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Amin R, Sohrabi MR, Zali AR, Hannani K. COVID-19 in pregnancy: A cross-sectional study on clinical features, disease severity, and health outcome. BIOMOLECULES & BIOMEDICINE 2024; 24:659-664. [PMID: 38315087 PMCID: PMC11088891 DOI: 10.17305/bb.2023.9748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/07/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
Assessing the impact of coronavirus disease 2019 (COVID-19) reveals unique challenges for pregnant women, who experience distinct clinical manifestations and health outcomes compared to their non-pregnant counterparts. We aimed to evaluate the clinical features, disease severity, and health outcomes of COVID-19 in pregnant women and compare them to those of non pregnant women. In this population-based study, we included all women diagnosed with COVID-19 across the province of Tehran during the first two years of the epidemic. Descriptive statistics, the chi-squared test, and the logistic regression model were applied. Overall, 79,338 non-pregnant women and 3249 pregnant women diagnosed with COVID-19 were included. Pregnant women were most commonly in the age group of 25 - 34 years (54%, n = 1758), while the age group of 34-44 had the highest representation among non-pregnant women (56%, n = 44,492). After accounting for age and comorbidities, pregnancy was associated with an increased risk of requiring intensive care (odds ratio [OR] 1.38, confidence interval [CI] 1.223 - 1.564). However, the probability of dying due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was lower in pregnant women compared to non-pregnant women (OR 0.55, CI 0.394-0.793). Cough (41%) and fever (30%) were the most frequent clinical presentations in pregnant women, whereas cough (57%) and muscle ache (38%) were the most common symptoms in non-pregnant women. Furthermore, diarrhea (P < 0.001) and skin lesions (P < 0.001) were reported more frequently by pregnant patients than non-pregnant patients. A significant prevalence of diabetes (P < 0.001), hypertension (P < 0.001), cancers (P < 0.001), and chronic hematological diseases (P < 0.001) was observed in pregnant patients. In conclusion, COVID-19-infected pregnant women exhibit different clinical manifestations and a more severe clinical course but have better health outcomes compared to their non-pregnant counterparts.
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Affiliation(s)
- Rozhin Amin
- Community Medicine Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Sohrabi
- Community Medicine Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Reza Zali
- Functional Neurosurgery Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khatereh Hannani
- Statistics and Information Technology Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hurley E, Geisler BP, Lupattelli A, Poblador-Plou B, Lassalle R, Jové J, Bernard MA, Sakr D, Sanfélix-Gimeno G, Sánchez-Saez F, Rodríguez-Bernal CL, Sabaté M, Ballarín E, Aguilera C, Jordan S, Thayer D, Farr I, Ahmed S, Bartolini C, Limoncella G, Paoletti O, Gini R, Maglanoc LA, Dudukina E, Ehrenstein V, Alsina E, Vaz TA, Riera-Arnau J, Sturkenboom MCJM, Nordeng HME. COVID-19 and pregnancy: A European study on pre- and post-infection medication use. Eur J Clin Pharmacol 2024; 80:707-716. [PMID: 38347228 PMCID: PMC11001745 DOI: 10.1007/s00228-024-03639-z] [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: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The COVID-19 pandemic has impacted medication needs and prescribing practices, including those affecting pregnant women. Our goal was to investigate patterns of medication use among pregnant women with COVID-19, focusing on variations by trimester of infection and location. METHODS We conducted an observational study using six electronic healthcare databases from six European regions (Aragon/Spain; France; Norway; Tuscany, Italy; Valencia/Spain; and Wales/UK). The prevalence of primary care prescribing or dispensing was compared in the 30-day periods before and after a positive COVID-19 test or diagnosis. RESULTS The study included 294,126 pregnant women, of whom 8943 (3.0%) tested positive for, or were diagnosed with, COVID-19 during their pregnancy. A significantly higher use of antithrombotic medications was observed particularly after COVID-19 infection in the second and third trimesters. The highest increase was observed in the Valencia region where use of antithrombotic medications in the third trimester increased from 3.8% before COVID-19 to 61.9% after the infection. Increases in other countries were lower; for example, in Norway, the prevalence of antithrombotic medication use changed from around 1-2% before to around 6% after COVID-19 in the third trimester. Smaller and less consistent increases were observed in the use of other drug classes, such as antimicrobials and systemic corticosteroids. CONCLUSION Our findings highlight the substantial impact of COVID-19 on primary care medication use among pregnant women, with a marked increase in the use of antithrombotic medications post-COVID-19. These results underscore the need for further research to understand the broader implications of these patterns on maternal and neonatal/fetal health outcomes.
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Affiliation(s)
- Eimir Hurley
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Benjamin P Geisler
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute, Miguel Servet University Hospital, Saragossa, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion, Research Network on Health Services in Chronic Diseases, Institute of Health Carlos III, Madrid, Spain
| | - Régis Lassalle
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Marie-Agnes Bernard
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Dunia Sakr
- Bordeaux PharmacoEpi, Plateforme de recherche en Pharmaco-épidémiologie, Bordeaux, France
| | - Gabriel Sanfélix-Gimeno
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Francisco Sánchez-Saez
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Clara L Rodríguez-Bernal
- Health Services Research and Pharmacoepidemiology Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Valencia, Spain
| | - Mònica Sabaté
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Elena Ballarín
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Cristina Aguilera
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Daniel Thayer
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Ian Farr
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Saira Ahmed
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | | | | | - Olga Paoletti
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Luigi A Maglanoc
- IT Department, Data Management, University of Oslo, Oslo, Norway
| | - Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ema Alsina
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tiago A Vaz
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judit Riera-Arnau
- Department of Clinical Pharmacology, Vall d`Hebron Hospital Universitari, Vall Hebron Institut de Recerca, Barcelona, Spain
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miriam C J M Sturkenboom
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hedvig M E Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.
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Palma A, Niño-Huertas A, Bendezu-Quispe G, Herrera-Añazco P. Association between the degree of severity of COVID-19 infection during pregnancy and preterm premature rupture of membranes in a level III hospital in Peru. Rev Peru Med Exp Salud Publica 2024; 40:432-440. [PMID: 38597471 PMCID: PMC11138821 DOI: 10.17843/rpmesp.2023.404.12957] [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: 06/11/2023] [Accepted: 11/29/2023] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES. To determine the association between the degree of severity of COVID-19 infection during pregnancy and preterm premature rupture of membranes (PPROM) in a level III hospital in Peru. MATERIALS AND METHODS. Cross-sectional, analytical and observational study in women older than 18 years diagnosed with COVID-19 infection during pregnancy, between the years 2020 and 2022. Clinical and obstetric variables were collected. The chi-square and Fisher's exact tests were used for the descriptive analysis. For the multivariate analysis, we calculated the prevalence ratio by using Poisson regression in crude and adjusted models. All statistical tests were performed considering a value of p<0.05 as significant and with a confidence level of 95%. RESULTS. We analyzed data from 163 pregnant women with COVID-19, of which 9.2% had PPROM; all were symptomatic cases. Mild COVID-19 cases were 1.10 times more likely to have PPROM (RPa=1.10; 95%CI: 1.02-1.18) and moderate/severe cases were 1.64 times more likely (RPa=1.64; 95%CI: 1.43-1.87), compared to asymptomatic cases. CONCLUSIONS. We identified that a higher degree of severity of COVID-19 infection during pregnancy was associated with a higher probability of having PPROM.
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Affiliation(s)
- Aitana Palma
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru.Universidad Peruana de Ciencias AplicadasUniversidad Peruana de Ciencias AplicadasLimaPeru
| | - Adrian Niño-Huertas
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru.Universidad Peruana de Ciencias AplicadasUniversidad Peruana de Ciencias AplicadasLimaPeru
| | - Guido Bendezu-Quispe
- Universidad Privada Norbert Wiener, Lima, Peru.Universidad Privada Norbert WienerUniversidad Privada Norbert WienerLimaPeru
| | - Percy Herrera-Añazco
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru.Universidad Peruana de Ciencias AplicadasUniversidad Peruana de Ciencias AplicadasLimaPeru
- Red Peruana de Salud Colectiva, Lima, Peru. Red Peruana de Salud ColectivaLimaPeru
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AlJohi A, Alohali A, Alsaeed S, Sakkijah HM, Obeid DA. Outcome of pregnant women admitted to critical care unit with confirmed severe COVID-19: A center experience. Saudi Med J 2024; 45:379-386. [PMID: 38657988 PMCID: PMC11147573 DOI: 10.15537/smj.2024.45.4.20240022] [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: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To explore the traits and risk factors of pregnant women admitted to intensive care units (ICUs) with COVID-19. Moreover, the study classifies outcomes based on differing levels of required respiratory support during their intensive care stay. METHODS This retrospective and descriptive study included all pregnant women with COVID-19 admitted to the adult critical care unit at a specialized tertiary hospital in Riyadh, Saudi Arabia. Between January 2020 and December 2022. A total of 38 pregnant women were identified and were eligible for our study. RESULTS The mean age of the patients was 32.9 (19-45) years, and the average Acute Physiology and Chronic Health Evaluation IV (APACHI IV) score was 49.9 (21-106). Approximately 60.5% of the patients suffered from superimposed infections during their ICU stay. Approximately 81.6% patients were delivered by C-section, 33 of the newborns survived, and 5 died. The crude mortality rate among pregnant women in our cohort was 15.8%. Patients treated with high-flow nasal cannula (HFNC) were mostly discharged or delivered normally, while the mechanical ventilation (MV) and extracorporeal membrane oxygenation groups mostly underwent C-sections. Most of the surviving newborns were on HFNC and MV. Patients with multiple infections had the longest ICU stay and had the highest risk of death. CONCLUSION The results of this study highlight the characteristics of pregnant women admitted to the ICU at a specialized tertiary healthcare center in Saudi Arabia. The APACHI IV scores accurately predicted patient's mortality, duration of MV, and length of ICU stay. In our study, we shared our experience of managing severe COVID-19 infections in pregnant patients.
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Affiliation(s)
- Amani AlJohi
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmad Alohali
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Saffanah Alsaeed
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Hussam M. Sakkijah
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
| | - Dalia A. Obeid
- From the Department of Physical Medicine and Rehabilitation (AlJohi, Alsaeed); from the Department of Critical Care Services Administration (Alohali, Sakkijah), King Fahad Medical City, and from the Department of Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence, Transplant Research and Innovation (Obeid), King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
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5
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Sivalingam D, Ajith Kumar AK, Shashank MR, Murthy PR, Venkatesha Gupta KV. COVID-19 complicating pregnancy: A retrospective study of nine intensive care unit patients. Obstet Med 2024; 17:28-35. [PMID: 38655195 PMCID: PMC10183341 DOI: 10.1177/1753495x231169849] [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: 07/11/2022] [Accepted: 03/29/2023] [Indexed: 04/26/2024] Open
Abstract
Background With the emergence of the coronavirus 2019 (COVID-19) pandemic, it was essential to determine the impact of this disease on pregnant women and neonatal outcomes. In this study, we present a series of nine cases of pregnant women with COVID-19 disease requiring intensive care unit (ICU) admission. Methods We retrospectively collected clinical data of pregnant women with COVID-19 disease admitted to ICU between September 2020 and September 2021. Results Most common presenting symptom was cough. Two patients had no respiratory symptoms at presentation. Five of the nine patients required invasive mechanical ventilation. Seven patients required caesarean section, four of whom delivered preterm. There were no maternal or neonatal deaths. Conclusions Although maternal and neonatal outcomes reported in our study are encouraging, it is imperative to emphasize the importance of an individualized, multidisciplinary approach, and good healthcare infrastructure for optimal management of this group of patients.
