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Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Bonavita S, Buscarinu M, Calabrese M, Cavalla P, Cellerino M, Cordioli C, Dattola V, De Biase S, De Meo E, Fantozzi R, Gallo A, Iasevoli L, Karabudak R, Landi D, Lorefice L, Moiola L, Ragonese P, Ruscica F, Sen S, Sinisi L, Signoriello E, Toscano S, Verrengia E, Siva A, Masciulli C, Sormani MP, Amato MP. Impact of COVID-19 on pregnancy and fetal outcomes in women with multiple sclerosis. Mult Scler 2024; 30:707-713. [PMID: 38456445 DOI: 10.1177/13524585241232266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND In the general population, maternal COVID-19 is associated with worse maternal and fetal outcomes. Two previous studies have assessed COVID-19 clinical outcomes in pregnant women with multiple sclerosis (MS), but there are no data about maternal and fetal outcomes. OBJECTIVES In this multicenter study, we aimed to assess maternal and fetal outcomes in pregnant women with MS and COVID-19 infection. METHODS We recruited pregnant patients with MS who contracted COVID-19 and were followed up in Italian and Turkish Centers, during 2020-2022. A control group was extracted from a previous Italian cohort. Associations between group (COVID-19 or healthy patients) and clinical outcomes (maternal complications, fetal malformations, and spontaneous abortion) were investigated with a weighted logistic regression where propensity score-based inverse probability of treatment weighting (IPTW) approach was applied for adjusting for difference in baseline confounders. RESULTS In the multivariable analysis, COVID-19 during pregnancy was associated with a higher risk of maternal complications (odd ratio (OR) = 2.12; 95% confidence interval (CI) = 1.32-3.48; p = 0.002), while it was not associated with higher risk of spontaneous abortion and fetal malformations. CONCLUSION Our data indicate that COVID-19 during pregnancy increases the risk of maternal complications, while it seems to have no significant impact on fetal outcomes.
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Affiliation(s)
| | - Irene Schiavetti
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Simona Bonavita
- II Division, Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari Hospital, Brescia, Italy
| | - Vincenzo Dattola
- MS Center, Bianchi Melacrino Morelli Great Metropolitan Hospital, Reggio Calabria, Italy
| | | | - Ermelinda De Meo
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Antonio Gallo
- MS Center, I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Rana Karabudak
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Lorena Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Lucia Moiola
- Multiple Sclerosis Center and Neurology Department IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Sedat Sen
- School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Elisabetta Signoriello
- II Division, Department of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Simona Toscano
- Multiple Sclerosis Unit, University Hospital G. Rodolico, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Elena Verrengia
- Multiple Sclerosis Centre, ASST OVEST MI, Legnano Hospital, Legnano, Italy
| | - Aksel Siva
- Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | | | - Maria Pia Sormani
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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2
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Gee J, Shimabukuro TT, Su JR, Shay D, Ryan M, Basavaraju SV, Broder KR, Clark M, Buddy Creech C, Cunningham F, Goddard K, Guy H, Edwards KM, Forshee R, Hamburger T, Hause AM, Klein NP, Kracalik I, Lamer C, Loran DA, McNeil MM, Montgomery J, Moro P, Myers TR, Olson C, Oster ME, Sharma AJ, Schupbach R, Weintraub E, Whitehead B, Anderson S. Overview of U.S. COVID-19 vaccine safety surveillance systems. Vaccine 2024:S0264-410X(24)00224-X. [PMID: 38631952 DOI: 10.1016/j.vaccine.2024.02.065] [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: 09/30/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
The U.S. COVID-19 vaccination program, which commenced in December 2020, has been instrumental in preventing morbidity and mortality from COVID-19 disease. Safety monitoring has been an essential component of the program. The federal government undertook a comprehensive and coordinated approach to implement complementary safety monitoring systems and to communicate findings in a timely and transparent way to healthcare providers, policymakers, and the public. Monitoring involved both well-established and newly developed systems that relied on both spontaneous (passive) and active surveillance methods. Clinical consultation for individual cases of adverse events following vaccination was performed, and monitoring of special populations, such as pregnant persons, was conducted. This report describes the U.S. government's COVID-19 vaccine safety monitoring systems and programs used by the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the Department of Defense, the Department of Veterans Affairs, and the Indian Health Service. Using the adverse event of myocarditis following mRNA COVID-19 vaccination as a model, we demonstrate how the multiple, complementary monitoring systems worked to rapidly detect, assess, and verify a vaccine safety signal. In addition, longer-term follow-up was conducted to evaluate the recovery status of myocarditis cases following vaccination. Finally, the process for timely and transparent communication and dissemination of COVID-19 vaccine safety data is described, highlighting the responsiveness and robustness of the U.S. vaccine safety monitoring infrastructure during the national COVID-19 vaccination program.
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Affiliation(s)
- Julianne Gee
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Tom T Shimabukuro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - John R Su
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - David Shay
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Margaret Ryan
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Sridhar V Basavaraju
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Karen R Broder
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew Clark
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Francesca Cunningham
- Department of Veterans Affairs, Veterans Affairs Center for Medication Safety - Pharmacy Benefit Management Services, Hines, IL, United States
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Harrison Guy
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Kathryn M Edwards
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Richard Forshee
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
| | - Tanya Hamburger
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Anne M Hause
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ian Kracalik
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Chris Lamer
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - David A Loran
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Michael M McNeil
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Jay Montgomery
- Defense Health Agency, Immunization Healthcare Division, Bethesda, MD, United States
| | - Pedro Moro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Tanya R Myers
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Christine Olson
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew E Oster
- National Center for Birth Defects and Developmental Disabilities, CDC, Atlanta GA, United States; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrea J Sharma
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Ryan Schupbach
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Eric Weintraub
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Brett Whitehead
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Steven Anderson
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
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3
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Williams JTB, Kurlandsky K, Breslin K, Durfee MJ, Stein A, Hurley L, Shoup JA, Reifler LM, Daley MF, Lewin BJ, Goddard K, Henninger ML, Nelson JC, Vazquez-Benitez G, Hanson KE, Fuller CC, Weintraub ES, McNeil MM, Hambidge SJ. Attitudes Toward COVID-19 Vaccines Among Pregnant and Recently Pregnant Individuals. JAMA Netw Open 2024; 7:e245479. [PMID: 38587844 PMCID: PMC11002697 DOI: 10.1001/jamanetworkopen.2024.5479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/09/2024] [Indexed: 04/09/2024] Open
Abstract
Importance Pregnant people and infants are at high risk of severe COVID-19 outcomes. Understanding changes in attitudes toward COVID-19 vaccines among pregnant and recently pregnant people is important for public health messaging. Objective To assess attitudinal trends regarding COVID-19 vaccines by (1) vaccination status and (2) race, ethnicity, and language among samples of pregnant and recently pregnant Vaccine Safety Datalink (VSD) members from 2021 to 2023. Design, Setting, and Participants This cross-sectional surveye study included pregnant or recently pregnant members of the VSD, a collaboration of 13 health care systems and the US Centers for Disease Control and Prevention. Unvaccinated, non-Hispanic Black, and Spanish-speaking members were oversampled. Wave 1 took place from October 2021 to February 2022, and wave 2 took place from November 2022 to February 2023. Data were analyzed from May 2022 to September 2023. Exposures Self-reported or electronic health record (EHR)-derived race, ethnicity, and preferred language. Main Outcomes and Measures Self-reported vaccination status and attitudes toward monovalent (wave 1) or bivalent Omicron booster (wave 2) COVID-19 vaccines. Sample- and response-weighted analyses assessed attitudes by vaccination status and 3 race, ethnicity, and language groupings of interest. Results There were 1227 respondents; all identified as female, the mean (SD) age was 31.7 (5.6) years, 356 (29.0%) identified as Black race, 555 (45.2%) identified as Hispanic ethnicity, and 445 (36.3%) preferred the Spanish language. Response rates were 43.5% for wave 1 (652 of 1500 individuals sampled) and 39.5% for wave 2 (575 of 1456 individuals sampled). Respondents were more likely than nonrespondents to be White, non-Hispanic, and vaccinated per EHR. Overall, 76.8% (95% CI, 71.5%-82.2%) reported 1 or more COVID-19 vaccinations; Spanish-speaking Hispanic respondents had the highest weighted proportion of respondents with 1 or more vaccination. Weighted estimates of somewhat or strongly agreeing that COVID-19 vaccines are safe decreased from wave 1 to 2 for respondents who reported 1 or more vaccinations (76% vs 50%; χ21 = 7.8; P < .001), non-Hispanic White respondents (72% vs 43%; χ21 = 5.4; P = .02), and Spanish-speaking Hispanic respondents (76% vs 53%; χ21 = 22.8; P = .002). Conclusions and Relevance Decreasing confidence in COVID-19 vaccine safety in a large, diverse pregnant and recently pregnant insured population is a public health concern.
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Affiliation(s)
- Joshua T. B. Williams
- Ambulatory Care Services, Denver Health and Hospitals, Denver, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Kate Kurlandsky
- Ambulatory Care Services, Denver Health and Hospitals, Denver, Colorado
| | - Kristin Breslin
- Ambulatory Care Services, Denver Health and Hospitals, Denver, Colorado
| | - M. Joshua Durfee
- Ambulatory Care Services, Denver Health and Hospitals, Denver, Colorado
| | - Amy Stein
- Ambulatory Care Services, Denver Health and Hospitals, Denver, Colorado
| | - Laura Hurley
- Ambulatory Care Services, Denver Health and Hospitals, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Liza M. Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Matthew F. Daley
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | | | | | | | | | | | | | - Candace C. Fuller
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Eric S. Weintraub
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M. McNeil
- Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Simon J. Hambidge
- Ambulatory Care Services, Denver Health and Hospitals, Denver, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
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4
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Pugni L, Crippa BL, Raimondi F, Vento G, Mangili G, Coscia A, Artieri G, Ronchi A, Ventura ML, Lago P, Pietrasanta C, Crimi R, Bonfante G, Perrone S, Boncompagni A, Solinas A, Agosti M, Poggi C, Falcone A, Pagliotta C, Gianotti D, Gottardi G, Paviotti G, Allodi A, Maffei G, Proto A, Travierso A, Salomè S, Costa S, Ferrari S, Peila C, Sinelli M, Fanelli F, Giordano L, Saruggia M, Capasso L, Spada E, Gizzi C, Orfeo L, Mosca F. SARS-CoV-2 perinatal transmission and neonatal outcomes across four different waves of COVID-19 pandemic: A nationwide prospective cohort study from the Italian Society of Neonatology. Int J Infect Dis 2024; 140:17-24. [PMID: 38157929 DOI: 10.1016/j.ijid.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES To describe how SARS-CoV-2 infection at the time of delivery affected maternal and neonatal outcomes across four major waves of the COVID-19 pandemic in Italy. METHODS This is a large, prospective, nationwide cohort study collecting maternal and neonatal data in case of maternal peripartum SARS-CoV-2 infection between February 2020 and March 2022. Data were stratified across the four observed pandemic waves. RESULTS Among 5201 COVID-19-positive mothers, the risk of being symptomatic at delivery was significantly higher in the first and third waves (20.8-20.8%) than in the second and fourth (13.2-12.2%). Among their 5284 neonates, the risk of prematurity (gestational age <37 weeks) was significantly higher in the first and third waves (15.6-12.5%). The risk of intrauterine transmission was always very low, while the risk of postnatal transmission during rooming-in was higher and peaked at 4.5% during the fourth wave. A total of 80% of positive neonates were asymptomatic. CONCLUSION The risk of adverse maternal and neonatal outcomes was significantly higher during the first and third waves, dominated by unsequenced variants and the Delta variant, respectively. Postnatal transmission accounted for most neonatal infections and was more frequent during the Omicron period. However, the paucity of symptoms in infected neonates should lead us not to separate the dyad.
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Affiliation(s)
- Lorenza Pugni
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesco Raimondi
- Division of Neonatology, University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy
| | - Giovanni Vento
- Neonatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Neonatology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alessandra Coscia
- AOU Città della Salute e della Scienza di Torino, Neonatologia Universitaria, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Torino, Italy
| | - Giacomo Artieri
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Ronchi
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Paola Lago
- NICU, Ospedale Regionale Cà Foncello, Treviso, Italy
| | - Carlo Pietrasanta
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Riccardo Crimi
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppina Bonfante
- NICU, AOU Città della Salute e della Scienza di Torino, PO S. Anna, Torino, Italy
| | - Serafina Perrone
- University of Parma, Pietro Barilla University Children's Hospital, Parma, Italy
| | - Alessandra Boncompagni
- Women's and Children's Health Department, NICU, University of Modena and Reggio Emilia, Modena, Italy
| | - Agostina Solinas
- NICU, Azienda Ospedaliero Universitaria di Ferrara, Arcispedale S.Anna, Ferrara, Italy
| | - Massimo Agosti
- NICU, Del Ponte Hospital, Varese, Italy; Department of Pediatrics, University of Insubria, Varese, Italy
| | - Chiara Poggi
- Department of Mother and Child Care, NICU, Careggi University Hospital, Florence, Italy
| | | | | | | | - Genny Gottardi
- NICU, ULSS8 Berica, Ospedale San Bortolo, Vicenza, Italy
| | - Giulia Paviotti
- Neonatology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero di Udine - Santa Maria della Misericordia, Udine, Italy
| | | | | | - Alice Proto
- NICU, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Serena Salomè
- Division of Neonatology, University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy
| | - Simonetta Costa
- Neonatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Chiara Peila
- AOU Città della Salute e della Scienza di Torino, Neonatologia Universitaria, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Torino, Italy
| | | | - Federica Fanelli
- Division of Neonatology, University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy
| | - Lucia Giordano
- Neonatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Letizia Capasso
- Division of Neonatology, University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy
| | - Elena Spada
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Gizzi
- Pediatric and Neonatal Unit, Sandro Pertini Hospital, Rome, Italy; NICU, Sant'Eugenio Hospital, Rome, Italy
| | - Luigi Orfeo
- NICU, Ospedale Isola Tiberina Gemelli, Isola, Rome, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Meaney-Delman D, Carroll S, Polen K, Jatlaoui TC, Meyer S, Oliver S, Gee J, Shimabukuro T, Razzaghi H, Riley L, Galang RR, Tong V, Gilboa S, Ellington S, Cohn A. Planning for the future of maternal immunization: Building on lessons learned from the COVID-19 pandemic. Vaccine 2024:S0264-410X(24)00081-1. [PMID: 38423818 DOI: 10.1016/j.vaccine.2024.01.069] [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: 09/30/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
As the worldwide COVID-19 pandemic unfolded, the clinical and public health community raced to understand SARS-CoV-2 infection and develop life-saving vaccines. Pregnant persons were disproportionately impacted, experiencing more severe illness and adverse pregnancy outcomes. And yet, when COVID-19 vaccines became available in late 2020, safety and efficacy data were not available to inform their use during pregnancy because pregnant persons were excluded from pre-authorization clinical trials. Concerns about vaccine safety during pregnancy and misinformation linking vaccination and infertility circulated widely, creating a lack of vaccine confidence. Many pregnant people initially chose not to get vaccinated, and while vaccination rates rose after safety and effectiveness data became available, COVID-19 vaccine acceptance was suboptimal and varied across racial and ethnic distribution of the pregnant population. The COVID-19 pandemic experience provided valuable insights that can inform current and future approaches to maternal vaccination against.
