Why are pregnant women susceptible to COVID-19? An immunological viewpoint

Maternal COVID-19 infection and associated factors: A cross-sectional study

BACKGROUND

Since the declaration of COVID-19 as a global pandemic, several studies have been conducted to examine associated factors. However, few studies have focused on pregnant women infected with COVID-19 in sub-Saharan Africa. Therefore, this study investigated the prevalence and factors associated with COVID-19 infection among pregnant women at the Levy Mwanawasa University Teaching Hospital and Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia.

METHODS

A cross-sectional study was conducted between March and July 2021. Women were recruited as they presented for antenatal care. Data was collected using a structured questionnaire to capture variables of interest (socio-demographic, clinical and obstetric). COVID-19 diagnosis was made using a nasopharyngeal swab by PCR test. Multivariable logistic regression was used to control for confounding and calculate the odds ratios for each explanatory variable and respective 95% confidence intervals.

RESULTS

The study enrolled 352 participants with a mean (standard deviation [SD]) age of 30.1 years (5.6). One hundred thirty of 352 (36.9%; 95% CI: 31.9 to 42.2) participants had a confirmed positive SARS-CoV-2 test result. At univariable analysis, factors associated with COVID-19 were increased gestational age, education status and maternal HIV serostatus. Women with a secondary level of education were less likely to have COVID-19 infection than those with a primary level of education (AOR = 0.23, 95% CI: 0.09-0.63). On the other hand, a one-week increase in gestational age was associated with higher odds of COVID-19 infection (AOR = 1.03, 95% CI: 1.01-1.06).

CONCLUSION

The results showed that the prevalence of COVID-19 infection among pregnant women was 36.9% and was associated with increased gestational age and a lower level of education. To mitigate adverse maternal outcomes, there is a need to screen for COVID-19 strictly and broadly monitor prenatal women presenting for healthcare.

Fear and Anxiety in Pregnant Women During the COVID-19 Pandemic: A Systematic Review

Objectives: The aim of this study was to explore the impact of the 2020-2022 pandemic on the levels of fear and anxiety in pregnant women and to identify risk and protective factors. Methods: A systematic review was conducted. Electronic databases were consulted for studies published between January 2020 and August 2022. The methodological quality was assessed using a critical appraisal tool for non-randomised studies. Results: Seventeen studies were included in the review. A high prevalence of levels of fear and anxiety were observed. Risk factors such as unplanned pregnancy, poor support from partners, or intolerance of uncertainty were identified for high levels of fear. Regarding anxiety, risk factors such as maternal age, social support, financial status, or concern about being able to maintain antenatal follow-ups were identified. Conclusion: The COVID-19 pandemic had a significant impact on the mental health of pregnant women through increased levels of fear and anxiety. It has not been possible to establish a relationship between significant factors such as gestational age or health emergency control measures with high levels of fear or anxiety.

Morbidity and mortality of newborn from preeclampsia mother with SARS-CoV-2 infection

BACKGROUND

Preeclampsia is a major cause of maternal and infant mortality in Indonesia. Several studies have investigated the association between SARS-CoV-2 infection and adverse maternal, fetal, and neonatal outcomes. The studies found that SARS-CoV-2 infection during pregnancy is associated with an increased risk of maternal morbidity and mortality related to hypertensive disorders, including preeclampsia. However, the studies did not provide specific information on the morbidity and mortality of newborns from mothers diagnosed with preeclampsia with conjunction SARS-CoV-2 infection.

METHODS

This hospital-based case-control study was conducted on 28 mother-infant pairs using a systematic sampling method from February 2021 to December 2021. Data were analyzed using SPSS software (version 26), and statistical tests including chi-square analysis, Fisher's exact test, Mann-Whitney U-test and independent t-test were performed to identify factors associated with study variables in a 95% confidence interval (CI).

RESULTS

We conducted a prospective study involving the enrollment of 28 pregnant women with confirmed SARS-CoV-2 infection through RT-PCR tests. Within this cohort, a subset of 4 mothers (14.8%) were diagnosed with preeclampsia. Four preeclamptic patients (100%) experienced fatal outcomes. Furthermore, among the infants born to preeclamptic mothers with SARS-CoV-2 infections, two (50%) newborns not survive. One infant passed away shortly after birth at 30 weeks of gestation, while the other had intrauterine demise at 28 weeks of gestation.

CONCLUSIONS

SARS-CoV-2 infection during pregnancy is associated with an increased risk of maternal morbidity and mortality related preeclampsia.

Pretesting of Infographic as a Communication Tool on Pregnant Women During Covid-19 Period

Purpose

This study was to analyze the responses of informants about Instagram infographics on Covid-19 prevention for pregnant women.

Methods

This was a qualitative study that used Rapid Assessment Procedure (RAP) and used pretesting communication theory. The informant selection technique was purposive sampling that consist of three pregnant women as main informants, a midwifery lecturer and a visual graphic designer as key informants. One-to-one pretesting communication procedure was selected because the research was conducted at the beginning of the Covid-19 pandemic, so it had a difficulty in recruiting informants. The interview guideline was conducted by the research team and was examined in a field trial. Data collection was by semi-structured interview using voice call WhatsApp application. Data were analysed using thematic analysis.

Results

In attraction aspect, this was considered quite interesting by the informants. In comprehension aspect, the messages were easily understood because of using brief, concise, and simple sentences. Furthermore, the messages were supported by images and comprehensive. In acceptance aspect, all the informants' opinions were identified that the messages of this infographic did not have a conflict with the existing norms. In self-involvement aspect, this infographic was in accordance with the current condition of the informants. In persuasion aspect, it had a good persuasive value as the informants were willing to share the infographic with others.

Conclusion

The infographic still needed improvements from the attraction aspect such as consider using contrasting colour between the background and text, equalize the font size and change icons to become related to the text. As from the comprehension aspect consider using terms that are more popular in the community. There were no need improvements from acceptance, self-involvement, and persuasion aspects. However, evidence-based research is still needed on how this infographic is developed and implemented to optimize transfer of knowledge.

An Assessment of Men Semen Alterations in SARS-CoV-2: Is Fever the Principal Concern?

The SARS-CoV-2 virus (COVID-19) was identified as a pandemic in March 2020 by the World Health Organization. The virus spreads primarily through saliva droplets or nasal discharges, in addition to coughing or sneezing from an infected person. The most common symptom at the onset of illness is fever, which may appear within 2-14 days after exposure. The high fever (above 38 °C) can persist from one to 4 days. The febrile illness usually has a variable negative impact on sperm characteristics such as sperm output, motility, morphology, and DNA fragmentation. These defects proliferated due to an increase in testicular temperature, and disturbance in the thermoregulatory systems that are responsible for the testicular heat loss. Coronavirus studies suggest that fever from SARS-CoV-2 virus infection induces a reversible negative effect on the sperm parameters until one cycle (74 days) of spermatogenesis. We believe that SARS-CoV-2 can have long-term adverse effects on testicles via immune or inflammatory reactions after the patient has fully recovered. This evidence could be added to the list of the long-term post-COVID-19 syndromes. Long-term follow-up and evaluation of the sperm parameters are necessary for all recovered male patients, especially the young ones.

Post-partum depression: From clinical understanding to preclinical assessments

Post-partum depression (PPD) with varying clinical manifestations affecting new parents remains underdiagnosed and poorly treated. This minireview revisits the pharmacotherapy, and relevant etiological basis, capable of advancing preclinical research frameworks. Maternal tasks accompanied by numerous behavioral readouts demand modeling different paradigms that reflect the complex and heterogenous nature of PPD. Hence, effective PPD-like characterization in animals towards the discovery of pharmacological intervention demands research that deepens our understanding of the roles of hormonal and non-hormonal components and mediators of this psychiatric disorder.

Vertical Transmission of SARS-CoV-2 in a Twin Pregnancy

Description Transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in 2019 and rapidly evolved into the global coronavirus disease 2019 (COVID-19) pandemic. The emergence of a highly morbid disease has posed ongoing challenges in the diagnosis, management, and prevention of COVID-19. The uncertainty underlying medical decision making is further compounded by preexisting conditions, including pregnancy. Here, we report a twin pregnancy complicated by maternal COVID-19 and the vertical transmission of SARS-CoV-2. We hope that our experiences contribute to a better understanding of the disease in pregnancy and, ultimately, guide the development of effective treatment and prevention strategies.