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Affiliation(s)
- Deepak Sivalingam
- Liver Transplant Anaesthesia and Intensive Care, Rela Institute and Medical Center, Chennai, India
| | - AK Ajith Kumar
- Critical Care Medicine, Manipal Hospital, Bangalore, India
| | - MR Shashank
- Critical Care Medicine, Aster CMI Hospital, Bangalore, India
| | - Pooja R Murthy
- Critical Care Medicine, Manipal Hospital, Bangalore, India
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Kanecki K, Lewtak K, Tyszko P, Kosińska I, Tarka P, Goryński P, Nitsch-Osuch A. Newborn Hospitalizations Before and During COVID-19 Pandemic in Poland: A Comparative Study Based on a National Hospital Registry. Int J Public Health 2024; 69:1606272. [PMID: 38420514 PMCID: PMC10899492 DOI: 10.3389/ijph.2024.1606272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives: There are limited data on the impact of the COVID-19 outbreak in Poland on newborn health. The aim of the study is to show recent information on hospitalizations of newborns in Poland in the pre-pandemic and COVID-19 pandemic era. Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized in 2017-2021. Results: The data on which the study was based consisted of a substantial number of 104,450 hospitalization records. Annual hospitalization rate was estimated to be 50.3-51.9 per 1,000 in 2017-2019, 56 per 1,000 in 2020 and it rose to 77.7 per 1,000 in 2021. In comparison to the pre-pandemic period, in the COVID-19 era, we observed significantly more hospitalization cases of newborns affected by maternal renal and urinary tract diseases (p < 0.001), syndrome of infant of mother with gestational diabetes (p < 0.001), maternal complications of pregnancy (p < 0.001). In the COVID-19 era, the prevalence of COVID-19 among newborns was 4.5 cases per 1,000 newborn hospitalizations. Conclusion: The COVID-19 pandemic outbreak could significantly contribute to qualitative and quantitative changes in hospitalizations among newborns.
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Affiliation(s)
- Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, Faculty of Medicine, Warsaw, Poland
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, Faculty of Medicine, Warsaw, Poland
| | - Piotr Tyszko
- Department of Social Medicine and Public Health, Medical University of Warsaw, Faculty of Medicine, Warsaw, Poland
- Institute of Rural Health in Lublin, Lublin, Poland
| | - Irena Kosińska
- Department of Social Medicine and Public Health, Medical University of Warsaw, Faculty of Medicine, Warsaw, Poland
| | - Patryk Tarka
- Department of Social Medicine and Public Health, Medical University of Warsaw, Faculty of Medicine, Warsaw, Poland
| | - Paweł Goryński
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH—National Research Institute, Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Faculty of Medicine, Warsaw, Poland
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Lucot-Royer L, Nallet C, Vouga M, Puyraveau M, Mauny F, Marty-Quinternet S, Bertholdt C, Bory JP, Devalland C, Canaguier M, Copolla C, Eszto ML, Montoya Y, Roesch M, Reviron S, Riethmuller D, Rufenacht E, Simon E, Mottet N. Analysis of the transplacental transmission of SARS CoV-2 virus and antibody transfer according to the gestational age at maternal infection. Sci Rep 2024; 14:3458. [PMID: 38342940 PMCID: PMC10859378 DOI: 10.1038/s41598-024-53580-5] [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: 10/01/2023] [Accepted: 02/02/2024] [Indexed: 02/13/2024] Open
Abstract
To quantify transplacental transmission of SARS-CoV-2 virus and antibody transfer in pregnant women and their newborns according to the gestational age at maternal infection. A prospective observational multicenter study including pregnant women with a positive RT-PCR or a positive serology for SARS-CoV-2 and compatible symptoms, from April to December 2020, in 11 French maternities. The study was designed to obtain a systematic collection of mother-infant dyad's samples at birth. SARS-CoV-2 viral load was measured by RT-PCR. IgG and IgM antibodies against the SARS-CoV-2 spike protein were measured by enzyme-linked immunosorbent assay. Antibody concentrations and transplacental transfer ratios were analyzed according to the gestational age at maternal infection. The primary outcome was the rate of SARS CoV-2 materno-fetal transmission at birth. The secondary outcome was the quantification of materno-fetal antibody transfer. Maternal and neonatal outcomes at birth were additionally assessed. Among 165 dyads enrolled, one congenital infection was confirmed {n = 1 (0.63%) IC95% [0.02%; 3.48%]}. The average placental IgG antibody transfer ratio was 1.27 (IC 95% [0.69-2.89]). The transfer ratio increased with increasing time between the onset of maternal infection and delivery (P Value = 0.0001). Maternal and neonatal outcomes were reassuring. We confirmed the very low rate of SARS-CoV-2 transplacental transmission (< 1%). Maternal antibody transfer to the fetus was more efficient when the infection occurred during the first and second trimester of pregnancy.
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Affiliation(s)
- Louise Lucot-Royer
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Camille Nallet
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Manon Vouga
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Marc Puyraveau
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Frederic Mauny
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Solène Marty-Quinternet
- Nanomedicine Lab, Imagery and Therapeutics, EA4662, University of Franche-Comte, 25000, Besançoon, France
| | - Charline Bertholdt
- Department of Obstetrics and Gynecology, University Hospital of Nancy, Nancy Hopital Central, 54000, Nancy, France
| | - Jean-Paul Bory
- Department of Obstetrics and Gynecology, University Hospital of Reims, 51092, Reims, France
| | - Christine Devalland
- Department of Obstetrics and Gynecology, Hopital Nord Franche Comté, 90400, Trévenans, France
| | - Margaux Canaguier
- Department of Obstetrics and Gynecology, Hopital Nord Franche Comté, 90400, Trévenans, France
| | - Camille Copolla
- Department of Obstetrics and Gynecology, Groupe Hospitalier de la Haute-Saone, 70000, Vesoul, France
| | - Marie-Laure Eszto
- Department of Obstetrics and Gynecology, CHR Metz-Thionville, 57100, Thionville, France
| | - Yohny Montoya
- Department of Obstetrics and Gynecology, CHR Metz-Thionville, 57100, Thionville, France
| | - Marion Roesch
- Department of Obstetrics and Gynecology, CHR Metz-Thionville, 57100, Thionville, France
| | - Sandrine Reviron
- Department of Obstetrics and Gynecology, Hopital Jura Sud, 39000, Lons-Le-Saunier, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Hospital of Grenoble, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Emma Rufenacht
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Haute Comté, 25300, Pontarlier, France
| | - Emmanuel Simon
- Department of Obstetrics and Gynecology, University Hospital of Dijon, CHU Mitterand, 21000, Dijon, France
| | - Nicolas Mottet
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France.
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Celik IH, Ozkaya Parlakay A, Canpolat FE. Management of neonates with maternal prenatal coronavirus infection and influencing factors. Pediatr Res 2024; 95:436-444. [PMID: 37857851 DOI: 10.1038/s41390-023-02855-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/09/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
The coronavirus disease 2019 (COVID-19) in pregnancy causes adverse outcomes for both the mother and the fetus. Neonates are at risk of vertical transmission and in-utero infection. Additionally, intensive care unit (ICU) admission and impairment in the organ systems of the mother are associated with neonatal outcomes, including impaired intrauterine growth, prematurity, and neonatal ICU admission. The management of neonates born from infected mothers has changed over the progress of the pandemic. At the beginning of the pandemic, cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoiding of skin-to-skin contact, breast milk, and breastfeeding were the main practices to reduce vertical and horizontal transmission risk in the era of insufficient knowledge. The effects of antenatal steroids and delayed cord clamping on COVID-19 were also not known. As the pandemic progressed, data showed that prenatal, delivery room, and postnatal care of neonates can be performed as pre-pandemic practices. Variants and vaccines that affect clinical course and outcomes have emerged during the pandemic. The severity of the disease and the timing of infection in pregnancy also influence maternal and neonatal outcomes. The knowledge and lessons from COVID-19 will be helpful for the next pandemic if it happens. IMPACT: Prenatal infection with COVID-19 is associated with adverse maternal and neonatal outcomes. Our review includes the management of neonates with prenatal COVID-19 infection exposure, maternal-fetal, delivery room, and postnatal care of neonates, clinical features, treatment of neonates, and influencing factors such as variants, vaccination, severity of maternal disease, and timing of infection during pregnancy. There is a growing body of data and evidence about the COVID-19 pandemic. The knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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Affiliation(s)
- Istemi Han Celik
- University of Health Sciences Turkey; Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye.
| | - Aslinur Ozkaya Parlakay
- Ankara Yildirim Beyazit University; Ankara Bilkent City Hospital, Department of Pediatrics, Pediatric Infectious Diseases Unit, Ankara, Türkiye
| | - Fuat Emre Canpolat
- University of Health Sciences Turkey, Ankara Bilkent City Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
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9
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Celik IH, Tanacan A, Canpolat FE. Neonatal outcomes of maternal prenatal coronavirus infection. Pediatr Res 2024; 95:445-455. [PMID: 38057579 DOI: 10.1038/s41390-023-02950-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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Affiliation(s)
- Istemi Han Celik
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Türkiye; Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, 06010, Ankara, Türkiye.
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Perinatology Clinic, University of Health Sciences Turkiye, Ankara Bilkent City Hospital, 06800, Ankara, Türkiye
| | - Fuat Emre Canpolat
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Türkiye, Ankara Bilkent City Hospital, 06800, Ankara, Türkiye
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10
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Torche F, Nobles J. Vaccination, immunity, and the changing impact of COVID-19 on infant health. Proc Natl Acad Sci U S A 2023; 120:e2311573120. [PMID: 38011548 DOI: 10.1073/pnas.2311573120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023] Open
Abstract
In utero exposure to COVID-19 infection may lead to large intergenerational health effects. The impact of infection exposure has likely evolved since the onset of the pandemic as new variants emerge, immunity from prior infection increases, vaccines become available, and vaccine hesitancy persists, such that when infection is experienced is as important as whether it is experienced. We examine the changing impact of COVID-19 infection on preterm birth and the moderating role of vaccination. We offer the first plausibly causal estimate of the impact of maternal COVID-19 infection by using population data with no selectivity, universal information on maternal COVID-19 infection, and linked sibling data. We then assess change in this impact from 2020 to 2023 and evaluate the protective role of COVID-19 vaccination on infant health. We find a substantial adverse effect of prenatal COVID-19 infection on the probability of preterm birth. The impact was large during the first 2 y of the pandemic but had fully disappeared by 2022. The harmful impact of COVID-19 infection disappeared almost a year earlier in zip codes with high vaccination rates, suggesting that vaccines might have prevented thousands of preterm births. The findings highlight the need to monitor the changing consequences of emerging infectious diseases over time and the importance of mitigation strategies to reduce the burden of infection on vulnerable populations.