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Affiliation(s)
- Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Sarah Carroll
- American College of Obstetricians and Gynecologists, Washington, D.C, United States
| | - Kara Polen
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tara C Jatlaoui
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Meyer
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sara Oliver
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julianne Gee
- Immunization Safety Office, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tom Shimabukuro
- Immunization Safety Office, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hilda Razzaghi
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laura Riley
- Department of Obstetrics and Gynecology, Weill Cornell School of Medicine, New York, NY, United States
| | - Romeo R Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Van Tong
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Suzanne Gilboa
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sascha Ellington
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amanda Cohn
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, GA, United States
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6
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Oh DS, Kim E, Lu G, Normand R, Shook LL, Lyall A, Jasset O, Demidkin S, Gilbert E, Kim J, Akinwunmi B, Tantivit J, Tirard A, Arnold BY, Slowikowski K, Goldberg MB, Filbin MR, Hacohen N, Nguyen LH, Chan AT, Yu XG, Li JZ, Yonker L, Fasano A, Perlis RH, Pasternak O, Gray KJ, Choi GB, Drew DA, Sen P, Villani AC, Edlow AG, Huh JR. SARS-CoV-2 infection elucidates unique features of pregnancy-specific immunity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.05.24301794. [PMID: 38370801 PMCID: PMC10871456 DOI: 10.1101/2024.02.05.24301794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Pregnancy is a risk factor for increased severity of SARS-CoV-2 and other respiratory infections. The mechanisms underlying this risk have not been well-established, partly due to a limited understanding of how pregnancy shapes immune responses. To gain insight into the role of pregnancy in modulating immune responses at steady state and upon perturbation, we collected peripheral blood mononuclear cells (PBMC), plasma, and stool from 226 women, including 152 pregnant individuals (n = 96 with SARS-CoV-2 infection and n = 56 healthy controls) and 74 non-pregnant women (n = 55 with SARS-CoV-2 and n = 19 healthy controls). We found that SARS-CoV-2 infection was associated with altered T cell responses in pregnant compared to non-pregnant women. Differences included a lower percentage of memory T cells, a distinct clonal expansion of CD4-expressing CD8 + T cells, and the enhanced expression of T cell exhaustion markers, such as programmed cell death-1 (PD-1) and T cell immunoglobulin and mucin domain-3 (Tim-3), in pregnant women. We identified additional evidence of immune dysfunction in severely and critically ill pregnant women, including a lack of expected elevation in regulatory T cell (Treg) levels, diminished interferon responses, and profound suppression of monocyte function. Consistent with earlier data, we found maternal obesity was also associated with altered immune responses to SARS-CoV-2 infection, including enhanced production of inflammatory cytokines by T cells. Certain gut bacterial species were altered in pregnancy and upon SARS-CoV-2 infection in pregnant individuals compared to non-pregnant women. Shifts in cytokine and chemokine levels were also identified in the sera of pregnant individuals, most notably a robust increase of interleukin-27 (IL-27), a cytokine known to drive T cell exhaustion, in the pregnant uninfected control group compared to all non-pregnant groups. IL-27 levels were also significantly higher in uninfected pregnant controls compared to pregnant SARS-CoV-2-infected individuals. Using two different preclinical mouse models of inflammation-induced fetal demise and respiratory influenza viral infection, we found that enhanced IL-27 protects developing fetuses from maternal inflammation but renders adult female mice vulnerable to viral infection. These combined findings from human and murine studies reveal nuanced pregnancy-associated immune responses, suggesting mechanisms underlying the increased susceptibility of pregnant individuals to viral respiratory infections.
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Reeves EL, Neelam V, Carlson JM, Olsen EO, Fox CJ, Woodworth KR, Nestoridi E, Mobley E, Montero Castro S, Dzimira P, Sokale A, Sizemore L, Hall AJ, Ellington S, Cohn A, Gilboa SM, Tong VT. Pregnancy and infant outcomes following SARS-CoV-2 infection in pregnancy during delta variant predominance - Surveillance for Emerging Threats to Pregnant People and Infants. Am J Obstet Gynecol MFM 2024; 6:101265. [PMID: 38135220 DOI: 10.1016/j.ajogmf.2023.101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse birth outcomes such as preterm birth, stillbirth, and maternal and infant complications. Previous research suggests an increased risk of severe COVID-19 illness and stillbirth in pregnant people during delta variant predominance in 2021; however, those studies did not assess timing of infection during pregnancy, and few of them described COVID-19 vaccination status. OBJECTIVE Using a large population-based cohort, this study compared pregnancy and infant outcomes and described demographic and clinical characteristics of pregnant people with SARS-CoV-2 infection prior to and during the delta variant period. STUDY DESIGN This retrospective cohort analysis included persons with confirmed SARS-CoV-2 infection in pregnancy from 6 US jurisdictions reporting to the Surveillance for Emerging Threats to Pregnant People and Infants Network. Data were collected through case reports of polymerase chain reaction-positive pregnant persons and linkages to birth certificates, fetal death records, and immunization records. We described clinical characteristics and compared frequency of spontaneous abortion (<20 weeks of gestation), stillbirth (≥20 weeks), preterm birth (<37 weeks), small for gestational age, and term infant neonatal intensive care unit admission between the time periods of pre-delta and delta variant predominance. Study time periods were determined by when variants constituted more than 50% of sequences isolated according to regional SARS-CoV-2 genomic surveillance data, with time periods defined for pre-delta (March 3, 2020-June 25, 2021) and Delta (June 26, 2021-December 25, 2021). Adjusted prevalence ratios were estimated for each outcome measure using Poisson regression and were adjusted for continuous maternal age, race and ethnicity, and insurance status at delivery. RESULTS Among 57,563 pregnancy outcomes, 57,188 (99.3%) were liveborn infants, 65 (0.1%) were spontaneous abortions, and 310 (0.5%) were stillbirths. Most pregnant persons were unvaccinated at the time of SARS-CoV-2 infection, with a higher proportion in pre-delta (99.4%) than in the delta period (78.4%). Of those with infections during delta and who were previously vaccinated, the timing from last vaccination to infection was a median of 183 days. Compared to pre-delta, infections during delta were associated with a higher frequency of stillbirths (0.7% vs 0.4%; adjusted prevalence ratio, 1.55; 95% confidence interval, 1.14-2.09) and preterm births (12.8% vs 11.9%; adjusted prevalence ratio, 1.14; 95% confidence interval, 1.07-1.20). The delta period was associated with a lower frequency of neonatal intensive care unit admission (adjusted prevalence ratio, 0.74; 95% confidence interval, 0.67-0.82) than in the pre-delta period. During the delta period, infection during the third trimester was associated with a higher frequency of preterm birth (adjusted prevalence ratio, 1.41; 95% confidence interval, 1.28-1.56) and neonatal intensive care unit admission (adjusted prevalence ratio, 1.21; 95% confidence interval, 1.01-1.45) compared to the first and second trimester combined. CONCLUSION In this US-based cohort of persons with SARS-CoV-2 infection in pregnancy, the majority were unvaccinated, and frequencies of stillbirth and preterm birth were higher during the delta variant predominance period than in the pre-delta period. During the delta period, frequency of preterm birth and neonatal intensive care unit admission was higher among infections occurring in the third trimester vs those earlier in pregnancy. These findings demonstrate population-level increases of adverse fetal and infant outcomes, specifically in the presence of a COVID-19 variant with more severe presentation.
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Affiliation(s)
- Emily L Reeves
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox).
| | - Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Jeffrey M Carlson
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox)
| | - Emily O Olsen
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Charise J Fox
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox)
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Eirini Nestoridi
- Massachusetts Department of Public Health, Boston, MA (Dr Nestoridi)
| | - Evan Mobley
- Missouri Department of Health and Senior Services, Jefferson City, MO (Mr Mobley)
| | | | - Paula Dzimira
- Pennsylvania Department of Health, Pittsburgh, PA (Ms Dzimira)
| | - Ayomide Sokale
- Philadelphia Department of Public Health, Philadelphia, PA (Ms Sokale)
| | | | - Aron J Hall
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Dr Hall)
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Dr Ellington)
| | - Amanda Cohn
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
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Iacovazzo C, Capasso L, Visani C, Salomè S, Vargas M. Pregnant Patients with COVID-19 Admitted to an ICU: A Comparison with a Historical Cohort of Critical Pregnant Patients without COVID-19. Life (Basel) 2024; 14:165. [PMID: 38398674 PMCID: PMC10890200 DOI: 10.3390/life14020165] [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: 10/25/2023] [Revised: 12/19/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
AIM OF THE STUDY Maternal mortality and ICU admissions have increased during the COVID-19 pandemic. We reported a case-series of pregnant patients with COVID-19 admitted to an ICU and we compared them with a historical cohort of pregnant patients admitted to an ICU without COVID-19. METHODS We included all pregnant patients with laboratory-confirmed COVID-19 infection admitted to our ICU in 2021. As a historical control group, we included all pregnant women who were admitted to our ICU between 1 January 2008 and 31 December 2013. RESULTS In 2021, 11 pregnant patients (pts) with COVID-19 were admitted to an ICU, representing 2.87% of ICU admissions. We found that pregnant patients with COVID-19 (1) had a higher BMI (34.6 vs. 28.8, p = 0.04) and a lower gestational age (30.6 vs. 34 weeks, p = 0.03), (2) were mainly admitted for respiratory failure (100% vs. 2.7%; p = 0.001) and (3) required more days of invasive and non-invasive ventilations (54.5% vs. 5.2%, p = 0.002), a longer duration of stay at the ICU (21.9 vs. 4.8 days, p < 0.0001) and had a higher mortality rate (27.3% vs. 0%, p = 0.0192). CONCLUSIONS Pregnant patients with COVID-19 represent a challenge for ICU physicians due to their different characteristics and outcomes when compared to pregnant patients without COVID-19.
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Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100 Naples, Italy
| | - Letizia Capasso
- Department of Translational Medical Sciences, Division of Neonatology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (S.S.)
| | - Carola Visani
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100 Naples, Italy
| | - Serena Salomè
- Department of Translational Medical Sciences, Division of Neonatology, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (S.S.)
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100 Naples, Italy
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9
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Tomori C, O'Connor DL, Ververs M, Orta-Aleman D, Paone K, Budhathoki C, Pérez-Escamilla R. Critical research gaps in treating growth faltering in infants under 6 months: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001860. [PMID: 38190356 PMCID: PMC10773941 DOI: 10.1371/journal.pgph.0001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024]
Abstract
In 2020, 149.2 million children worldwide under 5 years suffered from stunting, and 45.4 million experienced wasting. Many infants are born already stunted, while others are at high risk for growth faltering early after birth. Growth faltering is linked to transgenerational impacts of poverty and marginalization. Few interventions address growth faltering in infants under 6 months, despite a likely increasing prevalence due to the negative global economic impacts of the COVID-19 pandemic. Breastfeeding is a critical intervention to alleviate malnutrition and improve child health outcomes, but rarely receives adequate attention in growth faltering interventions. A systematic review and meta-analysis were undertaken to identify and evaluate interventions addressing growth faltering among infants under 6 months that employed supplemental milks. The review was carried out following guidelines from the USA National Academy of Medicine. A total of 10,405 references were identified, and after deduplication 7390 studies were screened for eligibility. Of these, 227 were assessed for full text eligibility and relevance. Two randomized controlled trials were ultimately included, which differed in inclusion criteria and methodology and had few shared outcomes. Both studies had small sample sizes, high attrition and high risk of bias. A Bangladeshi study (n = 153) found significantly higher rates of weight gain for F-100 and diluted F-100 (DF-100) compared with infant formula (IF), while a DRC trial (n = 146) did not find statistically significant differences in rate of weight gain for DF-100 compared with IF offered in the context of broader lactation and relactation support. The meta-analysis of rate of weight gain showed no statistical difference and some evidence of moderate heterogeneity. Few interventions address growth faltering among infants under 6 months. These studies have limited generalizability and have not comprehensively supported lactation. Greater investment is necessary to accelerate research that addresses growth faltering following a new research framework that calls for comprehensive lactation support.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Population, Johns Hopkins University Bloomberg School of Public Health, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Deborah L O'Connor
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Mija Ververs
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Dania Orta-Aleman
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katerina Paone
- Department of Social and Behavioral Health, Yale University School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Health, Yale University School of Public Health, Yale University, New Haven, Connecticut, United States of America
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10
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Simeone RM, Meghani M, Meeker JR, Zapata LB, Galang RR, Salvesen Von Essen B, Dieke A, Ellington SR. Differences in delivery hospitalization experiences during the COVID-19 pandemic by maternal race and ethnicity, Pregnancy Risk Assessment Monitoring System, 2020. J Perinatol 2024; 44:20-27. [PMID: 37660214 DOI: 10.1038/s41372-023-01763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE We investigated maternal COVID-19 related experiences during delivery hospitalizations, and whether experiences differed by maternal race and ethnicity. STUDY DESIGN Data from the Pregnancy Risk Assessment Monitoring System among women with live births between April-December 2020 were used. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) estimated associations between maternal race and ethnicity and COVID-19 related delivery experiences. RESULTS Among 12,879 women, 3.6% reported infant separation and 1.8% reported not being allowed support persons. Compared with non-Hispanic White women, American Indian/Alaska Native (AI/AN) (aPR = 2.7; CI: 1.2-6.2), Hispanic (aPR = 2.2; CI: 1.5-3.1), non-Hispanic Black (aPR = 2.4; CI: 1.7-3.6), and non-Hispanic Asian (aPR = 2.8; CI: 1.6-4.9) women reported more infant separation due to COVID-19. Not being allowed support persons was more common among AI/AN (aPR = 5.2; CI: 1.8-14.8) and non-Hispanic Black (aPR = 2.3; CI: 1.3-4.1) women. CONCLUSIONS COVID-19 related delivery hospitalization experiences were unequally distributed among racial and ethnic minorities.
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Affiliation(s)
- Regina M Simeone
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mehreen Meghani
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC Foundation, Atlanta, GA, USA
| | - Jessica R Meeker
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service, Rockville, MD, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service, Rockville, MD, USA
| | - Romeo R Galang
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beatriz Salvesen Von Essen
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- CDC Foundation, Atlanta, GA, USA
| | - Ada Dieke
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sascha R Ellington
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Carlson J, Simeone RM, Ellington S, Galang R, DeSisto CL, Fleming-Dutra K, Riley L, Meaney-Delman D, Tong VT. Pre-Delta, Delta, and Omicron Periods of the Coronavirus Disease 2019 (COVID-19) Pandemic and Health Outcomes During Delivery Hospitalization. Obstet Gynecol 2024; 143:131-138. [PMID: 37917932 PMCID: PMC10949122 DOI: 10.1097/aog.0000000000005449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To examine the relationship between coronavirus disease 2019 (COVID-19) diagnosis at delivery and adverse maternal health and pregnancy outcomes during pre-Delta, Delta, and Omicron variant predominance, with a focus on the time period of Omicron variant predominance. METHODS We conducted a cross-sectional observational study with data from delivery hospitalizations in the Premier Healthcare Database from February 2020 to August 2023. The pre-Delta (February 2020-June 2021), Delta (July 2021-December 2021), and Omicron (January 2022-August 2023) periods of variant predominance were examined. Exposure to COVID-19 was identified by having a diagnostic code for COVID-19 during the delivery hospitalization. Adjusted prevalence ratios (aPRs) were calculated to compare the risks of adverse maternal and pregnancy outcomes for women with and without COVID-19 diagnoses at the time of delivery for each variant period. RESULTS Among 2,990,973 women with delivery hospitalizations, 1.9% (n=56,618) had COVID-19 diagnoses noted at delivery admission discharge, including 26,053 during the Omicron period. Across all variant time periods, the prevalence of many adverse maternal and pregnancy outcomes during the delivery hospitalization was significantly higher for pregnant women with COVID-19 compared with pregnant women without COVID-19. In adjusted models, COVID-19 during the Omicron period was associated with significant increased risks for maternal sepsis (COVID-19: 0.4% vs no COVID-19: 0.1%; aPR 3.32, 95% CI, 2.70-4.08), acute respiratory distress syndrome (0.6% vs 0.1%; aPR 6.19, 95% CI, 5.26-7.29), shock (0.2% vs 0.1%; aPR 2.14, 95% CI, 1.62-2.84), renal failure (0.5% vs 0.2%; aPR 2.08, 95% CI, 1.73-2.49), intensive care unit admission (2.7% vs 1.7%; aPR 1.64, 95% CI, 1.52-1.77), mechanical ventilation (0.3% vs 0.1%; aPR 3.15, 95% CI, 2.52-3.93), in-hospital death (0.03% vs 0.01%; aPR 5.00, 95% CI, 2.30-10.90), stillbirth (0.7% vs 0.6%; aPR 1.17, 95% CI, 1.01-1.36), and preterm delivery (12.3% vs 9.6%; aPR 1.28, 95% CI, 1.24-1.33). CONCLUSION Despite the possibility of some level of immunity due to previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, vaccination, or testing differences, risks of adverse outcomes associated with COVID-19 diagnosis at delivery remained elevated during the Omicron variant time period.