Impact of COVID-19 on Breastfeeding among SARS-CoV-2 Infected Pregnant Women: A Single Centre Survey Study

Background: Although current guidelines recommend that mothers with suspected or confirmed SARS-CoV-2 infection should be encouraged to initiate and continue breastfeeding, up-to-date literature shows conflicting data regarding breastfeeding experiences in infected women. This survey aimed to report on the psychological impact of SARS-CoV-2 infection on breastfeeding practice and medical counselling in a single tertiary center in Southern Italy. Methods: One-hundred breastfeeding women with SARS-CoV-2 infection at delivery were given an anonymous questionnaire regarding breastfeeding and women’s perception of the impact of COVID-19 on breastfeeding. Results: 75% of women reported they had difficulty breastfeeding; among them, 66 (66%) declared that separation from their babies after delivery affected their ability to breastfeed. Incidence of reported difficulties in breastfeeding was higher in women who underwent caesarean section compared to women with vaginal delivery (56/65, 86.2% vs. 19/35, 54.3%, χ2 = 12.322, p < 0.001) and in women with a hospital stay of more than 5 days (48/57, 84.2% vs. 23/37, 62.2%, χ2 = 5.902, p = 0.015). Furthermore, the incidence of difficulties in breastfeeding was higher in women who subsequently decided to use exclusively infant formula compared to women who mixed maternal milk with infant formula and women who breastfed exclusively with maternal milk (48/49, 98% vs. 20/25, 80% vs. 7/26, 26.9%, χ2 = 46.160, p < 0.001). Conclusions: Our survey highlights the importance of healthcare support and information on hygiene practices to decrease the perceived stress related to breastfeeding for infected mothers under restrictions, especially in women undergoing cesarean section and with a long hospital stay.

SARS-CoV-2 (COVID-19) as a possible risk factor for neurodevelopmental disorders

Pregnant women constitute one of the most vulnerable populations to be affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the cause of coronavirus disease 2019. SARS-CoV-2 infection during pregnancy could negatively impact fetal brain development via multiple mechanisms. Accumulating evidence indicates that mother to fetus transmission of SARS-CoV-2 does occur, albeit rarely. When it does occur, there is a potential for neuroinvasion via immune cells, retrograde axonal transport, and olfactory bulb and lymphatic pathways. In the absence of maternal to fetal transmission, there is still the potential for negative neurodevelopmental outcomes as a consequence of disrupted placental development and function leading to preeclampsia, preterm birth, and intrauterine growth restriction. In addition, maternal immune activation may lead to hypomyelination, microglial activation, white matter damage, and reduced neurogenesis in the developing fetus. Moreover, maternal immune activation can disrupt the maternal or fetal hypothalamic-pituitary-adrenal (HPA) axis leading to altered neurodevelopment. Finally, pro-inflammatory cytokines can potentially alter epigenetic processes within the developing brain. In this review, we address each of these potential mechanisms. We propose that SARS-CoV-2 could lead to neurodevelopmental disorders in a subset of pregnant women and that long-term studies are warranted.

Clinical analysis of pregnancy complicated with miliary tuberculosis

BACKGROUND

Pregnancy complicated with tuberculosis is increasingly common. The clinical characteristics of pregnancy complicated with miliary tuberculosis are summarized in this study.

METHODS

A retrospective analysis of pregnant patients with miliary tuberculosis was performed in terms of epidemiology, demography, clinical characteristics, laboratory tests, treatment, and prognosis.

RESULTS

Of the 23 patients that were included, 12 became pregnant after in vitro fertilization combined with embryo transfer (IVF-ET). The average gestational age at symptom onset was 13.96 weeks, and the average time from symptom onset to diagnosis was 33 days. Clinical symptoms included fever, dyspnoea, cough, headache, abdominal pain, and chest pain. Extrapulmonary tuberculosis occurred in 10 patients, respiratory failure in 11 patients, and ARDS in 9 patients. Chest HRCT showed diffusely distributed miliary nodules in all patients. Six patients were on mechanical ventilation, two underwent ECMO, and one died. Symptoms appeared in the first trimester of nine pregnancies after IVF-ET and in the second trimester of seven natural pregnancies.

CONCLUSIONS

Miliary tuberculosis can occur in pregnant patients, especially in patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Lacking specificity, the common clinical characteristics include elevated inflammation markers, anaemia, low lymphocyte count, and multiple miliary nodules shown on a chest HRCT scan. Half of patients with miliary tuberculosis may develop respiratory failure, and some may progress to ARDS. Therefore, infertile patients should be required to undergo TB screening before undergoing IVF-ET, and preventive anti-TB treatment should be given to patients with latent TB infections or untreated TB disease.Key MessageMiliary tuberculosis can occur in pregnant patients, especially in pregnant patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Many patients develop respiratory failure or ARDS.

A socio-ecological exploration to identify factors influencing the COVID-19 vaccine decision-making process among pregnant and lactating women: Findings from Kenya

The vaccine decision-making process of pregnant and lactating women is complex. Regarding COVID-19, pregnant women are at increased risk for severe disease and poor health outcomes. While pregnant and lactating women were excluded from COVID-19 vaccine trials, available evidence suggests that COVID-19 vaccines are safe and protective during pregnancy. In this study, we used a socio-ecological approach to explore factors influencing the decision-making process for COVID-19 vaccines in pregnant and lactating women in Kenya, for the purpose of informing demand generation strategies. As pregnant and lactating women are influenced by many factors, we conducted 84 in-depth interviews with a variety of stakeholders, including 31 pregnant or lactating women, 20 healthcare workers such as nurses, midwives, doctors, and frontline workers, 25 male family members of pregnant or lactating women, and 8 gatekeepers such as community leaders and faith-based leaders. These individuals were recruited from six communities in Kenya: three urban, and three rural. We applied a grounded theory approach to identify emerging themes and organized emerging themes using the SAGE Vaccine Hesitancy model, which includes three categories of determinants of vaccine acceptance, including contextual influences, individual and group influences, and vaccine and vaccination specific issues. Myths, interpersonal norms, and religion emerged as themes related to contextual influences. Safety, risk perception, and the role of the healthcare worker emerged as themes related to individual and group influences. For vaccine and vaccination specific issues, emerging themes included availability, accessibility, and eligibility. While maternal immunization can substantially reduce the effect of infectious diseases in mothers and infants, vaccine acceptance is critical. However, vaccines do not save lives; vaccination does. We hope the results of this study can be used to tailor communication efforts to increase vaccine demand among pregnant and lactating women.

Sociodemographic characteristics of professional categories most affected by COVID-19 in Mozambique from March to July 2020

Introduction

the risk of a worker becoming ill due to coronavirus disease 2019 (COVID-19) is related to occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the need to restore work activities in Mozambique, the study was conducted with the aim of identifying the occupational categories most affected by COVID-19 in the former in the period from March to July 2020.

Methods

this is a cross-sectional descriptive study, in which data from professions of confirmed cases of COVID-19 from 22 March to 29 July 2020 in Mozambique were analyzed. The professionals' data were reported daily by the National Institute of Health (NIH) and merged into a single database and exported to Excel, the latter categorized according to standard operating procedure (SOP) and descriptive statistics performed for its analysis.

Results

in the period under analysis, 1,127 professionals were diagnosed with COVID-19, divided into 11 categories. Nampula province had the highest frequency of cases with 25.00% (277). The highest frequency of cases was registered in the domestic professional category, which had 16.77% (189/1,127) with the female sex being more frequent, 79.37% (150/189); and defense and security had 14.20% (160/1,127) of cases and male gender with 91.25% (146/160); Health workers had 13.04% (147/1,127), and the maximum number of COVID-19 cases was recorded in June with 58.50% (86/147).

Conclusion

the professional categories most affected by COVID-19 in the period under review correspond to those groups that carry out activities requiring a physical presence at the workplace and from this; it is recommended that professionals reinforce preventive measures.

Healthcare of pregnant women with diabetes during the COVID-19 pandemic: a Southern Brazilian cross-sectional panel data

OBJECTIVES

To evaluate the indirect effects of the COVID-19 pandemic on the care of women with pregnancies complicated by gestational or pre-existing diabetes, and their maternal-fetal outcomes.

METHODS

A cross-sectional panel data conducted in a University Hospital in Southern Brazil. Maternal-fetal outcomes and predictors of care from 235 pregnant women with type 1, type 2, or gestational diabetes were evaluated. Two time periods were compared: six months preceding the pandemic, in 2019, and the COVID-19 period from September 2020 to March 2021. Comparisons were performed using analysis of variance, Mann-Whitney U, Fisher's exact and T-tests. Risks were calculated using the Poisson regression with robust estimates.

RESULTS

Maternal age was lower (32.1 ± 6.8 vs. 34.4 ± 6.6, p=0.009) and rates of depression/anxiety were higher (16.5 vs. 7.4%, p=0.046) in the group evaluated during the COVID-19. Neonatal hypoglycemia (RR 4.04; 95% CI 1.37-11.98, p=0.012), and SGA rates (RR 4.29; 95% CI 1.93-9.54, p<0.001) were higher in the group assessed before the pandemic.

CONCLUSIONS

Despite economic, social and structural impacts of the pandemic, parameters of maternal care were similar; diabetes control improved, and neonatal hypoglycemia and SGA rates were lower among pregnant women with diabetes during the pandemic.

