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Saberi H, Ghorashi Z, Loripoor M. Comparison of pregnancy outcome during pandemic of COVID-19 and non-pandemic situations, Yazd, Iran, in 2019-2020. J OBSTET GYNAECOL 2022; 42:1937-1943. [PMID: 35603710 DOI: 10.1080/01443615.2022.2054685] [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: 10/18/2022]
Abstract
This study aimed to compare the pregnancy outcomes during pandemic and non-pandemic COVID-19 in women referred to health service centres in Yazd. This descriptive study was performed based on the information obtained from all pregnant women referred to comprehensive health service centres in Yazd city using census method, between March 21 2019 and December 21 2019 and between March 20 2020 and December 20 2020. The pregnant mothers' information, including their pregnancy outcome, and maternal and neonatal complications, was extracted from the electronic health information system of Yazd city. The obtained data were analysed by Chi-Square test. No significant difference was found between non-pandemic and pandemic COVID-19 situations in most variables. As well, maternal and neonatal death were equally observed in both non-pandemic and pandemic COVID-19 situations. Wanted pregnancy, post term birth, multiple pregnancy and caesarean section rates were found to be higher in pandemic than non-pandemic COVID-19 (p<.001). Reported abortion, screening for foetal anueploidy in the first and second trimesters as well as the number of episodes of prenatal care during COVID-19 pandemic were significantly lower than those of non-pandemic period (p<.001). The outcome of pregnancy during the pandemic was not significantly different from that of non-pandemic situation.Impact StatementWhat is already known on this subject? Studies already showed COVID-19 in pregnancy alter the maternal and neonatal outcomes in different degrees compared with pregnant individuals without COVID-19. However, it is not clear that pregnancy outcome dose alter during pandemic of COVID-19 compared to non-pandemic situations in general population?What do the results of this study add? The results of this study revealed that the outcome of pregnancy during pandemic was not significantly different from that of non-pandemic situation.What are the implications of these findings for clinical practice and/or further research? According to results of this study, we can ensure pregnant women in the situation of pandemic COVID-19 that they are not in greater risk. We suggest future research should be done for comparison of pregnancy outcome in the situation of delta variant pandemic with non-pandemic COVID-19.
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Affiliation(s)
- Hengameh Saberi
- Department of Midwifery, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zohreh Ghorashi
- Department of Midwifery, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Marzeyeh Loripoor
- Department of Midwifery, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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The association between maternal characteristics and SARS-CoV-2 in pregnancy: a population-based registry study in Sweden and Norway. Sci Rep 2022; 12:8355. [PMID: 35589871 PMCID: PMC9120467 DOI: 10.1038/s41598-022-12395-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/10/2022] [Indexed: 01/08/2023] Open
Abstract
The objectives of the current study were to identify risk factors for SARS-CoV-2 positivity, and to address how different testing strategies, choice of comparison group, and population background characteristics may influence observed associations. National registries data for 107,627 pregnant women in Sweden and 81,195 in Norway, were used to identify risk factors for SARS-CoV-2, separately for women under non-universal testing (testing by indication) and universal testing (testing of all pregnant women in contact with a delivery ward). We also investigated underlying characteristics associated with testing for SARS-CoV-2. Overall, 2.1% of pregnant women in Sweden and 1.1% in Norway were test-positive during the pandemic’s first 18 months. We show that the choice of test strategy for SARS-CoV-2 provided different associations with risk factors for the disease; for instance, women who were overweight, obese or had gestational diabetes had increased odds of being test-positive under non-universal testing, but not under universal testing. Nevertheless, a consistent pattern of association between being born in the Middle East and Africa and test-positivity was found independent of test strategy and in both countries. These women were also less likely to get tested. Our results are useful to consider for surveillance and clinical recommendations for pregnant women during the current and future pandemics.
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Hernandez-Pacheco JA, Torres-Torres J, Martinez-Portilla RJ, Solis-Paredes JM, Estrada-Gutierrez G, Mateu-Rogell P, Nares-Torices MA, Lopez-Marenco ME, Escobedo-Segura KR, Posadas-Nava A, Villafan-Bernal JR, Rojas-Zepeda L, Becerra-Navarro NP, Casillas-Barrera M, Pichardo-Cuevas M, Muñoz-Manrique C, Cortes-Ramirez IA, Espino-y-Sosa S. sFlt-1 Is an Independent Predictor of Adverse Maternal Outcomes in Women With SARS-CoV-2 Infection and Hypertensive Disorders of Pregnancy. Front Med (Lausanne) 2022; 9:894633. [PMID: 35615097 PMCID: PMC9125178 DOI: 10.3389/fmed.2022.894633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/31/2022] [Indexed: 12/19/2022] Open
Abstract
BackgroundPreeclampsia (PE) and COVID-19 share a common vascular–endothelial physiopathological pathway that may aggravate or worsen women's outcomes when both coexist. This study aims to evaluate the association of sFlt-1 levels and adverse maternal outcomes among positive SARS-CoV-2 pregnant women with and without hypertensive disorders of pregnancy (HDP).MethodsWe performed a multicenter retrospective cohort study of pregnant women with confirmed SARS-CoV-2 infection that required hospital admission. The exposed cohort comprised women with a diagnosis of an HDP. The primary outcome was a composite definition of adverse maternal outcome. The association between predictors and the main and secondary outcomes was assessed using an elastic-net regression which comprised a Lasso and Ridge regression method for automatic variable selection and penalization of non-statistically significant coefficients using a 10-fold cross-validation where the best model if automatically chosen by the lowest Akaike information criterion (AIC) and Bayesian information criteria (BIC).ResultsAmong 148 pregnant women with COVID-19, the best predictive model comprised sFlt-1 MoMs [odds ratio (OR): 5.13; 95% CI: 2.19–12.05], and HDP (OR: 32.76; 95% CI: 5.24–205). sFlt-1 MoMs were independently associated with an increased probability of an adverse maternal outcome despite adjusting for HDP.ConclusionsOur study shows that sFlt-1 is an independent predictor of adverse outcomes in women with SARS-CoV-2 despite hypertension status.
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Affiliation(s)
- Jose Antonio Hernandez-Pacheco
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Hospital de la Mujer, Mexico City, Mexico
| | - Johnatan Torres-Torres
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | - Raigam Jafet Martinez-Portilla
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | - Juan Mario Solis-Paredes
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Guadalupe Estrada-Gutierrez
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Paloma Mateu-Rogell
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
- Centro de Investigación en Ciencias de la Salud, FCS, Universidad Anahuac México Campus Norte, Huixquilucan, Mexico
| | - Miguel Angel Nares-Torices
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | | | | | | | - Jose Rafael Villafan-Bernal
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
- Laboratory of Immunogenomics and Metabolic Diseases, Instituto Nacional de Medicina Genomica, Mexico City, Mexico
| | - Lourdes Rojas-Zepeda
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
- Maternal Fetal Medicine Department, Instituto Materno Infantil del Estado de Mexico, Toluca, Mexico
| | | | | | | | - Cinthya Muñoz-Manrique
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
| | | | - Salvador Espino-y-Sosa
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City, Mexico
- *Correspondence: Salvador Espino-y-Sosa
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Pineles BL, Goodman KE, Pineles L, O'Hara LM, Nadimpalli G, Magder LS, Baghdadi JD, Parchem JG, Harris AD. Pregnancy and the Risk of In-Hospital Coronavirus Disease 2019 (COVID-19) Mortality. Obstet Gynecol 2022; 139:846-854. [PMID: 35576343 PMCID: PMC9015030 DOI: 10.1097/aog.0000000000004744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/02/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether pregnancy is an independent risk factor for in-hospital mortality among patients of reproductive age hospitalized with coronavirus disease 2019 (COVID-19) viral pneumonia. METHODS We conducted a retrospective cohort study (April 2020-May 2021) of 23,574 female inpatients aged 15-45 years with an International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code for COVID-19 discharged from 749 U.S. hospitals in the Premier Healthcare Database. We used a viral pneumonia diagnosis to select for patients with symptomatic COVID-19. The associations between pregnancy and in-hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation were analyzed using propensity score-matched conditional logistic regression. Models were matched for age, marital status, race and ethnicity, Elixhauser comorbidity score, payer, hospital number of beds, season of discharge, hospital region, obesity, hypertension, diabetes mellitus, chronic pulmonary disease, deficiency anemias, depression, hypothyroidism, and liver disease. RESULTS In-hospital mortality occurred in 1.1% of pregnant patients and 3.5% of nonpregnant patients hospitalized with COVID-19 and viral pneumonia (propensity score-matched odds ratio [OR] 0.39, 95% CI 0.25-0.63). The frequency of ICU admission for pregnant and nonpregnant patients was 22.0% and 17.7%, respectively (OR 1.34, 95% CI 1.15-1.55). Mechanical ventilation was used in 8.7% of both pregnant and nonpregnant patients (OR 1.05, 95% CI 0.86-1.29). Among patients who were admitted to an ICU, mortality was lower for pregnant compared with nonpregnant patients (OR 0.33, 95% CI 0.20-0.57), though mechanical ventilation rates were similar (35.7% vs 38.3%, OR 0.90, 95% CI 0.70-1.16). Among patients with mechanical ventilation, pregnant patients had a reduced risk of in-hospital mortality compared with nonpregnant patients (0.26, 95% CI 0.15-0.46). CONCLUSION Despite a higher frequency of ICU admission, in-hospital mortality was lower among pregnant patients compared with nonpregnant patients with COVID-19 viral pneumonia, and these findings persisted after propensity score matching.
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Affiliation(s)
- Beth L Pineles
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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55
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Guo X, Semerci N, De Assis V, Kayisli UA, Schatz F, Steffensen TS, Guzeloglu-Kayisli O, Lockwood CJ. Regulation of Proinflammatory Molecules and Tissue Factor by SARS-CoV-2 Spike Protein in Human Placental Cells: Implications for SARS-CoV-2 Pathogenesis in Pregnant Women. Front Immunol 2022; 13:876555. [PMID: 35464466 PMCID: PMC9022221 DOI: 10.3389/fimmu.2022.876555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
SARS-CoV-2 infects cells via binding to ACE2 and TMPRSS2, which allows the virus to fuse with host cells. The viral RNA is detected in the placenta of SARS-CoV-2-infected pregnant women and infection is associated with adverse pregnancy complications. Therefore, we hypothesize that SARS-CoV-2 infection of placental cells induces pro-inflammatory cytokine release to contribute to placental dysfunction and impaired pregnancy outcomes. First, expression of ACE2 and TMPRSS2 was measured by qPCR in human primary cultured term cytotrophoblasts (CTBs), syncytiotrophoblast (STBs), term and first trimester decidual cells (TDCs and FTDCs, respectively), endometrial stromal cells (HESCs) as well as trophoblast cell lines HTR8, JEG3, placental microvascular endothelial cells (PMVECs) and endometrial endothelial cells (HEECs). Later, cultured HTR8, JEG3, PMVECs and HEECs were treated with 10, 100, 1000 ng/ml of recombinant (rh-) SARS-CoV-2 S-protein ± 10 ng/ml rh-IFNγ. Pro-inflammatory cytokines IL-1β, 6 and 8, chemokines CCL2, CCL5, CXCL9 and CXCL10 as well as tissue factor (F3), the primary initiator of the extrinsic coagulation cascade, were measured by qPCR as well as secreted IL-6 and IL-8 levels were measured by ELISA. Immunohistochemical staining for SARS-CoV-2 spike protein was performed in placental specimens from SARS-CoV-2–positive and normal pregnancies. ACE2 levels were significantly higher in CTBs and STBs vs. TDCs, FTDCs and HESCs, while TMPRSS2 levels were not detected in TDCs, FTDCs and HESCs. HTR8 and JEG3 express ACE2 and TMPRSS2, while PMVECs and HEECs express only ACE2, but not TMPRSS2. rh-S-protein increased proinflammatory cytokines and chemokines levels in both trophoblast and endothelial cells, whereas rh-S-protein only elevated F3 levels in endothelial cells. rh-IFNγ ± rh-S-protein augments expression of cytokines and chemokines in trophoblast and endothelial cells. Elevated F3 expression by rh-IFNγ ± S-protein was observed only in PMVECs. In placental specimens from SARS-CoV-2-infected mothers, endothelial cells displayed higher immunoreactivity against spike protein. These findings indicated that SARS-CoV-2 infection in placental cells: 1) induces pro-inflammatory cytokine and chemokine release, which may contribute to the cytokine storm observed in severely infected pregnant women and related placental dysfunction; and 2) elevates F3 expression that may trigger systemic or placental thrombosis.
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Affiliation(s)
- Xiaofang Guo
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Nihan Semerci
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Viviana De Assis
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Umit A Kayisli
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Frederick Schatz
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Thora S Steffensen
- Department of Pathology, Tampa General Hospital, Tampa, FL, United States
| | - Ozlem Guzeloglu-Kayisli
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Charles J Lockwood
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
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Kuciel N, Mazurek J, Hap K, Marciniak D, Biernat K, Sutkowska E. COVID-19 Vaccine Acceptance in Pregnant and Lactating Women and Mothers of Young Children in Poland. Int J Womens Health 2022; 14:415-424. [PMID: 35378877 PMCID: PMC8975803 DOI: 10.2147/ijwh.s348652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The World Health Organization indicated vaccine hesitancy as one of the top 10 threats to global health. The success of a vaccine depends not only on its efficacy but also on its acceptance. Our study aims to define COVID-19 vaccine acceptance in a sample of pregnant and lactating women in Poland. Since mothers are often key decision-makers for whether their children will receive vaccination, it is vital to measure vaccine confidence among this group. Patients and Methods An anonymous online survey was distributed to assess the level of acceptance of COVID-19 vaccination among pregnant and lactating women for themselves and their children in Poland. Results The trust of pregnant and breastfeeding women and women who have offspring in government, in healthcare professionals, in scientific authorities, and sound scientific data is strongly associated with vaccine acceptance and may influence an individual's decision to perceive recommended actions as beneficial to the society as a whole. Conclusion Acceptance and confidence in receiving the COVID-19 vaccination among pregnant and lactating women and mothers with young children is strongly associated with feelings of trust in government, health professionals, scientific authorities, and sound scientific data. The dissemination of professional and reliable information regarding the safety and efficacy of COVID-19 vaccine uptake by qualified health care personnel can significantly increase the level of trust and public awareness regarding the safety and efficacy of COVID-19 vaccine uptake in pregnancy, while breastfeeding, and mothers with young children.
