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Vasarri MV, Fernicola F, Arienti F, Carli A, Colciago E, Locatelli A, Trotta M, Procopio A, Zammarchi L, Ornaghi S. Indirect impact of SARS-CoV-2 pandemic on incidence of maternal primary cytomegalovirus and Toxoplasma gondii infection in pregnancy. Int J Gynaecol Obstet 2024. [PMID: 38619337 DOI: 10.1002/ijgo.15534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Public health interventions promoted during the SARS-CoV-2 pandemic to control viral spread have impacted the occurrence of other communicable disease. Yet no studies have focused on perinatal infections with the potential for neonatal sequelae, including cytomegalovirus (CMV) and Toxoplasma gondii (TG). Here we investigate whether incidence rates of maternal primary CMV and TG infection in pregnancy were affected by the implementation of pandemic-related public health measures. METHODS A retrospective study including all pregnant women with confirmed primary CMV or TG infection in pregnancy, managed between 2018 and 2021 at two university centers. The incidence rate was calculated as the number of CMV and TG infections per 100 consultations with a 95% confidence interval (CI). Data were compared between pre-pandemic (2018-2019) and pandemic (2020 and 2021) years. The Newcombe Wilson with Continuity Correction method was employed to compare incidence rates. RESULTS The study population included 215 maternal primary CMV and 192 TG infections. Rate of maternal primary CMV infection decreased in 2021 compared with 2018-2019 (4.49% vs 6.40%, attributable risk [AR] 1.92, P = 0.019). By contrast, the rate of TG infection substantially increased in 2020 (6.95% vs 4.61%, AR 2.34, P = 0.006). Close contact with cats was more common among patients with TG infection in 2020 and 2021 than among pre-pandemic TG-infected women (26.3% and 24.4% vs 13.3%, P = 0.013). CONCLUSION Pandemic-related public health interventions and associated behavioral and lifestyle changes exerted a divergent effect on the incidence of primary CMV and TG infection in pregnancy, likely due to modulation of exposure to risk factors for these infections.
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Affiliation(s)
- Maria Viola Vasarri
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Federica Fernicola
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Arienti
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Anna Carli
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Anna Locatelli
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Michele Trotta
- Tuscany Referral Centre for Infectious Diseases in Pregnancy, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Angelica Procopio
- School of Human Health Sciences, Degree Course in Medicine and Surgery, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Tuscany Referral Centre for Infectious Diseases in Pregnancy, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Ornaghi
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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2
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Mihajlovic S, Nikolic D, Milicic B, Santric-Milicevic M, Glushkova N, Nurgalieva Z, Lackovic M. Association of Pre-Pregnancy Obesity and COVID-19 with Poor Pregnancy Outcome. J Clin Med 2023; 12:jcm12082936. [PMID: 37109271 PMCID: PMC10144693 DOI: 10.3390/jcm12082936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index with clinical, laboratory, and radiology diagnostic parameters as well as pregnancy complications and maternal outcomes in pregnant patients with COVID-19. MATERIALS AND METHODS Clinical status, laboratory, and radiology diagnostic parameters and pregnancy outcomes were analyzed for pregnant women hospitalized between March 2020 and November 2021 in one tertiary-level university clinic in Belgrade, Serbia, due to infection with SARS-CoV-2. Pregnant women were divided into the three sub-groups according to their pre-pregnancy body mass index. For testing the differences between groups, a two-sided p-value <0.05 (the Kruskal-Wallis and ANOVA tests) was considered statistically significant. RESULTS Out of 192 hospitalized pregnant women, obese pregnant women had extended hospitalizations, including ICU duration, and they were more likely to develop multi-organ failure, pulmonary embolism, and drug-resistant nosocomial infection. Higher maternal mortality rates, as well as poor pregnancy outcomes, were also more likely to occur in the obese group of pregnant women. Overweight and obese pregnant women were more likely to develop gestational hypertension, and they had a higher grade of placental maturity. CONCLUSIONS Obese pregnant women hospitalized due to COVID-19 infection were more likely to develop severe complications.
