Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn

Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned

Pregnant individuals with viral illness may experience significant morbidity and have higher rates of pregnancy and neonatal complications. With the growing number of viral infections and new viral pandemics, it is important to examine the effects of infection during pregnancy on both the gestational parent and the offspring. Febrile illness and inflammation during pregnancy are correlated with risk for autism, attention deficit/hyperactivity disorder, and developmental delay in the offspring in human and animal models. Historical viral epidemics had limited follow-up of the offspring of affected pregnancies. Infants exposed to seasonal influenza and the 2009 H1N1 influenza virus experienced increased risks of congenital malformations and neuropsychiatric conditions. Zika virus exposure in utero can lead to a spectrum of abnormalities, ranging from severe microcephaly to neurodevelopmental delays which may appear later in childhood and in the absence of Zika-related birth defects. Vertical infection with severe acute respiratory syndrome coronavirus-2 has occurred rarely, but there appears to be a risk for developmental delays in the infants with antenatal exposure. Determining how illness from infection during pregnancy and specific viral pathogens can affect pregnancy and neurodevelopmental outcomes of offspring can better prepare the community to care for these children as they grow. IMPACT: Viral infections have impacted pregnant people and their offspring throughout history. Antenatal exposure to maternal fever and inflammation may increase risk of developmental and neurobehavioral disorders in infants and children. The recent SARS-CoV-2 pandemic stresses the importance of longitudinal studies to follow pregnancies and offspring neurodevelopment.

Perinatal Outcomes of Newborns of COVID-19-Infected Pregnant Women: An Updated Systematic Review and Meta-Analysis

In this systematic review and meta-analysis, we aimed to review the characteristics and outcomes of the newborns of Coronavirus disease 2019 (COVID-19) infected pregnant women. We conducted an online bibliographic search using the following electronic databases: MEDLINE via PubMed, Scopus, Web of Science, and Cochrane Central. Studies were deemed eligible if they recruited newborns from mothers with confirmed COVID-19 and reported the perinatal outcomes of neonatal COVID-19 cases. A total of 20 studies were included. Neonates born to mothers with positive COVID-19 results have been shown to have significantly lower birth weights (mean difference, MD = -48.54 g, p = 0.04), increased risks of fetal distress (odds ratio, OR = 1.76, p < 0.00001), respiratory distress (OR = 1.96, p = 0.006), premature birth (OR = 2.08, p < 0.00001), neonatal death (OR = 2.20, p = 0.004), and a lower 5-minute Apgar score (OR = 1.44, p = 0.02). Additionally, they were more likely to be admitted to the neonatal intensive care unit (NICU) (OR = 2.25, p = 0.007) and test positive for COVID-19 themselves (OR = 9.88, p = 0.03). However, other parameters, such as risks for malformations, mechanical ventilation, hypoglycemia, and sepsis, appeared to be comparable between the two groups. Maternal infection with COVID-19 during pregnancy is associated with several neonatal outcomes, some of which are adverse and others that do not show significant deviation from norms. While our meta-analysis clearly illustrates heightened risks associated with premature birth, reduced neonatal weight, and other challenges, it also emphasizes that not all neonatal outcomes can be directly attributed to maternal SARS-CoV-2 infection.

Study of the Vertical Transmission of COVID-19 by Using the World Health Organisation Protocol in a Tertiary Care Hospital in Eastern India

BACKGROUND

The World Health Organisation (WHO) has established criteria to diagnose vertical transmission in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the incidence of vertical transmission of SARS-CoV-2 using WHO criteria in a tertiary care centre in eastern India.

METHODS

A hospital-based prospective observational study was conducted from June 2021 to February 2022 on women admitted for delivery with a positive nasopharyngeal (NP) swab and a SARS-CoV-2 real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test. Following the delivery, the amniotic fluid (AF) and swab from the placenta were tested for SARS-CoV-2 by the Truenat test. The umbilical cord and maternal blood were analyzed to detect immunoglobulin M (IgM) and immunoglobulin G (IgG). The nasopharyngeal swabs of the newborns were tested for SARS-CoV-2 by RT-PCR.

RESULTS

Forty-eight SARS-CoV-2-positive asymptomatic women were included in the study. Twenty-eight (58.3%) were delivered via cesarean section. Preterm delivery occurred in 13 (27.1%) cases. In only one case, vertical transmission was confirmed as the neonate had a positive nasopharyngeal SARS-CoV-2 RT-PCR test and the cord blood was IgM positive (suggesting an immune response in the neonate). The placenta was positive in three cases, and amniotic fluid was positive in two. However, vertical transmission was deemed unlikely in these cases as there was no evidence of immune response or viral persistence according to the WHO criteria. There was one stillbirth, and it tested negative for SARS-CoV-2.

CONCLUSION

This study strengthens the evidence of vertical transmission in COVID-19-positive asymptomatic mothers. The data suggest a low transmission rate.

Neonatal outcomes of maternal prenatal coronavirus infection

The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

Pregnancy and SARS-CoV-2 infection with a focus on its vertical transmission, breastfeeding, cord blood banking, and vaccination during COVID-19 infection

The SARS-CoV-2 outbreak led to a health crisis worldwide. This infection can infect individuals, particularly pregnant women. In this review, we tried to find the possibility of vertical transmission of COVID-19 and investigate the effects of COVID-19 on pregnancy, breastfeeding, cord blood banking, and the effects of recommended vaccines on pregnant and lactating women. Keywords include COVID-19, congenital infection, SARS-CoV-2, pregnancy, and COVID-19 vaccines. Vertical transmission of SARS-CoV-2 was searched in scientific databases, such as PubMed, Google Scholar, and Scopus. The criteria for including studies in this article are the study of SARS-CoV-2 infection in pregnant women, fetuses, and neonates during pregnancy and while breastfeeding, and also the effect of COVID-19 vaccines on them. There are several conflicting results in the transmission of SARS-CoV-2 from the maternal-fetal interface. Since many neonates born from COVID-19-infected mothers had no signs of this infection, the possibility of SARS-CoV-2 congenital transmission cannot be confirmed. Also, SARS-CoV-2-infected women can breastfeed their babies if they have mild symptoms. Up till now, no adverse effect of COVID-19 vaccines has been identified on mothers, infants, and the fertility of men or women. Even so, more investigations are needed on the long-term effects of COVID-19 vaccines.

Investigating Factors Influencing Prenatal Stress, Anxiety, and Fear of Childbirth During the COVID-19 Pandemic in Germany and Switzerland: An Online Survey

OBJECTIVES

Pregnant women are likely to experience high levels of stress during the COVID-19 pandemic. However, the factors that might influence the extent of experienced emotional distress are poorly understood. Therefore, we aimed to investigate potential correlates of prenatal emotional distress during the COVID-19 pandemic.

