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Farias-Jofre M, Romero R, Galaz J, Xu Y, Miller D, Garcia-Flores V, Arenas-Hernandez M, Winters AD, Berkowitz BA, Podolsky RH, Shen Y, Kanninen T, Panaitescu B, Glazier CR, Pique-Regi R, Theis KR, Gomez-Lopez N. Blockade of IL-6R prevents preterm birth and adverse neonatal outcomes. EBioMedicine 2023; 98:104865. [PMID: 37944273 PMCID: PMC10665693 DOI: 10.1016/j.ebiom.2023.104865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Preterm birth preceded by spontaneous preterm labour often occurs in the clinical setting of sterile intra-amniotic inflammation (SIAI), a condition that currently lacks treatment. METHODS Proteomic and scRNA-seq human data were analysed to evaluate the role of IL-6 and IL-1α in SIAI. A C57BL/6 murine model of SIAI-induced preterm birth was developed by the ultrasound-guided intra-amniotic injection of IL-1α. The blockade of IL-6R by using an aIL-6R was tested as prenatal treatment for preterm birth and adverse neonatal outcomes. QUEST-MRI evaluated brain oxidative stress in utero. Targeted transcriptomic profiling assessed maternal, foetal, and neonatal inflammation. Neonatal biometrics and neurodevelopment were tested. The neonatal gut immune-microbiome was evaluated using metagenomic sequencing and immunophenotyping. FINDINGS IL-6 plays a critical role in the human intra-amniotic inflammatory response, which is associated with elevated concentrations of the alarmin IL-1α. Intra-amniotic injection of IL-1α resembles SIAI, inducing preterm birth (7% vs. 50%, p = 0.03, Fisher's exact test) and neonatal mortality (18% vs. 56%, p = 0.02, Mann-Whitney U-test). QUEST-MRI revealed no foetal brain oxidative stress upon in utero IL-1α exposure (p > 0.05, mixed linear model). Prenatal treatment with aIL-6R abrogated IL-1α-induced preterm birth (50% vs. 7%, p = 0.03, Fisher's exact test) by dampening inflammatory processes associated with the common pathway of labour. Importantly, aIL-6R reduces neonatal mortality (56% vs. 22%, p = 0.03, Mann-Whitney U-test) by crossing from the mother to the amniotic cavity, dampening foetal organ inflammation and improving growth. Beneficial effects of prenatal IL-6R blockade carried over to neonatal life, improving survival, growth, neurodevelopment, and gut immune homeostasis. INTERPRETATION IL-6R blockade can serve as a strategy to treat SIAI, preventing preterm birth and adverse neonatal outcomes. FUNDING NICHD/NIH/DHHS, Contract HHSN275201300006C. WSU Perinatal Initiative in Maternal, Perinatal and Child Health.
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Affiliation(s)
- Marcelo Farias-Jofre
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA.
| | - Jose Galaz
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Yi Xu
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Derek Miller
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Valeria Garcia-Flores
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Marcia Arenas-Hernandez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Andrew D Winters
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MO, USA
| | - Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine; Detroit, MI, USA
| | - Robert H Podolsky
- Division of Biostatistics and Design Methodology, Center for Translational Research, Children's National Hospital, Silver Spring, MD, USA
| | - Yimin Shen
- Department of Radiology, School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tomi Kanninen
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bogdan Panaitescu
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Catherine R Glazier
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Roger Pique-Regi
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kevin R Theis
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MO, USA
| | - Nardhy Gomez-Lopez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, USA; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MO, USA; Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
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2
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Jha S, Singh JB, Naaz S. Risk Factors and Clinical Outcomes Associated With Acute Respiratory Distress Syndrome in Pregnant and Non-pregnant Women Diagnosed With COVID-19: A Comparative Analysis. Cureus 2023; 15:e39514. [PMID: 37384100 PMCID: PMC10294118 DOI: 10.7759/cureus.39514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE We aim to compare risk factors and clinical outcomes of acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19) in pregnant versus non-pregnant women of reproductive age. MATERIALS AND METHODS This retrospective study included all women (18-45 years) with ARDS and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted during the study period from May 2020 to July 2021. Pregnant women were considered as case and non-pregnant women as control. Primary outcomes included ventilatory support, the need for high-flow nasal oxygenation (HFNO), severe ARDS, and death. Secondary outcomes included intensive care unit (ICU) admission, length of hospital stay, and requirement of oxygen at discharge. RESULTS We included 59 women diagnosed with ARDS and confirmed SARS-CoV-2 infection, of them 12 were pregnant and 47 were non-pregnant. The non-pregnant women were significantly older than pregnant women (28.7±5 versus 35.5±8.2, p=0.008). Presenting symptoms were comparable among the groups. Diabetes was significantly higher in the non-pregnant group (8.3% versus 31.9%, p<0.02). Pregnant women had a significantly higher range of D-dimer (5.8±7.2 versus 1.8±1.9, p<0.01) and interleukin-6 (IL-6) (212.0±300.8 versus 49.7±57.7, p<0.011) and lower platelet count (129.4±120.1 versus 197.6±92.9, p<0.05) compared to non-pregnant women. Pregnant women were more likely to experience primary outcomes including the need for HFNO (33% versus 8.5%, odds ratio (OR): 5.3, p<0.02) and death (50% versus 31.9%, OR: 2.1, p<0.04) compared to non-pregnant women. CONCLUSION Pregnant women with severe COVID-19 and ARDS were at an increased risk for experiencing ICU admission, intubation, and mechanical ventilation compared to age-matched non-pregnant women, although comorbidities such as diabetes were higher among the non-pregnant cohort. These findings suggest that pregnancy itself is a potential risk factor for complications and morbidities among women with severe COVID-19.
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Affiliation(s)
- Sangam Jha
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Patna, IND
| | - Jafeesha B Singh
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Patna, IND
| | - Shagufta Naaz
- Anesthesiology, All India Institute of Medical Sciences, Patna, IND
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3
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Akinosoglou K, Schinas G, Rigopoulos EA, Polyzou E, Tzouvelekis A, Adonakis G, Gogos C. COVID-19 Pharmacotherapy in Pregnancy: A Literature Review of Current Therapeutic Choices. Viruses 2023; 15:v15030787. [PMID: 36992497 PMCID: PMC10054527 DOI: 10.3390/v15030787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
The clinical management of COVID-19 in pregnant women, who are considered a vulnerable population, remains uncertain even as the pandemic subsides. SARS-CoV-2 affects pregnant individuals in multiple ways and has been associated with severe maternal morbidity and mortality, as well as neonatal complications. The unique anatomy and physiology of gestation make managing COVID-19 in this population a complex and challenging task, emphasizing the importance of spreading knowledge and expertise in this area. Therapeutic interventions require distinct clinical consideration, taking into account differences in pharmacokinetics, vertical transmission, drug toxicities, and postnatal care. Currently, there is limited data on antiviral and immunomodulating COVID-19 pharmacotherapy in pregnancy. Some medication has been shown to be safe and well tolerated among pregnant women with COVID-19; however, the lack of randomized clinical trials and studies in this patient population is evident. Available vaccines are considered safe and effective, with no evidence of harm to the fetus, embryo development, or short-term postnatal development. Pregnant women should be counseled about the risks of SARS-CoV-2 infection and informed of available ways to protect themselves and their families. Effective treatments for COVID-19 should not be withheld from pregnant individuals, and more research is needed to ensure the best outcomes.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Department of Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
- Division of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - Georgios Schinas
- Department of Medicine, University of Patras, 26504 Patras, Greece
| | | | - Eleni Polyzou
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Division of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - Argyrios Tzouvelekis
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Department of Pulmonology, University General Hospital of Patras, 26504 Patras, Greece
| | - George Adonakis
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Department of Obstetrics and Gynecology, University General Hospital of Patras, 26504 Patras, Greece
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Jorgensen SCJ, Tabbara N, Burry L. A review of COVID-19 therapeutics in pregnancy and lactation. Obstet Med 2022; 15:225-232. [PMID: 36514791 PMCID: PMC9732495 DOI: 10.1177/1753495x211056211] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 12/16/2022] Open
Abstract
Pregnant people have an elevated risk of severe COVID-19-related complications compared to their non-pregnant counterparts, underscoring the need for safe and effective therapies. In this review, we summarize published data on COVID-19 therapeutics in pregnancy and lactation to help inform clinical decision-making about their use in this population. Although no serious safety signals have been raised for many agents, data clearly have serious limitations and there are many important knowledge gaps about the safety and efficacy of key therapeutics used for COVID-19. Moving forward, diligent follow-up and documentation of outcomes in pregnant people treated with these agents will be essential to advance our understanding. Greater regulatory push and incentives are needed to ensure studies to obtain pregnancy data are expedited.
