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Packer CH, Prabhu M. COVID-19 in Pregnancy: An Update for Clinicians. Clin Obstet Gynecol 2024; 67:565-575. [PMID: 38967474 DOI: 10.1097/grf.0000000000000885] [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: 07/06/2024]
Abstract
In this review, we will discuss the risks of COVID-19 on maternal, obstetric, and neonatal outcomes. We will also review the safety of COVID-19 vaccination in pregnancy, as well as review the management of COVID-19 in pregnancy.
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Affiliation(s)
- Claire H Packer
- Department of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts
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2
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Liu CH, Koire A, Ma C, Mittal L, Roffman JL, Erdei C. Prenatal mental health and emotional experiences during the pandemic: associations with infant neurodevelopment screening results. Pediatr Res 2024; 96:237-244. [PMID: 38431665 DOI: 10.1038/s41390-024-03100-y] [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] [Received: 07/11/2023] [Revised: 11/27/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND This study determined whether parental mental health and emotional experiences during the prenatal period were linked to infant developmental outcomes through the Ages and Stages Questionnaire (ASQ-3) at 8-10 months. METHODS Participants included 133 individuals who were living in the US and were pregnant or had given birth within 6 months prior to enrollment. Respondents were majority White with high education and income levels. Online surveys were administered from May 2020 to September 2021; follow-up surveys were administered from November 2020 to August 2022. RESULTS Parent generalized anxiety symptoms were positively associated with infant communication (β = 0.34, 95% CI [0.15, 1.76], p < 0.05), while parent-fetal bonding was positively associated with infant communication (β = 0.20, 95% CI [0.05, 0.76], p < 0.05) and personal-social performance (β = 0.20, 95% CI [0.04, 0.74], p < 0.05). COVID-19-related worry was negatively associated with infant communication (β = -0.30, 95% CI [-0.75, -0.12], p < 0.05) and fine motor performance (β = -0.25, 95% CI [-0.66, -0.03], p < 0.05). CONCLUSION Parent mental health and emotional experiences may contribute to infant developmental outcomes in high risk conditions such as a pandemic. IMPACT STATEMENT Maternal SARS-CoV-2 infection has been evaluated in relation to child outcomes, however, parent psychosocial experiences should not be overlooked when considering pandemic risks to child development. Specific prenatal mental health and pandemic-related emotional experiences are associated with infant developmental performance, as assessed by the Ages and Stages. Questionnaire (ASQ-3) at 8 to 10 months old. Findings indicate that parental prenatal anxiety and emotional experiences from the pandemic should be assessed when evaluating child developmental delays.
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Affiliation(s)
- Cindy H Liu
- Brigham and Women's Hospital, 221 Longwood Ave., BLI 341, Boston, MA, 02115, USA.
- Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
| | - Amanda Koire
- Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Candice Ma
- Brigham and Women's Hospital, 221 Longwood Ave., BLI 341, Boston, MA, 02115, USA
| | - Leena Mittal
- Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Joshua L Roffman
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
- Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Carmina Erdei
- Brigham and Women's Hospital, 221 Longwood Ave., BLI 341, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
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Peng Z, Liu J, Liu B, Zhou J, Zhang L, Zhang Y. Psychological interventions to pregnancy-related complications in patients with post-traumatic stress disorder: a scoping review. BMC Psychiatry 2024; 24:478. [PMID: 38937748 PMCID: PMC11212442 DOI: 10.1186/s12888-024-05926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE This scoping review sought to investigate the association between pregnancy-related complications and post-traumatic stress disorder (PTSD) among postpartum women, then summarize effective psychological interventions for pregnancy-related PTSD or sub-PTSD. METHOD Publications in English and Chinese were searched in PubMed, Embase, Cochrane, ISI Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang databases using the subject headings of "Stress Disorders, Post-Traumatic", "Pregnant Women", and "psychotherapy". To ensure that as many relevant studies are incorporated as possible, free terms such as prenatal, postnatal, perinatal and gestation were also used. Intervention studies and related cases published by July 1st, 2023, were also searched. RESULTS Twenty-one articles (including 3,901 mothers) were included in this review. Evidence showed that typical psychological interventions exhibited great effect, and family support programs, peer support, online yoga, and music therapy were also effective in reducing risk and improving the psychological well-being of the studied population. CONCLUSION Fetal abnormalities, miscarriage, premature birth, infants with low birth weights, hypertension, pre-eclampsia, HELLP syndrome, and hyperemesis gravidarum are associated with an increased risk of PTSD. Moreover, high-risk pregnant women may benefit from psychological interventions such as cognitive behavioral therapy (CBT). It may also be feasible and well-accepted for music therapy and exposure therapy to lessen the intensity of PTSD in mothers.
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Affiliation(s)
- Zhuo Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jin Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Bangshan Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Li Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Yan Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
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Abreu RWFD, Lima CRG, Verdério BN, Santos MMD, Dos Santos AN, Brugnaro BH, Rocha NACF. Association between environmental factors during the COVID-19 pandemic and functioning of infants with biological risk in the first year of life: Cross-sectional exploratory study. Early Hum Dev 2024; 191:105987. [PMID: 38520911 DOI: 10.1016/j.earlhumdev.2024.105987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Child development can be influenced by family and environmental factors, which changed during the COVID-19 pandemic. Thus, it is important to explore how these factors are associated with the functioning of infants with biological risk in the first year of life. OBJECTIVE This study aimed to investigate associations between family factors, home opportunities, caregiver perception of environmental support and barriers at home and environmental factors during the COVID-19 pandemic and gross motor skills and home participation in infants with biological risk in the first year of life. METHODS Fifty-six infants aged two to 12 months (M = 5.80 months; ±2.44) and their mothers performed remote assessments of gross motor skills using the Alberta Infant Motor Scale (AIMS); participation and environment (phone call) by the Young Children's Participation and Environment Measure (YC-PEM); family factors (income, age and maternal education), home opportunities - The Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) and environmental factors during the COVID-19 pandemic (social distancing, emotional and financial factors and physiotherapy) (online forms). Regression models were constructed, considering gross motor skills and home participation as outcome variables, with a 5 % significance level. RESULTS We found that older maternal age (p = 0.001), more home opportunities (p = 0.043), and less rigorous social distancing (as opposed to total social distancing [p = 0.045]) were significantly associated with better gross motor skills; and higher maternal education (p = 0.050) was associated with more involvement in home activities. CONCLUSION Family factors, home opportunities and social distancing were differently associated with the gross motor skills and home participation of infants with biological risk in the first year of life.
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Affiliation(s)
- Raissa Wanderley Ferraz de Abreu
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Camila Resende Gâmbaro Lima
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Bruna Nayara Verdério
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Mariana Martins Dos Santos
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Adriana Neves Dos Santos
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil; Departament of Health Science, Federal University of Santa Catarina (UFSC), Araranguá, SC, Brazil.
| | - Beatriz Helena Brugnaro
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Nelci Adriana Cicuto Ferreira Rocha
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
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Mergl R, Quaatz SM, Lemke V, Allgaier AK. Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths - A systematic review. J Psychiatr Res 2024; 169:84-96. [PMID: 38006823 DOI: 10.1016/j.jpsychires.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
Women who have had miscarriages or stillbirths are known to have an elevated risk for depression. However, the prevalence of depressive disorders and/or symptoms in this group is unclear. Therefore, our aim was to estimate the corresponding prevalence of depression and depressive symptoms. A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 2022 in English or German on the prevalence of depression or depressive symptoms in women following miscarriages or stillbirths. Studies using valid psychiatric diagnoses or validated assessment methods regarding depression were included in the systematic review. The PRISMA guidelines were followed. Data concerning depressive symptoms were extracted from 14 studies. The range regarding prevalence of depressive symptoms in women with previous miscarriages or stillbirths was very wide (5%-91.2%). All longitudinal studies demonstrate a reduction of depressive symptoms over time. The prevalence of depressive disorders had a range of 5.4 (only for minor depression according to DSM-IV) - 18.6% (for depressive disorders according to ICD-10). The included studies are very heterogeneous considering the investigated groups, the length of pregnancies and time passed since the occurrence of miscarriages or stillbirths. Women with miscarriages or stillbirths have an elevated risk for depressive symptoms and disorders. In most affected women, depressive symptoms are most pronounced in the first months after the pregnancy loss and diminish over time.
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Affiliation(s)
- Roland Mergl
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
| | - Sarah M Quaatz
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
| | - Vanessa Lemke
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
| | - Antje-Kathrin Allgaier
- Institute of Psychology, Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577, Neubiberg, Germany.
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Wu J, Cao B, Liao J, Li Y, Lu G, Gong F, Lin G, Zhao M. Navigation of Knowledge: the Impact of COVID-19 on Pregnancy-a Bibliometric Analysis. Reprod Sci 2023; 30:3548-3562. [PMID: 37488404 DOI: 10.1007/s43032-023-01312-x] [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: 04/28/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
Since the outbreak of COVID-19, countries around the world have faced huge economic and social burdens. SARS-COV-2 may exist in nature for a long time due to the diversity of its different variants. Pregnant women and newborns as vulnerable groups will suffer serious health threats. Bibliometrics as a method of summarizing publications can be used to extract important achievements and hot topics in this field. We search the target publications from the Web of Science Core collection database, and then use Microsoft Office Excel, CiteSpace, R, Scimago, and VOSviewer for visual analysis. Finally, we included 1709 publications from 2998 institutions in 104 countries. The number of publications has exploded since the COVID-19 pandemic in 2019. Among them, the USA, China, Britain, and Italy have higher quantity and quality. We identified important journals, authors, keywords, and references in this field. Anxiety, stress, risk of pregnancy complications, and vaccine safety and acceptance have received extensive attention from scholars during the COVID-19 pandemic and will continue to be urgent issues to be addressed in the future. Most of the current studies fall into the category of case reports and clinical data analysis. COVID-19 has been linked to serious pregnancy complications and mental illness, and vaccination during pregnancy is recommended to protect both mother and fetus. Further large-scale cohort studies and discovery of molecular mechanisms are needed in this field.
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Affiliation(s)
- Jingrouzi Wu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China
| | - Buzi Cao
- Hunan Normal University School of Medicine, Changsha, Hunan, China
| | - Jingnan Liao
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China
| | - Yuan Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China
| | - Guangxiu Lu
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China
| | - Ge Lin
- Institute of Reproductive and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China.
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, Hunan, China.
| | - Mingyi Zhao
- Pediatric Department of the 3rd Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Liu H, Wu F, Liao G, Mai S, Ouyang M. Impact of the intensive psychological intervention care on post-traumatic stress disorder and negative emotions of teenage female patients seeking an induced abortion. Front Psychiatry 2023; 14:1033320. [PMID: 37900292 PMCID: PMC10602776 DOI: 10.3389/fpsyt.2023.1033320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Aim This study aimed to investigate the effects of intensive psychological intervention care on adverse emotions and post-traumatic stress disorder (PTSD) symptoms in female teenage patients after induced abortion. Methods This prospective cohort study included 100 teenage female patients seeking induced abortion who were randomly divided into two groups: the intervention group (n = 50) and the control group (n = 50). The intervention group received intensive psychological intervention care, while the control group received standard routine nursing. The scores of the PTSD checklist for DSM-5 (PCL-5), self-rating depression (SDS), and self-rating anxiety scale (SAS) were compared between the two groups at 1 month and 3 months after the operation. Results The intervention group had lower risk of developing PTSD (24% vs. 44%), depression (10% vs. 32%), and anxiety (0% vs. 12%) symptoms at 1 month after the surgery. However, there were no significant differences observed between the two groups at 3 months after the surgery. Furthermore, the intervention group had significantly lower scores in PCL-5 (27.4 ± 5.4 vs. 31.8 ± 5.7; 20.5 ± 7.1 vs. 25.0 ± 7.5; p < 0.05), SDS (31.8 ± 5.4 vs. 37.8 ± 6.6; 26.8 ± 5.0 vs. 31.4 ± 7.2; p < 0.05), and SAS (32.7 ± 5.0 vs. 39.8 ± 6.9; 25.0 ± 2.7 vs. 27.5 ± 2.8; p < 0.05) at 1 month and 3 months after induced abortion. Conclusion These findings suggest that intensive psychological intervention care can reduce the incidence and severity of depression, anxiety, and PTSD symptoms in teenage patients who undergo induced abortion. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=185200, identifier ChiCTR2300067531.