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Affiliation(s)
- Sladjana Mihajlovic
- University Hospital "Dragisa Misovic", Heroja Milana Tepica 1, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children's Hospital, 11000 Belgrade, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milena Santric-Milicevic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Center-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Natalya Glushkova
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty 050044, Kazakhstan
| | - Zhansaya Nurgalieva
- Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty 050044, Kazakhstan
| | - Milan Lackovic
- University Hospital "Dragisa Misovic", Heroja Milana Tepica 1, 11000 Belgrade, Serbia
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Attini R, Laudani ME, Versino E, Massaro A, Pagano A, Petey F, Revelli A, Masturzo B. COVID-19 in Pregnancy: Influence of Body Weight and Nutritional Status on Maternal and Pregnancy Outcomes-A Review of Literature and Meta-Analysis. Nutrients 2023; 15:nu15041052. [PMID: 36839410 PMCID: PMC9962478 DOI: 10.3390/nu15041052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
In the last two and a half years, COVID-19 has been one of the most challenging public health issues worldwide. Based on the available evidence, pregnant women do not appear to be more susceptible to infection than the general population but having COVID-19 during pregnancy may increase the risk of major complications for both the mother and the fetus. The aim of this study is to identify the correlation between BMI and nutritional status and the likelihood of contracting COVID-19 infection in pregnancy, its severity, and maternal pregnancy outcomes. We carry out a systematic literature search and a meta-analysis using three databases following the guidelines of the Cochrane Collaboration. We include 45 studies about COVID-19-positive pregnant women. Compared with normal-weight pregnant women with COVID-19, obesity is associated with a more severe infection (OR = 2.32 [1.65-3.25]), increased maternal death (OR = 2.84 [2.01-4.02]), and a higher rate of hospital admission (OR = 2.11 [1.37-3.26]). Obesity may be associated with adverse maternal and pregnancy outcomes by increasing symptom severity and, consequently, hospital and Intensive Care Unit (ICU) admission, and, finally, death rates. For micronutrients, the results are less definite, even if there seems to be a lower level of micronutrients, in particular Vitamin D, in COVID-19-positive pregnant women.
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Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
- Correspondence:
| | - Maria Elena Laudani
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Elisabetta Versino
- Department of Clinical and Biological Sciences, University of Turin, 10100 Turin, Italy
- Centre for Biostatistics, Epidemiology and Public Health (C-BEPH), 10100 Turin, Italy
| | - Alessio Massaro
- Department of Obstetrics and Gynecology SC1U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Arianna Pagano
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Francesca Petey
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Alberto Revelli
- Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant’Anna Hospital, 10126 Turin, Italy
| | - Bianca Masturzo
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
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4
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Morris R, Moustafa AS, Kassahun-yimer W, Novotny S, Billsby B, Abbas A, Wallace K. COVID-19 not Hypertension or Diabetes increases the risk of Preeclampsia among a high-risk population. Pregnancy Hypertens 2023. [DOI: 10.1016/j.preghy.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Di Martino DD, Soldavini CM, Rossi G, Lonardoni MC, Tinè G, Caneschi A, D’Ambrosi F, Ferrazzi E. The sFlt-1/PlGF Ratio in Patients Affected by Gestational Diabetes and SARS-CoV-2 Infection. Metabolites 2022; 13:metabo13010054. [PMID: 36676978 PMCID: PMC9866868 DOI: 10.3390/metabo13010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Low values of the ratio of plasmatic soluble blocking factor FMS-like tyrosine Kinase 1 and placental growth factor (sFlt-1/PlGF) are required for an adequate placental angiogenesis and function. It has been shown that patients affected by gestational diabetes (GD) and patients with pneumonia from SARS-CoV-2 are characterized by an increased sFlt-1/PlGF ratio. The aim of the present study was to evaluate the sFlt-1-PlGF ratio in pregnancies complicated by COVID-19 and GD. We compared the plasmatic sFlt-1/PlGF ratio among the following groups of pregnant women: COVID-19, GD patients; COVID-19, non-GD patients; non-COVID-19, GD patients; and non-COVID-19, non-GD controls. We enrolled 62 women in the present study, who were divided as follows: 14 COVID-19, GD patients; 12 COVID-19, non-GD patients; 11 non-COVID-19, GD patients; and 25 non-COVID-19, non-GD controls. The COVID-19, GD patients presented a higher pre-pregnancy BMI, a higher prevalence of hypertensive disorders of pregnancy as a co-morbidity, and an increased need for medication for their diabetes. Neonatal data were similar between the groups. The controls showed a significantly lower sFlt-1/PlGF ratio compared to pregnancies complicated by GD and SARS-CoV-2 infection. The sFlt-1/PlGF ratio was higher in patients affected by both GD and SARS-CoV-2 infection; these subjects were characterized by a greater incidence of obesity and hypertensive disorders of pregnancy.