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Affiliation(s)
- Sarah CJ Jorgensen
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
- Sarah CJ Jorgensen, 1 Kings College Circle,
Toronto, ON, Canada, M5S 1A8.
| | - Najla Tabbara
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lisa Burry
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada
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5
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Oliver-Commey JA, Puplampu P, Owoo C, Asare-Boateng K, Yawson AO, Tetteh J, Calys-Tagoe BNL, Udofia E, Kenu E, Samba A, Yawson AE, Lartey M. Prevalence of pneumonia by chest x-ray, associated demographic characteristics and health risk factors among COVID-19 patients in Ghana. Ghana Med J 2022; 55:21-28. [PMID: 35233111 PMCID: PMC8853696 DOI: 10.4314/gmj.v55i2s.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective The study was conducted to determine the prevalence of radiologically diagnosed pneumonia among COVID-19 patients and associated factors. Design setting and participants A retrospective manual data extraction of 275 medical records of COVID-19 patients was conducted at two COVID-19 national treatment centres in Accra from March to May 2020. All patients had a chest x-ray done. Main outcome and analysis The main outcome was the presence of pneumonia. Descriptive statistics and Chi-square test of independence were employed to determine the associations between independent variables and the presence of pneumonia. All analysis was performed using Stata 16, and a p-value ≤ 0.05 was deemed significant. Results The prevalence of pneumonia was 44%(95%CI) =38.2-50.0). Chi-square independent test indicated that pneumonia in the COVID-19 patients was associated with educational level, history of domestic and international travel, mass gathering in the past 14 days before diagnosis, and discharge plan (p-value< 0.05). Patients classified as secondary cases (61.5%) and those discharged as fully recovered from the health facility (61.2%) had a higher prevalence of pneumonia. In addition, COVID-19 patients with hypertension (32.1%) and asthma (5.2%) had a significantly higher prevalence of pneumonia. Conclusion Overall, the prevalence of pneumonia was 44% and was associated with the demographic and personal characteristics of the patients. Early detection through contact tracing and community surveillance should be intensified to pick up more asymptomatic cases. The role of the chest x-ray for triaging patients and for clinical management of symptomatic patients remains key. Funding None declared.
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Affiliation(s)
- Joseph A Oliver-Commey
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS).,LEKMA Hospital, Ghana Health Service.,National COVID-19 Case Management Team, Ghana
| | - Peter Puplampu
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS).,Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra.,Pentecost Convention Centre- National CoOVID-19 Treatment Centre
| | - Christian Owoo
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS).,National COVID-19 Case Management Team, Ghana.,National COVID-19 Treatment Centre, University of Ghana Medical Centre, Accra.,Department of Anaesthesia, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
| | - Kwame Asare-Boateng
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS)
| | - Anita O Yawson
- National COVID-19 Treatment Centre, Ga East Municipal Hospital, Ghana Health Service (GHS).,Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
| | - Benedict N L Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
| | - Emilia Udofia
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana
| | - Ali Samba
- Department of Obstetrics & Gynaecology Department, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
| | - Margaret Lartey
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra
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Venkataraman M, Basker N, Prakash L. Lung involvement in COVID-19 positive pregnant women and their outcomes – A clinical and imaging based retrospective case study. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_32_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Baptista FS, Paganoti CF, Gomez UT, Peres SV, Malbouisson LM, Brizot MDL, Francisco RPV. Risk factors for oxygen requirement in hospitalized pregnant and postpartum women with COVID-19. Clinics (Sao Paulo) 2022; 77:100072. [PMID: 35767901 PMCID: PMC9212857 DOI: 10.1016/j.clinsp.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/23/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify risk factors for Oxygen (O2) needs in pregnant and postpartum women with COVID-19. METHODS Prospective cohort involving pregnant women hospitalized with COVID-19 from April to October 2020. The oxygen need was analyzed regarding risk factors: demographic characteristics, clinical and laboratory parameters at hospital admission, and chest Computer Tomography (CT) findings. Poisson univariate analysis was used to estimate the Relative Risk (RR) and 95% Confidence Intervals. RESULTS 145 patients, 80 who used and 65 who did not use O2, were included. Body mass index ≥ 30, smoking, and chronic hypertension increased the risk of O2 need by 1.86 (95% CI 1.10-3.21), 1.57 (95% CI 1.16‒2.12), and 1.46 (95% CI 1.09‒1.95), respectively. Patients who were hospitalized for COVID-19 and for obstetric reasons had 8.24 (95% CI 2.8‒24.29) and 3.44 (95% CI 1.05‒11.31) times more use of O2 than those admitted for childbirth and abortion. Respiratory rate ≥ 24 breaths/min and O2 saturation < 95% presented RR for O2 requirements of 2.55 (1.82‒3.56) and 1.68 (95% CI 1.27-2.20), respectively. Ground Glass (GG) < 50% and with GG ≥ 50%, the risk of O2 use were respectively 3.41-fold and 5.33-fold higher than in patients who haven't viral pneumonia on CT. The combination of C-reactive protein ≥ 21 mg/L, hemoglobin < 11.0 g/dL, and lymphopenia < 1500 mm3 on hospital admission increased the risk of O2 use by 4.97-times. CONCLUSIONS In obstetric patients, clinical history, laboratory, clinical and radiological parameters at admission were identified as a risk for O2 need, selecting the population with the greatest chance of worsening.
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Affiliation(s)
- Fernanda Spadotto Baptista
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Cristiane Freitas Paganoti
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ursula Trovato Gomez
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Stela Verzinhasse Peres
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Marcelo Malbouisson
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Maria de Lourdes Brizot
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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8
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Jorgensen SC, Lapinsky SE. Tocilizumab for coronavirus disease 2019 in pregnancy and lactation: a narrative review. Clin Microbiol Infect 2022; 28:51-57. [PMID: 34438068 PMCID: PMC8381634 DOI: 10.1016/j.cmi.2021.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Tocilizumab is a monoclonal antibody that interrupts interleukin-6 signalling, reducing downstream effects on inflammation and the innate immune response. It was shown to reduce mortality in patients with severe or critical coronavirus disease 2019 (COVID-19). Pregnant and breastfeeding people were largely excluded from clinical trials and hence, the extent to which results can be applied to these populations is not clear. OBJECTIVES To synthesize published data on tocilizumab in pregnancy and lactation, highlight important knowledge gaps, and help inform clinical decision-making about tocilizumab's use in these populations with COVID-19. SOURCES PubMed was searched for studies evaluating tocilizumab in pregnancy and lactation for COVID-19 and other indications. Literature on pharmacokinetics and reproductive/fetal safety of monoclonal antibodies in general was also sought. The US Food and Drug Administration and the European Medicines Agency guidance for the industry and regulatory approval documents were reviewed. CONTENT Published data on tocilizumab in pregnancy include 610 cases (n = 20 with COVID-19) together with seven mother-infant breastfeeding pairs. Higher rates of spontaneous abortion and premature birth have been reported compared with the general population, but multiple confounding variables limit interpretation. There is little data on tocilizumab exposure in the second and third trimesters when transplacental transport is highest. The effects of tocilizumab on the developing immune system are unclear. Pregnant patients with COVID-19 who received tocilizumab were often critically ill and corticosteroid use was uncommon. Neonatal follow up was limited. Tocilizumab appears to be compatible with breastfeeding. IMPLICATIONS Although the available data do not raise serious safety signals, they have significant limitations and are not sufficient to delineate the complete spectrum of potential adverse outcomes that may be associated with tocilizumab exposure during pregnancy and lactation. Diligent follow up and documentation of pregnancy outcomes will be important moving forward. A more effective regulatory framework to ensure equitable inclusion of pregnant people in research is clearly needed.
