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Muacevic A, Adler JR, Albalawi BM, Alghamdi SS, Alghamdi EH, Almahl AA, Alagoul HA, Alamori AM, Mobarki AY, Hadi IM, Asiri MA, Dighriri IM. Consequences of SARS-CoV-2 Infection in Pregnant Women and Their Infants: A Systematic Review. Cureus 2022; 14:e32787. [PMID: 36694500 PMCID: PMC9857045 DOI: 10.7759/cureus.32787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a worldwide health problem, particularly for pregnant women. This review assesses the effects of COVID-19 on pregnant women and their infants. A systematic search was performed of studies published on PubMed, Web of Science, Google Scholar, and Embase from January 2020 to January 2021, without restriction by language. This review included 27 studies (22 from China, one from the United States, one from Honduras, one from Italy, one from Iran, and one from Spain), which cumulatively evaluated 386 pregnant women with clinically confirmed COVID-19 and their 334 newborns. Of the 386 pregnant women, 356 had already delivered their infants, four had medical abortions at the time of research, 28 were still pregnant, and two died from COVID-19 before they were able to give birth. Cesarean sections were performed on 71% of pregnant women with COVID-19 to give birth. Fever and cough were common symptoms among women. Premature rupture of membranes, distress, and preterm birth were pregnancy complications. Low birth weight and a short gestational age were common outcomes for newborns. The common laboratory findings among pregnant women were lymphopenia, leukocytosis, and elevated levels of C-reactive protein. Chest computed tomography revealed abnormal viral lung changes in 73.3% of women. Eleven infants tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There was no evidence of vertical transmission. Most infants were observed to have lymphopenia and thrombocytopenia. The clinical features of pregnant women were found to be similar to those of generally infected patients. There is evidence of adverse pregnancy and neonatal outcomes caused by COVID-19.
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Al-Kuraishy HM, Al-Gareeb AI, Albezrah NKA, Bahaa HA, El-Bouseary MM, Alexiou A, Al-Ziyadi SH, Batiha GES. Pregnancy and COVID-19: high or low risk of vertical transmission. Clin Exp Med 2022:10.1007/s10238-022-00907-z. [PMID: 36251144 PMCID: PMC9574177 DOI: 10.1007/s10238-022-00907-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
Coronavirus disease 19 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). Throughout the pandemic, evidence on the effects of COVID-19 during pregnancy has been inadequate due to the limited number of studies published. Therefore, the objective of this systematic review was to evaluate current literature regarding the effects of COVID-19 during pregnancy and establish pregnancy outcomes and vertical and perinatal transmission during pregnancy. Multiple databases were searched, including Embase, Medline, Web of Science, Scopus, and Cochrane Central Register of Control Clinical Trials, using the following keywords: [Pregnancy] AND [COVID-19 OR SARS-CoV-2 OR nCoV-19] OR [Perinatal transmission, Vertical transmission (VT), Pregnancy complications], [Pregnancy] AND [Hyperinflammation OR Cytokine storm]. We excluded in vitro and experimental studies, but also ex-vivo and animal study methods. To exclude the risk of bias during data collection and interpretation, all included studies were peer-reviewed publications. This review is estimated to tabulate the study intervention characteristics and compare them against the planned groups for each synthesis. Our findings showed that pregnant women are commonly susceptible to respiratory viral infections and severe pneumonia due to physiological immune suppression and pregnancy-induced changes. VT of SARS-CoV-2 infection during pregnancy is associated with a great deal of controversy and conflict. However, there is still no robust clinical evidence of VT. Furthermore, the clinical presentation and management of COVID-19 during pregnancy are nearly identical to those of non-pregnant women. Finally, chloroquine and remdesivir are the only two drugs evaluated as adequate for the management of COVID-19 during pregnancy.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | | | - Haitham Ahmed Bahaa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Maisra M El-Bouseary
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
| | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, Australia.,AFNP Med Austria, Vienna, Austria
| | - Shatha Hallal Al-Ziyadi
- Saudi Board Certified in Obstetrics & Gynecology, Assistant Professor at Taif University, Taif, Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, 22511, AlBeheira, Egypt.