METHODS

In total, N = 1437 pregnant women from Germany and Switzerland participated in an online study during the first wave of the COVID-19 pandemic (May-August 2020). The survey assessed prenatal distress, pandemic-related pregnancy stress, general anxiety, fear of childbirth, and several socio-demographic, pregnancy- and COVID-19-related factors. Linear multivariate regression models were the main analytical strategy.

RESULTS

The results highlight that several factors such as full-time employment, nulliparity, high-risk pregnancy, emotional problems, cancelled prenatal appointments, and stating that COVID-19 affected the choice of birth mode were significantly associated with elevated prenatal distress, anxiety, pandemic-related pregnancy stress, and fear of childbirth. Conversely, access to an outdoor space was a protective factor for pandemic-related pregnancy stress and prenatal distress.

CONCLUSIONS FOR PRACTICE

Overall, the study highlights significant correlates influencing the levels of emotional distress pregnant women experienced during the COVID-19 pandemic. These findings may contribute to the improvement of maternal prenatal medical and psychological care during a public health crisis of international concern, such as the COVID-19 pandemic.

Breastfeeding vs. breast milk transmission during COVID-19 pandemic, which is more important?

The catastrophic coronavirus disease 2019 (COVID-19) pandemic has raised many health questions, and whether breast milk from SARS-CoV-2 infected mothers may be a vector for SARS-CoV-2 transmission has become a hot topic of concern worldwide. Currently, there are extremely limited and conflicting data on the risk of infection in infants through breastfeeding. For this reason, we investigated almost all current clinical studies and systematically analyzed the presence of SARS-CoV-2 and antibodies in the breast milk of mothers infected with SARS-CoV-2, their effects on newborns, and the mechanisms involved. A total of 82 studies were included in this review, of which 66 examined the presence of SARS-CoV-2 in breast milk samples from mothers diagnosed with COVID-19, 29 reported results of antibody detection of SARS-CoV-2 in breast milk, and 13 reported both nucleic acid and antibody test results. Seventeen studies indicated the presence of detectable SARS-CoV-2 nucleic acid in breast milk samples, and only two studies monitored viral activity, both of which reported that infectious viruses could not be cultured from RNA-positive breast milk samples. All 29 studies indicated the presence of at least one of the three antibodies, IgA, IgG and IgM, in breast milk. Five studies indicated the presence of at least one antibody in the serum of breastfed newborns. No COVID-19-related deaths were reported in all 1,346 newborns. Our study suggests that direct breastfeeding does not pose an additional risk of infection to newborns and that breast milk is a beneficial source of anti-SARS-CoV-2 antibodies that provide passive immune protection to infants. In addition, direct breastfeeding would provide maternal benefits. Our review supports the recommendation to encourage direct breastfeeding under appropriate infection control guidelines. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: 458043.

Siglecs family used by pathogens for immune escape may engaged in immune tolerance in pregnancy

The Siglecs family is a group of type I sialic acid-binding immunoglobulin-like receptors that regulate cellular signaling by recognizing sialic acid epitopes. Siglecs are predominantly expressed on the surface of leukocytes, where they play a crucial role in regulating immune activity. Pathogens can exploit inhibitory Siglecs by utilizing their sialic acid components to promote invasion or suppress immune functions, facilitating immune evasion. The establishing of an immune-balanced maternal-fetal interface microenvironment is essential for a successful pregnancy. Dysfunctional immune cells may lead to adverse pregnancy outcomes. Siglecs are important for inducing a phenotypic switch in leukocytes at the maternal-fetal interface toward a less toxic and more tolerant phenotype. Recent discoveries regarding Siglecs in the reproductive system have drawn further attention to their potential roles in reproduction. In this review, we primarily discuss the latest advances in understanding the impact of Siglecs as immune regulators on infections and pregnancy.

COVID-19 in third trimester of pregnancy

The COVID-19 pandemic disease, which affects the respiratory system and produces flu-like symptoms, is caused by the SARS-CoV-2 virus. It is transmitted by close contact, oronasal secretions, or droplets. In general, pregnant individuals are at increased risk than nonpregnant individuals for developing serious SARS-CoV-2 virus-related illnesses, particularly during the third trimester. Despite the lack of research on COVID-19-infected pregnant mothers, this review article has discussed the clinical and laboratory characteristics and impact of COVID-19 on delivery, management, and vaccination of pregnant individuals with COVID-19 infection.

Comparison of in-hospital mortality of COVID-19 between pregnant and non-pregnant women infected with SARS-CoV-2: a historical cohort study

OBJECTIVES

This study aimed to compare pregnant and non-pregnant women infected with SARS-CoV-2 disease (COVID-19) in terms of in-hospital mortality.

METHODS

This historical cohort study was conducted on hospitalized women of reproductive ages (15-49 years) infected with SARS-CoV-2 in Fars province, Iran during 15 March 2019-10 May 2021.

RESULTS

Out of the 5,322 patients, 330 were pregnant. The fatality rate of SARS-CoV-2 was 1.2% amongst pregnant women and 3.5% amongst non-pregnant ones. Pregnant and non-pregnant women reported the same history of smoking, opium use, previous COVID-19 infection, vaccination against SARS-CoV-2, and COVID-19 symptoms (p>0.05 for all). However, the pregnant women were younger and had fewer underlying diseases (p<0.001 for both). The results revealed no significant difference between the two groups regarding in-hospital clinical manifestations including the number of days after the onset of COVID-19 symptoms, mechanical ventilation, and long involvement (cRR; 95% CI=0.99 (0.96-1.02), 1.18 (0.72-2.02), and 0.95 (0.88-1.02), respectively). Nonetheless, Intensive Care Unit (ICU) admission was significantly higher in pregnant women (cRR; 95% CI=2.37(1.85-3.02)). After adjusting for age, history of underlying diseases, and ICU admission, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant women (aRR; 95% CI=0.32 (0.12-0.87)).

CONCLUSIONS

Based on the current study findings, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant ones. Nevertheless, they should follow the same recommendations as non-pregnant women, avoiding exposure to the virus and receiving medical treatment and vaccination. Further studies are recommended to address the follow-up of recovered pregnant women, their babies, and puerperium.

Association between burnout and nurses' quality of life in neonatal intensive care units: During the COVID-19 pandemic

BACKGROUND

Neonatal intensive care unit (NICUs) nurses could suffer from job stress and burnout, which could cause increased turnover rates and decreased Quality of Life (QoL) among nurses.

PURPOSE

To determine the association between burnout and nurses' QoL in NICUs.

STUDY DESIGN

This correlational study was performed in 2020 on 140 nurses working in NICUs. The Maslach burnout and WHO Quality of Life-BREF was used to collect data.

RESULTS

There is a positive association between personal accomplishment and all dimensions of QoL (r = 0.40 to 0.56) and a negative association between emotional exhaustion, depersonalization of burnout and all dimensions of QoL (r = -0.47 to -0.79).