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Affiliation(s)
- Florencia Torche
- Department of Sociology, Stanford University, Stanford, CA 94305
| | - Jenna Nobles
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI 53706
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Simbar M, Nazarpour S, Sheidaei A. Evaluation of pregnancy outcomes in mothers with COVID-19 infection: a systematic review and meta-analysis. J OBSTET GYNAECOL 2023; 43:2162867. [PMID: 36651606 DOI: 10.1080/01443615.2022.2162867] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that reported adverse pregnancy outcomes in pregnant women with COVID-19 infection. A literature search was performed in PubMed and Scopus up to 1 September 2022, for retrieving original articles published in the English language assessing the association between COVID-19 infection and adverse pregnancy outcomes. Finally, in this review study, of 1790 articles obtained in the initial search, 141 eligible studies including 1,843,278 pregnant women were reviewed. We also performed a meta-analysis of a total of 74 cohort and case-control studies. In this meta-analysis, both fixed and random effect models were used. Publication bias was also assessed by Egger's test and the trim and fill method was conducted in case of a significant result, to adjust the bias. The result of the meta-analysis showed that the pooled prevalence of preterm delivery, maternal mortality, NICU admission and neonatal death in the group with COVID-19 infection was significantly more than those without COVID-19 infection (p<.01). A meta-regression was conducted using the income level of countries. COVID-19 infection during pregnancy may cause adverse pregnancy outcomes including of preterm delivery, maternal mortality, NICU admission and neonatal death. Pregnancy loss and SARS-CoV2 positive neonates in Lower middle income are higher than in High income. Vertical transmission from mother to foetus may occur, but its immediate and long-term effects on the newborn are unclear.
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Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Nazarpour
- Department of Midwifery, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Di Gennaro F, Guido G, Frallonardo L, Segala FV, De Nola R, Damiani GR, De Vita E, Totaro V, Barbagallo M, Nicastri E, Vimercati A, Cicinelli E, Liuzzi G, Veronese N, Saracino A. Efficacy and safety of therapies for COVID-19 in pregnancy: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:776. [PMID: 37946100 PMCID: PMC10634005 DOI: 10.1186/s12879-023-08747-2] [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: 05/03/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Clinical evidence suggests that pregnant women are more vulnerable to COVID-19, since they are at increased risk for disease progression and for obstetric complications, such as premature labor, miscarriage, preeclampsia, cesarean delivery, fetal growth restriction and perinatal death. Despite this evidence, pregnant women are often excluded from clinical trials, resulting in limited knowledge on COVID-19 management. The aim of this systematic review and meta-analysis is to provide better evidence on the efficacy and safety of available COVID-19 treatment in pregnant women. METHODS Four authors searched major electronic databases from inception until 1 st November-2022 for controlled trials/observational studies, investigating outcomes after the administration of anti-SARS-CoV-2 treatments in pregnant women affected by COVID-19. The analyses investigated the cumulative incidence of delivery and maternal outcomes in pregnant women, comparing those taking active medication vs standard care. Risk ratios (RRs) with 95% confidence intervals were calculated. Statistical significance was assessed using the random effects model and inverse-variance method. This systematic review and meta-analysis was conducted in accordance with the updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol has been registered in Prospero (number registration: CRD42023397445). RESULTS From initially 937 non duplicate records, we assessed the full texts of 40 articles, finally including ten studies. In six studies, including 1627 patients, the use of casirivimab/imdevimab (CAS/IMD), remdesivir, and IFN-alpha 2b significantly decreased the need of cesarean section ((RR = 0.665; 95%CI: 0.491-0.899; p = 0.008; I 2 = 19.5%;) (Table 1, (Fig. 1). Treatments did not decrease the risk of preterm delivery, admission to neonatal ICU, or stillbirth/perinatal loss (p-values > 0.50 for all these outcomes) and did not prevent the progression of disease towards severe degrees (k = 8; 2,374 pregnant women; RR = 0.778; 95%CI: 0.550-1.099; p = 0.15; I 2 = 0%). Moreover, the use of medications during pregnancy did not modify the incidence of maternal death in two studies (Table 2). CONCLUSIONS To our analysis, CAS/IMD, remdesivir, and IFN alpha 2b reduced the number of cesarean sections but demonstrated no effect on disease progression and other obstetric and COVID-19 related outcomes. The inability to evaluate the influence of viral load on illness development in pregnant women was attributed to lack of data. In our systematic review, no major side effects were reported. Though, it is essential for the medical community to focus more on clinical trials and less on episodic case reports and case series, with standardization of fetal and maternal outcomes.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy.
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Rosalba De Nola
- Clinic of Obstetrics & Gynaecology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Elda De Vita
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Valentina Totaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
| | - Mario Barbagallo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Antonella Vimercati
- Clinic of Obstetrics & Gynaecology, University of Bari "Aldo Moro", Bari, Italy
| | - Ettore Cicinelli
- Clinic of Obstetrics & Gynaecology, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of "Aldo Moro", University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap 70124, Bari, Italy
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Virk S, Gangu K, Nasrullah A, Shah A, Faiz Z, Khan U, Jackson DB, Javed A, Farooq A, DiSilvio B, Cheema T, Sheikh AB. Impact of COVID-19 on Pregnancy Outcomes across Trimesters in the United States. Biomedicines 2023; 11:2886. [PMID: 38001887 PMCID: PMC10669814 DOI: 10.3390/biomedicines11112886] [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: 09/01/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Current knowledge regarding the association between trimester-specific changes during pregnancy and COVID-19 infection is limited. We utilized the National Inpatient Sample (NIS) database to investigate trimester-specific outcomes among hospitalized pregnant women diagnosed with COVID-19. RESULTS Out of 3,447,771 pregnant women identified, those with COVID-19 exhibited higher in-hospital mortality rates in their third trimester compared with those without the virus. Notably, rates of mechanical ventilation, acute kidney injury, renal replacement therapy, and perinatal complications (preeclampsia, HELLP syndrome, and preterm birth) were significantly elevated across all trimesters for COVID-19 patients. COVID-19 was found to be more prevalent among low-income, Hispanic pregnant women. CONCLUSIONS Our findings suggest that COVID-19 during pregnancy is associated with increased risk of maternal mortality and complications, particularly in the third trimester. Furthermore, we observed significant racial and socioeconomic disparities in both COVID-19 prevalence and pregnancy outcomes. These findings emphasize the need for equitable healthcare strategies to improve care for diverse and socioeconomically marginalized groups, ultimately aiming to reduce adverse COVID-19-associated maternal and fetal outcomes.
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Affiliation(s)
- Shiza Virk
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA; (S.V.); (A.S.); (A.J.)
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA; (A.N.); (B.D.); (T.C.)
| | - Aaisha Shah
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA; (S.V.); (A.S.); (A.J.)
| | - Zohaa Faiz
- Department of Medicine, School of Medicine, Aga Khan University, Karachi 74000, Pakistan;
| | - Umair Khan
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA; (U.K.); (D.B.J.)
| | - David Bradley Jackson
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA; (U.K.); (D.B.J.)
| | - Anam Javed
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA; (S.V.); (A.S.); (A.J.)
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX 79409, USA;
| | - Briana DiSilvio
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA; (A.N.); (B.D.); (T.C.)
| | - Tariq Cheema
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA; (A.N.); (B.D.); (T.C.)
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA; (U.K.); (D.B.J.)
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14
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Magalhães JE, Sampaio Rocha-Filho PA. Neurological manifestations of COVID-19 in pregnancy: a cross-sectional study. J Neurovirol 2023; 29:472-478. [PMID: 37306922 DOI: 10.1007/s13365-023-01150-2] [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: 01/23/2023] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
The occurrence of neurological manifestations and complications in pregnant women compared to non-pregnant women with COVID-19 is unclear. This cross-sectional study included women aged over 18 years hospitalized with SARS-CoV-2 infection confirmed by RT-PCR from March to June 2020 in Recife, Brazil. We evaluated 360 women, including 82 pregnant patients who were significantly younger (27.5 vs. 53.6 years; p < 0.01) and less frequently obese (2.4% vs. 15.1%; p < 0.01) than the non-pregnant group. All pregnancies were confirmed using ultrasound imaging. Abdominal pain was the only more frequent COVID-19 manifestation during pregnancy (23.2% vs. 6.8%; p < 0.01), but was not associated with the outcomes. Almost half the pregnant women presented neurological manifestations, including anosmia (31.7%), headache (25.6%), ageusia (17.1%), and fatigue (12.2%). However, neurological manifestations occurred similarly in pregnant and non-pregnant women. Four (4.9%) pregnant women and 64 non-pregnant women (23%) presented delirium, but the frequency with age-adjustment was similar in the non-pregnant group. Pregnant women with COVID and preeclampsia (19.5%) or eclampsia (3.7%) were older (31.8 vs. 26.5 years; p < 0.01), and epileptic seizures occurred more often in association with eclampsia (18.8% vs. 1.5%; p < 0.01) regardless of previous epilepsy. There were three maternal deaths (3.7%), one dead fetus, and one miscarriage. The overall prognosis was good. There was no difference in prolonged hospital stay, the need for ICU and mechanical ventilation, or death when comparing pregnant and non-pregnant women.
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Affiliation(s)
- João Eudes Magalhães
- Department of Neurology, Faculdade de Ciências Médicas - Universidade de Pernambuco, Recife, Brazil
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Pedro A Sampaio Rocha-Filho
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE). Rua General Joaquim Inacio, 830, Sala 1412 - Edf The Plaza Business Center, Recife, Pernambuco, CEP: 50070-495, Brazil.
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Al Ghaithi I, Ahmed B, Al Dughaishi T, Al Riyami N, Al Haddabi R, Gowri V. Maternal, Perinatal, and Neonatal Outcomes of COVID-19 Severity in Pregnant Women: A Retrospective Study from Oman. Oman Med J 2023; 38:e530. [PMID: 37711979 PMCID: PMC10498356 DOI: 10.5001/omj.2023.90] [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: 11/19/2022] [Accepted: 01/07/2023] [Indexed: 09/16/2023] Open
Abstract
Objectives To evaluate the effect of COVID-19 severity on maternal, perinatal, and neonatal outcomes in pregnant women infected with SARS-CoV-2. We also aimed to assess the effect of medical comorbidities on the severity of COVID-19. Methods A retrospective cohort study was conducted on women who became infected with SARS-CoV-2 during pregnancy and delivered at Sultan Qaboos University Hospital, Oman, from 1 March 2020 to 31 December 2021. Results A total of 118 pregnant women with COVID-19 and their 118 newborns were included in the study. Mean maternal age was 32.0 years, with 60.2% of women infected in the third trimester. The majority of the participants had mild symptoms. Eleven (9.3%) women had moderate infection needing inpatient care. Six (5.1%) with severe infection were admitted to intensive care unit. The chronic diseases among the participants were hypothyroidism, obesity, sickle cell disease, epilepsy, and diabetes. The mean gestational age at delivery was 37.0 weeks with 20.9% of women delivering by cesarean section out of whom 37.5% had moderate-to-severe COVID-19. The most common complications associated with COVID-19 severity were preterm labor (p =0.002), preeclampsia (p =0.002), and intrauterine fetal death (p =0.089). Of the total 118 newborns, 111 were singletons and six were twins. One fetus died and three singletons were lost to miscarriage. Placental histopathology conducted in 64 patients had no COVID-specific findings in most cases. Conclusions Most pregnant women with COVID-19 infections had mild symptoms. The majority of women with moderate-to-severe infection were admitted for COVID-19 pneumonia. There was no direct effect of COVID-19 severity in neonatal outcomes or placental histopathology changes.