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Affiliation(s)
- Daniela Denis Di Martino
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Chiara Maria Soldavini
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gabriele Rossi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Chiara Lonardoni
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gabriele Tinè
- Department of Economics and Quantitative Methods, University of Milano Bicocca, 20900 Monza, Italy
| | - Agnese Caneschi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesco D’Ambrosi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Enrico Ferrazzi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, 20122 Milan, Italy
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6
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Morris R, Moustafa ASZ, Kassahun-Yimer W, Novotny S, Billsby B, Abbas A, Wallace K. COVID-19 Not Hypertension or Diabetes Increases the Risk of Preeclampsia among a High-Risk Population. Int J Environ Res Public Health 2022; 19:16631. [PMID: 36554511 PMCID: PMC9779111 DOI: 10.3390/ijerph192416631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has been associated with greater morbidity and increased mortality in certain populations, such as those with chronic medical conditions, the elderly, and pregnant women. Our goal was to determine if COVID-19 infection during pregnancy increased the risk of preeclampsia in a population of women with increased risk factors for preeclampsia. We present a prospective observational matched case-control study of 100 deliveries with confirmed SARS-CoV2. Specifically, we investigated the maternal and neonatal outcomes in a high-risk population of pregnant women. Among women with COVID-19, the severity of symptoms was associated with the incidence of preeclampsia, but not with pre-existing diabetes or hypertension. Women with more severe symptoms were more likely to delivery pre-term with smaller babies. After adjusting for diabetes, hypertensive women with COVID-19 had an increased risk of preeclampsia aOR4.3 [1.5,12.4] compared to non-hypertensive women with COVID-19. After adjusting for hypertension, women with diabetes and COVID-19 had an increased risk of preeclampsia aOR3.9 [1.2,12.5]. This relationship was not seen among women without COVID-19. For women who had pre-existing diabetes or hypertension, the risk of developing preeclampsia was only increased if they were also diagnosed with COVID-19, suggesting that in our population of women the risk of preeclampsia is not associated with pre-existing diabetes or hypertension.
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Affiliation(s)
- Rachael Morris
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Ahmed S. Z. Moustafa
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | - Sarah Novotny
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Brittney Billsby
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Amira Abbas
- School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kedra Wallace
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Pharmacology & Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Myrlie Evers-Williams Institute for Elimination of Health Disparities, Jackson, MS 39213, USA
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7
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Santa S, Doku DA, Olwal CO, Brown CA, Tagoe EA, Quaye O. Paradox of COVID-19 in pregnancy: are pregnant women more protected against or at elevated risk of severe COVID-19? Future Microbiol 2022; 17:803-812. [PMID: 35510478 PMCID: PMC9070559 DOI: 10.2217/fmb-2021-0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Many underlying medical conditions have been linked to worse COVID-19 prognosis. Based on reports on SARS-CoV-1 and Middle East respiratory syndrome infections, pregnancy has been considered a predisposing factor to severe COVID-19, with pregnant women being a high-risk group for several physiological reasons. Specifically, pregnant women undergo physiological adaptations that predispose them to severe respiratory viral diseases, including SARS-CoV-2. However, a significant amount of evidence suggests that the clinical outcome of COVID-19 among pregnant women is not different from the general population. In view of this, this report discusses the physiological conditions in pregnant women that adversely affect their immunity, cardiovascular homeostasis, and their endothelial and coagulopathic functions, thereby making them more prone to severe viral infections. We also discuss how these physiological adaptations appear to paradoxically offer protection against severe COVID-19 among pregnant women.