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Cai J, Lin Y, Zhou X, Tao W, Wu MJ. Comment on: "A systematic review of pregnant women with COVID-19 and their neonates". Arch Gynecol Obstet 2022; 306:921-924. [PMID: 35092458 PMCID: PMC8800435 DOI: 10.1007/s00404-022-06421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jianghui Cai
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiaoling Zhou
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Wanjun Tao
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Meng-Jun Wu
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1314 Riyue Avenue, Qingyang District, Chengdu, 611731, China.
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Khedmat L, Mohaghegh P, Veysizadeh M, Hosseinkhani A, Fayazi S, Mirzadeh M. Pregnant women and infants against the infection risk of COVID-19: a review of prenatal and postnatal symptoms, clinical diagnosis, adverse maternal and neonatal outcomes, and available treatments. Arch Gynecol Obstet 2022; 306:323-335. [PMID: 34842975 PMCID: PMC8628058 DOI: 10.1007/s00404-021-06325-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 05/01/2020] [Accepted: 10/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The establishment of a risk-appropriate care approach for pregnant women and newborn infants under the COVID-19 pneumonia is vital to prevent the main pregnancy complications. OBJECTIVES AND DESIGN This study reviewed the vertical transmission (VT) potential of COVID-19 pneumonia in pregnant women. Key-related symptoms and adverse clinical outcomes for mothers and infants before and after childbirth were summarized. Some practical therapies and preventive health solutions were also proposed. RESULTS There was a high susceptibility in pregnant women to COVID-19 infection, especially in the third trimester of pregnancy. The most common symptoms in 22-40-year-old patients infected with COVID-19 were fever (87.6%), cough (52.3%), dyspnea (27.6%), fatigue (22.4%), sore throat (13.5%), malaise (9.4%), and diarrhea (3.4%), respectively. The viral infection led to an increase in preterm labor and cesarean delivery without any intrauterine infection and severe neonatal asphyxia. No infection in the newborn infants was reported despite a high risk of the VT phenomenon. The most important therapies were the reception of antiviral and antibiotic drugs, oxygenation therapy, psychological interventions, and food supplements with health-promoting effects. The best proposed medical strategies to control the COVID-19 infection were bi-monthly screening and following-up the mothers' and fetuses' health, not using the potent broad-spectrum antibiotics and corticosteroids, providing the delivery room with negative pressure for emergency cesarean section, and the immediate isolation of newborns after childbirth without direct breastfeeding. CONCLUSION Babies with respiratory problems may be born to some mothers with COVID-19, who have weak immune systems. Thus, the virus transmission cycle should be disrupted to prevent adverse maternal and fetal outcomes by integrating individual health guidelines, efficient medical care therapies, and hospital preventive practices.
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Affiliation(s)
- Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Pegah Mohaghegh
- Department of Community Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Veysizadeh
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Hosseinkhani
- Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Sanaz Fayazi
- Department of Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Monirsadat Mirzadeh
- Metabolic Disease Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Bahonar Boulevard, 34197-59811, Qazvin, Iran.
