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Varpula R, Äyräs O, Aabakke AJM, Klungsøyr K, Svanvik T, Kanerva J, Jonasdottir E, Mentzoni CT, Thurn L, Jones E, Fredriksson L, Pettersson K, Nyfløt LT, Vangen S, Røe K, Júlíusson PB, Källén K, Gissler M, Pyykönen A, Jakobsson M, Krebs L, Engjom HM. Early suppression policies protected pregnant women from COVID-19 in 2020: A population-based surveillance from the Nordic countries. Acta Obstet Gynecol Scand 2024; 103:1063-1072. [PMID: 38382894 PMCID: PMC11103151 DOI: 10.1111/aogs.14808] [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: 11/21/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13-17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. MATERIAL AND METHODS This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1-December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. RESULTS In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. CONCLUSIONS There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.
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Affiliation(s)
- Reetta Varpula
- Department of Obstetrics and GynecologyHelsinki University Hospital and Helsinki UniversityHelsinkiFinland
| | - Outi Äyräs
- Department of Obstetrics and GynecologyHelsinki University Hospital and Helsinki UniversityHelsinkiFinland
| | - Anna J. M. Aabakke
- Department of Obstetrics and GynecologyCopenhagen University Hospital‐HolbækHolbækDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Kari Klungsøyr
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Department for Health PromotionNorwegian Institute of Public HealthBergenNorway
| | - Teresia Svanvik
- Department of Obstetrics and GynecologySahlgrenska University HospitalGothenburgSweden
| | - Julia Kanerva
- Department of Obstetrics and GynecologySahlgrenska University HospitalGothenburgSweden
| | - Eva Jonasdottir
- Department of Obstetrics and GynecologyLandspitali University HospitalReykjavikIceland
| | | | - Lars Thurn
- Department of Obstetrics and GynecologySkåne University HospitalLundSweden
| | - Elin Jones
- Department of Obstetrics and GynecologyKarolinska University HospitalStockholmSweden
| | - Lisa Fredriksson
- Department of Obstetrics and GynecologyKarolinska University HospitalStockholmSweden
| | - Karin Pettersson
- Department of Obstetrics and GynecologyKarolinska University HospitalStockholmSweden
| | - Lill Trine Nyfløt
- Norwegian Research Center for Women's HealthOslo University HospitalOsloNorway
| | - Siri Vangen
- Norwegian Research Center for Women's HealthOslo University HospitalOsloNorway
| | - Kjerstine Røe
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway
| | - Pétur B. Júlíusson
- Department for Health Registry Research and DevelopmentNorwegian Institute of Public HealthBergenNorway
| | - Karin Källén
- Department of Obstetrics and Gynecology, Institution of Clinical SciencesLund UniversityLundSweden
| | - Mika Gissler
- Department of Knowledge BrokersTHL Finnish Institute of Health and WelfareHelsinkiFinland
- Academic Primary Health Care CenterStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | | | - Maija Jakobsson
- Department of Obstetrics and Gynecology, HUS Hyvinkää HospitalHelsinki UniversityHelsinkiFinland
| | - Lone Krebs
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of Obstetrics and GynecologyCopenhagen University Hospital‐Amager and Hvidovre HospitalCopenhagenDenmark
| | - Hilde Marie Engjom
- Department for Health PromotionNorwegian Institute of Public HealthBergenNorway
- Department for Health Registry Research and DevelopmentNorwegian Institute of Public HealthBergenNorway
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Lopez M, Altamirano J, Melchor S, Perez S, Maldonado Y, Aziz N, Igbinosa I. Learning Lessons from the COVID-19 Pandemic-A Qualitative Assessment of the Experiences of Pregnant Latinas Infected with COVID-19 and Their Perspectives on Vaccination. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02010-3. [PMID: 38709334 DOI: 10.1007/s40615-024-02010-3] [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: 01/31/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To examine the experiences of pregnant Hispanic/Latine people with COVID-19, as well as their perspectives on COVID-19 vaccination in pregnancy. METHODS We interviewed birthing parents who received care from a teaching hospital in California and tested positive for COVID-19 during pregnancy or delivery. We analyzed transcripts using the constant comparative method for analyzing data to using a phenomological epidemiological approach. We used root cause analysis to identify consistent themes across interviews and assess relationships between social determinants of health and COVID-19 infectivity. RESULTS We interviewed 14 women from November 2021 to June 2022. Participants reported COVID-19 adversely impacted their clinical care and well-being during pregnancy or postpartum. Impacts among Spanish-speaking participants included unexpected financial hardships, challenges navigating in-patient experiences, and difficulty securing reliable childcare. While most participants were at least partially vaccinated, participants also described doubts and concerns about the vaccine. CONCLUSIONS Our findings suggest that Spanish-speaking Hispanic/Latine patients could benefit from receiving more information about COVID-19 in pregnancy from their healthcare providers. Leveraging familial and social networks, providing reliable information in people's preferred language, and increasing communication through trusted partners may also help combat vaccine hesitancy.