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Affiliation(s)
- Sheila Santa
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.,Department of Biochemistry, Cell & Molecular Biology, College of Basic & Applied Sciences, University of Ghana, Accra, Ghana.,Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana
| | - Derek A Doku
- Department of Biochemistry, Cell & Molecular Biology, College of Basic & Applied Sciences, University of Ghana, Accra, Ghana.,Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana.,West African Genetic Medicine Center, University of Ghana, Accra, Ghana
| | - Charles O Olwal
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.,Department of Biochemistry, Cell & Molecular Biology, College of Basic & Applied Sciences, University of Ghana, Accra, Ghana
| | - Charles A Brown
- Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana
| | - Emmanuel A Tagoe
- Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana
| | - Osbourne Quaye
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana.,Department of Biochemistry, Cell & Molecular Biology, College of Basic & Applied Sciences, University of Ghana, Accra, Ghana
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8
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Kim HM, Kwon KT, Cha HH, Seong WJ, Kim MJ. Prediction of Adverse Outcomes among Women in the Third Trimester of Pregnancy with Coronavirus Disease 2019. Infect Chemother 2022; 54:493-503. [PMID: 36196608 PMCID: PMC9533151 DOI: 10.3947/ic.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to compare the clinical and laboratory characteristics of two groups of women (favorable and adverse outcome groups) in the third trimester of pregnancy with coronavirus disease 2019 (COVID-19) and to investigate the predictors of specific adverse outcomes. Materials and Methods We retrospectively reviewed the medical records of patients hospitalized with COVID-19 between November 2020 and October 2021 at Kyungpook National University Chilgok Hospital. Adverse outcomes were clinically defined using the Novel Coronavirus Pneumonia Emergency Response Epidemiology Team criteria. The group without adverse outcomes was defined as the “favorable outcome” group and the rest as the “adverse outcome” group. We compared the clinical characteristics between the two groups and examined the correlation between their laboratory results and adverse outcomes. Results Of the 70 pregnant women included, 37 were in their third trimester. No significant differences in clinical characteristics, except the length of hospitalization, were noted between the groups. In laboratory tests conducted immediately after hospitalization, C-reactive protein (CRP) (1.0 [0.3 - 1.4] vs. 2.3 [1.3 - 3.6], P = 0.001) and ferritin (25.0 [14.5 - 34.5] vs. 53.1 [36.0 - 98.0], P <0.03) levels were significantly different between the groups. Logistic regression analysis revealed that CRP (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.09 - 5.51, P = 0.040) and ferritin (OR: 1.06; 95% CI: 1.01 - 1.15, P = 0.047) levels were predictors of adverse outcomes. Conclusion CRP and ferritin levels are associated with poor prognosis and can predict adverse outcomes in women with COVID-19 in the third trimester of pregnancy.
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Affiliation(s)
- Hyun Mi Kim
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mi Ju Kim
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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9
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Galang RR, Newton SM, Woodworth KR, Griffin I, Oduyebo T, Sancken CL, Olsen EO, Aveni K, Wingate H, Shephard H, Fussman C, Alaali ZS, Silcox K, Siebman S, Halai UA, Lopez CD, Lush M, Sokale A, Barton J, Chaudhary I, Patrick PH, Schlosser L, Reynolds B, Gaarenstroom N, Chicchelly S, Read JS, de Wilde L, Mbotha D, Azziz-Baumgartner E, Hall AJ, Tong VT, Ellington S, Gilboa SM. Risk Factors for Illness Severity Among Pregnant Women With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 Infection-Surveillance for Emerging Threats to Mothers and Babies Network, 22 State, Local, and Territorial Health Departments, 29 March 2020-5 March 2021. Clin Infect Dis 2021; 73:S17-S23. [PMID: 34021332 PMCID: PMC8194562 DOI: 10.1093/cid/ciab432] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with SARS-CoV-2 infection. Methods Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during March 29, 2020–March 5, 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. Results Among 7,950 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 25 years and older, healthcare occupation, pre-pregnancy obesity, chronic lung disease, chronic hypertension, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. Conclusions Older age and having underlying medical conditions were associated with increased risk of moderate-to-severe or critical COVID-19 illness among pregnant women. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and inform targeted public health messaging.