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Affiliation(s)
- Natalia Kuciel
- University Centre of Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Justyna Mazurek
- University Centre of Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Hap
- University Centre of Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Dominik Marciniak
- Department of Drugs Form Technology, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Biernat
- University Centre of Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Edyta Sutkowska
- University Centre of Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
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Plasma Total Antioxidant Capacity and Carbonylated Proteins Are Increased in Pregnant Women with Severe COVID-19. Viruses 2022; 14:v14040723. [PMID: 35458453 PMCID: PMC9025616 DOI: 10.3390/v14040723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 02/07/2023] Open
Abstract
Oxidative stress (OS) induced by SARS-CoV-2 infection may play an important role in COVID-19 complications. However, information on oxidative damage in pregnant women with COVID-19 is limited. Objective: We aimed to compare lipid and protein oxidative damage and total antioxidant capacity (TAC) between pregnant women with severe and non-severe COVID-19. Methods: We studied a consecutive prospective cohort of patients admitted to the obstetrics emergency department. All women positive for SARS-CoV-2 infection by reverse transcription-polymerase chain reaction (RT-qPCR) were included. Clinical data were collected and blood samples were obtained at hospital admission. Plasma OS markers, malondialdehyde (MDA), carbonylated proteins (CP), and TAC; angiogenic markers, fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF); and renin-angiotensin system (RAS) markers, angiotensin-converting enzyme 2 (ACE-2) and angiotensin-II (ANG-II) were measured. Correlation between OS, angiogenic, and RAS was evaluated. Results: In total, 57 pregnant women with COVID-19 were included, 17 (28.9%) of which had severe COVID-19; there were 3 (5.30%) maternal deaths. Pregnant women with severe COVID-19 had higher levels of carbonylated proteins (5782 pmol vs. 6651 pmol; p = 0.024) and total antioxidant capacity (40.1 pmol vs. 56.1 pmol; p = 0.001) than women with non-severe COVID-19. TAC was negatively correlated with ANG-II (p < 0.0001) and MDA levels (p < 0.0001) and positively with the sFlt-1/PlGF ratio (p = 0.027). Conclusions: In pregnant women, severe COVID-19 is associated with an increase in protein oxidative damage and total antioxidant capacity as a possible counterregulatory mechanism.
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Lucovnik M, Druskovic M, Vidmar Simic M, Verdenik I, Mesaric V, Kosir R, Kornhauser Cerar L, Tojner Bregar A, Steblovnik L, Kavsek G, Premru Srsen T. Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls. J Perinat Med 2022; 50:253-260. [PMID: 34881547 DOI: 10.1515/jpm-2021-0313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare perinatal outcomes in women with vs. without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS Perinatal outcomes in SARS-CoV-2 positive pregnant women who delivered at our institution between October 27th 2020 and January 31st 2021 were compared to SARS-CoV-2 negative pregnancies (contemporary controls) and historical 2019 controls matched by maternal age, pre-pregnancy body mass index and parity. Testing was performed based on symptoms or close contact at any time during pregnancy and as part of universal screening at hospital admission. Multivariable log-linear regression models were used adjusting for potential confounders (p < 0.05 statistically significant). RESULTS One thousand three hundred seventeen women delivered at our institution during the study period. 1,124 (85%) tested negative and 193 (15%) positive for SARS-CoV-2. 189 (98%) were infected during third trimester. 19 (10%) were asymptomatic, 171 (89%) had mild to moderate coronavirus disease 2019 (COVID-19), and 3 (2%) were critically ill with one case of maternal death. There were no significant differences in preterm birth, small-for-gestational-age birth weight, congenital anomalies, operative delivery, intrapartum hypoxia, and perinatal mortality in SARS-CoV-2 positive pregnancies compared to contemporary reference group or historical controls from pre-COVID-19 period. Labor was more commonly induced in SARS-CoV-2 positive women compared to reference SARS-CoV-2 negative group (68 [35%] vs. 278 [25%], adjusted odds ratio 1.62; 95% confidence interval 1.14-2.28). CONCLUSIONS SARS-CoV-2 infection in pregnancy was not strongly associated with adverse perinatal outcomes. While the majority of SARS-CoV-2 positive women had no or mild/moderate symptoms, 2% were critically ill, with one case of maternal death.
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Affiliation(s)
- Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druskovic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Marijana Vidmar Simic
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Vita Mesaric
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Renata Kosir
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Andreja Tojner Bregar
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lili Steblovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Gorazd Kavsek
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tanja Premru Srsen
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Sahin D, Tanacan A, Anuk AT, Sinaci S, Besimoglu B, Oluklu D, Hendem DU, Beser DM, Yildirim M, Sakcak B, Erol SA, Colakoglu Y, Ayhan SG, Turgut E, Unlu S, Canpolat FE, Izdes S, Turan S, Surel AA, Tekin OM. Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases. Arch Gynecol Obstet 2022; 306:1939-1948. [PMID: 35257193 PMCID: PMC8901098 DOI: 10.1007/s00404-022-06493-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/25/2022] [Indexed: 12/20/2022]
Abstract
Purpose To compare the clinical features and perinatal outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-variant and post-variant periods. Methods This prospective cohort study includes pregnant women with SARS-CoV-2 who were followed-up at Ankara City Hospital between 11, March 2020 and 15, September 2021. Demographic features, clinical characteristics and pregnancy outcomes were compared between the pre-variant (n = 1416) and post-variant (n = 519) groups. Results The rates of severe and critical cases significantly increased in the post-variant group (9.7% vs 2%, p < 0.001). The rates of respiratory support (26.8% vs 7.3%, p < 0.001), ICU admission (12.9% vs 1.8%, p < 0.001) and maternal mortality (2.9% vs 0.4%, p < 0.001) were significantly higher in the post-variant group. A significant increase was observed for pregnancy complications in the post-variant group (45.6% vs 18.8%, p = 0.007). The rates of preterm delivery (26.4% vs 4.4%, p < 0.001) and NICU admission (34% vs 18.8%, p < 0.001) were significantly higher in the post-variant group. Positive, weak, statistically significant correlations were observed between the post-variant period, disease severity and maternal mortality (r = 0.19, r = 0.12 and p < 0.001). Conclusion Post-variant COVID-19 period was associated with a severe course of the disease and increased rates of adverse obstetric outcomes in pregnant patients.
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Affiliation(s)
- Dilek Sahin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey.
| | - Ali Taner Anuk
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Selcan Sinaci
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Berhan Besimoglu
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Bedri Sakcak
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Seyit Ahmet Erol
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Yeliz Colakoglu
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, 06800, Ankara, Turkey
| | - Serpil Unlu
- Department of Infectious Diseases, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Fuat Emre Canpolat
- Division of Neonatology, Department of Pediatrics, Head of Center for Clinical Research, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Seval Izdes
- Intensive Care Clinic, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Sema Turan
- Intensive Care Clinic, Ankara Yildirim Beyazit University, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Aziz Ahmet Surel
- Coordinator Head Physician of Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Khalil A, Blakeway H, Samara A, O'Brien P. COVID-19 and stillbirth: direct vs indirect effect of the pandemic. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:288-295. [PMID: 34951732 DOI: 10.1002/uog.24846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - H Blakeway
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Samara
- Division of Clinical Paediatrics, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
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61
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Kalafat E, Prasad S, Birol P, Tekin AB, Kunt A, Di Fabrizio C, Alatas C, Celik E, Bagci H, Binder J, Le Doare K, Magee LA, Mutlu MA, Yassa M, Tug N, Sahin O, Krokos P, O’brien P, von Dadelszen P, Palmrich P, Papaioannou G, Ayaz R, Ladhani SN, Kalantaridou S, Mihmanli V, Khalil A. An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women. Am J Obstet Gynecol 2022; 226:403.e1-403.e13. [PMID: 34582796 PMCID: PMC8463298 DOI: 10.1016/j.ajog.2021.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
Background Pregnant women are at an increased risk of mortality and morbidity owing to COVID-19. Many studies have reported on the association of COVID-19 with pregnancy-specific adverse outcomes, but prediction models utilizing large cohorts of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events. Objective The main aim of this study was to develop a prediction model to quantify the risk of progression to critical COVID-19 and intensive care unit admission in pregnant women with symptomatic infection. Study Design This was a multicenter retrospective cohort study including 8 hospitals from 4 countries (the United Kingdom, Austria, Greece, and Turkey). The data extraction was from February 2020 until May 2021. Included were consecutive pregnant and early postpartum women (within 10 days of birth); reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. The primary outcome was progression to critical illness requiring intensive care. The secondary outcomes included maternal death, preeclampsia, and stillbirth. The association between the primary outcome and 12 candidate predictors having a known association with severe COVID-19 in pregnancy was analyzed with log-binomial mixed-effects regression and reported as adjusted risk ratios. All the potential predictors were evaluated in 1 model and only the baseline factors in another. The predictive accuracy was assessed by the area under the receiver operating characteristic curves. Results Of the 793 pregnant women who were positive for SARS-CoV-2 and were symptomatic, 44 (5.5%) were admitted to intensive care, of whom 10 died (1.3%). The ‘mini-COvid Maternal Intensive Therapy’ model included the following demographic and clinical variables available at disease onset: maternal age (adjusted risk ratio, 1.45; 95% confidence interval, 1.07–1.95; P=.015); body mass index (adjusted risk ratio, 1.34; 95% confidence interval, 1.06–1.66; P=.010); and diagnosis in the third trimester of pregnancy (adjusted risk ratio, 3.64; 95% confidence interval, 1.78–8.46; P=.001). The optimism-adjusted area under the receiver operating characteristic curve was 0.73. The ‘full-COvid Maternal Intensive Therapy’ model included body mass index (adjusted risk ratio, 1.39; 95% confidence interval, 1.07–1.95; P=.015), lower respiratory symptoms (adjusted risk ratio, 5.11; 95% confidence interval, 1.81–21.4; P=.007), neutrophil to lymphocyte ratio (adjusted risk ratio, 1.62; 95% confidence interval, 1.36–1.89; P<.001); and serum C-reactive protein (adjusted risk ratio, 1.30; 95% confidence interval, 1.15–1.44; P<.001), with an optimism-adjusted area under the receiver operating characteristic curve of 0.85. Neither model showed signs of a poor fit. Categorization as high-risk by either model was associated with a shorter diagnosis to intensive care unit admission interval (log-rank test P<.001, both), higher maternal death (5.2% vs 0.2%; P<.001), and preeclampsia (5.7% vs 1.0%; P<.001). A spreadsheet calculator is available for risk estimation. Conclusion At presentation with symptomatic COVID-19, pregnant and recently postpartum women can be stratified into high- and low-risk for progression to critical disease, even where resources are limited. This can support the nature and place of care. These models also highlight the independent risk for severe disease associated with obesity and should further emphasize that even in the absence of other comorbidities, vaccination is particularly important for these women. Finally, the model also provides useful information for policy makers when prioritizing national vaccination programs to quickly protect those at the highest risk of critical and fatal COVID-19.
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Vera von Bargen H, Espinosa Serrano M, Martin Navarrete D, Ahumada Droguett P, Méndez Benavente C, Flores Castillo M, Ramírez González N, Ulloa Contador G, López Aceiton M. Analysis of prevalence and sociodemographic conditions among women in labor with and without COVID-19 in public hospitals in Chile. J Perinat Med 2022; 50:132-138. [PMID: 34881550 DOI: 10.1515/jpm-2021-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The SARS-CoV-2 virus continues wreaking worldwide havoc on health and between March and August 2020, the first outbreak of COVID-19 hit Chile. The pregnant population is especially vulnerable to infection. Studies have been published that associate socioeconomic status, overcrowding, and poverty with a higher prevalence of SARS-CoV-2 infection. There are few studies about the development of this pandemic in Latin American countries so far. This study seeks to show the prevalence and sociodemographic and perinatal characteristics in pregnant women at the time of delivery, comparing both groups with positive and negative COVID-19 PCR results. METHODS A prospective, cross-sectional study of pregnant women who delivered at the San Juan de Dios Hospital in Santiago between April 15, 2020 and June 15, 2020. Analysis of epidemiological, sociodemographic, obstetric, perinatal and sociodemographic data of patients with positive and negative COVID-19 PCR results. RESULTS There were 701 patients included in the study. The prevalence of those with a positive COVID-19 PCR was 9.7% and 67.7% being asymptomatic. Pre-term delivery was significantly higher in the group of positive patients (23.5%) vs. negative patients (8.7%), which was not the same rate as with cesarean sections (C-sections). A 13.2% of patients required management of the pathology in the Critical Care Unit (CCU) and there were no cases of maternal or fetal deaths. We found no significant difference between both groups when analyzing socioeconomic variables, though we noted a trend of greater overcrowding among the group of patients with infection. CONCLUSIONS The majority of pregnant patients with SARS-CoV-2 infection are asymptomatic. COVID-19 increases the rate of premature births, but this rate is not same with C-sections. Sociodemographic conditions and overcrowding do not show a higher infection rate in a homogeneous population in relation to the economic, social and demographic level.