CONCLUSION

It is suggested that several interventions must be taken to prevent burnout and increased QoL in NICU nurses. The findings could provide scientific evidence for managers and encourage evidence-based decision-making to reduce burnout and improve the QoL of nurses especially during the Covid-19 pandemic.

A neonatal case of cerebral venous sinus thrombosis with intrauterine onset after COVID-19 infection during pregnancy: Cause or coincidence?

Coronavirus 19 disease (COVID-19) is known to predispose patients to increased thrombotic events and the risk is higher in pregnancy which is already a hypercoagulable state. Vertical transmission of the disease during pregnancy was neglected according to data early in the pandemic, however, despite conflicting results from different studies, there is an increasing suspicion of vertical transmission with the rise of new fetal and neonatal cases and perinatal transmission can be higher than expected. An early term neonate, with the history of maternal COVID-19 infection in the start of third trimester, was diagnosed as cerebral venous sinus thrombosis and chronic hemorrhagic ischemia, with intrauterine onset.

Pregnancy Outcomes in Women With SARS-CoV-2 Infection During the First and Second Waves of the COVID-19 Pandemic in a Tertiary Care Hospital in Ayodhya, Uttar Pradesh, India: A Comparative Study

Introduction Pregnancy is an altered immunological state and not necessarily an immune-compromised state. These immune changes subject pregnant women to increased susceptibility to infection. During the coronavirus disease 2019 (COVID-19) pandemic, pregnant women were more susceptible to serious illness for reasons other than their immune response. The purpose of this study was to compare the feto-maternal outcome (morbidity and mortality) in relation to pre-existing maternal co-morbidities, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-related disease severity, and its impact on the mode of delivery and long-term sequelae in pregnant women in the first and second waves of the COVID-19 pandemic. Materials and methods This was a hospital-based comparative study carried out on 101 pregnant patients during the first wave (April 2020 to December 2020) and 22 patients in the second wave (March 2021 to July 2021) of the COVID-19 pandemic, in Rajashri Dashrath Autonomous State Medical College, Ayodhya, India. All pregnant women with COVID-19 in the first and second waves were included. Non-pregnant patients with COVID-19 infection, pregnant patients lost to follow-up, pregnant patients without COVID-19 infection, and patients in the puerperal period were excluded. Results Seventy-three (72.27%) patients in the first wave and 12 (54.54%) in the second wave were asymptomatic. Those with mild disease numbered 20 (25.74%) in the first wave and six (27.27%) in the second wave. Disease severity was more in the second wave, that is four (18.18%) as compared to one (0.99%) in the first wave. Severe anemia was the most common co-morbidity associated with both first (n=4, 3.96%) and second (n=5, 22.72%) waves. Four (6.45%) spontaneous abortions occurred in the first wave as compared to three (20%) in the second wave. Intensive care unit (ICU) admission was more in the second wave (n=4, 26.66%) as compared to the first wave (n=1, 1.61%). Two (13.33%) maternal deaths occurred in the second wave and none in the first wave. Cesarean sections in both the first and second waves were performed for obstetric indications only. No newborns tested positive in the COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) in the first and second waves at the time of birth; however, three (4.83%) tested positive on day five of birth in the first wave. Fever was the most common presentation in newborns; seven (11.26%) in the first wave and three (20%) in the second wave. No neonatal death occurred in the first or second waves. No congenital anomalies were noted in the first or second waves of COVID-19. Conclusion In this study, we found that the maximum number of COVID-19-positive pregnant patients in both the first and second waves of COVID-19 were either asymptomatic or had mild infections. Second-wave infection was more lethal as compared to the first wave in terms of adverse maternal as well as fetal outcomes. No gestational age was an exception to the severity of disease and its adverse feto-maternal outcome. In our study, maternal co-morbidities did not impact the overall outcome. All cesarean sections were performed for indications other than COVID-19 infection. Long-term sequelae associated with COVID-19 were seen in both groups but more so in the second wave. No long-term sequelae like congenital anomalies in the babies were associated with COVID-19 either in the first or second wave.

Protecting Breastfeeding during the COVID-19 Pandemic

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has impacted all patient populations including pregnant mothers. There is an incomplete understanding of SARS-CoV-2 pathogenesis and transmission potential at this time and the resultant anxiety has led to variable breastfeeding recommendations for suspected or confirmed mothers with novel coronavirus disease 2019 (COVID-19). Due to the potential concern for transmission of infection from maternal respiratory secretions to the newborn, temporary separation of the maternal-baby dyad, allowing for expressed breast milk to be fed to the infant, was initially recommended but later revised to include breastfeeding by the American Academy of Pediatrics in contrast to international societies, which recommend direct breastfeeding. This separation can have negative health and emotional implications for both mother and baby. Only two publications have reported SARS-CoV-2 in human breast milk but the role of breast milk as a vehicle of transmission of COVID-19 to the newborns still remains unclear and may indeed be providing protective antibodies against SARS-CoV-2 infection even in infected neonates. Other modes of transmission of infection to neonates from infected mothers or any care providers cannot be overemphasized. Symptomatic mothers on hydroxychloroquine can safely breastfeed and no adverse effects were reported in a baby treated with remdesivir in another drug trial. The excretion of sarilumab in human breast milk is unknown at this time. Hence, given the overall safety of breast milk and both short-term and long-term nutritional, immunological, and developmental advantages of breast milk to newborn, breast milk should not be withheld from baby. The setting of maternal care, severity of maternal infection and availability of resources can impact the decision of breastfeeding, the role of shared decision making on breastfeeding between mother and physician needs to be emphasized. We strongly recommend direct breastfeeding with appropriate hygiene precautions unless the maternal or neonatal health condition warrants separation of this dyad. KEY POINTS: · Breastmilk does not appear to play a significant role in transmission of SARS-CoV-2.. · Mother-baby separation has negative health and emotional consequences.. · Mothers with suspected or confirmed COVID-19 can directly breastfeed with appropriate precautions..

Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate

The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.

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.

Consequences of SARS-CoV-2 Infection in Pregnant Women and Their Infants: A Systematic Review

Coronavirus disease 2019 (COVID-19) is a worldwide health problem, particularly for pregnant women. This review assesses the effects of COVID-19 on pregnant women and their infants. A systematic search was performed of studies published on PubMed, Web of Science, Google Scholar, and Embase from January 2020 to January 2021, without restriction by language. This review included 27 studies (22 from China, one from the United States, one from Honduras, one from Italy, one from Iran, and one from Spain), which cumulatively evaluated 386 pregnant women with clinically confirmed COVID-19 and their 334 newborns. Of the 386 pregnant women, 356 had already delivered their infants, four had medical abortions at the time of research, 28 were still pregnant, and two died from COVID-19 before they were able to give birth. Cesarean sections were performed on 71% of pregnant women with COVID-19 to give birth. Fever and cough were common symptoms among women. Premature rupture of membranes, distress, and preterm birth were pregnancy complications. Low birth weight and a short gestational age were common outcomes for newborns. The common laboratory findings among pregnant women were lymphopenia, leukocytosis, and elevated levels of C-reactive protein. Chest computed tomography revealed abnormal viral lung changes in 73.3% of women. Eleven infants tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There was no evidence of vertical transmission. Most infants were observed to have lymphopenia and thrombocytopenia. The clinical features of pregnant women were found to be similar to those of generally infected patients. There is evidence of adverse pregnancy and neonatal outcomes caused by COVID-19.

