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Zhao SW, Li YM, Li YL, Su C. Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments. World J Gastroenterol 2023; 29:241-256. [PMID: 36687127 PMCID: PMC9846943 DOI: 10.3748/wjg.v29.i2.241] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/11/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been a serious threat to global health for nearly 3 years. In addition to pulmonary complications, liver injury is not uncommon in patients with novel COVID-19. Although the prevalence of liver injury varies widely among COVID-19 patients, its incidence is significantly increased in severe cases. Hence, there is an urgent need to understand liver injury caused by COVID-19. Clinical features of liver injury include detectable liver function abnormalities and liver imaging changes. Liver function tests, computed tomography scans, and ultrasound can help evaluate liver injury. Risk factors for liver injury in patients with COVID-19 include male sex, preexisting liver disease including liver transplantation and chronic liver disease, diabetes, obesity, and hypertension. To date, the mechanism of COVID-19-related liver injury is not fully understood. Its pathophysiological basis can generally be explained by systemic inflammatory response, hypoxic damage, ischemia-reperfusion injury, and drug side effects. In this review, we systematically summarize the existing literature on liver injury caused by COVID-19, including clinical features, underlying mechanisms, and potential risk factors. Finally, we discuss clinical management and provide recommendations for the care of patients with liver injury.
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Affiliation(s)
- Shu-Wu Zhao
- Department of Anesthesiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Yi-Ming Li
- School of Basic Medical Science, Naval Medical University/Second Military University, Shanghai 200433, China
| | - Yi-Lin Li
- Department of Pathology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Chen Su
- Department of Anesthesiology and Pain, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha 410013, Hunan Province, China
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Sobkowski M, Pięta B, Sowińska A, Grabowska M, Koch-Brzozowska K, Wilczak M, Bień A. SARS-CoV-2 in Pregnancy-A Retrospective Analysis of Selected Maternal and Fetal Laboratory Parameters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15307. [PMID: 36430023 PMCID: PMC9690975 DOI: 10.3390/ijerph192215307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
Pregnant women and their neonates belong to the group of individuals with elevated risk for COVID-19 infection. Data on the course of the disease and how it affects the pregnancy and neonatal wellbeing remain conflicting. The aim of the study was to evaluate the effect of SARS CoV-2 infection on the mode of delivery, neonatal condition and selected maternal and fetal laboratory parameters. This was a single-center retrospective case-control study. This dataset was generated using electronic medical records collected by medical personnel. Two groups of patients, hospitalized between April, 2020 and February, 2021, were included in the study: study group (304)-pregnant women with SARS-CoV-2 and control group (N = 329)-healthy pregnant women or parturients. Mothers with a severe course of COVID-19 had higher activated partial thromboplastin-APTT (p = 0.02), C-Reactive Protein-CRP (p = 0.00) and procalcitonin (p = 0.032) levels as compared to pregnant women with mild or moderate course of the disease. Neonates born to SARS-CoV-2-infected mothers presented with worse condition at 1 and 5 minutes of life (p = 0.000 and 0.00, respectively) and lower Arterial Blood Gas-ABG pH scores (p = 0.016). Elective cesarean section is the most common mode of delivery for SARS-CoV2-infected mothers. Emergency cesarean sections are performed at earlier gestational age as compared to vaginal delivery and elective cesarean section. Lower Apgar scores were observed in neonates born to SARS-CoV-2-infected mothers who required oxygen therapy and whose procalcitonin levels were elevated. There is a relationship between more severe course of COVID-19 and APTT, as well as CRP and procalcitonin levels.
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Affiliation(s)
- Maciej Sobkowski
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Beata Pięta
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Anna Sowińska
- Department of Informatics and Statistics, University of Medical Sciences, Rokietnicka Street 7, 60-806 Poznań, Poland
| | - Marlena Grabowska
- Gynecological and Obstetric Hospital of the University of Medical Sciences in Poznan, Polna Street 33, 60-535 Poznań, Poland
| | | | - Maciej Wilczak
- Department of Mother and Child Health, Poznan University of Medical Sciences, Polna Street 33, 60-535 Poznań, Poland
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4/6 Staszica St., 20-081 Lublin, Poland
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COVID-19 infection among pregnant and non-pregnant women: Comparison of biochemical markers and outcomes during COVID-19 pandemic, A retrospective cohort study. Ann Med Surg (Lond) 2022; 76:103527. [PMID: 35371473 PMCID: PMC8958856 DOI: 10.1016/j.amsu.2022.103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/20/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background & Objectives: We conducted this single-centered retrospective study including female patients infected with COVID-19 with aim to compare laboratory findings and the outcomes between pregnant and non-pregnant women infected with COVID-19. Previous data rendered pregnant women as vulnerable population for COVID-19. Methods We included 131 patients in our analysis out of which 60 were pregnant females and rest 71 were non-pregnant females. Results Factors like fatigue, total leukocyte count (TLC) and neutrophils were higher in pregnant patients, while mean age, fever, hemoglobin, ferritin, D-dimer and use of mechanical ventilation was lower in pregnant patients as compared to non-pregnant females. Conclusion Our study concluded that COVID-19 do not show significant high risk of disease severity when compared with non-pregnant females of similar age group. Previous studies reported that pregnant women are vulnerable population appearing to be at higher risk of morbidity and mortality from COVID-19. Our study concluded that COVID-19 do not show significant high risk of disease severity in pregnancy when compared with non-pregnant females of similar age group.
