in the absence of an explicit recommendation for use and without pregnancy-specific data. While permissive recommendations for use in pregnancy are ethically preferable to unjustly denying vaccine access, objectives to protect the frontline workforce will fall short until there is evidence to support explicit recommendations for COVID-19 vaccination in pregnancy. In this article, we provide three actionable recommendations to ensure equitable protection of pregnant frontline workers as vaccines against COVID-19 continue to be developed and rolled out globally. First, efforts must be taken now to leverage critical opportunities for narrowing the evidence gaps around currently authorized COVID-19 vaccines in pregnancy. Next, action in the near term is needed to preempt evidence gaps for COVID-19 vaccines still in development. Finally, in the absence of an explicit recommendation for use in pregnancy, and while pregnancy-specific data lags behind, pregnant people should be prioritized for alternate preventive and treatment measures. Achieving equitable protection for those who are pregnant and serving on the frontlines of the pandemic will require no less.
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Sharma S, Burd I, Liao A. Special issue on COVID-19 and pregnancy: Consequences for maternal and neonatal health. Am J Reprod Immunol 2020; 84:e13354. [PMID: 33001481 PMCID: PMC7536926 DOI: 10.1111/aji.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Surendra Sharma
- Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Irina Burd
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aihua Liao
- Institute of Reproductive Health, Center for Reproductive Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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