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Dileep A, ZainAlAbdin S, AbuRuz S. Investigating the association between severity of COVID-19 infection during pregnancy and neonatal outcomes. Sci Rep 2022; 12:3024. [PMID: 35194128 DOI: 10.1038/s41598-022-07093-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Ravindra K, Malik V, Padhi B, Goel S, Gupta M. Asymptomatic infection and transmission of COVID-19 among clusters: systematic review and meta-analysis. Public Health 2022; 203:100-109. [PMID: 35038628 PMCID: PMC8654597 DOI: 10.1016/j.puhe.2021.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 04/20/2021] [Revised: 09/08/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Countries throughout the world are experiencing COVID-19 viral load in their populations, leading to potential transmission and infectivity of asymptomatic COVID-19 cases. The current systematic review and meta-analysis aims to investigate the role of asymptomatic infection and transmission reported in family clusters, adults, children and health care workers, globally. STUDY DESIGN Systematic review and meta-analysis. METHODS An online literature search of PubMed, Google Scholar, medRixv and BioRixv was performed using standard Boolean operators and included studies published up to 17 August 2021. For the systematic review, case reports, short communications and retrospective studies were included to ensure sufficient asymptomatic COVID-19 transmission data were reported. For the quantitative synthesis (meta-analysis), participant data from a collection of cohort studies focusing on groups of familial clusters, adults, children and health care workers were included. Inconsistency among studies was assessed using I2 statistics. The data synthesis was computed using the STATA 16.0 software. RESULTS This study showed asymptomatic transmission among familial clusters, adults, children and health care workers of 15.72%, 29.48%, 24.09% and 0%, respectively. Overall, asymptomatic transmission was 24.51% (95% confidence interval [CI]: 14.38, 36.02) among all studied population groups, with a heterogeneity of I2 = 95.30% (P < 0.001). No heterogeneity was seen in the population subgroups of children and health care workers. The risk of bias in all included studies was assessed using the Newcastle Ottawa Scale. CONCLUSIONS For minimising the spread of COVID-19 within the community, this study found that following the screening of asymptomatic cases and their close contacts for chest CT scan (for symptomatic patients), even after negative nucleic acid testing, it is essential to perform a rigorous epidemiological history, early isolation, social distancing and an increased quarantine period (a minimum of 14-28 days). This systematic review and meta-analysis supports the notion of asymptomatic COVID-19 infection and person-to-person transmission and suggests that this is dependent on the varying viral incubation period among individuals. Children, especially those of school age (i.e. <18 years), need to be monitored carefully and follow mitigation strategies (e.g. social distancing, hand hygiene, wearing face masks) to prevent asymptomatic community transmission of COVID-19.
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Affiliation(s)
- K. Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Corresponding author. Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. Tel.: +911722755262; fax: +911722744401
| | - V.S. Malik
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B.K. Padhi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S. Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M. Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cai J, Lin Y, Zhou X, Tao W, Wu MJ. Comment on: "A systematic review of pregnant women with COVID-19 and their neonates". Arch Gynecol Obstet 2022. [PMID: 35092458 DOI: 10.1007/s00404-022-06421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Binte Masud S, Zebeen F, Alam DW, Hossian M, Zaman S, Begum RA, Nabi MH, Hawlader MDH. Adverse Birth Outcomes Among Pregnant Women With and Without COVID-19: A Comparative Study From Bangladesh. J Prev Med Public Health 2021; 54:422-430. [PMID: 34875825 PMCID: PMC8655376 DOI: 10.3961/jpmph.21.432] [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: 08/06/2021] [Accepted: 09/20/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Pregnant women are especially vulnerable to respiratory infections such as coronavirus disease 2019 (COVID-19), but insufficient research has investigated pregnancy and its outcomes in women with COVID-19. This cross-sectional study compared birth outcomes related to COVID-19 between Bangladeshi pregnant women with and without COVID-19. METHODS The study was conducted at 3 tertiary referral hospitals in Dhaka, Bangladesh, from March to August 2020. Pregnant women admitted for delivery at these hospitals with laboratory results (reverse-transcription polymerase chain reaction) were analyzed. Using convenience sampling, we included 70 COVID-19-positive and 140 COVID-19-negative pregnant women. Trained and experienced midwives conducted the interviews. Data were analyzed using the t-test, the chi-square test, and univariate and multivariable linear and logistic regression. RESULTS Pregnant women with COVID-19 were more likely to give birth to a preterm baby (adjusted odds ratio [aOR], 2.15; 95% confidence interval [CI], 1.06 to 4.37) and undergo a cesarean section (aOR, 3.27; 95% CI, 1.51 to 7.07). There were no significant differences in birth weight, premature rupture of membranes, and the Apgar score at 1 minute or 5 minutes post-delivery between women with and without COVID-19. All the newborn babies who were born to COVID-19-positive women were COVID-19-negative. CONCLUSIONS Our study suggests that pregnant women with COVID-19 were more likely to give birth to a preterm baby and undergo a cesarean section. For this reason, physicians should be particularly cautious to minimize adverse birth outcomes among pregnant women with COVID-19 and their newborn babies.