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Affiliation(s)
| | - María Espinosa Serrano
- Gynecolgy and Obstetrics Physician, San Juan de Dios Hospital, Santiago, Chile.,Obstetrics and Gynecology Program Scholarship, San Juan de Dios Hospital, Universidad de Chile, Santiago, Chile
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63
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Egloff C, Couffignal C, Cordier AG, Deruelle P, Sibiude J, Anselem O, Benachi A, Luton D, Mandelbrot L, Vauloup-Fellous C, Vivanti AJ, Picone O. Pregnant women's perceptions of the COVID-19 vaccine: A French survey. PLoS One 2022; 17:e0263512. [PMID: 35130318 PMCID: PMC8820613 DOI: 10.1371/journal.pone.0263512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Pregnant women are at increased risk for COVID-19, and COVID-19 vaccine is the most promising solution to overcome the current pandemic. This study was conducted to evaluate pregnant women’s perceptions and acceptance of COVID-19 vaccination. Materials & methods A cross-sectional study was conducted from February 18 to April 5 2021. An anonymous survey was distributed in 7 French obstetrics departments to all pregnant women before a prenatal visit. All pregnant women attending a follow-up consultation were asked to participate in the study. An anonymous web survey was available through a QR code and participants were asked whether or not they would agree to be vaccinated against SARS-CoV-2, and why. The questionnaire included questions on the patients’ demographics and their knowledge of COVID-19 vaccines. Results Of the 664 pregnant women who completed the questionnaire, 29.5% (95% CI 27.7; 31.3) indicated they would agree to be vaccinated against COVID-19. The main reason for not agreeing was being more afraid of potential side effects of the SARS-CoV-2 vaccine on the fetus than of COVID-19. Factors influencing acceptance of vaccination were: being slightly older, multiparity, having discussed it with a caregiver and acceptance of the influenza vaccine. Discussion Nearly one-third of pregnant women in this population would be willing to be vaccinated. In addition to studies establishing fetal safety, public health agencies and healthcare professionals should provide accurate information about the safety of COVID-19 vaccines.
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Affiliation(s)
- Charles Egloff
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
| | - Camille Couffignal
- FHU PREMA, Paris, France
- AP-HP, Hôpital Bichat, Clinical Research, Biostatistics and Epidemiology Department, Paris, France
| | - Anne Gael Cordier
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Paris Saclay University, AP-HP, Clamart, France
| | - Philippe Deruelle
- Pôle de gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jeanne Sibiude
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
- FHU PREMA, Paris, France
| | - Olivia Anselem
- Maternité Port-Royal, Hôpital Cochin, AP-HP, Centre-Université de Paris, Paris, France
| | - Alexandra Benachi
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Paris Saclay University, AP-HP, Clamart, France
| | - Dominique Luton
- Université de Paris, Paris, France
- FHU PREMA, Paris, France
- Service de gynécologie-obstétrique, FHU Prematurity, Bichat Hospital Assistance publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
- FHU PREMA, Paris, France
| | - Christelle Vauloup-Fellous
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Laboratoire de Virologie, Hôpital Paul Brousse, AP-HP, Université Paris-Saclay, Villejuif, France
| | - Alexandre J. Vivanti
- Université Paris-Saclay, INSERM U1193, Villejuif, France
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Paris Saclay University, AP-HP, Clamart, France
| | - Olivier Picone
- Assistance Publique-Hôpitaux de Paris APHP, Nord, Service de Gynécologie Obstétrique, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, Paris, France
- FHU PREMA, Paris, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- * E-mail:
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Giesbrecht G, Rojas L, Patel S, Kuret V, MacKinnon A, Tomfohr-Madsen L, Lebel C. Fear of COVID-19, mental health, and pregnancy outcomes in the pregnancy during the COVID-19 pandemic study: Fear of COVID-19 and pregnancy outcomes. J Affect Disord 2022; 299:483-491. [PMID: 34952107 PMCID: PMC8690287 DOI: 10.1016/j.jad.2021.12.057] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/19/2021] [Accepted: 12/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sustained fear during pregnancy has the potential to increase psychological distress and obstetric risk. This study aimed to (1) identify factors and characteristics associated with fear of COVID-19, (2) investigate the relationship between fear of COVID-19 and maternal anxiety and depression, and (3) determine the relationship between fear of COVID-19 and pregnancy outcomes. METHODS 9251 pregnant Canadians were recruited between April - December 2020. Participants self-reported (scale of 0-100) the degree of threat they perceived from the SARS-CoV-2 virus in relation to themselves and their unborn baby. RESULTS Mean fear scores indicated moderate to elevated concern. In multivariable linear regression, fear of COVID-19 was associated with food insecurity, ethnicity, geographic location, history of anxiety prior to pregnancy, having a chronic health condition, pre-pregnancy BMI, parity, and stage of pregnancy at study enrollment. Higher COVID-19 fear was associated with increased odds of depression, adjusted odds ratio (aOR) = 1.75, p < 0.001, 95% CI 1.66-1.85, and anxiety, aOR=2.04, p < 0.001, 95% CI 1.94-2.15). Furthermore, fear of COVID-19 was associated with a 192-gram reduction in infant birthweight, and a 6.1-day reduction in gestational age at birth. LIMITATIONS The sample has higher education compared to the Canadian population and cannot test causal effects. CONCLUSION This study suggests that sociodemographic, health, and obstetric factors may contribute to increased fear of COVID-19 and associated adverse psychological and pregnancy outcomes.
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Affiliation(s)
- G.F. Giesbrecht
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada,Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada,Department of Psychology, University of Calgary, Calgary, AB, Canada,Corresponding author at: Department of Paediatrics, University of Calgary, 2500 University Drive, NW, Calgary, AB, T2N 1N4
| | - L. Rojas
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada,Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
| | - S. Patel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - V. Kuret
- Department of Obstetrics & Gynecology, University of Calgary, AB, Canada
| | - A.L. MacKinnon
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada,Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - L. Tomfohr-Madsen
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada,Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada,Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - C. Lebel
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada,Department of Radiology, University of Calgary, Calgary, AB, Canada
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65
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Torres‐Torres J, Espino‐y‐Sosa S, Poon LC, Solis‐Paredes JM, Estrada‐Gutierrez G, Espejel‐Nuñez A, Juarez‐Reyes A, Etchegaray‐Solana A, Alfonso‐Guillen Y, Aguilar‐Andrade L, Hernández‐Pacheco JA, Villafan‐Bernal JR, Martinez‐Portilla RJ. Increased levels of soluble fms-like tyrosine kinase-1 are associated with adverse outcome in pregnant women with COVID-19. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:202-208. [PMID: 34664753 PMCID: PMC8661924 DOI: 10.1002/uog.24798] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 06/02/2023]
Abstract
OBJECTIVE In addition to the lungs, the placenta and the endothelium can be affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are markers of endothelial dysfunction and could potentially serve as predictors of severe coronavirus disease 2019 (COVID-19). We aimed to investigate the association of serum concentrations of sFlt-1 and PlGF with the severity of COVID-19 in pregnancy. METHODS This was a prospective cohort study carried out in a tertiary care hospital in Mexico City, Mexico. Symptomatic pregnant women with a positive reverse-transcription quantitative polymerase chain reaction test for SARS-CoV-2 infection who fulfilled the criteria for hospitalization were included. The primary outcome was severe pneumonia due to COVID-19. Secondary outcomes were intensive care unit (ICU) admission, viral sepsis and maternal death. sFlt-1 levels were expressed as multiples of the median (MoM). The association between sFlt-1 and each adverse outcome was explored by logistic regression analysis, adjusted for gestational age for outcomes occurring in more than five patients, and the predictive performance was assessed by receiver-operating-characteristics-curve analysis. RESULTS Among 113 pregnant women with COVID-19, higher sFlt-1 MoM was associated with an increased probability of severe pneumonia (adjusted odds ratio (aOR), 1.817 (95% CI, 1.365-2.418)), ICU admission (aOR, 2.195 (95% CI, 1.582-3.047)), viral sepsis (aOR, 2.318 (95% CI, 1.407-3.820)) and maternal death (unadjusted OR, 5.504 (95% CI, 1.079-28.076)). At a 10% false-positive rate, sFlt-1 MoM had detection rates of 45.2%, 66.7%, 83.3% and 100% for severe COVID-19 pneumonia, ICU admission, viral sepsis and maternal death, respectively. PlGF values were similar between women with severe and those with non-severe COVID-19 pneumonia. CONCLUSION sFlt-1 MoM is higher in pregnant women with severe COVID-19 and has the capability to predict serious adverse pregnancy events, such as severe pneumonia, ICU admission, viral sepsis and maternal death. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. Torres‐Torres
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
| | - S. Espino‐y‐Sosa
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
| | - L. C. Poon
- Chinese University of Hong KongHong Kong SAR
| | | | | | - A. Espejel‐Nuñez
- Immunobiochemistry DepartmentNational Institute of PerinatologyMexico CityMexico
| | - A. Juarez‐Reyes
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - A. Etchegaray‐Solana
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - Y. Alfonso‐Guillen
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - L. Aguilar‐Andrade
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
| | | | | | - R. J. Martinez‐Portilla
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
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66
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Khalil A, Samara A, Chowdhury T, O'Brien P. Does COVID-19 cause pre-eclampsia? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:146-152. [PMID: 34766403 PMCID: PMC8661727 DOI: 10.1002/uog.24809] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 06/02/2023]
Affiliation(s)
- A. Khalil
- Fetal Medicine Unit, St George's HospitalSt George's University of LondonLondonUK
- Vascular Biology Research CentreMolecular and Clinical Sciences Research Institute, St George's University of LondonLondonUK
- Fetal Medicine Unit, Liverpool Women's HospitalUniversity of LiverpoolLiverpoolUK
| | - A. Samara
- Division of Clinical Paediatrics, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Astrid Lindgren, Children's HospitalKarolinska University HospitalStockholmSweden
| | - T. Chowdhury
- Fetal Medicine Unit, St George's HospitalSt George's University of LondonLondonUK
| | - P. O'Brien
- University College London Hospitals NHS Foundation TrustLondonUK
- The Royal College of Obstetricians and GynaecologistsLondonUK
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67
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Maternal Death by COVID-19 Associated with Elevated Troponin T Levels. Viruses 2022; 14:v14020271. [PMID: 35215865 PMCID: PMC8878370 DOI: 10.3390/v14020271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023] Open
Abstract
Cardiomyocyte injury and troponin T elevation has been reported within COVID-19 patients and are associated with a worse prognosis. Limited data report this association among COVID-19 pregnant patients. Objective: We aimed to analyze the association between troponin T levels in severe COVID-19 pregnant women and risk of viral sepsis, intensive care unit (ICU) admission, or maternal death. Methods: We performed a prospective cohort of all obstetrics emergency admissions from a Mexican National Institute. All pregnant women diagnosed by reverse transcription-polymerase chain reaction (RT-qPCR) for SARS-CoV-2 infection between October 2020 and May 2021 were included. Clinical data were collected, and routine blood samples were obtained at hospital admission. Seric troponin T was measured at admission. Results: From 87 included patients, 31 (35.63%) had severe COVID-19 pneumonia, and 6 (6.89%) maternal deaths. ROC showed a significant relationship between troponin T and maternal death (AUC 0.979, CI 0.500–1.000). At a cutoff point of 7 ng/mL the detection rate for severe pneumonia was 83.3% (95%CI: 0.500–0.100) at 10% false-positive rate. Conclusion: COVID-19 pregnant women with elevated levels of troponin T present a higher risk of death and severe pneumonia.
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68
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Shoji K, Tsuzuki S, Akiyama T, Matsunaga N, Asai Y, Suzuki S, Iwamoto N, Funaki T, Yamada M, Ozawa N, Yamaguchi K, Miyairi I, Ohmagari N. Clinical characteristics and outcomes of COVID-19 in pregnant women: a propensity score matched analysis of the data from the COVID-19 Registry Japan. Clin Infect Dis 2022; 75:e397-e402. [PMID: 35037051 PMCID: PMC8807242 DOI: 10.1093/cid/ciac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background Several studies have investigated whether pregnancy is a risk factor for developing severe COVID-19; however, the results remain controversial. In addition, the information regarding risk factors for developing severe COVID-19 in pregnant women is limited. Methods A retrospective cohort study analyzing the data from the nationwide COVID-19 registry in Japan was conducted. Propensity score matched analysis was performed to compare COVID-19 severity between pregnant and nonpregnant women. Multivariate analysis was also conducted to evaluate risk factors for developing moderate-to-severe COVID-19 in pregnant women. Results During the study period, 254 pregnant and 3752 nonpregnant women of reproductive age were identified. After propensity score matching, 187 pregnant women and 935 nonpregnant women were selected. A composite outcome of moderate-to-severe COVID-19 was more frequently observed in pregnant women than that of nonpregnant women (n=18, 9.6% vs. n=46, 4.9%; P=0.0155). In multivariate analysis, the presence of underlying diseases and being in the second-to-third trimester of pregnancy were recognized as risk factors for moderate-to-severe COVID-19 in pregnant women (odds ratio [95% confidence interval]: 5.295 [1.21-23.069] and 3.871 [1.201-12.477], respectively). Conclusions Pregnancy could be a risk factor for moderate-to-severe COVID-19 for women in Japan. In addition to the presence of comorbidities, advanced pregnancy stages may contribute to greater risks for developing moderate-to-severe COVID-19 in pregnant women.