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Affiliation(s)
- Jeffrey Carlson
- Eagle Global Scientific, LLC, and the Division of Birth Defects and Infant Disorders, the Coronavirus and Other Respiratory Viruses Division, the Influenza Division, the Division of Reproductive Health, and the Division of Viral Disease, Centers for Disease Control and Prevention, Atlanta, Georgia; and Weill Cornell Medicine, New York, New York
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12
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Zhang Y, Li J, Feng L, Luo Y, Pang W, Qiu K, Mao M, Song Y, Cheng D, Rao Y, Wang X, Hu Y, Ying Z, Pu X, Lin S, Huang S, Liu G, Zhang W, Xu W, Zhao Y, Ren J. A Population-Based Outcome-Wide Association Study of the Comorbidities and Sequelae Following COVID-19 Infection. J Epidemiol Glob Health 2023; 13:870-885. [PMID: 37889436 PMCID: PMC10686900 DOI: 10.1007/s44197-023-00161-w] [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: 05/03/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Immense attention has been given to the outcome of COVID-19 infection. However, comprehensive studies based on large populational cohort with long-term follow-up are still lacking. This study aimed to investigate the risk of various short-term comorbidities (within one month) and long-term sequelae (above one month) after COVID-19 infection. METHODS In this large prospective cohort study with 14 months follow-up information based on UK biobank, we included 16,776 COVID-19-positive participants and 58,281 COVID-19-negative participants matched for comparison. The risk of each comorbidity and sequela was evaluated by multivariable logistic regression analysis and presented as hazard ratio (HR) and 95% confidence interval (95% CI). RESULTS COVID-19-positive individuals had a higher risk of 47 types of comorbidities within one month following COVID-19 infection, especially those who were older, male, overweight/obese, ever-smoked, with more pre-existing comorbidities and hospitalized. About 70.37% of COVID-19 patients with comorbidities had more than one co-occurring comorbidities. Additionally, only 6 high-risk sequelae were observed after one month of COVID-19 infection, and the incidence was relatively low (< 1%). CONCLUSION In addition to long-term sequelae following COVID-19 infection, plenty of comorbidities were observed, especially in patients with older age, male gender, overweight/obese, more pre-existing comorbidities and severe COVID-19, indicating that more attention should be given to these susceptible persons within this period.
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Affiliation(s)
- Yuyang Zhang
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Junhong Li
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Feng
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yaxin Luo
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Wendu Pang
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Minzi Mao
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Song
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyi Wang
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiye Ying
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaobin Pu
- Department of Oto-Rhino-Laryngology, Langzhong People's Hospital, Langzhong, China
| | - Shuyan Lin
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shaohui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, 10-511, 610 University Avenue Toronto, Toronto, ON, Canada.
| | - Yu Zhao
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Jianjun Ren
- Department of Otolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
- Department of Oto-Rhino-Laryngology, Langzhong People's Hospital, Langzhong, China.
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13
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Cunha ACMC, Katz L, Amorim AFC, Coutinho IC, Souza AS, Katz S, Souza G, Souza G, Farias L, Lemos R, Mello MZ, Neves L, Albuquerque M, Feitosa FE, Paiva J, Lima C, Lima M, Amorim MM. Clinical, epidemiological and laboratory characteristics of cases of Covid-19-related maternal near miss and death at referral units in northeastern Brazil: a cohort study. J Matern Fetal Neonatal Med 2023; 36:2260056. [PMID: 37748920 DOI: 10.1080/14767058.2023.2260056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
Objective: Covid-19 poses a major risk during pregnancy and postpartum, resulting in an increase in maternal mortality worldwide, including in Brazil; however, little research has been conducted into cases of a near miss. This study aimed to describe the frequency of COVID-19-related near miss and deaths during pregnancy or in the postpartum in referral centers in northeastern Brazil, as well as the clinical, epidemiological, and laboratory characteristics of the women who experienced a severe maternal outcome.Methods: A retrospective and prospective cohort study was performed between April 2020 and June 2021 with hospitalized pregnant and postpartum women with a diagnosis of COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR). Data from five tertiary hospitals in northeastern Brazil were evaluated. Descriptive statistical analysis was performed using Epi Info, version 7.2.5.0.Results: A total of 463 patients were included. Of these, 64 (14% of the sample) had a severe maternal outcome, with 42 cases of near miss (9%) and 22 maternal deaths (5%). Patients who had a severe maternal outcome were predominantly young (median age 30 years) and 65.6% were black or brown-skinned. The women had between 6 and 16 years of schooling; 45.3% had a stable partner; 81.3% were pregnant at the time of admission to the study; and 76.6% required a Cesarean section. The great majority (82.8%) had severe acute respiratory syndrome (SARS). Other complications included hypertensive syndromes (40.6%), pneumonia (37.5%), urinary tract infections (29.7%), acute renal failure (25.0%) and postpartum hemorrhage (21.9%). Sepsis developed in 18.8% of cases, neurological dysfunction in 15.6%, and hepatic dysfunction and septic shock in 14.1% of cases each. The relative frequency of admission to an intensive care unit was 87.5%, while 67.2% of the patients required assisted mechanical ventilation, and 54.7% required noninvasive ventilation. Antibiotics were prescribed in 93.8% of cases and corticosteroids in 71.9%, while blood transfusion was required in 25.0% of cases and renal replacement therapy in 15.6%. Therapeutic anticoagulants were administered to 12.5% of the patients. Of the patients who had a severe maternal outcome, the frequency of respiratory dysfunction was 93.8%, with 50.0% developing neurological dysfunction and 37.5% cardiovascular dysfunction. Hematological dysfunction was found in 29.7%, renal dysfunction in 18.8%, and uterine dysfunction in 14.1%. Hepatic dysfunction occurred in 7.8% of the sample. The near-miss ratio for Covid-19 was 1.6/1000 live births and the maternal mortality ratio for Covid-19 was 84.8/100,000 live births, with a mortality index of 34.4% in the sample.Conclusion: This study revealed a low Covid-19-related maternal near miss (MNM) ratio of 1.6/1000 live births and a high Covid-19-related maternal mortality ratio (MMR) of 84.81/100,000 live births. The mortality index was also high. Most of the patients were admitted while pregnant, were young, married and black or brown-skinned, and none had completed university education. The majority had SARS and required admission to an intensive care unit and mechanical ventilation. Most were submitted to a Cesarean section.
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Affiliation(s)
- Anna Catharina M C Cunha
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | | | - Isabela Cristina Coutinho
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | - Alex Sandro Souza
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
| | - Sara Katz
- Universidade de Pernambuco, Recife, Brazil
| | | | | | | | - Raissa Lemos
- Universidade Catolica de Pernambuco, Recife, Brazil
| | | | - Lucas Neves
- Universidade Federal de Campina Grande, Campina Grande, Brazil
| | | | | | - Jordana Paiva
- Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Carolina Lima
- Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Marcelo Lima
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Petrolina Brazil
| | - Melania Maria Amorim
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
- Federal University of Campina Grande (UFCG), Campina Grande, Brazil
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14
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Regan AK, Arah OA, Fell DB, Sullivan SG. Risk of Severe Maternal Morbidity Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection During Pregnancy. Open Forum Infect Dis 2023; 10:ofad613. [PMID: 38143851 PMCID: PMC10745255 DOI: 10.1093/ofid/ofad613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy increases the risk of adverse fetal and neonatal outcomes, but the contribution to severe maternal morbidity (SMM) has been less frequently documented. Methods We conducted a national cohort study of 93 624 deliveries occurring between 11 March 2020 and 1 July 2021 using medical claims information from the OptumLabs Data Warehouse. SARS-CoV-2 infection was identified from diagnostic and laboratory testing claims records. We identified 21 SMM conditions using International Classification of Diseases, Tenth Revision, Clinical Modification and procedure codes and compared SMM conditions by SARS-CoV-2 status using Poisson regression with robust variance, adjusting for maternal sociodemographic and health factors, onset of labor, and week of conception. Results Approximately 5% of deliveries had a record of SARS-CoV-2 infection: 27.0% <7 days before delivery, 13.5% within 7-30 days of delivery, and 59.5% earlier in pregnancy. Compared to uninfected pregnancies, the adjusted risk of SMM was 2.22 times higher (95% confidence interval [CI], 1.97-2.48) among those infected <7 days before delivery and 1.66 times higher (95% CI, 1.23-2.08) among those infected 7-30 days before delivery. The highest risks were observed for acute respiratory distress syndrome (adjusted risk ratio [aRR], 13.24 [95% CI, 12.86-13.61]) and acute renal failure (aRR, 3.91 [95% CI, 3.32-4.50]). Conclusions COVID-19 is associated with increased rates of SMM.
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Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, Orange, California, USA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Onyebuchi A Arah
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- Department of Statistics and Data Science, University of California, Los Angeles, Los Angeles, California, USA
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Sheena G Sullivan
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- World Health Organization Collaborating Centre for Reference and Research on Influenza, Melbourne, Victoria, Australia
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15
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DuBose B, Tembunde Y, Goodman KE, Pineles L, Nadimpalli G, Baghdadi JD, Parchem JG, Harris AD, Pineles BL. Delivery outcomes in a cohort of pregnant patients with COVID-19 with and without viral pneumonia. Am J Obstet Gynecol MFM 2023; 5:101077. [PMID: 37399892 PMCID: PMC11018246 DOI: 10.1016/j.ajogmf.2023.101077] [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: 01/12/2023] [Revised: 06/18/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Among pregnant people, COVID-19 can lead to adverse outcomes, but the specific pregnancy outcomes that are affected by the disease are unclear. In addition, the effect of the severity of COVID-19 on pregnancy outcomes has not been clearly identified. OBJECTIVE This study aimed to evaluate the associations between COVID-19 with and without viral pneumonia and cesarean delivery, preterm delivery, preeclampsia, and stillbirth. STUDY DESIGN We conducted a retrospective cohort study (April 2020-May 2021) of deliveries between 20 and 42 weeks of gestation from US hospitals in the Premier Healthcare Database. The primary outcomes were cesarean delivery, preterm delivery, preeclampsia, and stillbirth. We used a viral pneumonia diagnosis (International Classification of Diseases -Tenth-Clinical Modification codes J12.8 and J12.9) to categorize patients by severity of COVID-19. Pregnancies were categorized into 3 groups: NOCOVID (no COVID-19), COVID (COVID-19 without viral pneumonia), and PNA (COVID-19 with viral pneumonia). Groups were balanced for risk factors by propensity-score matching. RESULTS A total of 814,649 deliveries from 853 US hospitals were included (NOCOVID: n=799,132; COVID: n=14,744; PNA: n=773). After propensity-score matching, the risks of cesarean delivery and preeclampsia were similar in the COVID group compared with the NOCOVID group (matched risk ratio, 0.97; 95% confidence interval, 0.94-1.00; and matched risk ratio, 1.02; 95% confidence interval, 0.96-1.07; respectively). The risks of preterm delivery and stillbirth were greater in the COVID group than in the NOCOVID group (matched risk ratio, 1.11; 95% confidence interval, 1.05-1.19; and matched risk ratio, 1.30; 95% confidence interval, 1.01-1.66; respectively). The risks of cesarean delivery, preeclampsia, and preterm delivery were higher in the PNA group than in the COVID group (matched risk ratio, 1.76; 95% confidence interval, 1.53-2.03; matched risk ratio, 1.37; 95% confidence interval, 1.08-1.74; and matched risk ratio, 3.33; 95% confidence interval, 2.56-4.33; respectively). The risk of stillbirth was similar in the PNA and COVID group (matched risk ratio, 1.17; 95% confidence interval, 0.40-3.44). CONCLUSION Within a large national cohort of hospitalized pregnant people, we found that the risk of some adverse delivery outcomes was elevated in people with COVID-19 with and without viral pneumonia, with much higher risks in the group with viral pneumonia.
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Affiliation(s)
- Brianna DuBose
- University of Maryland School of Medicine, Baltimore, MD (Mses DuBose and Tembunde)
| | - Yazmeen Tembunde
- University of Maryland School of Medicine, Baltimore, MD (Mses DuBose and Tembunde)
| | - Katherine E Goodman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Gita Nadimpalli
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Jacqueline G Parchem
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Dr Parchem)
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Beth L Pineles
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr B Pineles).
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16
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Simon M, Buchanan J, Schimmel J, Brent J, Burkhart K, Wax P, Taylor N, Aldy K. Adverse Events in Pregnant Patients Treated with Coronavirus Disease 2019 Therapeutics. J Med Toxicol 2023; 19:381-388. [PMID: 37581858 PMCID: PMC10522537 DOI: 10.1007/s13181-023-00961-3] [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: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Pregnant patients are at high risk of maternal and fetal complications from Coronavirus Disease 2019 (COVID-19) infections. The COVID-19 pandemic prompted a surge in the development and repurposing of therapies for the SARS-CoV-2 virus. Evidence is sparse on the efficacy and safety of these therapies in pregnant patients. Our objective was to describe adverse events (AEs) to COVID-19 therapeutics in pregnant patients. METHODS This was a case series of AEs reported to the FDA ACMT COVID-19 ToxIC (FACT) Pharmacovigilance Project between November 23, 2020, and June 28, 2022. FACT is an ongoing toxicosurveillance project at 17 sites to proactively identify and report AEs associated with COVID-19 therapeutics. Abstracted information includes demographics, case narratives, exposure details, clinical information, pregnancy details, treatments, and outcomes. RESULTS Forty-six COVID-19-positive pregnant patients who developed AEs following COVID-19 therapeutics were reported to the FACT Pharmacovigilance Project over 19 months. The most reported medications were remdesivir in 22 patients (47.8%) and casirivimab/imdevimab in 8 patients (17.4%). Four patients (8.7%) had life-threatening clinical manifestation, and 16 patients (34.8%) required intervention to prevent permanent damage. The most common maternal and fetal events were elevated serum alanine aminotransferase (26.1%) and non-reassuring fetal heart patterns (20.0%), respectively. CONCLUSIONS This case series reports AEs of elevated serum alanine aminotransferase, maternal bradycardia, maternal hypothermia, non-reassuring fetal heart patterns, and emergent or unplanned cesarean sections following administration of several COVID-19 therapeutics. This study was not designed to definitely identify causation, and further study is needed to evaluate the causal role of these therapeutics in AEs affecting pregnant COVID-19 patients.
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Affiliation(s)
- Mark Simon
- Rocky Mountain Poison & Drug Safety, Denver Health & Hospital Authority, 1391 Speer Blvd, Unit 600, Denver, CO, 80204, USA.
