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Rohweder R, Pereira NG, Micheletti BH, Mosello J, Campos JRM, Pereira MG, Santos CN, Simões NL, Matielo RLB, Bernardes LS, Oppermann MLR, Wender MCO, Lupattelli A, Nordeng H, Schuler-Faccini L. Medication Use Among Pregnant Women With SARS-CoV-2 Infection and Risk of Hospitalization-A Study in Two Brazilian Hospitals. J Pregnancy 2024; 2024:8915166. [PMID: 39021875 PMCID: PMC11254464 DOI: 10.1155/2024/8915166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 07/20/2024] Open
Abstract
There is limited evidence about the use of medications among pregnant women with COVID-19, as well as risk factors for hospitalization due to COVID-19 in pregnancy. We aimed to describe the use of medications among SARS-CoV-2-positive pregnant women at the time around infection and identify predictors for hospitalization due to COVID-19 in two hospitals in Brazil. This is a hospital record-based study among pregnant women with positive SARS-CoV-2 tests between March 2020 and August 2022 from two Brazilian hospitals. Characteristics of sociodemographic, obstetrical, and COVID-19 symptoms were extracted retrospectively. The prevalence use of medications was based on self-reported use, and this was administered at the hospital. Logistic regression was used to estimate predictors of hospitalization due to COVID-19. There were 278 pregnant women included in the study, of which 41 (14.7%) required hospitalization due to COVID-19. The remaining 237 (85.3%) had mild symptoms or were asymptomatic. Most of the women had the infection in the third trimester (n = 149; 53.6%). The most prevalent medications used across all trimesters were analgesics (2.4% to 20.0%), antibacterials (15.0% to 23.1%), and corticosteroids (7.2% to 10.4%). Pre- or gestational hypertensive disorder (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.65, 14.87) and having at least one dose of vaccine against SARS-CoV-2 (OR 0.13, 95% CI 0.04, 0.39) were associated with hospitalization due to COVID-19. Analgesics, antibacterials, and corticosteroids were the most frequently used medications among pregnant women with COVID-19. Women with hypertensive disorders have almost a five-fold increased risk of hospitalization due to COVID-19. Vaccination was the strongest protective factor for severe COVID-19. The COVID-19 vaccination among pregnant women should be promoted, and pregnant women diagnosed with COVID-19 who have hypertensive disorders should be closely monitored.
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Affiliation(s)
- Ricardo Rohweder
- Graduate Program in Genetics and Molecular BiologyDepartment of GeneticsUniversidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Natálya G. Pereira
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Bruna H. Micheletti
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Jéssica Mosello
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Júlia R. M. Campos
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Matheus G. Pereira
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Cristina N. Santos
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Natália L. Simões
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Regina L. B. Matielo
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
| | - Lisandra S. Bernardes
- Department of Obstetrics and NeonatologyHospital e Maternidade SEPACO, São Paulo, Brazil
- Center for Klinisk Forskning and Afdeling for Kvindesygdomme, Graviditet og FødselNorth Denmark Regional Hospital, Hjørring, Denmark
| | - Maria L. R. Oppermann
- Gynecology and Obstetrics ServiceHospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria C. O. Wender
- Gynecology and Obstetrics ServiceHospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research GroupDepartment of PharmacyUniversity of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research GroupDepartment of PharmacyUniversity of Oslo, Oslo, Norway
| | - Lavinia Schuler-Faccini
- Graduate Program in Genetics and Molecular BiologyDepartment of GeneticsUniversidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Maltezou HC, Rodolakis A. Vaccination of pregnant women against influenza: what is the optimal timing? Hum Vaccin Immunother 2021; 17:2723-2727. [PMID: 33599569 DOI: 10.1080/21645515.2021.1889934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Pregnant women and young infants are at increased risk for severe influenza and its complications. Influenza vaccination during pregnancy is increasingly implemented as a strategy aiming to protect the pregnant woman, the fetus and the young infant. In clinical practice, the achievement of satisfactory protection for the pregnant woman without compromising the protection of her infant during the first months of life remains a challenge. Determinants that are implicated in the optimal timing of influenza vaccination in pregnancy include influenza season, trimester of pregnancy, maternal host factors and infant factors. This article addresses influenza vaccination in pregnancy and presents recent published evidence on issues that affect the optimization of the timing of maternal vaccination.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, University of Athens, Alexandra General Hospital, Athens, Greece
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Abstract
Viral myocarditis is not uncommon but the role of the influenza virus in causing myocarditis is less studied. It is difficult to diagnose influenza myocarditis. Due to bacterial and viral co-infection during influenza outbreaks, it becomes more difficult to distinguish influenza myocarditis from other causes. Our article provides current information on influenza myocarditis. We did a literature search using appropriate terms and reviewed articles published by November 2020. Our study highlights the incidence of influenza myocarditis and the need to become aware of this condition, especially during epidemics and pandemics. Our study highlights that although influenza myocarditis is a rare condition, it can be fatal. There should be increased awareness about the condition. By the early diagnosis and treatment of influenza myocarditis, we can prevent fatal complications.