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Affiliation(s)
- Huiling Liu
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
| | - Fengdi Wu
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
| | - Guixia Liao
- Nursing Department, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
| | - Sizi Mai
- Department of Clinical Psychology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
| | - Meijin Ouyang
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
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López-Morales H, Canet-Juric L, Del-Valle MV, Sosa JM, López MC, Urquijo S. Prenatal anxiety during the pandemic context is related to neurodevelopment of 6-month-old babies. Eur J Pediatr 2023; 182:4213-4226. [PMID: 37452845 DOI: 10.1007/s00431-023-05112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Prenatal anxiety and depression in pandemic context could introduce changes in the fetal developmental trajectories that, ultimately, could alter the adaptive behaviors of the offspring, potentially affecting, for example, general neurodevelopment. The sample consisted of 105 mother-child dyads, recruited between March and May 2020. The dyads were evaluated longitudinally, prenatally and postnatally (6 months). The Pandemic Impact Questionnaire, the State-Trait Anxiety Inventory, and the Beck-II Depression Inventory were used to assess indicators of maternal anxiety and depression, respectively. Regarding the babies, their mothers responded to Age and Stages: 3, which assesses different dimensions of early neurodevelopment, in addition to a closed questionnaire to identify sociodemographic and maternal and child health variables. A series of mediation models were tested to examine the association between prenatal psychopathology/negative experiences of the pandemic and neurodevelopment. The results indicated that the negative experiences of the pandemic were indirectly associated with the socio-individual and fine motor neurodevelopment of the offspring, through maternal anxiety symptoms, during the third trimester, which functioned as a mediator. Conclusions: This study provides evidence on the mediating effects of maternal anxiety on infant neurodevelopment in contexts of early adversity. It is important to point out the need to implement public health policies that allow a timely evaluation of neurodevelopmental variables during early childhood, which can implement early interventions to reduce the risks associated with these deficits. What is Known: • Effects of maternal mental health have been reported, effects on child neurodevelopment, in motor, cognitive, linguistic and socio-emotional dimensions. • Contexts of early adversity have been associated with maternal mental health and offspring development. What is New: • The context of pandemic adversity caused by COVID-19 is associated with motor and socio-individual neurodevelopment, mediated by maternal prenatal anxiety.
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Affiliation(s)
- Hernán López-Morales
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina.
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina.
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
- Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina.
| | - Lorena Canet-Juric
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Macarena Verónica Del-Valle
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Julieta Mariel Sosa
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
| | - Marcela Carolina López
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
| | - Sebastián Urquijo
- Instituto de Psicología Básica Aplicada y Tecnología (IPSIBAT), Mar del Plata, Argentina
- Universidad Nacional de Mar del Plata (UNMDP), Mar del Plata, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Woods R, Lorusso J, Fletcher J, ElTaher H, McEwan F, Harris I, Kowash H, D'Souza SW, Harte M, Hager R, Glazier JD. Maternal immune activation and role of placenta in the prenatal programming of neurodevelopmental disorders. Neuronal Signal 2023; 7:NS20220064. [PMID: 37332846 PMCID: PMC10273029 DOI: 10.1042/ns20220064] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Maternal infection during pregnancy, leading to maternal immune activation (mIA) and cytokine release, increases the offspring risk of developing a variety of neurodevelopmental disorders (NDDs), including schizophrenia. Animal models have provided evidence to support these mechanistic links, with placental inflammatory responses and dysregulation of placental function implicated. This leads to changes in fetal brain cytokine balance and altered epigenetic regulation of key neurodevelopmental pathways. The prenatal timing of such mIA-evoked changes, and the accompanying fetal developmental responses to an altered in utero environment, will determine the scope of the impacts on neurodevelopmental processes. Such dysregulation can impart enduring neuropathological changes, which manifest subsequently in the postnatal period as altered neurodevelopmental behaviours in the offspring. Hence, elucidation of the functional changes that occur at the molecular level in the placenta is vital in improving our understanding of the mechanisms that underlie the pathogenesis of NDDs. This has notable relevance to the recent COVID-19 pandemic, where inflammatory responses in the placenta to SARS-CoV-2 infection during pregnancy and NDDs in early childhood have been reported. This review presents an integrated overview of these collective topics and describes the possible contribution of prenatal programming through placental effects as an underlying mechanism that links to NDD risk, underpinned by altered epigenetic regulation of neurodevelopmental pathways.
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Affiliation(s)
- Rebecca M. Woods
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
| | - Jarred M. Lorusso
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
| | - Jennifer Fletcher
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Medicine, Biology and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
| | - Heidi ElTaher
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Medicine, Biology and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
- Department of Physiology, Faculty of Medicine, Alexandria University, Egypt
| | - Francesca McEwan
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
| | - Isabella Harris
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
| | - Hager M. Kowash
- Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9WL, U.K
| | - Stephen W. D'Souza
- Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9WL, U.K
| | - Michael Harte
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Medicine, Biology and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
| | - Reinmar Hager
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
| | - Jocelyn D. Glazier
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, U.K
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Martín-González NS, Castro-Quintas Á, Marques-Feixa L, Ayesa-Arriola R, López M, Fañanás L. Maternal respiratory viral infections during pregnancy and offspring's neurodevelopmental outcomes: a systematic review. Neurosci Biobehav Rev 2023; 149:105178. [PMID: 37059407 DOI: 10.1016/j.neubiorev.2023.105178] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/18/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
Maternal infections during pregnancy, as cytomegalovirus and zika, have been consistently associated with severe newborn neurodevelopmental conditions, mainly related to vertical transmission and congenital infection. However, little is known about the neurodevelopmental consequences of maternal respiratory viral infections, which are the most prevalent infections during pregnancy. The recent COVID-19 pandemic has increased the interest in understanding the consequences of infections in offspring's development. This systematic review explores whether maternal gestational viral respiratory infections are associated with neurodevelopmental deviations in children below 10 years-old. The search was conducted in Pubmed, PsychInfo and Web of Science databases. 12 articles were revised, including information about maternal infection (Influenza, SARS-CoV-2 and unspecified respiratory infections) and offspring's neurodevelopment (global development, specific functions, temperament and behavioral/emotional aspects). Controversial results were reported regarding maternal respiratory infections during pregnancy and infants' neurodevelopment. Maternal infections seem to be associated with subtle alterations in some offspring's developmental subdomains, as early motor development, and attentional, behavioral/emotional minor problems. Further studies are needed to determine the impact of other psychosocial confounding factors.
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Affiliation(s)
- Nerea San Martín-González
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBER-SAM), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain.
| | - Águeda Castro-Quintas
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBER-SAM), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain.
| | - Laia Marques-Feixa
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBER-SAM), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain.
| | - Rosa Ayesa-Arriola
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBER-SAM), Madrid, Spain; Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, Santander, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Marta López
- Fetal Medicine Research Center, Maternal fetal medicine department, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER of Rare Diseases, CIBER-ER), Madrid, Spain.
| | - Lourdes Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBER-SAM), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain.
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11
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Gomez-Lopez N, Romero R, Escobar MF, Carvajal JA, Echavarria MP, Albornoz LL, Nasner D, Miller D, Gallo DM, Galaz J, Arenas-Hernandez M, Bhatti G, Done B, Zambrano MA, Ramos I, Fernandez PA, Posada L, Chaiworapongsa T, Jung E, Garcia-Flores V, Suksai M, Gotsch F, Bosco M, Than NG, Tarca AL. Pregnancy-specific responses to COVID-19 revealed by high-throughput proteomics of human plasma. COMMUNICATIONS MEDICINE 2023; 3:48. [PMID: 37016066 PMCID: PMC10071476 DOI: 10.1038/s43856-023-00268-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/03/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Pregnant women are at greater risk of adverse outcomes, including mortality, as well as obstetrical complications resulting from COVID-19. However, pregnancy-specific changes that underlie such worsened outcomes remain unclear. METHODS Plasma samples were collected from pregnant women and non-pregnant individuals (male and female) with (n = 72 pregnant, 52 non-pregnant) and without (n = 29 pregnant, 41 non-pregnant) COVID-19. COVID-19 patients were grouped as asymptomatic, mild, moderate, severe, or critically ill according to NIH classifications. Proteomic profiling of 7,288 analytes corresponding to 6,596 unique protein targets was performed using the SOMAmer platform. RESULTS Herein, we profile the plasma proteome of pregnant and non-pregnant COVID-19 patients and controls and show alterations that display a dose-response relationship with disease severity; yet, such proteomic perturbations are dampened during pregnancy. In both pregnant and non-pregnant state, the proteome response induced by COVID-19 shows enrichment of mediators implicated in cytokine storm, endothelial dysfunction, and angiogenesis. Shared and pregnancy-specific proteomic changes are identified: pregnant women display a tailored response that may protect the conceptus from heightened inflammation, while non-pregnant individuals display a stronger response to repel infection. Furthermore, the plasma proteome can accurately identify COVID-19 patients, even when asymptomatic or with mild symptoms. CONCLUSION This study represents the most comprehensive characterization of the plasma proteome of pregnant and non-pregnant COVID-19 patients. Our findings emphasize the distinct immune modulation between the non-pregnant and pregnant states, providing insight into the pathogenesis of COVID-19 as well as a potential explanation for the more severe outcomes observed in pregnant women.
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Affiliation(s)
- Nardhy Gomez-Lopez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA.
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA.
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA.
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
- Detroit Medical Center, Detroit, MI, USA.
| | - María Fernanda Escobar
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia
- Departamento de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Javier Andres Carvajal
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia
- Departamento de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Maria Paula Echavarria
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia
- Departamento de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Ludwig L Albornoz
- Departamento de Laboratorio Clínico y Patología, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Derek Miller
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dahiana M Gallo
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jose Galaz
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcia Arenas-Hernandez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gaurav Bhatti
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bogdan Done
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Maria Andrea Zambrano
- Departamento de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Departamento de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Paula Andrea Fernandez
- Departamento de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Leandro Posada
- Departamento de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Tinnakorn Chaiworapongsa
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eunjung Jung
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Valeria Garcia-Flores
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Manaphat Suksai
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Francesca Gotsch
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mariachiara Bosco
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nandor Gabor Than
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Maternity Private Clinic of Obstetrics and Gynecology, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
- Genesis Theranostix Group, Budapest, Hungary
| | - Adi L Tarca
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Detroit, MI, USA.
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA.
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, USA.
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12
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Sturrock S, Ali S, Gale C, Battersby C, Le Doare K. Neonatal outcomes and indirect consequences following maternal SARS-CoV-2 infection in pregnancy: a systematic review. BMJ Open 2023; 13:e063052. [PMID: 36921946 PMCID: PMC10030282 DOI: 10.1136/bmjopen-2022-063052] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To identify the association between maternal SARS-CoV-2 infection in pregnancy and individual neonatal morbidities and outcomes, particularly longer-term outcomes such as neurodevelopment. DESIGN Systematic review of outcomes of neonates born to pregnant women diagnosed with a SARS-CoV-2 infection at any stage during pregnancy, including asymptomatic women. DATA SOURCES MEDLINE, Embase, Global Health, WHOLIS and LILACS databases, last searched on 28 July 2021. ELIGIBILITY CRITERIA Case-control and cohort studies published after 1 January 2020, including preprint articles were included. Study outcomes included neonatal mortality and morbidity, preterm birth, caesarean delivery, small for gestational age, admission to neonatal intensive care unit, level of respiratory support required, diagnosis of culture-positive sepsis, evidence of brain injury, necrotising enterocolitis, visual or hearing impairment, neurodevelopmental outcomes and feeding method. These were selected according to a core outcome set. DATA EXTRACTION AND SYNTHESIS Data were extracted into Microsoft Excel by two researchers, with statistical analysis completed using IBM SPSS (Version 27). Risk of bias was assessed using a modified Newcastle-Ottawa Scale. RESULTS The search returned 3234 papers, from which 204 were included with a total of 45 646 infants born to mothers with SARS-CoV-2 infection during pregnancy across 36 countries. We found limited evidence of an increased risk of some neonatal morbidities, including respiratory disease. There was minimal evidence from low-income settings (1 study) and for neonatal outcomes following first trimester infection (17 studies). Neonatal mortality was very rare. Preterm birth, neonatal unit admission and small for gestational age status were more common in infants born following maternal SARS-CoV-2 infection in pregnancy in most larger studies. CONCLUSIONS There are limited data on neonatal morbidity and mortality following maternal SARS-CoV-2 infection, particularly from low-income countries and following early pregnancy infections. Large, representative studies addressing these outcomes are needed to understand the consequences for babies born to women with SARS-CoV-2. PROSPERO REGISTRATION NUMBER CRD42021249818.