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
| | - Jennie Buchanan
- Rocky Mountain Poison & Drug Safety, Denver Health & Hospital Authority, 1391 Speer Blvd, Unit 600, Denver, CO, 80204, USA
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Jonathan Schimmel
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Brent
- School of Medicine, University of Colorado, CO, Aurora, USA
| | - Keith Burkhart
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Paul Wax
- American College of Medical Toxicology, Phoenix, AZ, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Natalie Taylor
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA
| | - Kim Aldy
- American College of Medical Toxicology, Phoenix, AZ, USA
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17
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Piekos SN, Hwang YM, Roper RT, Sorensen T, Price ND, Hood L, Hadlock JJ. Effect of COVID-19 vaccination and booster on maternal-fetal outcomes: a retrospective cohort study. Lancet Digit Health 2023; 5:e594-e606. [PMID: 37537121 PMCID: PMC10473855 DOI: 10.1016/s2589-7500(23)00093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND COVID-19 in pregnant people increases the risk for poor maternal-fetal outcomes. However, COVID-19 vaccination hesitancy remains due to concerns over the vaccine's potential effects on maternal-fetal outcomes. Here we examine the impact of COVID-19 vaccination and boosters on maternal SARS-CoV-2 infections and birth outcomes. METHODS This was a retrospective multicentre cohort study on the impact of COVID-19 vaccination on maternal-fetal outcomes for people who delivered (n=106 428) at Providence St Joseph Health across seven western US states from Jan 26, 2021 to Oct 26, 2022. Cohorts were defined by vaccination status at delivery: vaccinated (n=35 926; two or more doses of mRNA-1273 Moderna or BNT162b2 Pfizer-BioNTech), unvaccinated (n=55 878), unvaccinated propensity score matched (n=16 771), boosted (n=10 927; three or more doses), vaccinated unboosted (n=13 243; two doses only), and vaccinated unboosted with propensity score matching (n=4414). We built supervised machine learning classification models, which we used to determine which people were more likely to be vaccinated or boosted at delivery. The primary outcome was maternal SARS-CoV-2 infection. COVID-19 vaccination status at delivery, COVID-19-related health care, preterm birth, stillbirth, and very low birthweight were evaluated as secondary outcomes. FINDINGS Vaccinated people were more likely to conceive later in the pandemic, have commercial insurance, be older, live in areas with lower household composition vulnerability, and have a higher BMI than unvaccinated people. Boosted people were more likely to have more days since receiving the second COVID-19 vaccine dose, conceive earlier in the pandemic, have commercial insurance, be older, and live in areas with lower household composition vulnerability than vaccinated unboosted people. Vaccinated pregnant people had lower rates of COVID-19 during pregnancy (4·0%) compared with unvaccinated matched people (5·3%; p<0·0001). COVID-19 rates were even lower in boosted people (3·2%) compared with vaccinated unboosted matched people (5·6%; p<0·0001). Vaccinated people were also less likely to have a preterm birth (7·9%; p<0·0001), stillbirth (0·3%; p<0·0002), or very low birthweight neonate (1·0%; p<0·0001) compared with unvaccinated matched people (preterm birth 9·4%; stillbirth 0·6%; very low birthweight 1·5%). Boosted people were less likely to have a stillbirth (0·3%; p<0·025) and have no differences in rates of preterm birth (7·6%; p=0·090) or very low birthweight neonates (0·8%; p=0·092) compared with vaccinated unboosted matched people (stillbirth 0·5%; preterm birth 8·4%; very low birthweight 1·1%). INTERPRETATION COVID-19 vaccination protects against adverse maternal-fetal outcomes, with booster doses conferring additional protection. Pregnant people should be high priority for vaccination and stay up to date with their COVID-19 vaccination schedule. FUNDING National Institute for Child Health & Human Development and the William O and K Carole Ellison Foundation.
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Affiliation(s)
| | | | | | - Tanya Sorensen
- Swedish Health Services, Swedish Medical Center, Seattle, WA, USA
| | - Nathan D Price
- Institute for Systems Biology, Seattle, WA, USA; Thorne HealthTech, New York, NY, USA
| | - Leroy Hood
- Institute for Systems Biology, Seattle, WA, USA
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18
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Lyu T, Liang C, Liu J, Hung P, Zhang J, Campbell B, Ghumman N, Olatosi B, Hikmet N, Zhang M, Yi H, Li X. Risk for stillbirth among pregnant individuals with SARS-CoV-2 infection varied by gestational age. Am J Obstet Gynecol 2023; 229:288.e1-288.e13. [PMID: 36858096 PMCID: PMC9970919 DOI: 10.1016/j.ajog.2023.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Despite previous research findings on higher risks of stillbirth among pregnant individuals with SARS-CoV-2 infection, it is unclear whether the gestational timing of viral infection modulates this risk. OBJECTIVE This study aimed to examine the association between timing of SARS-CoV-2 infection during pregnancy and risk of stillbirth. STUDY DESIGN This retrospective cohort study used multilevel logistic regression analyses of nationwide electronic health records in the United States. Data were from 75 healthcare systems and institutes across 50 states. A total of 191,403 pregnancies of 190,738 individuals of reproductive age (15-49 years) who had childbirth between March 1, 2020 and May 31, 2021 were identified and included. The main outcome was stillbirth at ≥20 weeks of gestation. Exposures were the timing of SARS-CoV-2 infection: early pregnancy (<20 weeks), midpregnancy (21-27 weeks), the third trimester (28-43 weeks), any time before delivery, and never infected (reference). RESULTS We identified 2342 (1.3%) pregnancies with COVID-19 in early pregnancy, 2075 (1.2%) in midpregnancy, and 12,697 (6.9%) in the third trimester. After adjusting for maternal and clinical characteristics, increased odds of stillbirth were observed among pregnant individuals with SARS-CoV-2 infection only in early pregnancy (odds ratio, 1.75, 95% confidence interval, 1.25-2.46) and midpregnancy (odds ratio, 2.09; 95% confidence interval, 1.49-2.93), as opposed to pregnant individuals who were never infected. Older age, Black race, hypertension, acute respiratory distress syndrome or acute respiratory failure, and placental abruption were found to be consistently associated with stillbirth across different trimesters. CONCLUSION Increased risk of stillbirth was associated with COVID-19 only when pregnant individuals were infected during early and midpregnancy, and not at any time before the delivery or during the third trimester, suggesting the potential vulnerability of the fetus to SARS-CoV-2 infection in early pregnancy. Our findings underscore the importance of proactive COVID-19 prevention and timely medical intervention for individuals infected with SARS-CoV-2 during early and midpregnancy.
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Affiliation(s)
- Tianchu Lyu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Chen Liang
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Jihong Liu
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Berry Campbell
- Department of Obstetrics and Gynecology, School of Medicine Columbia, University of South Carolina, Columbia, SC
| | - Nadia Ghumman
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Neset Hikmet
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC
| | - Manting Zhang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Honggang Yi
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
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19
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Changizi N, Eshraghi N, Ghafoori F, Hejazi S, Hadipour Jahromy L, Farahani Z, Sharifi H, Beheshtian M. COVID-19 knowledge, attitudes, and practices among Iranian pregnant and postpartum women: A national study. J Obstet Gynaecol Res 2023; 49:2295-2303. [PMID: 37433477 DOI: 10.1111/jog.15724] [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: 03/04/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND To control the spread of COVID-19, Iran has adopted rigorous precautionary and preventive measures, particularly for vulnerable groups. Considering the effects of knowledge and attitudes about COVID-19 on adherence to preventive measures, we examined women's knowledge, attitudes, and practices (KAP) from pregnancy to 6 weeks postpartum about COVID-19 during this pandemic. METHODS In a cross-sectional study, 7363 women were recruited via an online questionnaire between June 23, 2021 and July 7, 2021. The questionnaire consisted of 27 questions, measuring KAP. RESULTS Most of the participants had a good understanding of COVID-19 (Mean: 7.30 out of 9, standard deviation [SD]: 1.27), but the knowledge of the disease's main symptoms and modes of transmission was at the lowest levels. The mean attitudes score was 31.47 out of 50 (SD: 7.70). The participants had good practices against COVID-19 with a mean score of 35.48 out of 40 (SD: 3.94). To reduce anxiety and fear during the pandemic, half of our participants strongly emphasized the role of family emotional support. Income status and educational levels were the most significant variables influencing KAP (p-value ≤0.001). A correlation was found between knowledge and practice scores (r = 0.205, p-value = 0.001). CONCLUSION Our findings may serve to formulate awareness-raising interventions and can be a guide to health policymakers and workers such as obstetricians, clinicians, and midwives for more effective educational communication emphasizing the COVID-19 symptoms and transmission modes and rendering appropriate counseling, particularly on the importance of emotional family support during the pandemic.
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Affiliation(s)
- Nasrin Changizi
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Eshraghi
- Department of Perinatology, Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Faezeh Ghafoori
- Population Office, Vice Chancellery for Health, Iran Ministry of Health and Medical Education, Tehran, Iran
| | - Saiedeh Hejazi
- Maternal Health Department, Population, Family and School Health Office, Vice Chancellery for Health, Iran Ministry of Health and Medical Education, Tehran, Iran
| | - Leila Hadipour Jahromy
- Maternal Health Department, Population, Family and School Health Office, Vice Chancellery for Health, Iran Ministry of Health and Medical Education, Tehran, Iran
| | - Zahra Farahani
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Beheshtian
- Maternal Health Department, Population, Family and School Health Office, Vice Chancellery for Health, Iran Ministry of Health and Medical Education, Tehran, Iran
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20
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Mohanty S, Tita AT, Varner M, Stockwell MS, Newes‐Adeyi G, Battarbee AN, Reichle L, Morrill T, Daugherty M, Mourad M, Silverio Francisco RA, Woodworth K, Wielgosz K, Galang R, Maniatis P, Semenova V, Dawood FS. Association between SARS-CoV-2 infections during pregnancy and preterm live birth. Influenza Other Respir Viruses 2023; 17:e13192. [PMID: 37744991 PMCID: PMC10511836 DOI: 10.1111/irv.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
We examined associations between mild or asymptomatic prenatal SARS-CoV-2 infection and preterm live birth in a prospective cohort study. During August 2020-October 2021, pregnant persons were followed with systematic surveillance for RT-PCR or serologically confirmed SARS-CoV-2 infection until pregnancy end. The association between prenatal SARS-CoV-2 infection and preterm birth was assessed using Cox proportional-hazards regression. Among 954 pregnant persons with a live birth, 185 (19%) had prenatal SARS-CoV-2 infection and 123 (13%) had preterm birth. The adjusted hazard ratio for the association between SARS-CoV-2 infection and preterm birth was 1.28 (95% confidence interval 0.82-1.99, p = 0.28), although results did not reach statistical significance.
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Affiliation(s)
- Sarita Mohanty
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Alan T. Tita
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Michael Varner
- Department of Obstetrics and GynecologyUniversity of Utah Health Sciences CenterSalt Lake CityUtahUSA
| | - Melissa S. Stockwell
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Department of Population and Family Health, Mailman School of Public HealthColumbia University Irving Medical CenterNew YorkNew YorkUSA
- New York‐Presbyterian HospitalNew YorkNew YorkUSA
| | | | - Ashley N. Battarbee
- Center for Women's Reproductive Health and Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | | | | | - Mirella Mourad
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Raul A. Silverio Francisco
- Division of Child and Adolescent Health, Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kate Woodworth
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Romeo Galang
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Pete Maniatis
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Vera Semenova
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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21
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Young D, Houshmand B, Tan CC, Kirubarajan A, Parbhakar A, Dada J, Whittle W, Sobel ML, Gomez LM, Rüdiger M, Pecks U, Oppelt P, Ray JG, Hobson SR, Snelgrove JW, D'Souza R, Kashef R, Sussman D. Predicting adverse outcomes in pregnant patients positive for SARS-CoV-2: a machine learning approach- a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:553. [PMID: 37532986 PMCID: PMC10394879 DOI: 10.1186/s12884-023-05679-2] [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: 05/24/2022] [Accepted: 05/04/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Pregnant people are particularly vulnerable to SARS-CoV-2 infection and to ensuing severe illness. Predicting adverse maternal and perinatal outcomes could aid clinicians in deciding on hospital admission and early initiation of treatment in affected individuals, streamlining the triaging processes. METHODS An international repository of 1501 SARS-CoV-2-positive cases in pregnancy was created, consisting of demographic variables, patient comorbidities, laboratory markers, respiratory parameters, and COVID-19-related symptoms. Data were filtered, preprocessed, and feature selection methods were used to obtain the optimal feature subset for training a variety of machine learning models to predict maternal or fetal/neonatal death or critical illness. RESULTS The Random Forest model demonstrated the best performance among the trained models, correctly identifying 83.3% of the high-risk patients and 92.5% of the low-risk patients, with an overall accuracy of 89.0%, an AUC of 0.90 (95% Confidence Interval 0.83 to 0.95), and a recall, precision, and F1 score of 0.85, 0.94, and 0.89, respectively. This was achieved using a feature subset of 25 features containing patient characteristics, symptoms, clinical signs, and laboratory markers. These included maternal BMI, gravidity, parity, existence of pre-existing conditions, nicotine exposure, anti-hypertensive medication administration, fetal malformations, antenatal corticosteroid administration, presence of dyspnea, sore throat, fever, fatigue, duration of symptom phase, existence of COVID-19-related pneumonia, need for maternal oxygen administration, disease-related inpatient treatment, and lab markers including sFLT-1/PlGF ratio, platelet count, and LDH. CONCLUSIONS We present the first COVID-19 prognostication pipeline specifically for pregnant patients while utilizing a large SARS-CoV-2 in pregnancy data repository. Our model accurately identifies those at risk of severe illness or clinical deterioration, presenting a promising tool for advancing personalized medicine in pregnant patients with COVID-19.
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Affiliation(s)
- Dylan Young
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University (formerly Ryerson University), 350 Victoria St, Toronto, ON, M5B 0A1, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), Toronto Metropolitan University & St. Michael's Hospital, Toronto, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Bita Houshmand
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University (formerly Ryerson University), 350 Victoria St, Toronto, ON, M5B 0A1, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), Toronto Metropolitan University & St. Michael's Hospital, Toronto, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Chunyi Christie Tan
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abirami Kirubarajan
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - Ashna Parbhakar
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jazleen Dada
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wendy Whittle
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Mara L Sobel
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Luis M Gomez
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, INOVA Health System, Falls Church, VA, USA
| | - Mario Rüdiger
- Saxony Center for Feto-Neonatal Health, Medizinische Fakultät Der TU Dresden, Dresden, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Peter Oppelt
- Department for Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Joel G Ray
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, St, Michael's Hospital, Toronto, Canada
| | - Sebastian R Hobson
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - John W Snelgrove
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada
- Department of Obstetrics & Gynaecology and Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada
| | - Rasha Kashef
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University (formerly Ryerson University), 350 Victoria St, Toronto, ON, M5B 0A1, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), Toronto Metropolitan University & St. Michael's Hospital, Toronto, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada
| | - Dafna Sussman
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University (formerly Ryerson University), 350 Victoria St, Toronto, ON, M5B 0A1, Canada.
- Institute for Biomedical Engineering, Science and Technology (iBEST), Toronto Metropolitan University & St. Michael's Hospital, Toronto, Canada.
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada.
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Canada.
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22
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Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Battaglia MA, Bergamaschi R, Brichetto G, Bunul SD, Calabrese M, Capobianco M, Cavalla P, Celani MG, Clerico M, Cocco E, Comi G, Confalonieri P, Conte A, Cordioli C, De Luca G, De Rossi N, Filippi M, Gumes H, Immovilli P, Inglese M, Karabudak R, Landi D, Lanzillo R, L’Episcopo MR, Lorefice L, Mantero V, Marangoni S, Marfia GA, Masciulli C, Milano E, Moiola L, Orlandi R, Patti F, Perini P, Pesci I, Pucci E, Puthenparampil M, Radaelli M, Salvetti M, Sartori A, Scandellari C, Sen S, Siva A, Strumia S, Teatini F, Tedeschi G, Trojano M, Tutuncu M, Vaula G, Sormani MP, Amato MP. Sars-CoV2 infection in pregnant women with multiple sclerosis. Mult Scler 2023; 29:1090-1098. [PMID: 37232279 PMCID: PMC10225808 DOI: 10.1177/13524585231176174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients. OBJECTIVE In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis. METHODS We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022. A control group of 1354 women was extracted from the database of the Multiple Sclerosis and COVID-19 (MuSC-19). Univariate and subsequent logistic regression models were fitted to search for risk factors associated with severe COVID-19 course (at least one outcome among hospitalization, intensive care unit [ICU] admission and death). RESULTS In the multivariable analysis, independent predictors of severe COVID-19 were age, body mass index ⩾ 30, treatment with anti-CD20 and recent use of methylprednisolone. Vaccination before infection was a protective factor. Vaccination before infection was a protective factor. Pregnancy was not a risk nor a protective factor for severe COVID-19 course. CONCLUSION Our data show no significant increase of severe COVID-19 outcomes in patients with multiple sclerosis who contracted the infection during pregnancy.