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Debi H, Itu ZT, Amin MT, Hussain F, Hossain MS. Association of serum C-reactive protein (CRP) and D-dimer concentration on the severity of COVID-19 cases with or without diabetes: a systematic review and meta-analysis. Expert Rev Endocrinol Metab 2022; 17:83-93. [PMID: 34781810 PMCID: PMC8607539 DOI: 10.1080/17446651.2022.2002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Coronavirus disease (COVID-19) is a highly contagious disease that poses major public health risks. Fewer studies link high CRP and D-dimer levels to severe COVID-19 infection. Therefore, this study investigates the association of serum CRP and D-dimer concentration with COVID-19 severity in diabetic and non-diabetic patients. AREAS COVERED Relevant published articles were identified using electronic search engines, such as Google Scholar, PubMed, Springer, Science Direct, and Researchgate. A total of 29 articles reporting on 15,282 patients (4,733 diabetes and 10,549 non-diabetes) were included in this systematic review and meta-analysis. RevMan V5.4, STATA V14 software, and SPSS V25 were used for the meta-analysis. Egger's regression and Begg-Mazumdar's test were used for assessing publication bias. The pooled result of all studies revealed that serum CRP (Standard mean difference (SMD) 0.41 mg/L; P < 0.0001; I2 93%) and D-dimer (SMD 0.32 mg/L; P < 0.0001; I2 83%) concentration was significantly higher in COVID-19 diabetic patients. The prevalence of COVID-19 infection was comparatively higher in male diabetic patients (OR 2.41; P < 0.00001; I2 88%). There was no publication bias. CRP and D-dimer rose with age in COVID-19 diabetic and non-diabetic patients. EXPERT OPINION Overall, the serum CRP and D-dimer concentration in COVID-19 diabetic patients was significantly higher than non-diabetic patients indicating severe illness.
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Affiliation(s)
- Hoimonti Debi
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Zarin Tasnim Itu
- Department of Pharmacy, Mawlana Bashani Science and Technology University, Tangail, Bangladesh
| | - Mohammad Tohidul Amin
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Fahad Hussain
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Mohammad Salim Hossain
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
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Guleroglu FY, Atalmis HA, Bafali IO, Dikdere GB, Dikdere I, Ekmez M, Kaban A, Karasabanoglu F, Atas BS, Selvi E, Sumnu G, Topaktas M, Dayan MY, Dogu SY, Cetin A. Short-term outcomes of COVID-19 in pregnant women unvaccinated for SARS-CoV-2 in the first, second, and third trimesters: a retrospective study. SAO PAULO MED J 2022; 141:e2022323. [PMID: 36472869 PMCID: PMC10065103 DOI: 10.1590/1516-3180.2022.0323.r1.19082022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) may be asymptomatic or symptomatic in pregnant women. Compared to non-pregnant reproductive-aged women, symptomatic individuals appear to have a higher risk of acquiring severe illness sequelae. OBJECTIVES We assessed the clinical and laboratory characteristics and outcomes of pregnant COVID-19 patients unvaccinated for severe acute respiratory syndrome coronavirus 2 according to the trimester of pregnancy. DESIGN AND SETTING This was a retrospective observational study conducted in a tertiary-level hospital in Turkey. METHODS This retrospective study reviewed the clinical and laboratory characteristics and outcomes of 445 pregnant COVID-19 patients hospitalized during the first, second, and third trimesters of pregnancy and 149 other pregnant women as controls in a tertiary center from April 2020 to December 2021. All participants were unvaccinated. RESULTS Overall, the study groups were comparable in terms of baseline clinical pregnancy characteristics. There was no clear difference among the study participants with COVID-19 in the first, second, and third trimesters of pregnancy. However, a considerably high number of clinical and laboratory findings revealed differences that were consistent with the inflammatory nature of the disease. CONCLUSIONS The study results reveal the importance of careful follow-up of hospitalized cases as a necessary step by means of regular clinical and laboratory examinations in pregnant COVID-19 patients. With further studies, after implementing vaccination programs for COVID-19 in pregnant women, these data may help determine the impact of vaccination on the outcomes of pregnant COVID-19 patients.