Incidence and Mortality Trends of Upper Respiratory Infections in China and Other Asian Countries from 1990 to 2019

Respiratory infections remain a major public health problem, affecting people of all age groups, but there is still a lack of studies analyzing the burden of upper respiratory infections (URIs) in Asian countries. We used the data from the Global Burden of Diseases Study 2019 results to assess the current status and trends of URI burden from 1990 to 2019 in Asian countries. We found that Thailand had the highest age-standardized incidence rate (ASIR) of URI both in 1990 (354,857.14 per 100,000) and in 2019 (344,287.93 per 100,000); and the highest age-standardized mortality rate (ASMR) was in China in 1990 (2.377 per 100,000), and in Uzbekistan in 2019 (0.418 per 100,000). From 1990 to 2019, ASIRs of URI slightly increased in several countries, with the speediest in Pakistan (estimated annual percentage change [EAPC] = 0.404%, 95% CI, 0.322% to 0.486%); and Kuwait and Singapore had uptrends of ASMRs, at a speed of an average 3.332% (95% CI, 2.605% to 4.065%) and 3.160% (95% CI, 1.971% to 4.362%) per year, respectively. The age structure of URI was similar at national, Asian and Global levels. Children under the age of five had the highest incidence rate, and the elderly had the highest mortality rate of URI. Asian countries with a Socio-demographic Index between 0.5 and 0.7 had relatively lower ASIRs but higher ASMRs of URIs. The declined rate of URI ASMR in Asian countries was more pronounced in higher baseline (ASMR in 1990) countries. Our findings suggest that there was a huge burden of URI cases in Asia that affected vulnerable and impoverished people's livelihoods. Continuous and high-quality surveillance data across Asian countries are needed to improve the estimation of the disease burden attributable to URIs, and the best public health interventions are needed to curb this burden.

Pregnant women's knowledge, attitude, and practice towards COVID-19 infection prevention in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Coronavirus disease (COVID-19) infection during pregnancy causes adverse maternal and perinatal outcomes such as preterm birth, low birth weight, severe illness, intensive care unit admission, mechanical ventilation, and death. Pregnant women's knowledge, attitude, and practice (KAP) towards COVID-19 infection prevention are crucial to ensure the health of the mother and foetus. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of pregnant women's KAP towards COVID-19 infection prevention in Ethiopia.

METHODS

We searched PubMed, Scopus, Google Scholar, African Online Journal, and Web of Sciences database to retrieve related articles. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was used. Funnel plot and Eggers test were done to assess publication bias. Cochrane Q-test and I2 statistic were done to chick evidence of heterogeneity. Subgroup analysis was computed based on the study region and year of publication. Data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA version 14 statistical software. Weighted inverse variance random effect model was run to estimate the pooled prevalence of pregnant women's KAP towards COVID-19 infection prevention.

RESULTS

A total of 9 studies with 4,103 pregnant women were included. The pooled prevalence of knowledge, attitude, and practice towards COVID-19 infection prevention among pregnant women's in Ethiopia were 60.24% (95% CI; 53.69 to 66.79, I2 = 95%), 62.46% (95% CI; 45.68, 79.23, I2 = 98.8%), and 52.29% (95% CI; 43.91%-60.66% I2 = 96.5%) respectively. Maternal age (AOR = 1.87, 1.40-2.49), residence (AOR = 2.23, 1.50-3.31), secondary and above educational status (AOR = 3.36, 2.46-4.58), good knowledge (AOR = 2.73, 2.18-3.41), and fear of COVID-19 infection (AOR = 2.60, 1.78, 3.80) were factors associated with COVID-19 infection prevention practice among pregnant women's in Ethiopia.

CONCLUSION

The knowledge, attitude, and practice of COVID-19 infection prevention among pregnant women were low. Therefore, policymakers, maternal and child health program planners, and stakeholders should target to improve pregnant women's awareness regarding COVID-19 infection preventive measures.

Maternal and neonatal immune response to SARS-CoV-2, IgG transplacental transfer and cytokine profile

SARS-CoV-2 infected pregnant women are at increased risk of severe COVID-19 than non-pregnant women and have a higher risk of adverse pregnancy outcomes like intrauterine/fetal distress and preterm birth. However, little is known about the impact of SARS-CoV-2 infection on maternal and neonatal immunological profiles. In this study, we investigated the inflammatory and humoral responses to SARS-CoV-2 in maternal and cord blood paired samples. Thirty-six pregnant women were recruited at delivery at Hospital Sant Joan de Déu, Barcelona, Spain, between April-August 2020, before having COVID-19 available vaccines. Maternal and pregnancy variables, as well as perinatal outcomes, were recorded in questionnaires. Nasopharyngeal swabs and maternal and cord blood samples were collected for SARS-CoV-2 detection by rRT-PCR and serology, respectively. We measured IgM, IgG and IgA levels to 6 SARS-CoV-2 antigens (spike [S], S1, S2, receptor-binding domain [RBD], nucleocapsid [N] full-length and C-terminus), IgG to N from 4 human coronaviruses (OC43, HKU1, 229E and NL63), and the concentrations of 30 cytokines, chemokines and growth factors by Luminex. Mothers were classified as infected or non-infected based on the rRT-PCR and serology results. Sixty-four % of pregnant women were infected with SARS-CoV-2 (positive by rRT-PCR during the third trimester and/or serology just after delivery). None of the newborns tested positive for rRT-PCR. SARS-CoV-2 infected mothers had increased levels of virus-specific antibodies and several cytokines. Those with symptoms had higher cytokine levels. IFN-α was increased in cord blood from infected mothers, and in cord blood of symptomatic mothers, EGF, FGF, IL-17 and IL-15 were increased, whereas RANTES was decreased. Maternal IgG and cytokine levels showed positive correlations with their counterparts in cord blood. rRT-PCR positive mothers showed lower transfer of SARS-CoV-2-specific IgGs, with a stronger effect when infection was closer to delivery. SARS-CoV-2 infected mothers carrying a male fetus had higher antibody levels and higher EGF, IL-15 and IL-7 concentrations. Our results show that SARS-CoV-2 infection during the third trimester of pregnancy induces a robust antibody and cytokine response at delivery and causes a significant reduction of the SARS-CoV-2-specific IgGs transplacental transfer, with a stronger negative effect when the infection is closer to delivery.

Do SARS-CoV-2-Infected Pregnant Women Have Adverse Pregnancy Outcomes as Compared to Non-Infected Pregnant Women?

Purpose

To determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies.

Patients and Methods

A retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups.

Results

Our hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46-3.34; p<0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72-30.77; p<0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65-203.5; p<0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99-27.23; p<0.001].

Conclusion

Significant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.

Pregnancy outcomes among pregnant women infected with COVID-19 with and without underlying disease: A case-control study

Emerging infections have many effects on the health of pregnant mothers and their fetuses. Given the importance of coronavirus disease (COVID-19) during pregnancy, this study aims to evaluate the pregnancy and fetal outcomes in pregnant women with COVID-19 by using previous studies. To conduct this study, all studies related to the subject under discussion during the years 2000-2021 were checked out by systematic search in internationally available databases, including Web of Science, Science Direct, Scopus, PubMed, and Google Scholar. Finally, 21 closely related studies were selected to investigate the main objective. The results showed that common symptoms of COVID-19 in pregnant women included fever, cough, and muscle aches. The most common laboratory results included decreased blood lymphocytes and increased blood CRP. Consequences of pregnancy and childbirth in pregnant women included increased preterm delivery and increased cesarean section. Based on the results of the reviewed study, it can be concluded that newborns of mothers with COVID-19 were negative for COVID-19. However, the most common outcome for infants born to mothers with COVID-19 was low birth weight. Clinical signs, laboratory results, and radiographic criteria in pregnant women with COVID-19 are similar to those in non-infected adults. However, it is recommended that precautions be taken to prevent transmission of the virus, as well as preventive health instructions, particularly masking.

COVID-19 vaccination in pregnancy: A review of maternal and infant benefits

Pregnant women with COVID-19 are more likely to be admitted to the intensive care unit and their babies born prematurely. Clinical trials excluded pregnant women from the vaccine and safety data were limited. However, an increasing number of studies have demonstrated the safety and immunogenicity of the COVID-19 vaccines for pregnant women and their babies including evidence of maternal transfer of antibodies. In addition to these benefits, the vaccines are proved to be effective for both the pregnant women and infants. The current evidence supports the safety, immunogenicity of the COVID-19 vaccine and its effectiveness in reducing the theoretical risk of the infection among pregnant women and their infants. This review summarizes the recent data on the beneficial effects of COVID-19 immunization on both the pregnant mother and infant.

Prevalence of anxiety and depression among pregnant women during the COVID-19 pandemic: a meta-analysis

PURPOSE

Coronavirus disease (COVID-19) is a newly emerged respiratory illness, which has spread around the world. Pregnant women are exposed to additional pressure due to the indirect adverse effects of this pandemic on their physical and mental health. Since the psychological wellness framework is weak in developing countries, it is likely that geographical factors affect the prevalence. Therefore, the goal of this meta-analysis is to investigate the prevalence of anxiety and depression among pregnant women during the COVID-19 pandemic.