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Affiliation(s)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy/Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | - S Destan Bunul
- Kocaeli University School of Medicine, Kocaeli, Kocaeli, Turkey
| | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Marco Capobianco
- Department of Neurology, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science, University Hospital of Turin, Turin, Italy
| | - Maria Grazia Celani
- Servizio Malattie Demielinizzanti, SC di Neurofisiopatologia, AO di Perugia, Perugia, UK
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | | | - Paolo Confalonieri
- Multiple Sclerosis Centre, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Giovanna De Luca
- MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Haluk Gumes
- Selcuk University School of Medicine, Konya, Turkey
| | - Paolo Immovilli
- Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy/Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | | | - Vittorio Mantero
- UOC Neurologia—Stroke Unit, Presidio “A. Manzoni,” ASST Lecco, Italy/Department of Neurology, Ospedale Santa Chiara, Trento, Italy
| | - Sabrina Marangoni
- Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, “Tor Vergata” University, Rome, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Eva Milano
- SC Neurologia 1, Ospedale Maria Vittoria, Torino, Italy
| | - Lucia Moiola
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Riccardo Orlandi
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Patti
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Paola Perini
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy
| | | | - Marco Puthenparampil
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Marta Radaelli
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy/Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Arianna Sartori
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Cinzia Scandellari
- IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy
| | - Sedat Sen
- Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Aksel Siva
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Silvia Strumia
- UOC di Neurologia, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Francesco Teatini
- Multiple Sclerosis Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - Melih Tutuncu
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Giovanna Vaula
- Department of Neuroscience, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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23
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Asadi F, Shakiba R, Rabiei R, Emami H, Sabahi A. COVID-19 vaccine registry for pregnant women: policy to control complications of vaccination in pregnant women in 2021-2022. BMC Pregnancy Childbirth 2023; 23:542. [PMID: 37501112 PMCID: PMC10375670 DOI: 10.1186/s12884-023-05856-3] [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: 03/12/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Data management related to COVID-19 vaccination in pregnant women is vital to improve the treatment process and to establish preventive programs. Implementing a registry to manage data is an essential part of this process. This study aims to design a national model of the COVID-19 vaccination registry for pregnant women in Iran. METHODS The present study is an applied descriptive study conducted in 2021 and 2022 in two stages. In the first stage, the coordinates of the National Registry of COVID-19 vaccination of pregnant women from related references and articles, as well as the comparative study of the National Registry of COVID-19 vaccination of pregnant women in the United States, Canada, and the United Kingdom was done. In the second stage, the preliminary model was designed. The model was validated using the Delphi technique and questionnaire tools and analyzing the data. RESULTS The presented national COVID-19 vaccination registry model of pregnant women's main components consist of objectives, data sources, structure, minimum data set, standards, and registry processes, all of which received 100% expert consensus. CONCLUSION The vaccination registry of pregnant women has a major role in managing COVID-19 vaccination data of pregnant women and can be one of the Ministry of Health and Medical Education priorities.
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Affiliation(s)
- Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Roya Shakiba
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rabiei
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Emami
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Sabahi
- Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
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24
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Bosworth ML, Schofield R, Ayoubkhani D, Charlton L, Nafilyan V, Khunti K, Zaccardi F, Gillies C, Akbari A, Knight M, Wood R, Hardelid P, Zuccolo L, Harrison C. Vaccine effectiveness for prevention of covid-19 related hospital admission during pregnancy in England during the alpha and delta variant dominant periods of the SARS-CoV-2 pandemic: population based cohort study. BMJ MEDICINE 2023; 2:e000403. [PMID: 37564827 PMCID: PMC10410807 DOI: 10.1136/bmjmed-2022-000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/18/2023] [Indexed: 08/12/2023]
Abstract
Objective To estimate vaccine effectiveness for preventing covid-19 related hospital admission in individuals first infected with the SARS-CoV-2 virus during pregnancy compared with those of reproductive age who were not pregnant when first infected with the virus. Design Population based cohort study. Setting Office for National Statistics Public Health Data Asset linked dataset, providing national linked census and administrative data in England, 8 December 2020 to 31 August 2021. Participants 815 477 females aged 18-45 years (mean age 30.4 years) who had documented evidence of a first SARS-CoV-2 infection in the NHS Test and Trace or Hospital Episode Statistics data. Main outcome measures Hospital admission where covid-19 was recorded as the primary diagnosis. Cox proportional hazards models, adjusted for calendar time of infection, sociodemographic factors, and pre-existing health conditions related to uptake of the covid-19 vaccine and risk of severe covid-19 outcomes, were used to estimate vaccine effectiveness as the complement of the hazard ratio for hospital admission for covid-19. Results Compared with pregnant individuals who were not vaccinated, the adjusted rate of hospital admission for covid-19 was 77% (95% confidence interval 70% to 82%) lower for pregnant individuals who had received one dose and 83% (76% to 89%) lower for those who had received two doses of vaccine. These estimates were similar to those found in the non-pregnant group: 79% (77% to 81%) for one dose and 83% (82% to 85%) for two doses of vaccine. Among those who were vaccinated >90 days before infection, having two doses of vaccine was associated with a greater reduction in risk than one dose. Conclusions Covid-19 vaccination was associated with reduced rates of hospital admission in pregnant individuals infected with the SARS-CoV-2 virus, and the reduction in risk was similar to that in non-pregnant individuals. Waning of vaccine effectiveness occurred more quickly after one than after two doses of vaccine.
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Affiliation(s)
| | | | - Daniel Ayoubkhani
- Office for National Statistics, Newport, UK
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kamlesh Khunti
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Clare Gillies
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Pia Hardelid
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Luisa Zuccolo
- Health Data Science Centre, Fondazione Human Technopole, Milan, Italy
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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25
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Cassidy AG, Li L, Golan Y, Gay C, Lin CY, Jigmeddagva U, Chidboy MA, Ilala M, Buarpung S, Gonzalez VJ, Basilio E, Duck M, Murtha AP, Wu AHB, Lynch KL, Asiodu IV, Prahl MK, Gaw SL. Assessment of Adverse Reactions, Antibody Patterns, and 12-month Outcomes in the Mother-Infant Dyad After COVID-19 mRNA Vaccination in Pregnancy. JAMA Netw Open 2023; 6:e2323405. [PMID: 37450302 PMCID: PMC10349345 DOI: 10.1001/jamanetworkopen.2023.23405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/28/2023] [Indexed: 07/18/2023] Open
Abstract
Importance Longitudinal data on COVID-19 messenger RNA (mRNA) vaccine reactogenicity and immunogenicity in pregnancy and for the mother-infant dyad are needed. Objective To examine COVID-19 mRNA vaccine reactogenicity and immunogenicity in pregnancy and observe longitudinal maternal and infant outcomes. Design, Setting, and Participants This prospective cohort study of pregnant individuals enrolled in the COVID-19 Vaccination in Pregnancy and Lactation study from December 1, 2020, through December 31, 2021, with follow-up through March 31, 2022, was conducted at a large academic medical center in an urban metropolitan area in California. Pregnant individuals receiving COVID-19 mRNA vaccines (mRNA-1273 [Moderna] and BNT162b2 [Pfizer-BioNTech]) were eligible. Of 81 participants enrolled, 5 were excluded after enrollment: 1 terminated pregnancy, 1 received the third vaccine dose prior to delivery, and 3 delivered prior to completing the initial vaccine series. Exposure COVID-19 mRNA vaccination at any time during pregnancy. Main Outcomes and Measures The primary outcomes were vaccine response as measured by blood Immunoglobulin G (IgG) titers after each vaccine dose and self-reported postvaccination symptoms. Patients' IgG titers were measured in cord blood and in infant blood at intervals up to 1 year of life; IgG and IgA titers were measured in maternal milk. Clinical outcomes were collected from medical records. Results Of 76 pregnant individuals included in final analyses (median [IQR] maternal age, 35 [29-41] years; 51 [67.1%] White; 28 [36.8%] primigravid; 37 [48.7%] nulliparous), 42 (55.3%) received BNT162b2 and 34 (44.7%) received mRNA-1237. There were no significant differences in maternal characteristics between the 2 vaccine groups. Systemic symptoms were more common after receipt of the second vaccine dose than after the first dose (42 of 59 [71.2%] vs 26 of 59 [44.1%]; P = .007) and after mRNA-1237 than after BNT162b2 (25 of 27 [92.6%] vs 17 of 32 53.1%; P = .001). Systemic symptoms were associated with 65.6% higher median IgG titers than no symptoms after the second vaccine dose (median [IQR], 2596 [1840-4455] vs 1568 [1114-4518] RFU; P = .007); mean cord titers in individuals with local or systemic symptoms were 6.3-fold higher than in individuals without symptoms. Vaccination in all trimesters elicited a robust maternal IgG response. The IgG transfer ratio was highest among individuals vaccinated in the second trimester. Anti-SARS-CoV-2 IgG was detectable in cord blood regardless of vaccination trimester. In milk, IgG and IgA titers remained above the positive cutoff for at least 5-6 months after birth, and infants of mothers vaccinated in the second and third trimesters had positive IgG titers for at least 5 to 6 months of life. There were no vaccine-attributable adverse perinatal outcomes. Conclusions and Relevance The findings of this cohort study suggest that mRNA COVID-19 vaccination in pregnancy provokes a robust IgG response for the mother-infant dyad for approximately 6 months after birth. Postvaccination symptoms may indicate a more robust immune response, without adverse maternal, fetal, or neonatal outcomes.
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Affiliation(s)
- Arianna G. Cassidy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Lin Li
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Yarden Golan
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco
- Institute for Human Genetics, University of California, San Francisco
| | - Caryl Gay
- Department of Family Health Care Nursing, University of California, San Francisco
| | - Christine Y. Lin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Unurzul Jigmeddagva
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Megan A. Chidboy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Mikias Ilala
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco
| | - Sirirak Buarpung
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Veronica J. Gonzalez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Emilia Basilio
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Meghan Duck
- UCSF Benioff Children’s Hospital, University of California, San Francisco
| | - Amy P. Murtha
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Alan H. B. Wu
- Department of Laboratory Medicine, University of California, San Francisco
| | - Kara L. Lynch
- Department of Laboratory Medicine, University of California, San Francisco
| | - Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, University of California, San Francisco
| | - Mary K. Prahl
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
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26
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Jeong Y, Kim MA. The coronavirus disease 2019 infection in pregnancy and adverse pregnancy outcomes: a systematic review and meta-analysis. Obstet Gynecol Sci 2023; 66:270-289. [PMID: 37194243 PMCID: PMC10375217 DOI: 10.5468/ogs.22323] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak which started in December 2019 rapidly developed into a global health concern. Pregnant women are susceptible to respiratory infections and can experience adverse outcomes. This systematic review and meta-analysis compared pregnancy outcomes according to COVID-19 disease status. The MEDLINE, EMBASE, and Cochrane Library databases were searched for relevant articles published between December 1, 2019, and October 19, 2022. Main inclusion criterion was any population-based, cross-sectional, cohort, or case-control study that assessed pregnancy outcomes in women with or without laboratory-confirmed COVID-19. Sixty-nine studies including 1,606,543 pregnant women (39,716 [2.4%] diagnosed with COVID-19) were retrieved. COVID-19-infected pregnant women had a higher risk of preterm birth (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.42-1.78), preeclampsia (OR, 1.41; 95% CI, 1.30-1.53), low birth weight (OR, 1.52; 95% CI, 1.30-1.79), cesarean delivery (OR, 1.20; 95% CI, 1.10-1.30), stillbirth (OR, 1.71; 95% CI, 1.39-2.10), fetal distress (OR, 2.49; 95% CI, 1.54-4.03), neonatal intensive care unit admission (OR, 2.33; 95% CI, 1.72-3.16), perinatal mortality (OR, 1.96; 95% CI, 1.15-3.34), and maternal mortality (OR, 6.15; 95% CI, 3.74-10.10). There were no significant differences in total miscarriage, preterm premature rupture of membranes, postpartum hemorrhage, cholestasis, or chorioamnionitis according to infection. This review demonstrates that COVID-19 infection during pregnancy can lead to adverse pregnancy outcomes. This information could aid researchers and clinicians in preparing for another pandemic caused by newly discovered respiratory viruses. The findings of this study may assist with evidence-based counseling and help clinicians manage pregnant women with COVID-19.
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Affiliation(s)
- Yeonsong Jeong
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min-A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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27
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Cunha CMP, Amorim MM, de Azevedo Guendler J, Katz L. Factors associated with severe acute respiratory syndrome in pregnant/postpartum women with COVID-19 receiving care at referral centers in northeastern Brazil: Secondary analysis of a cohort study. Heliyon 2023; 9:e17131. [PMID: 37441093 PMCID: PMC10292915 DOI: 10.1016/j.heliyon.2023.e17131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Background At the beginning of the COVID-19 pandemic, the greater risks associated with the new SARS-CoV-2 pathogen in pregnant women were as yet unclear. This study analyzed factors associated with severe acute respiratory syndrome (SARS) in pregnant/postpartum women with COVID-19. Methods A prospective and retrospective cohort study was conducted in eight referral centers in northeastern Brazil between April 2020 and December 2021 involving pregnant/postpartum women with a positive COVID-19 RT-PCR test. A multivariate analysis was then conducted using a hierarchical logistic regression model to evaluate the association between the independent variables and the presence of SARS. Findings Of 611 patients included, 522 were pregnant and 83 were postpartum, at the time of admission. Criteria for SARS were present in 215 patients (35·2%). Factors associated with SARS included overweight and/or obesity (adjusted odds ratio/AOR: 1·95; 95%CI: 1·21-3·12; p = 0·0054), parity ≥2 (AOR: 1·72; 95%CI: 1·21-2·45; p = 0·0025), gestational age <34 weeks (AOR: 3·54; 95%CI: 2·47-5·07; p < 0·0001) and duration of symptoms >7 days (AOR: 1·97; 95%CI: 1·35-2·89; p = 0·0004). SARS increased the likelihood of requiring oxygen therapy (RR = 8·80; 95%CI: 6·25-12·40; p = 0·0000), mechanical ventilation (RR = 8·15; 95%CI: 4·67-14·21; p = 0·0000), and admission to an ICU (RR = 6·54; 95%CI: 4·70-9·11; p = 0·0000), and of maternal near miss (RR = 10·82; 95%CI: 1·20-22·47; p = 0·0000) and maternal death (RR = 8·12; 95%CI: 3·11-21·09; p = 0·0000). Interpretation In patients with COVID-19, parity ≥2, overweight/obesity, gestational age <34 weeks and duration of symptoms >7 days increased the risk of SARS. Cesarean sections, oxygen therapy, and mechanical ventilation were more common in patients with SARS.
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Affiliation(s)
- Carolina Maria Pires Cunha
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Pernambuco, Brazil
| | - Melania Maria Amorim
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Pernambuco, Brazil
- Federal University of Campina Grande (UFCG), Campina Grande, Paraíba, Brazil
| | - Julianna de Azevedo Guendler
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Pernambuco, Brazil
| | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Pernambuco, Brazil
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Baki Yıldırım S, Yeniay D. Characteristics and Outcomes of Women With Mild and Moderate Forms of COVID-19 Giving Birth During the COVID-19 Pandemic. Cureus 2023; 15:e41397. [PMID: 37546030 PMCID: PMC10401895 DOI: 10.7759/cureus.41397] [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: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION We aim to investigate the clinical course and impact of mild and moderate forms of coronavirus disease 2019 (COVID-19) infection on pregnant women. METHOD A retrospective cohort study was conducted on pregnant women who delivered in a hospital with confirmed COVID-19 infection. Demographic features, clinical characteristics, and perinatal outcomes were retrospectively evaluated. RESULTS In total, 157 pregnant women with COVID-19 were hospitalized. In a total of 46 deliveries, three (6.5%) had comorbidities and six (13%) were symptomatic. Myalgia and cough were the leading symptoms. In total, 11 (23.8%) patients received COVID-19 therapy, 41 (90%) had mild disease, and five (10.9%) were transferred to the intensive care unit (ICU). Maternal mortality was observed in two (4.3%) cases. Of the patients, 15 (32.6) had pregnancy complications (preterm delivery) (n = 13, 28.2%), and the cesarean section rate was 91.3%. CONCLUSION The course of COVID-19 was mild in the majority of cases. However, accompanying comorbid conditions may accelerate the return to severe form and cause death.