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Affiliation(s)
- Istaqlal Al Ghaithi
- Obstetrics and Gynecology Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Bushra Ahmed
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Tamima Al Dughaishi
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nihal Al Riyami
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University,
Muscat, Oman
| | - Rahma Al Haddabi
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Vaidyanathan Gowri
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University,
Muscat, Oman
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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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Dandona R, Kumar GA, Akbar M, Dora SSP, Dandona L. Substantial increase in stillbirth rate during the COVID-19 pandemic: results from a population-based study in the Indian state of Bihar. BMJ Glob Health 2023; 8:e013021. [PMID: 37491108 PMCID: PMC10373740 DOI: 10.1136/bmjgh-2023-013021] [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: 03/30/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION We report on the stillbirth rate (SBR) and associated risk factors for births during the COVID-19 pandemic, and change in SBR between prepandemic (2016) and pandemic periods in the Indian state of Bihar. METHODS Births between July 2020 and June 2021 (91.5% participation) representative of Bihar were listed. Stillbirth was defined as fetal death with gestation period of ≥7 months where the fetus did not show any sign of life. Detailed interviews were conducted for all stillbirths and neonatal deaths, and for 25% random sample of surviving live births. We estimated overall SBR, and during COVID-19 peak and non-peak periods per 1000 births. Multiple logistic regression models were run to assess risk factors for stillbirth. The change in SBR for Bihar from 2016 to 2020-2021 was estimated. RESULTS We identified 582 stillbirths in 30 412 births with an estimated SBR of 19.1 per 1000 births (95% CI 17.7 to 20.7); SBR was significantly higher in private facility (38.4; 95% CI 34.3 to 43.0) than in public facility (8.6; 95% CI 7.3 to 10.1) births, and for COVID-19 peak (21.2; 95% CI 19.2 to 23.4) than non-peak period (16.3; 95% CI 14.2 to 18.6) births. Pregnancies with the last pregnancy trimester during the COVID-19 peak period had 40.4% (95% CI 10.3% to 70.4%) higher SBR than those who did not. Risk factor associations for stillbirths were similar between the COVID-19 peak and non-peak periods, with gestation age of <8 months with the highest odds of stillbirth followed by referred deliveries and deliveries in private health facilities. A statistically significant increase of 24.3% and 68.9% in overall SBR and intrapartum SBR was seen between 2016 and 2020-2021, respectively. CONCLUSIONS This study documented an increase in SBR during the COVID-19 pandemic as compared with the prepandemic period, and the varied SBR based on the intensity of the COVID-19 pandemic and by the place of delivery.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Md Akbar
- Public Health Foundation of India, New Delhi, India
| | | | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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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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Salehi Z, Motlagh Ghoochani BFN, Hasani Nourian Y, Jamalkandi SA, Ghanei M. The controversial effect of smoking and nicotine in SARS-CoV-2 infection. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:49. [PMID: 37264452 DOI: 10.1186/s13223-023-00797-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/18/2023] [Indexed: 06/03/2023]
Abstract
The effects of nicotine and cigarette smoke in many diseases, notably COVID-19 infection, are being debated more frequently. The current basic data for COVID-19 is increasing and indicating the higher risk of COVID-19 infections in smokers due to the overexpression of corresponding host receptors to viral entry. However, current multi-national epidemiological reports indicate a lower incidence of COVID-19 disease in smokers. Current data indicates that smokers are more susceptible to some diseases and more protective of some other. Interestingly, nicotine is also reported to play a dual role, being both inflammatory and anti-inflammatory. In the present study, we tried to investigate the effect of pure nicotine on various cells involved in COVID-19 infection. We followed an organ-based systematic approach to decipher the effect of nicotine in damaged organs corresponding to COVID-19 pathogenesis (12 related diseases). Considering that the effects of nicotine and cigarette smoke are different from each other, it is necessary to be careful in generalizing the effects of nicotine and cigarette to each other in the conducted researches. The generalization and the undifferentiation of nicotine from smoke is a significant bias. Moreover, different doses of nicotine stimulate different effects (dose-dependent response). In addition to further assessing the role of nicotine in COVID-19 infection and any other cases, a clever assessment of underlying diseases should also be considered to achieve a guideline for health providers and a personalized approach to treatment.
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Affiliation(s)
- Zahra Salehi
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Yazdan Hasani Nourian
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sadegh Azimzadeh Jamalkandi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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20
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Maisonneuve E, Gerbier E, Tauqeer F, Pomar L, Favre G, Winterfeld U, Passier A, Oliver A, Baud D, Nordeng H, Ceulemans M, Panchaud A. Determinants of Vaccination and Willingness to Vaccinate against COVID-19 among Pregnant and Postpartum Women during the Third Wave of the Pandemic: A European Multinational Cross-Sectional Survey. Viruses 2023; 15:1090. [PMID: 37243177 PMCID: PMC10220755 DOI: 10.3390/v15051090] [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: 03/29/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
With COVID-19 vaccination hesitancy at around 50% in the obstetric population, it is critical to identify which women should be addressed and how. Our study aimed to assess COVID-19 vaccination willingness among pregnant and postpartum women in Europe and to investigate associated determinants. This study was a cross-sectional, web-based survey conducted in Belgium, Norway, Switzerland, The Netherlands, and United Kingdom (UK) in June-August 2021. Among 3194 pregnant women, the proportions of women vaccinated or willing to be vaccinated ranged from 80.5% in Belgium to 21.5% in Norway. The associated characteristics were country of residence, chronic illness, history of flu vaccine, trimester of pregnancy, belief that COVID-19 is more severe during pregnancy, and belief that the COVID-19 vaccine is effective and safe during pregnancy. Among 1659 postpartum women, the proportions of women vaccinated or willing to be vaccinated ranged from 86.0% in the UK to 58.6% in Switzerland. The associated determinants were country of residence, chronic illness, history of flu vaccine, breastfeeding, and belief that the COVID-19 vaccine is safe during breastfeeding. Vaccine hesitancy in the obstetric population depends on medical history and especially on the opinion that the vaccine is safe and on the country of residence.
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Affiliation(s)
- Emeline Maisonneuve
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
| | - Eva Gerbier
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Fatima Tauqeer
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway; (F.T.); (H.N.)
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical pharmacology Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Anneke Passier
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH ’s Hertogenbosch, The Netherlands; (A.P.); (M.C.)
| | - Alison Oliver
- UK Teratology Information Service, Newcastle upon Tyne Hospitals, NHS Foundation Trust and the UK Health Security Agency, Newcastle upon Tynes NE2 4AB, UK;
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (L.P.); (G.F.); (D.B.)
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway; (F.T.); (H.N.)
| | - Michael Ceulemans
- Teratology Information Service, Pharmacovigilance Centre Lareb, 5237 MH ’s Hertogenbosch, The Netherlands; (A.P.); (M.C.)
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- L-C&Y, KU Leuven Child & Youth Institute, 3000 Leuven, Belgium
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
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21
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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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22
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Moscucci F, Gallina S, Bucciarelli V, Aimo A, Pelà G, Cadeddu-Dessalvi C, Nodari S, Maffei S, Meloni A, Deidda M, Mercuro G, Pedrinelli R, Penco M, Sciomer S, Mattioli AV. Impact of COVID-19 on the cardiovascular health of women: a review by the Italian Society of Cardiology Working Group on 'gender cardiovascular diseases'. J Cardiovasc Med (Hagerstown) 2023; 24:e15-e23. [PMID: 36729627 PMCID: PMC10100638 DOI: 10.2459/jcm.0000000000001398] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/02/2022] [Indexed: 02/03/2023]
Abstract
The coronavirus disease 19 (COVID-19), due to coronavirus 2 (SARS-CoV-2) infection, presents with an extremely heterogeneous spectrum of symptoms and signs. COVID-19 susceptibility and mortality show a significant sex imbalance, with men being more prone to infection and showing a higher rate of hospitalization and mortality than women. In particular, cardiovascular diseases (preexistent or arising upon infection) play a central role in COVID-19 outcomes, differently in men and women. This review will discuss the potential mechanisms accounting for sex/gender influence in vulnerability to COVID-19. Such variability can be ascribed to both sex-related biological factors and sex-related behavioural traits. Sex differences in cardiovascular disease and COVID-19 involve the endothelial dysfunction, the innate immune system and the renin-angiotensin system (RAS). Furthermore, the angiotensin-converting enzyme 2 (ACE2) is involved in disease pathogenesis in cardiovascular disease and COVID-19 and it shows hormone-dependent actions. The incidence of myocardial injury during COVID-19 is sex-dependent, predominantly in association with a greater degree of inflammation and coagulation disorders among men. Its pathogenesis is not fully elucidated, but the main theories foresee a direct role for the ACE2 receptor, the hyperimmune response and the RAS imbalance, which may also lead to isolated presentation of COVID-19-mediated myopericarditis. Moreover, the latest evidence on cardiovascular diseases and their relationship with COVID-19 during pregnancy will be discussed. Finally, authors will analyse the prevalence of the long-covid syndrome between the two sexes and its impact on the quality of life and cardiovascular health.
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Affiliation(s)
- Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome ‘Sapienza’, Policlinico Umberto I, Rome
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti
| | - Valentina Bucciarelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona ‘Umberto I, G. M. Lancisi, G. Salesi’, Ancona
| | - Alberto Aimo
- Cardiology Division, Fondazione Toscana Gabriele Monasterio
- Scuola Superiore Sant’Anna, Pisa
| | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma
- Department of General and Specialistic Medicine, University-Hospital of Parma, Parma
| | | | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Silvia Maffei
- Cardiovascular and Gynaecological Endocrinology Unit, Fondazione G Monasterio CNR-Regione Toscana
| | - Antonella Meloni
- Department of Radiology, Fondazione G Monasterio CNR-Regione Toscana, Pisa
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome ‘Sapienza’, Policlinico Umberto I, Rome
| | - Anna Vittoria Mattioli
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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23
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Marginean CM, Cinteza E, Vasile CM, Popescu M, Biciusca V, Docea AO, Mitrut R, Popescu MS, Mitrut P. Features of Liver Injury in COVID-19 Pathophysiological, Biological and Clinical Particularities. GASTROENTEROLOGY INSIGHTS 2023. [DOI: 10.3390/gastroent14020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
The outbreak of the coronavirus pandemic in March 2020 has caused unprecedented pressure on public health and healthcare. The spectrum of COVID-19 onset is large, from mild cases with minor symptoms to severe forms with multi-organ dysfunction and death. In COVID-19, multiple organ damage has been described, including lung damage, acute kidney injury, liver damage, stroke, cardiovascular and digestive tract disorders. The aspects of liver injury are different, sometimes presenting with only a slight increase in liver enzymes, but sometimes with severe liver injury, leading to acute liver failure requiring liver transplantation. In patients with chronic liver disease, especially liver cirrhosis, immune dysfunction can increase the risk of infection. Immune dysfunction has a multifactorial physiopathological mechanism, implying a complement system and macrophage activation, lymphocyte and neutrophil activity dysfunction, and intestinal dysbiosis. This review aims to evaluate the most relevant studies published in the last years related to the etiopathogenetic, biochemical, and histological aspects of liver injury in patients diagnosed with COVID-19. Liver damage is more evident in patients with underlying chronic liver disease, with a significantly higher risk of developing severe outcomes of COVID-19 and death. Systemic inflammation, coagulation disorders, endothelial damage, and immune dysfunction explain the pathogenic mechanisms involved in impaired liver function. Although various mechanisms of action of SARS-CoV-2 on the liver cell have been studied, the impact of the direct viral effect on hepatocytes is not yet established.