METHODS

We searched databases including PubMed/MEDLINE, Web of Science, Cochrane Library for articles. The quality of studies was determined based on the STROBE checklist. I2 and Cochrane Q-test were used to determine heterogeneity. Fixed effects and/or random effects models were also employed to estimate pooled prevalence.

RESULTS

Since heterogeneity was fairly high in all analyses, the random effect model was used. According to the results of random effects in the meta-analysis, the pooled prevalence was 18.7% (95% CI: 0.06-0.36%; I2=99%,P<0.001) for anxiety and 25.1% (95% CI: 0.18-0.33%; I2=97%, P<0.001) for depression. The results of continent subgroup analysis showed that the prevalence of anxiety was higher in western country (38%) than in Asia country (7.8%). The prevalence of anxiety in Italy (38%), Canada (56%), Pakistan (14%), Greece (53%), Sri Lanka (17.5%), and China (0.3-29%) and Iran 3.8% as well as the prevalence of depression in Canada (37%), Belgium (25%), Turkey (35.4%), Sri Lanka (19.5%), and China (11-29%) has been reported.

CONCLUSION

Covid-19 may impose extra pressure on the emotional wellbeing of pregnant women. Therefore, there is an urgent need for resources to help mitigate anxiety and depression in pregnant women.

Review of Impact of COVID-19 on Maternal, Neonatal Outcomes, and Placental Changes

Coronavirus disease (COVID-19), caused by SARS-CoV-2, is a disease that has caused a global impact. COVID-19 is transmitted through airborne droplets, respiratory secretions, and direct contact. The pandemic has affected individuals of different ages, and studying the impact of COVID-19 on maternal and newborn outcomes is critical. In this review, we highlight the impact of COVID-19 infection in pregnancy and its repercussion in the maternal-fetal binomial. Physiological changes that occur during pregnancy have significant effects on the immune system, cardiopulmonary system, and coagulation, and these changes can result in an altered response to COVID-19 infection. The symptoms, risk factors, and maternal health consequences of COVID-19 were discussed. In addition, the impact of newborns born to mothers with COVID-19 was reviewed. Finally, placental changes and vertical transmission of COVID-19 during pregnancy were also discussed in this review.

A Mixed-Methods Study of COVID-19 Vaccine Acceptance and Its Determinants Among Pregnant Women in Northeast Ethiopia

Background

The World Health Organization recommends that pregnant women should receive a vaccine against COVID-19. However, COVID-19 vaccine hesitance was one of the barriers to delivering the vaccine, and this issue was not well addressed in Ethiopia. Therefore, we aimed to determine the prevalence of COVID-19 vaccination acceptability and the factors that influence it among pregnant women in Northeast Ethiopia.

Methods

A mixed-methods approach comprising both qualitative interviews and a quantitative survey was conducted from January 1-30, 2022. For the quantitative part, a multi-stage sampling technique was used to recruit the study participants (n=702). Data was collected through face-to-face interviews using pretested and structured questionnaires. Bivariate and multivariable logistic regression analyses were employed. The statistical difference was considered at P-0.05, and the strength of association was assessed by the odds ratio and respective 95% confidence intervals. For the qualitative part, 18 participants were selected purposively for in-depth interviews, an interviewer guide was used for data collection and thematic content analysis was performed.

Results

In this study, a total of 702 pregnant women were included with the response rate of 100%. The rate of COVID-19 vaccine acceptance was 22.6% (95% CI: 19.6%, 25.9%). The husbands' educational level (AOR = 1.99, 95% CI: 1.09, 3.64), chronic medical illness (AOR = 2.41, 95% CI: 1.28, 4.54), positive attitude (AOR = 1.59, 95% CI: 1.09, 2.31), and good practice of COVID-19 preventive measures (AOR = 1.59, 95% CI: 1.09, 2.31) were determinant factors of COVID-19 vaccine acceptance. According to the qualitative findings, the most common reasons for COVID-19 vaccine hesitancy were fear of fetal side effects, misconceptions about the vaccine, and religious beliefs.

Conclusion

In this study, the acceptability of the COVID-19 vaccine was low. Therefore, health professionals should disseminate accurate vaccination information and address misinformation to boost vaccine acceptance among pregnant women.

COVID-19 vaccine hesitancy among pregnant women: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis to estimate the vaccines' acceptance level and to find the factors influencing pregnant women's vaccination decisions, with the goal of assisting in the development of interventions and promoting more research in this area.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, CINAHL and PubMed.

ELIGIBILITY CRITERIA

Studies providing any kind of quantitative assessment of overall COVID-19 vaccination acceptance among pregnant women in any country or region across the globe.

DATA EXTRACTION AND SYNTHESIS

The pooled prevalence of COVID-19 vaccine acceptance among pregnant women was calculated using the random-effects model. Subgroup (sensitivity) analysis was performed to determine the overall COVID-19 vaccine acceptance level to understand the sources of substantial heterogeneity.

RESULTS

Out of the 375 studies identified, 17 studies from four continents assessing 25 147 participants (pregnant women) were included in this study. Among the participants, only 49% (95% CI 42% to 56%, p<0.001) had COVID-19 vaccine acceptance. High-income countries (47%; 95% CI 38% to 55%, p<0.001), participants with fewer than 12 years of education (38%; 95% CI 19% to 58%, p<0.001) and multiparous women (48%; 95% CI 31% to 66%, p<0.001) had lower COVID-19 vaccine acceptance. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (p<0.001). A very weak positive correlation between COVID-19 knowledge and COVID-19 vaccine acceptance was observed (r=0.164; 95% CI -0.946 to 0.972; p=0.8359).

CONCLUSION

Overall, COVID-19 vaccine acceptance among pregnant women was low across the studies and considerably low among some specific subgroups of participants. These research findings have implications for the development of effective interventions that could increase the COVID-19 vaccine acceptance level among pregnant women to attain herd immunity.

PROSPERO REGISTRATION NUMBER

CRD42021277754.

Giving Birth in the Early Phases of the COVID-19 Pandemic: The Patient Experience

Objective

Obstetrical patients are at risk of complications from COVID-19 and face increased stress due to the pandemic and changes in hospital birth setting. The objective was to describe the perinatal care experiences of obstetrical patients who gave birth during the early phases of the COVID-19 pandemic.

Methods

A descriptive epidemiological survey was administered to consenting patients who gave birth at The Ottawa Hospital (TOH) between March 16th and June 16th, 2020. The participants reported on prenatal, in-hospital, and postpartum care experiences. COVID-19 pandemic related household stress factors were investigated. Frequencies and percentages are presented for categorical variables and median and interquartile range (IQR) for continuous variables.

Results

A total of 216 participants were included in the analyses. Median participants age was 33 years (IQR: 30–36). Collectively, 94 (43.5%) participants felt elevated stress for prenatal appointments and 105 (48.6%) for postpartum appointments because of COVID-19. There were 108 (50.0%) were scared to go to the hospital for delivery, 97 (44.9%) wore a mask during labour and 54 (25.0%) gave birth without a support person. During postpartum care, 125 (57.9%) had phone appointments (not offered prior to COVID-19), and 18 (8.3%) received no postpartum care at all.

Conclusion

COVID-19 pandemic and public health protocols created a stressful healthcare environment for the obstetrical population where many were fearful of accessing services, experienced changes to standard care, or no care at all. As the pandemic continues, careful attention should be given to the perinatal population to reduce stress and improve continuity of care.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-022-03495-2.

Vertical Transmission of SARS-CoV-2 Infection and Miscarriage in the Second Trimester: Report of an Immunohistochemically Proven Case

It is an acknowledged fact that SARS-CoV-2 exhibits tropism for the human placenta. A possible mechanism of SARS-CoV-2 entry into host cells is via angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in trophoblasts, endothelial cells, and macrophages. The present study describes a case of spontaneous miscarriage in the 20th gestational week after maternal SARS-CoV-2 infection. The placenta and various fetal organs were examined for structural alterations and expression of the viral nucleocapsid protein and several immune cell markers via immunohistochemistry (IHC). Histopathological examination of the placenta revealed acute chorioamnionitis, acute subamnionic placentitis, multiple intervillous thrombi, increased fibrinoid deposition, and necrotic changes of the chorionic villi. Immunohistochemistry confirmed the presence of SARS-CoV-2 nucleocapsid protein regions predominantly in the syncytiotrophoblast. Staining of the placental tissue for different markers helped elucidate the distribution of immune cells. Pathomorphological examination of the fetal organs demonstrated changes in microcirculation with the presence of sludge phenomenon and diapedesis haemorrhages, mostly in the lungs, brain, and myocardium. IHC staining of fetal organs revealed expression of SARS-CoV-2 nucleocapsid protein, which was detected to the highest extent in the brain, lungs, and liver. The findings of the present report support the hypothesis of possible vertical transmission of SARS-CoV-2 from mother to fetus.