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Affiliation(s)
- Sumaya Binte Masud
- Obstetrical and Gynaecological Society of Bangladesh (OGSB), Dhaka, Bangladesh.,Department of Public Health, North South University, Dhaka, Bangladesh
| | - Faiza Zebeen
- Obstetrical and Gynaecological Society of Bangladesh (OGSB), Dhaka, Bangladesh.,Department of Public Health, North South University, Dhaka, Bangladesh
| | - Dil Ware Alam
- Obstetrical and Gynaecological Society of Bangladesh (OGSB), Dhaka, Bangladesh
| | - Mosharap Hossian
- Public Health Professional Development Society (PPDS), Dhaka, Bangladesh
| | - Sanjana Zaman
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Rowshan Ara Begum
- Obstetrical and Gynaecological Society of Bangladesh (OGSB), Dhaka, Bangladesh
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Young EM, Green O, Stewart J, King Y, O'Donoghue K, Walker KF, Thornton JG. COVID-19 and pregnancy: A comparison of case reports, case series and registry studies. Eur J Obstet Gynecol Reprod Biol 2021; 268:135-142. [PMID: 34920270 PMCID: PMC8647390 DOI: 10.1016/j.ejogrb.2021.12.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Selection, outcome and publication biases are well described in case reports and case series but may be less of a problem early in the appearance of a new disease when all cases might appear to be worth publishing. OBJECTIVE To use a prospectively collected database of primary sources to compare the reporting of COVID-19 in pregnancy in case reports, case series and in registries over the first 8 months of the pandemic. STUDY DESIGN MEDLINE, Embase and Maternity and Infant Care databases were searched from 22 March to 5 November 2020, to create a curated list of primary sources. Duplicate reports were excluded. Case reports, case series and registry studies of pregnant women with confirmed COVID-19, where neonatal outcomes were reported, were selected and data extracted on neonatal infection status, neonatal death, neonatal intensive care unit admission, preterm birth, stillbirth, maternal critical care unit admission and maternal death. RESULTS 149 studies comprising 41,658 mothers and 8,854 neonates were included. All complications were more common in case reports, and in retrospective series compared with presumably prospective registry studies. Extensive overlap is likely in registry studies, with cases from seven countries reported by multiple registries. The UK Obstetric Surveillance System was the only registry to explicitly report identification and removal of duplicate cases, although five other registries reported collection of patient identifiable data which would facilitate identification of duplicates. CONCLUSIONS Since it is likely that registries provide the least biased estimates, the higher rates seen in the other two study designs are probably due to selection or publication bias. However even some registry studies include self- or doctor-reported cases, so might be biased, and we could not completely exclude overlap of cases in some registries.
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Affiliation(s)
- Eloise M Young
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Oleia Green
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Joel Stewart
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Yasmin King
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, College Road, University College, Cork, Ireland
| | - Kate F Walker
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England
| | - Jim G Thornton
- University of Nottingham, University of Nottingham Medical School, Nottingham NG7 2UH, England.
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10
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Zaharie G, Hasmasanu M, Muresan D, Kovacs T, Matyas M. Diagnostic challenges, management, and outcome of infants born to mothers with COVID 19 during the first wave of the pandemic. Exp Ther Med 2021; 23:102. [PMID: 34976144 PMCID: PMC8674959 DOI: 10.3892/etm.2021.11025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Severe acute respiratory distress syndrome with coronavirus 2 (SARS-CoV-2) infection affected pregnant women during the pandemic. Immunological particularity of this population and the increased need for medical assistance placed this population in a high-risk category for SARS-Cov-2 infection. Owing to high contamination risk and limited studies regarding vertical transmission, the labor and delivery of positive women required particular conditions. Cesarean section probably proved to be the optimal option for delivery of infants to reduce the risk of infection during birth. The aim of the present study was to present the management and outcome of infants born to mothers confirmed with coronavirus disease 2019 (COVID 19) prior to delivery. This is a longitudinal, retrospective study, analyzing demographics, laboratory data and management of neonates born to mothers with diagnosis of SARS-Cov-2 infection. The results showed that 5 neonates were born to SARS-Cov-2-positive mothers, all by Cesarean section and had a negative reverse transcription-quantitative polymerase chain reaction (RT-qPCR) test. None of the women breastfed during the hospital stay. The negative RT-qPCR test allowed us to reduce the hospital stay of infants and care in non-isolated areas. In summary, in the present study, vertical or perinatal transmission of the infection was not present. The testing of the pregnant women, their isolation and delivery in safe conditions for the medical staff were possible, with the latter using adequate protection equipment to limit their infection and the risk for the newborns.