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Affiliation(s)
- Cristina Maria Marginean
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Eliza Cinteza
- Pediatrics Department, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Corina Maria Vasile
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33600 Pessac, France
| | - Mihaela Popescu
- Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Viorel Biciusca
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Radu Mitrut
- Department of Cardiology, University and Emergency Hospital, 050098 Bucharest, Romania
| | - Marian Sorin Popescu
- Ph.D. School Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Paul Mitrut
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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24
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Addressing Rehabilitation Healthcare Disparities During the COVID-19 Pandemic and Beyond. Phys Med Rehabil Clin N Am 2023. [PMCID: PMC10063577 DOI: 10.1016/j.pmr.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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25
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Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment. Semin Fetal Neonatal Med 2023; 28:101426. [PMID: 36964118 PMCID: PMC9990893 DOI: 10.1016/j.siny.2023.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Pregnancy-related acute respiratory distress syndrome (ARDS) is fast becoming a growing and clinically relevant subgroup of ARDS amidst global outbreaks of various viral respiratory pathogens that include H1N1-influenza, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS), and the most recent COVID-19 pandemic. Pregnancy is a risk factor for severe viral-induced ARDS and commonly associated with poor maternal and fetal outcomes including fetal growth-restriction, preterm birth, and spontaneous abortion. Physiologic changes of pregnancy further compounded by mechanical and immunologic alterations are theorized to impact the development of ARDS from viral pneumonia. The COVID-19 sub-phenotype of ARDS share overlapping molecular features of maternal pathogenicity of pregnancy with respect to immune-dysregulation and endothelial/microvascular injury (i.e., preeclampsia) that may in part explain a trend toward poor maternal and fetal outcomes seen with severe COVID-19 maternal infections. To date, current ARDS diagnostic criteria and treatment management fail to include and consider physiologic adaptations that are unique to maternal physiology of pregnancy and consideration of maternal-fetal interactions. Treatment focused on lung-protective ventilation strategies have been shown to improve clinical outcomes in adults with ARDS but may have adverse maternal-fetal interactions when applied in pregnancy-related ARDS. No specific pharmacotherapy has been identified to improve outcomes in pregnancy with ARDS. Adjunctive therapies aimed at immune-modulation and anti-viral treatment with COVID-19 infection during pregnancy have been reported but data in regard to its efficacy and safety is currently lacking.
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Affiliation(s)
- Michelle J Lim
- UC Davis School of Medicine, UC Davis Children's Hospital, Department of Pediatrics, Division of Critical Care and Neonatology, Sacramento, CA, USA.
| | - Satyan Lakshminrusimha
- UC Davis School of Medicine, UC Davis Children's Hospital, Department of Pediatrics, Division of Critical Care and Neonatology, Sacramento, CA, USA
| | - Herman Hedriana
- UC Davis School of Medicine, UC Davis Medical Center, Department of Obstetrics and Gynecology, Sacramento, CA, USA
| | - Timothy Albertson
- UC Davis School of Medicine, UC Davis Medical Center, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Sacramento, CA, USA
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26
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Influence of Immune System Abnormalities Caused by Maternal Immune Activation in the Postnatal Period. Cells 2023; 12:cells12050741. [PMID: 36899877 PMCID: PMC10001371 DOI: 10.3390/cells12050741] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
The developmental origins of health and disease (DOHaD) indicate that fetal tissues and organs in critical and sensitive periods of development are susceptible to structural and functional changes due to the adverse environment in utero. Maternal immune activation (MIA) is one of the phenomena in DOHaD. Exposure to maternal immune activation is a risk factor for neurodevelopmental disorders, psychosis, cardiovascular diseases, metabolic diseases, and human immune disorders. It has been associated with increased levels of proinflammatory cytokines transferred from mother to fetus in the prenatal period. Abnormal immunity induced by MIA includes immune overreaction or immune response failure in offspring. Immune overreaction is a hypersensitivity response of the immune system to pathogens or allergic factor. Immune response failure could not properly fight off various pathogens. The clinical features in offspring depend on the gestation period, inflammatory magnitude, inflammatory type of MIA in the prenatal period, and exposure to prenatal inflammatory stimulation, which might induce epigenetic modifications in the immune system. An analysis of epigenetic modifications caused by adverse intrauterine environments might allow clinicians to predict the onset of diseases and disorders before or after birth.
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27
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Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study. Int J Obstet Anesth 2023; 53:103624. [PMID: 36634448 PMCID: PMC9795802 DOI: 10.1016/j.ijoa.2022.103624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with adverse maternal and neonatal outcomes. Early studies suggested that COVID-19 was associated with a higher incidence of hypotension following neuraxial anesthesia in parturients. We explored the hemodynamic response to spinal anesthesia for cesarean delivery in pregnant severe respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) positive patients, using a retrospective case-control design. METHODS We searched our electronic medical records for patients who received spinal anesthesia for cesarean delivery, and were SARS-CoV-2 positive or recovered at delivery, and used historical and SARS-CoV-2 negative controls from two tertiary care hospitals. We compared the demographic, clinical, and hemodynamic variables between patients who were SARS-CoV-2 positive at delivery, those who were positive during pregnancy and recovered before delivery, and controls. Analyses were stratified by normotensive versus hypertensive status of the patients at delivery. RESULTS We identified 22 SARS-CoV-2 positive, 73 SARS-CoV-2 recovered, and 1517 controls. The SARS-CoV-2 positive, and recovered pregnant patients, had on average 5.6 and 2.2 mmHg, respectively, higher post-spinal mean arterial pressures (MAPs) than control patients, adjusting for covariates. Additionally, the lowest post-spinal MAP was negatively correlated with the number of daysbetween the onset of COVID-19 symptoms and delivery in patients with hypertension (correlation -0.55, 95% CI -0.81 to -0.09). CONCLUSIONS Patients with SARS-CoV-2 infection during pregnancy exhibit less spinal hypotension than non-infected patients. While the clinical significance of this finding is unknown, it points to important cardiovascular effects of the virus.
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Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study. Vaccines (Basel) 2023; 11:vaccines11020226. [PMID: 36851103 PMCID: PMC9963914 DOI: 10.3390/vaccines11020226] [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: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Our study determined the association of pregnancy with various clinical outcomes among women with COVID-19 infection. METHODS We conducted a retrospective, cohort, subgroup analysis of the Philippine CORONA Study datasets comparing the clinical/neurological manifestations and outcomes of pregnant and nonpregnant women admitted in 37 Philippine hospitals for COVID-19 infection. RESULTS We included 2448 women in the analyses (322 pregnant and 2.126 nonpregnant). Logistic regression models showed that crude odds ratio (OR) for mortality (OR 0.26 [95% CI 0.11, 0.66]), respiratory failure [OR 0.37 [95% CI 0.17, 0.80]), need for intensive care (OR 0.39 [95% CI 0.19, 0.80]), and prolonged length of hospital stay (OR 1.73 [95% CI 1.36, 2.19]) among pregnant women were significant. After adjusting for age, disease severity, and new-onset neurological symptoms, only the length of hospital stay remained significant (adjusted OR 1.99 [95% CI 1.56,2.54]). Cox regression models revealed that the unadjusted hazard ratio (HR) for mortality (HR 0.22 [95% CI 0.09, 0.55]) among pregnant women was statistically significant; however, after adjustment, the HR for mortality became nonsignificant. CONCLUSION We did not find a significantly increased risk of mortality, respiratory failure, and need for ICU admission in pregnant women compared with nonpregnant women with COVID-19. However, the likelihood of hospital confinement beyond 14 days was twice more likely among pregnant women than nonpregnant women with COVID-19.
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Rood M, ten Kate L, Boeddha NP, van ‘t Kruys K. Clinical Characteristics, Transmission Rate and Outcome of Neonates Born to COVID-19-Positive Mothers: A Prospective Case Series From a Resource-Limited Setting. Pediatr Infect Dis J 2023; 42:35-42. [PMID: 36476523 PMCID: PMC9725735 DOI: 10.1097/inf.0000000000003758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease (COVID-19) infection during pregnancy could damage the placenta, but data on neonates born to COVID-19-positive mothers is scarce. In this case series, we aim to describe clinical characteristics, transmission rate and outcomes at 3 months of age among neonates born to mothers with COVID-19 diagnosed near the time of delivery. METHODS Prospective, multicenter case series from Suriname. We collected clinical data of neonates born to mothers with COVID-19 infection between June and August 2021. COVID-19 swabs were taken within 5 days and 2 weeks after birth. Follow-up took place at 3 months. RESULTS We enrolled 18 neonates. However, 18/18 (100%) mothers were infected in the third trimester and 10/18 (55.6%) had severe COVID-19 infection requiring ICU admission and 2/10 (20%) died. In total 16/18 (77.8%) neonates were born after cesarean section and 13/18 (72.2%) were born preterm (median 35 weeks, Interquartile range 32 + 4-38 + 0). Neonatal intensive care unit admission was needed in 7/18 (38.9%) neonates. Respiratory symptoms occurred in 12/18 (66.7%), 5/18 (27.8%) were suspected of early-onset sepsis and 1/18(5.6%) of late-onset sepsis. One preterm neonate developed necrotizing enterocolitis. A nasopharyngeal swab was positive in 1/18 (5.5%) neonates within 5 days of life and in 0/11 (0%) neonates after 2 weeks. Follow-up showed mild neurodevelopmental delay in 2/14 (14.3%) patients. CONCLUSION We describe a high proportion of severely ill mothers due to COVID-19 infection with subsequent cesarean delivery and prematurity. Accounting for gestational age at birth, the neonatal clinical course and findings at follow-up appeared similar to neonates born to COVID-19-negative mothers. Maternal vaccination is recommended to prevent neonatal risks associated with prematurity and cesarean delivery.