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Affiliation(s)
- Marcela Lopez
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Jonathan Altamirano
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie Melchor
- Department of Obstetrics and Gynecology, UCSF Fresno, Fresno, CA, USA
| | - Susan Perez
- Department of Kinesiology and Health Science, California State University, Sacramento, CA, USA
| | - Yvonne Maldonado
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Natali Aziz
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Irogue Igbinosa
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
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van Baar JAC, Kostova EB, Allotey J, Thangaratinam S, Zamora JR, Bonet M, Kim CR, Mofenson LM, Kunst H, Khalil A, van Leeuwen E, Keijzer J, Strikwerda M, Clark B, Verschuuren M, Coomarasamy A, Goddijn M, van Wely M. COVID-19 in pregnant women: a systematic review and meta-analysis on the risk and prevalence of pregnancy loss. Hum Reprod Update 2024; 30:133-152. [PMID: 38016805 PMCID: PMC10905512 DOI: 10.1093/humupd/dmad030] [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: 08/03/2023] [Revised: 10/01/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to experience preterm birth and their neonates are more likely to be stillborn or admitted to a neonatal unit. The World Health Organization declared in May 2023 an end to the coronavirus disease 2019 (COVID-19) pandemic as a global health emergency. However, pregnant women are still becoming infected with SARS-CoV-2 and there is limited information available regarding the effect of SARS-CoV-2 infection in early pregnancy on pregnancy outcomes. OBJECTIVE AND RATIONALE We conducted this systematic review to determine the prevalence of early pregnancy loss in women with SARS-Cov-2 infection and compare the risk to pregnant women without SARS-CoV-2 infection. SEARCH METHODS Our systematic review is based on a prospectively registered protocol. The search of PregCov19 consortium was supplemented with an extra electronic search specifically on pregnancy loss in pregnant women infected with SARS-CoV-2 up to 10 March 2023 in PubMed, Google Scholar, and LitCovid. We included retrospective and prospective studies of pregnant women with SARS-CoV-2 infection, provided that they contained information on pregnancy losses in the first and/or second trimester. Primary outcome was miscarriage defined as a pregnancy loss before 20 weeks of gestation, however, studies that reported loss up to 22 or 24 weeks were also included. Additionally, we report on studies that defined the pregnancy loss to occur at the first and/or second trimester of pregnancy without specifying gestational age, and for second trimester miscarriage only when the study presented stillbirths and/or foetal losses separately from miscarriages. Data were stratified into first and second trimester. Secondary outcomes were ectopic pregnancy (any extra-uterine pregnancy), and termination of pregnancy. At least three researchers independently extracted the data and assessed study quality. We calculated odds ratios (OR) and risk differences (RDs) with corresponding 95% CI and pooled the data using random effects meta-analysis. To estimate risk prevalence, we performed meta-analysis on proportions. Heterogeneity was assessed by I2. OUTCOMES We included 120 studies comprising a total of 168 444 pregnant women with SARS-CoV-2 infection; of which 18 233 women were in their first or second trimester of pregnancy. Evidence level was considered to be of low to moderate certainty, mostly owing to selection bias. We did not find evidence of an association between SARS-CoV-2 infection and miscarriage (OR 1.10, 95% CI 0.81-1.48; I2 = 0.0%; RD 0.0012, 95% CI -0.0103 to 0.0127; I2 = 0%; 9 studies, 4439 women). Miscarriage occurred in 9.9% (95% CI 6.2-14.0%; I2 = 68%; 46 studies, 1797 women) of the women with SARS CoV-2 infection in their first trimester and in 1.2% (95% CI 0.3-2.4%; I2 = 34%; 33 studies; 3159 women) in the second trimester. The proportion of ectopic pregnancies in women with SARS-CoV-2 infection was 1.4% (95% CI 0.02-4.2%; I2 = 66%; 14 studies, 950 women). Termination of pregnancy occurred in 0.6% of the women (95% CI 0.01-1.6%; I2 = 79%; 39 studies; 1166 women). WIDER IMPLICATIONS Our study found no indication that SARS-CoV-2 infection in the first or second trimester increases the risk of miscarriages. To provide better risk estimates, well-designed studies are needed that include pregnant women with and without SARS-CoV-2 infection at conception and early pregnancy and consider the association of clinical manifestation and severity of SARS-CoV-2 infection with pregnancy loss, as well as potential confounding factors such as previous pregnancy loss. For clinical practice, pregnant women should still be advised to take precautions to avoid risk of SARS-CoV-2 exposure and receive SARS-CoV-2 vaccination.