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Affiliation(s)
- Romeo R Galang
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M Newton
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate R Woodworth
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isabel Griffin
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Titilope Oduyebo
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina L Sancken
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily O'Malley Olsen
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn Aveni
- Division of Family Health Services, New Jersey Department of Health, Trenton, New Jersey, USA
| | - Heather Wingate
- Communicable and Environmental Disease and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Hanna Shephard
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Chris Fussman
- Maternal and Child Health Epidemiology Section, Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Zahra S Alaali
- Division of Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Kristin Silcox
- Maternal and Child Health Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Samantha Siebman
- Emerging Infections Program, Minnesota Department of Health, St Paul, Minnesota, USA
| | - Umme-Aiman Halai
- Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Camille Delgado Lopez
- Division of Children With Special Medical Needs, Puerto Rico Department of Health, San Juan, Puerto Rico, USA
| | - Mamie Lush
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, USA
| | - Ayomide Sokale
- Division of Maternal, Child and Family Health, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Jerusha Barton
- Epidemiology Division, Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Ifrah Chaudhary
- Division of Disease Prevention and Control, Houston Health Department, Houston, Texas, USA
| | - Paul H Patrick
- Perinatal and Reproductive Health Division, Oklahoma State Department of Health, Oklahoma City, Oklahoma, USA
| | - Levi Schlosser
- Division of Disease Control, North Dakota Department of Health, Bismarck, North Dakota, USA
| | - Bethany Reynolds
- Bureau of Epidemiology, Pennsylvania Department of Health, Pittsburgh, Pennsylvania, USA
| | | | - Sarah Chicchelly
- Infectious Disease Epidemiology and Response, Kansas Department of Health and Environment, Topeka, Kansas, USA
| | - Jennifer S Read
- Infectious Disease Epidemiology, Vermont Department of Health, Burlington, Vermont, USA.,Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Leah de Wilde
- Epidemiology Division, US Virgin Islands Department of Health, Christiansted, St Croix, US Virgin Islands
| | - Deborah Mbotha
- Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, Washington, USA
| | | | - Aron J Hall
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Van T Tong
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha Ellington
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M Gilboa
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Cesano N, D'Ambrosi F, Cetera GE, Carbone IF, Di Maso M, Ossola MW, Iurlaro E, Ferrazzi E. Maternity ward management and COVID-19 pandemic: Experience of a single center in Northern Italy during lockdown. Eur J Midwifery 2021; 5:29. [PMID: 34316547 PMCID: PMC8288518 DOI: 10.18332/ejm/137605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim of our study is to describe the management of a maternity ward in a referral center during the COVID-19 pandemic and 2020 lockdown. METHODS This is a retrospective single-center study. We analyzed the records of all women consecutively admitted to our delivery ward during lockdown and compared them with those of women admitted in the same period in 2019. RESULTS The number of patients (1260) admitted to our department in 2020 was similar (1215) to that in 2019. Among patients admitted during lockdown, 50 presented with a Sars-CoV-2 infection (3.9%). In 2020, the number of antenatal check-ups was lower than in 2019 [7.9 (1.5) vs 8.2 (1.3), p<0.001] and the rate of labor inductions was higher [436 (34.6) vs 378 (31.1), p=0.008] although no difference in delivery mode was found. Moreover, women admitted during lockdown were more likely to give birth alone [140 (11.1) vs 50 (4.1), p<0.001]. However, during 2020, the rate of mother and newborn skinto-skin contact [1036 (82.2) vs 897 (73.8), p<0.001] and that of breastfeeding within 2 hours from birth [1003 (79.6) vs 830 (68.3), p<0.001] was higher. We found no significant differences in maternal or neonatal outcomes. CONCLUSIONS Despite the COVID-19 pandemic, we were able to guarantee a safe birth assistance to all pregnant women, both for those infected and those not infected by Sars-CoV-2.