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Affiliation(s)
- Marloes Rood
- From the Department of Pediatrics, Rijnstate Hospital Arnhem, Wagnerlaan, Arnhem, The Netherlands,Department of Pediatrics, Academic Pediatric Hospital Suriname, Academic Hospital Suriname, Flustraat, Paramaribo, Suriname
| | - Lisa ten Kate
- Department of Pediatrics, Academic Pediatric Hospital Suriname, Academic Hospital Suriname, Flustraat, Paramaribo, Suriname
| | - Navin P. Boeddha
- Department of Pediatrics, Academic Pediatric Hospital Suriname, Academic Hospital Suriname, Flustraat, Paramaribo, Suriname,Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg, Rotterdam, The Netherlands
| | - Kevin van ‘t Kruys
- Department of Pediatrics, Academic Pediatric Hospital Suriname, Academic Hospital Suriname, Flustraat, Paramaribo, Suriname
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Mori H, Kondo E, Yoshino K. Acute Myositis in a Pregnant Woman Complicated With COVID-19 and Hyperemesis Gravidarum: A Case Report. J UOEH 2023; 45:161-165. [PMID: 37661388 DOI: 10.7888/juoeh.45.161] [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: 09/05/2023]
Abstract
Myalgia is the most frequently reported neuromuscular symptom in COVID-19 patients, with a frequency of around 20% in pregnant women. Acute myositis due to COVID-19 is severe and requires medical intervention. There have been some reports of acute myositis due to COVID-19, mostly in elderly men, but rarely in pregnant women. Here we report a case of a pregnant woman who was diagnosed with acute myositis following COVID-19 illness early in her pregnancy. She had been affected by morning sickness since the 6th week of gestation and was diagnosed with COVID-19 at the 12th week. Muscle pain appeared in her limbs 5 days after the diagnosis of COVID-19, with a predominance of pain in the lower limbs, and her gait gradually became unstable. We concluded that it was acute myositis complicated by COVID-19 and hypokalemia, but we could not determine whether hypokalemia or COVID-19 or both were the cause of the muscle damage in this case. Pregnant women diagnosed with COVID-19 often complain of myalgia and fatigue, and when a pregnant woman's symptoms are severe we should keep in mind that they may be suffering from muscle damage that needs medical intervention.
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Affiliation(s)
- Hiroshi Mori
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental health, Japan
| | - Emi Kondo
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental health, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental health, Japan
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Arakaki T, Hasegawa J, Sekizawa A, Ikeda T, Ishiwata I, Kinoshita K. Risk factors for severe disease and impact of severity on pregnant women with COVID-19: a case-control study based on data from a nationwide survey of maternity services in Japan. BMJ Open 2022; 12:e068575. [PMID: 36585128 PMCID: PMC9808759 DOI: 10.1136/bmjopen-2022-068575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify independent risk factors for severe COVID-19 in pregnant women and to evaluate the impact of disease severity on preterm birth. DESIGN A case-control study based on data from a nationwide questionnaire-based survey of maternity services in Japan. SETTING A questionnaire was mailed to all 2135 delivery institutions in Japan between July and August 2021. A total of 1288 institutions responded (60% of all delivery institutions in Japan). 566 facilities reported having cared for pregnant women with COVID-19, and 722 facilities reported having had no such patients. PARTICIPANTS One thousand and forty-three hospitalised and non-hospitalised pregnant women diagnosed with COVID-19 between July 2020 and 30 June 2021. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was progression to severe COVID-19. The secondary outcome was preterm birth due to COVID-19 infection. RESULTS 56 cases (5.4%) were severe, and 987 (94.6%) were non-severe. Multivariable logistic regression analysis showed that gestational age≥24 weeks (adjusted OR (aOR) 6.68, 95% CI 2.8 to 16.0) and maternal age≥32 years (aOR 2.40, 95% CI 1.3 to 4.3) were independently associated with severe cases. Using the Kaplan-Meier method, the probability of continued pregnancy at 14 days after diagnosis for severe cases was 0.57 between 24 and 31 weeks' gestation and 0.27 between 32 and 36 weeks' gestation. The probability for non-severe cases was 1.0 between 24 and 31 weeks' gestation and 0.8 between 32 and 36 weeks' gestation. Among the patients with COVID-19 in the preterm period, preterm birth due to infection was significantly more common in severe than non-severe cases (48% vs 6%, p< 0.0001). CONCLUSIONS Severe COVID-19 in pregnant women was associated with gestational age≥24 weeks and maternal age≥32. The rate of preterm delivery due to the infection was significantly higher in severe COVID-19 cases.
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Affiliation(s)
- Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
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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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Tormen M, Taliento C, Salvioli S, Piccolotti I, Scutiero G, Cappadona R, Greco P. Effectiveness and safety of COVID-19 vaccine in pregnant women: A systematic review with meta-analysis. BJOG 2022; 130:348-357. [PMID: 36444098 PMCID: PMC9878107 DOI: 10.1111/1471-0528.17354] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are limited data regarding COVID-19 vaccination during pregnancy. OBJECTIVES To evaluate the effects of COVID-19 vaccination received during pregnancy on SARS-CoV-2 infection, COVID-19-related hospitalisation, COVID-19-related intensive care unit (ICU) admission and maternal-fetal complications. SEARCH STRATEGY MEDLINE, CINHAL, Embase, Scopus and CENTRAL databases, as well as ClinicalTrials.gov, reference lists, related articles and grey literature sources. SELECTION CRITERIA Randomised controlled trials, non-randomised studies of interventions, pregnant women, COVID-19 vaccination during pregnancy. DATA COLLECTION AND ANALYSIS Study selection, risk-of-bias assessment, data extraction and assessment of the certainty of evidence using the GRADE method were performed independently by two authors. Meta-analyses were performed using Cochrane RevMan 5.4. PROSPERO registration number: CRD42022308849. MAIN RESULTS We included 14 observational studies (362 353 women). The administration of a COVID-19 vaccine during pregnancy resulted in a statistically significant reduction in SARS-CoV-2 infection (OR 0.46, 95% CI 0.28-0.76) and COVID-19-related hospitalisation (OR 0.41, 95% CI 0.33-0.51). The effect appeared to be greater in fully vaccinated women, for both infection (OR 0.31, 95% CI 0.16-0.59) and hospitalisation (OR 0.15, 95% CI 0.10-0.21). However, the certainty of evidence was very low. The difference in COVID-19-related ICU admission between vaccinated and unvaccinated individuals did not reach statistical significance (OR 0.58, 95% CI 0.13-2.58). Finally, there were no statistically significant differences in any of the maternal-fetal complications considered in the included studies. CONCLUSIONS COVID-19 vaccination administered during pregnancy seems to reduce SARS-CoV-2 infection and COVID-19-related hospitalisation, with no significant effects on maternal-fetal complications.
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Affiliation(s)
- Mara Tormen
- Maternal and Child Department, Unit of Obstetrics and GynecologyS. Anna University HospitalConaFerraraItaly,Department of Medical SciencesUniversity of FerraraFerraraItaly
| | | | - Stefano Salvioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI)University of Genoa – Campus of SavonaSavonaItaly,Department of Neuroscience and RehabilitationUniversity of FerraraFerraraItaly
| | | | - Gennaro Scutiero
- Maternal and Child Department, Unit of Obstetrics and GynecologyS. Anna University HospitalConaFerraraItaly,Department of Medical SciencesUniversity of FerraraFerraraItaly
| | | | - Pantaleo Greco
- Maternal and Child Department, Unit of Obstetrics and GynecologyS. Anna University HospitalConaFerraraItaly,Department of Medical SciencesUniversity of FerraraFerraraItaly
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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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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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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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37
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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. Active Intrapartum SARS-CoV-2 Infection and Pregnancy Outcomes. Am J Perinatol 2022; 39:S42-S48. [PMID: 36307090 DOI: 10.1055/s-0042-1757274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy has been associated with poor pregnancy outcomes. There is, however, not much information on the impact of the timing of SARS-CoV-2 infection on pregnancy outcomes, and studies from low-middle income settings are also scarce. STUDY DESIGN We conducted a cross-sectional study from April to December 2020, in South Africa, to assess the association of SARS-CoV-2 infection on a nasal swab at the time of labor with fetal death, preterm birth, low birth weight, or pregnancy-induced complications. When possible, maternal blood, cord blood, and placenta were collected. SARS-CoV-2 infection was investigated by a nucleic acid amplification test (NAAT). RESULTS Overall, 3,117 women were tested for SARS-CoV-2 on a nasal swab, including 1,562 (50%) healthy women with uncomplicated term delivery. A positive NAAT was detected among 132 (4%) women. Adverse birth outcomes or pregnancy-related complications were not associated with SARS-CoV-2 infection at the time of labor. Among SARS-CoV-2-infected women, an NAAT-positive result was also obtained from 6 out of 98 (6%) maternal blood samples, 8 out of 93 (9%) cord-blood samples, 14 out of 54 (26%) placentas, and 3 out of 22 (14%) nasopharyngeal swabs from newborns collected within 72 hours of birth. Histological assessment of placental tissue revealed that women with SARS-CoV-2 nasal infection had a higher odds (3.82, 95% confidence interval: 1.20, 12.19) of chronic chorioamnionitis compared with those without SARS-CoV-2 infection. CONCLUSION Our study demonstrates that intrapartum, SARS-CoV-2 infection was not associated with evaluated poor outcomes. In utero fetal and placental infections and possible vertical and/or horizontal viral transfer to the newborn were detected among women with nasal SARS-CoV-2 infection. KEY POINTS · Intrapartum SARS-CoV-2 infection was not associated with evaluated poor outcomes.. · In utero fetal and placental infections were detected among women with nasal SARS-CoV-2 infection.. · Women with SARS-CoV-2 nasal infection had a higher odds of chronic chorioamnionitis..
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Affiliation(s)
- Marta C Nunes
- South African Medical Research Council, Vaccines, and 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, and 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, and 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, and 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, and 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, and 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, and 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, and 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
| | - Wendy Fraser
- Lancet Laboratories, Johannesburg, Gauteng, South Africa
| | - Colleen Wright
- Lancet Laboratories, Johannesburg, Gauteng, South Africa.,Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | | | - 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, and 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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Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review. J Clin Med 2022; 11:jcm11206194. [PMID: 36294520 PMCID: PMC9604883 DOI: 10.3390/jcm11206194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background: COVID-19 is a viral infectious disease leading to a spectrum of clinical complications, especially cardiovascular. Evidence shows that this infection can potentially accompany a worse outcome in pregnant women. Cardiovascular complications in mothers and their fetuses are reported by previous studies. Objective: In this systematic review, we aim to investigate the cardiovascular complications of COVID-19 during pregnancy in the mothers and fetus, according to the published literature. Method: We systematically searched the online databases of PubMed, Scopus, Web of Science, and Google Scholar, using relevant keywords up to April 2022. We included all observational studies reporting cardiovascular complications among COVID-19-affected pregnant women and their fetuses. Results: We included 74 studies containing 47582 pregnant COVID-19 cases. Pre-eclampsia, hypertensive disorders, cardiomyopathy, heart failure, myocardial infarction, thrombosis formation, alterations in maternal–fetal Doppler patterns, and maternal and fetal arrhythmia were reported as cardiovascular complications. The highest incidences of pre-eclampsia/eclampsia among COVID-19 pregnant cases, reported by studies, were 69% and 62%, and the lowest were 0.5% and 3%. The highest and lowest incidences of fetal bradycardia were 20% and 3%, and regarding fetal tachycardia, 5.4% and 1%, respectively. Conclusion: SARS-CoV-2 infection during pregnancy can potentially be associated with cardiovascular complications in the mother, particularly pre-eclampsia and heart failure. Moreover, SARS-CoV-2 infection during pregnancy can potentially cause cardiovascular complications in the fetus, particularly arrhythmia.