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Affiliation(s)
- Filiz Yarsilikal Guleroglu
- MD. Perinatologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Hatice Argun Atalmis
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Icten Olgu Bafali
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Gulser Bingol Dikdere
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Irfan Dikdere
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Murat Ekmez
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Alpaslan Kaban
- MD. Gynecologic Oncologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Fatma Karasabanoglu
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Busra Seker Atas
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Esra Selvi
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Gulay Sumnu
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Merve Topaktas
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Merve Yasti Dayan
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Sevilay Yavuz Dogu
- MD. Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
| | - Ali Cetin
- MD, PhD. Perinatologist, Department of Obstetrics and Gynecology, Haseki Training and Research Hospital affiliated with Health Sciences University, Sultangazi, Istanbul, Turkey
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Covali R, Socolov D, Socolov R, Pavaleanu I, Carauleanu A, Akad M, Boiculese VL, Adam AM. Complete Blood Count Peculiarities in Pregnant SARS-CoV-2-Infected Patients at Term: A Cohort Study. Diagnostics (Basel) 2021; 12:diagnostics12010080. [PMID: 35054247 PMCID: PMC8774532 DOI: 10.3390/diagnostics12010080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023] Open
Abstract
Background: During viral outbreaks, pregnancy poses an increased risk of infection for women. Methods: In a prospective study, all patients admitted for delivery at term to Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, between 1 April 2020 and 31 December 2020 were included. There were 457 patients, divided into two groups: group 1, SARS-CoV-2-positive patients (n = 46) and group 2, SARS-CoV-2-negative patients (n = 411). Among other tests, complete blood count was determined upon admittance, and the following values were studied: white blood cell count, lymphocytes, neutrophils, red blood cell count, hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red blood cell distribution width, hematocrit, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and platelet large cell ratio. Results: in pregnant SARS-CoV-2-infected patients at term, there was a significant decrease in white blood cell, neutrophil, and lymphocyte count, and an increase in mean corpuscular hemoglobin concentration, compared to healthy pregnant women at term, although all still within normal limits. None of the other components of the complete blood count or fetal outcomes studied was significantly influenced by SARS-CoV-2 infection in pregnant patients at term.
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Affiliation(s)
- Roxana Covali
- Department of Radiology, Biomedical Engineering Faculty, Grigore T. Popa University of Medicine and Pharmacy Iasi, Elena Doamna Obstetrics and Gynecology University Hospital, 700115 Iasi, Romania
- Correspondence: ; Tel.: +40-232-210-390 (ext. 275)
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Cuza Voda Obstetrics and Gynecology University Hospital, 700115 Iasi, Romania; (D.S.); (A.C.)
| | - Razvan Socolov
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Elena Doamna Obstetrics and Gynecology University Hospital, 700115 Iasi, Romania; (R.S.); (I.P.)
| | - Ioana Pavaleanu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Elena Doamna Obstetrics and Gynecology University Hospital, 700115 Iasi, Romania; (R.S.); (I.P.)
| | - Alexandru Carauleanu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Cuza Voda Obstetrics and Gynecology University Hospital, 700115 Iasi, Romania; (D.S.); (A.C.)
| | - Mona Akad
- Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.A.); (A.M.A.)
| | - Vasile Lucian Boiculese
- Department of Statistics, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Ana Maria Adam
- Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.A.); (A.M.A.)
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Young EM, Green O, Stewart J, King Y, O'Donoghue K, Walker KF, Thornton JG. COVID-19 and pregnancy: A comparison of case reports, case series and registry studies. Eur J Obstet Gynecol Reprod Biol 2021; 268:135-142. [PMID: 34920270 PMCID: PMC8647390 DOI: 10.1016/j.ejogrb.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Selection, outcome and publication biases are well described in case reports and case series but may be less of a problem early in the appearance of a new disease when all cases might appear to be worth publishing. OBJECTIVE To use a prospectively collected database of primary sources to compare the reporting of COVID-19 in pregnancy in case reports, case series and in registries over the first 8 months of the pandemic. STUDY DESIGN MEDLINE, Embase and Maternity and Infant Care databases were searched from 22 March to 5 November 2020, to create a curated list of primary sources. Duplicate reports were excluded. Case reports, case series and registry studies of pregnant women with confirmed COVID-19, where neonatal outcomes were reported, were selected and data extracted on neonatal infection status, neonatal death, neonatal intensive care unit admission, preterm birth, stillbirth, maternal critical care unit admission and maternal death. RESULTS 149 studies comprising 41,658 mothers and 8,854 neonates were included. All complications were more common in case reports, and in retrospective series compared with presumably prospective registry studies. Extensive overlap is likely in registry studies, with cases from seven countries reported by multiple registries. The UK Obstetric Surveillance System was the only registry to explicitly report identification and removal of duplicate cases, although five other registries reported collection of patient identifiable data which would facilitate identification of duplicates. CONCLUSIONS Since it is likely that registries provide the least biased estimates, the higher rates seen in the other two study designs are probably due to selection or publication bias. However even some registry studies include self- or doctor-reported cases, so might be biased, and we could not completely exclude overlap of cases in some registries.