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Affiliation(s)
- Nischit Baral
- Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, USA
| | - Prakash Adhikari
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Govinda Adhikari
- Internal Medicine, McLaren Flint/Michigan State University, Flint, USA
| | - Sandip Karki
- Internal Medicine, McLaren Flint/Michigan State University, Flint, USA
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Putra M, Kesavan M, Brackney K, Hackney DN, Roosa KM. Forecasting the impact of coronavirus disease during delivery hospitalization: an aid for resource utilization. Am J Obstet Gynecol MFM 2020; 2:100127. [PMID: 32342041 PMCID: PMC7182514 DOI: 10.1016/j.ajogmf.2020.100127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 01/15/2023]
Abstract
Background The ongoing coronavirus disease 2019 pandemic has severely affected the United States. During infectious disease outbreaks, forecasting models are often developed to inform resource utilization. Pregnancy and delivery pose unique challenges, given the altered maternal immune system and the fact that most American women choose to deliver in the hospital setting. Objective This study aimed to forecast the first pandemic wave of coronavirus disease 2019 in the general population and the incidence of severe, critical, and fatal coronavirus disease 2019 cases during delivery hospitalization in the United States. Study Design We used a phenomenological model to forecast the incidence of the first wave of coronavirus disease 2019 in the United States. Incidence data from March 1, 2020, to April 14, 2020, were used to calibrate the generalized logistic growth model. Subsequently, Monte Carlo simulation was performed for each week from March 1, 2020, to estimate the incidence of coronavirus disease 2019 for delivery hospitalizations during the first pandemic wave using the available data estimate. Results From March 1, 2020, our model forecasted a total of 860,475 cases of coronavirus disease 2019 in the general population across the United States for the first pandemic wave. The cumulative incidence of coronavirus disease 2019 during delivery hospitalization is anticipated to be 16,601 (95% confidence interval, 9711–23,491) cases, 3308 (95% confidence interval, 1755–4861) cases of which are expected to be severe, 681 (95% confidence interval, 1324–1038) critical, and 52 (95% confidence interval, 23–81) fatal. Assuming similar baseline maternal mortality rate as the year 2018, we projected an increase in maternal mortality rate in the United States to at least 18.7 (95% confidence interval, 18.0–19.5) deaths per 100,000 live births as a direct result of coronavirus disease 2019. Conclusion Coronavirus disease 2019 in pregnant women is expected to severely affect obstetrical care. From March 1, 2020, we forecast 3308 severe and 681 critical cases with about 52 coronavirus disease 2019–related maternal mortalities during delivery hospitalization for the first pandemic wave in the United States. These results are significant for informing counseling and resource allocation.