PERINATAL ASPECTS OF SARS-CoV-2 INFECTION DURING PREGNANCY: A POTENTIAL CAUSE FOR CONCERN

Ever since the beginning of COVID-19 pandemic, uncertainty regarding clinical presentation and differences among various subpopulations exist. With more than 209,870,000 confirmed cases and more than 4,400,000 deaths worldwide, we are facing the new era of health crisis which will undoubtedly impair global health, economic and social circumstances. In the past year, numerous genetic mutations which code SARS-CoV-2 proteins led to the occurrence of new viral strains, with higher transmission rates. Apart from the implementation of vaccination, the effect of SARS-CoV-2 on pregnancy outcome and maternal fetal transmission remains an important concern. Although neonates diagnosed with COVID-19 were mostly asymptomatic or presented with mild disease, the effect on early pregnancy is yet to be evident. While positive finding of SARS-CoV-2 RNA in some samples such as amniotic fluid, placental tissue, cord blood and breast milk exists, additional research should confirm its association with transplacental transmission.

Observational cohort study of perinatal outcomes of women with COVID-19

BACKGROUND

Understanding the impact of SARS-CoV-2 infection on pregnancy outcomes and of pregnancy on COVID-19 outcomes is critical for ensuring proper prenatal and antenatal care. No similar studies have been published in Saudi Arabia.

METHODS

We performed a prospective cohort study of pregnant women with confirmed SARS-CoV-2 infection who presented at King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Kingdom of Saudi Arabia. COVID-19 staging was performed, pregnancy-related complications were assessed, and neonatal infection was evaluated.

RESULTS

We enrolled 81 patients (mean age 31.75 years, SD 5.25) of which there were 17 cases in the first trimester, 20 in the second trimester, and 34 in the third trimester. The distribution of COVID-19 severity was 40 patients with Stage A, 36 with Stage B, 4 with Stage C, and 1 with Stage D. Complications were pregnancy loss in 2 patients (one in each first and second trimester) and 1 fetal death after 20 weeks of pregnancy, 7 patients with fetal growth restriction, and 8 with pre-term delivery.

CONCLUSIONS

We did not observe an unusual frequency of pregnancy-related complications due to SARS-CoV-2 infection in this high-risk obstetric population and there was no evidence of vertical transmission in newborns from women who delivered while positive for the virus.

Viral pulmonary infection in pregnancy - Including COVID-19, SARS, influenza A, and varicella

The COVID-19 pandemic has been at the forefront of medicine over the last few years. Pregnant women are often exposed to infectious agents that can be harmful not only to the mother but also to the foetus. Moreover, changes during pregnancy means that pregnant women have increased vulnerability to viral infections, especially pulmonary infections. Epidemiological studies have shown a link between maternal viral infections and miscarriage, preterm birth as well as congenital defects. With potential poor outcomes for both women and their newborns, having a good understanding of the presentation and management of these viral pulmonary infections is essential. The increased risk of adverse outcomes has been highlighted during the COVID-19, SARS and H1N1 influenza pandemics.

Perinatal Outcome in Maternal COVID-19 infection at a Tertiary care Institute- A cross Sectional Study

Abstract

COVID 19 pandemic is one of the biggest challenge to health system of developing as well as developed countries. Because of the novelty of the virus, limited data were available regarding perinatal outcome. The objective of this study is to find out the perinatal outcome in COVID-19 infected mothers who delivered during COVID Pandemic.

Methodology

A cross sectional study was carried out at PCMC'S Post-Graduate Institute and YCM Hospital Pune (Maharashtra) from 1 May 2020 to 31 October 2021 which was a dedicated COVID hospital during COVID pandemic. A total of 362 maternity patients (including 5 twin pregnancies) having COVID 19 infection who gave birth to 367 Newborns were studied. Maternal COVID -19 infection was diagnosed either by RTPCR test or Rapid Antigen test. Demographic variables, maternal symptoms, labour and neonatal outcome were recorded. RT PCR of neonates at birth was performed. Data was analyzed statistically by using Epi Info Software.

Aim

To analyze the perinatal outcome among COVID-19 infected mothers who delivered during Covid pandemic.

Objectives

Study was conducted with the primary objective to analyze the labour outcome, maternal symptoms and secondarily to study maternal demographic profile and to compare disease severity during 1^st and 2^nd wave of COVID and to detect possibility of vertical transmission of COVID-19 in neonates of covid positive mothers.

Results

74.2% patients from young reproductive age (21-30 years age) were affected. All socioeconomic classes were affected. 61% patients were multigravida. Normal BMI was noted in 49.8%. 28.2% deliveries were preterm. Caesarean section rate was 50.5%. Following obstetric high risk factors were noted-anaemia in 34.2% followed by previous LSCS in 26.2% cases and preeclampsia in 18.7%Overall 54.6% patients were asymptomatic while 45.4% were symptomatic. Symptomatology between 1^st and 2^nd wave showed statistical significance (p value < .05%) for mild, moderate and severe symptoms. Myalgia, cough, fever and fatigue were common presenting symptoms. 14% patients required ICU/HDU care. HDU/ICU requirement showed statistical significance (p value < .05) between 1^st and 2^nd wave. Overall maternal mortality was 1.1% (4 maternal deaths in 2^nd wave) with no mortality in 1^st wave.96.4% were live births. Birth weight was more than 2.5 kg in 62% cases and 21.3% cases required NICU. Vertical transmission of COVID was seen in 1.1% cases.

Conclusion

Pregnant patients with moderate and severe disease are at higher risk of perinatal complications. ICU/HDU management with multidisciplinary management may reduce morbidity and mortality. Neonatal affection due to COVID may not be severe but may increase prematurity due to iatrogenic intervention.