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Affiliation(s)
- Sema Baki Yıldırım
- Department of Obstetrics and Gynecology, Giresun University, Giresun, TUR
| | - Dilek Yeniay
- Department of Anesthesiology and Reanimation, Giresun Maternity and Child Health Training and Research Hospital, Giresun, TUR
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29
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Charuta A, Smuniewska M, Woźniak Z, Paziewska A. Effect of COVID-19 on Pregnancy and Neonate's Vital Parameters: A Systematic Review. J Pregnancy 2023; 2023:3015072. [PMID: 37215313 PMCID: PMC10199793 DOI: 10.1155/2023/3015072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 03/19/2023] [Accepted: 04/04/2023] [Indexed: 05/24/2023] Open
Abstract
Background COVID-19 is a new pandemic, which was declared by the World Health Organization in 2019 as a threat to public health. According to numerous reports, it can have negative consequences for pregnant women, labour, and neonates born to infected mothers. The aim of this paper was to gather the evidence and to present a summary of the results of studies concerning COVID-19 in pregnant women and their neonates. Methods Articles from prestigious journals covering the period from 2020 to February 2023, relevant review papers, and original research articles from PubMed were analysed. In order to analyse the available research literature, the Web of Science, Scopus, and PubMed databases were used, in which the search for articles was conducted using terms ("pregnancy," "coronavirus," "SARS-CoV-2," and "newborn") and using PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis) guidelines for clinical trials. Meta-analyses and systematic reviews (2022-2023) on symptoms, neonatal course, and risk of COVID-19 infection have been summarized. Summary of meta-analyses and systematic reviews (2022-2023) on the effect and adverse reaction of the COVID-19 vaccination is presented. Results As a result of the research conducted, it was confirmed that in most pregnant women, no serious signs of the infection were observed, although isolated cases of death related to COVID-19 in pregnant women were reported. Several authors called attention to the more severe course of the infection in pregnant women with obesity. It seemed that no vertical transmission from mother to child was occurring. Nevertheless, the information was not clinching. The condition of the neonates born to mothers with COVID-19 was in most cases described as normal; however, some papers reported deaths of infected neonates. Conclusions Due to insufficient data, further research is necessary. Further studies and follow-up are recommended, which would make possible an assessment of remote effects of COVID-19 on pregnancy and vital parameters of the newborn.
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Affiliation(s)
- Anna Charuta
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Poland
| | - Monika Smuniewska
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Mazowiecki Provincial Hospital in Siedlce Named after Saint John Paul II in Siedlce, Poland
| | - Zofia Woźniak
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Independent Public Health Care Center in Sokołów Podlaski, Poland
| | - Agnieszka Paziewska
- Siedlce University of Natural Sciences and Humanities, Institute of Health, Faculty of Medical and Health Sciences, Poland
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30
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Pryshliak OY, Marynchak OV, Kondryn OY, Hryzhak IH, Henyk NI, Makarchuk OM, Golovchak IS, Boichuk OP, Protsyk AL, Prokofiev MV. Clinical and laboratory characteristics of COVID-19 in pregnant women. J Med Life 2023; 16:766-772. [PMID: 37520486 PMCID: PMC10375343 DOI: 10.25122/jml-2023-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/13/2023] [Indexed: 08/01/2023] Open
Abstract
This article discusses the distinct characteristics of COVID-19 in pregnant women and investigates potential early predictors of disease severity in this specific patient population. The study included 116 pregnant women with a confirmed diagnosis of COVID-19 in different trimesters of pregnancy. In addition to clinical features, we evaluated general clinical research methods, biochemical parameters (procalcitonin, C-reactive protein, D-dimer), and the leukocyte index of endogenous intoxication and lymphocytic index to identify potential early predictors of disease severity. All pregnant women were divided into two study groups: Group I - pregnant women with mild course, and Group II - pregnant women with moderate and severe course of COVID-19. Most pregnant women (72.4%) experienced a non-severe course characterized by catarrhal symptoms and moderate intoxication. However, pulmonary manifestations and pregnancy-related complications were detected in pregnant women from Group 2. The levels of C-reactive protein and procalcitonin in both study groups were significantly increased compared to the control group. In pregnant women with moderate and severe COVID-19, indicators of endogenous intoxication were significantly pronounced. Establishing associations between leukocyte indices and biomarkers, such as procalcitonin and C-reactive protein, enables the utilization of routine complete blood counts as a primary screening tool for predicting the severity of COVID-19 in pregnant women.
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Affiliation(s)
| | - Oleksandra Vasulivna Marynchak
- Department of Infectious Diseases and Epidemiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oksana Yevgenivna Kondryn
- Department of Infectious Diseases and Epidemiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Ihor Hnatovych Hryzhak
- Department of Infectious Diseases and Epidemiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Natalia Ivanivna Henyk
- Department of Obstetrics and Gynecology named after I.D. Lanovyi Ivano-Frankivsk, National Medical University, Ivano-Frankivsk, Ukraine
| | - Oksana Mykhailivna Makarchuk
- Department of Obstetrics and Gynecology named after I.D. Lanovyi Ivano-Frankivsk, National Medical University, Ivano-Frankivsk, Ukraine
| | | | - Oleksandr Petrovych Boichuk
- Department of Infectious Diseases and Epidemiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Andriy Liubomyrovych Protsyk
- Department of Infectious Diseases and Epidemiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Mykola Valeriiovych Prokofiev
- Department of Infectious Diseases and Epidemiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
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31
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Kumari U, Sharma RK, Sinha A, Sinha M, Keshari JR. Impact of COVID-19 Vaccination on Women During Pregnancy and Breastfeeding. Cureus 2023; 15:e38547. [PMID: 37288225 PMCID: PMC10241700 DOI: 10.7759/cureus.38547] [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: 04/29/2023] [Indexed: 06/09/2023] Open
Abstract
Rapid development of anti-SARS-CoV-2 vaccinations in the late 2020s has significantly altered the trajectory in which the virus affects various patient demographics, especially the most susceptible ones. In light of ethical and conceptual safety considerations, pregnant women were initially barred from participating in clinical studies for the coronavirus disease 2019 (COVID-19) vaccination programs. However, the steady accumulation of reliable observational data from cohorts of pregnant women who received vaccinations enabled the research establishments to quickly address a number of open questions. Still, more than a year after vaccines were widely available, the safety concerns of expectant or nursing mothers are cited as the primary justification for refusing COVID-19 vaccination, and notably, the rate of vaccination in the said populations is known to be consistently lower than those of the general populace. In light of such a scenario, we have made an attempt to garner relevant studies that evaluated the effect of COVID-19 vaccination on pregnant and lactating mothers which may prove to be supporting evidence for its wide usage among the said population.
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Affiliation(s)
- Usha Kumari
- Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | | | - Archana Sinha
- Obstetrics and Gynaecology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Minakshi Sinha
- Gynecology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - J R Keshari
- Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND
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32
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Habel JR, Chua BY, Kedzierski L, Selva KJ, Damelang T, Haycroft ER, Nguyen TH, Koay HF, Nicholson S, McQuilten HA, Jia X, Allen LF, Hensen L, Zhang W, van de Sandt CE, Neil JA, Pragastis K, Lau JS, Jumarang J, Allen EK, Amanant F, Krammer F, Wragg KM, Juno JA, Wheatley AK, Tan HX, Pell G, Walker S, Audsley J, Reynaldi A, Thevarajan I, Denholm JT, Subbarao K, Davenport MP, Hogarth PM, Godfrey DI, Cheng AC, Tong SY, Bond K, Williamson DA, McMahon JH, Thomas PG, Pannaraj PS, James F, Holmes NE, Smibert OC, Trubiano JA, Gordon CL, Chung AW, Whitehead CL, Kent SJ, Lappas M, Rowntree LC, Kedzierska K. Immune profiling of SARS-CoV-2 infection during pregnancy reveals NK cell and γδ T cell perturbations. JCI Insight 2023; 8:167157. [PMID: 37036008 PMCID: PMC10132165 DOI: 10.1172/jci.insight.167157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/15/2023] [Indexed: 04/11/2023] Open
Abstract
Pregnancy poses a greater risk for severe COVID-19; however, underlying immunological changes associated with SARS-CoV-2 during pregnancy are poorly understood. We defined immune responses to SARS-CoV-2 in unvaccinated pregnant and nonpregnant women with acute and convalescent COVID-19, quantifying 217 immunological parameters. Humoral responses to SARS-CoV-2 were similar in pregnant and nonpregnant women, although our systems serology approach revealed distinct antibody and FcγR profiles between pregnant and nonpregnant women. Cellular analyses demonstrated marked differences in NK cell and unconventional T cell activation dynamics in pregnant women. Healthy pregnant women displayed preactivated NK cells and γδ T cells when compared with healthy nonpregnant women, which remained unchanged during acute and convalescent COVID-19. Conversely, nonpregnant women had prototypical activation of NK and γδ T cells. Activation of CD4+ and CD8+ T cells and T follicular helper cells was similar in SARS-CoV-2-infected pregnant and nonpregnant women, while antibody-secreting B cells were increased in pregnant women during acute COVID-19. Elevated levels of IL-8, IL-10, and IL-18 were found in pregnant women in their healthy state, and these cytokine levels remained elevated during acute and convalescent COVID-19. Collectively, we demonstrate perturbations in NK cell and γδ T cell activation in unvaccinated pregnant women with COVID-19, which may impact disease progression and severity during pregnancy.
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Affiliation(s)
- Jennifer R Habel
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Brendon Y Chua
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Lukasz Kedzierski
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin J Selva
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Timon Damelang
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ebene R Haycroft
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Thi Ho Nguyen
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Hui-Fern Koay
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Hayley A McQuilten
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Xiaoxiao Jia
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lilith F Allen
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Luca Hensen
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Wuji Zhang
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Carolien E van de Sandt
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jessica A Neil
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Katherine Pragastis
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Jillian Sy Lau
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Eastern Health, Box Hill, Victoria, Australia
| | - Jaycee Jumarang
- Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - E Kaitlynn Allen
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Fatima Amanant
- Department of Microbiology, and
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Kathleen M Wragg
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jennifer A Juno
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Adam K Wheatley
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, Victoria, Australia
| | - Hyon-Xhi Tan
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Gabrielle Pell
- Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan Walker
- Mercy Perinatal Research Centre, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jennifer Audsley
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Arnold Reynaldi
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Irani Thevarajan
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Miles P Davenport
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - P Mark Hogarth
- Immune Therapies Laboratory, Burnet Institute, Melbourne, Victoria, Australia
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Dale I Godfrey
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, and Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Steven Yc Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Katherine Bond
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah A Williamson
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - James H McMahon
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Paul G Thomas
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Pia S Pannaraj
- Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA
- Departments of Pediatrics, Molecular Microbiology and Immunology, Keck School of Medicine, UCLA, Los Angeles, California, USA
| | - Fiona James
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Data Analytics Research and Evaluation Centre, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Olivia C Smibert
- Departments of Pediatrics, Molecular Microbiology and Immunology, Keck School of Medicine, UCLA, Los Angeles, California, USA
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, and
- National Centre for Infections in Cancer, Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jason A Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, and
- National Centre for Infections in Cancer, Peter McCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
| | - Claire L Gordon
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Amy W Chung
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Clare L Whitehead
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Infectious Diseases Department, Alfred Health, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Louise C Rowntree
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
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Adam AM, Popa RF, Vaduva C, Georgescu CV, Adam G, Melinte-Popescu AS, Popa C, Socolov D, Nechita A, Vasilache IA, Mihalceanu E, Harabor A, Melinte-Popescu M, Harabor V, Neagu A, Socolov R. Pregnancy Outcomes, Immunophenotyping and Immunohistochemical Findings in a Cohort of Pregnant Patients with COVID-19-A Prospective Study. Diagnostics (Basel) 2023; 13:diagnostics13071345. [PMID: 37046564 PMCID: PMC10092994 DOI: 10.3390/diagnostics13071345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: SARS-CoV-2 infection during pregnancy could determine important maternal and fetal complications. We aimed to prospectively assess placental immunohistochemical changes, immunophenotyping alterations, and pregnancy outcomes in a cohort of patients with COVID-19; (2) Methods: 52 pregnant patients admitted to a tertiary maternity center between October 2020 and November 2021 were segregated into two equal groups, depending on the presence of SARS-CoV-2 infection. Blood samples, fragments of umbilical cord, amniotic membranes, and placental along with clinical data were collected. Descriptive statistics and a conditional logistic regression model were used for data analysis; (3) Results: Adverse pregnancy outcomes such as preterm labor and neonatal intensive care unit admission did not significantly differ between groups. The immunophenotyping analysis indicated that patients with moderate-severe forms of COVID-19 had a significantly reduced population of T lymphocytes, CD4+ T cells, CD8+ T cells (only numeric), CD4+/CD8+ index, B lymphocytes, and natural killer (NK) cells. Our immunohistochemistry analysis of tissue samples failed to demonstrate positivity for CD19, CD3, CD4, CD8, and CD56 markers; (4) Conclusions: Immunophenotyping analysis could be useful for risk stratification of pregnant patients, while further studies are needed to determine the extent of immunological decidual response in patients with various forms of COVID-19.
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Affiliation(s)
- Ana-Maria Adam
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Radu-Florin Popa
- Department of Vascular Surgery, University of Medicine and Pharmacy "Grigore T. Popa", 700111 Iasi, Romania
| | - Cristian Vaduva
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Costinela Valerica Georgescu
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800216 Galati, Romania
| | - Gigi Adam
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800216 Galati, Romania
| | - Alina-Sinziana Melinte-Popescu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, 'Ștefan cel Mare' University, 720229 Suceava, Romania
| | - Cristina Popa
- Discipline of Oral Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Aurel Nechita
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Mihalceanu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - AnaMaria Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Marian Melinte-Popescu
- Department of Internal Medicine, Faculty of Medicine and Biological Sciences, 'Ștefan cel Mare' University, 720229 Suceava, Romania
| | - Valeriu Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800216 Galati, Romania
| | - Anca Neagu
- 'Saint John' Clinical Emergency Hospital for Children, 800487 Galati, Romania
| | - Razvan Socolov
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Murray Horwitz ME, Prifti CA, Battaglia TA, Ajayi AT, Edwards CV, Benjamin EJ, Yarrington CD, Parker SE. Prepregnancy Cardiovascular Disease Risk Factors and Adverse Pregnancy Outcomes in a Safety-Net Hospital. J Womens Health (Larchmt) 2023; 32:401-408. [PMID: 36827080 PMCID: PMC10329150 DOI: 10.1089/jwh.2022.0322] [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] [Indexed: 02/25/2023] Open
Abstract
Background: Many adverse pregnancy outcomes (APOs) are associated with elevated cardiovascular disease (CVD) risk. However, APO data in the context of pre-existing CVD risk factors, and from diverse populations, are limited. We assessed the occurrence of APOs among individuals with and without prepregnancy CVD risk factors, overall and by race/ethnicity. Methods: We conducted a retrospective study using electronic medical record data from a large urban safety-net hospital. Individuals with prenatal care and delivery between 2016 and 2018 at the hospital were included, and data from prenatal intake through the delivery hospitalization were captured. The exposure, prepregnancy CVD risk factors (hypertension, diabetes, tobacco use, and obesity), and the outcome, APOs (hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, low birth weight, and stillbirth), were identified from electronic medical records. Results: We identified 3760 unique delivering individuals, of whom 55.1% self-identified as Black non-Hispanic and 17% as Hispanic. Prepregnancy CVD risk factor prevalence was 45.6%, most commonly obesity (26.6%). APO prevalence was 35.6%, most commonly a hypertensive disorder of pregnancy (20.1%). Overall, 45.7% of APOs occurred in the absence of recognized prepregnancy CVD risk factors, representing 16.3% of the total sample. Among individuals without prepregnancy CVD risk factors, APO prevalence was 30.0% and did not vary by race/ethnicity. Conclusions: In this racially and ethnically diverse hospital-based sample, APOs were present in one in three parous individuals without prepregnancy CVD risk factors-a group with potentially elevated CVD risk who might otherwise be missed by traditional CVD risk factor screening.