RNA Viruses, Pregnancy and Vaccination: Emerging Lessons from COVID-19 and Ebola Virus Disease

Pathogenic viruses with an RNA genome represent a challenge for global human health since they have the tremendous potential to develop into devastating pandemics/epidemics. The management of the recent COVID-19 pandemic was possible to a certain extent only because of the strong foundations laid by the research on previous viral outbreaks, especially Ebola Virus Disease (EVD). A clear understanding of the mechanisms of the host immune response generated upon viral infections is a prime requisite for the development of new therapeutic strategies. Hence, we present here a comparative study of alterations in immune response upon SARS-CoV-2 and Ebola virus infections that illustrate many common features. Vaccination and pregnancy are two important aspects that need to be studied from an immunological perspective. So, we summarize the outcomes and immune responses in vaccinated and pregnant individuals in the context of COVID-19 and EVD. Considering the significance of immunomodulatory approaches in combating both these diseases, we have also presented the state of the art of such therapeutics and prophylactics. Currently, several vaccines against these viruses have been approved or are under clinical trials in various parts of the world. Therefore, we also recapitulate the latest developments in these which would inspire researchers to look for possibilities of developing vaccines against many other RNA viruses. We hope that the similar aspects in COVID-19 and EVD open up new avenues for the development of pan-viral therapies.

I Had to Go in a Bubble: Investigating the Effects of COVID-19 on Fertility Treatments and Nutrition

Background:

Individuals modify their lifestyles including nutrition to improve fertility. The COVID-19 pandemic limited access to clinical offices or resulted in the closure of fertility clinics. The pandemic also impacted diet through reduced availability and lifestyle choices. This article's purpose was to understand the consequences of the COVID-19 pandemic on diet, lifestyle, and the course of fertility treatment.

Methods:

The research was conducted through qualitative data collected for a larger study regarding fertility and nutritional guidance. Thematic analysis from eight interviews was used to uncover major and subthemes among the transcripts.

Results:

The results showed two resulting main themes: disruption and distress on the fertility journey of these individuals, as well as the added stress of limited food access, which reduced their ability to continue their dietary choices.

Conclusions:

Our findings indicate substantial disruptions to food access and to individuals' fertility treatment during the first year of the COVID-19 pandemic. Recommendations from these findings suggest that consistent clinic policies can allow for increased support system integration. A further recommendation is the need for a multidisciplinary team to support the individuals going through fertility treatments, such as a registered dietitian to help meal plan around their diet protocol. A registered dietitian would be able to assist patients in making adjustments when faced with limited access to certain food resources as a result of the pandemic.

SARS-CoV-2 reinfection across a spectrum of immunological states

Purpose

Several cases of symptomatic reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after full recovery from a prior episode have been reported. As reinfection has become an increasingly common phenomenon, an improved understanding of the risk factors for reinfection and the character and duration of the serological responses to infection and vaccination is critical for managing the coronavirus disease 2019 (COVID-19) pandemic.

Methods

We described four cases of SARS-CoV-2 reinfection in individuals representing a spectrum of healthy and immunocompromised states, including (1) a healthy 41-year-old pediatrician, (2) an immunocompromised 31-year-old with granulomatosis with polyangiitis, (3) a healthy 26-year-old pregnant woman, and (4) a 50-year-old with hypertension and hyperlipidemia. We performed confirmatory quantitative reverse transcription-polymerase chain reaction and qualitative immunoglobulin M and quantitative IgG testing on all available patient samples to confirm the presence of infection and serological response to infection.

Results

Our analysis showed that patients 1 and 2, a healthy and an immunocompromised patient, both failed to mount a robust serologic response to the initial infection. In contrast, patients 3 and 4, with minimal comorbid disease, both mounted a strong serological response to their initial infection, but were still susceptible to reinfection.

Conclusion

Repeat episodes of COVID-19 are capable of occurring in patients regardless of the presence of known risk factors for infection or level of serological response to infection, although this did not trigger critical illness in any instance.

Severe maternal morbidity in pregnant patients with SARS-CoV-2 infection

BACKGROUND

Although the increased risk for severe illness and adverse pregnancy outcomes associated with SARS-CoV-2 infection during pregnancy is well described, the association of infection with severe maternal morbidity has not been well characterized.

OBJECTIVE

This study aimed to evaluate the risk for severe maternal morbidity associated with SARS-CoV-2 infection during pregnancy.

STUDY DESIGN

This was a multicenter retrospective cohort study of all pregnant patients who had a SARS-CoV-2 test done and who delivered in a New York health system between March 1, 2020 and March 1, 2021. Patients with missing test results were excluded. The primary outcome of severe maternal morbidity, derived from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine example list of diagnoses and complications, was compared between the following 2 groups: patients who tested positive for SARS-CoV-2 during pregnancy and patients who tested negative. Secondary outcomes included subgroups of severe maternal morbidity. Multivariable logistic regression was used to adjust for potential confounders such as maternal demographics, neighborhood socioeconomic status, hospital location, and pregnancy-related complications. A subanalysis was performed to determine if the risk for severe obstetrical hemorrhage and hypertension-associated or neurologic morbidity differed based on the timing of SARS-CoV-2 infection between those who tested positive for SARS-CoV-2 at their delivery hospitalization (ie, active infection) and those who tested positive during pregnancy but negative at their delivery hospitalization (ie, resolved infection).

RESULTS

Of the 22,483 patients included, 1653 (7.4%) tested positive for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were more commonly Black, multiracial, Hispanic, non-English speaking, used Medicaid insurance, were multiparous, and from neighborhoods with a lower socioeconomic status. Patients with SARS-CoV-2 infection were at an increased risk for severe maternal morbidity when compared with those without infection (9.3 vs 6.5%; adjusted odds ratio, 1.52; 95% confidence interval, 1.21–1.88). Patients with SARS-CoV-2 infection were also at an increased risk for severe obstetrical hemorrhage (1.1% vs 0.5%; adjusted odds ratio, 1.78; 95% confidence interval, 1.04–2.88), pulmonary morbidity (2.0% vs 0.5%; adjusted odds ratio, 3.90; 95% confidence interval, 2.52–5.89), and intensive care unit admission (1.8% vs 0.5%; adjusted odds ratio, 3.29; 95% confidence interval, 2.09–5.04) when compared with those without infection. The risk for hypertension-associated or neurologic morbidity was similar between the 2 groups. The timing of SARS-CoV-2 infection (whether active or resolved at time of delivery) was not associated with the risk for severe obstetrical hemorrhage or hypertension-associated or neurologic morbidity when compared with those without infection.

CONCLUSION

SARS-CoV-2 infection during pregnancy was associated with an increased risk for severe maternal morbidity, severe obstetrical hemorrhage, pulmonary morbidity, and intensive care unit admission. These data highlight the need for obstetrical unit preparedness in caring for patients with SARS-CoV-2 infection, continued public health efforts aimed at minimizing the risk for infection, and support in including this select population in investigational therapy and vaccine trials.

Immune System and Psychological State of Pregnant Women during COVID-19 Pandemic: Are Micronutrients Able to Support Pregnancy?

The immune system is highly dynamic and susceptible to many alterations throughout pregnancy. Since December 2019, a pandemic caused by coronavirus disease 19 (COVID-19) has swept the globe. To contain the spread of COVID-19, immediate measures such as quarantine and isolation were implemented. These containment measures have contributed to exacerbate situations of anxiety and stress, especially in pregnant women, who are already particularly anxious about their condition. Alterations in the psychological state of pregnant women are related to alterations in the immune system, which is more vulnerable under stress. COVID-19 could therefore find fertile soil in these individuals and risk more severe forms. Normally a controlled dietary regimen is followed during pregnancy, but the use of particular vitamins and micronutrients can help counteract depressive-anxiety states and stress, can improve the immune system, and provide an additional weapon in the defense against COVID-19 to bring the pregnancy to fruition. This review aims to gather data on the impact of COVID-19 on the immune system and psychological condition of pregnant women and to assess whether some micronutrients can improve their psychophysical symptoms.

Investigation of maternal and perinatal outcome in a population of Iranian pregnant women infected with COVID-19

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnant women might affect both maternal and neonatal outcomes. Based on the inconsistency between the results of the previous studies and the lack of data about the possible vertical transmission of SARS-CoV-2, we designed the present study to investigate the maternal and perinatal outcomes in 182 Iranian pregnant women infected with COVID-19. Among 40 PCR tests conducted on neonatal throat samples, 11 tests were positive. Among the assessed women, 22 women needed ICU admission and 30 premature labors occurred. There were significant associations between ICU admission and many parameters such as the presence of dyspnea (P < 0.001), COVID-19-related CT scan findings (P = 0.003), need for a ventilator (P < 0.001), and low O₂ saturation (P < 0.001), all of which indicate the critical situation of patients. Notably, the cause of delivery was significantly different in both groups, with labor pain and fetal distress being the most frequent causes of delivery in non-ICU and ICU-admitted patients, respectively. Moreover, delivery route (P = 0.003), frequencies of IUGR (P = 0.042), neonatal death (P = 0.008) and asphyxia (P = 0.016), Apgar score (P = 0.003), and gestational age at delivery (P = 0.009) have been associated with ICU admission. The present investigation exhibits association between the critical situation of pregnant women affected with COVID-19 and some adverse neonatal outcomes.