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Affiliation(s)
- Janneke A C van Baar
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Elena B Kostova
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Cochrane Gynaecology and Fertility Satellite, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - John Allotey
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Center, University Hospitals Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Center, University Hospitals Birmingham, Birmingham, UK
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Javier R Zamora
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | | | - Elisabeth van Leeuwen
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Women and Childrens Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Julia Keijzer
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marije Strikwerda
- Department Vrouw & Baby, Utrecht UMC, location University of Utrecht, Utrecht, The Netherlands
| | - Bethany Clark
- Department Vrouw & Baby, Utrecht UMC, location University of Utrecht, Utrecht, The Netherlands
| | - Maxime Verschuuren
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arri Coomarasamy
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Center, University Hospitals Birmingham, Birmingham, UK
- Tommy's Centre for Miscarriage Research, Birmingham, UK
| | - Mariëtte Goddijn
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Madelon van Wely
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Cochrane Gynaecology and Fertility Satellite, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Longardt AC, Zöllkau J, Mand N, Wowretzko F, Büchel J, Andresen K, Hoyer BF, Kraft K, Pecks U. Breastfeeding Rates During the COVID-19 Pandemic in Germany: Data from the CRONOS Registry. Z Geburtshilfe Neonatol 2024; 228:88-96. [PMID: 38330963 DOI: 10.1055/a-2222-6491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
SARS-CoV-2 infection and COVID-19 disease are thought to have an impact on breastfeeding rate - besides other known peripartal issues. Data of the national CRONOS registry regarding breastfeeding behavior in 6,746 women was analyzed regarding the time window between maternal SARS-CoV-2 infection and time of delivery. In addition, other influencing factors like the predominant viral variant, maternal disease severity, and gestational age at delivery were taken into account. Our data suggest that within the variables analyzed, in the case of acute maternal infection (<14 days before birth), breastfeeding behavior improved with increasing gestational age at birth (p<0.0001), with less severe maternal illness (p<0.0001) and as the pandemic progressed with less virulent viral variants (p=0.01). When adjusting for COVID-19-associated and non-associated factors, rooming-in remains the most important factor positively influencing breastfeeding behavior. With regards to the benefits for mother and infants from breastfeeding, a separation of mother and child even in case of infectious settings should be avoided.
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Affiliation(s)
- Ann Carolin Longardt
- Klinik für Kinder- und Jugendmedizin I / Neonatologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Nadine Mand
- Neonatology and Pediatric Intensive Care, University of Marburg, Marburg, Germany
| | - Feline Wowretzko
- Obstetrics and Gynaecology, Buchholz Hospital, Buchholz in der Nordheide, Germany
| | - Johanna Büchel
- Department of Obstetrics and Gynecology, LMU, München, Germany
| | - Kristin Andresen
- Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
| | | | - Katrina Kraft
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lubeck, Germany
| | - Ulrich Pecks
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
- Maternal Health and Midwifery Science, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
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Backes C, Pecks U, Keil CN, Zöllkau J, Scholz C, Hütten M, Rüdiger M, Büchel J, Andresen K, Mand N. Post-COVID in women after SARS-CoV-2 infection during pregnancy - a pilot study with follow-up data from the COVID-19-related Obstetric and Neonatal Outcome Study (CRONOS). Z Geburtshilfe Neonatol 2024; 228:74-79. [PMID: 38330962 DOI: 10.1055/a-2213-1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Pregnant women are at an increased risk of severe COVID-19 and adverse pregnancy outcomes; data on maternal long-term outcome is scarce. We analyzed long-term follow-ups on women who experienced a SARS-CoV-2 infection during pregnancy to evaluate post-COVID symptoms, particularly fatigue, and their association with quality of life (QoL). METHODS 773 women who enrolled in the CRONOS registry between April 2020 and August 2021 were contacted for follow-up from December 2022 to April 2023. Data was gathered through a web-based questionnaire. Subsequently, study coordinators matched the follow-up data with the existing CRONOS data. RESULTS 110/773 (14%) women provided data. 20.9% experienced only acute symptoms during their SARS-CoV-2 infection in pregnancy, while 2.7% women experienced symptoms lasting longer than 4 weeks (long COVID). Symptoms lasting longer than 12 weeks (post-COVID) were reported by 63.6% women and occurred more often after severe COVID-19. Fatigue was the most frequently reported symptom (88%), with 55% of women still experiencing it more than one year after initial infection. 76% of women rated their QoL as "good" or "very good". Women experiencing post-COVID reported a significantly lower QoL. CONCLUSION This is the first German long-term data on women after SARS-CoV-2 infection during pregnancy, showing a high rate of post-COVID, a persistence of fatigue, and the impact on QoL. Continuous monitoring of pregnant women with COVID-19 is needed to develop comprehensive management strategies.