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Affiliation(s)
- Gabriela Zaharie
- Department of Neonatology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj Napoca, Romania
| | - Monica Hasmasanu
- Department of Neonatology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj Napoca, Romania
| | - Daniel Muresan
- Department of Obstetrics and Gynecology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj Napoca, Romania
| | - Tunde Kovacs
- Department of Obstetrics and Gynecology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj Napoca, Romania
| | - Melinda Matyas
- Department of Neonatology, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400006 Cluj Napoca, Romania
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Citu C, Neamtu R, Sorop VB, Horhat DI, Gorun F, Tudorache E, Gorun OM, Boarta A, Tuta-Sas I, Citu IM. Assessing SARS-CoV-2 Vertical Transmission and Neonatal Complications. J Clin Med 2021; 10:5253. [PMID: 34830532 DOI: 10.3390/jcm10225253] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022] Open
Abstract
We designed and implemented a prospective study to analyze the maternal and neonatal outcomes associated with COVID-19 and determine the likelihood of viral transmission to the fetus and newborn by collecting samples from amniotic fluid, placenta, umbilical cord blood, and breast milk. The study followed a prospective observational design, starting in July 2020 and lasting for one year. A total of 889 pregnant women were routinely tested for SARS-CoV-2 infection in an outpatient setting at our clinic, using nasal swabs for PCR testing. A total of 76 women were diagnosed with COVID-19. The positive patients who accepted study enrollment were systematically analyzed by collecting weekly nasal, urine, fecal, and serum samples, including amniotic fluid, placenta, umbilical cord, and breast milk at hospital admission and postpartum. Mothers with COVID-19 were at a significantly higher risk of developing gestational hypertension and giving birth prematurely by c-section than the general pregnant population. Moreover, their mortality rates were substantially higher. Their newborns did not have negative outcomes, except for prematurity, and an insignificant number of newborns were infected with SARS-CoV-2 (5.4%). No amniotic fluid samples were positive for SARS-CoV-2, and only 1.01% of PCR tests from breast milk were confirmed positive. Based on these results, we support the idea that SARS-CoV-2 positive pregnant women do not expose their infants to an additional risk of infection via breastfeeding, close contact, or in-utero. Consequently, we do not support maternal–newborn separation at delivery since they do not seem to be at an increased risk of SARS-CoV-2 infection.
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Rodríguez-Díaz M, Alonso-Molero J, Cabero-Perez MJ, Llorca J, Dierssen-Sotos T, Gómez-Acebo I. Pregnancy and Birth Outcomes during the Early Months of the COVID-19 Pandemic: The MOACC-19 Cohort. Int J Environ Res Public Health 2021; 18:10931. [PMID: 34682679 PMCID: PMC8535818 DOI: 10.3390/ijerph182010931] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
The new coronavirus, SARS-CoV-2, is devastating for specific groups of patients, but currently there is not enough information concerning its effects on pregnant women. The purpose of this study is to identify the impact of SARS-CoV-2 infection on pregnancy and the consequences that it could cause. We studied a cohort of pregnant ladies who were tested for SARS-CoV-2 infection by RT-PCR and classified as infected or not infected. The recruitment was carried out in the HUMV hospital, a third-level hospital located in Santander, northern Spain. It started on 23 March 2020 and ended on 14 October 2020. Data from our cohort were compared to another cohort recruited in 2018 at the same hospital. We found that gestational hypertension, placental abruptio, and home exposure to an infected person, among other variables, could be associated with SARS-CoV-2 infection. In conclusion, we consider pregnant women a high-risk group of patients towards a possible SARS-CoV-2 infection, especially those who present with conditions such as gestational hypertension or obesity; moreover, we think that SARS-CoV-2 infection could increase the possibilities of having an abruptio placentae, although this result was found in only a few women, so it requires further confirmation.
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Affiliation(s)
- Marta Rodríguez-Díaz
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
| | - Jéssica Alonso-Molero
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
| | - María J. Cabero-Perez
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Javier Llorca
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Trinidad Dierssen-Sotos
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Inés Gómez-Acebo
- Faculty of Medicine, Universidad de Cantabria, 39011 Santander, Spain; (M.R.-D.); (J.A.-M.); (M.J.C.-P.); (J.L.)