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Carneiro ICR, Feronato SG, Silveira GF, Chiavegatto Filho ADP, dos Santos HG. Clusters of Pregnant Women with Severe Acute Respiratory Syndrome Due to COVID-19: An Unsupervised Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13522. [PMID: 36294103 PMCID: PMC9603349 DOI: 10.3390/ijerph192013522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has been widely explored in relation to its symptoms, outcomes, and risk profiles for the severe form of the disease. Our aim was to identify clusters of pregnant and postpartum women with severe acute respiratory syndrome (SARS) due to COVID-19 by analyzing data available in the Influenza Epidemiological Surveillance Information System of Brazil (SIVEP-Gripe) between March 2020 and August 2021. The study's population comprised 16,409 women aged between 10 and 49 years old. Multiple correspondence analyses were performed to summarize information from 28 variables related to symptoms, comorbidities, and hospital characteristics into a set of continuous principal components (PCs). The population was segmented into three clusters based on an agglomerative hierarchical cluster analysis applied to the first 10 PCs. Cluster 1 had a higher frequency of younger women without comorbidities and with flu-like symptoms; cluster 2 was represented by women who reported mainly ageusia and anosmia; cluster 3 grouped older women with the highest frequencies of comorbidities and poor outcomes. The defined clusters revealed different levels of disease severity, which can contribute to the initial risk assessment of the patient, assisting the referral of these women to health services with an appropriate level of complexity.
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Nasa P, Juneja D, Jain R, Nasa R. COVID-19 and hemolysis, elevated liver enzymes and thrombocytopenia syndrome in pregnant women - association or causation? World J Virol 2022; 11:310-320. [PMID: 36188744 PMCID: PMC9523323 DOI: 10.5501/wjv.v11.i5.310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 02/05/2023] Open
Abstract
Pregnant women are among the high-risk population for severe coronavirus disease 2019 (COVID-19) with unfavorable peripartum outcomes and increased incidence of preterm births. Hemolysis, the elevation of liver enzymes, and low platelet count (HELLP) syndrome and severe preeclampsia are among the leading causes of maternal mortality. Evidence supports a higher odd of pre-eclampsia in women with COVID-19, given overlapping pathophysiology. Involvement of angiotensin-converting enzyme 2 receptors by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for the entry to the host cells and its downregulation cause dysregulation of the renin-angiotensin-aldosterone system. The overexpression of Angiotensin II mediated via p38 Mitogen-Activated Protein Kinase pathways can cause vasoconstriction and uninhibited platelet aggregation, which may be another common link between COVID-19 and HELLP syndrome. On PubMed search from January 1, 2020, to July 30, 2022, we found 18 studies on of SARS-COV-2 infection with HELLP Syndrome. Most of these studies are case reports or series, did not perform histopathology analysis of the placenta, or measured biomarkers linked to pre-eclampsia/HELLP syndrome. Hence, the relationship between SARS-CoV-2 infection and HELLP syndrome is inconclusive in these studies. We intend to perform a mini-review of the published literature on HELLP syndrome and COVID-19 to test the hypothesis on association vs causation, and gaps in the current evidence and propose an area of future research.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
- Department of Internal Medicine, College of Medicine and Health Sciences, Al Ain 17666, Abu Dhabi, United Arab Emirates
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Specialty Hospital Saket, New Delhi 110017, India
| | - Ravi Jain
- Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur 302001, India
| | - Ruchi Nasa
- Department of Pathology, Fakeeh University Hospital, Dubai 00000, United Arab Emirates
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Leon‐Sicairos N, Angulo‐Zamudio UA, Pacheco‐Avila M, Medina‐Ramirez I, Velazquez‐Roman J, Angulo‐Rocha J, Martínez‐Villa FA, Flores‐Villaseñor H, Martinez‐Garcia JJ, Sanchez‐Cuen J, Garzon‐Lopez O, Guel‐Gomez M, Cuen‐Diaz HM, Barajas‐Olivas MF, Campos‐Romero A, Alcántar‐Fernández J, Esparza MAL, Canizalez‐Roman A. Epidemiological and clinical characteristics of pregnant women and neonates with COVID-19 in Northwest Mexico. Am J Reprod Immunol 2022; 88:e13583. [PMID: 35661465 PMCID: PMC9348056 DOI: 10.1111/aji.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The SARS-CoV-2 virus, which causes COVID-19, has spread quickly worldwide, causing millions of cases and thousands of deaths. Some risk factors in the general population are related to the development of severe COVID-19 or death, but in pregnant women and neonates, the information is limited. OBJECTIVE To determine the epidemiological and clinical characteristics of pregnant women and neonates diagnosed with COVID-19 by RT-PCR and serological tests, and analyze the relationship between the influenza vaccination and COVID-19 symptoms in infected pregnant women in Sinaloa state. METHODS We collected samples from 116 pregnant women and 84 neonates from the Women´s Hospital of Sinaloa. They were diagnosed with COVID-19 by RT-PCR and serological tests (IgG), and sociodemographic, clinical and laboratory parameters were recorded. RESULTS A total of 11.2% (13/116) of the pregnant women were RT-PCR+, 25% (29/116) were IgG+ and 4.3% (5/116) were positive for both tests. Symptoms such as rhinorrhea (P = .04), cough (P = .02) and polypnea (P = .04) in pregnant women were related to COVID-19, also leukocyte index was higher in pregnant women with COVID-19 (P = .03), but the associations were lost after the Bonferroni correction. No laboratory parameters or underlying diseases were associated with COVID-19, and most infected pregnant women had mild cases. We found an association between the influenza vaccine and less common COVID-19 symptoms in pregnant women who were infected (P = .01). A total of 7.2% (6/84) of neonates were RT-PCR+, 35.7% (30/84) were IgG+, and there were no symptoms or underlying diseases associated with neonates who were infected. In conclusion, this work demonstrated that some symptoms were related to COVID-19, most pregnant women and neonates had mild cases, and the influenza vaccine could decrease the severity of COVID-19 cases in pregnant women.
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Affiliation(s)
- Nidia Leon‐Sicairos
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- Pediatric Hospital of SinaloaCuliacanSinaloaMexico
| | | | | | | | | | | | | | - Hector Flores‐Villaseñor
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- The Sinaloa State Public Health LaboratorySecretariat of HealthCuliacanSinaloaMexico
| | - Jesus J. Martinez‐Garcia
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- Pediatric Hospital of SinaloaCuliacanSinaloaMexico
| | - Jaime Sanchez‐Cuen
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
| | | | | | | | | | | | | | | | - Adrian Canizalez‐Roman
- CIASaPSchool of MedicineAutonomous University of SinaloaCuliacanSinaloaMexico
- The Women's Hospital, Secretariat of HealthCuliacanSinaloaMexico
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42
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Leung C, Simões e Silva AC, Oliveira EA. Are in-hospital COVID-19-related mortality and morbidity in pregnancy associated with gestational age? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:234-242. [PMID: 35502537 PMCID: PMC9347440 DOI: 10.1002/uog.24931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pregnancy involves dynamic changes in the maternal immune system, thus potentially affecting women's response to infection. The aim of this study was to investigate whether gestational age at the time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with mortality and morbidity related to coronavirus disease 2019 (COVID-19) in hospitalized pregnant women. METHODS This was a cohort study of pregnant women with confirmed SARS-CoV-2 infection at any gestational age (categorized into trimesters) who were hospitalized in Brazil from February 2020 to November 2021. Sociodemographic and epidemiological characteristics, signs and symptoms, comorbidities, interventions, vaccination status and type of healthcare establishment were obtained from a nationwide database. Multivariate logistic and Cox regression analyses were used to identify independent risk factors for in-hospital COVID-19-related mortality and morbidity (defined as time from hospital admission to recovery). RESULTS A total of 7461 SARS-CoV-2-infected pregnant women were included in the study (9.3%, 28.4% and 62.3% in the first, second and third trimesters, respectively). After adjustment for sociodemographic, epidemiological and clinical characteristics, and intervention-related variables, gestational age at infection was found not to be associated with COVID-19-related mortality and morbidity. Women admitted to establishments with an obstetric center, compared to hospitals without, were 38% less likely to die from SARS-CoV-2 infection (adjusted odds ratio, 0.62; 95% CI, 0.48-0.80), while patients who received private not-for-profit healthcare had a 13% shorter time to recovery (adjusted hazard ratio, 1.13; 95% CI, 1.07-1.20) compared to those who received public healthcare. CONCLUSIONS Despite a higher percentage of women being admitted in the third trimester, we found no association between gestational age and COVID-19 mortality and morbidity. The previously reported increase in morbidity and mortality in the third trimester in pregnant women with COVID-19 may be attributable to other gestational-age-affected variables for which adjustment was made in our study. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Leung
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
- Deakin UniversityBurwoodVictoriaAustralia
| | - A. C. Simões e Silva
- Department of Pediatrics, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
| | - E. A. Oliveira
- Department of Pediatrics, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
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Twitchell DK, Christensen MB, Hackett G, Morgentaler A, Saad F, Pastuszak AW. Examining Male Predominance of Severe COVID-19 Outcomes: A Systematic Review. ANDROGENS: CLINICAL RESEARCH AND THERAPEUTICS 2022; 3:41-53. [PMID: 36199281 PMCID: PMC9527649 DOI: 10.1089/andro.2022.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 05/26/2023]
Abstract
Although not universal, many epidemiological data sources signal that a higher proportion of males than females with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections have adverse outcomes, such as intensive care unit (ICU) admission and death. Though likely multifactorial, the various hypotheses that have been proposed as underlying factors behind this trend are related to greater smoking prevalence among males, testosterone (T) deficiency causing an inflammatory storm, androgen-driven pathogenesis of SARS-CoV-2, a protective effect of estrogen in females, and inborn errors of cytokine immunity. This review aims at examining the evidence and at assessing the likelihood that the factors being investigated are contributory to the reported trend of male predominance of severe COVID-19 cases. Sources were obtained using the PubMed database and were selected based on their relevance to one of the primary hypotheses attempting to explain the strong male sex bias of severe SARS-CoV-2 infections. Emphasis was placed on meta-analyses and population-based studies. Sources are current through February 22, 2022. A severe COVID-19 case or outcome is defined in this review as a progression of the SARS-CoV-2 virus that results in either admission to an ICU for management of symptoms and clinical stabilization or which leads to death. Although the trend of male predominance of severe COVID-19 cases is likely multifactorial, the hypothesis of T deficiency causing an inflammatory storm has support from many studies with limited conflicting evidence. An inborn error in cytokine immunity is also well supported, but it needs more studies to add support to the hypothesis. The immunologic protective effect of estrogen is supported by multiple studies, but it also has conflicting evidence. It appears less likely that the trend is caused solely by an increased prevalence of smoking among males or an androgen-driven pathogenesis, based on the extent of conflicting evidence.