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Affiliation(s)
- Sarah Sturrock
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | - Shohaib Ali
- School of Public Health, Imperial College London Faculty of Medicine, London, UK
| | - Chris Gale
- School of Public Health, Imperial College London Faculty of Medicine, London, UK
| | - Cheryl Battersby
- School of Public Health, Imperial College London Faculty of Medicine, London, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
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13
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Edlow AG, Castro VM, Shook LL, Haneuse S, Kaimal AJ, Perlis RH. Sex-Specific Neurodevelopmental Outcomes Among Offspring of Mothers With SARS-CoV-2 Infection During Pregnancy. JAMA Netw Open 2023; 6:e234415. [PMID: 36951861 PMCID: PMC10037162 DOI: 10.1001/jamanetworkopen.2023.4415] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/02/2023] [Indexed: 03/24/2023] Open
Abstract
Importance Prior studies using large registries have suggested a modest increase in risk for neurodevelopmental diagnoses among children of mothers with immune activation during pregnancy, and such risk may be sex-specific. Objective To determine whether in utero exposure to SARS-CoV-2 is associated with sex-specific risk for neurodevelopmental disorders up to 18 months after birth, compared with unexposed offspring born during or prior to the COVID-19 pandemic period. Design, Setting, and Participants This retrospective cohort study included the live offspring of all mothers who delivered between January 1 and December 31, 2018 (born and followed up before the COVID-19 pandemic), between March 1 and December 31, 2019 (born before and followed up during the COVID-19 pandemic), and between March 1, 2020, and May 31, 2021 (born and followed up during the COVID-19 pandemic). Offspring were born at any of 8 hospitals across 2 health systems in Massachusetts. Exposures Polymerase chain reaction evidence of maternal SARS-CoV-2 infection during pregnancy. Main Outcomes and Measures Electronic health record documentation of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes corresponding to neurodevelopmental disorders. Results The COVID-19 pandemic cohort included 18 355 live births (9399 boys [51.2%]), including 883 (4.8%) with maternal SARS-CoV-2 positivity during pregnancy. The cohort included 1809 Asian individuals (9.9%), 1635 Black individuals (8.9%), 12 718 White individuals (69.3%), and 1714 individuals (9.3%) who were of other race (American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, more than 1 race); 2617 individuals (14.3%) were of Hispanic ethnicity. Mean maternal age was 33.0 (IQR, 30.0-36.0) years. In adjusted regression models accounting for race, ethnicity, insurance status, hospital type (academic center vs community), maternal age, and preterm status, maternal SARS-CoV-2 positivity was associated with a statistically significant elevation in risk for neurodevelopmental diagnoses at 12 months among male offspring (adjusted OR, 1.94 [95% CI 1.12-3.17]; P = .01) but not female offspring (adjusted OR, 0.89 [95% CI, 0.39-1.76]; P = .77). Similar effects were identified using matched analyses in lieu of regression. At 18 months, more modest effects were observed in male offspring (adjusted OR, 1.42 [95% CI, 0.92-2.11]; P = .10). Conclusions and Relevance In this cohort study of offspring with SARS-CoV-2 exposure in utero, such exposure was associated with greater magnitude of risk for neurodevelopmental diagnoses among male offspring at 12 months following birth. As with prior studies of maternal infection, substantially larger cohorts and longer follow-up will be required to reliably estimate or refute risk.
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Affiliation(s)
- Andrea G. Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Victor M. Castro
- Center for Quantitative Health, Massachusetts General Hospital, Boston
- Research Information Science and Computing, Mass General Brigham, Somerville, Massachusetts
| | - Lydia L. Shook
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa
| | - Roy H. Perlis
- Center for Quantitative Health, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston
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14
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Penna AL, de Aquino CM, Pinheiro MSN, do Nascimento RLF, Farias-Antúnez S, Araújo DABS, Mita C, Machado MMT, Castro MC. Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review. BMC Public Health 2023; 23:388. [PMID: 36823592 PMCID: PMC9950022 DOI: 10.1186/s12889-023-15003-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/05/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status. AIMS This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures. METHODS Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains. RESULTS The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices. CONCLUSIONS Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.
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Affiliation(s)
- Ana Luiza Penna
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Camila Machado de Aquino
- grid.8395.70000 0001 2160 0329Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Simone Farias-Antúnez
- grid.411237.20000 0001 2188 7235Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil
| | | | - Carol Mita
- grid.38142.3c000000041936754XCountway Library, Harvard Medical School, Boston, USA
| | | | - Marcia C. Castro
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
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15
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Motrico E, Galán-Luque T, Rodríguez-Domínguez C, Gómez-Gómez I, Domínguez-Salas S. Factors Associated with Post-Traumatic Stress Symptoms in Pregnant and Postpartum Women. J Womens Health (Larchmt) 2023; 32:583-591. [PMID: 36787455 DOI: 10.1089/jwh.2022.0400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Introduction: Evidence of post-traumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic during the perinatal period and the associated risk factors are still limited. Thus, we aimed to investigate the PTSD symptoms associated with the COVID-19 pandemic in a large sample of both pregnant and postpartum women. Methods: A cross-sectional study was conducted on 3319 pregnant and up to 6-month postpartum women from Spain. An online survey was completed between June 2020 and January 2021. The assessment included measures of PTSD symptoms associated with COVID-19 (evaluated with 10 questions from the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), pandemic-related concerns and health background (assessed by the Coronavirus Perinatal Experiences-Impact Survey), and demographic characteristics. Results: We found that >40% of women suffered from symptoms of PTSD associated with the COVID-19 pandemic. Difficulty concentrating and irritability were the most common symptoms, showing marked alterations in arousal and reactivity associated with the traumatic event. Being younger, suffering from pandemic concerns and distress, changes due to the pandemic and previous mental health problems were risk factors associated with PTSD symptoms in perinatal women. In addition, whereas being an immigrant (non-Spanish) was a risk factor for pregnant women, having other children and financial problems were risk factors for postpartum women. COVID-19 infection did not appear to be a risk factor for symptoms of PTSD in perinatal women. Conclusions: The increased risk of PTSD in pregnant and postpartum women highlights the importance of early detection and treatment of PTSD for pregnant and postnatal women, both during and beyond the pandemic. Trial Registration: ClinicalTrials.gov Identifier (NCT04595123).
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Affiliation(s)
- Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Spain
| | - Teresa Galán-Luque
- Department of Health Psychology, Universidad Miguel Hernández de Elche, Elche, Spain
| | | | - Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Spain
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16
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Sobczak E, Swafford EP, Samano D, Bass D, Ghamasaee P, Kottapally M, Merenda A, O'Phelan K, Romano JG, Sacco RL, Rundek T, Alkhachroum A. Posttraumatic Stress Symptoms Among COVID-19 Survivors After Hospitalization. J Neuropsychiatry Clin Neurosci 2023; 35:256-261. [PMID: 36710628 DOI: 10.1176/appi.neuropsych.20220126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Limited data are available on posttraumatic stress symptoms (PTSS) among COVID-19 survivors. This study aimed to contribute to this knowledge base. METHODS PTSS among COVID-19 survivors who had been hospitalized were investigated. Patients were identified as COVID-19 positive at hospital admission. COVID-19 survivors were surveyed with the Posttraumatic Stress Disorder Checklist (PCL-5) between March and October 2020 at 5- and 12-month postdischarge follow-up points. RESULTS Of 411 patients, 331 (81%) survived to hospital discharge. Of these survivors, 83 (25%) completed the PCL-5 at the 5-month follow-up. Of those patients, 12 (14%) screened positive for PTSS. At the 12-month follow-up, four of eight patients remained PTSS positive. Mean age of follow-up participants was 62±15 years; 47% were women, 65% were White, and 63% were Hispanic. PTSS-positive patients were predominantly non-White (67% vs. 30%, p=0.02), and although the differences were not statistically significant, these patients tended to be younger (56 vs. 63 years, p=0.08) and have shorter intensive care unit stays (2.0 vs. 12.5 days, p=0.06). PTSS-positive and PTSS-negative groups did not differ significantly in prehospitalization neurological diagnoses (11% vs. 8%), psychiatric diagnoses (17% vs. 21%), and intensive care admission status (25% vs. 25%). More patients in the PTSS-positive group had returned to the emergency department (50% vs. 14%, p<0.01) and reported fatigue at follow-up (100% vs. 42%, p<0.001). In the multivariate logistic regression model, non-White race (OR=11, 95% CI=2-91) and returning to the emergency department (OR=19, 95% CI=3-252) were associated with PTSS-positive status. CONCLUSION PTSS were twice as common among hospitalized COVID-19 survivors than among those in the general population.
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Affiliation(s)
- Evie Sobczak
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Emily P Swafford
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Daniel Samano
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Danielle Bass
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Pardis Ghamasaee
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Mohan Kottapally
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Amedeo Merenda
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Kristine O'Phelan
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Jose G Romano
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Ralph L Sacco
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Tatjana Rundek
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Ayham Alkhachroum
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
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17
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Delanerolle G, McCauley M, Hirsch M, Zeng Y, Cong X, Cavalini H, Sajid S, Shetty A, Rathod S, Shi JQ, Hapangama DK, Phiri P. The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis. BMC Pregnancy Childbirth 2023; 23:76. [PMID: 36709255 PMCID: PMC9883834 DOI: 10.1186/s12884-022-05243-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women. METHODS All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed. RESULTS This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic. DISCUSSION It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times. OTHER The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.
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Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Health Care Sciences, Uuniversity of Oxford, Oxford, UK
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Mary McCauley
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Martin Hirsch
- University College London, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Yutian Zeng
- Southern University of Science and Technology, Shenzhen, China
| | - Xu Cong
- Southern University of Science and Technology, Shenzhen, China
| | - Heitor Cavalini
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Sana Sajid
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Ashish Shetty
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Jian Qing Shi
- Southern University of Science and Technology, Shenzhen, China
- National Center for Applied Mathematics, Shenzhen, China
| | | | - Peter Phiri
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK.
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
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18
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Relationships between Depression, Fear of Childbirth, and Obsessive-Compulsive Symptoms among Pregnant Women under the COVID-19 Pandemic in Japan. Healthcare (Basel) 2023; 11:healthcare11030361. [PMID: 36766936 PMCID: PMC9914326 DOI: 10.3390/healthcare11030361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
Little is known about the causality of antenatal depression (AND). We focused on the causal relationships between AND, fear of childbirth (FOC), and obsessive-compulsive symptoms (OCS) during the COVID-19 pandemic in Japan. We also examined whether the perceived threat of COVID-19 is associated with AND. Participants were recruited for an Internet survey conducted in December 2020. A total of 245 pregnant women completed the online survey at 12 to 15 weeks' gestational age (Time 1) and approximately 10 weeks later (Time 2). AND was estimated using the first two diagnostic items of Major Depressive Episode. The estimated prevalence of AND was 4.5% and 2.9% at Time 1 and Time 2, respectively. At both time points, no association was found between AND and the perception of COVID-19 threat. Structural equation modeling showed that AND predicted OCS (β = 0.16, p < 0.001), which, in turn, predicted FOC (β = 0.09, p = 0.042); FOC, in turn, predicted AND (β = 0.23, p < 0.001). AND, OCS, and FOC were predicted by borderline personality traits. Insecure adult attachment influenced AND and FOC via the perceived negative impact of the current pregnancy. Perinatal care providers should assess the personality and perception of pregnancy to prevent depression and pay attention to symptoms such as FOC and OCS in addition to those of depression.
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19
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Fajardo Martinez V, Zhang D, Paiola S, Mok T, Cambou MC, Kerin T, Rao R, Brasil P, Ferreira F, Fuller T, Bhattacharya D, Foo SS, Chen W, Jung J, Einspieler C, Marschik PB, Nielsen-Saines K. Neuromotor repertoires in infants exposed to maternal COVID-19 during pregnancy: a cohort study. BMJ Open 2023; 13:e069194. [PMID: 36690405 PMCID: PMC9871864 DOI: 10.1136/bmjopen-2022-069194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate neuromotor repertoires and developmental milestones in infants exposed to antenatal COVID-19. DESIGN Longitudinal cohort study. SETTING Hospital-based study in Los Angeles, USA and Rio de Janeiro, Brazil between March 2020 and December 2021. PARTICIPANTS Infants born to mothers with COVID-19 during pregnancy and prepandemic control infants from the Graz University Database. INTERVENTIONS General movement assessment (GMA) videos between 3 and 5 months post-term age were collected and clinical assessments/developmental milestones evaluated at 6-8 months of age. Cases were matched by gestational age, gender and post-term age to prepandemic neurotypical unexposed controls from the database. MAIN OUTCOME MEASURES Motor Optimality Scores Revised (MOS-R) at 3-5 months. Presence of developmental delay (DD) at 6-8 months. RESULTS 239 infants were enrolled; 124 cases (83 in the USA/41 in Brazil) and 115 controls. GMA was assessed in 115 cases and 115 controls; 25% were preterm. Median MOS-R in cases was 23 (IQR 21-24, range 9-28) vs 25 (IQR 24-26, range 20-28) in controls, p<0.001. Sixteen infants (14%) had MOS-R scores <20 vs zero controls, p<0.001. At 6-8 months, 13 of 109 case infants (12%) failed to attain developmental milestones; all 115 control infants had normal development. The timing of maternal infection in pregnancy (first, second or third trimester) or COVID-19 disease severity (NIH categories asymptomatic, mild/moderate or severe/critical) was not associated with suboptimal MOS-R or DD. Maternal fever in pregnancy was associated with DD (OR 3.7; 95% CI 1.12 to 12.60) but not suboptimal MOS-R (OR 0.25; 95% CI 0.04 to 0.96). CONCLUSIONS Compared with prepandemic controls, infants exposed to antenatal COVID-19 more frequently had suboptimal neuromotor development.