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Affiliation(s)
- Sarah C.J. Jorgensen
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada,Corresponding author. Sarah C.J. Jorgensen, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Stephen E. Lapinsky
- Division of Respirology, Mount Sinai Hospital, Toronto, ON, Canada,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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9
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Al Hashmi I, Khalaf A, Seshan V, Alsabti H, Al Omari O, Yehia D, Baqer M, Al Khadhuri J. Maternal and Neonatal Outcomes of Healthy Pregnant Women With COVID-19 Versus High-risk Pregnant Women: A Multi-Center Case-Control Comparison Study. Clin Nurs Res 2021; 31:702-712. [PMID: 34955040 DOI: 10.1177/10547738211064027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this retrospective, matched case-control study (two controls [healthy control and high- risk control] vs. COVID-19 cases) was to compare the maternal and neonatal outcomes of pregnant women with and without COVID-19. A total of 261 pregnant women from three different countries with and without COVID-19 were included in this study. Several pregnancy complications were more common in high-risk pregnant women compared to COVID-19 cases and healthy pregnant women. These include preeclampsia (p < .01), vaginal bleeding (p < .05), preterm labor (p < .05), premature rupture of membrane (p < .01), requiring induction of labor (p < .05), have lower gestational age on delivery (F (2) = 3.1, p < .05), requiring cesarean section (p < .01), neonatal admission in the NICU (p < .01), and low neonatal Apgar score (p < .01). Nurses are advised to provide equal attention to pregnant women with underlying health issues and to pregnant women infected with COVID-19 in terms of the risk assessment, health care, and follow-up for optimal maternal and neonatal outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Jamal Al Khadhuri
- Office of Directorate General of Nursing Affairs, Ministry of Health, Muscat, Oman
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10
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]. Z Geburtshilfe Neonatol 2021; 226:e1-e35. [PMID: 34918334 DOI: 10.1055/a-1688-9398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
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11
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BahaaEldin H, El Sood HA, Samy S, Khader Y, AbdelFatah M, Hassany M, Afifi S, Eid A. COVID-19 outcomes among pregnant and nonpregnant women at reproductive age in Egypt. J Public Health (Oxf) 2021; 43:iii12-iii18. [PMID: 34741171 PMCID: PMC8660011 DOI: 10.1093/pubmed/fdab376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/11/2021] [Accepted: 10/04/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To describe demographic, clinical and epidemiological characteristics of pregnant and nonpregnant women with confirmed COVID-19 at reproductive age and determine risk factors of COVID-19 severe outcomes during pregnancy. METHODS A retrospective study for females aged 18-49 with confirmed COVID-19 by RT-PCR in Egypt, February-July 2020. Data were obtained from Egypt National Surveillance, bivariate and multivariate analysis for demographic and clinical characteristics and outcomes of COVID-19 between pregnant and nonpregnant women including ICU admission, need for ventilator and death was performed. RESULTS A total of 23 095 females were identified, with mean (SD) age of 35.1 (8.1) year. Of those, 408 (1.8%) were pregnant, with mean (SD) age of 29.3 (8.1) years. Compared to nonpregnant, pregnant patients were more likely to be admitted to hospital (OR = 1.7 CI = 1.4-2.1), ICU (OR = 2.4, CI = 1.3-4.3), need ventilator (OR = 3.9, CI = 2.1-7.4) and have severe outcome (OR = 3.0, CI = 1.9-4.7). Factors associated with severe outcome included: pregnancy, age > 30 years, underlying medical conditions, and living in rural areas. CONCLUSION Pregnant women with COVID-19 are at higher risk of severe symptoms and outcome including ICU admission, requiring ventilator and death. To reduce risk of severe outcome, counseling about for seeking medical care and health education about COVID-19 preventive measures should be performed.
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Affiliation(s)
- Hala BahaaEldin
- Department of Epidemiology and Surveillance - Preventive Sector, Ministry of Health and Population, Cairo 11516, Egypt
| | - Hanaa Abu El Sood
- Department of Epidemiology and Surveillance - Preventive Sector, Ministry of Health and Population, Cairo 11516, Egypt
| | - Sahar Samy
- Communicable Disease Control Department - Preventive Sector, Ministry of Health and Population, Cairo 11516, Egypt
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohamad AbdelFatah
- Central Administration of Preventive Affairs, Ministry of Health and Population, Cairo 11516, Egypt
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Ministry of Health and Population, Cairo 11516, Egypt
| | - Salma Afifi
- Department of Epidemiology and Surveillance - Preventive Sector, Ministry of Health and Population, Cairo 11516, Egypt
| | - Alaa Eid
- Preventive Sector, Ministry of Health and Population, Cairo 11516, Egypt
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12
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Young EM, Green O, Stewart J, King Y, O'Donoghue K, Walker KF, Thornton JG. COVID-19 and pregnancy: A comparison of case reports, case series and registry studies. Eur J Obstet Gynecol Reprod Biol 2021; 268:135-142. [PMID: 34920270 PMCID: PMC8647390 DOI: 10.1016/j.ejogrb.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Selection, outcome and publication biases are well described in case reports and case series but may be less of a problem early in the appearance of a new disease when all cases might appear to be worth publishing. OBJECTIVE To use a prospectively collected database of primary sources to compare the reporting of COVID-19 in pregnancy in case reports, case series and in registries over the first 8 months of the pandemic. STUDY DESIGN MEDLINE, Embase and Maternity and Infant Care databases were searched from 22 March to 5 November 2020, to create a curated list of primary sources. Duplicate reports were excluded. Case reports, case series and registry studies of pregnant women with confirmed COVID-19, where neonatal outcomes were reported, were selected and data extracted on neonatal infection status, neonatal death, neonatal intensive care unit admission, preterm birth, stillbirth, maternal critical care unit admission and maternal death. RESULTS 149 studies comprising 41,658 mothers and 8,854 neonates were included. All complications were more common in case reports, and in retrospective series compared with presumably prospective registry studies. Extensive overlap is likely in registry studies, with cases from seven countries reported by multiple registries. The UK Obstetric Surveillance System was the only registry to explicitly report identification and removal of duplicate cases, although five other registries reported collection of patient identifiable data which would facilitate identification of duplicates. CONCLUSIONS Since it is likely that registries provide the least biased estimates, the higher rates seen in the other two study designs are probably due to selection or publication bias. However even some registry studies include self- or doctor-reported cases, so might be biased, and we could not completely exclude overlap of cases in some registries.
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Affiliation(s)
- Eloise M Young
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Oleia Green
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Joel Stewart
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Yasmin King
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, College Road, University College, Cork, Ireland
| | - Kate F Walker
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Jim G Thornton
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England.