Human early syncytiotrophoblasts are highly susceptible to SARS-CoV-2 infection

Direct in vivo investigation of human placenta trophoblast's susceptibility to SARS-CoV-2 is challenging. Here we report that human trophoblast stem cells (hTSCs) and their derivatives are susceptible to SARS-CoV-2 infection, which reveals heterogeneity in hTSC cultures. Early syncytiotrophoblasts (eSTBs) generated from hTSCs have enriched transcriptomic features of peri-implantation trophoblasts, express high levels of angiotensin-converting enzyme 2 (ACE2), and are productively infected by SARS-CoV-2 and its Delta and Omicron variants to produce virions. Antiviral drugs suppress SARS-CoV-2 replication in eSTBs and antagonize the virus-induced blockage of STB maturation. Although less susceptible to SARS-CoV-2 infection, trophoblast organoids originating from hTSCs show detectable viral replication reminiscent of the uncommon placental infection. These findings implicate possible risk of COVID-19 infection in peri-implantation embryos, which may go unnoticed. Stem cell-derived human trophoblasts such as eSTBs can potentially provide unlimited amounts of normal and genome-edited cells and facilitate coronavirus research and antiviral discovery.

The influence of COVID-19 pandemic on intrauterine fetal demise and possible vertical transmission of SARS-CoV-2

OBJECTIVE

The impact of COVID-19 on intrauterine fetal demise (IUFD) and vertical transmission of the SARS-CoV-2 from the mother to the fetus are crucial issues of the COVID-19 pandemic. In the current study, we aimed to detect the pandemic's influence on the IUFD and evaluate the vertical transmission of the SARS-CoV-2 through analysis of placental tissues collected from PCR positive women with IUFD above 20 weeks of gestation.

MATERIALS AND METHODS

The pregnant women above 20 weeks of gestation and had a fetus intrauterine demised during pandemic were included in the study. The pregnant women screened for COVID-19. Vertical transmission searched from placental tissues of COVID-19 positive women by RT-PCR tests for the presence of SARS-CoV-2 RNA. The number of IUFD before the pandemic and during the pandemic compared to assess the influence of the COVID-19 pandemic on the IUFD ratio.

RESULTS

Among 138 pregnant women with IUFD, 100 of them could screen for COVID-19 status. RT-PCR test results of 6 of the screened pregnant women were positive for SARS-CoV-2. Placental tissues of these six women were analyzed, and one test result was positive for SARS-CoV-2 RNA. The IUFD ratio was significantly increased during the pandemic.

CONCLUSION

It is clear that COVID-19 increases the IUFD ratio. Previous data for vertical transmission of SARS-CoV-2 during the second trimester is limited. We present the third case of literature that has positive placental results for SARS-CoV-2 RNA in the second trimester of pregnancy.

The Adverse Outcome Pathway Framework Applied to Neurological Symptoms of COVID-19

Several reports have shown that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential to also be neurotropic. However, the mechanisms by which SARS-CoV-2 induces neurologic injury, including neurological and/or psychological symptoms, remain unclear. In this review, the available knowledge on the neurobiological mechanisms underlying COVID-19 was organized using the AOP framework. Four AOPs leading to neurological adverse outcomes (AO), anosmia, encephalitis, stroke, and seizure, were developed. Biological key events (KEs) identified to induce these AOs included binding to ACE2, blood–brain barrier (BBB) disruption, hypoxia, neuroinflammation, and oxidative stress. The modularity of AOPs allows the construction of AOP networks to visualize core pathways and recognize neuroinflammation and BBB disruption as shared mechanisms. Furthermore, the impact on the neurological AOPs of COVID-19 by modulating and multiscale factors such as age, psychological stress, nutrition, poverty, and food insecurity was discussed. Organizing the existing knowledge along an AOP framework can represent a valuable tool to understand disease mechanisms and identify data gaps and potentially contribute to treatment, and prevention. This AOP-aligned approach also facilitates synergy between experts from different backgrounds, while the fast-evolving and disruptive nature of COVID-19 emphasizes the need for interdisciplinarity and cross-community research.

Pregnancy and COVID-19: high or low risk of vertical transmission

Coronavirus disease 19 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). Throughout the pandemic, evidence on the effects of COVID-19 during pregnancy has been inadequate due to the limited number of studies published. Therefore, the objective of this systematic review was to evaluate current literature regarding the effects of COVID-19 during pregnancy and establish pregnancy outcomes and vertical and perinatal transmission during pregnancy. Multiple databases were searched, including Embase, Medline, Web of Science, Scopus, and Cochrane Central Register of Control Clinical Trials, using the following keywords: [Pregnancy] AND [COVID-19 OR SARS-CoV-2 OR nCoV-19] OR [Perinatal transmission, Vertical transmission (VT), Pregnancy complications], [Pregnancy] AND [Hyperinflammation OR Cytokine storm]. We excluded in vitro and experimental studies, but also ex-vivo and animal study methods. To exclude the risk of bias during data collection and interpretation, all included studies were peer-reviewed publications. This review is estimated to tabulate the study intervention characteristics and compare them against the planned groups for each synthesis. Our findings showed that pregnant women are commonly susceptible to respiratory viral infections and severe pneumonia due to physiological immune suppression and pregnancy-induced changes. VT of SARS-CoV-2 infection during pregnancy is associated with a great deal of controversy and conflict. However, there is still no robust clinical evidence of VT. Furthermore, the clinical presentation and management of COVID-19 during pregnancy are nearly identical to those of non-pregnant women. Finally, chloroquine and remdesivir are the only two drugs evaluated as adequate for the management of COVID-19 during pregnancy.

The correlation between COVID-19 segmentation volume based on artificial intelligence technology and gastric wall edema: a multi-center study in Wuhan

PURPOSE

This study aimed to investigate manifestations of the gastric wall and related risk factors in COVID-19 patients with gastrointestinal symptoms by CT.

MATERIALS AND METHODS

Two hundred and forty patients diagnosed with COVID-19 by RT-PCR were enrolled from January 2020 to April 2020. Patients showed gastrointestinal symptoms, including nausea, vomiting, or diarrhea. Results of the initial laboratory examination were performed after admission. Chest CT was performed for all patients, with the lower bound including the gastric antrum. The volume of COVID-19 and lungs was segmented, and the ratio was calculated as follows: PV/LV = Volume_pneumonia/Volume_lungs.

RESULTS

Among the 240 patients, 109 presented with gastric wall edema (edema group), and 131 showed no gastric wall edema (non-edema group); the PV/LV values between the two groups were significantly different (P = 0.002). Univariate analysis revealed the following: fibrinogen (Fib), thrombin time (TT), activated partial thromboplastin time (APTT), and albumin (ALB) significantly differed between the two groups (P < 0.05). Binary logistic regression analysis showed that only APTT had a negative effect on gastric wall edema (P = 0.003).

CONCLUSIONS

SARS-CoV-2 invades the gastrointestinal tract, gastric wall edema is the primary CT manifestation, and gastric wall edema is more likely to occur with a shorter APTT and severe pneumonia, with a slightly longer hospitalization time. Patients with gastric wall edema observed by CT should intervene early, which may improve digestive function, and further strengthen immune potency against COVID-19.