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Affiliation(s)
- Viviana Fajardo Martinez
- Pediatrics, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Dajie Zhang
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany
- iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Sophia Paiola
- Pediatrics, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Thalia Mok
- Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Mary C Cambou
- Internal Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Tara Kerin
- Pediatrics, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Rashmi Rao
- Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | | | - Fatima Ferreira
- Pediatrics, Escola de Medicina, Universidade do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Trevon Fuller
- FIOCRUZ, Rio de Janeiro, Brazil
- Institute for the Environment and Sustainability, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Debika Bhattacharya
- Internal Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Suan-Sin Foo
- Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Weiqiang Chen
- Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jae Jung
- Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christa Einspieler
- iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany
- iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Nielsen-Saines
- Pediatrics, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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20
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Ennab F, Nawaz FA, Al-Sharif GA, Yaqoob S, Nchasi G. The psychological aftermath of an emerging infection affecting pregnant women: is monkeypox to blame? Arch Womens Ment Health 2023; 26:75-77. [PMID: 36585500 PMCID: PMC9803879 DOI: 10.1007/s00737-022-01288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Farah Ennab
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Faisal A. Nawaz
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, United Arab Emirates
| | - Ghadah A. Al-Sharif
- Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates ,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Sadia Yaqoob
- Jinnah Medical and Dental College, Karachi, Pakistan
| | - Goodluck Nchasi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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21
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Naja S, Elyamani R, Chehab M, Ali Siddig Ahmed M, Babeker G, Lawand G, Singh R, Adli N, Mohamad T, Bougmiza I. The impact of telemental health interventions on maternal mental health outcomes: a pilot randomized controlled trial during the COVID-19 pandemic. Health Psychol Behav Med 2022; 11:1-21. [PMID: 36606005 PMCID: PMC9809366 DOI: 10.1080/21642850.2022.2155167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The lethal potential of COVID-19 was often emphasized and repeatedly brought to the attention of pregnant women, leading to a higher level of anxiety, depression, and COVID-19-specific phobia among this population. Furthermore, legislation forced social distancing and isolation to interrupt the infection cycle. Together these factors resulted in higher maternal mental health distress requiring intervention. Nevertheless, there is a lack of evidence regarding the impact of low-intensity psychosocial telemental interventions on maternal mental health outcomes. Therefore, the objective of this pilot study is to assess the efficacy of video low-intensity psychosocial telemental maternal intervention on COVID-19-specific phobia, antenatal depression, and anxiety among pregnant women. We hypothesized that the intervention arm would be superior to the control arm. A parallel design randomized interventional controlled trial with 1:1 randomization was conducted at the Women Wellness and Research Center. We enrolled fifty-eight pregnant women in their second trimester who spoke English or Arabic. We assessed antenatal anxiety, depression, and Covid-19-specific phobia at baseline (T0), and thirty-three pregnant women completed the follow-up after four weeks (T1). Pregnant women receiving psychotropic medications and follow up in mental health services were excluded. Results A low-intensity psychosocial telemental maternal session helps reduce antenatal anxiety. We found statistically significant differences in antenatal anxiety scores between the intervention (2.4 ± 2.2) and control (4.2 ± 1.6) groups (p = 0.013) with a large effect size of Hedges' g value (0.96, 0.22-1.74). The absolute risk reduction was 27.27 percent. However, the intervention had no statistically significant effect on reducing antenatal depression or COVID-19-specific phobia. Conclusions Low-intensity psychosocial telemental maternal sessions effectively reduce antenatal anxiety. While our findings are promising, further RCTs are needed to replicate these findings. Trial registration 2a-ClinicalTrials.gov identifier: NCT04594525.. Registered on 20/October/2020; updated 9/March/ 2022. Available from: Maternal Telemental Health Interventions in Response to Covid-19* - Full Text View - ClinicalTrials.gov.
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Affiliation(s)
- Sarah Naja
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar, Sarah Naja Community Medicine Residency Program, Department of Medical Education, Hamad Medical Corporation, DohaPO Box 3050, Qatar
| | - Rowaida Elyamani
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Chehab
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ghidaa Babeker
- Community Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Ghinwa Lawand
- Obstetrics and Gynecology Department, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research Department, Hamad Medical Corporation, Doha, Qatar
| | - Nada Adli
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Tagreed Mohamad
- Obstetrics and Gynecology Department, Hamad Medical Corporation, Doha, Qatar
| | - Iheb Bougmiza
- Community Medicine Department, Primary Health Care Corporation, Doha, Qatar
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22
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Dubey H, Sharma RK, Krishnan S, Knickmeyer R. SARS-CoV-2 (COVID-19) as a possible risk factor for neurodevelopmental disorders. Front Neurosci 2022; 16:1021721. [PMID: 36590303 PMCID: PMC9800937 DOI: 10.3389/fnins.2022.1021721] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Pregnant women constitute one of the most vulnerable populations to be affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the cause of coronavirus disease 2019. SARS-CoV-2 infection during pregnancy could negatively impact fetal brain development via multiple mechanisms. Accumulating evidence indicates that mother to fetus transmission of SARS-CoV-2 does occur, albeit rarely. When it does occur, there is a potential for neuroinvasion via immune cells, retrograde axonal transport, and olfactory bulb and lymphatic pathways. In the absence of maternal to fetal transmission, there is still the potential for negative neurodevelopmental outcomes as a consequence of disrupted placental development and function leading to preeclampsia, preterm birth, and intrauterine growth restriction. In addition, maternal immune activation may lead to hypomyelination, microglial activation, white matter damage, and reduced neurogenesis in the developing fetus. Moreover, maternal immune activation can disrupt the maternal or fetal hypothalamic-pituitary-adrenal (HPA) axis leading to altered neurodevelopment. Finally, pro-inflammatory cytokines can potentially alter epigenetic processes within the developing brain. In this review, we address each of these potential mechanisms. We propose that SARS-CoV-2 could lead to neurodevelopmental disorders in a subset of pregnant women and that long-term studies are warranted.
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Affiliation(s)
- Harikesh Dubey
- Division of Neuroengineering, Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI, United States
| | - Ravindra K. Sharma
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Suraj Krishnan
- Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, NY, United States
| | - Rebecca Knickmeyer
- Division of Neuroengineering, Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI, United States,Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, United States,*Correspondence: Rebecca Knickmeyer,
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23
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Smith KA, Howard LM, Vigod SN, D’Agostino A, Cipriani A. Perinatal mental health and COVID-19: Navigating a way
forward. Aust N Z J Psychiatry 2022:48674221137819. [PMID: 36440619 PMCID: PMC9708536 DOI: 10.1177/00048674221137819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic and its aftermath have increased pre-existing inequalities and risk factors for mental disorders in general, but perinatal mental disorders are of particular concern. They are already underdiagnosed and undertreated, and this has been magnified by the pandemic. Access to services (both psychiatric and obstetric) has been reduced, and in-person contact has been restricted because of the increased risks. Rates of perinatal anxiety and depressive symptoms have increased. In the face of these challenges, clear guidance in perinatal mental health is needed for patients and clinicians. However, a systematic search of the available resources showed only a small amount of guidance from a few countries, with a focus on the acute phase of the pandemic rather than the challenges of new variants and variable rates of infection. Telepsychiatry offers advantages during times of restricted social contact and also as an additional route for accessing a wide range of digital technologies. While there is a strong evidence base for general telepsychiatry, the particular issues in perinatal mental health need further examination. Clinicians will need expertise and training to navigate a hybrid model, flexibly combining in person and remote assessments according to risk, clinical need and individual patient preferences. There are also wider issues of care planning in the context of varying infection rates, restrictions and vaccination access in different countries. Clinicians will need to focus on prevention, treatment, risk assessment and symptom monitoring, but there will also need to be an urgent and coordinated focus on guidance and planning across all organisations involved in perinatal mental health care.
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Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of
Oxford, Oxford, UK,Oxford Health NHS Foundation Trust,
Oxford, UK,Oxford Precision Psychiatry Lab, NIHR
Oxford Health Biomedical Research Centre, Oxford, UK
| | - Louise M Howard
- Section of Women’s Mental Health,
Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Simone N Vigod
- Women’s College Hospital and Women’s
College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Faculty of
Medicine, University of Toronto, Toronto, ON, Canada
| | - Armando D’Agostino
- Department of Health Sciences,
Università degli Studi di Milano, Milano, Italy
| | - Andrea Cipriani
- Department of Psychiatry, University of
Oxford, Oxford, UK,Oxford Health NHS Foundation Trust,
Oxford, UK,Oxford Precision Psychiatry Lab, NIHR
Oxford Health Biomedical Research Centre, Oxford, UK,Andrea Cipriani, Department of Psychiatry,
University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
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24
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Edlow AG, Castro VM, Shook LL, Haneuse S, Kaimal AJ, Perlis RH. Sex-specific neurodevelopmental outcomes in offspring of mothers with SARS-CoV-2 in pregnancy: an electronic health records cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.11.18.22282448. [PMID: 36415457 PMCID: PMC9681056 DOI: 10.1101/2022.11.18.22282448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Importance Prior studies using large registries suggested a modest increase in risk for neurodevelopmental diagnoses among children of mothers with immune activation during pregnancy, and such risk may be sex-specific. Objective To determine whether in utero exposure to the novel coronavirus SARS-CoV-2 is associated with sex-specific risk for neurodevelopmental disorders up to 18 months after birth, compared to unexposed offspring born during or prior to the pandemic period. Design Retrospective cohort. Participants Live offspring of all mothers who delivered between March 2018 and May 2021 at any of eight hospitals across two health systems in Massachusetts. Exposure PCR evidence of maternal SARS-CoV-2 infection during pregnancy. Main Outcome and Measures Electronic health record documentation of ICD-10 diagnostic codes corresponding to neurodevelopmental disorders. Results The pandemic cohort included 18,323 live births, including 877 (4.8%) to individuals with SARS-CoV-2 positivity during pregnancy. The cohort included 1806 (9.9%) Asian individuals, 1634 (8.9%) Black individuals, 1711 (9.3%) individuals of another race, and 12,694 (69%) White individuals; 2614 (14%) were of Hispanic ethnicity. Mean maternal age was 33.0 years (IQR 30.0-36.0). In adjusted regression models accounting for race, ethnicity, insurance status, hospital type (academic center vs. community), maternal age, and preterm status, SARS-CoV-2 positivity was associated with statistically significant elevation in risk for neurodevelopmental diagnoses among male offspring (adjusted OR 1.99, 95% CI 1.19-3.34; p=0.009) but not female offspring (adjusted OR 0.90, 95% CI 0.43-1.88; p=0.8). Similar effects were identified using matched analyses in lieu of regression. Conclusion and Relevance SARS-CoV-2 exposure in utero was associated with greater magnitude of risk for neurodevelopmental diagnoses among male offspring in the 12 months following birth. As with prior studies of maternal infection, substantially larger cohorts and longer follow-up will be required to reliably estimate or refute risk. Trial Registration NA. Key Points Question: Are rates of neurodevelopmental disorder diagnoses greater among male or female children with COVID-19 exposure in utero compared to those with no such exposure?Findings: In a cohort of 18,323 infants delivered after February 2020, males but not females born to mothers with a positive SARS-CoV-2 PCR test during pregnancy were more likely to receive a neurodevelopmental diagnosis in the first 12 months after delivery, even after accounting for preterm delivery.Meaning: These findings suggest that male offspring exposed to COVID-19 in utero may be at increased risk for neurodevelopmental disorders.