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13
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Giesbers S, Goh E, Kew T, Allotey J, Brizuela V, Kara E, Kunst H, Bonet M, Thangaratinam S. Treatment of COVID-19 in pregnant women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:120-128. [PMID: 34768118 PMCID: PMC8527829 DOI: 10.1016/j.ejogrb.2021.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022]
Abstract
Objective Clinical trials evaluating
pharmacological and non-pharmacological treatment of COVID-19, either
excluded pregnant women or included very few women. Unlike the numerous
systematic reviews on prevalence, symptoms and adverse outcomes of
COVID-19 in pregnancy, there are very few on the effects of treatment on
maternal and neonatal outcomes in pregnancy. We undertook a systematic
review of all published and unpublished studies on the effects of
pharmacological and non-pharmacological interventions for COVID-19 on
maternal and neonatal pregnancy outcomes. Data sources We performed a systematic literature
search of the following databases: Medline, Embase, Cochrane database,
WHO (World Health Organization) COVID-19 database, China National
Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December
2019 to 1 December 2020. Study eligibility criteria Studies were only included if they
involved pregnant or postnatal women who were exposed to pregnancy
specific interventions like the mode of delivery and type of anaesthesia,
pharmacological or non-pharmacological interventions. Study appraisal and synthesis
methods We first screened the titles and
abstracts of studies and then assessed the full text of the selected
studies in detail for eligibility. Data on study design, population, type
of screening for COVID-19, country, hospital, country status (high or low
and middle income), treatment given (mode of delivery, type of
anaesthesia, type of pharmacological and non-pharmacological treatment
was extracted. The pre-defined maternal outcomes we collected were mode
of delivery (vaginal or by caesarean section), severe or critical
COVID-19 (as defined by the authors), symptomatic COVID-19, maternal
death, maternal hospital admission, ICU admission, mechanical
ventilation, ECMO and maternal pneumonia. The pre-defined neonatal
outcomes we extracted were preterm birth (<37 weeks), stillbirth,
neonatal death, NICU admission, neonatal COVID-19 positive, neonatal
acidosis (pH<7.0) and Apgar scores (<8 after 5 minutes). Study
quality assessment was performed. Results From a total of 342 potential
eligible studies, we included 27 studies in our systematic review,
including 4943 pregnant women (appendix 3). Sixteen studies had a
retrospective cohort design and 11 a prospective cohort design. There
were no randomised controlled trials. There was a significant association
between caesarean section and admission to ICU (OR 4.99, 95% CI 1.24 to
20.12; 4 studies, 153 women, I2=0%), and
diagnosis of maternal COVID-19 pneumonia as defined by study authors (OR
3.09, 95% CI 1.52 to 6.28; 2 studies, 228 women, I2=0%). Women who had a preterm birth were more likely to
have the baby via caesarean section (OR 3.03, 95% CI 1.71 to 5.36, 12
studies; 314 women, I2=0%). For
pharmacological and non-pharmacological we provided estimates of the
expected rates of outcomes in women exposed to various treatment of
COVID-19. Comparative data for pregnant women, in particular for
treatments proven to be effective in the general population, however, is
lacking to provide clinically meaningful interpretation. Conclusions We found associations for pregnancy
specific interventions, like mode of delivery and outcomes of the
disease, but there were too few data on pharmacological and
non-pharmacological treatments in pregnant women with COVID-19. We report
the rates of complications found in the literature. We encourage
researchers to include pregnant women in their trials and report the data
on pregnant women separately.
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Affiliation(s)
- Steven Giesbers
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Edwina Goh
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Tania Kew
- Birmingham Medical School, Birmingham, United Kingdom
| | - John Allotey
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Institute of Applied Health Research, Birmingham, United Kingdom
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts Health NHS Trust, London, United Kingdom
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- University of Birmingham, WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, United Kingdom; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
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14
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Subramanian H, Ilangovan J, Chatterjee P. Redefining the use of subarachnoid block for caesarean section in severe COVID-19 pneumonia. Indian J Anaesth 2021; 65:626-627. [PMID: 34584287 PMCID: PMC8445215 DOI: 10.4103/ija.ija_12_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/08/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hariharan Subramanian
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jayaram Ilangovan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Protiti Chatterjee
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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15
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Lassi ZS, Ali A, Das JK, Salam RA, Padhani ZA, Irfan O, Bhutta ZA. A systematic review and meta-analysis of data on pregnant women with confirmed COVID-19: Clinical presentation, and pregnancy and perinatal outcomes based on COVID-19 severity. J Glob Health 2021; 11:05018. [PMID: 34221361 PMCID: PMC8248750 DOI: 10.7189/jogh.11.05018] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We determined the clinical presentation, risk factors, and pregnancy and perinatal outcomes in pregnant women with confirmed COVID-19 and identified if these are different based on COVID-19 severity. METHODS We included all observational studies on pregnant women with confirmed COVID-19 reporting clinical presentation, risk factors, and pregnancy and perinatal outcomes. We included all studies published between Dec/2019-Feb/2021 in Medline, Embase, the WHO COVID-19 databases, and clinicaltrials.gov. The methodological quality of cohort and case-series was assessed using NHLBI criteria. RESULTS 31 016 pregnant women from 62 studies were included. Women were an average of 30.9 years of age, most (77.7%) were in the third trimester, and 16.4% developed severe COVID-19. Nearly half were asymptomatic, while the most commonly reported symptoms were cough, fever, fatigue, and anosmia/ageusia. About 7% were admitted to the intensive care unit (ICU), 8% required mechanical ventilation, and 2% of the women died. Almost 80% of women delivered; 48.4% had cesarean births. Among newborns, 23.4% were preterm (<37 weeks), 16.6% were low birth weight, and 23.7% were admitted to neonatal ICU. A total of 21 stillbirths (1.6%) and 24 neonatal deaths (1.6%) were recorded, while 50 babies (3.5%) were COVID-19 positive. Studies comparing pregnant women with severe and non-severe COVID-19 showed that women with severe COVID-19 were 3.7 years older and the risk of severe COVID-19 was 1.5 times higher among women >35 years. The risk of severe COVID-19 was significantly higher among women who were obese, had smoked, diabetic, and had pre-eclampsia. The risk of preterm birth was almost 2.4 folds among women with severe COVID-19. CONCLUSIONS Our review suggests a heightened risk of COVID-19 severity and adverse pregnancy and perinatal outcomes among women with certain demographic and health profiles. These findings can inform the formation of current guidelines; however, these should be constantly updated as the global COVID-19 scenario unfolds. REGISTRATION PROSPERO: CRD42020182048.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, the University of Adelaide, Adelaide, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
| | - Anna Ali
- Robinson Research Institute, the University of Adelaide, Adelaide, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
| | - Jai K Das
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zahra A Padhani
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Omar Irfan
- Centre for Global Child Health, the Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, the Hospital for Sick Children (SickKids), Toronto, Canada
- Centre of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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16
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Hammad WAB, Al Beloushi M, Ahmed B, Konje JC. Severe acute respiratory syndrome (SARS) coronavirus-2 infection (COVID-19) in pregnancy - An overview. Eur J Obstet Gynecol Reprod Biol 2021; 263:106-116. [PMID: 34225131 PMCID: PMC8205284 DOI: 10.1016/j.ejogrb.2021.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023]
Abstract
The novel severe acute respiratory syndrome (SARS) coronavirus-2 which causes COVID-19 disease results in severe morbidity and mortality especially in vulnerable groups. Pregnancy by virtue of its physiological and anatomical adaptations increases the risk of severe infections especially those of the respiratory tract. This single stranded RNA virus is transmitted by droplets as well as soiled fomites. There are various degrees of disease severity– asymptomatic, mild, moderate severe and critical. Most infections in pregnancy are asymptomatic or mildly symptomatic. For these women, the consequences on the mother or pregnancy are minimal unless they have additional risk factors such as diabetes, hypertension, cardiorespiratory disease, obesity or are of ethnic minority background. Most women with symptoms will present with fever, unproductive cough, sore throat, myalgia, nasal congestion, loss of smell and taste with associated leukocytosis and lymphopenia. Diagnosis is by RT-PCR on nasopharyngeal flocked swabs or saliva and pathognomonic features of ground-glass appearance and pulmonary infiltrates on chest X-ray or CT scans. Management in pregnancy is same as that for non-pregnant women with COVID-19. It is not an indication for elective delivery but assisted delivery in the second stage for those with moderate, severe or critical disease may be required to shorten this stage. COVID-19 is not an indication for interrupting pregnancy or caesarean section but the latter may be performed to facilitate ventilation support or resuscitation in those with severe disease. Pain relief in labour should not be different but regional analgesia is preferred for operative deliveries. Postpartum thromboprophylaxis should be considered and breast feeding encouraged with appropriate precautions to minimize vertical transmission. Pregnant and lactating women should be encouraged to receive the mRNA based vaccines as there is no evidence of adverse outcomes with these.
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Affiliation(s)
- Wafaa Ali Belail Hammad
- Department of Obstetrics and Gynaecology Basildon and Thurrock University Hospitals NHS Foundation Trust Nethermayne, Basildon Essex SS16 5NL, United Kingdom
| | - Mariam Al Beloushi
- Women's Wellness Research Center, Hamad Medical Corporation, Doha, Qatar and Department of Obstetrics and Gynaecology, Qatar University, Doha Qata and Weil Cornell Medicine, Qatar
| | - Badreleden Ahmed
- Feto-Maternal Medicine Center, Doha Qatar and Department of Obstetrics and Gynaecology, Qatar University Doha Qata and Weil Cornell Medicine, Qatar
| | - Justin C Konje
- Department of Health Sciences, University of Leicester, Leicester, UK.