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Affiliation(s)
- Mara E. Murray Horwitz
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Christine A. Prifti
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tracy A. Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ayodele T. Ajayi
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Camille V. Edwards
- Section of Hematology/Oncology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Christina D. Yarrington
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Samantha E. Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Tanacan A, Oluklu D, Laleli Koc B, Sinaci S, Menekse Beser D, Uyan Hendem D, Yildirim M, Sakcak B, Besimoglu B, Tugrul Ersak D, Akgun Aktas B, Gulen Yildiz E, Unlu S, Kara O, Alyamac Dizdar E, Canpolat FE, Ates İ, Moraloglu Tekin O, Sahin D. The utility of systemic immune-inflammation index and systemic immune-response index in the prediction of adverse outcomes in pregnant women with coronavirus disease 2019: Analysis of 2649 cases. J Obstet Gynaecol Res 2023; 49:912-919. [PMID: 36582132 DOI: 10.1111/jog.15533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
AIM To investigate the association of systemic immune-inflammation index (SII) and systemic immune-response index (SIRI) with adverse perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19). METHODS The cases were divided into (1) the Mild-moderate COVID-19 group (n = 2437) and (2) the Severe-critical COVID-19 group (n = 212). Clinical characteristics, perinatal outcomes, SII (neutrophilXplatelet/lymphocyte), and SIRI (neutrophilXmonocyte/lymphocyte) were compared between the groups. Afterward, SII and SIRI values were compared between subgroups based on pregnancy complications, neonatal intensive care unit (NICU) admission, and maternal mortality. A receiver operator characteristic analysis was performed for the determination of optimal cutoff values for SII and SIRI in the prediction of COVID-19 severity, pregnancy complications, NICU admission, and maternal mortality. RESULTS Both SII and SIRI were significantly higher in complicated cases (p < 0.05). Cutoff values in the prediction of severe-critical COVID-19 were 1309.8 for SII, and 2.3 for SIRI. For pregnancy complications, optimal cutoff values were 973.2 and 1.6. Cutoff values of 1045.4 and 1.8 were calculated for the prediction of NICU admission. Finally, cut-off values of 1224.2 and 2.4 were found in the prediction of maternal mortality. CONCLUSION SII and SIRI might be used in combination with other clinical findings in the prediction of poor perinatal outcomes.
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Affiliation(s)
- Atakan Tanacan
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bergen Laleli Koc
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Selcan Sinaci
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bedri Sakcak
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Berhan Besimoglu
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Duygu Tugrul Ersak
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Betul Akgun Aktas
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Esra Gulen Yildiz
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Serpil Unlu
- Department of Infectious Diseases, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Perinatology Clinic, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Evrim Alyamac Dizdar
- Neonatal Intensive Care Unit, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Fuat Emre Canpolat
- Neonatal Intensive Care Unit, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - İhsan Ates
- Department of Internal Medicine, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Pregnancy Outcomes in SARS-CoV-2-Positive Patients: A 20-Month Retrospective Analysis of Delivery Cases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020341. [PMID: 36837541 PMCID: PMC9968024 DOI: 10.3390/medicina59020341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023]
Abstract
Background and Objectives: The SARS-CoV-2 infection brings supplemental risks for pregnant women. Due to controversial hesitancy, their vaccination rate was lower in 2021 compared to the general population. In addition, access to maternal care was reduced during the pandemic. We conducted a retrospective cross-sectional analysis of the health records data over 20 months (1 April 2020 to 20 November 2021) aiming to explore the outcomes in SARS-CoV-2-positive cases referred for delivery to a tertiary public hospital in Western Romania. Materials and Methods: Women with SARS-CoV-2 infection diagnosed for the first time at the moment of birth who delivered singletons after 24 weeks of gestation, and had a clear immunization status were included in the analysis. Results: Out of the 97 patients included in the study, 35 (36%) had undergone ARN-based vaccination. Five cases of maternal death were recorded (all unvaccinated). Our retrospective exploratory analysis showed that the presence of COVID-19 symptoms in the SARS-CoV-2-positive patients made a significant impact on the delivery hospitalization, with a median hospital stay increase from 5 to 9 days (Mann-Whitney test, p = 0.014): longer hospitalization was recorded in the symptomatic cases irrespective of their vaccination status. No other adverse outcomes, such as gestational age at delivery, C-section rate, 5 min Apgar index, or birth weight were associated with the presence of symptoms. Conclusions: Our clinic maintained safe maternal care for the COVID-19 patients during the analyzed period. Vaccination of the expectant women was beneficial in SARS-CoV-2-positive patients by lowering the risk of COVID-19 symptoms, with subsequent implications on the newborns' health and maternal attachment.
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Young‐Wolff KC, Ray GT, Alexeeff SE, Benowitz N, Adams SR, Does MB, Goler N, Ansley D, Conway A, Avalos LA. Association of cannabis use during pregnancy with severe acute respiratory syndrome coronavirus 2 infection: a retrospective cohort study. Addiction 2023; 118:317-326. [PMID: 36189777 PMCID: PMC9812868 DOI: 10.1111/add.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Cannabis use is increasingly common among pregnant individuals and might be a risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to test whether prenatal cannabis use is associated with increased risk of SARS-CoV-2 infection during pregnancy. DESIGN This is a retrospective cohort study. SETTING The study was conducted in California, USA. PARTICIPANTS A total of 58 114 pregnancies (with outcomes from 5 March 2020 to 30 September 2021) among 57 287 unique pregnant women aged 14-54 years who were screened for prenatal substance use, enrolled in Kaiser Permanente Northern California (KPNC) (a health-care system) and had not tested positive for COVID-19 prior to pregnancy onset. MEASUREMENTS We utilized data from the KPNC electronic health record. Cannabis use status (current, recently quit and non-user) was based on universal screenings during prenatal care (including urine toxicology testing and self-reported use on a self-administered questionnaire). SARS-CoV-2 infection [based on polymerase chain reaction (PCR) tests] was estimated in time-to-event analyses using Cox proportional hazard regression models adjusting for covariates. Secondary analyses examined differences in (a) SARS-CoV-2 testing rates and (b) SARS-CoV-2 infection rates among those tested. FINDINGS We observed 348 810 person-months of follow-up time in our cohort with 41 064 SARS-CoV-2 PCR tests and 6% (n = 2414) of tests being positive. At the start of follow-up, 7% of pregnant individuals had current use, 12% had recently quit and 81% did not use cannabis. Adjusting for covariates, current use was associated with lower rates of SARS-CoV-2 infection [adjusted hazard ratio (aHR) = 0.60, 95% confidence interval (CI) = 0.49-0.74 than non-use. Those who had recently quit did not differ from non-cannabis users in infection rates (aHR = 0.96, 95% CI = 0.86-1.08). Sensitivity analyses among patients who received a SARS-CoV-2 test also found lower odds of infection associated with current versus no cannabis use (aOR = 0.76, CI = 0.61-0.93). CONCLUSIONS Current cannabis use appears to be associated with a reduced risk of SARS-CoV-2 infection among pregnant individuals.
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Affiliation(s)
- Kelly C. Young‐Wolff
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA,Department of Psychiatry and Behavioral SciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | - G. Thomas Ray
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | | | - Neal Benowitz
- Research Program in Clinical Pharmacology, Division of Cardiology, Department of Medicine and Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Sara R. Adams
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Monique B. Does
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Nancy Goler
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Deborah Ansley
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Amy Conway
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Lyndsay A. Avalos
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
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Liu XI, Dallmann A, Brooks K, Best BM, Clarke DF, Mirochnick M, van den Anker JN, Capparelli EV, Momper JD. Physiologically-based pharmacokinetic modeling of remdesivir and its metabolites in pregnant women with COVID-19. CPT Pharmacometrics Syst Pharmacol 2023; 12:148-153. [PMID: 36479969 PMCID: PMC9877749 DOI: 10.1002/psp4.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Pregnant individuals are at high risk for severe illness from COVID-19, and there is an urgent need to identify safe and effective therapeutics for this population. Remdesivir (RDV) is a SARS-CoV-2 nucleotide analog RNA polymerase inhibitor. Limited RDV pharmacokinetic (PK) and safety data are available for pregnant women receiving RDV. The aims of this study were to translate a previously published nonpregnant adult physiologically based PK (PBPK) model for RDV to pregnancy and evaluate model performance with emerging clinical PK data in pregnant women with COVID-19. The pregnancy model was built in the Open Systems Pharmacology software suite (Version 10) including PK-Sim® and MoBi® with pregnancy-related changes of relevant enzymes applied. PK were predicted in a virtual population of 1000 pregnant subjects, and prediction results were compared with in vivo PK data from the International Maternal, Pediatric, Adolescent AIDS Clinical Trials (IMPAACT) Network 2032 study. The developed PBPK model successfully captured RDV and its metabolites' plasma concentrations during pregnancy. The ratios of prediction versus observation for RDV area under the curve from time 0 to infinity (AUC0-∞ ) and maximum concentration (Cmax ) were 1.61 and 1.17, respectively. For GS-704277, the ratios of predicted versus observed were 0.94 for AUC0-∞ and 1.20 for Cmax . For GS-441524, the ratios of predicted versus observed were 1.03 for AUC0-24 , 1.05 for Cmax , and 1.07 for concentrations at 24 h. All predictions of AUC and Cmax for RDV and its metabolites were within a twofold error range, and about 60% of predictions were within a 10% error range. These findings demonstrate the feasibility of translating PBPK models to pregnant women to potentially guide trial design, clinical decision making, and drug development.
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Affiliation(s)
- Xiaomei I. Liu
- Division of Clinical PharmacologyChildren's National HospitalWashingtonDCUSA
| | - André Dallmann
- Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AGLeverkusenGermany
| | - Kristina Brooks
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Brookie M. Best
- Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
- Pediatrics Department, School of Medicine‐Rady Children's Hospital San DiegoUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Diana F. Clarke
- Section of Pediatrics Infectious Diseases, Boston Medical CenterBostonMassachusettsUSA
| | - Mark Mirochnick
- Department of PediatricsBoston University School of MedicineBostonMassachusettsUSA
| | | | - Edmund V. Capparelli
- Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
- Pediatrics Department, School of Medicine‐Rady Children's Hospital San DiegoUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Jeremiah D. Momper
- Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of California, San DiegoLa JollaCaliforniaUSA
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Hudak ML, Flannery DD, Barnette K, Getzlaff T, Gautam S, Dhudasia MB, Mukhopadhyay S, Pfeifer MR, Ellington SR, Galang RR, Snead MC, Woodworth KR, Zapata LB, Puopolo KM. Maternal and Newborn Hospital Outcomes of Perinatal SARS-CoV-2 Infection: A National Registry. Pediatrics 2023; 151:190431. [PMID: 36995183 DOI: 10.1542/peds.2022-059595] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES:
The American Academy of Pediatrics National Registry for the Surveillance and Epidemiology of Perinatal coronavirus disease 2019 (COVID-19) (NPC-19) was developed to provide information on the effects of perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
METHODS:
National Registry for the Surveillance and Epidemiology of Perinatal COVID-19 participating centers entered maternal and newborn data for pregnant persons who tested positive for SARS-CoV-2 infection between 14 days before and 10 days after delivery. Incidence of and morbidities associated with maternal and newborn SARS-CoV-2 infection were assessed.
RESULTS:
From April 6, 2020 to March 19, 2021, 242 centers in the United States centers reported data for 7524 pregnant persons; at the time of delivery, 78.1% of these persons were asymptomatic, 18.2% were symptomatic but not hospitalized specifically for COVID-19, 3.4% were hospitalized for COVID-19 treatment, and 18 (0.2%) died in the hospital of COVID-related complications. Among 7648 newborns, 6486 (84.8%) were tested for SARS-CoV-2, and 144 (2.2%) were positive; the highest rate of newborn infection was observed when mothers first tested positive in the immediate postpartum period (17 of 125, 13.6%). No newborn deaths were attributable to SARS-CoV-2 infection. Overall, 15.6% of newborns were preterm: among tested newborns, 30.1% of polymerase chain reaction-positive and 16.2% of polymerase chain reaction-negative were born preterm (P < .001). Need for mechanical ventilation did not differ by newborn SARS-CoV-2 test result, but those with positive tests were more likely to be admitted to a NICU.
CONCLUSIONS:
Early in the pandemic, SARS-CoV-2 infection was acquired by newborns at variable rates and without apparent short-term effects. During a period that preceded widespread availability of vaccines, we observed higher than expected numbers of preterm births and maternal in-hospital deaths.
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Affiliation(s)
- Mark L Hudak
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Dustin D Flannery
- Division of Neonatology
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kimberly Barnette
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Trace Getzlaff
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Shiva Gautam
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - Miren B Dhudasia
- Division of Neonatology
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sagori Mukhopadhyay
- Division of Neonatology
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Sascha R Ellington
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Romeo R Galang
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret C Snead
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kate R Woodworth
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren B Zapata
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen M Puopolo
- Division of Neonatology
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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40
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Lucà F, Colivicchi F, Parrini I, Russo MG, Di Fusco SA, Ceravolo R, Riccio C, Favilli S, Rossini R, Gelsomino S, Oliva F, Gulizia MM. The role of the pregnancy heart team in clinical practice. Front Cardiovasc Med 2023; 10:1135294. [PMID: 37139137 PMCID: PMC10150137 DOI: 10.3389/fcvm.2023.1135294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Significant maternal and fetal morbidity and mortality risk has been shown to be associated with cardiovascular disease in pregnancy. Several determinants, such as the increasing number of females with corrected congenital heart disease in reproductive age, a more advanced maternal age associated with cardiovascular risk factors, and a greater prevalence of preexisting comorbidities related to cardiac disorders such as cancer and COVID-19), lead to a higher incidence of cardiac complications in pregnancy in the last few decades. However, adopting a multidisciplinary strategy may influence maternal and neonatal outcomes. This review aims at assessing the role of the Pregnancy Heart Team, which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital and other cardiac or metabolic disorders, addressing several emerging aspects in the multidisciplinary team-based approach.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, Reggio Calabria, Italy
- Correspondence: Fabiana Lucà
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy
| | - Iris Parrini
- Cardiology Department, Mauriziano Hospital, Torino, Italy
| | - Maria Giovanna Russo
- U.O.C. Cardiologia e UTIC Pediatrica, AORN dei Colli, Ospedale Monaldi, Università Della Campania “L. Vanvitelli”, Napoli, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy
| | | | - Carmine Riccio
- Cardiovascular Department, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - Silvia Favilli
- Department of Pediatric Cardiology, Meyer Hospital, Florence, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Fabrizio Oliva
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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41
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Jackson-Gibson M, Diseko M, Caniglia EC, Mayondi G, Mabuta J, Luckett R, Moyo S, Lawrence P, Matshaba M, Mosepele M, Mmalane M, Banga J, Lockman S, Makhema J, Zash R, Shapiro RL. Association of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection With Maternal Mortality and Neonatal Birth Outcomes in Botswana by Human Immunodeficiency Virus Status. Obstet Gynecol 2023; 141:135-143. [PMID: 36701614 PMCID: PMC10462386 DOI: 10.1097/aog.0000000000005020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the combined association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) infection on adverse birth outcomes in an HIV-endemic region. METHODS The Tsepamo Study abstracts data from antenatal and obstetric records in government maternity wards across Botswana. We assessed maternal mortality and adverse birth outcomes for all singleton pregnancies from September 2020 to mid-November 2021 at 13 Tsepamo sites among individuals with documented SARS-CoV-2 screening tests and known HIV status. RESULTS Of 20,410 individuals who gave birth, 11,483 (56.3%) were screened for SARS-CoV-2 infection; 4.7% tested positive. People living with HIV were more likely to test positive (144/2,421, 5.9%) than those without HIV (392/9,030, 4.3%) (P=.001). Maternal deaths occurred in 3.7% of those who had a positive SARS-CoV-2 test result compared with 0.1% of those who tested negative (adjusted relative risk [aRR] 31.6, 95% CI 15.4-64.7). Maternal mortality did not differ by HIV status. The offspring of individuals with SARS-CoV-2 infection experienced more overall adverse birth outcomes (34.5% vs 26.6%; aRR 1.2, 95% CI 1.1-1.4), severe adverse birth outcomes (13.6% vs 9.8%; aRR 1.2, 95% CI 1.0-1.5), preterm delivery (21.4% vs 13.4%; aRR 1.4, 95% CI 1.2-1.7), and stillbirth (5.6% vs 2.7%; aRR 1.7 95% CI 1.2-2.5). Neonates exposed to SARS-CoV-2 and HIV infection had the highest prevalence of adverse birth outcomes (43.1% vs 22.6%; aRR 1.7, 95% CI 1.4-2.0). CONCLUSION Infection with SARS-CoV-2 at the time of delivery was associated with 3.7% maternal mortality and 5.6% stillbirth in Botswana. Most adverse birth outcomes were worse among neonates exposed to both SARS-CoV-2 and HIV infection.