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Affiliation(s)
- Andrea G. Edlow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Victor M. Castro
- Center for Quantitative Health and Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Research Information Science and Computing, Mass General Brigham, Somerville, MA
| | - Lydia L. Shook
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, FL
| | - Roy H. Perlis
- Center for Quantitative Health and Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Hamadneh J, Hamadneh S, ALBashtawy M, Alkhawaldeh A, Bashtawi M, Alshloul M, Rayan A, Abdalrahim A. Impact of COVID-19 on perinatal mental health among pregnant mothers infected with COVID-19, during the first wave of the epidemic in Jordan. Heliyon 2022; 8:e12017. [PMCID: PMC9705010 DOI: 10.1016/j.heliyon.2022.e12017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
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Shook LL, Fourman LT, Edlow AG. Immune Responses to SARS-CoV-2 in Pregnancy: Implications for the Health of the Next Generation. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 209:1465-1473. [PMID: 36192115 PMCID: PMC9536183 DOI: 10.4049/jimmunol.2200414] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
Widespread SARS-CoV-2 infection among pregnant individuals has led to a generation of fetuses exposed in utero, but the long-term impact of such exposure remains unknown. Although fetal infection is rare, children born to mothers with SARS-CoV-2 infection may be at increased risk for adverse neurodevelopmental and cardiometabolic outcomes. Fetal programming effects are likely to be mediated at least in part by maternal immune activation. In this review, we discuss recent evidence regarding the effects of prenatal SARS-CoV-2 infection on the maternal, placental, and fetal immune response, as well as the implications for the long-term health of offspring. Extrapolating from what is known about the impact of maternal immune activation in other contexts (e.g., obesity, HIV, influenza), we review the potential for neurodevelopmental and cardiometabolic morbidity in offspring. Based on available data suggesting potential increased neurodevelopmental risk, we highlight the importance of establishing large cohorts to monitor offspring born to SARS-CoV-2-positive mothers for neurodevelopmental and cardiometabolic sequelae.
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Affiliation(s)
- Lydia L Shook
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; and
| | - Lindsay T Fourman
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA;
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; and
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Abstract
Importance The COVID-19 pandemic has prompted an unprecedented need to rapidly investigate the potential consequences for maternal mental health, infant and child development, and the mother-infant relationship. Observations Globally, the mental health of pregnant and postpartum individuals has worsened during the pandemic regardless of infection status, and these concerning changes have disproportionally affected racial and ethnic minoritized people from underserved populations. Early indicators of infant neurobehavioral outcomes suggest that while in utero exposure to a maternal SARS-CoV-2 infection is likely negligible, limited data are available regarding the neurodevelopmental consequences for the generation of infants born during the pandemic. High maternal depression and grief during the COVID-19 pandemic are associated with lower levels of self-reported maternal-infant bonding. Yet nearly all published reports of child neurodevelopmental outcomes and dyadic functioning in the context of the pandemic rely on self-reported and parent-reported measures, which are subject to bias. Conclusions and Relevance In the context of prior research, and considering the paucity of research on infant neurodevelopment following prenatal SARS-CoV-2 exposure and birth during the pandemic, robust scientific investigation is needed to detect indicators of compromised early outcomes that could inform widespread assessment and accessible intervention. We simultaneously caution against reflexive apprehension regarding the generation of children born during the COVID-19 pandemic.
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Affiliation(s)
- Morgan R Firestein
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Dani Dumitriu
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- New York State Psychiatric Institute, New York
| | - Catherine Monk
- New York State Psychiatric Institute, New York
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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28
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Gomez-Lopez N, Romero R, Escobar MF, Carvajal JA, Echavarria MP, Albornoz LL, Nasner D, Miller D, Gallo DM, Galaz J, Arenas-Hernandez M, Bhatti G, Done B, Zambrano MA, Ramos I, Fernandez PA, Posada L, Chaiworapongsa T, Jung E, Garcia-Flores V, Suksai M, Gotsch F, Bosco M, Than NG, Tarca AL. Pregnancy-specific responses to COVID-19 are revealed by high-throughput proteomics of human plasma. RESEARCH SQUARE 2022:rs.3.rs-1906806. [PMID: 36032966 PMCID: PMC9413722 DOI: 10.21203/rs.3.rs-1906806/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregnant women are at greater risk of adverse outcomes, including mortality, as well as obstetrical complications resulting from COVID-19. However, pregnancy-specific changes that underlie such worsened outcomes remain unclear. Herein, we profiled the plasma proteome of pregnant and non-pregnant COVID-19 patients and controls and showed alterations that display a dose-response relationship with disease severity; yet, such proteomic perturbations are dampened during pregnancy. In both pregnant and non-pregnant state, the proteome response induced by COVID-19 showed enrichment of mediators implicated in cytokine storm, endothelial dysfunction, and angiogenesis. Shared and pregnancy-specific proteomic changes were identified: pregnant women display a tailored response that may protect the conceptus from heightened inflammation, while non-pregnant individuals display a stronger response to repel infection. Furthermore, the plasma proteome can accurately identify COVID-19 patients, even when asymptomatic or with mild symptoms. This study represents the most comprehensive characterization of the plasma proteome of pregnant and non-pregnant COVID-19 patients.
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Affiliation(s)
- Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
| | - María Fernanda Escobar
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Javier Andres Carvajal
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Paula Echavarria
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Ludwig L. Albornoz
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Derek Miller
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dahiana M. Gallo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jose Galaz
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcia Arenas-Hernandez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bogdan Done
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Maria Andrea Zambrano
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Paula Andrea Fernandez
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Leandro Posada
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Valeria Garcia-Flores
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Manaphat Suksai
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mariachiara Bosco
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nandor Gabor Than
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Maternity Private Clinic of Obstetrics and Gynecology, Budapest, Hungary
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, USA
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29
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Guo J, Tan M, Zhu J, Tian Y, Liu H, Luo F, Wang J, Huang Y, Zhang Y, Yang Y, Wang G. Proteomic Analysis of Human Milk Reveals Nutritional and Immune Benefits in the Colostrum from Mothers with COVID-19. Nutrients 2022; 14:nu14122513. [PMID: 35745243 PMCID: PMC9227629 DOI: 10.3390/nu14122513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023] Open
Abstract
Despite the well-known benefits of breastfeeding and the World Health Organization’s breastfeeding recommendations for COVID-19 infected mothers, whether these mothers should be encouraged to breastfeed is under debate due to concern about the risk of virus transmission and lack of evidence of breastmilk’s protective effects against the virus. Here, we provide a molecular basis for the breastfeeding recommendation through mass spectrometry (MS)-based proteomics and glycosylation analysis of immune-related proteins in both colostrum and mature breastmilk collected from COVID-19 patients and healthy donors. The total protein amounts in the COVID-19 colostrum group were significantly higher than in the control group. While casein proteins in COVID-19 colostrum exhibited significantly lower abundances, immune-related proteins, especially whey proteins with antiviral properties against SARS-CoV-2, were upregulated. These proteins were detected with unique site-specific glycan structures and improved glycosylation diversity that are beneficial for recognizing epitopes and blocking viral entry. Such adaptive differences in milk from COVID-19 mothers tended to fade in mature milk from the same mothers one month postpartum. These results suggest that feeding infants colostrum from COVID-19 mothers confers both nutritional and immune benefits, and provide molecular-level insights that aid breastmilk feeding decisions in cases of active infection.
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Affiliation(s)
- Juanjuan Guo
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan 430071, China; (J.G.); (H.L.); (Y.Z.)
| | - Minjie Tan
- Institute for Cell Analysis, Shenzhen Bay Laboratory, Shenzhen 518132, China; (M.T.); (Y.T.); (Y.H.)
| | - Jing Zhu
- Institute of Biotechnology and Health, Beijing Academy of Science and Technology, Beijing 100089, China
- Correspondence: (J.Z.); (G.W.)
| | - Ye Tian
- Institute for Cell Analysis, Shenzhen Bay Laboratory, Shenzhen 518132, China; (M.T.); (Y.T.); (Y.H.)
| | - Huanyu Liu
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan 430071, China; (J.G.); (H.L.); (Y.Z.)
| | - Fan Luo
- State Key Laboratory of Virology, Institute of Medical Virology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China;
| | - Jianbin Wang
- School of Life Sciences, Tsinghua-Peking Center for Life Sciences, Tsinghua University, Beijing 100084, China;
| | - Yanyi Huang
- Institute for Cell Analysis, Shenzhen Bay Laboratory, Shenzhen 518132, China; (M.T.); (Y.T.); (Y.H.)
- Biomedical Pioneering Innovation Center, Peking University, Beijing 100871, China
| | - Yuanzhen Zhang
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan 430071, China; (J.G.); (H.L.); (Y.Z.)
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Yuexin Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
| | - Guanbo Wang
- Institute for Cell Analysis, Shenzhen Bay Laboratory, Shenzhen 518132, China; (M.T.); (Y.T.); (Y.H.)
- Biomedical Pioneering Innovation Center, Peking University, Beijing 100871, China
- Correspondence: (J.Z.); (G.W.)
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30
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Wang R, Wu Z, Huang C, Hashimoto K, Yang L, Yang C. Deleterious effects of nervous system in the offspring following maternal SARS-CoV-2 infection during the COVID-19 pandemic. Transl Psychiatry 2022; 12:232. [PMID: 35668063 PMCID: PMC9169439 DOI: 10.1038/s41398-022-01985-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022] Open
Abstract
During the Coronavirus disease 2019 (COVID-19) pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is universally susceptible to all types of populations. In addition to the elderly and children becoming the groups of great concern, pregnant women carrying new lives need to be even more alert to SARS-CoV-2 infection. Studies have shown that pregnant women infected with SARS-CoV-2 can lead to brain damage and post-birth psychiatric disorders in offspring. It has been widely recognized that SARS-CoV-2 can affect the development of the fetal nervous system directly or indirectly. Pregnant women are recommended to mitigate the effects of COVID-19 on the fetus through vaccination, nutritional supplements, and psychological support. This review summarizes the possible mechanisms of the nervous system effects of SARS-CoV-2 infection on their offspring during the pregnancy and analyzes the available prophylactic and treatment strategies to improve the prognosis of fetal-related neuropsychiatric diseases after birth.
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Affiliation(s)
- Ruting Wang
- grid.452253.70000 0004 1804 524XDepartment of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003 China
| | - Zifeng Wu
- grid.412676.00000 0004 1799 0784Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Chaoli Huang
- grid.412676.00000 0004 1799 0784Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China
| | - Kenji Hashimoto
- grid.411500.1Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670 Japan
| | - Ling Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
| | - Chun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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31
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Edlow AG, Castro VM, Shook LL, Kaimal AJ, Perlis RH. Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy. JAMA Netw Open 2022; 5:e2215787. [PMID: 35679048 PMCID: PMC9185175 DOI: 10.1001/jamanetworkopen.2022.15787] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/06/2022] [Indexed: 12/23/2022] Open
Abstract
Importance Epidemiologic studies suggest maternal immune activation during pregnancy may be associated with neurodevelopmental effects in offspring. Objective To evaluate whether in utero exposure to SARS-CoV-2 is associated with risk for neurodevelopmental disorders in the first 12 months after birth. Design, Setting, and Participants This retrospective cohort study examined live offspring of all mothers who delivered between March and September 2020 at any of 6 Massachusetts hospitals across 2 health systems. Statistical analysis was performed from October to December 2021. Exposures Maternal SARS-CoV-2 infection confirmed by a polymerase chain reaction test during pregnancy. Main Outcomes and Measures Neurodevelopmental disorders determined from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes over the first 12 months of life; sociodemographic and clinical features of mothers and offspring; all drawn from the electronic health record. Results The cohort included 7772 live births (7466 pregnancies, 96% singleton, 222 births to SARS-CoV-2 positive mothers), with mean (SD) maternal age of 32.9 (5.0) years; offspring were 9.9% Asian (772), 8.4% Black (656), and 69.0% White (5363); 15.1% (1134) were of Hispanic ethnicity. Preterm delivery was more likely among exposed mothers: 14.4% (32) vs 8.7% (654) (P = .003). Maternal SARS-CoV-2 positivity during pregnancy was associated with greater rate of neurodevelopmental diagnoses in unadjusted models (odds ratio [OR], 2.17 [95% CI, 1.24-3.79]; P = .006) as well as those adjusted for race, ethnicity, insurance status, offspring sex, maternal age, and preterm status (adjusted OR, 1.86 [95% CI, 1.03-3.36]; P = .04). Third-trimester infection was associated with effects of larger magnitude (adjusted OR, 2.34 [95% CI, 1.23-4.44]; P = .01). Conclusions and Relevance This cohort study of SARS-CoV-2 exposure in utero found preliminary evidence that maternal SARS-CoV-2 may be associated with neurodevelopmental sequelae in some offspring. Prospective studies with longer follow-up duration will be required to exclude confounding and confirm these associations.