Breastfeeding Practices During COVID-19: A Narrative Article

COVID-19 was declared a pandemic because of the rapid rise in cases worldwide. Since then, it has altered the ordinary lives of people around the globe. The surge in the pandemic also questioned breastfeeding practices. As breastfeeding is one of the most critical steps toward the wellness of the newborn and maternal health, whether to follow this practice with a child born COVID-19 positive or in the case of suspected infection in the mother was also questioned. There was little information and awareness on the influence of COVID-19 on breastfeeding and postnatal care of newborns; as a result, this situation created havoc and confusion about which processes were to be carried out and how. Thus, this article examines the supporting data and correct procedures to carry out while breastfeeding newborns born during the pandemic. For the collection of evidence, searches were conducted using PubMed and Web of Science along with multiple data published on the websites of the World Health Organization (WHO) and Ministry of Health and Family Welfare, Government of India (MoHFW) between the period March 2020 to March 2022. Articles suggested significant changes in the hospital policies, such as disallowing visits to the mother or baby and changes in the mentality of mothers where a few mothers breastfed their newborn with all the septic care, like masks and frequent handwashing practices and others discontinued breastfeeding and used artificial feeds for the newborn. Even the WHO guidelines state that the mother should breastfeed the infant with good septic care. However, due to the havoc of the pandemic and miscommunication of the various policies, there was a gap in implementing the correct measures. This article provides insight into the breastfeeding scenario in COVID-19-positive or suspected mothers with COVID-19.

Prevalence of SARS-CoV-2 infection in neonates born to mothers or relatives with COVID-19

BACKGROUND

In December 2019, in Wuhan, China, coronavirus disease 2019 (COVID-19) was emerged due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It seems that children and neonates, similar to adult and elderly individuals, are at risk of SARS-CoV-2 infection. However, adequate data are not available about neonates infected with SARS-CoV-2.

METHODS

This study evaluated the presence of SARS-CoV-2 infection in neonates born to mothers or relatives with COVID-19. This cross-sectional study was performed on 25,044 consecutive Iranian participants in Tehran, Iran, from January 2020 to August 2020. Viral ribonucleic acid (RNA) was extracted from 500 µl of the oropharyngeal and nasopharyngeal specimens of the participants. The genomic RNA of SARS-CoV-2 was detected by real-time polymerase chain reaction (PCR) assay.

RESULTS

Out of all participants, 98 (0.40%) cases were neonates born to mothers or relatives with SARS-CoV-2 infection. Therefore, the current study was performed on these neonates. Out of 98 studied neonates, 6 (6.1%) cases had positive PCR results for SARS-CoV-2 infection. Moreover, among 98 studied neonates' mothers, 25 (25.5%) cases had positive PCR results for SARS-CoV-2 infection.

CONCLUSION

The findings of this study demonstrated that the rate of COVID-19 in neonates born to mothers or relatives with SARS-CoV-2 infection in the Iranian population is about 6.1%.

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.

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.

Clinical, Laboratory, and Imaging Findings of Pregnant Women with Possible Vertical Transmission of SARS-CoV-2-Case Series

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic significantly impacted the general population's health. At times, the infection has unfavorably influenced pregnancy evolution and the result of birth. However, vertical transmission of the virus is rare and generates controversial discussions. The study aimed to highlight the clinical, laboratory, and imaging findings of pregnant women with confirmed Coronavirus Disease 2019 (COVID-19) with possible vertical transmission and identify possible factors that encourage vertical transmission. Between 1 April 2020 and 31 December 2021, 281 pregnant women diagnosed with COVID-19 gave birth in the Obstetrics and Gynecology Departments of the tertiary unit of County Emergency Clinical Hospital from Timisoara. Three newborns (1.06%) tested positive. The characteristic of these three cases was described as a short series. In two cases, the patients were asymptomatic. In one case, the patient developed a mild form of COVID-19 with a favorable evolution in all cases. We did not identify the presence of smoking history, vaccine before admission, atypical presentation, fever, or chest X-ray abnormalities. We note possible factors that encourage vertical transmission: Pregnancy-induced hypertension, thrombophilia, asymptomatic cough, an asymptomatic or mild form of the disease, a ruptured membrane, and cesarean. The laboratory results highlight the inconstant presence of some changes found in the list of potential predictors of the severity of the infection: Lymphopenia, high values of C-reactive protein, D-dimer, fibrinogen, platelets, Aspartate Aminotransferase, Lactate dehydrogenase, and ferritin. The study's conclusion of this small group suggests that there may have been an intrauterine infection in late pregnancy and described characteristics of the pregnant women. Possible risk factors that could encourage vertical transmission have been identified.

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.

SARS-CoV-2, COVID-19, and Reproduction: Effects on Fertility, Pregnancy, and Neonatal Life

Since its discovery in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread over the world, having a huge impact on people’s lives and health. The respiratory system is often targeted in people with the coronavirus disease 2019 (COVID-19). The virus can also infect many organs and tissues in the body, including the reproductive system. The consequences of the SARS-CoV-2 infection on fertility and pregnancy in hosts are poorly documented. Available data on other coronaviruses, such as severe acute respiratory syndrome (SARS-CoV) and Middle Eastern Respiratory Syndrome (MERS-CoV) coronaviruses, identified pregnant women as a vulnerable group with increased pregnancy-related complications. COVID-19 was also shown to impact pregnancy, which can be seen in either the mother or the fetus. Pregnant women more likely require COVID-19 intensive care treatment than non-pregnant women, and they are susceptible to giving birth prematurely and having their newborns admitted to the neonatal intensive care unit. Angiotensin converting enzyme 2 (ACE2), a key player of the ubiquitous renin-angiotensin system (RAS), is the principal host cellular receptor for SARS-CoV-2 spike protein. ACE2 is involved in the regulation of both male and female reproductive systems, suggesting that SARS-CoV-2 infection and associated RAS dysfunction could affect reproduction. Herein, we review the current knowledge about COVID-19 consequences on male and female fertility, pregnant women, and their fetuses. Furthermore, we describe the effects of COVID-19 vaccination on reproduction.

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.