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Affiliation(s)
- Nicola Cesano
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Co-first authors
| | - Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Co-first authors
| | - Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilma F Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Maso
- Branch of Medical Statistics, Biometry and Epidemiology 'G.A. Maccacaro', Department of Clinical Sciences and Community Health, Faculty of Medicine, University of Milan, Milan, Italy
| | - Manuela W Ossola
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Iurlaro
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Faculty of Medicine, University of Milan, Milan, Italy
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11
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Franchini M, Prefumo F, Grisolia G, Bergamini V, Glingani C, Pisello M, Presti F, Zaffanello M. Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review. Viruses 2021; 13:1194. [PMID: 34206468 PMCID: PMC8310344 DOI: 10.3390/v13071194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 12/23/2022] Open
Abstract
The treatment of COVID-19 is particularly critical in pregnant women, considering the potential teratogenic effects of antiviral agents and the immune-depression related with pregnancy. The aim of this review is to systematically examine the current evidence on the clinical use of convalescent plasma during pregnancy. The electronic databases Medline PubMed Advanced Search Builder, Scopus, Web Of Science and Google Scholar were searched (until 1 January 2021). Inclusion criteria were pregnant women with COVID-19 (or SARS-CoV-2 infection), in whom convalescent plasma (or hyperimmune plasma) was used as treatment. We searched clinical trial registries (censored 5 January 2021) for eligible studies under way. After elimination of duplications, the initial search yielded 79 potentially relevant records, of which 67 were subsequently excluded. The 12 remaining records were case reports involving 12 pregnancies. Six of the mothers were reported to be well, two were reported to have preeclampsia, and in one case each the maternal outcome was described as survival, clinical improvement, discharged with oxygen and rehabilitation. With regard to the neonates, two were declared to be well, four had transient morbidity, two were critically ill and one died; normal ongoing pregnancies, but no post-delivery information, were reported for the remaining three cases. Clinical trials under way or planned to investigate the use of convalescent plasma for COVID-19 during pregnancy are lacking. This is the first systematic review of the literature regarding the treatment of COVID-19 in pregnancy. The published literature data seem to indicate that convalescent plasma administered to pregnant women with severe COVID-19 provides benefits for both the mother and the fetus. The quality of the available studies is, however, very limited since they are all case reports and thus suffer from relevant reporting bias.
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, I-46100 Mantova, Italy; (M.F.); (C.G.)
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, I-25123 Brescia, Italy;
| | - Gianpaolo Grisolia
- Obstetrics and Gynecology Unit, Carlo Poma Hospital, I-46100 Mantova, Italy; (G.G.); (M.P.)
| | - Valentino Bergamini
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, I-37126 Verona, Italy; (V.B.); (F.P.)
| | - Claudia Glingani
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, I-46100 Mantova, Italy; (M.F.); (C.G.)
| | - Marlene Pisello
- Obstetrics and Gynecology Unit, Carlo Poma Hospital, I-46100 Mantova, Italy; (G.G.); (M.P.)
| | - Francesca Presti
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, I-37126 Verona, Italy; (V.B.); (F.P.)
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, I-37126 Verona, Italy
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12
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Reichelt AJ, Hirakata VN, Genro VK, Oppermann MLR. A snapshot of the prevalence of endocrine disorders in pregnancies complicated by coronavirus disease 2019: A narrative review with meta-analysis. Int J Gynaecol Obstet 2021; 154:204-211. [PMID: 33866551 PMCID: PMC9087602 DOI: 10.1002/ijgo.13714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/16/2021] [Indexed: 11/11/2022]
Abstract
Background Some maternal characteristics indicate worse prognosis in pregnant women with coronavirus disease 2019 (COVID‐19). Objective To describe the prevalence of endocrine disorders in pregnancies involving COVID‐19, and its impact on maternal outcomes. Search strategy Search terms were “pregnancy” and “COVID‐19”. Selection PubMed, Embase, medRxiv, and Cochrane worksheet from February to July 2020 were searched. Data collection and analysis Articles describing endocrine disorders in pregnancies with and without COVID‐19 involvement were considered. We performed meta‐analyses of prevalence using random‐effect models and estimated relative risk and 95% confidence intervals (CI) of maternal outcomes relative to presence of endocrine disorders. Main results Articles included (n = 141) were divided into three data sets: individual (119 articles, 356 women), case series (17 articles, 1064 women), and national registries (7 articles, 10 178 women). Prevalence of obesity ranged from 16% to 46% and hyperglycemia in pregnancy (HIP) ranged from 8% to 12%. In data set 1, HIP and obesity were risk factors for severe disease in crude and age‐adjusted models, although not for intensive care unit admission. In data from two national registries, risk of dying was 5.62 (95% CI 0.30–105.95) in women with diabetes and 2.26 (95% CI 1.03–4.96) in those with obesity. Conclusion Obesity and HIP were prevalent in pregnant women with severe COVID‐19. In pregnant women with COVID‐19, obesity and hyperglycemia were prevalent and associated with adverse maternal outcomes.
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Affiliation(s)
- Angela J Reichelt
- Serviço de Endocrinologia e Metabologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vânia N Hirakata
- Unidade de Bioestatística, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vanessa K Genro
- Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Maria Lúcia R Oppermann
- Serviço de Ginecologia e Obstetrícia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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