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17
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Grudlewska-Buda K, Wiktorczyk-Kapischke N, Wałecka-Zacharska E, Kwiecińska-Piróg J, Buszko K, Leis K, Juszczuk K, Gospodarek-Komkowska E, Skowron K. SARS-CoV-2-Morphology, Transmission and Diagnosis during Pandemic, Review with Element of Meta-Analysis. J Clin Med 2021; 10:1962. [PMID: 34063654 PMCID: PMC8125301 DOI: 10.3390/jcm10091962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
The outbreak of Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2). Thus far, the virus has killed over 2,782,112 people and infected over 126,842,694 in the world (state 27 March 2021), resulting in a pandemic for humans. Based on the present data, SARS-CoV-2 transmission from animals to humans cannot be excluded. If mutations allowing breaking of the species barrier and enhancing transmissibility occurred, next changes in the SARS-CoV-2 genome, leading to easier spreading and greater pathogenicity, could happen. The environment and saliva might play an important role in virus transmission. Therefore, there is a need for strict regimes in terms of personal hygiene, including hand washing and surface disinfection. The presence of viral RNA is not an equivalent of active viral infection. The positive result of the RT-PCR method may represent either viral residues or infectious virus particles. RNA-based tests should not be used in patients after the decline of disease symptoms to confirm convalescence. It has been proposed to use the test based on viral, sub-genomic mRNA, or serological methods to find the immune response to infection. Vertical transmission of SARS-CoV-2 is still a little-known issue. In our review, we have prepared a meta-analysis of the transmission of SARS-CoV-2 from mother to child depending on the type of delivery. Our study indicated that the transmission of the virus from mother to child is rare, and the infection rate is not higher in the case of natural childbirth, breastfeeding, or contact with the mother. We hope that this review and meta-analysis will help to systemize knowledge about SARS-CoV-2 with an emphasis on diagnostic implications and transmission routes, in particular, mother-to-child transmission.
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Affiliation(s)
- Katarzyna Grudlewska-Buda
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Natalia Wiktorczyk-Kapischke
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Ewa Wałecka-Zacharska
- Department of Food Hygiene and Consumer Health, Wrocław University of Environmental and Life Sciences, 50-375 Wrocław, Poland;
| | - Joanna Kwiecińska-Piróg
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Katarzyna Buszko
- Department of Theoretical Foundations of Biomedical Science and Medical Informatics, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-067 Bydgoszcz, Poland;
| | - Kamil Leis
- Faculty of Medicile, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-067 Bydgoszcz, Poland;
| | - Klaudia Juszczuk
- Clinic of General, Colorectal and Oncological Surgery, Dr. Jana Biziel University Hospital, No. 2 in Bydgoszcz, 75 Ujejskiego St., 85-168 Bydgoszcz, Poland;
| | - Eugenia Gospodarek-Komkowska
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
| | - Krzysztof Skowron
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University in Toruń, 87-094 Bydgoszcz, Poland; (K.G.-B.); (N.W.-K.); (J.K.-P.); (E.G.-K.)
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18
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Carrasco I, Muñoz-Chapuli M, Vigil-Vázquez S, Aguilera-Alonso D, Hernández C, Sánchez-Sánchez C, Oliver C, Riaza M, Pareja M, Sanz O, Pérez-Seoane B, López J, Márquez E, Domínguez-Rodríguez S, Hernanz-Lobo A, De León-Luis JA, Sánchez-Luna M, Navarro ML. SARS-COV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave. BMC Pregnancy Childbirth 2021; 21:326. [PMID: 33902483 PMCID: PMC8072086 DOI: 10.1186/s12884-021-03784-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Knowledge about SARS-CoV-2 infection in pregnancy and newborns is scarce. The objective of this study is to analyse clinical and epidemiological characteristics of a cohort of women infected with SARS-CoV-2 during pregnancy and their newborns exposed to SARS-CoV-2 during gestation. METHODS Multicentric observational study of Spanish hospitals from the GESNEO-COVD cohort, participants in RECLIP (Spanish Network of Paediatric Clinical Assays). Women with confirmed SARS-CoV-2 infection by PCR and/or serology during pregnancy, diagnosed and delivering during the period 15/03/2020-31/07/2020 were included. Epidemiological, clinical, and analytical data was collected. RESULTS A total of 105 pregnant women with a median of 34.1 years old (IQR: 28.8-37.1) and 107 newborns were included. Globally, almost 65% of pregnant women had some COVID-19 symptoms and more than 43% were treated for SARS-COV-2. Overall, 30.8% of pregnant women had pneumonia and 5 (4.8%) women were admitted to the intensive care unit needing invasive mechanical ventilation. There was a rate of 36.2% of caesarean sections, which was associated with pneumonia during pregnancy (OR: 4.203, CI 95%: 1.473-11.995) and lower gestational age at delivery (OR: 0.724, CI 95%: 0.578-0.906). The prevalence of preterm birth was 20.6% and prematurity was associated with pneumonia during gestation (OR: 6.970, CI95%: 2.340-22.750) and having a positive SARS-CoV-2 PCR at delivery (OR: 6.520, CI95%: 1.840-31.790). All nasopharyngeal PCR in newborns were negative at birth and one positivized at 15 days of life. Two newborns died, one due to causes related to prematurity and another of unexpected sudden death during early skin-to-skin contact after delivery. CONCLUSIONS Although vertical transmission has not been reported in this cohort, the prognosis of newborns could be worsened by SARS-CoV-2 infection during pregnancy as COVID-19 pneumonia increased the risk of caesarean section deliveries and preterm births.
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MESH Headings
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- COVID-19/epidemiology
- COVID-19/physiopathology
- COVID-19/therapy
- COVID-19 Nucleic Acid Testing
- Carrier State/epidemiology
- Cesarean Section/statistics & numerical data
- Cohort Studies
- Comorbidity
- Cough/physiopathology
- Diabetes, Gestational/epidemiology
- Dyspnea/physiopathology
- Female
- Fever/physiopathology
- Gestational Age
- Humans
- Hypertension/epidemiology
- Hypothyroidism/epidemiology
- Immunologic Factors/therapeutic use
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Intensive Care Units/statistics & numerical data
- Lung/diagnostic imaging
- Male
- Obesity, Maternal/epidemiology
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pregnancy
- Pregnancy Complications/epidemiology
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Premature Birth/epidemiology
- Radiography, Thoracic
- Respiration, Artificial
- Risk Factors
- SARS-CoV-2
- Severity of Illness Index
- Spain/epidemiology
- COVID-19 Drug Treatment
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Affiliation(s)
- Itzíar Carrasco
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain.
| | - Mar Muñoz-Chapuli
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Hernández
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - César Sánchez-Sánchez
- Department of Paediatric Gastroenterology Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Oliver
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mónica Riaza
- Department of Paediatrics, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Marta Pareja
- Department of Paediatrics, Hospital General de Albace, Castilla La Mancha, Spain
| | - Olga Sanz
- Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Juan López
- Department of Paediatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Elena Márquez
- Department of Paediatrics, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Sara Domínguez-Rodríguez
- Paediatric Infectious Diseases Unit, Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain
| | - Alicia Hernanz-Lobo
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Antonio De León-Luis
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Sánchez-Luna
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Navarro
- Paediatric Infectious Disease Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
- Department of Paediatric Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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19
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Wu L, Zheng Y, Liu J, Luo R, Wu D, Xu P, Wu D, Li X. Comprehensive evaluation of the efficacy and safety of LPV/r drugs in the treatment of SARS and MERS to provide potential treatment options for COVID-19. Aging (Albany NY) 2021; 13:10833-10852. [PMID: 33879634 PMCID: PMC8109137 DOI: 10.18632/aging.202860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) experienced an outbreak that expanded worldwide. Lopinavir/ritonavir (LPV/r), which is used effectively for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections, was applied for COVID-19 treatment given similarities in the molecular structures of these viruses. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of lopinavir/ritonavir antiviral treatment in patients with SARS, MERS, and COVID-19. After registration with INPLASY, a search was conducted in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Cochrane Library, WanFang Data, China Biomedical Literature Database (CBM) and other databases for all relevant literature on lopinavir/ritonavir treatment of SARS, MERS and COVID-19. The Cochrane Collaboration’s bias risk assessment tool and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the literature, and RevMan 5.3 software was used to evaluate the relevant outcome indicators of the efficacy and safety of lopinavir/ritonavir in the treatment of COVID-19. A total of 18 eligible studies (including randomized controlled studies, cohort studies, and case-control studies) were retrieved and included with a total of 2273 patients. The lopinavir/ritonavir group exhibited an increased nucleic acid conversion rate (P=0.004), higher virus clearance rate (P<0.0001), lower mortality rate (P=0.002), and reduced incidence of acute respiratory distress syndrome (ARDS) (P=0.02) compared with the control group. No significant benefit in the improvement rate of chest CT (P=0.08) or incidence of adverse events (P=0.45) was noted. The lopinavir/ritonavir group had a lower incidence of acute respiratory distress syndrome (P=0.02). According to the clinical prognostic results, the incidence of adverse events between the two groups was not statistically significant (P<0.0001). The efficacy of lopinavir/ritonavir in the treatment of patients with SARS, MERS and COVID-19 was significantly better than that of the control. Furthermore, the incidence of adverse events did not significantly increase. Lopinavir/ritonavir is effective in the treatment of COVID-19, and this combination should be further assessed in RCT studies. In addition, when we analyzed the differences in age and sex, we found that the differences were statistically significant in the safety and effectiveness of lopinavir/ritonavir in patients with COVID-19, and both of these factors played a significant role in the trial.