- IDIVAL Instituto de Investigación Sanitaria Valdecilla, 39011 Santander, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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13
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Violante-Cumpa JR, Lavalle-González FJ, Mancillas-Adame LG, Ávila-Hipólito ED, Violante-Cumpa KA. Gestational diabetes mellitus and COVID-19, clinical characteristics and review of the literature. Prim Care Diabetes 2021; 15:887-889. [PMID: 34389278 PMCID: PMC8326005 DOI: 10.1016/j.pcd.2021.07.016] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 06/18/2021] [Accepted: 07/29/2021] [Indexed: 01/27/2023]
Abstract
There is a lack of information about the maternal-fetal outcomes in patients with gestational diabetes and concomitant COVID-19; and there is even less information about the outcomes of pregnant women with gestational diabetes and COVID-19. We present a case of a primigravidae of 20-year-old woman with gestational diabetes and COVID-19 and a review of the literature.
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Affiliation(s)
- Jorge R Violante-Cumpa
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Fernando J Lavalle-González
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico.
| | - Leonardo G Mancillas-Adame
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Edmundo D Ávila-Hipólito
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
| | - Karla A Violante-Cumpa
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av. s/n Col. Mitras Centro, Monterrey, Nuevo León, 64460, Mexico
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14
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Abstract
COVID-19 has afflicted the health of children and women across all age groups. Since the outbreak of the pandemic in December 2019, various epidemiologic, immunologic, clinical, and pharmaceutical studies have been conducted to understand its infectious characteristics, pathogenesis, and clinical profile. COVID-19 affects pregnant women more seriously than nonpregnant women, endangering the health of the newborn. Changes have been implemented to guidelines for antenatal care of pregnant women, delivery, and newborn care. We highlight the current trends of clinical care in pregnant women and newborns during the COVID-19 pandemic.
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Affiliation(s)
- Pezad N. Doctor
- Department of Pediatrics, Children’s Hospital of Michigan, 3901, Beaubien Boulevard, Detroit, MI 48201, USA,Corresponding author. Office of Pediatric education, 3901 Beaubien, Detroit, MI 48201
| | - Deepak Kamat
- Department of Pediatrics, UT Health Science Center, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Beena G. Sood
- Department of Pediatrics, Wayne State University School of Medicine, 540E Canfield Street, Detroit, Michigan 48201, USA
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15
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Bahrami R, Schwartz DA, Karimi-Zarchi M, Javaheri A, Dastgheib SA, Ferdosian F, Noorishadkam M, Mirjalili SR, Neamatzadeh H. Meta-analysis of the frequency of intrauterine growth restriction and preterm premature rupture of the membranes in pregnant women with COVID-19. Turk J Obstet Gynecol 2021; 18:236-244. [PMID: 34580931 PMCID: PMC8480208 DOI: 10.4274/tjod.galenos.2021.74829] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022] Open
Abstract
The impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in pregnancy has yet to be determined. Some studies indicate that SARSCoV- 2 infection may be associated with a higher risk of adverse outcomes in pregnant women. Here, we performed a meta-analysis to estimate the frequency of intrauterine growth restriction (IUGR) and preterm premature rupture of the membranes (PPROM) in pregnant women with Coronavirus disease-2019 (COVID-19). A comprehensive search was performed in various databases, such as PubMed, Scopus, SciELO, MedRxiv, and Web of Science, to find all relevant studies published before 10 February 2021. Cross-sectional and consecutive case series reporting the pregnancy outcomes of COVID-19 were included. A total of 24 studies, including 8 studies on IUGR and 16 studies on PPROM, were selected. Pooled data showed that the frequencies of IUGR and PPROM in pregnant women with COVID-19 were 2.6% and 9.9%, respectively. Analyses stratified by ethnicity showed that the frequencies of IUGR in Asian and Caucasian COVID-19-infected pregnant women were 2.9% and 2.0%, respectively. Moreover, the frequencies of PPROM in Asian and Caucasian COVID-19-infected pregnant women were 10.2% and 5.8%, respectively. This meta-analysis showed that the frequencies of IUGR and PPROM in COVID-19-infected pregnant women were 2.6% and 9.9%, respectively. However, well-designed, large-scale and multicenter clinical studies are required to improve and validate these results.