First Neonates with Vertical Transmission of SARS-CoV-2 Infection in Late Pregnancy in West Part of Romania: Case Series

The Coronavirus disease 2019 (COVID-19) pandemic has exposed the vulnerable neonatal population to unknown risks. Given that herd immunity is has not been reached, the entire population is susceptible to Severe Acute Respiratory Syndrome Coronavirus 2 Virus(SARS-CoV-2) infection. The arising concern about the vertical transmission of neonatal complications caused by the novel coronavirus is a continuous challenge for managing newborns, considering the rare cases and unclear guidelines. Therefore, a retrospective study was conducted in a tertiary unit from Timisoara, Romania. Of the 283 newborns born during the study period, only 3 neonates were diagnosed with SARS-CoV-2 infection in the first 24 h of life (DOL-0). The present study plans to identify the findings, including clinical features, laboratory characteristics, and outcomes of newborns with vertical transmission of SARS-CoV-2. All infected neonates were confirmed with COVID-19 by Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) from nasal aspirates and were isolated in the neonatology department. They were the first and the only neonate infected at birth from the West part of Romania. The clinical findings were unremarkable except for one neonate who developed mild respiratory distress syndrome. Elevated IgG-specific anti-SARS-CoV-2 serum levels were found in one newborn. Swab samples in DOL-0 strengthened the awareness of vertical transmission, although peripartum SARS-CoV-2 infection does not seem responsible for severe symptoms. We conclude that vertical transmission is rare in late pregnancy. Even if the studied newborns showed mild forms of COVID-19, it is essential to note that newborns represent a particular category of patients. More studies are needed to complete the observations of this study.

Consequences of Transplacental Transmission of the SARS-CoV-2 Virus: A Single-Center Experience

The issues of vertical viral transmission from mother to fetus and the potential complications caused by SARS-CoV-2 coagulopathy are still unclear. There are few literature data about the vertical transmission of SARS-CoV-2 and health outcomes in neonates born to mothers with symptomatic or asymptomatic coronavirus disease, with the existing data based on small sample sizes. This case series study consists of two newborn children (one pre-term and one term) who were born to SARS-CoV-2-positive mothers and admitted to the neonatal intensive care unit a few hours after birth. One child had cyanotic changes that affected the entire left leg and the left forearm, with multiple livid changes on the front of the chest and abdomen, the right upper arm, right thigh, neck, and face, and one child had an altered umbilical cord. The first child was treated conservatively, and the second child was treated surgically.

Maternal and perinatal outcomes of pregnancy associated with COVID-19: Systematic review and meta-analysis

INTRODUCTION

This study explored maternal and infant outcomes in the periods of pregnancy, birth and the postpartum, in women with COVID-19.

METHODS

After PROSPERO registration (CRD42020191106), scanning for the studies was carried out over the period 5-15 May 2020 in the PubMed, Science Direct, EBSCO and Web of Science databases with the search string: ['COVID-19' AND ('pregnancy' OR 'pregnant' OR 'maternal outcomes' OR 'infant outcomes' OR 'fetal outcomes' OR 'birth')]. Studies reporting maternal and perinatal outcomes of pregnant women with COVID-19 were included. Data were extracted independently by two researchers and combined with meta-analysis and pooled analysis.

RESULTS

The 54 studies included in this analysis contained data on 517 pregnant women diagnosed with COVID-19 and 385 infants. Of the pregnant women, 18% had gone into preterm labor and 77% had given birth by caesarean. Of the newborns, 19% had low birth weight, 14% had fetal distress, and 24% were admitted into the neonatal intensive care unit. Nine maternal and eight baby mortalities were reported in the studies.

CONCLUSIONS

The study revealed that COVID-19 in pregnant women appeared to be negative maternal and infant outcomes, with mortalities as well.

Evidence of Infection of Human Embryonic Stem Cells by SARS-CoV-2

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initially described to target the respiratory system and now has been reported to infect a variety of cell types, including cardiomyocytes, neurons, hepatocytes, and gut enterocytes. However, it remains unclear whether the virus can directly infect human embryonic stem cells (hESCs) or early embryos. Herein, we sought to investigate this question in a cell-culture system of hESCs. Both the RNA and S protein of SARS-CoV-2 were detected in the infected hESCs and the formation of syncytium was observed. The increased level of subgenomic viral RNA and the presence of dsRNA indicate active replication of SARS-CoV-2 in hESCs. The increase of viral titers in the supernatants revealed virion release, further indicating the successful life cycle of SARS-CoV-2 in hESCs. Remarkably, immunofluorescence microscopy showed that only a small portion of hESCs were infected, which may reflect low expression of SARS-CoV-2 receptors. By setting |log2 (fold change)| > 0.5 as the threshold, a total of 1,566 genes were differentially expressed in SARS-CoV-2-infected hESCs, among which 17 interferon-stimulated genes (ISGs) were significantly upregulated. Altogether, our results provide novel evidence to support the ability of SARS-CoV-2 to infect and replicate in hESCs.

Infections and Pregnancy: Effects on Maternal and Child Health

Pregnancy causes physiological and immunological adaptations that allow the mother and fetus to communicate with precision in order to promote a healthy pregnancy. At the same time, these adaptations may make pregnant women more susceptible to infections, resulting in a variety of pregnancy complications; those pathogens may also be vertically transmitted to the fetus, resulting in adverse pregnancy outcomes. Even though the placenta has developed a robust microbial defense to restrict vertical microbial transmission, certain microbial pathogens have evolved mechanisms to avoid the placental barrier and cause congenital diseases. Recent mechanistic studies have begun to uncover the striking role of the maternal microbiota in pregnancy outcomes. In this review, we discuss how microbial pathogens overcome the placental barrier to cause congenital diseases. A better understanding of the placental control of fetal infection should provide new insights into future translational research.

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.

Deleterious effects of nervous system in the offspring following maternal SARS-CoV-2 infection during the COVID-19 pandemic

During the Coronavirus disease 2019 (COVID-19) pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is universally susceptible to all types of populations. In addition to the elderly and children becoming the groups of great concern, pregnant women carrying new lives need to be even more alert to SARS-CoV-2 infection. Studies have shown that pregnant women infected with SARS-CoV-2 can lead to brain damage and post-birth psychiatric disorders in offspring. It has been widely recognized that SARS-CoV-2 can affect the development of the fetal nervous system directly or indirectly. Pregnant women are recommended to mitigate the effects of COVID-19 on the fetus through vaccination, nutritional supplements, and psychological support. This review summarizes the possible mechanisms of the nervous system effects of SARS-CoV-2 infection on their offspring during the pregnancy and analyzes the available prophylactic and treatment strategies to improve the prognosis of fetal-related neuropsychiatric diseases after birth.

Attitude and Level of COVID-19 Vaccination among Women in Reproductive Age during the Fourth Pandemic Wave: A Cross-Sectional Study in Poland

COVID-19 vaccination, apart from the sanitary regime, is the most efficient strategy to limit the spread of the SARS-CoV-2 virus and significantly reduce the severity of the disease following infection. A cross-sectional survey was conducted during the fourth wave of the COVID-19 pandemic among pregnant Polish women and women who have already given birth to evaluate the level and attitude to vaccination. Briefly, 1196 women (256 pregnant and 940 mothers) participated in the study; 68.0% of pregnant women and 66.2% of mothers declared that they had received COVID-19 vaccination. The most frequently stated reasons not to get vaccinated were possible adverse effects on the mother, fetus or breastfed child, post-vaccination complications and limited scientific evidence on the safety of the COVID-19 vaccine. The identified predictors of avoiding COVID-19 vaccination are young age, residing in small cities or rural areas, cohabitation, low anxiety level regarding SARS-CoV-2 infection, and little knowledge concerning maternal vaccine-induced immune protection delivered to offspring. Despite the unlimited access to COVID-19 vaccination, the declared level of vaccination is worryingly low. The knowledge concerning the benefits of vaccination to mothers and their offspring is not satisfactory and requires urgent educational action, particularly among young women living outside big cities and single motherhood.