A bias away from Th2 in amniotic fluid is involved in preeclampsia

Inflammatory cytokines contribute to the pathophysiology of preeclampsia. However, whether the imbalance of Th1/Th2 cytokines in amniotic fluid is associated with preeclampsia is not well defined. In the present study, we collected peripheral blood and amniotic fluid from normal pregnancy (n = 25) and preeclampsia (n = 22) at last trimester during cesarean section. The Th1/Th2 cytokine levels in amniotic fluid supernatant were detected by a bead-based immunoassay. The percentage of IFN-γ⁺CD4⁺ T cells, TNF-α⁺CD4⁺ T cells, IL-4⁺CD4⁺ T cells and IL-10⁺CD4⁺ T cells in peripheral blood was detected by flow cytometry. We found that in normal pregnancy, the IFN-γ/IL-4 and IFN-γ/IL-5 ratios were decreased in amniotic fluid supernatant compared to that in plasma, indicating a Th2 bias. However, IFN-γ/IL-4 (P = 0.014), IFN-γ/IL-5 (P = 0.005) and IFN-γ/IL-13 (P = 0.047) ratios in amniotic fluid supernatant was significantly increased in preeclampsia patients. The percentage of IFN-γ⁺CD4⁺ T cells (20.70 ± 7.61% vs 16.55 ± 4.96%, P = 0.041) and TNF-α⁺CD4⁺ T cells (31.78 ± 10.66% vs 19.47 ± 13.54%, P = 0.048) was significantly elevated in preeclampsia compared to normal pregnancy. Our finding demonstrates that a shift away from Th2 bias in amniotic fluid and circulating CD4⁺ T cells is involved in the pathogenesis of preeclampsia. This study suggests restoring the Th2 bias in amniotic fluid might be a therapeutic target of preeclampsia.

Clinical Characteristics and Outcome of Neonates Born to SARS-CoV2 Positive Mothers: An Observation Study from a Single Center in South India

Background: The World Health Organization has declared coronavirus disease 2019 (COVID-19) a pandemic worldwide. Older people, individuals with comorbidities, and pregnant women are more susceptible to this virus, leading to adverse outcomes and mortality. Methods: Mothers with COVID-19 were divided into two groups of symptomatic and asymptomatic positive cases. Neonates were clinically evaluated and screened at 24 - 48 hours of age for SARS-CoV-2 by real-time polymerase chain reaction. Maternal and neonatal demographics, clinical characteristics, and follow-up at 14 days post-discharge were recorded. The adverse birth outcomes, preterm premature rupture of membrane (PPROM), cesarean section delivery (C-section), and duration of hospital stay were evaluated. Results: Out of 453 pregnant women, 59 (13.1%) and 394 (86.9%) were positive and negative for SARS-CoV-2, respectively. We subclassified 59 infected pregnant women were into two groups symptomatic (10.1%) and asymptomatic (89.8%). The PPROM (P = 0.001), gestational diabetes mellitus (P = 0.006), C-section (P = 0.002), and APGAR score (P = 0.029) had a significant association with SARS-CoV-2 presence in mothers and neonates. Conclusions: None of the neonates from infected pregnant women were infected with SARS-CoV-2, suggesting no negligible risk for mother-to-child transmission of the virus. However, the mother-newborn dyad needs to be followed up further to confirm our results.

What is the Hidden Biological Mechanism Underlying the Possible SARS-CoV-2 Vertical Transmission? A Mini Review

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2) represents an emerging infection that is spreading around the world. Among susceptible patients, pregnant women are more likely to develop serious complications and negative obstetric outcomes. Vertical transmission constitutes a debating issue which has not been completely understood. This review aims at describing the currently available evidence on SARS-CoV2 vertical transmission. We carried out a computerized literature search in the Cochrane Library, PubMed, Scopus and Web of Science, selecting the most relevant studies on vertical transmission from the outbreak onset until February 2022. The analysis of the available literature identifies the presence of SARS-CoV2 genome in different biological specimens, confirming the hypothesis that a transplacental infection can occur. In spite of the high number of infected people around the world, mother-to-child infections have been infrequently reported but it can be observed under certain biologic conditions. A deep knowledge of the underlying mechanisms of SARS-CoV2 vertical transmission is of paramount importance for planning an adequate management for the affected mothers and newborns.

Understanding the content of COVID-19 vaccination and pregnancy videos on YouTube: An analysis of videos published at the start of the vaccine rollout

Over 2 years into the COVID-19 pandemic, information on the safety and efficacy of COVID-19 vaccination, particularly for people in high-risk populations, has become a popular topic of discussion. The purpose of this study was to analyze the content and characteristics of YouTube videos related to COVID-19 vaccination and pregnancy. The 50 most viewed English language videos on pregnancy and COVID-19 vaccination were included in this study. The 50 YouTube videos were viewed 4,589,613 times, with 6% uploaded by consumers, 40% by medical professionals, and 44% by television or internet-based news. Videos from consumer sources more often mentioned a human trial of the COVID-19 vaccine (75% of consumer videos vs. 65% of medical professional videos and 31.8% of television or internet-based news videos, P = .036) and more often mentioned anti-vaccination sentiment, fear, or distrust of the vaccines (37.5% of consumer videos vs 5.0% of medical professional videos and 4.5% of television or internet-based news videos, P = .018). Videos uploaded by medical professionals more often mentioned emergency use of the COVID-19 vaccines (P = .016), passive immunity in general (P = .011), and that the COVID-19 vaccine is either unlikely to or will not cause harm in breastfeeding more often than did videos from consumer or television-based news sources (P = .034). New information regarding COVID-19 vaccination and pregnancy is continuing to emerge, and this study highlights that the information found in the most viewed YouTube videos on this topic can quickly become outdated.

A temporal study of Brazilian pregnant and postpartum women vulnerability for COVID-19: Characteristics, risk factors and outcomes

Background

During the COVID-19 second wave in Brazil, there has been a significant increase in the number of daily cases and deaths, including pregnant and postpartum women. We assess risk factors and outcomes for this priority group compared to the COVID-19 non-pregnant cohort in two epidemic waves.

Methods

In this retrospective cohort study we evaluated data of hospitalized pregnant, postpartum, and nonpregnant women aged 15-44 years, between epidemiological weeks 2020–8 and 2021–15, who tested positive for SARS-CoV-2, retrieved from the Influenza Epidemiological Surveillance Information System maintained by Ministry of Health of Brazil. We analysed in-hospital case fatality rate, crude and adjusted risk ratios on different outcomes aiming to compare data in two waves.

Findings

The study included pregnant women (n = 7,132), postpartum women (n = 2,405) and nonpregnant women (n = 76,278) hospitalized with COVID-19. Case fatality rates of pregnant women were lower in both waves compared to nonpregnant women, but higher among postpartum women. The risk for admission to the intensive care unit and invasive mechanical ventilation requirement in both waves was significantly higher among postpartum women compared to nonpregnant women. Cardiac disease, diabetes, obesity, and asthma were the most frequent underlying medical conditions in all patient groups. These comorbidities were significantly less frequent among pregnant women.

Interpretation

Pregnant women with COVID-19 are at lower risk of poor outcome compared to nonpregnant women. On the other hand, postpartum women are at higher risk of adverse outcomes compared to pregnant and nonpregnant women, especially during the second wave. There was a significant increase in the in-hospital case fatality rate for all patient groups during the second wave of COVID-19.

Funding

This study was financed in part by CAPES, CNPq, FAPEMIG and UFSJ.

Food Intake and Diet Quality of Pregnant Women in China During the COVID-19 Pandemic: A National Cross-Sectional Study

Background:

Between January and April 2020, China implemented differentiated prevention and control strategies across the country, based on the severity of the COVID-19 epidemic/pandemic in different regions. These strategies included lockdowns, social distancing, and the closure of public places. These measures may have affected dietary intake to varying degrees. This study aimed to assess variations in food intake and diet quality among pregnant women according to regional severity and related control measures during the most severe period of COVID-19 restrictions in 2020.

Methods

A total of 3,678 pregnant women from 19 provinces/municipalities in mainland China were analyzed in this nationwide, multi-center study. Food intake data were obtained and assessed using a validated food frequency questionnaire (FFQ). Diet quality was quantified using the Diet Balance Index for Pregnancy (DBI-P), which included high bound score (HBS, excessive dietary intake), low bound score (LBS, insufficient dietary intake), and diet quality distance (DQD, dietary imbalance). Linear trend tests and multivariable regression analyses were performed to examine the association between food intake, DBI-P and the severity of pandemic.