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Affiliation(s)
- Liusheng Wu
- Peking University Shenzhen Hospital, Clinical College of Anhui Medical University, Shenzhen 518036, Guangdong, China.,Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.,Anhui Medical University, Hefei 230032, Anhui, China
| | - Yuzhen Zheng
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, Guangdong, China
| | - Jixian Liu
- Peking University Shenzhen Hospital, Clinical College of Anhui Medical University, Shenzhen 518036, Guangdong, China.,Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
| | - Ruixing Luo
- Peking University Shenzhen Hospital, Clinical College of Anhui Medical University, Shenzhen 518036, Guangdong, China.,Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.,Anhui Medical University, Hefei 230032, Anhui, China
| | - Dingwang Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
| | - Pengcheng Xu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
| | - Da Wu
- Peking University Shenzhen Hospital, Clinical College of Anhui Medical University, Shenzhen 518036, Guangdong, China.,Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
| | - Xiaoqiang Li
- Peking University Shenzhen Hospital, Clinical College of Anhui Medical University, Shenzhen 518036, Guangdong, China.,Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
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20
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Terry PD, Heidel RE, Dhand R. Asthma in Adult Patients with COVID-19. Prevalence and Risk of Severe Disease. Am J Respir Crit Care Med 2021; 203:893-905. [PMID: 33493416 PMCID: PMC8017581 DOI: 10.1164/rccm.202008-3266oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Rationale: Health outcomes of people with coronavirus disease (COVID-19) range from no symptoms to severe illness and death. Asthma, a common chronic lung disease, has been considered likely to increase the severity of COVID-19, although data addressing this hypothesis have been scarce until very recently.Objectives: To review the epidemiologic literature related to asthma's potential role in COVID-19 severity.Methods: Studies were identified through the PubMed (MEDLINE) and medRxiv (preprint) databases using the search terms "asthma," "SARS-CoV-2" (severe acute respiratory syndrome coronavirus 2), and "COVID-19," and by cross-referencing citations in identified studies that were available in print or online before December 22, 2020.Measurements and Main Results: Asthma prevalence data were obtained from studies of people with COVID-19 and regional health statistics. We identified 150 studies worldwide that allowed us to compare the prevalence of asthma in patients with COVID-19 by region, disease severity, and mortality. The results of our analyses do not provide clear evidence of increased risk of COVID-19 diagnosis, hospitalization, severity, or mortality due to asthma.Conclusions: These findings could provide some reassurance to people with asthma regarding its potential to increase their risk of severe morbidity from COVID-19.
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Affiliation(s)
| | | | - Rajiv Dhand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
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21
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Fung M, Otani I, Pham M, Babik J. Zoonotic coronavirus epidemics: Severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019. Ann Allergy Asthma Immunol 2021; 126:321-337. [PMID: 33310180 PMCID: PMC7834857 DOI: 10.1016/j.anai.2020.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review the virology, immunology, epidemiology, clinical manifestations, and treatment of the following 3 major zoonotic coronavirus epidemics: severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19). DATA SOURCES Published literature obtained through PubMed database searches and reports from national and international public health agencies. STUDY SELECTIONS Studies relevant to the basic science, epidemiology, clinical characteristics, and treatment of SARS, MERS, and COVID-19, with a focus on patients with asthma, allergy, and primary immunodeficiency. RESULTS Although SARS and MERS each caused less than a thousand deaths, COVID-19 has caused a worldwide pandemic with nearly 1 million deaths. Diagnosing COVID-19 relies on nucleic acid amplification tests, and infection has broad clinical manifestations that can affect almost every organ system. Asthma and atopy do not seem to predispose patients to COVID-19 infection, but their effects on COVID-19 clinical outcomes remain mixed and inconclusive. It is recommended that effective therapies, including inhaled corticosteroids and biologic therapy, be continued to maintain disease control. There are no reports of COVID-19 among patients with primary innate and T-cell deficiencies. The presentation of COVID-19 among patients with primary antibody deficiencies is variable, with some experiencing mild clinical courses, whereas others experiencing a fatal disease. The landscape of treatment for COVID-19 is rapidly evolving, with both antivirals and immunomodulators demonstrating efficacy. CONCLUSION Further data are needed to better understand the role of asthma, allergy, and primary immunodeficiency on COVID-19 infection and outcomes.
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Affiliation(s)
- Monica Fung
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California.
| | - Iris Otani
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Michele Pham
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer Babik
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California
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22
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A Clinical Study on Initial Experience of COVID-19 ARDS in Obstetric Patients at a Tertiary Care Centre in India. Case Rep Obstet Gynecol 2021; 2021:5591041. [PMID: 33815855 PMCID: PMC8010524 DOI: 10.1155/2021/5591041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) which causes severe viral pneumonia rapidly leading to acute respiratory distress syndrome (ARDS). Pregnant women are considered more vulnerable to severe viral respiratory infections owing to the physiological changes in pregnancy. In COVID-19, patient can present with a variety of symptoms of which dyspnoea is one that is also commonly seen in the late stages of pregnancy. The clinical presentation as well as response to therapy is highly variable, and since no conclusive proven treatment is available yet, prevention and symptomatic treatment remains the mainstay of management. Thus, we report a case series of four SARS-CoV-2-positive obstetric patients who presented with severe ARDS in a tertiary care hospital, posing diagnostic and therapeutic challenges to the clinician, and were managed with a holistic multidisciplinary stepwise approach. Through this, an effort has been made to sensitize the attending obstetrician on diverse presentation of COVID-19 disease and to emphasize the importance of prevention, early pick up, and timely optimal management of pneumonia in pregnant females with COVID-19. The clinical presentation of respiratory illness due to SARS-CoV-2 in pregnancy can be mistaken for exaggerated physiological changes of pregnancy leading to delay in seeking medical care. During the current pandemic, high suspicion for COVID-19 should be kept. If found symptomatic, immediate care should be sought in a designated facility and managed accordingly preferably with a multidisciplinary approach.
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23
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Grünebaum A, Chervenak FA, McCullough LB, Dudenhausen JW, Bornstein E, Mackowiak PA. How fever is defined in COVID-19 publications: a disturbing lack of precision. J Perinat Med 2021; 49:255-261. [PMID: 33554570 DOI: 10.1515/jpm-2020-0546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Fever is the single most frequently reported manifestation of COVID-19 and is a critical element of screening persons for COVID-19. The meaning of "fever" varies depending on the cutoff temperature used, the type of thermometer, the time of the day, the site of measurements, and the person's gender and race. The absence of a universally accepted definition for fever has been especially problematic during the current COVID-19 pandemic. METHODS This investigation determined the extent to which fever is defined in COVID-19 publications, with special attention to those associated with pregnancy. RESULTS Of 53 publications identified in which "fever" is reported as a manifestation of COVID-19 illness, none described the method used to measure patient's temperatures. Only 10 (19%) publications specified the minimum temperature used to define a fever with values that varied from a 37.3 °C (99.1 °F) to 38.1 °C (100.6 °F). CONCLUSIONS There is a disturbing lack of precision in defining fever in COVID-19 publications. Given the many factors influencing temperature measurements in humans, there can never be a single, universally accepted temperature cut-off defining a fever. This clinical reality should not prevent precision in reporting fever. To achieve the precision and improve scientific and clinical communication, when fever is reported in clinical investigations, at a minimum the cut-off temperature used in determining the presence of fever, the anatomical site at which temperatures are taken, and the instrument used to measure temperatures should each be described. In the absence of such information, what is meant by the term "fever" is uncertain.