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Affiliation(s)
- Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - David A. Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
| | - Mojgan Karimi-Zarchi
- Department of Obstetrics and Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atiyeh Javaheri
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzad Ferdosian
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmood Noorishadkam
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Reza Mirjalili
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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16
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Karimi-Zarchi M, Schwartz DA, Bahrami R, Dastgheib SA, Javaheri A, Tabatabaiee RS, Ferdosian F, Asadian F, Neamatzadeh H. A meta-analysis for the risk and prevalence of preeclampsia among pregnant women with COVID-19. Turk J Obstet Gynecol 2021; 18:224-235. [PMID: 34580872 PMCID: PMC8480209 DOI: 10.4274/tjod.galenos.2021.66750] [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] [Indexed: 12/01/2022] Open
Abstract
Preeclampsia and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are both life-threatening disorders when they occur during pregnancy. They are similarly characterized by systemic immune activation and have a deleterious effect on maternal endothelial cells. During the coronavirus disease-2019 (COVID-19) pandemic, there were reports of preeclampsia or a preeclampsia-like syndrome occurring in pregnant women with SARS-CoV-2 infection. We performed a meta-analysis to estimate the risk and prevalence of preeclampsia and SARS-CoV-2 infection in pregnant women. A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and China National Knowledge Infrastructure to identify all relevant studies published up to February 29, 2020. All studies that reported the prevalence of preeclampsia in pregnant women with SARS-CoV-2 infection were selected. A total of 10 case-control studies and 15 case series met our inclusion criteria. Pooled data revealed no significant difference between infected pregnant women and uninfected pregnant women for the risk of preeclampsia [odds ratio (OR)=1.676, 95% confidence interval (CI) 0.679-4.139, p=0.236]. The stratified analysis revealed significant risk in the infected Asian pregnant women (OR=2.637, 95% CI 1.030-6.747, p=0.043), but not Caucasian. The prevalence of preeclampsia was 8.2% (95% CI 0.057-0.117) in infected pregnant women with COVID-19 in the overall population. Its prevalence was highest in North America (10.7%), followed by Asian (7.9%), Caucasian (6.7%), European (4.9%), and West Asian (2.6%) infected pregnant women. Our pooled data showed that the prevalence of preeclampsia in pregnant women with SARS-CoV-2 infection was 8.2%. However, there was no increased risk of occurrence of preeclampsia among pregnant women with SARS-CoV-2 infection.
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Affiliation(s)
- Mojgan Karimi-Zarchi
- Department of Obstetrics and Gynecology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
| | - Reza Bahrami
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atiyeh Javaheri
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Razieh Sadat Tabatabaiee
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzad Ferdosian
- Department of Medical Laboratory Sciences, School of Paramedical Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Asadian
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Department of Medical Laboratory Sciences, School of Paramedical Science, Shiraz University of Medical Sciences, Shiraz, Iran
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17
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Principi N, Esposito S. Is the Immunization of Pregnant Women against COVID-19 Justified? Vaccines (Basel) 2021; 9:970. [PMID: 34579207 PMCID: PMC8473171 DOI: 10.3390/vaccines9090970] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Maternal immunization against some infectious diseases can offer significant advantages for women, preventing maternal morbidity and mortality, or for offspring, preventing fetal disease and conferring passive immunity to neonates. Recently, clinical trials specifically to evaluate the immunogenicity, safety, and tolerability of some of the available coronavirus disease 2019 (COVID-19) vaccines in pregnant and lactating women have been planned, initiated and, in some cases, completed. This paper discusses whether the immunization of pregnant women against COVID-19 is justified and presents knowledge about the immunogenicity and safety of mRNA COVID-19 vaccines for these subjects. The results of recent studies indicate that pregnant women are at increased risk of developing severe disease compared with nonpregnant women of the same age. Studies carried out with mRNA vaccines indicate that the immunogenicity, safety and tolerability of these preventive measures in pregnant women are not different from those in nonpregnant women of the same age. Moreover, antibodies are efficiently transferred through the placenta and can be detected in breastmilk, suggesting a potential prevention of infection in the child. All these findings authorize the use of mRNA vaccines in pregnant women to protect both the mother and the child. However, further studies with larger sample size and with follow-up of the pregnant women vaccinated during different periods of pregnancy and their children are needed to better characterize the immune response of pregnant women, to define when these vaccines should be administered to obtain the best protection, and to measure vaccine efficacy against virus variants in both mothers and infants. COVID-19 vaccines based on different technological platforms cannot presently be used, and their role in pregnant women should be clarified.