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Affiliation(s)
- Clara Backes
- Frauenklinik, München Klinik Harlaching, München, Germany
| | - Ulrich Pecks
- Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
- Maternale Gesundheit und Hebammenwissenschaft, Julius-Maximilians-Universität Würzburg Medizinische Fakultät, Würzburg, Germany
| | | | | | | | - Matthias Hütten
- Department of Pediatrics, Maastricht University, Maastricht, Netherlands
| | | | - Johanna Büchel
- Gynäkologie und Geburtshilfe, Ludwig-Maximilians-Universität München, München, Germany
| | - Kristin Andresen
- Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
| | - Nadine Mand
- Neonatologie und pädiatrische Intensivmedizin, Philipps-Universität Marburg, Marburg, Germany
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Nielsen SY, Hvidman LE, Aabakke AJM, Olsen TE, Johnsen IBG, Bogaard PW, Petersen A, Westergaard HB, Sørensen A, Hedermann G, Rønneberg ET, Thisted D, Boris J, Andersen LLT, Eggers AGH, Lindved BF, Henriksen TB. SARS-CoV-2 placentitis and severe pregnancy outcome after maternal infection: A Danish case series. Acta Obstet Gynecol Scand 2023; 102:567-576. [PMID: 36958983 PMCID: PMC10072246 DOI: 10.1111/aogs.14541] [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: 11/27/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION SARS-CoV-2 infection during pregnancy may cause viral inflammation of the placenta, resulting in fetal demise even without fetal or newborn infection. The impact of timing of the infection and the mechanisms that cause fetal morbidity and mortality are not well understood. MATERIAL AND METHODS To describe placental pathology from women with confirmed SARS-CoV-2 infection during pregnancy, a SARS-CoV-2 immunohistochemistry-positive placenta and late miscarriage, stillbirth, neonatal death, or medically indicated birth due to fetal distress. RESULTS The triad of trophoblastic necrosis, inflammatory intervillous infiltrates, and increased perivillous fibrinoid deposition was present in all 17 placentas; the pregnancies resulted in eight stillbirths, two late miscarriages (19 and 21 weeks' gestation), and seven liveborn children, two of which died shortly after delivery. The severity of maternal COVID-19 was not reflected by the extent of the placental lesions. In only one case, SARS-CoV-2 was detected in lung tissue samples from the fetus. The majority events (miscarriage, stillbirth, fetal distress resulting in indicated birth, or livebirth, but neonatal death) happened shortly after maternal SARS-CoV-2 infection was diagnosed. Seven of eight sequenced cases were infected with the Delta (B.1.617.2) virus strain. CONCLUSION We consolidate findings from previous case series describing extensive SARS-CoV-2 placentitis and placental insufficiency leading to fetal hypoxia. We found sparse evidence to support the notion that SARS-CoV-2 virus had infected the fetus or newborn.