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Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics & Gynecology, Lenox Hill Hospital, New York, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Frank A Chervenak
- Department of Obstetrics & Gynecology, Lenox Hill Hospital, New York, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Laurence B McCullough
- Department of Obstetrics & Gynecology, Lenox Hill Hospital, New York, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joachim W Dudenhausen
- Faculty of Health Sciences, Joint Faculty of University Potsdam, B-TU and MHB, Germany
| | - Eran Bornstein
- Department of Obstetrics & Gynecology, Lenox Hill Hospital, New York, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Philip A Mackowiak
- Department of Medicine, University of Maryland School of Medicine, Emeritus Professor of Medicine and the Carolyn Frenkil and Selvin Passen History of Medicine Scholar-in-Residence at the University of Maryland School of Medicine, Baltimore, ML, USA
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24
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Dubey P, Thakur B, Reddy S, Martinez CA, Nurunnabi M, Manuel SL, Chheda S, Bracamontes C, Dwivedi AK. Current trends and geographical differences in therapeutic profile and outcomes of COVID-19 among pregnant women - a systematic review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:247. [PMID: 33761892 PMCID: PMC7990381 DOI: 10.1186/s12884-021-03685-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women. METHODS A PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively. RESULTS One thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed. CONCLUSIONS Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.
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Affiliation(s)
- Pallavi Dubey
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Bhaskar Thakur
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Sireesha Reddy
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Carla A Martinez
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Md Nurunnabi
- School of Pharmacy, the University of Texas at El Paso, El Paso, TX, USA
| | - Sharron L Manuel
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Sadhana Chheda
- Department of Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Christina Bracamontes
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Alok K Dwivedi
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
- Biostatistics and Epidemiology Consulting Lab, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
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25
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Abu-Amara J, Szpecht D, Al-Saad SR, Karbowski LM. Contracting COVID-19 in the first and second trimester of pregnancy: what we know - a concise qualitative systematic review. Arch Med Sci 2021; 17:1548-1557. [PMID: 34900033 PMCID: PMC8641503 DOI: 10.5114/aoms/133121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Recent medical literature has drawn attention to the possible influence of COVID-19 on the course of pregnancies. As the coherence of results seems to vary, especially in relation to first and second trimester pregnancies, a concise qualitative systematic review can shed light on the most recent data. MATERIAL AND METHODS A structured systematic search was performed to collect all COVID-19 pregnancy-related articles published between January 1 and September 16, 2020. Two independent reviewers evaluated studies using the STROBE statement in combination with the CERQual quality assessment of findings. RESULTS In total 1387 articles were screened and finally 22 studies were evaluated (179 1st/2nd trimesters of pregnant women with COVID-19). The majority of reported mothers who contracted COVID-19 during 1st/2nd trimesters are yet to complete their pregnancy. CONCLUSIONS Evidently a limited amount of data is available. Usually, mothers and newborns are discharged from the hospital without any serious complications. Further observations are imperative.
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Affiliation(s)
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
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26
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A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19. ACTA ACUST UNITED AC 2021; 3:1272-1294. [PMID: 33754135 PMCID: PMC7968576 DOI: 10.1007/s42399-021-00836-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
The maternal-fetal/newborn unit is established at risk for COVID-19 infection. This narrative review summarizes the contemporary and cumulative publications which detail maternal infection, antenatal and newborn infections, and maternal/fetal/newborn management and prevention. There is a wide spectrum of maternal disease, but the potential for severe disease albeit in a minority is confirmed. COVID-19 carries risk for preterm delivery. Pregnant females can suffer multisystem disease, and co-morbidities play a significant role in risk. Congenital infection has been supported by several anecdotal reports, but strong confirmatory data are few. No typical congenital dysmorphisms are evident. Nevertheless, placental vascular compromise must be considered a risk for the fetus during advanced maternal infections. Clinical manifestations of newborn infection have been mild to moderate and relatively uncommon. Proven antiviral therapy is of yet lacking. The mode of delivery is a medical decision that must include patient risk assessment and patient directives. Both presymptomatic and asymptomatic mothers and offspring can complicate infection control management with the potential for spread to others in several regards. In the interim, infections of the maternal-fetal-newborn unit must be taken seriously both for the disease so caused and the potential for further dissemination of disease.
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27
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Karimi L, Makvandi S, Vahedian-Azimi A, Sathyapalan T, Sahebkar A. Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis. J Pregnancy 2021; 2021:8870129. [PMID: 33728066 PMCID: PMC7938334 DOI: 10.1155/2021/8870129] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/12/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. METHODS Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. RESULTS 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. CONCLUSION COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.
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Affiliation(s)
- Leila Karimi
- Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Somayeh Makvandi
- Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, UK
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Soheili M, Moradi G, Baradaran HR, Soheili M, Mokhtari MM, Moradi Y. Clinical manifestation and maternal complications and neonatal outcomes in pregnant women with COVID-19: a comprehensive evidence synthesis and meta-analysis. J Matern Fetal Neonatal Med 2021; 35:5672-5685. [PMID: 33602025 DOI: 10.1080/14767058.2021.1888923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES There is little known about pregnancy-related complications and comorbidity in this group of women. Therefore, this systematic review and meta-analysis were performed to find out whether COVID-19 may cause different manifestations and outcomes in the antepartum and postpartum period or not. MATERIAL AND METHODS We searched databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid, and CINHAL to retrieve all articles reporting the prevalence of maternal and neonatal complications, in addition to clinical manifestations, in pregnant women with COVID-19 that published with English language January to November 2020. RESULTS Seventy-four studies with total 5560 pregnant women included in this systematic review. The results show that the pooled prevalence of neonatal mortality, lower birth weight, stillbirth, premature birth, and intrauterine fetal distress in women with COVID-19 was 4% (95% Cl: 1 - 9%), 21% (95% Cl: 11 - 31%), 2% (95% Cl: 1 - 6%), 28% (95% Cl: 13 - 43%), and 14% (95% Cl: 4 - 25%); respectively. Moreover, the pooled prevalence of fever, cough, diarrhea, and dyspnea were 56% (95% Cl: 32 - 81%), 29% (95% Cl: 21 - 38%), 9% (95% Cl: 2 - 16%), and 3% (95% Cl: 1 - 6%) in pregnant women with COVID-19. Two studies reported that pregnant women with severe COVID pneumonia have higher levels of d-dimer. Also, COVID pneumonia is more common in pregnant women than non-pregnant. CONCLUSION According to this meta-analysis, pregnant women with COVID-19 with or without pneumonia, are at a higher risk of preeclampsia, preterm birth, miscarriage and cesarean delivery. Furthermore, the risk of LBW and intrauterine fetal distress seems to be increased in neonates. In addition, our evaluations are investigative of higher risk of COVID-19 in the third trimester in pregnant women comparing to the first and second trimester. It can be due to higher BMI in the third trimester causing to increase the likelihood of disease deterioration, which can trigger a cascade of side effects starting with coagulation, pneumonia, hypoxemia affecting the placenta leading to ICU admission, fetal distress, premature birth and higher rates of C-section.