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Affiliation(s)
- Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takayuki Akiyama
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Setsuko Suzuki
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Iwamoto
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takanori Funaki
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Masaki Yamada
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.,Department for Advanced Medicine for Viral Infections, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Nobuaki Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koushi Yamaguchi
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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López-Briones H, Villalobos-Gómez R, Chávez-González E, Martínez-Rodríguez M, Helue-Mena A, Gámez-Varela A, Cruz-Martinez R. Twin-to-twin transfusion syndrome and coronavirus disease 2019: Impact on diagnosis, referral, eligibility for fetoscopic laser therapy and outcomes. AJOG GLOBAL REPORTS 2022; 2:100040. [PMID: 35039807 PMCID: PMC8755450 DOI: 10.1016/j.xagr.2021.100040] [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: 11/06/2022] Open
Abstract
BACKGROUND Because of the progressive nature of twin-to-twin transfusion syndrome, difficulties in healthcare access during the COVID-19 pandemic may lead to delayed diagnosis and referral to fetal surgery centers, which may have repercussions on outcomes. OBJECTIVE This study aimed to assess the clinical impact of the COVID-19 pandemic on pregnancies complicated with twin-to-twin transfusion syndrome. STUDY DESIGN A retrospective cohort study of consecutive monochorionic diamniotic twin pregnancies complicated with twin-to-twin transfusion syndrome evaluated in our national referral fetal surgery center at Queretaro, Mexico, for possible surgical fetoscopy was conducted. Maternal-fetal characteristics and perinatal outcomes of cases evaluated during the first year of the World Health Organization's COVID-19 pandemic declaration (March 11, 2020 to March 10, 2021) were retrospectively compared with outcomes of cases evaluated during the same period in the previous year (March 11, 2019 to March 10, 2020). RESULTS Overall, 109 consecutive twin-to-twin transfusion syndrome cases were evaluated during the 2-year study period, 54 during the COVID-19 pandemic and 55 in the previous year. In the former group, a higher proportion of cases with fetal surveillance interval longer than 2 weeks (70.4% vs 47.3%; P=.01); twin-to-twin transfusion syndrome complications precluding laser therapy, such as intrauterine fetal demise, preterm rupture of membranes, or cervical dilatation with prolapsed amniotic membranes (18.5% vs 1.8%; P<.01); advanced twin-to-twin transfusion syndrome (53.7% vs 36.4%; P=.07); preoperative short cervix (25.9% vs 10.9%; P<.05); and lower overall perinatal survival (56.9% vs 80.0% [P=.01; at least 1 twin] and 39.2% vs 56.4% [P=.08; both twins], respectively) were observed. A significantly lower number of cases were selected for fetoscopic laser therapy during the pandemic (75.9% vs 92.7%; P=.01), with similar postoperative outcomes seen in both study periods. CONCLUSION In pregnancies with twin-to-twin transfusion syndrome, the COVID-19 pandemic has shown an adverse impact involving suboptimal fetal surveillance, advanced stages at diagnosis, poorer survival rates, and higher number of complications that preclude fetoscopic laser therapy.
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Affiliation(s)
- Hugo López-Briones
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)
| | - Rosa Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)
| | - Eréndira Chávez-González
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)
| | - Miguel Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)
| | - Antonio Helue-Mena
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)
| | - Alma Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)
| | - Rogelio Cruz-Martinez
- Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)
- Instituto de Ciencias de Salud, Universidad Autónoma del Estado de Hidalgo, Hidalgo, México (Dr Cruz-Martinez)
- Corresponding author: Rogelio Cruz-Martinez, MD, PhD
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70
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Shen CJ, Fu YC, Lin YP, Shen CF, Sun DJ, Chen HY, Cheng CM. Evaluation of Transplacental Antibody Transfer in SARS-CoV-2-Immunized Pregnant Women. Vaccines (Basel) 2022; 10:101. [PMID: 35062762 PMCID: PMC8778956 DOI: 10.3390/vaccines10010101] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy could result in adverse perinatal outcome. Clinical data on the assessment of the immune response in vaccinated pregnant women and subsequent transplacental antibody transfer are quite limited. OBJECTIVE To assess maternal and neonatal neutralizing antibody levels against both wildtype and Delta (B.1.617.2) variants after maternal mRNA vaccination. STUDY DESIGN This cohort study was conducted 29 pregnant women who were vaccinated at least one dose of Moderna (mRNA-1273) vaccine. Both neutralizing antibody (wildtype and Delta variant) and S1 receptor binding domain IgG antibody levels were evaluated in maternal and cord blood on the day of delivery. RESULTS Superiority of antibody level was significant in fully vaccinated women compared with the one-dose group (maternal sera, median, 97.46%; cord sera, median, 97.37% versus maternal sera, median, 4.01%; cord sera, median, 1.44%). No difference in antibody level was noted in relation to interval of second immunization to delivery in the two-dose group (95.99% in 0-2 weeks, 97.45% in 2-4 weeks, 97.48% in 4-8 weeks, 97.72% in 8-10 weeks). The most pronounced reduction was observed for the Delta variant. The wildtype neutralizing antibody level of full-vaccinated women was not influenced by the pertussis vaccination. CONCLUSION The data underscore the importance of full vaccination in pregnancy and support the recommendation of COVID-19 immunization for pregnant women. The lower level of vaccine-induced neutralizing antibodies for the Delta variant indicates insufficient protection for mother and newborn and highlights the need for development of effective vaccine strategies.
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Affiliation(s)
- Ching-Ju Shen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Chen Fu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Yen-Pin Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Der-Ji Sun
- Department of Obstetrics and Gynecology, Pojen Hospital, Kaohsiung 804, Taiwan;
| | - Huan-Yun Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
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Torres‐Torres J, Martinez‐Portilla RJ, Espino‐y‐Sosa S, Estrada‐Gutierrez G, Solis‐Paredes JM, Villafan‐Bernal JR, Medina‐Jimenez V, Rodriguez‐Morales AJ, Rojas‐Zepeda L, Poon LC. Comorbidity, poverty and social vulnerability as risk factors for mortality in pregnant women with confirmed SARS-CoV-2 infection: analysis of 13 062 positive pregnancies including 176 maternal deaths in Mexico. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:76-82. [PMID: 34672382 PMCID: PMC8662032 DOI: 10.1002/uog.24797] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Mortality in pregnancy due to coronavirus disease 2019 (COVID-19) is a current health priority in developing countries. Identification of clinical and sociodemographic risk factors related to mortality in pregnant women with COVID-19 could guide public policy and encourage such women to accept vaccination. We aimed to evaluate the association of comorbidities and socioeconomic determinants with COVID-19-related mortality and severe disease in pregnant women in Mexico. METHODS This is an ongoing nationwide prospective cohort study that includes all pregnant women with a positive reverse-transcription quantitative polymerase chain reaction result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the Mexican National Registry of Coronavirus. The primary outcome was maternal death due to COVID-19. The association of comorbidities and socioeconomic characteristics with maternal death was explored using a log-binomial regression model adjusted for possible confounders. RESULTS There were 176 (1.35%) maternal deaths due to COVID-19 among 13 062 consecutive SARS-CoV-2-positive pregnant women. Maternal age, as a continuous (adjusted relative risk (aRR), 1.08 (95% CI, 1.05-1.10)) or categorical variable, was associated with maternal death due to COVID-19; women aged 35-39 years (aRR, 3.16 (95% CI, 2.34-4.26)) or 40 years or older (aRR, 4.07 (95% CI, 2.65-6.25)) had a higher risk for mortality, as compared with those aged < 35 years. Other clinical risk factors associated with maternal mortality were pre-existing diabetes (aRR, 2.66 (95% CI, 1.65-4.27)), chronic hypertension (aRR, 1.75 (95% CI, 1.02-3.00)) and obesity (aRR, 2.15 (95% CI, 1.46-3.17)). Very high social vulnerability (aRR, 1.88 (95% CI, 1.26-2.80)) and high social vulnerability (aRR, 1.49 (95% CI, 1.04-2.13)) were associated with an increased risk of maternal mortality, while very low social vulnerability was associated with a reduced risk (aRR, 0.47 (95% CI, 0.30-0.73)). Being poor or extremely poor were also risk factors for maternal mortality (aRR, 1.53 (95% CI, 1.09-2.15) and aRR, 1.83 (95% CI, 1.32-2.53), respectively). CONCLUSION This study, which comprises the largest prospective consecutive cohort of pregnant women with COVID-19 to date, has confirmed that advanced maternal age, pre-existing diabetes, chronic hypertension, obesity, high social vulnerability and low socioeconomic status are risk factors for COVID-19-related maternal mortality. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. Torres‐Torres
- Maternal–Fetal Medicine DepartmentGeneral Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical CenterMedical AssociationMexico CityMexico
| | - R. J. Martinez‐Portilla
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical CenterMedical AssociationMexico CityMexico
| | - S. Espino‐y‐Sosa
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical CenterMedical AssociationMexico CityMexico
| | | | | | | | | | - A. J. Rodriguez‐Morales
- Clinical Epidemiology and BiostatisticsUniversidad Científica del Sur, Lima, Peru
- Grupo de Investigación BiomedicinaFaculty of Medicine, Fundación Universitaria Autónoma de las Américas, PereiraRisaraldaColombia
| | - L. Rojas‐Zepeda
- Instituto Materno Infantil del Estado de MéxicoToluca, Mexico
| | - L. C. Poon
- Department of Obstetrics and GynaecologyPrince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
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Glynn SM, Yang YJ, Thomas C, Friedlander RL, Cagino KA, Matthews KC, Riley LE, Baergen RN, Prabhu M. SARS-CoV-2 and Placental Pathology: Malperfusion Patterns Are Dependent on Timing of Infection During Pregnancy. Am J Surg Pathol 2022; 46:51-57. [PMID: 34310367 PMCID: PMC8662940 DOI: 10.1097/pas.0000000000001772] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at different points in the pregnancy timeline may affect maternal and fetal outcomes remains unknown. We sought to characterize the impact of SARS-CoV-2 infection proximate and remote from delivery on placental pathology. We performed a secondary analysis of placental pathology from a prospective cohort of universally tested SARS-CoV-2 positive women >20 weeks gestation at 1 institution. Subjects were categorized as having acute or nonacute SARS-CoV-2 based on infection <14 or ≥14 days from delivery admission, respectively, determined by nasopharyngeal swab, symptom history, and serologies, when available. A subset of SARS-CoV-2 negative women represented negative controls. Placental pathology was available for 90/97 (92.8%) of SARS-CoV-2 positive women, of which 26 were from women with acute SARS-CoV-2 infection and 64 were from women with nonacute SARS-CoV-2. Fetal vascular malperfusion lesions were significantly more frequent among the acute SARS-CoV-2 group compared with the nonacute SARS-CoV-2 group (53.8% vs. 18.8%; P=0.002), while frequency of maternal vascular malperfusion lesions did not differ by timing of infection (30.8% vs. 29.7%; P>0.99). When including 188 SARS-CoV-2 negative placentas, significant differences in frequency of fetal vascular malperfusion lesions remained between acute, nonacute and control cases (53.8% vs. 18.8% vs. 13.2%, respectively; P<0.001). No differences were noted in obstetric or neonatal outcomes between acutely and nonacutely infected women. Our findings indicate timing of infection in relation to delivery may alter placental pathology, with potential clinical implications for risk of thromboembolic events and impact on fetal health.
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Affiliation(s)
| | - Yawei J. Yang
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine
| | | | | | | | | | - Laura E. Riley
- Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine
| | - Malavika Prabhu
- Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
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Baptista FS, Paganoti CF, Gomez UT, Peres SV, Malbouisson LM, Brizot MDL, Francisco RPV. Risk factors for oxygen requirement in hospitalized pregnant and postpartum women with COVID-19. Clinics (Sao Paulo) 2022; 77:100072. [PMID: 35767901 PMCID: PMC9212857 DOI: 10.1016/j.clinsp.2022.100072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/23/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify risk factors for Oxygen (O2) needs in pregnant and postpartum women with COVID-19. METHODS Prospective cohort involving pregnant women hospitalized with COVID-19 from April to October 2020. The oxygen need was analyzed regarding risk factors: demographic characteristics, clinical and laboratory parameters at hospital admission, and chest Computer Tomography (CT) findings. Poisson univariate analysis was used to estimate the Relative Risk (RR) and 95% Confidence Intervals. RESULTS 145 patients, 80 who used and 65 who did not use O2, were included. Body mass index ≥ 30, smoking, and chronic hypertension increased the risk of O2 need by 1.86 (95% CI 1.10-3.21), 1.57 (95% CI 1.16‒2.12), and 1.46 (95% CI 1.09‒1.95), respectively. Patients who were hospitalized for COVID-19 and for obstetric reasons had 8.24 (95% CI 2.8‒24.29) and 3.44 (95% CI 1.05‒11.31) times more use of O2 than those admitted for childbirth and abortion. Respiratory rate ≥ 24 breaths/min and O2 saturation < 95% presented RR for O2 requirements of 2.55 (1.82‒3.56) and 1.68 (95% CI 1.27-2.20), respectively. Ground Glass (GG) < 50% and with GG ≥ 50%, the risk of O2 use were respectively 3.41-fold and 5.33-fold higher than in patients who haven't viral pneumonia on CT. The combination of C-reactive protein ≥ 21 mg/L, hemoglobin < 11.0 g/dL, and lymphopenia < 1500 mm3 on hospital admission increased the risk of O2 use by 4.97-times. CONCLUSIONS In obstetric patients, clinical history, laboratory, clinical and radiological parameters at admission were identified as a risk for O2 need, selecting the population with the greatest chance of worsening.