Results

The median daily intake of vegetables, fruit, livestock/poultry meat, dairy, and nuts decreased (p < 0.05) according to low, moderate, and high severity of the pandemic, while no significant differences in cereals/potatoes, eggs, and fish/shrimp intake. The median daily intake of cereals/potatoes exceeded the recommended ranges, and the daily intake of eggs and fish/shrimp was below recommended ranges regardless of the pandemic severity (p < 0.05). Regarding diet quality, HBS decreased (lower excessive consumption) (p = 0.047) and LBS increased (greater insufficient consumption) (p = 0.046) with increased severity of the pandemic. On multivariable analyses, moderate and high pandemic severity were related to lower HBS risk (OR = 0.687, OR = 0.537) and higher LBS risk (β = 1.517, β = 3.020) when compared to low pandemic severity.

Conclusions

Under more severe COVID-19 pandemic conditions, pregnant women consumed less quality food, characterized by reduced consumption of vegetables, fruit, livestock/poultry meat, dairy and nuts, while the quality of the foods that pregnant women consumed in excess tended to improve, but the overconsumption of cereals/potatoes was a problem.

Recommendations for breastfeeding during Coronavirus Disease 2019 (COVID-19) pandemic

Background

Coronavirus Disease 2019 (COVID-19) has spread worldwide. The safety of breastfeeding of SARS-CoV-2-positive women has not yet reached a consensus among the scientific community, healthcare providers, experts in lactation care, health organizations and governments. This study was conducted to summarize the latest evidence about the safety of breastfeeding among suspected/confirmed infected mothers and to summarize the recommendations on breastfeeding during COVID-19 from different organizations.

Methods

A comprehensive literature review of publications about the safety of breastfeeding among SARS-CoV-2-infected mothers was conducted. Scientific databases were searched up to 26 May 2021. The evidence was summarized into five perspectives according to a framework proposed by van de Perre et al. with certain modifications. Moreover, websites of different health organizations were visited to gather the recommendations for breastfeeding.

Results

The current evidence demonstrated that the majority of infants breastfed by infected mothers were negative for SARS-CoV-2. Breast milk samples from suspected/infected mothers mainly demonstrated negative results in SARS-CoV-2 viral tests. There was insufficient evidence proving the infectivity of breast milk from infected mothers. Recent studies found other transmission modalities (e.g., milk containers, skin) associated with breastfeeding. Specific antibodies in the breast milk of infected mothers were also found, implying protective effects for their breastfed children. According to van de Perre’s criteria, the breast milk of infected mothers was unlikely to transmit SARS-CoV-2. Owing to the low quality of the current evidence, studies with a more robust design are needed to strengthen the conclusion regarding the safety of breastfeeding. Further studies to follow up the health status of infants who were directly breastfed by their suspected/infected mothers, to collect breast milk samples at multiple time points for viral tests and to examine specific antibodies in breast milk samples are warranted. Current recommendations on breastfeeding during COVID-19 from different organizations are controversial, while direct breastfeeding with contact precautions is generally suggested as the first choice for infected mothers.

Conclusions

This review determined the safety of breastfeeding and identified the focus for further research during the COVID-19 pandemic. Recommendations on breastfeeding are suggested to be updated in a timely manner according to the latest evidence.

Effect of restrictions imposed due to COVID-19 pandemic on the antenatal care and pregnancy outcomes: a prospective observational study from rural North India

OBJECTIVES

To assess the difficulties faced by the pregnant women in seeking appropriate antenatal care due to the restrictions imposed during the COVID-19 pandemic; assess the difficulties encountered during delivery and postpartum period; the suitability of the teleconsultation services offered; effect of COVID-19 infection on pregnancy outcomes and the effect of restrictions on the nutrition profile of the pregnant women.

DESIGN

Prospective observational study.

SETTING AND PARTICIPANTS

We included 1374 pregnant women from the rural areas of three districts of Punjab, India registered at government health centres before the implementation of lockdown due to the COVID-19 pandemic on 24 March 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the difficulties faced by the women during their pregnancies due to restrictions imposed during the lockdown. The secondary outcomes included the effect of COVID-19 infections on pregnancy outcomes, satisfaction from the telemedicine services and restrictions on the nutrition profile of the pregnant women.

RESULTS

One-third of the women (38.4%) considered their last pregnancy unplanned. Women faced difficulties due to the restrictions in getting adequate nutrition (76.5%), accessing transportation facilities (35.4%), consultations from doctors (22.4%) or getting an ultrasonography scan (48.7%). One-fifth (21.9%) of women could not access safe abortion services. Only 3.6% of respondents ever took any teleconsultation services offered by the government. Most of them felt unsatisfied compared with routine visits (77.5%). COVID-19-infected women were primarily asymptomatic (76.1%), but there was a high incidence of preterm birth (42.8%). Frontline workers could visit 64.3% of the women in the postpartum period despite restrictions.

CONCLUSIONS

Lockdown compromised the antenatal care in our study area while the frontline workers attempted to minimise the inconvenience. Telemedicine services did not prove to be of many benefits to pregnant women and should only work as a supplement to the existing protocols of antenatal care.

Impact of Pregnancy on Susceptibility and Severity of COVID-19: A Hospital-Based Prospective Observational Study

OBJECTIVE

 Pregnancy is a transient state of immunosuppression. The objective of this study was to ascertain whether pregnant women are more susceptible to coronavirus disease 2019 (COVID-19) than non-pregnant women and the impact of pregnancy on the severity of COVID-19 and associated morbidity and mortality.

METHODS

 A prospective observational study was performed at All India Institute of Medical Sciences (AIIMS) Rishikesh for a period of two months. A total of 42 and 33 COVID-19 positive women were included in the obstetric and non-obstetric cohorts respectively.

RESULTS

 Baseline characteristics were similar in both groups. Approximately 48% of the obstetric cohort had no COVID-19-related symptoms. Whereas, 100% of the non-obstetric cohort was symptomatic and had a significantly higher number of patients presenting with fever, cough, and breathlessness. The obstetric cohort had a significantly higher incidence of mild disease (p=0.009). In the obstetric cohort, the mean gestational age was 32.59 ± 2.57 weeks, with patients spread across all trimesters. Most of the patients with severe disease were in their second trimester. There was no difference in intensive care unit (ICU) admission, duration of ICU stay, duration of hospital stay, and mortality among both groups. A significantly smaller number of patients in the obstetric cohort required ventilatory support (p=0.0002). The maternal mortality rate was 16.67%. All of them had severe diseases requiring ICU admission. The cause of death was attributed to severe COVID pneumonia with septic shock in all cases. The mortality rate was comparatively higher (27.27%) in the non-obstetric group.

CONCLUSION

 Pregnancy, unlike other immunocompromised conditions, does not seem to affect the prognosis of COVID-19 in terms of disease severity or mortality.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Pregnancy. A Non-systematic Review of Clinical Presentation, Potential Effects of Physiological Adaptations in Pregnancy, and Placental Vascular Alterations

In December 2019, the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) rapidly spread to become a pandemic. To date, increasing evidence has described the potential negative impact of SARS-CoV-2 infection on pregnant women. Although the pathophysiology of coronavirus disease 2019 (COVID-19) is not entirely understood, there is emerging evidence that it causes a severe systemic inflammatory response associated with vascular alterations that could be of special interest considering some physiological changes in pregnancy. Additionally, these alterations may affect the physiology of the placenta and are associated with pregnancy complications and abnormal histologic findings. On the other hand, data about the vaccine against SARS-CoV-2 are limited, but the risks of administering COVID-19 vaccines during pregnancy appear to be minimal. This review summarizes the current literature on SARSCoV2 virus infection, the development of COVID-19 and its relationship with physiological changes, and angiotensin-converting enzyme 2 (ACE2) function during pregnancy. We have particularly emphasized evidence coming from Latin American countries.

Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls

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.

COVID 19 in pregnant women and neonates: Clinical characteristics and laboratory and imaging findings. An overview of systematic reviews

Introduction: SARS-CoV-2 infection in the perinatal period may be associated with an increased risk of morbidity and mortality in both the mother and the neonate. Objective: To describe the clinical characteristics and, laboratory and imaging findings in pregnant women with COVID-19 and their newborns. Materials and methods: We searched PubMed, Scopus, Web of Science, and Cochrane databases for systematic reviews published between February 1, 2020, and May 30, 2021, describing clinical characteristics and laboratory and imaging (chest) findings in pregnant women with COVID-19 and their newborns; there were no language restrictions. Data were reanalyzed by means of Bayesian meta-analysis using Markov Chain Monte Carlo methods. The study protocol is registered in PROSPERO under code CRD42020178329. Results: Six systematic reviews were retrieved (for a total of 617 primary studies). A narrative synthesis of the proportions of signs, symptoms, and imaging and laboratory findings of both mothers and neonates was performed. The Odds ratios (OR) between pregnant women with and without COVID-19 were as follows: fetal well-being involvement: 1.9 (95%CI:1.09-3.63); stillbirth: 1.73 (95%CI:1.01-2.94); preterm birth: 1.77 (95%CI:1.25-2.61); maternal admission to the intensive care unit (ICU): 6.75 (95%CI:1-31.19). Regarding symptomatology, the following OR was obtained for myalgia between pregnant women and non-pregnant women with COVID-19: 0.67 (95% CI:0.51-0.93). Conclusions: Cough, fever, dyspnea, and myalgia are the most common symptoms in pregnant women with COVID-19; in addition, there is a higher risk of admission to the ICU. Regarding complementary testing, the most frequent alterations are lymphopenia and the evidence of lesions in chest imaging studies. The presence of COVID-19 in pregnant women is associated with premature birth. It seems that SARS-CoV-2 infection in neonates is not serious and the risk of vertical transmission is low, since no data about congenital malformations attributable to the virus were found.