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Affiliation(s)
- Marzieh Soheili
- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Maryam Soheili
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Mohammad Mahdi Mokhtari
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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29
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Boushra MN, Koyfman A, Long B. COVID-19 in pregnancy and the puerperium: A review for emergency physicians. Am J Emerg Med 2021; 40:193-198. [PMID: 33162266 PMCID: PMC7605788 DOI: 10.1016/j.ajem.2020.10.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a novel virus responsible for causing the novel coronavirus disease of 2019 (COVID-19). OBJECTIVE This article discusses the clinical manifestations of COVID-19 in pregnant patients, the effects of pregnancy on the course of COVID-19 disease, and the impact of COVID-19 on pregnancy outcomes. DISCUSSION The physiological and mechanical changes associated with pregnancy increase maternal susceptibility to infections and complicate intubation and mechanical ventilation. The most common symptoms of COVID-19 in pregnant patients are cough and fever, although many infected individuals are asymptomatic. The majority of pregnant women diagnosed with COVID-19 disease have a mild course of illness and will recover without needing to deliver, but the risks of critical illness and need for mechanical ventilation are increased compared to the general population. Risk factors for death and severe disease include obesity, diabetes, and maternal age > 40 years. Women in their third trimester have the highest risk for critical illness, intensive care unit admission, and need for mechanical ventilation. Adverse fetal outcomes of maternal COVID-19 infection include increased risk of miscarriage, prematurity, and fetal growth restriction. Vertical transmission of SARS-CoV-2 is possible but has not been conclusively proven. CONCLUSIONS COVID-19 is a potentially deadly infection, but data are limited concerning the pregnant population. Pregnant patients appear to present similarly to the general population, with fever and cough being the most reported symptoms in studies. Knowledge of these presentations and outcomes can assist clinicians caring for these patients.
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Affiliation(s)
- Marina N Boushra
- Respiratory Institute at The Cleveland Clinic, Cleveland, OH 44106, United States of America
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States of America.
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30
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Abstract
PURPOSE OF REVIEW This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers. RECENT FINDINGS COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Although SARS-CoV-2 was associated with a certain neurotropism, neuraxial block was not associated with neurological damage in COVID-19 parturients, and seems as safe and effective as in normal situations. It permits to avoid a general anesthesia in case of intrapartum cesarean section. Epidural failure is a concern: it may lead to a general anesthesia in case of emergency cesarean section. Local protocols and well-trained anesthesiologists will be helpful. COVID-19 patients require special circuits and every step (transfer to and from theatre, recovery, analgesia, and so on) should be planned in advance. For cesarean section under general anesthesia, personal protection equipment must be enhanced. Postoperative analgesia with neuraxial opioids, NSAIDs, or regional blocks are recommended. COVID-19 and pregnancy increase the risk of thrombosis, so thromboprophylaxis has to be considered and protocolized. SUMMARY Anesthetic care for delivery in COVID-19 parturients should include neuraxial blocks. Special attention should be paid on the risk of thrombosis.
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Affiliation(s)
- Emilia Guasch
- Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz
| | - Nicolas Brogly
- Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz
| | - Fernando Gilsanz
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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31
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Carvalho BRD, Adami KDS, Gonçalves-Ferri WA, Samama M, Ferriani RA, Marcolin AC. COVID-19: Uncertainties from Conception to Birth. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:54-60. [PMID: 33513637 PMCID: PMC10183911 DOI: 10.1055/s-0040-1721856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Scientific information on the impact of the new coronavirus (SARS-CoV-2) on the health of pregnant women, fetuses and newborns is considered of limited confidence, lacking good-quality evidence, and drawing biased conclusions. As a matter of fact, the initial impressions that the evolution of COVID-19 was no different between pregnant and non-pregnant women, and that SARS-CoV-2 was not vertically transmitted, are confronted by the documentation of worsening of the disease during pregnancy, poor obstetric outcomes, and the possibility of vertical transmission. The present article aims to compile the data available on the association of COVID-19 and reproductive events, from conception to birth.
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Affiliation(s)
| | - Karina de Sá Adami
- Maternidade Climério de Oliveira, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Walusa Assad Gonçalves-Ferri
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Marise Samama
- Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Alessandra Cristina Marcolin
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Centeno‐Tablante E, Medina‐Rivera M, Finkelstein JL, Rayco‐Solon P, Garcia‐Casal MN, Rogers L, Ghezzi‐Kopel K, Ridwan P, Peña‐Rosas JP, Mehta S. Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci 2021; 1484:32-54. [PMID: 32860259 PMCID: PMC7970667 DOI: 10.1111/nyas.14477] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full-text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID-19 cases based on RT-PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID-19 were positive for SARS-CoV-2 RNA; of the exposed infants, four were positive and two were negative for COVID-19. Currently, there is no evidence of SARS-CoV-2 transmission through breast milk. Studies are needed with longer follow-up periods that collect data on infant feeding practices and on viral presence in breast milk.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn,
Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | - Lisa Rogers
- Department of Nutrition and Food
SafetyWorld Health OrganizationGenevaSwitzerland
| | | | - Pratiwi Ridwan
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| | | | - Saurabh Mehta
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
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Mejía Jiménez I, Salvador López R, García Rosas E, Rodriguez de la Torre I, Montes García J, de la Cruz Conty ML, Martínez Pérez O. Umbilical cord clamping and skin-to-skin contact in deliveries from women positive for SARS-CoV-2: a prospective observational study. BJOG 2020; 128:908-915. [PMID: 33187026 PMCID: PMC7753553 DOI: 10.1111/1471-0528.16597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
Objective To demonstrate that delayed cord clamping (DCC) is safe in mothers with confirmed SARS‐CoV‐2 infection. Design, setting and participants Prospective observational study involving epidemiological information from 403 pregnant women with SARS‐CoV‐2 between 1 March and 31 May 2020. Data were collected from 70 centres that participate in the Spanish Registry of COVID‐19. Methods Patients' information was collected from their medical chart. Main outcomes and measures The rate of perinatal transmission of SARS‐CoV‐2 and development of the infection in neonates within 14 days postpartum. Results The early cord clamping (ECC) group consisted of 231 infants (57.3%) and the DCC group consisted of 172 infants (42.7%). Five positive newborns (1.7% of total tests performed) were identified with the nasopharyngeal PCR tests performed in the first 12 hours postpartum, two from the ECC group (1.7%) and three from the DCC group (3.6%). No significant differences between groups were found regarding neonatal tests for SARS‐CoV‐2. No confirmed cases of vertical transmission were detected. The percentage of mothers who made skin‐to‐skin contact within the first 24 hours after delivery was significantly higher in the DCC group (84.3% versus 45.9%). Breastfeeding in the immediate postpartum period was also significantly higher in the DCC group (77.3% versus 50.2%). Conclusions The results of our study show no differences in perinatal outcomes when performing ECC or DCC, and skin‐to‐skin contact, or breastfeeding. Tweetable abstract This study demonstrates that delayed cord clamping is safe in mothers with confirmed SARS‐CoV‐2 infection. This study demonstrates that delayed cord clamping is safe in mothers with confirmed SARS‐CoV‐2 infection.
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Affiliation(s)
- I Mejía Jiménez
- Obstetrics and Gynaecology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Salvador López
- Obstetrics and Gynaecology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - E García Rosas
- Obstetrics and Gynaecology Service, Hospital del Mar, Barcelona, Spain
| | | | | | - M L de la Cruz Conty
- Fundación de Investigación Biomédica, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - O Martínez Pérez
- Obstetrics and Gynaecology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
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Rodrigues C, Baía I, Domingues R, Barros H. Pregnancy and Breastfeeding During COVID-19 Pandemic: A Systematic Review of Published Pregnancy Cases. Front Public Health 2020; 8:558144. [PMID: 33330308 PMCID: PMC7719788 DOI: 10.3389/fpubh.2020.558144] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023] Open
Abstract
Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19. Methods: Searches were conducted in PubMed®, Scopus®, Web of Science®, and MedRxiv® up to 26th June 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality. Results: We identified 161 original studies reporting 3,985 cases of pregnant women with COVID-19 (1,007 discharged while pregnant). The 2,059 published cases with pregnancy outcomes resulted in 42 abortions, 21 stillbirths, and 2,015 live births. Preterm birth occurred in 23% of cases. Around 6% of pregnant women required admission to an intensive care unit and 28 died. There were 10 neonatal deaths. From the 163 cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus, 10 were positive. Sixty-one newborns were positive for SARS-CoV-2. Four breast milk samples from 92 cases showed evidence of SARS-CoV-2. Conclusion: Emerging evidence suggests that vertical transmission is possible, however, there is still a limited number of reported cases with intrapartum samples. Information, counseling and adequate monitoring are essential to prevent and manage adverse effects of SARS-CoV-2 infection during pregnancy.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal,*Correspondence: Carina Rodrigues
| | - Inês Baía
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Rosa Domingues
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Henrique Barros
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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