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Affiliation(s)
- Fernanda Spadotto Baptista
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Cristiane Freitas Paganoti
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ursula Trovato Gomez
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Stela Verzinhasse Peres
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Marcelo Malbouisson
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Maria de Lourdes Brizot
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Conde-Agudelo A, Romero R. SARS-CoV-2 infection during pregnancy and risk of preeclampsia: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 226:68-89.e3. [PMID: 34302772 PMCID: PMC8294655 DOI: 10.1016/j.ajog.2021.07.009] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the relationship between SARS-CoV-2 infection during pregnancy and the risk for preeclampsia. DATA SOURCES MEDLINE, Embase, POPLINE, CINAHL, LILACS, and the World Health Organization COVID-19, Chinese, and preprint databases (all from December 1, 2019, to May 31, 2021). Google Scholar, bibliographies, and conference proceedings were also searched. STUDY ELIGIBILITY CRITERIA Observational studies that assessed the association between SARS-CoV-2 infection during pregnancy and preeclampsia and that reported unadjusted and/or adjusted risk estimates and 95% confidence intervals or data to calculate them. STUDY APPRAISAL AND SYNTHESIS METHODS The primary outcome was preeclampsia. Secondary outcomes included preeclampsia with severe features, preeclampsia without severe features, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Two reviewers independently reviewed studies for inclusion, assessed their risk of bias, and extracted data. Pooled unadjusted and adjusted odds ratios with 95% confidence intervals, and 95% prediction interval were calculated. Heterogeneity was quantified using the І2 statistic, for which І2≥30% indicated substantial heterogeneity. Subgroup and sensitivity analyses were performed to test the robustness of the overall findings. RESULTS A total of 28 studies comprising 790,954 pregnant women, among which 15,524 were diagnosed with SARS-CoV-2 infection, met the inclusion criteria. The meta-analysis of unadjusted odds ratios showed that the odds of developing preeclampsia were significantly higher among pregnant women with SARS-CoV-2 infection than among those without SARS-CoV-2 infection (7.0% vs 4.8%; pooled odds ratio, 1.62; 95% confidence interval, 1.45-1.82; P<.00001; І2=17%; 26 studies; 95% prediction interval of the odds ratio, 1.28-2.05). The meta-analysis of adjusted odds ratios also showed that SARS-CoV-2 infection during pregnancy was associated with a significant increase in the odds of preeclampsia (pooled odds ratio, 1.58; 95% confidence interval, 1.39-1.80; P<.0001; І2=0%; 11 studies). There was a statistically significant increase in the odds of preeclampsia with severe features (odds ratio, 1.76; 95% confidence interval, 1.18-2.63; І2=58%; 7 studies), eclampsia (odds ratio, 1.97; 95% confidence interval, 1.01-3.84; І2=0%, 3 studies), and HELLP syndrome (odds ratio, 2.10; 95% confidence interval, 1.48-2.97; 1 study) among pregnant women with SARS-CoV-2 infection when compared to those without the infection. Overall, the direction and magnitude of the effect of SARS-CoV-2 infection during pregnancy on preeclampsia was consistent across most prespecified subgroup and sensitivity analyses. Both asymptomatic and symptomatic SARS-CoV-2 infections significantly increased the odds of developing preeclampsial; however, it was higher among patients with symptomatic illness (odds ratio, 2.11; 95% confidence interval, 1.59-2.81) than among those with asymptomatic illness (odds ratio, 1.59; 95% confidence interval, 1.21-2.10). CONCLUSION SARS-CoV-2 during pregnancy is associated with higher odds of preeclampsia.
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Affiliation(s)
- Agustin Conde-Agudelo
- 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, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - 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, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI; Department of Obstetrics and Gynecology, Florida International University, Miami, FL.
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Kassis NE, Abdallah W, Chakra RA, Arab W, Sassine S, Atallah D. COVID-19 mRNA vaccine in pregnancy and newborn passive immunization: a case report. Future Sci OA 2022; 8:FSO761. [PMID: 34900336 PMCID: PMC8559592 DOI: 10.2144/fsoa-2021-0043] [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: 03/31/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
AIM Evaluating the newborn passive immunization after maternal vaccination against SARS-COV-2. CASE PRESENTATION We present the case of a pregnant woman, with no prior history of COVID-19 infection, who got her second dose of mRNA vaccine against SARS-COV-2, 3 days before the start of her spontaneous labor. She was delivered by cesarean section after dynamical dystocia. Placental cord blood was retrieved immediately and sent to evaluate the titers of COVID-19 antibodies. Vaccine-generated antibodies were present in the umbilical cord with IgG spike >100 AU/ml. CONCLUSION By reviewing the literature, vaccination seems to give hope about the potential protective effect of the maternal vaccination on her baby. Thus, pregnant women deserve a priority in the COVID-19 vaccination program.
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Affiliation(s)
- Nadine El Kassis
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, 116-5137, Lebanon
| | - Wael Abdallah
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, 116-5137, Lebanon
| | - Rim Abou Chakra
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, 116-5137, Lebanon
| | - Wissam Arab
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, 116-5137, Lebanon
| | - Serge Sassine
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, 116-5137, Lebanon
| | - David Atallah
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, 116-5137, Lebanon
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Kantarcioglu B, Iqbal O, Lewis J, Carter CA, Singh M, Lievano F, Ligocki M, Jeske W, Adiguzel C, Gerotziafas GT, Fareed J. An Update on the Status of Vaccine Development for SARS-CoV-2 Including Variants. Practical Considerations for COVID-19 Special Populations. Clin Appl Thromb Hemost 2022; 28:10760296211056648. [PMID: 35167393 PMCID: PMC8851053 DOI: 10.1177/10760296211056648] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/25/2021] [Accepted: 10/13/2021] [Indexed: 01/09/2023] Open
Abstract
The progress in the development of various vaccine platforms against SARS-CoV-2 have been rather remarkable owing to advancement in molecular and biologic sciences. Most of the current vaccines and those in development focus on targeting the viral spike proteins by generating antibodies of varying spectrum. These vaccines represent a variety of platforms including whole virus vaccines, viral vector vaccines, nucleic acid vaccines representing RNA, DNA, and their hybrid forms.The therapeutic efficacy of these vaccines varies owing to their pharmacodynamic individualities. COVID-19 variants are capable of inducing different pathologic responses and some of which may be resistant to antibodies generated by current vaccines. The current clinical use of these vaccines has been through emergency use authorization until recently. Moreover, the efficacy and safety of these vaccines have been tested in substantial numbers of individuals but studies in special populations that better reflect the global population are pending results. These specialized populations include young children, immunocompromised patients, pregnant individuals, and other specialized groups. Combination approaches, molecularly modified vaccination approaches, and vaccines conferring longer periods of immunity are being currently being investigated, as well as pharmacovigilance studies.The continual transformation of SARS-CoV-2 and its variants are of concern along with the breakthrough infections. These considerations pose new challenges for the development of vaccination platforms. For this purpose, booster doses, combination vaccine approaches, and other modalities are being discussed. This review provides an updated account of currently available vaccines and those in advanced development with reference to their composition and mechanisms of action.A discussion on the use of vaccines in special populations including immunocompromised patients, pregnant women and other specialized populations are also included.
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Affiliation(s)
- Bulent Kantarcioglu
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Omer Iqbal
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Joseph Lewis
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Charles A. Carter
- Campbell University College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA
| | - Meharvan Singh
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | | | | | - Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | | | - Grigoris T. Gerotziafas
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Thrombosis Center, Service D’Hématologie Biologique Hôpital Tenon, Paris, France
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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Kim SH, Choi Y, Lee D, Lee H, Kim JH, Choi ES, Jung YM, Lee J, Choe PG, Lee JY, Do Y, Park CW, Park JS, Jun JK, Lee SM, Lee JY. Impact of COVID-19 on pregnant women in South Korea: focusing on prevalence, severity, and clinical outcomes. J Infect Public Health 2022; 15:270-276. [PMID: 35066387 PMCID: PMC8761582 DOI: 10.1016/j.jiph.2022.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 02/09/2023] Open
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Gonçalves BMM, Franco RPV, Rodrigues AS. Maternal mortality associated with COVID-19 in Brazil in 2020 and 2021: Comparison with non-pregnant women and men. PLoS One 2021; 16:e0261492. [PMID: 34932589 PMCID: PMC8691656 DOI: 10.1371/journal.pone.0261492] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Mortality rates of pregnant and postpartum women grew in the second COVID-19 pandemic year. Our objective is to understand this phenomenon to avoid further deaths. METHODS We collected data from SIVEP-Gripe, a nationwide Brazilian database containing surveillance data on all severe acute respiratory syndrome caused by COVID-19, between the first notified case (February 2020) until the 17th epidemiological week of 2021. We stratified patients into maternal women (which includes pregnant and postpartum women), non-maternal women and men and divided them by time of diagnosis in two periods: first period (February to December 2020) and second period (the first 17 epidemiological weeks of 2021 before pregnant and postpartum women were vaccinated). RESULTS During the second period, all patients had higher risk of presenting severe COVID-19 cases, but the maternal population was at a higher risk of death (OR of 2.60 CI 95%: 2.28-2.97)-almost double the risk of the two other groups. Maternal women also had a higher risk of needing intensive care, intubation and of presenting desaturation in the second period. Importantly, maternal women presented fewer comorbidities than other patient groups, suggesting that pregnancy and postpartum can be an important risk factor associated with severe COVID-19. CONCLUSION Our results suggest that the Gama variant, which has been related to greater virulence, transmissibility and mortality rates leads to more severe cases of COVID-19 for pregnant and postpartum women.
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Affiliation(s)
- Beatriz Martinelli Menezes Gonçalves
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brasil
| | - Rossana Pulcinelli V. Franco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brasil
| | - Agatha S. Rodrigues
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brasil
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Willis M, Dunn L, Okano S, Janssens S, Kumar S. The impact on obstetric and perinatal outcomes in term infants following the introduction of a colour-coded, hierarchical cardiotocography classification system: A retrospective non-inferiority study. Aust N Z J Obstet Gynaecol 2021; 62:370-375. [PMID: 34921390 DOI: 10.1111/ajo.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Queensland introduced a colour-coded cardiotocograph (CTG) classification system (green, blue, yellow and red) to complement the Royal Australian and New Zealand College of Obstetricians and Gynaecologists prose-based classification system of 'low, unlikely, maybe or likely' fetal compromise. AIMS The aim of the study was to determine the clinical impact of the introduction of the colour-coded CTG classification system compared to the prose-based system. We hypothesised there would be no change in the rate of operative delivery for intrapartum fetal compromise (OD-IFC). MATERIALS AND METHODS This retrospective non-inferiority study from November 2014 to May 2018 used routinely collected data from the Mater Mother's Hospital. Non-insured women with a singleton, non-anomalous, cephalic fetus at term, attempting a vaginal birth with continuous intrapartum CTG were included. The primary outcome was OD-IFC. Secondary outcomes included various obstetric and perinatal outcomes. Non-inferiority analysis was performed with a pre-specified non-inferiority margin of 2% risk difference. RESULTS Eleven thousand seven hundred and twenty-seven participants were included. The OD-IFC rate was similar across the study groups (prose-based 15.1% vs colour-coded 15.3%, adjusted odds ratio (aOR) 1.02, 95% CI 0.93-1.13) with the adjusted risk difference of 0.29% (95% CI -0.98 to 1.56), which did not exceed the inferiority margin. There were more spontaneous (aOR 1.11, 95% CI 1.04-1.19) and fewer instrumental (aOR 0.87, 95% CI 0.80-0.95) vaginal births in the colour-coded cohort. There were no differences in neonatal outcomes. CONCLUSIONS Reassuringly, the colour-coded CTG classification system was non-inferior to the prose-based system, did not influence OD-IFC but was associated with more spontaneous vaginal deliveries.
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Affiliation(s)
- Meg Willis
- Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Liam Dunn
- Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Satomi Okano
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sarah Janssens
- Mater Mother's Hospital, Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Mater Mother's Hospital, Brisbane, Queensland, Australia
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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 (Long Version)]. Z Geburtshilfe Neonatol 2021; 226:e1-e35. [PMID: 34918334 DOI: 10.1055/a-1688-9398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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 given birth, 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 long 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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81
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Prahl M, Golan Y, Cassidy AG, Matsui Y, Li L, Alvarenga B, Chen H, Jigmeddagva U, Lin CY, Gonzalez VJ, Chidboy MA, Warrier L, Buarpung S, Murtha AP, Flaherman VJ, Greene WC, Wu AHB, Lynch KL, Rajan J, Gaw SL. Evaluation of transplacental transfer of mRNA vaccine products and functional antibodies during pregnancy and early infancy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 34931197 DOI: 10.1101/2021.12.09.21267423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Studies are needed to evaluate the safety and effectiveness of mRNA SARS-CoV-2 vaccination during pregnancy, and the levels of protection provided to their newborns through placental transfer of antibodies. We evaluated the transplacental transfer of mRNA vaccine products and functional anti-SARS-CoV-2 antibodies during pregnancy and early infancy in a cohort of 20 individuals vaccinated during pregnancy. We found no evidence of mRNA vaccine products in maternal blood, placenta tissue, or cord blood at delivery. However, we found time-dependent efficient transfer of IgG and neutralizing antibodies to the neonate that persisted during early infancy. Additionally, using phage immunoprecipitation sequencing, we found a vaccine-specific signature of SARS-CoV-2 Spike protein epitope binding that is transplacentally transferred during pregnancy. In conclusion, products of mRNA vaccines are not transferred to the fetus during pregnancy, however timing of vaccination during pregnancy is critical to ensure transplacental transfer of protective antibodies during early infancy.