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Affiliation(s)
- Stine Y Nielsen
- Department of Clinical Microbiology, Lillebaelt University Hospital, Vejle, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Lone E Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, University of Copenhagen, Nordsjaelland, Hillerød, Denmark
- Department of Obstetrics and Gynecology, University of Copenhagen, Holbaek, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tina E Olsen
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Iben B G Johnsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Pauline W Bogaard
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Astrid Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Hanne B Westergaard
- Department of Obstetrics and Gynecology, University of Copenhagen, Nordsjaelland, Hillerød, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Hedermann
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Dorthe Thisted
- Department of Obstetrics and Gynecology, University of Copenhagen, Holbaek, Denmark
| | - Jane Boris
- Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark
| | - Lise L T Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Anne G H Eggers
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Slagelse Sygehus, Slagelse, Denmark
| | - Birgitte F Lindved
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | - Tine B Henriksen
- Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Clinical Institute, Aarhus University, Aarhus, Denmark
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Conte E, Di Girolamo R, D’Antonio F, Raffone A, Neola D, Saccone G, Dell’Aquila M, Sarno L, Miceli M, Carbone L, Maruotti GM. Do Anti-SARS-CoV-2 Monoclonal Antibodies Have an Impact on Pregnancy Outcome? A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:vaccines11020344. [PMID: 36851222 PMCID: PMC9962092 DOI: 10.3390/vaccines11020344] [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: 01/02/2023] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Monoclonal antibodies (mAbs) have been used as a rescue strategy for pregnant women affected by COVID-19. To explore its impact on maternal-fetal health, we included all observational studies reporting maternal, fetal, delivery and neonatal outcomes in women who underwent mAbs infusion for COVID-19. Primary outcome was the percentage of preterm delivery. We used meta-analyses of proportions to combine data for maternal, fetal, delivery and neonatal outcome of women treated with mAbs for COVID-19 and reported pooled proportions and their 95% confidence intervals (CIs) for categorical variables or mean difference (MD) with their 95% confidence intervals for continuous variables. Preterm birth was observed in 22.8% of cases (95% CI 12.9-34.3). Fetal distress was reported in 4.2% (95% CI 1.6-8.2). Gestational hypertension and pre-eclampsia were observed in 3.0% (95% CI 0.8-6.8) and 3.4% (95% CI 0.8-7.5) of cases, respectively. Fetal growth restriction was observed in 3.2% of fetuses (95% CI 0.8-7.0). Secondary prophylaxis with mAbs is currently considered the best treatment option for people with mild to moderate COVID-19 disease. More attention should be paid to infants born from mothers who were treated with mAbs, for the risk of immunosuppression.
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Affiliation(s)
- Ennio Conte
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaella Di Girolamo
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-746-2941
| | - Francesco D’Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, 66100 Chieti, Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
| | - Daniele Neola
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Gabriele Saccone
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Michela Dell’Aquila
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Laura Sarno
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Marco Miceli
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- CEINGE Biotecnologie Avanzate, 80145 Naples, Italy
| | - Luigi Carbone
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
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Boychuk AV, Yakymchuk YB, Shevchuk OО, Vari SG, Nikitina IM. PREGNANT WOMEN WITH COVID-19 AND PLACENTA ANGIOGENESIS. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:441-447. [PMID: 38069843 DOI: 10.36740/merkur202305101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Aim of our research was to conduct a clinical and laboratory analysis of the impact of COVID-19 on pregnancy and the condition of the fetus. PATIENTS AND METHODS Materials and Methods: At the first stage, we conducted a retrospective examination of 50 pregnant women treated at Ternopil Municipal Hospital No.2 (Ukraine) between November 2020 and January 2022 with the history of COVID-19, confirmed by PCR test, and 25 pregnant COVID-19 negative pregnant women (control group). At the second stage, we performed prospective cohort study and involved 40 pregnant women treated with the history of COVID-19, confirmed by PCR, and 10 pregnant COVID-19 negative women with a physiological course of pregnancy as a control group.Women were divided into the following groups: group I -10 women diagnosed with COVID-19 during the first trimester of pregnancy: group II-15 women diagnosed during the second trimester; group III-15 women diagnosed during the third trimester. Ultrasound examination and cardiotocograms were performed to assess fetus status. Blood samples were collected at delivery. To determine whether COVID-19 could alter placental angiogenesis, vascular endothelial growth factor A (VEGFA), PlGF and interleuin-32-α were assessed. RESULTS Results: We identified that concentration of VEGFA was 95.30±5.65 pg/ml in control group. In women who had COVID-19 in first trimester, this index was 1.3 times higher, in second trimester 1.63 times higher and in third trimester by 2 times compared to control group. PlGF concentration was only 27,4 percent in group I, 16 percent in group II and 30 percent in group III,compared to control group. Concentration of interleuin-32-α was 67.27±5.63 pg/ml in control group and increased to 167 percent in group I, by 2.8 times in group II and by 6.3 times in group III compared to control group. CONCLUSION Conclusions: COVID-19 has a negative impact on placental angiogenesis, including VEGFA and PlGF. Fetal post-COVID-19 syndrome requires timely diagnosis of disorders and further study. Post-COVID-19 syndrome is an immune-dependent pathology in which the processes of protracted cytokine activation occur in the body of a pregnant woman.
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Affiliation(s)
- Alla V Boychuk
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
| | | | - Oksana О Shevchuk
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
| | - Sandor G Vari
- INTERNATIONAL RESEARCH AND INNOVATION IN MEDICINE PROGRAM, CEDARS-SINAI MEDICAL CENTER, LOS ANGELES, CA, USA
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