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Affiliation(s)
- Andrea G. Edlow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Victor M. Castro
- Center for Quantitative Health and Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
- Research Information Science and Computing, Mass General Brigham, Somerville, Massachusetts
| | - Lydia L. Shook
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anjali J. Kaimal
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Roy H. Perlis
- Center for Quantitative Health and Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
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32
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Literature Review of Mothers Diagnosed With COVID-19 and the Impact on Breastfeeding Their Newborns. Nurs Womens Health 2022; 26:234-241. [PMID: 35551888 PMCID: PMC9611848 DOI: 10.1016/j.nwh.2022.03.010] [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] [Received: 09/20/2021] [Revised: 03/04/2022] [Accepted: 03/29/2022] [Indexed: 01/09/2023]
Abstract
In early 2020, newborns were separated from their mothers who were diagnosed with COVID-19 infection. The purpose of this literature review is to examine the current evidence to determine if the transmission of COVID-19 infection to the neonate increases if newborns are directly breastfed by mothers who are positive for COVID-19 infection. There were 28 studies conducted in seven countries, with 10 of those studies conducted in the United States. In total, 5,123 neonates were born to mothers diagnosed with COVID-19, with 3,872 neonates determined to have been breastfed or provided mixed feeding including breast milk. Overall, 2.35% (91/3,872) of the newborns tested positive, and all recovered from COVID-19 infection. As frontline health care providers, nurses are instrumental in offering support and education on the risks and benefits of breastfeeding for individuals diagnosed with COVID-19.
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33
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Shuffrey LC, Firestein MR, Kyle MH, Fields A, Alcántara C, Amso D, Austin J, Bain JM, Barbosa J, Bence M, Bianco C, Fernández CR, Goldman S, Gyamfi-Bannerman C, Hott V, Hu Y, Hussain M, Factor-Litvak P, Lucchini M, Mandel A, Marsh R, McBrian D, Mourad M, Muhle R, Noble KG, Penn AA, Rodriguez C, Sania A, Silver WG, O’Reilly KC, Stockwell M, Tottenham N, Welch MG, Zork N, Fifer WP, Monk C, Dumitriu D. Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection. JAMA Pediatr 2022; 176:e215563. [PMID: 34982107 PMCID: PMC8728661 DOI: 10.1001/jamapediatrics.2021.5563] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Associations between in utero exposure to maternal SARS-CoV-2 infection and neurodevelopment are speculated, but currently unknown. OBJECTIVE To examine the associations between maternal SARS-CoV-2 infection during pregnancy, being born during the COVID-19 pandemic regardless of maternal SARS-CoV-2 status, and neurodevelopment at age 6 months. DESIGN, SETTING, AND PARTICIPANTS A cohort of infants exposed to maternal SARS-CoV-2 infection during pregnancy and unexposed controls was enrolled in the COVID-19 Mother Baby Outcomes Initiative at Columbia University Irving Medical Center in New York City. All women who delivered at Columbia University Irving Medical Center with a SARS-CoV-2 infection during pregnancy were approached. Women with unexposed infants were approached based on similar gestational age at birth, date of birth, sex, and mode of delivery. Neurodevelopment was assessed using the Ages & Stages Questionnaire, 3rd Edition (ASQ-3) at age 6 months. A historical cohort of infants born before the pandemic who had completed the 6-month ASQ-3 were included in secondary analyses. EXPOSURES Maternal SARS-CoV-2 infection during pregnancy and birth during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Outcomes were scores on the 5 ASQ-3 subdomains, with the hypothesis that maternal SARS-CoV-2 infection during pregnancy would be associated with decrements in social and motor development at age 6 months. RESULTS Of 1706 women approached, 596 enrolled; 385 women were invited to a 6-month assessment, of whom 272 (70.6%) completed the ASQ-3. Data were available for 255 infants enrolled in the COVID-19 Mother Baby Outcomes Initiative (114 in utero exposed, 141 unexposed to SARS-CoV-2; median maternal age at delivery, 32.0 [IQR, 19.0-45.0] years). Data were also available from a historical cohort of 62 infants born before the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences on any ASQ-3 subdomain, regardless of infection timing or severity. However, compared with the historical cohort, infants born during the pandemic had significantly lower scores on gross motor (mean difference, -5.63; 95% CI, -8.75 to -2.51; F1,267 = 12.63; P<.005), fine motor (mean difference, -6.61; 95% CI, -10.00 to -3.21; F1,267 = 14.71; P < .005), and personal-social (mean difference, -3.71; 95% CI, -6.61 to -0.82; F1,267 = 6.37; P<.05) subdomains in fully adjusted models. CONCLUSIONS AND RELEVANCE In this study, birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2 infection, was associated with differences in neurodevelopment at age 6 months. These early findings support the need for long-term monitoring of children born during the COVID-19 pandemic.
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Affiliation(s)
- Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Margaret H. Kyle
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Andrea Fields
- Department of Psychology, Columbia University, New York, New York
| | | | - Dima Amso
- Department of Psychology, Columbia University, New York, New York
| | - Judy Austin
- Heilbrunn Department of Population and Family Health, Columbia University Irving Medical Center, New York, New York
| | - Jennifer M. Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Mary Bence
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Bianco
- Department of Psychology, Columbia University, New York, New York
| | - Cristina R. Fernández
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Sylvie Goldman
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla
| | - Violet Hott
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Yunzhe Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Maha Hussain
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Arthur Mandel
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Rachel Marsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Danielle McBrian
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - Rebecca Muhle
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Kimberly G. Noble
- Department of Neuroscience and Education, Teachers College, Columbia University, New York, New York
| | - Anna A. Penn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | | | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Wendy G. Silver
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, New York
| | - Kally C. O’Reilly
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,New York State Psychiatric Institute, New York
| | - Melissa Stockwell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, New York
| | - Martha G. Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Noelia Zork
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Obstetrics and Gynecology, Columbia University Irving Medical Center New York, New York
| | - Dani Dumitriu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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Ayed M, Embaireeg A, Kartam M, More K, Alqallaf M, AlNafisi A, Alsaffar Z, Bahzad Z, Buhamad Y, Alsayegh H, Al-Fouzan W, Alkandari H. Neurodevelopmental outcomes of infants born to mothers with SARS-CoV-2 infections during pregnancy: a national prospective study in Kuwait. BMC Pediatr 2022; 22:319. [PMID: 35637442 PMCID: PMC9149327 DOI: 10.1186/s12887-022-03359-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND An increasing proportion of women are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Intrauterine viral infections induce an increase in the levels of proinflammatory cytokines, which inhibit the proliferation of neuronal precursor cells and stimulate oligodendrocyte cell death, leading to abnormal neurodevelopment. Whether a maternal cytokine storm can affect neonatal brain development is unclear. The objective of the present study was to assess neurodevelopmental outcomes in neonates born to mothers with SARS-CoV-2 infections during pregnancy. METHODS In this prospective cohort study, the neurodevelopmental status of infants (N = 298) born to women with SARS-CoV-2 infections during pregnancy was assessed at 10-12 months post-discharge using the Ages and Stages Questionnaire, 3rd edition (ASQ-3). The ASQ-3 scores were classified into developmental delays (cutoff scores ≤ 2 standard deviations (SDs) below the population mean) and no delays (scores > 2 SDs above the population mean). RESULTS The majority (90%) of the infants born to mothers with SARS-CoV-2 infections during pregnancy had favorable outcomes and only 10% showed developmental delays. Two of the 298 infants tested positive for SARS-CoV-2, and both had normal ASQ-3 scores. The majority of the pregnant women had SARS-CoV-2 infections during their third trimester. The risk of developmental delays among infants was higher in those whose mothers had SARS-CoV-2 infections during the first (P = 0.039) and second trimesters (P = 0.001) than in those whose mothers had SARS-CoV-2 infections during the third trimester. CONCLUSION The neurodevelopmental outcomes of infants born to mothers with SARS-CoV-2 infections seem favorable. However, more studies with larger sample sizes and longer follow-up periods are required.
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Affiliation(s)
- Mariam Ayed
- grid.414755.60000 0004 4903 819XNeonatal Department, Farwaniya Hospital, 81400 Kuwait City, Kuwait
| | - Alia Embaireeg
- grid.414755.60000 0004 4903 819XNeonatal Department, Farwaniya Hospital, 81400 Kuwait City, Kuwait
| | - Mais Kartam
- grid.414755.60000 0004 4903 819XPaediatric Department, Farwaniya Hospital, 81400 Kuwait City, Kuwait
| | - Kiran More
- grid.467063.00000 0004 0397 4222Division of Neonatology, Sidra Medicine, Doha, Qatar
| | - Mafaza Alqallaf
- grid.413288.40000 0004 0429 4288Paediatric Department, Adan Hospital, Hadiya, Kuwait
| | - Abdullah AlNafisi
- grid.413527.6Paediatric Department, Sabah Hospital, Kuwait City, Kuwait
| | - Zainab Alsaffar
- grid.414755.60000 0004 4903 819XPaediatric Department, Farwaniya Hospital, 81400 Kuwait City, Kuwait
| | - Zainab Bahzad
- grid.414755.60000 0004 4903 819XPaediatric Department, Farwaniya Hospital, 81400 Kuwait City, Kuwait
| | - Yasmeen Buhamad
- grid.414755.60000 0004 4903 819XPaediatric Department, Farwaniya Hospital, 81400 Kuwait City, Kuwait
| | - Haneen Alsayegh
- grid.413513.1Paediatric Department, Amiri Hospital, Kuwait City, Kuwait
| | - Wadha Al-Fouzan
- grid.411196.a0000 0001 1240 3921Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Hessa Alkandari
- grid.452356.30000 0004 0518 1285Population Health Department, Dasman Diabetes Institute, Kuwait City, Kuwait
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Infants prenatally exposed to SARS-CoV-2 show the absence of fidgety movements and are at higher risk for neurological disorders: A comparative study. PLoS One 2022; 17:e0267575. [PMID: 35507630 PMCID: PMC9067650 DOI: 10.1371/journal.pone.0267575] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Congenital viral infections are believed to damage the developing neonatal brain. However, whether neonates exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) show manifestations of such damage remains unclear. For neurodevelopment evaluation, general movement assessments have been shown to be effective in identifying early indicators of neurological dysfunction, including the absence of fidgety movements. This study compared the early motor repertoire by general movement assessment at three to five months of age in neonates who were or were not prenatally exposed to SARS-CoV-2 to determine whether infants prenatally exposed to SARS-CoV-2 are at risk of developing neurological disorders. Fifty-six infants, including 28 in the exposed group of mothers without vaccination who had no need for intensive care and likely had SARS-CoV-2 infection close to the time of pregnancy resolution and 28 infants in the nonexposed group, were videotaped to compare their detailed early motor repertoires, in which a motor optimality score-revised (MOS-R) was calculated using Prechtl’s method by using the chi-square or Mann–Whitney U tests. In the exposed group, 3 (11%) infants showed the absence of fidgety movements with a total MOS-R<14 points, and 3 (11%) other infants showed abnormal fidgety movements. Between groups, atypical body symmetry (p = 0.009) and MOS-R values were significantly lower (Z = -3.08, p = 0.002), with a large size effect (Cohen’s d = 0.97). The consequences of this new virus go beyond the health of the pregnant mother, and these consequences in some of the infants in the exposed group are likely not transitory because of the absence of fidgety movements between 3–5 months; thus, these babies are at increased risk of developing a serious neurological disorder.
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Associations and Disease–Disease Interactions of COVID-19 with Congenital and Genetic Disorders: A Comprehensive Review. Viruses 2022; 14:v14050910. [PMID: 35632654 PMCID: PMC9146233 DOI: 10.3390/v14050910] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
Since December 2019, the COVID-19 pandemic, which originated in Wuhan, China, has resulted in over six million deaths worldwide. Millions of people who survived this SARS-CoV-2 infection show a number of post-COVID complications. Although, the comorbid conditions and post-COVID complexities are to some extent well reviewed and known, the impact of COVID-19 on pre-existing congenital anomalies and genetic diseases are only documented in isolated case reports and case series, so far. In the present review, we analyzed the PubMed indexed literature published between December 2019 and January 2022 to understand this relationship from various points of view, such as susceptibility, severity and heritability. Based on our knowledge, this is the first comprehensive review on COVID-19 and its associations with various congenital anomalies and genetic diseases. According to reported studies, some congenital disorders present high-risk for developing severe COVID-19 since these disorders already include some comorbidities related to the structure and function of the respiratory and cardiovascular systems, leading to severe pneumonia. Other congenital disorders rather cause psychological burdens to patients and are not considered high-risk for the development of severe COVID-19 infection.