Progression of COVID-19 Among Black Pregnant Women: Population-Based Study

The aim of this study was to evaluate the evolution of COVID-19 related to race/skin color among Brazilian pregnant women registered on the Sistema de Informação de Vigilância da Gripe (SIVEP Gripe). This is a population-based study, based on the data from SIVEP Gripe, with data collected at two time points, August 2020 and February 2021. From the complete database (575,935 cases on August 8, 2020 and 1,048,576 cases on January 2, 2021), the weeks 13 to 32 (563,851 cases) and 33 to 53 (469,241 cases) were selected. We selected cases of pregnant women with white, brown and black skin color and final evolution (1,884 and 1,286 cases). The final sample (939 and 858 cases) was defined by including participants who had all the targeted information recorded. The outcome variables were hospitalization, Intensive Care Unit (ICU) admission and COVID-19 deaths. The present study identified that there was a drop of approximately two-thirds in the proportion of pregnant women who required ICU care or died, when comparing the first and second periods. In the second period, black pregnant women had approximately five times higher risk of death compared to white and brown women.

Maternal and Perinatal Outcomes of Hospitalized COVID-19 Positive Pregnant Women

Introduction

The consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) /Coronavirus disease 2019 (COVID-19) on mothers and neonates are uncertain due to the lack of robust evidence from various available studies. Furthermore, conflicting data exist regarding the vertical transmission of coronavirus. Therefore, a hospital-based study was conducted to evaluate the effect of COVID-19 on maternal and perinatal outcomes of COVID-19 infected pregnant women.

Methodology

A hospital-based retrospective observational study was conducted between July-December 2020 in Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, a designated level-2 COVID-19 Hospital. A total of 37 confirmed COVID-19 positive pregnant women (mean age 27.5 ± 05 years) of more than 28 weeks of gestation were included in this study to evaluate the effect of COVID-19 on maternal and perinatal outcomes. Maternal symptoms related to COVID-19, comorbidities, intensive care unit (ICU) admissions, intrauterine growth retardation (IUGR), leaking per vagina, mode of delivery, preterm deliveries, and maternal deaths were recorded. Birth weight of newborns, neonatal intensive care unit (NICU) admissions, neonatal illness, neonatal deaths, and COVID-19 testing reports were recorded. 

Result

Out of 37 COVID-19 positive pregnant women, 27 (72.9%) women were asymptomatic, nine (24.4%) women were having mild disease, and one (2.7%) developed severe disease requiring ICU admission. No maternal deaths were observed. Twenty-six (70.3%) women were delivered by caesarean section, 11 (29.7%) women by normal vaginal delivery, four (10.8%) were of leaking per vagina. Among newborns, five (13.5%) were preterm, one (2.7%) newborn require NICU admission, two (5.4%) were tested COVID-19 positive on the 5th day of life but were asymptomatic, and four (10.8%) newborns developed a fever but were COVID-19 negative. One case (2.7%) was of stillbirth. No neonatal deaths were observed.

Conclusion

The present study did not reveal any direct evidence for vertical transmission of SARS-CoV-2 virus through the placenta and during vaginal delivery, but the possibility of mother-to-child infection cannot be completely ignored. SARS-CoV-2 infection during late pregnancy may have a maternal and neonatal impact. COVID-19 infections in late pregnancy might lead to an increased incidence of caesarean deliveries as observed in the present study. This study reveals that most of the COVID-19 positive pregnant women remained asymptomatic or had mild infections. Hence, efforts to limit exposure to COVID-19 of pregnant women should be strengthened for saving mother and child.

Pregnant and Postpartum Women Requiring Intensive Care Treatment for COVID-19-First Data from the CRONOS-Registry

(1) Background: Data on coronavirus 2 infection during pregnancy vary. We aimed to describe maternal characteristics and clinical presentation of SARS-CoV-2 positive women requiring intensive care treatment for COVID-19 during pregnancy and postpartum period based on data of a comprehensive German surveillance system in obstetric patients. (2) Methods: Data from COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS), a prospective multicenter registry for SARS-CoV-2 positive pregnant women, was analyzed with respect to ICU treatment. All women requiring intensive care treatment for COVID-19 were included and compared regarding maternal characteristics, course of disease, as well as maternal and neonatal outcomes. (3) Results: Of 2650 cases in CRONOS, 101 women (4%) had a documented ICU stay. Median maternal age was 33 (IQR, 30–36) years. COVID-19 was diagnosed at a median gestational age of 33 (IQR, 28–35) weeks. As the most invasive form of COVID-19 treatment interventions, patients received either continuous monitoring of vital signs without further treatment requirement (n = 6), insufflation of oxygen (n = 30), non-invasive ventilation (n = 22), invasive ventilation (n = 28), or escalation to extracorporeal membrane oxygenation (n = 15). No significant clinical differences were identified between patients receiving different forms of ventilatory support for COVID-19. Prevalence of preterm delivery was significantly higher in women receiving invasive respiratory treatments. Four women died of COVID-19 and six fetuses were stillborn. (4) Conclusions: Our cohort shows that progression of COVID-19 is rare in pregnant and postpartum women treated in the ICU. Preterm birth rate is high and COVID-19 requiring respiratory support increases the risk of poor maternal and neonatal outcome.

Transmitted Fetal Immune Response in Cases of SARS-CoV-2 Infections during Pregnancy

(1) Background: Little is known about the effects of SARS-CoV-2 on the placenta, and whether the maternal inflammatory response is transmitted vertically. This research aims to provide information about the effects of SARS-CoV-2 infection on maternal and fetal immunity. (2) Methods: We have studied placental changes and humoral and cellular immunity in maternal and umbilical cord blood (UCB) samples from a group of pregnant women delivering after the diagnosis of SARS-CoV-2 infection during pregnancy. IgG and IgM SARS-CoV-2 antibodies, Interleukin 1b (IL1b), Interleukin 6 (IL6), and gamma-Interferon (IFN-γ), have been studied in the UCB samples. Lymphocyte subsets were studied according to CD3, CD8, CD4, CD34, and invariant natural Killer T cells (iNKT) markers. We used in situ hybridization techniques for the detection of viral RNA in placentas. (3) Results: During the study period, 79 pregnant women and their corresponding newborns were recruited. The main gestational age at the time of delivery was 39.1 weeks (SD 1.3). We did not find traces of the SARS-CoV-2 virus RNA in any of the analyzed placental samples. Detectable concentrations of IgG anti-SARS-CoV-2 antibodies, IL1b, IL6, and IFN-γ, in UCB were found in all cases, but IgM antibodies anti-ARS-CoV-2 were systematically undetectable. We found significant correlations between fetal CD3+ mononuclear cells and UCB IgG concentrations. We also found significant correlations between UCB IgG concentrations and fetal CD3+/CD4+, as well as CD3+/CD8+ T cells subsets. We also discovered that fetal CD3+/CD8+ cell counts were significantly higher in those cases with placental infarctions. (4) Conclusion: we have not verified the placental transfer of SARS-CoV-2. However, we have discovered that a significant immune response is being transmitted to the fetus in cases of SARS-CoV-2 maternal infection.

COVID-19 during Gestation: Maternal Implications of Evoked Oxidative Stress and Iron Metabolism Impairment

COVID-19 has reached pandemic proportions worldwide, with considerable consequences for both health and the economy. In pregnant women, COVID-19 can alter the metabolic environment, iron metabolism, and oxygen supply of trophoblastic cells, and therefore have a negative influence on essential mechanisms of fetal development. The purpose of this study was to investigate, for the first time, the effects of COVID-19 infection during pregnancy with regard to the oxidative/antioxidant status in mothers' serum and placenta, together with placental iron metabolism. Results showed no differences in superoxide dismutase activity and placental antioxidant capacity. However, antioxidant capacity decreased in the serum of infected mothers. Catalase activity decreased in the COVID-19 group, while an increase in 8-hydroxy-2'-deoxyguanosine, hydroperoxides, 15-FT-isoprostanes, and carbonyl groups were recorded in this group. Placental vitamin D, E, and Coenzyme-Q10 also showed to be increased in the COVID-19 group. As for iron-related proteins, an up-regulation of placental DMT1, ferroportin-1, and ferritin expression was recorded in infected women. Due to the potential role of iron metabolism and oxidative stress in placental function and complications, further research is needed to explain the pathogenic mechanism of COVID-19 that may affect pregnancy, so as to assess the short-term and long-term outcomes in mothers' and infants' health.