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Affiliation(s)
- Eloise M Young
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Oleia Green
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Joel Stewart
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Yasmin King
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, College Road, University College, Cork, Ireland
| | - Kate F Walker
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Jim G Thornton
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England.
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Hoffman MC, Freedman R, Law AJ, Clark AM, Hunter SK. Maternal nutrients and effects of gestational COVID-19 infection on fetal brain development. Clin Nutr ESPEN 2021; 43:1-8. [PMID: 34024500 PMCID: PMC8144544 DOI: 10.1016/j.clnesp.2021.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Maternal gestational infection is a well-characterized risk factor for offsprings' development of mental disorders including schizophrenia, autism, and attention deficit disorder. The inflammatory response elicited by the infection is partly directed against the placenta and fetus and is the putative pathogenic mechanism for fetal brain developmental abnormalities. Fetal brain abnormalities are generally irreversible after birth and increase risk for later mental disorders. Maternal immune activation in animals models this pathophysiology. SARS-CoV-2 produces maternal inflammatory responses during pregnancy similar to previously studied common respiratory viruses. METHOD Choline, folic acid, Vitamin D, and n-3 polyunsaturated fatty acids are among the nutrients that have been studied as possible mitigating factors for effects of maternal infection and inflammation on fetal development. Clinical and animal studies relevant to their use in pregnant women who have been infected are reviewed. RESULTS Higher maternal choline levels have positive effects on the development of brain function for infants of mothers who experienced viral infections in early pregnancy. No other nutrient has been studied in the context of viral inflammation. Vitamin D reduces pro-inflammatory cytokines in some, but not all, studies. Active folic acid metabolites decrease anti-inflammatory cytokines. N-3 polyunsaturated fatty acids have no effect. CONCLUSIONS Vitamin D and folic acid are already supplemented in food additives and in prenatal vitamins. Despite recommendations by several public health agencies and medical societies, choline intake is often inadequate in early gestation when the brain is forming. A public health initiative for choline supplements during the pandemic could be helpful for women planning or already pregnant who also become exposed or infected with SARS-CoV-2.
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Affiliation(s)
- M Camille Hoffman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA; Department of Psychiatry, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA.
| | - Robert Freedman
- Department of Psychiatry, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA.
| | - Amanda J Law
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA; Department of Psychiatry, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA; Department of Cell and Developmental Biology, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA; Department of Medicine, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA.
| | - Alena M Clark
- Department of Nutrition and Dietetics, Campus Box 93, University of Northern Colorado, Greeley, CO, 80639, USA.
| | - Sharon K Hunter
- Department of Psychiatry, University of Colorado Denver School of Medicine, Mail Stop F-546, Anschutz Medical Center, Aurora, CO, 80045, USA.
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Cimolai N. A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1272-1294. [PMID: 33754135 PMCID: PMC7968576 DOI: 10.1007/s42399-021-00836-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
The maternal-fetal/newborn unit is established at risk for COVID-19 infection. This narrative review summarizes the contemporary and cumulative publications which detail maternal infection, antenatal and newborn infections, and maternal/fetal/newborn management and prevention. There is a wide spectrum of maternal disease, but the potential for severe disease albeit in a minority is confirmed. COVID-19 carries risk for preterm delivery. Pregnant females can suffer multisystem disease, and co-morbidities play a significant role in risk. Congenital infection has been supported by several anecdotal reports, but strong confirmatory data are few. No typical congenital dysmorphisms are evident. Nevertheless, placental vascular compromise must be considered a risk for the fetus during advanced maternal infections. Clinical manifestations of newborn infection have been mild to moderate and relatively uncommon. Proven antiviral therapy is of yet lacking. The mode of delivery is a medical decision that must include patient risk assessment and patient directives. Both presymptomatic and asymptomatic mothers and offspring can complicate infection control management with the potential for spread to others in several regards. In the interim, infections of the maternal-fetal-newborn unit must be taken seriously both for the disease so caused and the potential for further dissemination of disease.
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Affiliation(s)
- Nevio Cimolai
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Children’s and Women’s Health Centre of British Columbia, 4480 Oak Street, Vancouver, B.C. V6H3V4 Canada
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