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Pascal R, Crovetto F, Casas I, Youssef L, Trilla C, Larroya M, Cahuana A, Boada D, Foraster M, Llurba E, Sunyer J, Crispi F, Gratacos E, Gómez-Roig MD. Impact of the COVID-19 Pandemic on Maternal Well-Being during Pregnancy. J Clin Med 2022; 11:jcm11082212. [PMID: 35456306 PMCID: PMC9032494 DOI: 10.3390/jcm11082212] [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] [Received: 03/06/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 12/10/2022] Open
Abstract
The outbreak of a pandemic has negative psychological effects. We aimed to determine the impact of the SARS-CoV-2 pandemic during pregnancy and identify the risk factors for maternal well-being. A multicenter, prospective, population-based study was carried out that included women (n = 1320) who were pregnant during the SARS-CoV-2 pandemic in Barcelona (Spain) compared against a pre-pandemic cohort (n = 345). Maternal well-being was assessed using the validated World Health Organization Well-Being Index Questionnaire (WHO-5 Index). Pregnant women attended during the COVID-19 pandemic showed worst WHO-5 well-being scores (median (IQR) of 56 (36−72) for the pandemic cohort vs. 64 (52−76) for the pre-pandemic cohort p < 0.001), with 42.8% of women presenting a poor well-being score vs. 28% for the pre-pandemic cohort (p < 0.001). Presence of a previous psychiatric disorder (OR 7.1; 95% CI 2.6−19, p < 0.001), being in the third trimester of pregnancy (OR 1.7; 95% CI 1.5−2, p < 0.001), or requiring hospital admission for COVID-19 (OR 4.7; 95% CI 1.4−16.7, p = 0.014), significantly contributed to low maternal well-being during the COVID-19 pandemic (multivariate analysis). Being infected by SARS-CoV-2 was not associated with a lower well-being score. We conclude that, during the COVID-19 pandemic, there were higher rates of poor maternal well-being; the infection of SARS-CoV-2 itself did not worsen maternal well-being, but other factors as psychiatric disorders, being in the third trimester of pregnancy or hospital admission for COVID-19 disease did.
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Affiliation(s)
- Rosalia Pascal
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Francesca Crovetto
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases, 28029 Madrid, Spain
- Correspondence:
| | - Irene Casas
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
| | - Lina Youssef
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
| | - Cristina Trilla
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Marta Larroya
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
| | - Alex Cahuana
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
| | - David Boada
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
| | | | - Elisa Llurba
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Jordi Sunyer
- ISGlobal, 08003 Barcelona, Spain; (M.F.); (J.S.)
| | - Fàtima Crispi
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
- Center for Biomedical Network Research on Rare Diseases, 28029 Madrid, Spain
- Institut de Recerca August Pi Sunyer, 08036 Barcelona, Spain
| | - Eduard Gratacos
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases, 28029 Madrid, Spain
- Institut de Recerca August Pi Sunyer, 08036 Barcelona, Spain
| | - María Dolores Gómez-Roig
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain; (R.P.); (I.C.); (L.Y.); (M.L.); (A.C.); (D.B.); (F.C.); (E.G.); (M.D.G.-R.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
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He Y, Wong YWY, Ngeow AJH, Sim EY, Cherng BPZ, Arunachalam S, Ho SKY, Tan WC, Mok US. Preparation and consideration for establishment of an isolation maternity unit in a tertiary hospital during COVID-19 pandemic. BMC Pregnancy Childbirth 2022; 22:317. [PMID: 35418029 PMCID: PMC9007268 DOI: 10.1186/s12884-022-04643-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/30/2022] [Indexed: 12/13/2022] Open
Abstract
The SARS-CoV-2 pandemic is rapidly evolving and remains a major health challenge worldwide. With an increase in pregnant women with COVID-19 infection, we recognized an urgent need to set up a multidisciplinary taskforce to provide safe and holistic care for this group of women. In this review of practice in a tertiary hospital in Singapore, we discuss the key considerations in setting up an isolation maternity unit and our strategies for peripartum and postpartum care. Through teleconsultation, we involve these women and their families in the discussion of timing and mode of birth, disposition of babies after birth and safety of breastfeeding to enable them to make informed decisions and individualize their care.
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Affiliation(s)
- Yingke He
- Department of Anaesthesia, Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Yvonne Wan Yu Wong
- Department of Obstetrics and Gynaecology, Division of Surgery and Surgical Oncology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Alvin Jia Hao Ngeow
- Department of Neonatal and Developmental Medicine, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Eileen Yilin Sim
- Department of Anaesthesia, Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Benjamin Pei Zhi Cherng
- Department of Infectious Disease, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Sridhar Arunachalam
- Department of Neonatal and Developmental Medicine, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Selina Kah Ying Ho
- Department of Neonatal and Developmental Medicine, Division of Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Wei Ching Tan
- Department of Obstetrics and Gynaecology, Division of Surgery and Surgical Oncology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Un Sam Mok
- Department of Anaesthesia, Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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The Impact of Maternal Prenatal Stress Related to the COVID-19 Pandemic during the First 1000 Days: A Historical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084710. [PMID: 35457577 PMCID: PMC9029063 DOI: 10.3390/ijerph19084710] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has a major impact on society, particularly affecting its vulnerable members, including pregnant women and their unborn children. Pregnant mothers reported fear of infection, fear of vertical transmission, fear of poor birth and child outcomes, social isolation, uncertainty about their partner's presence during medical appointments and delivery, increased domestic abuse, and other collateral damage, including vaccine hesitancy. Accordingly, pregnant women's known vulnerability for mental health problems has become a concern during the COVID-19 pandemic, also because of the known effects of prenatal stress for the unborn child. The current narrative review provides a historical overview of transgenerational effects of exposure to disasters during pregnancy, and the role of maternal prenatal stress. We place these effects into the perspective of the COVID-19 pandemic. Hereby, we aim to draw attention to the psychological impact of the COVID-19 pandemic on women of reproductive age (15-49 year) and its potential associated short-term and long-term consequences for the health of children who are conceived, carried, and born during this pandemic. Timely detection and intervention during the first 1000 days is essential to reduce the burden of transgenerational effects of the COVID-19 pandemic.
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40
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Shook LL, Sullivan EL, Lo JO, Perlis RH, Edlow AG. COVID-19 in pregnancy: implications for fetal brain development. Trends Mol Med 2022; 28:319-330. [PMID: 35277325 PMCID: PMC8841149 DOI: 10.1016/j.molmed.2022.02.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/02/2022]
Abstract
The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy on the developing fetal brain is poorly understood. Other antenatal infections such as influenza have been associated with adverse neurodevelopmental outcomes in offspring. Although vertical transmission has been rarely observed in SARS-CoV-2 to date, given the potential for profound maternal immune activation (MIA), impact on the developing fetal brain is likely. Here we review evidence that SARS-CoV-2 and other viral infections during pregnancy can result in maternal, placental, and fetal immune activation, and ultimately in offspring neurodevelopmental morbidity. Finally, we highlight the need for cellular models of fetal brain development to better understand potential short- and long-term impacts of maternal SARS-CoV-2 infection on the next generation.
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Affiliation(s)
- Lydia L Shook
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Elinor L Sullivan
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA; Division of Neuroscience, Oregon National Primate Center, Beaverton, OR, USA
| | - Jamie O Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA; Department of Urology, Oregon Health & Science University, Portland, OR, USA; Division of Reproductive and Developmental Sciences, Oregon National Primate Center, Beaverton, OR, USA
| | - Roy H Perlis
- Center for Quantitative Health, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea G Edlow
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA.
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Short Version)]. Z Geburtshilfe Neonatol 2022; 226:16-24. [PMID: 35180805 DOI: 10.1055/a-1687-2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the short version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
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Araiana S, Hosseini MS, Khademi M, Kazemi SN, Ghaffari E, Falahatie M, Shahmirzadi SA, Hosseini A. A case-control study on the severity postpartum depression among COVID19 positive mother. Ann Med Surg (Lond) 2022; 73:103223. [PMID: 35003731 PMCID: PMC8719917 DOI: 10.1016/j.amsu.2021.103223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND COVID19 pandemic has caused a variety of psychological problems including panic disorder, anxiety and depression. It is also associated with adverse psychological outcomes in pregnant women. The aim of this study was to compare the severity of postpartum depression in pregnant women with and without COVID-19 during the coronavirus epidemic. METHODS This case-control study was performed on 102 pregnant women referred to the hospitals of (XXX). Using questionnaire, consisting of demographic and maternal data (age, number of pregnancies, type of delivery, history of any disease, history of drug use, breastfeeding experience, separation of mother from infant due to coronavirus) and score from Edinburgh postnatal depression scale (EPDS) score data from all the participants obtained and analyzed statistically using SPSSv23. RESULTS The results showed that the mean EPDS score in COVID-positive mothers was 26.64 and in COVID-negative mothers was 24.76, which was statistically significant, p < 0.001. The score did not vary among the two group with respect to age group and type of delivery method. The score was significantly higher among the women with 3-4 pregnancies. CONCLUSION COVID-positive status is associated with increased postnatal depression among women. Perinatal and postnatal psychological consultancy is required in such patients along with monitoring of maternal and neonate physical and mental health.
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Affiliation(s)
- Shideh Araiana
- Department of Obstetrics and Gynecology, Fellowship of Perinatology Division, School of Medicine, Imam Hossein Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam sadat Hosseini
- Department of Obstetrics and Gynecology, School of Medicine, Preventative Gynecology Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Khademi
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Neda Kazemi
- Department of Obstetrics and Gynecology, School of Medicine, Preventative Gynecology Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Ghaffari
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Masoome Falahatie
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | | | - Afsaneh Hosseini
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
- Corresponding author. Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Conducting Neonatal Intensive Care Unit Research During a Pandemic: Challenges and Lessons Learned. Nurs Res 2022; 71:147-152. [PMID: 35212498 PMCID: PMC8881673 DOI: 10.1097/nnr.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The coronavirus pandemic disrupted normal clinical operations and research. Nurse scientists conducting research studies in the neonatal intensive care unit experienced significant challenges to continuing their research studies amid national lockdowns and hospital visitation restrictions. OBJECTIVES The purpose of this article is to describe the challenges encountered by nurse scientists conducting research studies in the neonatal intensive care unit during the pandemic, the creative solutions devised to overcome these barriers, and the lessons learned during this unprecedented time. METHODS Using our pandemic area studies as exemplars, we highlight the barriers encountered in continuing our research in the intense environment of the neonatal intensive care unit. RESULTS Visitor restrictions limited the presence of parents and researchers in the neonatal intensive care unit during the pandemic, causing disruptions to participant recruitment and data collection. Laboratory closures further limited research activities during the pandemic. Strategies to overcome these barriers include building formal collaborations among researchers and clinicians, creating the infrastructure to support virtual recruitment and electronic consent, and developing contingency plans for studies involving the analysis of biological samples. DISCUSSION The neonatal intensive care unit is a unique environment because of vulnerable patient population and need for researchers to interact with parents to recruit study participants. Implementing the strategies developed during the coronavirus pandemic may allow for the continuation of research activities during future public health crises.
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Mundhra R, Bahadur A, Sharma S, Ajmani M, Zaman R, Chaturvedi J. Psychological Distress and Post-COVID Sequelae in Postpartum Females after Clinically Stable COVID-19 Infections: A Single-Center Observational Study from India. Int J Appl Basic Med Res 2022; 12:185-188. [PMID: 36131852 PMCID: PMC9484513 DOI: 10.4103/ijabmr.ijabmr_173_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The objective of this study was to identify the presence of any post-COVID physical and stress sequelae up to 3 months postpartum. Materials and Methods: This prospective cross-sectional study was carried out in a tertiary center from India wherein all clinically stable COVID-positive pregnant women delivering between May 2020 to January 2021 were included. These women were evaluated at 3 months postpartum using Standard Posttraumatic Stress Disorder (PTSD)-Civilian Checklist, Depression, Anxiety, and Stress Scale-21 (DASS-21), and Fatigue Severity Scale (FSS). Results Among 42 women evaluated, most of the women felt that they had returned to their pre-COVID health (76.19%, 32 women). Three women (7.14%) had some persistent symptoms, and another seven women (16.66%) were not sure whether they felt the same as pre-COVID health status. Self-reported symptoms such as fatigue, myalgia, and nightmare were reported in 21.43%, 14.28%, and 2.38%, respectively. The frequency of stress and anxiety as seen with the DASS was seen in one (2.38%) and three (7.14%) women, respectively. Although none of the women had PTSD, 9.52% were potential candidates for PTSD. The mean score in FSS was 12.57 ± 4.14 and through Visual Analog Fatigue Scale score was 4.76 ± 1.28. Conclusion Postpartum women are at risk of post-COVID physical and stress sequelae.