Detectable SARS-CoV-2 in Human Breast Milk: A Turkey Experience

Breastfeeding is considered the strongest postnatal bond between mother and baby and is the best source of nutrition that has implications for infant health and development. However, the global COVID-19 epidemic process and the lack of full understanding of vertical transmission of SARS-CoV-2 have significantly reduced breastfeeding practice. The aim of this study is to investigate the presence of SARS-CoV-2 virus in the milk of lactating mothers with COVID-19 disease and to provide scientific evidence on whether breastfeeding will be safe. For this purpose, breast milk samples were collected from 60 women with COVID-19 in Şanlıurfa city of Turkey, and breast milk samples were tested for the presence of SARS-CoV-2 RNA by RT-PCRs. As a result of the analysis, SARS-CoV-2 RNA was not detected in any breast milk. According to the results obtained in this study, it was concluded that there is no evidence of mother-to-child transmission of SARS-CoV-2 through breast milk and that mothers can safely breastfeed their children in this process. We think that it will be possible with more in-depth analyzes and comprehensive studies to fully understand whether the SARS-CoV-2 virus is transmitted to infants through breast milk.

COVID-19 Quarantine Dramatically Affected Male Sexual Behavior: Is There a Possibility to Go Back to Normality?

We performed a monocentric longitudinal study on sexually active male patients, from May 2021 to October 2021, with SARS-CoV-2 infection confirmed with a nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR). The questionnaires were delivered by email. The study period was divided into the periods before getting tested (T1), during quarantine (T2), 1 month after a negative test (T3), and 3 months after a negative test (T4). All participants were invited to complete these questionnaires: 10- and 6-item questionnaires, a sexual distress schedule (SDS), and the international index of erectile function questionnaire of 15 items (IIEF-15). The primary endpoint was to evaluate the impact of quarantine on male sexual function (SF) during and after the SARS-CoV-2 infection. A total of 22 male patients met the inclusion criteria. The differences for both SDS and IIEF-15 scores, between T1−T2 (27 (IQR 24.0−32.2) vs. 37.5 (IQR 34.2−45.5), 45 (IQR 38.0−50.2) vs. 28.5 (IQR 19.5−38.0)), T2−T3 (37.5 (IQR 34.2−45.5) vs. 28 (IQR 24.0−31.0), and 28.5 (IQR 19.5−38.0) vs. 39.5 (IQR 35.5−44.2)) were statistically significant (p < 0.001), respectively. Moreover, between T1−T4, no statistically significant difference (p > 0.05) was recorded in both SDS (27 (IQR 24.0−32.2) vs. 26.5 (IQR 24−30.2)) and IIEF-15 (45 (IQR 38.0−50.2) vs. 28.5 (IQR 19.5−38.0)). In 20 patients (90.9%), SARS-CoV-2 had a huge impact on relationship and sexual life, but no patient attended a clinic for sexual difficulties. In conclusion quarantine has negatively influenced SF in infected patients; however, 3 months after the rRT-PCR negative test, a promising return to the preinfection SF values is observed.

Antibody Response and Maternofetal Antibody Transfer in SARS-CoV-2-Positive Pregnant Women: A Multicenter Observational Study

Introduction Awareness of SARS-CoV-2 infection in pregnant women and the potential risk for infection of their neonates is increasing. The aim of this study was to examine the immune status of affected women and evaluate the dynamics of placental antibody transfer.

Materials and Methods The study included 176 women with SARS-CoV-2 infection during pregnancy who delivered between April 2020 and December 2021 at eight obstetric maternity sites. Demographic data, maternal and neonatal characteristics were summarized. Antibody testing for IgA and IgG in maternal blood sera and umbilical cord samples was evaluated and IgG transfer ratios were calculated. Values were related to the time of infection during pregnancy and birth.

Results The percentage of IgG positive women increased from 29.0% (95% CI 23.8 – 37.8) at presentation with a positive PCR test result to 75.7% (95% CI 71.6 – 79.8), the percentage of IgG positive umbilical cord blood samples increased from 17.1% (95% CI 13.0 – 21.3) to 76.4% (95% CI 72.2 – 80.7) at more than six weeks after infection. Regression lines differed significantly between maternal and fetal IgG responses (p < 0.0001). Newborns react with a latency of about one week; umbilical cord blood antibody concentrations are highly correlated with maternal concentration levels (ρ = 0.8042; p < 0.0001). IgG transplacental transfer ratios were dependent on infection-to-birth interval. Two of the umbilical cord blood samples tested positive for IgA.

Conclusions These findings confirm vertical SARS-CoV-2 transmission is rare; however, antibodies are transferred to the fetus soon after infection during pregnancy. Since transplacental antibody transfer might have a protective value for neonatal immunization this information may be helpful when counseling affected women.

A SARS-CoV-2 Delta Variant Case Manifesting as Extensive Placental Infection and Fetal Transmission

INTRODUCTION

Studies indicate a very low rate of SARS-CoV-2 detection in the placenta or occasionally a low rate of vertical transmission in COVID-19 pregnancy. SARS-CoV-2 Delta variant has become a dominant strain over the world and possesses higher infectivity due to mutations in its spike receptor-binding motif.

CASE PRESENTATION

To determine whether SARS-CoV-2 Delta variant has increased potential for placenta infection and vertical transmission, we analyzed SARS-CoV-2 infection in the placenta, umbilical cord, and fetal membrane from a case where an unvaccinated mother and her neonate were COVID-19 positive. A 35-year-old primigravida with COVID-19 underwent an emergent cesarean delivery due to placental abruption in the setting of premature rupture of membranes. The neonate tested positive for SARS-CoV-2 within the first 24 h, and then again on days of life 2, 6, 13, and 21. The placenta exhibited intervillositis, increased fibrin deposition, and syncytiotrophoblast necrosis. Sequencing of viral RNA from fixed placental tissue revealed SAR-CoV-2 B.1.167.2 (Delta) variant. Both spike protein and viral RNA were abundantly present in syncytiotrophoblasts, cytotrophoblasts, umbilical cord vascular endothelium, and fetal membranes.

CONCLUSION

We report with strong probability the first SARS-CoV-2 Delta variant transplacental transmission. Placental cells exhibited extensive apoptosis, senescence, and ferroptosis after SARS-CoV-2 Delta infection.