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Affiliation(s)
| | - Michael B. Christensen
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Geoffrey Hackett
- Department of Men's Health, Little Aston Hospital, Sutton Coldfield, United Kingdom
| | - Abraham Morgentaler
- Division of Urology, Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Farid Saad
- Department of Men's Health Research, Gulf Medical University, Ajman, UAE
| | - Alexander W. Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Vaivada T, Lassi ZS, Irfan O, Salam RA, Das JK, Oh C, Carducci B, Jain RP, Als D, Sharma N, Keats EC, Patton GC, Kruk ME, Black RE, Bhutta ZA. What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 years. Lancet 2022; 399:1810-1829. [PMID: 35489360 DOI: 10.1016/s0140-6736(21)02725-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Progress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, which has contributed to a decrease in child mortality and morbidity. However, inequities remain, and many children and adolescents are still not covered by life-saving and nurturing care interventions, despite their relatively low costs and high cost-effectiveness. This Series paper builds on a large body of work from the past two decades on evidence-based interventions and packages of care for survival, strategies for delivery, and platforms to reach the most vulnerable. We review the current evidence base on the effectiveness of a variety of essential and emerging interventions that can be delivered from before conception until age 20 years to help children and adolescents not only survive into adulthood, but also to grow and develop optimally, support their wellbeing, and help them reach their full developmental potential. Although scaling up evidence-based interventions in children younger than 5 years might have the greatest effect on reducing child mortality rates, we highlight interventions and evidence gaps for school-age children (5-9 years) and the transition from childhood to adolescence (10-19 years), including interventions to support mental health and positive development, and address unintentional injuries, neglected tropical diseases, and non-communicable diseases.
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Affiliation(s)
- Tyler Vaivada
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zohra S Lassi
- Robinson Research Institute and Adelaide Medical School, the University of Adelaide, SA, Australia; Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Omar Irfan
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Christina Oh
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bianca Carducci
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Reena P Jain
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daina Als
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Naeha Sharma
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Emily C Keats
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Johns Hopkins University, MD, USA
| | - Zulfiqar A Bhutta
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
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Abstract
Pregnant women with covid-19 are at greater risk of severe disease than their non-pregnant peers, and yet they are frequently denied investigations or treatments because of unfounded concerns about risk to the fetus. The basic principles of diagnosing and managing covid-19 are the same as for non-pregnant patients, and a multidisciplinary, expert team approach is essential to ensure optimal care. During pregnancy, treatment with corticosteroids should be modified to use non-fluorinated glucocorticoids. Il-6 inhibitors and monoclonal antibodies, together with specific antiviral therapies, may also be considered. Prophylaxis against venous thromboembolism is important. Women may require respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position (either awake or during invasive ventilation), intubation and ventilation, and extracorporeal membrane oxygenation (ECMO). Pregnancy is not a contraindication for any of these supportive therapies, and the criteria for providing them are the same as in the general population. Decisions regarding timing, place, and mode of delivery should be taken with a multidisciplinary team including obstetricians, physicians, anesthetists, and intensivists experienced in the care of covid-19 in pregnancy. Ideally these decisions should take place in consultation with centers that have experience and expertise in all these specialties.
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Affiliation(s)
- Melanie Nana
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Kenneth Hodson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Magalhães JE, Sampaio‐Rocha‐Filho PA. Pregnancy and neurologic complications of COVID-19: A scoping review. Acta Neurol Scand 2022; 146:6-23. [PMID: 35388457 PMCID: PMC9111489 DOI: 10.1111/ane.13621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
While neurologic complications are frequently reported among patients with COVID‐19 in the general population, they are unknown in pregnant women. This paper summarizes the case reports of pregnant women with confirmed SARS‐CoV‐2 infection plus a specified neurologic diagnosis. Until November 2021, 18 case reports were found. Both the central and peripheral nervous systems were equally affected: delirium (n = 1), posterior reversible encephalopathy syndrome (n = 4), cerebrovascular disease (n = 2), acute cerebral demyelinating disease (n = 1), acute necrotizing encephalopathy (n = 1), Guillain–Barré syndrome (n = 5), including one patient who also had vestibular neuritis, Bell's palsy (n = 3), and rhabdomyolysis (n = 1). The median maternal age was 32.5 (25—35) years, the median gestational age was 34 (30—36.5) weeks, and 38.9% presented previous medical conditions. Respiratory symptoms were reported in 76.5%, and 76.5% received immunotherapies to treat the COVID‐19 or the neurologic complications. Half the women required admission to ICU and, more often, were those with central nervous system involvement (77.8% vs. 22.2%; Chi‐square test, p = .018). For 64.7% of women, the most common method of delivery was surgical, although just one case was due to the neurologic complication. There were reports of one spontaneous abortion, two fetal deaths, and no maternal deaths. Only one case presented a poor neurologic outcome. It is possible that our findings are underestimated, considering that there are thousands of reports regarding neurologic complications in the general population with COVID‐19.
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Affiliation(s)
- João Eudes Magalhães
- Department of Neurology Faculdade de Ciências Médicas—Universidade de Pernambuco Recife Brazil
- Instituto de Medicina Integral Professor Fernando Figueira Recife Brazil
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47
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Coté JJ, Granger P, Mishra A, Sorini G. COVID-19 in a pregnant cystic fibrosis carrier with myasthenia gravis: A case report. Case Rep Womens Health 2022; 34:e00406. [PMID: 35340780 PMCID: PMC8940761 DOI: 10.1016/j.crwh.2022.e00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
A 16-year-old primigravida was diagnosed with COVID-19 in her second trimester. She decompensated quickly and had to be admitted to hospital and intubated. She was diagnosed with a fetal demise after being intubated and neurology suspected myasthenia gravis due to neurologic symptoms. Due to pan-sinusitis and increased mucus secretion, cystic fibrosis screening was ordered. After she was extubated, cervical ripening and induction was performed with eventual vaginal delivery without maternal complications. Myasthenia gravis and cystic fibrosis carrier status were confirmed after the patient was discharged. Cystic fibrosis carrier status may increase the risk for severe COVID-19. COVID-19 and myasthenia gravis in pregnancy may change treatment options. Cystic fibrosis screening may be recommended to improve maternal outcomes.
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Affiliation(s)
- John J Coté
- Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE, USA
| | - Peter Granger
- Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE, USA
| | - Anjali Mishra
- Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE, USA
| | - Giavanna Sorini
- PA Program, University of Texas Medical Branch at Galveston School of Medicine, Galveston, TX, USA
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48
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Manti S, Leonardi S, Rezaee F, Harford TJ, Perez MK, Piedimonte G. Effects of Vertical Transmission of Respiratory Viruses to the Offspring. Front Immunol 2022; 13:853009. [PMID: 35359954 PMCID: PMC8963917 DOI: 10.3389/fimmu.2022.853009] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.
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Affiliation(s)
- Sara Manti
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Fariba Rezaee
- Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
- Center for Pediatric Pulmonology, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Terri J. Harford
- Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Miriam K. Perez
- Department of General Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Giovanni Piedimonte
- Department of Pediatrics, Biochemistry and Molecular Biology, Tulane University, New Orleans, LA, United States
- *Correspondence: Giovanni Piedimonte,
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49
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Pérez-López FR, Savirón-Cornudella R, Chedraui P, López-Baena MT, Pérez-Roncero G, Sanz-Arenal A, Narváez-Salazar M, Dieste-Pérez P, Tajada M. Obstetric and perinatal outcomes of pregnancies with COVID 19: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022; 35:9742-9758. [PMID: 35282784 DOI: 10.1080/14767058.2022.2051008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This meta-analysis aimed at comparing obstetric and perinatal outcomes in laboratory-tested pregnant women for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before delivering. METHOD We performed a comprehensive systematic review of electronic databases for studies reporting pregnant women with and without SARS-CoV-2 infection, as determined by polymerase chain reaction (PCR) before delivery, during the pandemic period published up to June 25, 2021. Results are reported as mean difference (MD) or odds ratio (OR) and their 95% confidence interval (CI). RESULTS Seventeen observational studies with low to moderate risk of bias, reported on 2,769 pregnant women with a positive SARS-CoV-2 PCR test and 13,807 with a negative test. Pregnant women with a positive PCR test delivered at an earlier gestational age (MD -0.19; 95% CI -0.36 to -0.02 weeks), smoked less (OR 0.75; 95% CI 0.61-0.94) and were associated with higher odds for preeclampsia (OR 1.30; 95% CI 1.09-1.54), NICU admissions (OR 2.37; 95% CI 1.18-4.76), stillbirths (OR 2.70; 95% CI, 1.38-5.29), and perinatal mortality (OR 3.23; 95% CI 1.23-8.52). There were no significant differences between positive and negative tested women in terms of nulliparity, multiple pregnancies, gestational diabetes, route of delivery, labor induction, preterm birth, infant birth weight, 5 min Apgar scores < 7, small-for-gestational-age infants and fetal malformations. Eleven studies included neonatal PCR SARS-CoV-2 testing which was performed on 129 infants, of which 20 were positive. CONCLUSION Positive SARS-CoV-2 tested pregnant women had higher odds for preeclampsia/hypertensive disorders of pregnancy, NICU admissions, stillbirths and perinatal mortality.
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Affiliation(s)
- Faustino R Pérez-López
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | | | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral & Laboratorio de Biomedicina, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | | | | | - Ana Sanz-Arenal
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marta Narváez-Salazar
- Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Peña Dieste-Pérez
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Mauricio Tajada
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.,Faculty of Medicine, University of Zaragoza, Zaragoza, Spain.,Department of Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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50
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Investigating the association between severity of COVID-19 infection during pregnancy and neonatal outcomes. Sci Rep 2022; 12:3024. [PMID: 35194128 PMCID: PMC8863811 DOI: 10.1038/s41598-022-07093-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Pregnant women with COVID-19 require special attention and care, since the infection does not only affect the mother, but also her neonate and adversely affects pregnancy outcomes. The main goal of this retrospective cohort study is to investigate association between the maternal COVID-19 severity and risk of developing adverse neonatal outcomes. Patients were stratified into asymptomatic/mild and moderate to severe COVID-19. The following neonatal outcomes were assessed: gestational age at the time of delivery, birth weight, neonatal infection, neonatal intensive care unit (NICU) admission. The average age of patients was 28.5 ± 1.4 years old and majority were multigravida (74.0%, n = 148). Of total 200 pregnant women with COVID-19, 26.5% (n = 53) had moderate/severe disease and presented with higher incidence of preterm delivery and low birth weight (88.7%, n = 47; p < 0.001). In addition, more than half of the newborns delivered by mothers with severe disease were infected by SARS-COV-2 (58.5%, n = 31) and majority were admitted to the NICU (95.0%, n = 52). Based on the multivariate logistic regression analysis, pregnant women with moderate to severe COVID-19 were at much higher risk of preterm delivery, lower birth weight, neonatal infection, as well as neonatal ICU admission (p < 0.001). In addition, multigravida women were at higher risk for preterm delivery and lower birth weight (p = 0.017 and p = 0.02; respectively). Appropriate protective measures and early detection of suspected COVID-19 should be addressed for more favorable obstetric outcomes.
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