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Schou TM, Joca S, Wegener G, Bay-Richter C. Psychiatric and neuropsychiatric sequelae of COVID-19 - A systematic review. Brain Behav Immun 2021; 97:328-348. [PMID: 34339806 PMCID: PMC8363196 DOI: 10.1016/j.bbi.2021.07.018] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 12/12/2022] Open
Abstract
It has become evident that coronavirus disease 2019 (COVID-19) has a multi-organ pathology that includes the brain and nervous system. Several studies have also reported acute psychiatric symptoms in COVID-19 patients. An increasing number of studies are suggesting that psychiatric deficits may persist after recovery from the primary infection. In the current systematic review, we provide an overview of the available evidence and supply information on potential risk factors and underlying biological mechanisms behind such psychiatric sequelae. We performed a systematic search for psychiatric sequelae in COVID-19 patients using the databases PubMed and Embase. Included primary studies all contained information on the follow-up period and provided quantitative measures of mental health. The search was performed on June 4th 2021. 1725 unique studies were identified. Of these, 66 met the inclusion criteria and were included. Time to follow-up ranged from immediately after hospital discharge up to 7 months after discharge, and the number of participants spanned 3 to 266,586 participants. Forty studies reported anxiety and/or depression, 20 studies reported symptoms- or diagnoses of post-traumatic stress disorder (PTSD), 27 studies reported cognitive deficits, 32 articles found fatigue at follow-up, and sleep disturbances were found in 23 studies. Highlighted risk factors were disease severity, duration of symptoms, and female sex. One study showed brain abnormalities correlating with cognitive deficits, and several studies reported inflammatory markers to correlate with symptoms. Overall, the results from this review suggest that survivors of COVID-19 are at risk of psychiatric sequelae but that symptoms generally improve over time.
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Affiliation(s)
- Thor Mertz Schou
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Samia Joca
- Department of Biomedicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Gregers Wegener
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Cecilie Bay-Richter
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark.
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Karimi-Zarchi M, Schwartz DA, Bahrami R, Dastgheib SA, Javaheri A, Tabatabaiee RS, Ferdosian F, Asadian F, Neamatzadeh H. A meta-analysis for the risk and prevalence of preeclampsia among pregnant women with COVID-19. Turk J Obstet Gynecol 2021; 18:224-235. [PMID: 34580872 PMCID: PMC8480209 DOI: 10.4274/tjod.galenos.2021.66750] [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] [Indexed: 12/01/2022] Open
Abstract
Preeclampsia and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are both life-threatening disorders when they occur during pregnancy. They are similarly characterized by systemic immune activation and have a deleterious effect on maternal endothelial cells. During the coronavirus disease-2019 (COVID-19) pandemic, there were reports of preeclampsia or a preeclampsia-like syndrome occurring in pregnant women with SARS-CoV-2 infection. We performed a meta-analysis to estimate the risk and prevalence of preeclampsia and SARS-CoV-2 infection in pregnant women. A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and China National Knowledge Infrastructure to identify all relevant studies published up to February 29, 2020. All studies that reported the prevalence of preeclampsia in pregnant women with SARS-CoV-2 infection were selected. A total of 10 case-control studies and 15 case series met our inclusion criteria. Pooled data revealed no significant difference between infected pregnant women and uninfected pregnant women for the risk of preeclampsia [odds ratio (OR)=1.676, 95% confidence interval (CI) 0.679-4.139, p=0.236]. The stratified analysis revealed significant risk in the infected Asian pregnant women (OR=2.637, 95% CI 1.030-6.747, p=0.043), but not Caucasian. The prevalence of preeclampsia was 8.2% (95% CI 0.057-0.117) in infected pregnant women with COVID-19 in the overall population. Its prevalence was highest in North America (10.7%), followed by Asian (7.9%), Caucasian (6.7%), European (4.9%), and West Asian (2.6%) infected pregnant women. Our pooled data showed that the prevalence of preeclampsia in pregnant women with SARS-CoV-2 infection was 8.2%. However, there was no increased risk of occurrence of preeclampsia among pregnant women with SARS-CoV-2 infection.
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Affiliation(s)
- Mojgan Karimi-Zarchi
- Department of Obstetrics and Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
| | - Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atiyeh Javaheri
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Razieh Sadat Tabatabaiee
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzad Ferdosian
- Department of Medical Laboratory Sciences, School of Paramedical Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Asadian
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Department of Medical Laboratory Sciences, School of Paramedical Science, Shiraz University of Medical Sciences, Shiraz, Iran
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Freitas-Jesus JV, Sánchez ODR, Rodrigues L, Faria-Schützer DB, Serapilha AAA, Surita FG. Stigma, guilt and motherhood: Experiences of pregnant women with COVID-19 in Brazil. Women Birth 2021; 35:403-412. [PMID: 34493479 PMCID: PMC8390366 DOI: 10.1016/j.wombi.2021.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic raises health issues worldwide. Infected pregnant women may have negative mental health outcomes, but little is known about their emotional experiences. AIM We aimed to understand the experience of women infected with COVID-19 during pregnancy, regarding their feelings, their relationships, and the influence of social media. METHODS We conducted a qualitative study among 22 women infected with COVID-19 during pregnancy, from a tertiary hospital during the first wave of the pandemic in Brazil (May-August 2020). We applied semi-directed interviews, sociodemographic and health data sheets, and field diaries. We built the sample purposefully. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis and discussed data considering the health psychology framework. RESULTS We created five categories following a timeline perspective, from before infection to the experience after recovering. Pregnant women were resistant to believing the diagnosis. They described a fear of serious symptoms or death, concerns about the fetus, sorrow from being isolated, and worries about stigma. Family relationships were ambiguous, generating either support or tension. The attachment to the health team through telemedicine or support during hospitalization produced a feeling of security. CONCLUSIONS Participants psychologically denied the COVID-19 diagnosis and did not accomplish isolation properly, even upon medical recommendations. The illness may produce a traumatic experience, regardless of mild or severe symptoms, but family/friend support and contact with the health team helped them to cope. We offer important insights for the clinical approach and future research, emphasizing that infected pregnant women require emotional support.
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Affiliation(s)
- Juliana Vasconcellos Freitas-Jesus
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas- UNICAMP, R. Tessália Vieira de Camargo 126, Cidade Universitária, Campinas, São Paulo 13083-887, Brazil.
| | - Odette Del Risco Sánchez
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas- UNICAMP, R. Tessália Vieira de Camargo 126, Cidade Universitária, Campinas, São Paulo 13083-887, Brazil.
| | - Larissa Rodrigues
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas- UNICAMP, R. Tessália Vieira de Camargo 126, Cidade Universitária, Campinas, São Paulo 13083-887, Brazil.
| | - Débora Bicudo Faria-Schützer
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas- UNICAMP, R. Tessália Vieira de Camargo 126, Cidade Universitária, Campinas, São Paulo 13083-887, Brazil.
| | - Adrielle Amanda Altomani Serapilha
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas- UNICAMP, R. Tessália Vieira de Camargo 126, Cidade Universitária, Campinas, São Paulo 13083-887, Brazil.
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas- UNICAMP, R. Tessália Vieira de Camargo 126, Cidade Universitária, Campinas, São Paulo 13083-887, Brazil.
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Ahmad M, Vismara L. The Psychological Impact of COVID-19 Pandemic on Women's Mental Health during Pregnancy: A Rapid Evidence Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7112. [PMID: 34281049 PMCID: PMC8297318 DOI: 10.3390/ijerph18137112] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The perinatal period is a particularly vulnerable period in women's lives that implies significant physiological and psychological changes that can place women at higher risk for depression and anxiety symptoms. In addition, the ongoing pandemic of coronavirus disease 2019 (COVID-19) is likely to increase this vulnerability and the prevalence of mental health problems. This review aimed to investigate the existing literature on the psychological impact of the COVID-19 pandemic on women during pregnancy and the first year postpartum. METHOD The literature search was conducted using the following databases: Pubmed, Scopus, WOS-web of science, PsycInfo and Google Scholar. Out of the total of 116 initially selected papers, 17 have been included in the final work, according to the inclusion criteria. RESULTS The reviewed contributions report a moderate to severe impact of the COVID-19 outbreak on the mental health of pregnant women, mainly in the form of a significant increase in depression-up to 58% in Spain-and anxiety symptoms-up to 72% in Canada. In addition to the common psychological symptoms, COVID-19-specific worries emerged with respect to its potential effects on pregnancy and the well-being of the unborn child. Social support and being engaged in regular physical activities appear to be protective factors able to buffer against the effects of the pandemic on maternal mental health. CONCLUSIONS Despite the limitations of the study design, the evidence suggests that it is essential to provide appropriate psychological support to pregnant women during the emergency in order to protect their mental health and to minimize the risks of long-term effects on child development.
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Affiliation(s)
| | - Laura Vismara
- Department of Pedagogy, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, 09124 Cagliari, Italy;
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Kumar R, Yeni CM, Utami NA, Masand R, Asrani RK, Patel SK, Kumar A, Yatoo MI, Tiwari R, Natesan S, Vora KS, Nainu F, Bilal M, Dhawan M, Emran TB, Ahmad T, Harapan H, Dhama K. SARS-CoV-2 infection during pregnancy and pregnancy-related conditions: Concerns, challenges, management and mitigation strategies-a narrative review. J Infect Public Health 2021; 14:863-875. [PMID: 34118736 PMCID: PMC8062420 DOI: 10.1016/j.jiph.2021.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/10/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health problem. The SARS-CoV-2 triggers hyper-activation of inflammatory and immune responses resulting in cytokine storm and increased inflammatory responses on several organs like lungs, kidneys, intestine, and placenta. Although SARS-CoV-2 affects individuals of all age groups and physiological statuses, immune-compromised individuals such as pregnant women are considered as a highly vulnerable group. This review aims to raise the concerns of high risk of infection, morbidity and mortality of COVID-19 in pregnant women and provides critical reviews of pathophysiology and pathobiology of how SARS-CoV-2 infection potentially increases the severity and fatality during pregnancy. This article also provides a discussion of current evidence on vertical transmission of SARS-CoV-2 during pregnancy and breastfeeding. Lastly, guidelines on management, treatment, preventive, and mitigation strategies of SARS-CoV-2 infection during pregnancy and pregnancy-related conditions such as delivery and breastfeeding are discussed.
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Affiliation(s)
- Rakesh Kumar
- Department of Veterinary Pathology, Dr. G.C Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur, 176062, Himachal Pradesh, India.
| | - Cut Meurah Yeni
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, 23111, Banda Aceh, Indonesia; Department of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, 24415, Indonesia.
| | - Niken Asri Utami
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, 23111, Banda Aceh, Indonesia; Department of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, 24415, Indonesia.
| | - Rupali Masand
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
| | - Rajesh Kumar Asrani
- Department of Veterinary Pathology, Dr. G.C Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur, 176062, Himachal Pradesh, India.
| | - Shailesh Kumar Patel
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, Medanta Hospital, Gurgaon, 122001, India.
| | - Mohd Iqbal Yatoo
- Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, Alusteng Srinagar, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shalimar, Srinagar, 190006, Jammu and Kashmir, India.
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan (DUVASU), Mathura, 281001, India.
| | - Senthilkumar Natesan
- Indian Institute of Public Health Gandhinagar, Lekawada, Gandhinagar, Gujarat, 382042, India.
| | - Kranti Suresh Vora
- Indian Institute of Public Health Gandhinagar, Lekawada, Gandhinagar, Gujarat, 382042, India; Institute of Health Research, University of Canberra, ACT 2617, Australia.
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia.
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China.
| | - Manish Dhawan
- Department of Microbiology, Punjab Agricultural University, Ludhiana, 141004, India; The Trafford Group of Colleges, Manchester, WA14 5PQ, United Kingdom.
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
| | - Tauseef Ahmad
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China.
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia.
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
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Iyengar U, Jaiprakash B, Haitsuka H, Kim S. One Year Into the Pandemic: A Systematic Review of Perinatal Mental Health Outcomes During COVID-19. Front Psychiatry 2021; 12:674194. [PMID: 34248710 PMCID: PMC8264436 DOI: 10.3389/fpsyt.2021.674194] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Obstetric guidelines have rapidly evolved to incorporate new data and research on the novel coronavirus disease (COVID-19), with data on perinatal mental health building over the last year. Our aim in the present manuscript is to provide a systematic review of mental health outcomes in pregnant and postpartum women during the COVID-19 pandemic in the context of neonatal and obstetric guidelines addressing symptoms and complications of COVID-19 during pregnancy, mother-to-neonate transmission, Cesarean-section delivery, neonatal prematurity, maternal/neonate mortalities, maternal-neonatal separation, and breastfeeding. We summarize data from 81 mental health studies of pregnant and postpartum women and underscore protective and risk factors identified for perinatal mental health outcomes amidst the COVID-19 pandemic. Data reviewed here suggest increased psychological symptoms, especially depressive and anxiety symptoms, in pregnant and postpartum women during COVID-19. Our systematic review integrates the most current obstetric and neonate guidelines, along with perinatal mental health outcomes associated with COVID-19, highlighting the best available data for the care of women and their neonates amidst the current COVID-19 pandemic.
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Affiliation(s)
- Udita Iyengar
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), London, United Kingdom
| | - Bhavisha Jaiprakash
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), London, United Kingdom
| | - Hanako Haitsuka
- Yale Child Study Center, Yale University, New Haven, CT, United States
| | - Sohye Kim
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, United States
- Departments of Psychiatry, Pediatrics, and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States
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