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82
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Leung C, de Paiva KM. Is pregnancy a risk factor for in-hospital mortality in reproductive-aged women with SARS-CoV-2 infection? A nationwide retrospective observational cohort study. Int J Gynaecol Obstet 2021; 157:121-129. [PMID: 34888871 PMCID: PMC9087772 DOI: 10.1002/ijgo.14066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/16/2021] [Accepted: 12/08/2021] [Indexed: 01/21/2023]
Abstract
Objective To examine the effect of pregnancy on coronavirus disease 2019 (COVID‐19) ‐related in‐hospital mortality in women of reproductive age (between 15 and 45 years), with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection confirmed with polymerase chain reaction tests, adjusted for factors such as co‐infection and intervention that were not considered in existing literature. Methods Data gathered from a nationwide database in Brazil were analyzed using multivariate logistic regression and multivariate Cox regression. Adjusted odds ratios and hazard ratios of independent factors associated with in‐hospital death were calculated. Results A total of 97 712 women were included in the study. After the adjustment for sociodemographic factors, epidemiologic characteristics, pre‐existing medical conditions, and intervention, pregnant women were found to be associated with lower risk for in‐hospital mortality as well as longer survival time compared with non‐pregnant women. When covariates of intervention were omitted from the analysis, pregnancy did not appear to be a significant factor associated with mortality. Conclusion With the adjustment for intervention that was shown to be an independent factor associated with mortality, pregnancy appeared to have a favorable effect on SARS‐CoV‐2 infection. Given the immunosuppressed state of pregnancy, this finding is in line with the hypothetical protective role of a weaker immune response that inhibits the production of proinflammatory cytokine.
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Affiliation(s)
- Char Leung
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Deakin University, Burwood, Victoria, Australia
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83
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Prefumo F. In-Hospital Mortality in a Cohort of Hospitalized Pregnant and Nonpregnant Patients With COVID-19. Ann Intern Med 2021; 174:1779. [PMID: 34929125 DOI: 10.7326/l21-0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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84
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Plasma Lipidomic and Metabolomic Profiling after Birth in Neonates Born to SARS-CoV-19 Infected and Non-Infected Mothers at Delivery: Preliminary Results. Metabolites 2021; 11:metabo11120830. [PMID: 34940588 PMCID: PMC8706054 DOI: 10.3390/metabo11120830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 01/31/2023] Open
Abstract
Pregnant women are among the high-risk populations for COVID-19, whereas the risk of vertical transmission to the fetus is very low. Nevertheless, metabolic alternations described in COVID-19 patients may also occur in pregnant women and their offspring. We prospectively evaluated the plasma lipidomic and metabolomic profiles, soon after birth, in neonates born to infected mothers (cases, n = 10) and in the offspring of uninfected ones at delivery (controls, n = 10). All cases had two negative tests for SARS-CoV-2 (nasopharyngeal swabs) performed 72 h apart. Blood samples were obtained within the first hours after birth. Liquid chromatography-high resolution mass spectrometry (UHPLC-TOF/MS) and gas chromatography-mass spectrometry (GC-MS) were applied for the analyses. Multivariate statistical analysis was performed for data evaluation. Changes in several plasma lipid species-classes (long-chain fatty acids phosphatidylcholines, triglycerides), and amino-acids were identified that allowed for clear discrimination between the study groups. The results of this preliminary investigation suggest that neonates born to Sars-Cov-19 positive mothers, without evidence of viral infection at birth, have a distinct plasma lipidomic and metabolomic profile compared to those of uninfected mothers. Whether these findings are reflective of maternal metabolic alternations due to the virus or a metabolic response following an unidentified neonatal infection warrants further investigation.
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85
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Januszewski M, Ziuzia-Januszewska L, Jakimiuk AA, Wierzba W, Głuszko A, Żytyńska-Daniluk J, Jakimiuk AJ. Is the Course of COVID-19 Different during Pregnancy? A Retrospective Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12011. [PMID: 34831766 PMCID: PMC8620897 DOI: 10.3390/ijerph182212011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic has challenged health systems around the world. Maternal-foetal medicine, which has been particularly affected, must consider scientific data on the physiological processes occurring in the pregnant woman's body to develop relevant standards of care. Our study retrospectively compared the clinical and laboratory characteristics of 52 COVID-19 pregnant patients with 53 controls. Most of the pregnant patients required medical attention during the third trimester and therefore we propose that vaccination is needed prior to the 30th week of pregnancy. We found no differences between the 2 groups in the course of illness classification system, days of hospital stay, need for oxygen supplementation, need for mechanical ventilation, and ICU admission. Moreover, clinical manifestations and imaging findings were comparable. Pregnant patients needed a greater oxygen flow rate and required high flow oxygen therapy more frequently. Considering pregnancy-related physiological adaptations, we found that COVID-19 infection in pregnant patients is associated with higher levels of inflammatory markers, apart from serum ferritin, than in non-pregnant women, and concluded that biomarkers of cardiac and muscle injury, as well as kidney function, may not be good predictors of COVID-19 clinical course in pregnant patients at the time of admission, but more research needs to be conducted on this topic.
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Affiliation(s)
- Marcin Januszewski
- Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.J.); (W.W.)
| | - Laura Ziuzia-Januszewska
- Department of Otolaryngology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland;
| | - Alicja A. Jakimiuk
- Department of Plastic Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland;
| | - Waldemar Wierzba
- Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.J.); (W.W.)
- Satellite Campus in Warsaw, University of Humanities and Economics, 01-513 Warsaw, Poland
| | - Anna Głuszko
- Department of Neonatology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (A.G.); (J.Ż.-D.)
| | - Joanna Żytyńska-Daniluk
- Department of Neonatology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (A.G.); (J.Ż.-D.)
| | - Artur J. Jakimiuk
- Department of Obstetrics and Gynecology, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (M.J.); (W.W.)
- Center for Reproductive Health, Institute of Mother and Child, 01-211 Warsaw, Poland
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86
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Serra FE, Francisco RPV, de Rossi P, de Lourdes Brizot M, Rodrigues AS. COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women. PLoS One 2021; 16:e0259911. [PMID: 34780549 PMCID: PMC8592461 DOI: 10.1371/journal.pone.0259911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data. METHODS A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU. RESULTS As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p<0.0001). Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other (72.1%, 69.7% and 88.8%, respectively). Pregnant women, however, had a higher frequency of anosmia, and ageusia than the others. After PSM, puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death, with OR (95% CI) 1.97 (1.55 - 2.50), 2.71 (1.78 - 4.13), and 2.51 (1.79 - 3.52), respectively. CONCLUSION Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.
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Affiliation(s)
- Fabiano Elisei Serra
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Patricia de Rossi
- Curso de Medicina, Universidade de Santo Amaro (UNISA), São Paulo, São Paulo, Brazil
- Gerência de Medicina Perinatal e Ginecologia, Conjunto Hospitalar do Mandaqui, São Paulo, São Paulo, Brazil
| | - Maria de Lourdes Brizot
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Agatha Sacramento Rodrigues
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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Duarte G, Coutinho CM, Rolnik DL, Quintana SM, Rabelo e Silva AC, Poon LC, Costa FDS. Perspectives on administration of COVID-19 vaccine to pregnant and lactating women: a challenge for low- and middle-income countries. AJOG GLOBAL REPORTS 2021; 1:100020. [PMID: 34494014 PMCID: PMC8413092 DOI: 10.1016/j.xagr.2021.100020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Women who are in the pregnancy-puerperal cycle or are lactating have been deliberately excluded from participating in COVID-19 vaccine clinical trials that aimed to evaluate either the efficacy of the vaccines in inducing the formation of neutralizing antibodies or the investigational products' safety profile. The exclusion of pregnant and lactating women from such studies certainly and inequitably denies these women access to COVID-19 vaccines, since these products have become increasingly available to nonpregnant people and even to those who are pregnant and are in high-income settings. In this clinical opinion article, we discuss some aspects of the prolonged pandemic, the emergence of viral variants, the risks of severe complications of COVID-19 in pregnant women, and the disproportionate impact of the above on low- and middle-income countries. We argue that the decision to receive the COVID-19 vaccine should be a joint decision between the pregnant or lactating women and the healthcare providers, while considering the available data on vaccine efficacy, safety, the risks of SARS-CoV-2 infection in pregnant women, and the women's individual risks for infection and serious illness. The various types of vaccines that are already in use and their safety, effectiveness, and the potential risks and benefits of their administration to pregnant or lactating women are also reviewed.
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Affiliation(s)
- Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil (Drs Duarte, Coutinho, and Quintana and Ms Silva)
| | - Conrado Milani Coutinho
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil (Drs Duarte, Coutinho, and Quintana and Ms Silva)
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia (Dr Rolnik)
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil (Drs Duarte, Coutinho, and Quintana and Ms Silva)
| | - Ana Cláudia Rabelo e Silva
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil (Drs Duarte, Coutinho, and Quintana and Ms Silva)
| | - Liona C. Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China (Dr Poon)
| | - Fabrício da Silva Costa
- Maternal-Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia (Dr Costa)
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Radoi V, Pop LG, Bacalbasa N, Panaitescu AM, Ciobanu AM, Cretoiu D, Toader OD. Fatal Association of Mirror and Eisenmenger Syndrome during the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1031. [PMID: 34684068 PMCID: PMC8537604 DOI: 10.3390/medicina57101031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
Mirror syndrome (MS) or Ballantyne's syndrome is a rare maternal condition that can be life-threatening for both mother and fetus. The condition is characterized by maternal signs and symptoms similar to those seen in preeclampsia in the setting of fetal hydrops. Despite recent advances in the field of maternal-fetal medicine, the etiopathogenesis of MS remains elusive. For patients and doctors, the COVID-19 pandemic has become an extra hurdle to overcome. The following case illustrates how patients' non-compliance associated with mirror syndrome and SARS-CoV-2 infection led to the tragic end of a 19-year-old patient. Therefore, knowledge of the signs and symptoms of mirror syndrome should always be part of the armamentarium of every obstetrician.
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Affiliation(s)
- Viorica Radoi
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania; (V.R.); (D.C.); (O.D.T.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (A.M.P.); (A.M.C.)
| | - Lucian Gheorghe Pop
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania; (V.R.); (D.C.); (O.D.T.)
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (A.M.P.); (A.M.C.)
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (A.M.P.); (A.M.C.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Anca Marina Ciobanu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (A.M.P.); (A.M.C.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Dragos Cretoiu
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania; (V.R.); (D.C.); (O.D.T.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (A.M.P.); (A.M.C.)
| | - Oana Daniela Toader
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania; (V.R.); (D.C.); (O.D.T.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (A.M.P.); (A.M.C.)
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89
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Mitochondrial and Oxidative Unbalance in Placentas from Mothers with SARS-CoV-2 Infection. Antioxidants (Basel) 2021; 10:antiox10101517. [PMID: 34679654 PMCID: PMC8533135 DOI: 10.3390/antiox10101517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
SARS-CoV-2 infection has been related to adverse pregnancy outcomes. A placental role in protecting the fetus from SARS-CoV-2 infection has been documented. Nevertheless, it is still unclear how the placenta is affected in SARS-CoV-2 infection. Here we assessed placental mitochondrial (mt) and oxidative features in COVID-19 and healthy mothers. mtDNA levels, DNA oxidative damage, expression levels of genes involved in antioxidant defenses, mitochondrial dynamics and respiratory chain subunits were investigated in placentas from singleton pregnancies of 30 women with SARS-CoV-2 infection during the third trimester (12 asymptomatic, 18 symptomatic) and 16 controls. mtDNA levels decreased in COVID-19 placentas vs. controls and inversely correlated with DNA oxidative damage, which increased in the symptomatic group. Antioxidant gene expressions decreased in SARS-CoV-2 mothers (CAT, GSS). Symptomatic cases also showed a lower expression of respiratory chain (NDUFA9, SDHA, COX4I1) and mt dynamics (DNM1L, FIS1) genes. Alterations in placental mitochondrial features and oxidative balance in COVID-19-affected mothers might be due to the impaired intrauterine environment, generated by systemic viral effects, leading to a negative vicious circle that worsens placental oxidative stress and mitochondrial efficiency. This likely causes cell homeostasis dysregulations, raising the potential of possible long-term effects.
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90
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Espino-y-Sosa S, Martinez-Portilla RJ, Torres-Torres J, Solis-Paredes JM, Estrada-Gutierrez G, Hernandez-Pacheco JA, Espejel-Nuñez A, Mateu-Rogell P, Juarez-Reyes A, Lopez-Ceh FE, Villafan-Bernal JR, Rojas-Zepeda L, Guzman-Guzman IP, Poon LC. Novel Ratio Soluble Fms-like Tyrosine Kinase-1/Angiotensin-II (sFlt-1/ANG-II) in Pregnant Women Is Associated with Critical Illness in COVID-19. Viruses 2021; 13:v13101906. [PMID: 34696336 PMCID: PMC8538263 DOI: 10.3390/v13101906] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 01/05/2023] Open
Abstract
Background: In healthy pregnancies, components of the Renin-Angiotensin system (RAS) are present in the placental villi and contribute to invasion, migration, and angiogenesis. At the same time, soluble fms-like tyrosine kinase 1 (sFlt-1) production is induced after binding of ANG-II to its receptor (AT-1R) in response to hypoxia. As RAS plays an essential role in the pathogenesis of COVID-19, we hypothesized that angiogenic marker (sFlt-1) and RAS components (ANG-II and ACE-2) may be related to adverse outcomes in pregnant women with COVID-19; Methods: Prospective cohort study. Primary outcome was severe pneumonia. Secondary outcomes were ICU admission, intubation, sepsis, and death. Spearman’s Rho test was used to analyze the correlation between sFlt-1 and ANG-II levels. The sFlt-1/ANG-II ratio was determined and the association with each adverse outcome was explored by logistic regression analysis and the prediction was assessed using receiver-operating-curve (ROC); Results: Among 80 pregnant women with COVID-19, the sFlt-1/ANG-II ratio was associated with an increased probability of severe pneumonia (odds ratio [OR]: 1.31; p = 0.003), ICU admission (OR: 1.05; p = 0.007); intubation (OR: 1.09; p = 0.008); sepsis (OR: 1.04; p = 0.008); and death (OR: 1.04; p = 0.018); Conclusion: sFlt-1/ANG-II ratio is a good predictor of adverse events such as pneumonia, ICU admission, intubation, sepsis, and death in pregnant women with COVID-19.