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Affiliation(s)
| | - Modiegi Diseko
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Gloria Mayondi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Judith Mabuta
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rebecca Luckett
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Pamela Lawrence
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Ministry of Health and Wellness, Gaborone, Botswana
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | | | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Jaspreet Banga
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Rebecca Zash
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Roger L. Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Accurti V, Gambitta B, Iodice S, Manenti A, Boito S, Dapporto F, Leonardi M, Molesti E, Fabietti I, Montomoli E, Bollati V, Persico N. SARS-CoV-2 Seroconversion and Pregnancy Outcomes in a Population of Pregnant Women Recruited in Milan, Italy, between April 2020 and October 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416720. [PMID: 36554602 PMCID: PMC9778651 DOI: 10.3390/ijerph192416720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 06/12/2023]
Abstract
The possible link between SARS-CoV-2 infection and adverse pregnancy outcomes has so far demonstrated heterogeneous results in terms of maternal, fetal, and neonatal complications. We aim to investigate the correlation between SARS-CoV-2 seroconversion and/or neutralization titer and pregnancy outcomes. We analyzed a population of 528 pregnant women followed up from the first trimester of gestation until delivery. For each woman, we collected a first blood sample between 11 and 13 weeks of gestation and a second sample in the perinatal period (between peripartum and puerperium) to assess the presence of SARS-CoV-2 antibodies and/or microneutralization titer (MN titer). Data on pregnancy outcomes (gestational age at delivery, preterm birth before 34 weeks, hypertensive disorders, gestational diabetes, and abnormal fetal growth) were collected. We observed that serologic status per se is not associated with major pregnancy complications. On the contrary, the MN titer was associated with increased odds of gestational diabetes. Although we mainly reported asymptomatic SARS-CoV-2 infections and the absence of severe maternal and neonatal adverse outcomes, SARS-CoV-2 infection might challenge the maternal immune system and explain the moderate increase in adverse outcome odds.
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Affiliation(s)
- Veronica Accurti
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Bianca Gambitta
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Simona Iodice
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | | | - Simona Boito
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | | | | | - Isabella Fabietti
- Fetal Medicine and Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Emanuele Montomoli
- VisMederi Srl, 53100 Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Valentina Bollati
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Nicola Persico
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Kurokawa M, Kurokawa R, Lin AY, Capizzano AA, Baba A, Kim J, Johnson TD, Srinivasan A, Moritani T. Neurological and Neuroradiological Manifestations in Neonates Born to Mothers With Coronavirus Disease 2019. Pediatr Neurol 2022; 141:9-17. [PMID: 36731229 PMCID: PMC9741496 DOI: 10.1016/j.pediatrneurol.2022.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To investigate the complications that occurred in neonates born to mothers with coronavirus disease 2019 (COVID-19), focusing on neurological and neuroradiological findings, and to compare differences associated with the presence of maternal symptoms. METHODS Ninety neonates from 88 mothers diagnosed with coronavirus disease 2019 (COVID-19) during pregnancy were retrospectively reviewed. Neonates were divided into two groups: symptomatic (Sym-M-N, n = 34) and asymptomatic mothers (Asym-M-N, n = 56). The results of neurological physical examinations were compared between the groups. Data on electroencephalography, brain ultrasound, and magnetic resonance imaging abnormalities were collected for neonates with neurological abnormalities. RESULTS Neurological abnormalities at birth were found in nine neonates (Sym-M-N, seven of 34, 20.6%). Decreased tone was the most common physical abnormality (n = 7). Preterm and very preterm birth (P < 0.01), very low birth weight (P < 0.01), or at least one neurological abnormality on physical examination (P = 0.049) was more frequent in Sym-M-N neonates. All infants with abnormalities on physical examination showed neuroradiological abnormalities. The most common neuroradiological abnormalities were intracranial hemorrhage (n = 5; germinal matrix, n = 2; parenchymal, n = 2; intraventricular, n = 1) and hypoxic brain injury (n = 3). CONCLUSIONS Neonates born to mothers with symptomatic COVID-19 showed an increased incidence of neurological abnormalities. Most of the mothers (96.4%) were unvaccinated before the COVID-19 diagnosis. Our results highlight the importance of neurological and neuroradiological management in infants born to mothers with COVID-19 and the prevention of maternal COVID-19 infection.
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Affiliation(s)
- Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan.
| | - Ava Yun Lin
- Division of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Aristides A Capizzano
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - John Kim
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Timothy D Johnson
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Toshio Moritani
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Kusuma AANJ, Putra IGM, Suardika A, Novrita Sari A. Clinical Overview in Pregnancy with COVID-19 at prof. Dr. I.G.N.G. Ngoerah Hospital Period of April 2020-March 2021. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.11022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Pregnant women are one of the populations that are susceptible to coronavirus disease 2019 (COVID-19) infection due to physiological changes during pregnancy that is an adaptive response to pregnancy such as diaphragmatic elevation, increased oxygen consumption, and airway mucosal edema which can also make pregnant women more intolerant of hypoxia. In addition to being vulnerable, COVID-19 in pregnant women may have a different clinical course from the general population.
AIM: This study aims to determine the demographic and clinical characteristics in pregnancy with COVID-19 at Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, Indonesia.
METHODS: This study was a cross-sectional descriptive study using secondary data derived from patient medical records and carried out in the delivery room and medical record installation at Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, Indonesia, for the period of April 1, 2020–March 31, 2021.
RESULTS: Of the 275 patients, most were in the age range of 26–30 years (46.55%), in the third trimester (81.45%), and patients came alone (54.18%). Most of the patients came without symptoms with reactive rapid antibody results (60.97%). Of the 197 patients who delivered, 84.77% had CS and 66.55% without oxygen therapy. About 69.69% of patients experienced complications and the mortality rate was 1.09%. The highest birth weight was >2500 g by 76.8%, with the good neonatal outcome (82.92%) and negative swab results (89.45%). Inflammatory markers tend to increase as symptoms increase. Neutrophil-to-lymphocyte ratio, procalcitonin, and ferritin were markedly increased from moderate symptoms to severe-critical symptoms. The same was true for ferritin levels, where there was a sharp rise in significant symptoms. Meanwhile, procalcitonin levels have started to increase quite strikingly from moderate symptoms to the highest in severe symptoms.
CONCLUSION: It is hoped that this demographic and clinical picture would further our understanding of COVID-19 and help us develop methods to lessen the disease’s severity and spread to enhance maternal and newborn outcomes.
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Nunes MC, Jones S, Strehlau R, Baba V, Ditse Z, da Silva K, Bothma L, Serafin N, Baillie VL, Kwatra G, Burke M, Wise A, Adam M, Mlandu P, Melamu M, Phelp J, Fraser W, Wright C, Zell E, Adam Y, Madhi SA. Antepartum SARS-CoV-2 infection and adverse birth outcomes in South African women. J Glob Health 2022; 12:05050. [DOI: 10.7189/jogh.12.05050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Marta C Nunes
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Jones
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Renate Strehlau
- Nkanyezi Research Unit sub-division of VIDA, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vuyelwa Baba
- Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zanele Ditse
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kelly da Silva
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lané Bothma
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Natali Serafin
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- Nkanyezi Research Unit sub-division of VIDA, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynecology, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Adam
- Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philiswa Mlandu
- Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mpolokeng Melamu
- Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliette Phelp
- Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Colleen Wright
- Lancet Laboratories, Johannesburg, South Africa
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth Zell
- Stat-Epi Associates, Inc., Ponte Vedra Beach, Florida, USA
| | - Yasmin Adam
- Department of Obstetrics and Gynecology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Gupta A, Kamity R, Sharma R, Caprio M, Mally P, Verma S. Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic. Am J Perinatol 2022; 39:1764-1778. [PMID: 35738288 DOI: 10.1055/s-0042-1749635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal-newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. KEY POINTS: · COVID-19 in pregnancy can cause perinatal morbidities.. · Breastfeeding and breast milk are safe for newborns.. · COVID-19 vaccination reduces the risk for morbidities..
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Affiliation(s)
- Arpit Gupta
- Division of Neonatology, Department of Pediatrics, NYC Health, Hospitals/Metropolitan, New York City, New York
| | - Ranjith Kamity
- Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, New York City, New York
| | - Rishika Sharma
- Department of Pediatrics, Family Healthcare Network, Visalia, California
| | - Martha Caprio
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Pradeep Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
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The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes. Reprod Toxicol 2022; 114:33-43. [PMID: 36283657 PMCID: PMC9595355 DOI: 10.1016/j.reprotox.2022.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/24/2022] [Accepted: 10/17/2022] [Indexed: 12/22/2022]
Abstract
The rapidly evolving COVID-19 pandemic has resulted in an upsurge of scientific productivity to help address the global health crisis. One area of active research is the impact of COVID-19 on pregnancy. Here, we provide an epidemiological overview about what is known about the effects of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes, and identify gaps in knowledge. Pregnant people are at increased risk for severe COVID-19, and maternal SARS-CoV-2 infection increases the risk of negative maternal-fetal outcomes. Despite this elevated risk, there have been high rates of vaccine hesitancy, heightened by the initial lack of safety and efficacy data for COVID-19 vaccination in pregnancy. In response, retrospective cohort studies were performed to examine the impact of COVID-19 vaccination during pregnancy. Here, we report the vaccine's efficacy during pregnancy and its impact on maternal-fetal outcomes, as well as an overview of initial studies on booster shots in pregnancy. We found that pregnant people are at risk for more severe COVID-19 outcomes, maternal SARS-CoV-2 infection is associated with worse birth outcomes, COVID-19 vaccine hesitancy remains prevalent in the pregnant population, and COVID-19 vaccination and boosters promote better maternal-fetal outcomes. The results should help reduce vaccine hesitancy by alleviating concerns about the safety and efficacy of administering the COVID-19 vaccine during pregnancy. Overall, this review provides an introduction to COVID-19 during pregnancy. It is expected to help consolidate current knowledge, accelerate research of COVID-19 during pregnancy and inform clinical, policy, and research decisions regarding COVID-19 vaccination in pregnant people.
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Abstract
The COVID-19 pandemic has taken a large toll on population health and well-being. We examine the consequences of prenatal exposure for infant health, through which the pandemic may have lasting intergenerational effects. We examine multiple pathways by which the pandemic shaped birth outcomes and socioeconomic disparities in these consequences. Analysis of more than 3.5 million birth records in California with universal information on COVID infection among persons giving birth at the time of delivery reveals deep inequalities in infection by education, race/ethnicity, and place-based socioeconomic disadvantage. COVID infection during pregnancy, in turn, predicts a large increase in the probability of preterm birth, by approximately one third. At the population level, a surprising reduction in preterm births during the first months of the pandemic was followed by an increase in preterm births during the surge in COVID infections in the winter of 2021. Whereas the early-pandemic reduction in preterm births benefited primarily highly educated mothers, the increase in preterm births during the winter infection surge was entirely concentrated among mothers with low levels of schooling. The COVID-19 pandemic is expected to exacerbate U.S. inequality in multiple ways. Our findings highlight a particularly enduring pathway: the long-term legacy of prenatal exposure to an unequal pandemic environment.
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Affiliation(s)
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
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49
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Al-Hajjar S, Ibrahim L, Kurdi W, Tulbah M, Alnemer M, Bin Jabr M, Elsaidawi W, Binmanee A, Ali M, Bukhari H, Altuwaijri L, Allaboon R, Alghamdi R, Saeed B, Adi Y, Alhamlan F. Observational cohort study of perinatal outcomes of women with COVID-19. J Infect Public Health 2022; 15:1503-1507. [PMID: 36427409 PMCID: PMC9650259 DOI: 10.1016/j.jiph.2022.11.007] [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] [Received: 05/22/2022] [Revised: 09/04/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding the impact of SARS-CoV-2 infection on pregnancy outcomes and of pregnancy on COVID-19 outcomes is critical for ensuring proper prenatal and antenatal care. No similar studies have been published in Saudi Arabia. METHODS We performed a prospective cohort study of pregnant women with confirmed SARS-CoV-2 infection who presented at King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Kingdom of Saudi Arabia. COVID-19 staging was performed, pregnancy-related complications were assessed, and neonatal infection was evaluated. RESULTS We enrolled 81 patients (mean age 31.75 years, SD 5.25) of which there were 17 cases in the first trimester, 20 in the second trimester, and 34 in the third trimester. The distribution of COVID-19 severity was 40 patients with Stage A, 36 with Stage B, 4 with Stage C, and 1 with Stage D. Complications were pregnancy loss in 2 patients (one in each first and second trimester) and 1 fetal death after 20 weeks of pregnancy, 7 patients with fetal growth restriction, and 8 with pre-term delivery. CONCLUSIONS We did not observe an unusual frequency of pregnancy-related complications due to SARS-CoV-2 infection in this high-risk obstetric population and there was no evidence of vertical transmission in newborns from women who delivered while positive for the virus.
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Affiliation(s)
- Sami Al-Hajjar
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia,Correspondence to: Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, PO Box 3354, 11211 Riyadh, Saudi Arabia
| | - Lina Ibrahim
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
| | - Wesam Kurdi
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
| | - Maha Tulbah
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
| | - Maha Alnemer
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
| | - Mohammed Bin Jabr
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
| | - Weam Elsaidawi
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
| | - Abdulaziz Binmanee
- Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
| | - Mohanned Ali
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hanifa Bukhari
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Leena Altuwaijri
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Bashayer Saeed
- Obstetrics and Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Yasser Adi
- King Faisal Specialist Hospital and Research Center
| | - Fatima Alhamlan
- Department of Infection and Immunity,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia,College of Medicine, alfaisal University, Riyadh, Saudi arabia
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50
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Deng J, Ma Y, Liu Q, Du M, Liu M, Liu J. Association of Infection with Different SARS-CoV-2 Variants during Pregnancy with Maternal and Perinatal Outcomes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315932. [PMID: 36498007 PMCID: PMC9740636 DOI: 10.3390/ijerph192315932] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 05/30/2023]
Abstract
The aim of this study is to review the currently available data, and to explore the association of infection with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants during pregnancy with maternal and perinatal outcomes in the real world. Observational cohort studies were analyzed that described the maternal and perinatal outcomes of infection with different SARS-CoV-2 variants during pregnancy. Random-effects inverse-variance models were used to evaluate the pooled prevalence (PP) and its 95% confidence interval (CI) for maternal and perinatal outcomes. Random effects were used to estimate the pooled odds ratios (OR) and their 95% CI for different outcomes between Delta and pre-Delta periods, and between Omicron and Delta periods. Eighteen studies, involving a total of 133,058 cases of SARS-CoV-2 infection during pregnancy (99,567 cases of SARS-CoV-2 wild type or pre-variant infection and 33,494 cases of SARS-CoV-2 variant infections), were included in this meta-analysis. Among pregnant women with SARS-CoV-2 infections, the PPs for required respiratory support, severe or critical illness, intensive care unit (ICU) admission, maternal death, and preterm birth <37 weeks were, respectively, 27.24% (95%CI, 20.51−33.97%), 24.96% (95%CI, 15.96−33.96%), 11.31% (95%CI, 4.00−18.61%), 4.20% (95%CI, 1.43−6.97%), and 33.85% (95%CI, 21.54−46.17%) in the Delta period, which were higher than those in the pre-Delta period, while the corresponding PPs were, respectively, 10.74% (95%CI, 6.05−15.46%), 11.99% (95%CI, 6.23−17.74%), 4.17% (95%CI, 1.53−6.80%), 0.63% (95%CI, 0.05−1.20%), and 18.58% (95%CI, 9.52−27.65%). The PPs for required respiratory support, severe or critical illness, and ICU admission were, respectively, 2.63% (95%CI, 0.98−4.28%), 1.11% (95%CI, 0.29−1.94%), and 1.83% (95%CI, 0.85−2.81%) in the Omicron period, which were lower than those in the pre-Delta and Delta periods. These results suggest that Omicron infections are associated with less severe maternal and neonatal adverse outcomes, though maternal ICU admission, the need for respiratory support, and preterm birth did also occur with Omicron infections. Since Omicron is currently the predominant strain globally, and has the highest rates of transmission, it is still important to remain vigilant in protecting the vulnerable populations of mothers and infants. In particular, obstetricians and gynecologists should not ignore the adverse risks of maternal ICU admission, respiratory support, and preterm births in pregnant patients with SARS-CoV-2 infections, in order to protect the health of mothers and infants.
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Affiliation(s)
- Jie Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Address No. 38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yirui Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Address No. 38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Address No. 38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Address No. 38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Address No. 38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Address No. 38, Xueyuan Road, Haidian District, Beijing 100191, China
- Institute for Global Health and Development, Peking University, Address No. 5, Yiheyuan Road, Haidian District, Beijing 100871, China
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