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Cavalcante ANM, Almeida RLFD, Oliveira DN, Lima DM, Cavalcante CTDMB, Tavares LVDS, Almeida RP, Machado RPG, Araujo Júnior E, Cavalcante MB. Screening for coronavirus disease 2019 in pregnant women admitted for delivery: an observational study. Rev Assoc Med Bras (1992) 2023; 69:e20230084. [PMID: 37466595 DOI: 10.1590/1806-9282.20230084] [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] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim of this study was to examine the impact of symptom-based screening on the prevalence and outcomes of neonatal coronavirus disease 2019 in pregnant women admitted for delivery. METHODS A retrospective observational study was conducted from June to August 2020 at Gonzaga Mota of Messejana Hospital, Fortaleza, CE, Brazil. All pregnant women were screened for coronavirus disease 2019 based on symptoms. Reverse transcription-polymerase chain reaction or immunology assays for severe acute respiratory syndrome coronavirus 2 were performed when a patient reported a symptom. All newborns of symptomatic patients were submitted for Reverse transcription-polymerase chain reaction. Newborns were divided into groups according to the Reverse transcription-polymerase chain reaction results to identify the relationship between maternal symptoms and neonatal coronavirus disease 2019. RESULTS A total of 55 (55/1,026, 5.4%) and 50 (50/1,026, 4.8%) pregnant women reported symptoms and had a positive confirmatory test, respectively. The most common symptom of coronavirus disease 2019 among the pregnant women with positive confirmatory test was cough (n=23, 46%). Seven newborns (7/50, 14%) of symptomatic mothers had positive Reverse transcription-polymerase chain reaction. Upon birth, no newborn had serious complications. CONCLUSION Universal screening of pregnant women admitted for delivery can reduce the perinatal transmission of coronavirus disease 2019. Symptom-based screening can be an alternative for regions with a low prevalence of the disease where a better allocation of financial resources is necessary.
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Affiliation(s)
- Ana Nery Melo Cavalcante
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Public Health Postgraduate Program - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
| | | | | | - Danielle Malta Lima
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Sciences Postgraduate Program - Fortaleza (CE) Brazil
| | - Candice Torres de Melo Bezerra Cavalcante
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
| | | | | | - Rosângela Pinheiro Gonçalves Machado
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Paulista School of Medicine, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Medical Course - São Paulo (SP), Brazil
| | - Marcelo Borges Cavalcante
- Gonzaga Mota of Messejana Hospital, Department of Obstetrics and Neonatology - Fortaleza (CE), Brazil
- Universidade de Fortaleza, Medical Course - Fortaleza (CE), Brazil
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González-Ortiz M, Castro P, Vergara-Barra P, Huerta P, Escudero C. COVID-19 on Pregnancy Outcomes, Mental Health and Placenta: Focus in Latin America. Adv Exp Med Biol 2023; 1428:269-285. [PMID: 37466778 DOI: 10.1007/978-3-031-32554-0_12] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
The COVID-19 pandemic has impacted many aspects of health and society worldwide. One vulnerable group that faced SARS-CoV-2 infection is pregnant women, who were considered to have potentiated risk factors. In physiological pregnancy, maternal systems have several changes and adaptations to support fetal development. These changes involve regulations of cardiovascular, respiratory, and immunologic systems, among others, which SARS-CoV-2 could severely alter. Furthermore, the systemic effects of viral infection could be associated with placental dysfunction and adverse pregnancy outcomes, which have been studied from the start of the pandemic to date. Additionally, pregnancy is a condition of more significant mental health vulnerability, especially when faced with highly stressful situations. In this chapter, we have collected information on the effect of COVID-19 on maternal mortality, the SARS-CoV-2 infection rate in pregnancy, and the impact on pregnancy outcomes, maternal mental health, and placental function, with a particular focus on studies that consider the Latin American population.
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Affiliation(s)
- Marcelo González-Ortiz
- Laboratorio de Investigación Materno-Fetal (LIMaF), Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
- Group of Research and Innovation in Vascular Health (GRIVAS), Chillán, Chile.