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Affiliation(s)
- Salvador Espino-y-Sosa
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico;
| | - Raigam Jafet Martinez-Portilla
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico;
| | - Johnatan Torres-Torres
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico;
- Maternal Fetal Medicine Department, Hospital General de Mexico, “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (A.J.-R.); (F.E.L.-C.)
- Correspondence: ; Tel.: +52-55-5-520-9900 (ext. 317)
| | - Juan Mario Solis-Paredes
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
| | - Guadalupe Estrada-Gutierrez
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
| | - Jose Antonio Hernandez-Pacheco
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
| | - Aurora Espejel-Nuñez
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
| | - Paloma Mateu-Rogell
- Clinical Research Deparment, Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (S.E.-y.-S.); (R.J.M.-P.); (J.M.S.-P.); (G.E.-G.); (J.A.H.-P.); (A.E.-N.); (P.M.-R.)
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico;
| | - Angeles Juarez-Reyes
- Maternal Fetal Medicine Department, Hospital General de Mexico, “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (A.J.-R.); (F.E.L.-C.)
| | - Francisco Eduardo Lopez-Ceh
- Maternal Fetal Medicine Department, Hospital General de Mexico, “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (A.J.-R.); (F.E.L.-C.)
| | - Jose Rafael Villafan-Bernal
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico;
- Laboratory of Immunogenomics and Metabolic Diseases, Instituto Nacional de Medicina Genomica, Mexico City 14610, Mexico
| | - Lourdes Rojas-Zepeda
- Maternal Fetal Medicine Department, Instituto Materno Infantil del Estado de Mexico, Mexico City 50170, Mexico;
| | - Iris Paola Guzman-Guzman
- Faculty of Chemical-Biological Sciences, Autonomous University of Guerrero, Chilpancingo 39086, Mexico;
| | - Liona C. Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China;
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Deruelle P, Couffignal C, Sibiude J, Vivanti AJ, Anselem O, Luton D, Benachi A, Mandelbrot L, Vauloup-Fellous C, Cordier AG, Picone O. Prenatal care providers' perceptions of the SARS-Cov-2 vaccine for themselves and for pregnant women. PLoS One 2021; 16:e0256080. [PMID: 34516551 PMCID: PMC8437278 DOI: 10.1371/journal.pone.0256080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prenatal care providers will play an important role in the acceptance of SARS-Cov-2 vaccination for pregnant women. OBJECTIVE To determine the perceptions of French prenatal care providers: midwives, general practitioners (GPs) and obstetricians and gynaecologists (Ob-Gyn) regarding SARS-CoV-2 vaccination during pregnancy. STUDY DESIGN An anonymous online survey was sent to members of French professional societies representing prenatal practitioners. The participants were asked to answer questions on their characteristics and give their opinions of the SARS-CoV-2 vaccine for themselves and women who are pregnant or willing to become pregnant. RESULTS Access to the survey was opened from January 11th, 2021, to March 1st, 2021. A total of 1,416 responses were collected from 749 Ob-Gyn, 598 midwives and 69 GPs. Most respondents (86.7% overall, 90.4% for Ob-GYN, 81.1% for GPs and 80.1% for midwives) agreed to receive the SARS-CoV-2 vaccine. Vaccination against SARS-CoV-2 would be offered to pregnant women by 49.4% 95%CI [48.1-50.8] of the participants. Midwives were less likely to recommend vaccination than GP and Ob-Gyn (37.5%, 50.7% and 58.8%, respectively). The multinomial logistic regression revealed that being an obstetrician, working in a group, usually offering a flu vaccine and wanting to be vaccinated against SARS-CoV-2 were positively associated with considering pregnant women for SARS-CoV-2 vaccination. CONCLUSION Most French prenatal healthcare providers are favourable towards vaccinating pregnant women, but a large minority express reservation. More evidence on safety and involvement by professional organisations will be important to encourage the access of pregnant women to vaccination against SARS-CoV-2.
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Affiliation(s)
- Philippe Deruelle
- Pôle de gynécologie Obstétrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
| | - Camile Couffignal
- Clinical Research, Biostatistics and Epidemiology Department, AP-HP, Hôpital Bichat, Paris, France
- Université de Paris, INSERM, IAME, Paris, France
| | - Jeanne Sibiude
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Université de Paris, INSERM, IAME, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France (OP LM)
| | - Alexandre J. Vivanti
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Olivia Anselem
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Maternité Port-Royal, Hôpital Cochin, AP-HP. Centre-Université de Paris, Paris, France (OA)
| | - Dominique Luton
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Service de gynécologie-obstétrique, Paris University, FHU Prematurity, Bichat Hospital Assistance publique-Hôpitaux de Paris, Paris, France
- INSERM U1016, Institut IMAGINE, Paris, France
| | - Alexandra Benachi
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Laurent Mandelbrot
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Université de Paris, INSERM, IAME, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France (OP LM)
| | - Christelle Vauloup-Fellous
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Department of Virology, AP-HP, Hôpital Paul-Brousse, University Paris Saclay, Villejuif, France
| | - Anne Gael Cordier
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Olivier Picone
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), Vélizy, France
- Université de Paris, INSERM, IAME, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France (OP LM)
- FHU PREMA, Paris, France
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Kalafat E, Magee LA, von Dadelszen P, O'Brien P, Khalil A. SARS-CoV-2 vaccination in pregnancy: a unique opportunity for equity. Lancet 2021; 398:951. [PMID: 34390655 PMCID: PMC8357461 DOI: 10.1016/s0140-6736(21)01756-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Erkan Kalafat
- Koc University, School of Medicine, Department of Obstetrics and Gynaecology, Istanbul, Turkey
| | - Laura A Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Pat O'Brien
- The Royal College of Obstetricians and Gynaecologists, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, Cranmer Terrace, London SW17 0RE, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, UK.
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93
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Agbontaen KO, Somasundram K, Baker M. Critical COVID-19 in a 24-week pregnant woman with 32 days of invasive mechanical ventilation before delivery of fetus: a case of successful collaborative multidisciplinary care. BMJ Case Rep 2021; 14:14/9/e243516. [PMID: 34497055 PMCID: PMC8438726 DOI: 10.1136/bcr-2021-243516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe the successful treatment of a 24-week pregnant, 44-year-old woman with COVID-19. Management of this complex case required multidisciplinary collaboration and included prolonged invasive mechanical ventilation and prone positioning. Caesarean section delivery was delayed for 32 days, with no monitored fetal compromise, while stabilising the mother. To our knowledge, this is the longest reported duration of invasive ventilation while pregnant in a patient with COVID-19. COVID-19 has been shown to cause increased disease severity in pregnant women, and certain pregnancy-related physiological adaptations that occur could help explain this association. While COVID-19 has been shown to cause no increased adverse neonatal outcomes, clinicians should be aware that data show increased preterm birth in symptomatic pregnant women, thereby increasing the chance of prematurity-related complications. Further research on COVID-19 in pregnancy is crucial to facilitate better management, and full inclusion of pregnant women in therapeutic clinical trials will help achieve this.
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Affiliation(s)
| | - Khevan Somasundram
- Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Matthew Baker
- Intensive Care Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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94
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Bookstein Peretz S, Regev N, Novick L, Nachshol M, Goffer E, Ben‐David A, Asraf K, Doolman R, Gal Levin E, Regev Yochay G, Yinon Y. Short-term outcome of pregnant women vaccinated with BNT162b2 mRNA COVID-19 vaccine. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:450-456. [PMID: 34198360 PMCID: PMC8441755 DOI: 10.1002/uog.23729] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To determine the immunogenicity and reactogenicity of the Pfizer/BioNTech BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccine among pregnant women compared with non-pregnant women, and to evaluate obstetric outcome following vaccination. METHODS This was an observational case-control study of pregnant women who were vaccinated with a two-dose regimen of the BNT162b2 vaccine during gestation between January and February 2021 (study group) and age-matched non-pregnant women who received the vaccine during the same time period (control group). Participants received a digital questionnaire 1-4 weeks after the second dose and were asked to provide information regarding demographics, medication, medical history, history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, timing of COVID-19 vaccine doses and side effects after each vaccine dose. A second digital questionnaire, regarding current pregnancy and delivery outcomes, was sent to patients in the study group after the calculated due date. All recruited women were offered a serology blood test for SARS-CoV-2 immunoglobulin G (IgG) following the second vaccination dose and SARS-CoV-2 IgG levels were compared between the two groups. RESULTS Of 539 pregnant women who were recruited after completion of the two-dose regimen of the vaccine, 390 returned the digital questionnaire and were included in the study group and compared to 260 age-matched non-pregnant vaccinated women. The rates of rash, fever and severe fatigue following vaccination among pregnant women were comparable to those in non-pregnant women. Myalgia, arthralgia and headache were significantly less common among pregnant women after each dose, local pain or swelling and axillary lymphadenopathy were significantly less common among pregnant women after the first and second doses, respectively, while paresthesia was significantly more common among the pregnant population after the second dose. Among pregnant women, there were no significant differences in the rates of side effects according to whether the vaccine was administered during the first, second or third trimester of pregnancy, except for local pain/swelling, which was significantly less common after the first dose when administered during the third trimester, and uterine contractions, which were significantly more common after the second dose when administered during the third trimester. The rates of obstetric complications, including uterine contractions (1.3% after the first dose and 6.4% after the second dose), vaginal bleeding (0.3% after the first dose and 1.5% after the second dose) and prelabor rupture of membranes (0% after the first dose and 0.8% after the second dose), were very low following vaccination. All serum samples in both groups were positive for SARS-CoV-2 IgG. However, pregnant women had significantly lower serum SARS-CoV-2 IgG levels compared to non-pregnant women (signal-to-cut-off ratio, 27.03 vs 34.35, respectively; P < 0.001). Among the 57 pregnant women who delivered during the study period and who completed the second questionnaire, median gestational age at delivery was 39.5 (interquartile range, 38.7-40.0) weeks, with no cases of preterm birth < 37 weeks, no cases of fetal or neonatal death and two (3.5%) cases of admission to the neonatal intensive care unit for respiratory support. CONCLUSIONS The adverse-effect profile and short-term obstetric and neonatal outcomes among pregnant women who were vaccinated with the BNT162b2 vaccine at any stage of pregnancy do not indicate any safety concerns. The vaccine is effective in generating a humoral immune response in pregnant women, although SARS-CoV-2 IgG levels were lower than those observed in non-pregnant vaccinated women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. Bookstein Peretz
- Department of Obstetrics and GynecologySheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - N. Regev
- Department of Obstetrics and GynecologySheba Medical CenterTel HashomerIsrael
| | - L. Novick
- Department of Obstetrics and GynecologySheba Medical CenterTel HashomerIsrael
| | - M. Nachshol
- Department of Obstetrics and GynecologySheba Medical CenterTel HashomerIsrael
| | - E. Goffer
- Institute for Medical Engineering and Science, Massachusetts Institute of TechnologyCambridgeMAUSA
| | - A. Ben‐David
- Department of Obstetrics and GynecologySheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - K. Asraf
- Automated Mega LaboratorySheba Medical CenterTel HashomerIsrael
| | - R. Doolman
- Automated Mega LaboratorySheba Medical CenterTel HashomerIsrael
| | - E. Gal Levin
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
- Infection Prevention & Control UnitSheba Medical CenterTel HashomerIsrael
| | - G. Regev Yochay
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
- Infection Prevention & Control UnitSheba Medical CenterTel HashomerIsrael
| | - Y. Yinon
- Department of Obstetrics and GynecologySheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
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Wu T, Kang S, Peng W, Zuo C, Zhu Y, Pan L, Fu K, You Y, Yang X, Luo X, Jiang L, Deng M. Original Hosts, Clinical Features, Transmission Routes, and Vaccine Development for Coronavirus Disease (COVID-19). Front Med (Lausanne) 2021; 8:702066. [PMID: 34295915 PMCID: PMC8291337 DOI: 10.3389/fmed.2021.702066] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
The pandemic of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to public concern worldwide. Although a variety of hypotheses about the hosts of SARS-CoV-2 have been proposed, an exact conclusion has not yet been reached. Initial clinical manifestations associated with COVID-19 are similar to those of other acute respiratory infections, leading to misdiagnoses and resulting in the outbreak at the early stage. SARS-CoV-2 is predominantly spread by droplet transmission and close contact; the possibilities of fecal-oral, vertical, and aerosol transmission have not yet been fully confirmed or rejected. Besides, COVID-19 cases have been reported within communities, households, and nosocomial settings through contact with confirmed COVID-19 patients or asymptomatic individuals. Environmental contamination is also a major driver for the COVID-19 pandemic. Considering the absence of specific treatment for COVID-19, it is urgent to decrease the risk of transmission and take preventive measures to control the spread of the virus. In this review, we summarize the latest available data on the potential hosts, entry receptors, clinical features, and risk factors of COVID-19 and transmission routes of SARS-CoV-2, and we present the data about development of vaccines.