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Affiliation(s)
- Manesha Putra
- Division of Maternal-Fetal Medicine, Department of Reproductive Biology, MetroHealth Medical Center, Cleveland, OH.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH.,Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Malavika Kesavan
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kerri Brackney
- Division of Maternal-Fetal Medicine, Department of Reproductive Biology, MetroHealth Medical Center, Cleveland, OH.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH.,Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - David N Hackney
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH.,Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kimberlyn M Roosa
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA
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Kranke P, Weibel S, Sitter M, Meybohm P, Girard T. [Obstetric Anesthesia During the SARS-CoV-2 Pandemic - a Brief Overview of Published Recommendations for Action by National and International Specialist Societies and Committees]. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:266-274. [PMID: 32274774 PMCID: PMC7295301 DOI: 10.1055/a-1144-5562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The most common human corona viruses cause common colds. But three of these viruses cause more serious, acute diseases; Middle East Respiratory Syndrome (MERS by MERS-CoV), Severe Acute Respiratory Syndrome (SARS) by SARS-CoV and COVID-19 by SARS-CoV-2. The current outbreak was classified by the WHO as a "global public health emergency". Despite all efforts to reduce the surgical lists and to cancel or postpone non-time-critical surgical interventions, some surgical and anesthetic interventions outside of intensive care medicine are still necessary and must be performed. This is particularly true for obstetric interventions and neuraxial labor analgesia. Workload in the delivery room is presumably not going to decrease and planned cesarean sections cannot be postponed. In the meantime, the clinical course and outcome of some COVID-19 patients with an existing pregnancy or peripartum courses have been reported. There are already numerous recommendations from national and international bodies regarding the care of such patients. Some of these recommendations will be summarized in this manuscript. The selection of aspects should by no means be seen as a form of prioritization. The general treatment principles in dealing with COVID-19 patients and the recommendations for action in intensive care therapy also apply to pregnant and postpartum patients. In this respect, there are naturally considerable redundancies and only a few aspects apply strictly or exclusively to the cohort of obstetric patients. In summary, at present it must be stated that the general care recommendations that also apply to non-COVID-19 patients are initially valid with regard to obstetric anesthesia. Nevertheless, the special requirements on the part of hygiene and infection protection result in special circumstances that should be taken into account when caring for pregnant patients from an anesthetic point of view. These relate to both medical aspects, but also to a particular extent logistics issues with regard to spatial separation, staffing and material resources.
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Brillo E, Tosto V, Giardina I, Buonomo E. Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization: an overview. J Matern Fetal Neonatal Med 2019; 34:3415-3444. [PMID: 31645152 DOI: 10.1080/14767058.2019.1680633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization for women during pregnancy (the so-called "maternal immunization") has been introduced in several countries, and recently also in Italy, to protect mother and fetus during pregnancy, infant in his first months of life and mother during postpartum period. However, very low vaccination coverage rates have been reached due to several variables. METHODS A literature search was conducted on PubMed and Embase, including any experimental or observational studies, to assesses existing evidence on the effectiveness, efficacy, safety and optimal timing of administration of Tdap and influenza immunization in pregnancy for mothers and their infants. The search was finalized in August 2019. RESULTS Reviewing the literature, we identified only a few studies that, among several maternal and infant outcomes, found sporadic significant associations with maternal influenza immunization and even less with Tdap immunization. Moreover, most of the authors of these studies explained these findings as a result of residual confounding effect. The effectiveness of maternal influenza immunization is more complicated to prove than the effectiveness of Tdap immunization because of several reasons. Not all nations recommend and offer vaccines in the same weeks of pregnancy and this one manifests the complexity in defining the best timing for Tdap or influenza immunization. CONCLUSIONS The safety of maternal Tdap or influenza immunization is supported by the evidence so far, however, regular surveillance should be maintained, especially with regard to the influenza vaccine that changes in formulation each year. There is a need to optimize the timing of vaccination in pregnancy and to have a national system of detection of maternal immunization in each country.
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Affiliation(s)
- Eleonora Brillo
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Valentina Tosto
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Irene Giardina
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
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