| | - Patricio Castro
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Pablo Vergara-Barra
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Programa de Neurociencias, Psiquiatría y Salud Mental (NEPSAM), Universidad de Concepción, Concepción, Chile
| | - Patricia Huerta
- Departamento de Salud Pública, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Carlos Escudero
- Group of Research and Innovation in Vascular Health (GRIVAS), Chillán, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS), Chillán, Chile
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Hashim NAF, Mahdy ZA, Abdul Rahman R, Kalok AHM, Sutan R. Universal Testing Policy for COVID-19 in Pregnancy: A Systematic Review. Front Public Health 2022; 10:588269. [PMID: 35211434 PMCID: PMC8861085 DOI: 10.3389/fpubh.2022.588269] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Received: 09/01/2020] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background The coronavirus disease (COVID-19) has spread at an accelerated rate. WHO reported that in the general population, the majority are either asymptomatic or mildly infected. In view of the high risk of SARS-CoV-2 transmission from a pregnant woman to her newborn, healthcare workers and other patients, it is a raised concern whether universal testing should be implemented in this targeted population. The current guidelines have not recommended a universal testing policy. In certain European countries, however, the policy was implemented by some hospitals in regions with high prevalence of COVID-19 infection. Aim(s) To assess the justification for universal screening of pregnant women for COVID-19 prior to admission in labor through systematic review of antenatal prevalence of asymptomatic infection, hence risk of inadvertent spread of infection. Materials and Methods Three databases confined to PubMed, Ovid and Science Direct were used to search for articles from November 2019 onwards published in the English language. The search was conducted using the keywords “COVID-19” or “coronavirus” or “SARS-CoV-2” and “pregnancy” or “pregnant” or “obstetric” or “labor” and “universal” or “testing” or “prevalence”. The review was registered with PROSPERO. Results The search result retrieved 34 studies, with the majority consisting of retrospective cohort studies, while other studies such as prospective cohort study, research letters and a case series were also identified. A total of 19,958 pregnant women were universally tested until the date of report. Overall, the prevalence of universal testing among pregnant women presenting to labor and delivery units are higher in Western regions. From the total number of pregnant women 5.3% tested positive and among these, the majority (75.5%) did not manifest any symptoms at the time of testing. Conclusion In areas with high prevalence of COVID-19 infection, the implementation of a universal testing policy among pregnant women presenting to labor and admission units may be cost effective in helping to curb disease transmission. Systematic Trial Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020184248, PROSPERO: CRD42020184248.
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Affiliation(s)
- Nur Amirah Farhanah Hashim
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Rahana Abdul Rahman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Aida Hani Mohd Kalok
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Rosnah Sutan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
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Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Roggero P, Prefumo F, do Vale MS, Cardona-Perez JA, Maiz N, Cetin I, Savasi V, Deruelle P, Easter SR, Sichitiu J, Soto Conti CP, Ernawati E, Mhatre M, Teji JS, Liu B, Capelli C, Oberto M, Salazar L, Gravett MG, Cavoretto PI, Nachinab VB, Galadanci H, Oros D, Ayede AI, Sentilhes L, Bako B, Savorani M, Cena H, García-May PK, Etuk S, Casale R, Abd-Elsalam S, Ikenoue S, Aminu MB, Vecciarelli C, Duro EA, Usman MA, John-Akinola Y, Nieto R, Ferrazi E, Bhutta ZA, Langer A, Kennedy SH, Papageorghiou AT. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021; 175:817-826. [PMID: 33885740 PMCID: PMC8063132 DOI: 10.1001/jamapediatrics.2021.1050] [Citation(s) in RCA: 702] [Impact Index Per Article: 234.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
Importance Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.
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Affiliation(s)
- José Villar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Shabina Ariff
- Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Robert B. Gunier
- School of Public Health, University of California, Berkeley, Berkeley
| | | | - Stephen Rauch
- School of Public Health, University of California, Berkeley, Berkeley
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Nerea Maiz
- Obstetrics Department, Hospital Universitari Vall d’Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Irene Cetin
- Ospedale Vittore Buzzi Children’s Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valeria Savasi
- Ospedale Luigi Sacco University Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joanna Sichitiu
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France
| | | | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
- Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | - Jagjit Singh Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Becky Liu
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Carola Capelli
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Provincia de Buenos Aires, Argentina
| | - Manuela Oberto
- S.C. Obstetrics 2U, Sant’Anna Hospital, AOU Città della Salute e della scienza di Torino, Turin, Italy
| | - Laura Salazar
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Michael G. Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Paolo Ivo Cavoretto
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | | | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University Kano, Kano, Nigeria
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Daniel Oros
- Aragon Institute of Health Research, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Adejumoke Idowu Ayede
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Mónica Savorani
- Hospital de Moron, Moron, Provincia de Buenos Aires, Argentina
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
| | | | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Eduardo A. Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina
- Universidad de Moron, Moron, Argentina
| | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Yetunde John-Akinola
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires Argentina
| | - Enrico Ferrazi
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Zulfiqar A. Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ana Langer
- Women and Health Initiative, Global Health and Population Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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