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Affiliation(s)
- Ting Wu
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Shuntong Kang
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Wenyao Peng
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Chenzhe Zuo
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuhao Zhu
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Liangyu Pan
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
| | - Keyun Fu
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yaxian You
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
| | - Xinyuan Yang
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Xuan Luo
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Hunan Yuanpin Cell Biotechnology Co., Ltd, Changsha, China
| | - Liping Jiang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Meichun Deng
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
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96
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Soto‐Torres E, Hernandez‐Andrade E, Huntley E, Mendez‐Figueroa H, Blackwell SC. Ultrasound and Doppler findings in pregnant women with SARS-CoV-2 infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:111-120. [PMID: 33794060 PMCID: PMC8251118 DOI: 10.1002/uog.23642] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To describe and compare ultrasound and Doppler findings in pregnant women who were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with findings in those who were SARS-CoV-2-negative, evaluated during the pandemic period. METHODS In this retrospective case-control study, we analyzed data from 106 pregnant women who tested positive for SARS-CoV-2 at the time of, or within 1 week of, an ultrasound scan between 1 May and 31 August 2020. Scans were either performed for routine fetal evaluation or indicated due to a positive SARS-CoV-2 test. Forty-nine women were symptomatic and 57 were asymptomatic. For comparison, we analyzed data from 103 pregnant women matched for maternal age, parity, body mass index and gestational age at the time of the ultrasound scan. These control women did not report symptoms of SARS-CoV-2 infection at the time of the ultrasound scan or at the time of admission for delivery and had a negative SARS-CoV-2 test at admission for delivery. Fetal biometry, fetal anatomy, amniotic fluid volume and Doppler parameters, including umbilical and fetal middle cerebral artery pulsatility indices, cerebroplacental ratio and biophysical profile (BPP), were evaluated as indicated. Biometric and Doppler values were converted to Z-scores for comparison. Our primary outcome, an adverse prenatal composite outcome (APCO) included any one or more of: small-for-gestational-age (SGA) fetus, oligohydramnios, abnormal BPP, abnormal Doppler velocimetry and fetal death. Comorbidities, delivery information and neonatal outcome were compared between the two groups. RESULTS Eighty-seven (82.1%) women who were positive for SARS-CoV-2 had a body mass index > 25 kg/m2 . SARS-CoV-2-positive women had a higher prevalence of diabetes (26/106 (24.5%) vs 13/103 (12.6%); P = 0.03), but not of pre-eclampsia (21/106 (19.8%) vs 11/103 (10.7%); P = 0.08), compared with controls. The prevalence of APCO was not significantly different between SARS-CoV-2-positive women (19/106 (17.9%)) and controls (9/103 (8.7%)) (P = 0.06). There were no differences between SARS-CoV-2-positive women and controls in the prevalence of SGA fetuses (12/106 (11.3%) vs 6/103 (5.8%); P = 0.17), fetuses with abnormal Doppler evaluation (8/106 (7.5%) vs 2/103 (1.9%); P = 0.08) and fetuses with abnormal BPP (4/106 (3.8%) vs 0/103 (0%); P = 0.14). There were two fetal deaths in women who were positive for SARS-CoV-2 and these women had a higher rate of preterm delivery ≤ 35 weeks of gestation (22/106 (20.8%) vs 9/103 (8.7%); odds ratio, 2.73 (95% CI, 1.19-6.3); P = 0.01) compared with controls. CONCLUSIONS There were no significant differences in abnormal fetal ultrasound and Doppler findings observed between pregnant women who were positive for SARS-CoV-2 and controls. However, preterm delivery ≤ 35 weeks was more frequent among SARS-CoV-2-positive women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. Soto‐Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical SchoolUniversity of Texas, Health Science Center at Houston (UTHealth)HoustonTXUSA
| | - E. Hernandez‐Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical SchoolUniversity of Texas, Health Science Center at Houston (UTHealth)HoustonTXUSA
| | - E. Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical SchoolUniversity of Texas, Health Science Center at Houston (UTHealth)HoustonTXUSA
| | - H. Mendez‐Figueroa
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical SchoolUniversity of Texas, Health Science Center at Houston (UTHealth)HoustonTXUSA
| | - S. C. Blackwell
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical SchoolUniversity of Texas, Health Science Center at Houston (UTHealth)HoustonTXUSA
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97
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Cuñarro-López Y, Pintado-Recarte P, Hernández-Martín C, Paya-Martínez P, López-Pérez R, Cueto-Hernández I, Ruiz-Labarta J, Cano-Valderrama Ó, Martínez-Pérez Ó, Bravo-Arribas C, Ortega MA, De León-Luis JA. Comparing Infection Profiles of Expectant Mothers with COVID-19 and Impacts on Maternal and Perinatal Outcomes between the First Two Waves of the Pandemic. J Pers Med 2021; 11:jpm11070599. [PMID: 34201923 PMCID: PMC8306998 DOI: 10.3390/jpm11070599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 12/14/2022] Open
Abstract
During 2020, Coronavirus Disease-19 (COVID-19) incidence fluctuated in two clear waves across the spring and autumn periods. This study was designed to compare the maternal and perinatal clinical outcomes in obstetrics patients with COVID-19 between the two waves of infection in Spain. We conducted an observational, analytical, ambispective cohort study with longitudinal follow-up of mothers with confirmed SARV-CoV-2 infection from different hospitals in our country between March–November 2020. We recruited 1295 pregnant women with SARS-CoV2 infection from 78 hospitals, 846 (65.3%) of whom were diagnosed during the first wave and 449 (34.7%) during the second wave. Our results show that patients developing COVID-19 during the first wave had more symptoms at triage, early in pregnancy with greater rates of COVID-19-related maternal morbidity; caesarean section and preterm birth in the first wave. We register two cases of maternal mortality and only during the first wave. Maternal morbidity events showed a strong link to perinatal mortality events in the first wave compared to the second wave, in which maternal morbidity was more associated with pneumonia. Likewise, maternal morbidity showed a strong correlation with perinatal morbidity events in both waves. We describe the differences between the patients’ profiles and management between the two waves and related to maternal and perinatal outcomes. Differences were also observed in the management of pregnant women with COVID-19. Thus, there were fewer caesarean sections, and maternal and perinatal morbidity events were reduced in the second wave, while the impacts of respiratory symptoms and their severity, including a greater need for maternal treatment, were greater in this last period. Identifying the impact that changes in the profile as well as in the treatment have on maternal–perinatal morbidity and mortality will help improve the well-being of our patients and their newborns.
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Affiliation(s)
- Yolanda Cuñarro-López
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Pilar Pintado-Recarte
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Concepción Hernández-Martín
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Pilar Paya-Martínez
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Rocío López-Pérez
- Department of Obstetrics and Gynecology, Hospital Universitario Santa Lucia, 30202 Cartagena, Spain;
| | - Ignacio Cueto-Hernández
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Javier Ruiz-Labarta
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | | | - Óscar Martínez-Pérez
- Obstetrics and Gynaecology Department, Puerta de Hierro University Hospital, 28222 Madrid, Spain
- Correspondence:
| | - Coral Bravo-Arribas
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Madrid, Spain
| | - Juan Antonio De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (P.P.-R.); (C.H.-M.); (P.P.-M.); (I.C.-H.); (J.R.-L.); (C.B.-A.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
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98
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Brillo E, Tosto V, Gerli S, Buonomo E. COVID-19 vaccination in pregnancy and postpartum. J Matern Fetal Neonatal Med 2021; 35:7890-7910. [PMID: 34154501 DOI: 10.1080/14767058.2021.1937991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pregnant women were excluded from the initial phase 3 clinical trials of COVID-19 vaccines resulting in limited data on their efficacy and safety during pregnancy and postpartum. As a result, since December 2020, there has been conflicting advice from public health, governmental, and professional authorities on this matter. From the end of 2020 up to now, some consensus guidance has been published with a prevalent precautionary approach on the administration of vaccines in pregnant women, in breastfeeding ones, or for those who are planning a pregnancy (either spontaneously or with assisted technologies). After the first few months of vaccine administration in some countries, more permissiveness seems to prevail, although with inconsistencies. Some little indicative advice, their inconsistency around the world and their changes in a short time have probably disoriented both women and their health care providers and placed the burden of decision making upon women and their health care providers without information to assist in making an informed choice. We reviewed the COVID-19 vaccination guidance for pregnant and breastfeeding women published to date and evidence from cases of unplanned pregnancy during the course of vaccine trials, preclinical experimental and observational clinical studies, and discuss their implications. In this way, we have tried to identify the safety of COVID-19 vaccines for pregnant or breastfeeding women, and their offspring.
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Affiliation(s)
- Eleonora Brillo
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Valentina Tosto
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Sandro Gerli
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
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99
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Saadaoui M, Kumar M, Al Khodor S. COVID-19 Infection during Pregnancy: Risk of Vertical Transmission, Fetal, and Neonatal Outcomes. J Pers Med 2021; 11:483. [PMID: 34071251 PMCID: PMC8227688 DOI: 10.3390/jpm11060483] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/18/2022] Open
Abstract
The COVID-19 pandemic is a worldwide, critical public health challenge and is considered one of the most communicable diseases that the world had faced so far. Response and symptoms associated with COVID-19 vary between the different cases recorded, but it is amply described that symptoms become more aggressive in subjects with a weaker immune system. This includes older subjects, patients with chronic diseases, patients with immunosuppression treatment, and pregnant women. Pregnant women are receiving more attention not only because of their altered physiological and immunological function but also for the potential risk of viral vertical transmission to the fetus or infant. However, very limited data about the impact of maternal infection during pregnancy, such as the possibility of vertical transmission in utero, during birth, or via breastfeeding, is available. Moreover, the impact of infection on the newborn in the short and long term remains poorly understood. Therefore, it is vital to collect and analyze data from pregnant women infected with COVID-19 to understand the viral pathophysiology during pregnancy and its effects on the offspring. In this article, we review the current knowledge about pre-and post-natal COVID-19 infection, and we discuss whether vertical transmission takes place in pregnant women infected with the virus and what are the current recommendations that pregnant women should follow in order to be protected from the virus.
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Affiliation(s)
| | | | - Souhaila Al Khodor
- Research Department, Sidra Medicine, Doha P.O. Box 26999, Qatar; (M.S.); (M.K.)
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100
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Khan DSA, Pirzada AN, Ali A, Salam RA, Das JK, Lassi ZS. The Differences in Clinical Presentation, Management, and Prognosis of Laboratory-Confirmed COVID-19 between Pregnant and Non-Pregnant Women: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5613. [PMID: 34074005 PMCID: PMC8197383 DOI: 10.3390/ijerph18115613] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people across the globe. Previous coronavirus outbreaks led to worsened symptoms amongst pregnant women, suggesting that pregnant women are at greater risk. OBJECTIVES Our aim is to investigate the differences in clinical presentation, management, and prognosis of COVID-19 infection in pregnant and non-pregnant women. METHODS We ran a search on electronic databases and analysis of the relevant articles was done using Revie Manager 5.4. RESULTS The review consists of nine studies comprising 591,058 women (28,797 pregnant and 562,261 non-pregnant), with most of the data derived from two large studies. The risk of experiencing fever (RR: 0.74; 95% CI: 0.64-0.85), headache (RR: 0.77; 95% CI: 0.74-0.79), myalgia (RR: 0.92; 95% CI: 0.89-0.95), diarrhea (RR: 0.40, 95% CI: 0.39-0.43), chest tightness (RR: 0.86; 95% CI: 0.77-0.95), and expectoration (RR: 0.45; 95% CI: 0.21-0.97) were greater amongst non-pregnant COVID-19-infected women. Pregnant women with COVID-19 were less likely to be obese (RR: 0.68; 95% CI: 0.63-0.73) or have a smoking history (RR: 0.32; 95% CI: 0.26-0.39). COVID-19-infected non-pregnant women had a higher frequency of comorbidity such as chronic cardiac disease (RR: 0.58; 95% CI: 0.44-0.77), renal disease (RR: 0.45; 95% CI: 0.29-0.71), and malignancy (RR: 0.82; 95% CI: 0.68-0.98), compared to COVID-19-infected pregnant women. The risk of ICU admission (RR: 2.26; 95% CI: 1.68-3.05) and requirement of invasive mechanical ventilation (RR: 2.68; 95% CI: 2.07-3.47) were significantly higher amongst pregnant women. CONCLUSIONS Although the frequency of risk factors and the risk of experiencing clinical symptoms of COVID-19 were higher among non-pregnant women, COVID-19-infected pregnant women had a higher requirement of ICU admission and invasive mechanical ventilation compared to non-pregnant COVID-19-infected women. More well-conducted studies from varying contexts are needed to draw conclusions. Prospero registration: CRD42020204638.
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Affiliation(s)
- Durray Shahwar A. Khan
- Department of Maternal and Child Health, Aga Khan University, Karachi 74800, Pakistan; (D.S.A.K.); (A.N.P.); (R.A.S.); (J.K.D.)
| | - Areeba N. Pirzada
- Department of Maternal and Child Health, Aga Khan University, Karachi 74800, Pakistan; (D.S.A.K.); (A.N.P.); (R.A.S.); (J.K.D.)
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia;
| | - Rehana A. Salam
- Department of Maternal and Child Health, Aga Khan University, Karachi 74800, Pakistan; (D.S.A.K.); (A.N.P.); (R.A.S.); (J.K.D.)
| | - Jai K. Das
- Department of Maternal and Child Health, Aga Khan University, Karachi 74800, Pakistan; (D.S.A.K.); (A.N.P.); (R.A.S.); (J.K.D.)
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia;
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