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Affiliation(s)
- Nicola Principi
- Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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18
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Guo F, Yang X. A Comprehensive Review of the Management of Pregnant Women with COVID-19: Useful Information for Obstetricians. Infect Drug Resist 2021; 14:3363-3378. [PMID: 34466003 PMCID: PMC8402981 DOI: 10.2147/idr.s325496] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022] Open
Abstract
Due to the physiological changes of the cardiovascular system and respiratory system in pregnancy, pregnant women are vulnerable to pathogen infection and severe pneumonia. With the increasing incidence of COVID-19 pneumonia, its influence on pregnant women and neonates has attracted more attention. In this review, we collected all relevant articles published in English from September 1, 2019 to June 10, 2021, regarding the epidemiology, clinical presentations, chemical examinations, imaging findings, the timing of delivery and delivery mode, maternal and neonatal complications, medication, and vertical transmission of COVID-19 in pregnancy. It has been reported that compared with non-pregnant females, pregnant women with COVID-19 are more likely to develop into severe type. In particular, the risk of entering the intensive care unit and endotracheal intubation was higher. Chest computed tomography and blood routine examination are useful for the diagnosis of COVID-19 in a short period of time. COVID-19 pneumonia is not an independent indication for terminating the pregnancy, and it is not contraindicated for vaginal delivery. Compared to normal pregnant females, patients with COVID-19 showed an elevated susceptibility of preterm delivery. Multidisciplinary consultation was suggested in the treatment policy of COVID-19 in pregnancy. Currently, there is no evaluation on the safety, efficacy, and immunity of the approved vaccines for mothers and infants. In human placental tissues, the COVID-19 virus has been found by different detection methods. The mechanism by which the virus enters the placental tissue is unclear, which may be related to placental inflammation. The long-term prognosis of pregnant women with COVID-19 remains unclear and requires further detailed investigation.
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Affiliation(s)
- Feng Guo
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Xiuhua Yang
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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19
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Ranjbar F, Allahqoli L, Ahmadi S, Mousavi R, Gharacheh M, Eshraghi N, Alkatout I. Changes in pregnancy outcomes during the COVID-19 lockdown in Iran. BMC Pregnancy Childbirth 2021; 21:577. [PMID: 34420514 PMCID: PMC8380188 DOI: 10.1186/s12884-021-04050-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/16/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background The Covid-19 pandemic response is influencing maternal and neonatal health care services especially in developing countries. However, the indirect effects of Covid-19 on pregnancy outcomes remain unknown. The aim of the present study was to compare pregnancy outcomes before and after the beginning of the Covid-19 pandemic in Iran. Methods We performed a retrospective analysis of the medical records of 2,503 pregnant women with singleton pregnancies, admitted to the maternity department of a women’s hospital in Tehran, Iran, during the pre-Covid-19 pandemic (February 19 to April 19, 2019) and the intra-Covid- 19 pandemic (February 19 to April 19, 2020) period. Results We included 2,503 women admitted to the hospital; 1,287 (51.4 %) were admitted before the Covid-19 lockdown and 1,216 (48.6 %) during the Covid-19 lockdown. There were no significant differences in stillbirth rates (p = 0.584) or pregnancy complications (including preeclampsia, pregnancy-induced hypertension and gestational diabetes) (p = 0.115) between pregnant women in the pre- and intra-pandemic periods. However, decreases in preterm births (p = 0.001), and low birth weight (p = 0.005) were observed in the pandemic period compared to the pre-pandemic period. No significant difference in the mode of delivery, and no maternal deaths were observed during the two time periods. Conclusions In our study we observed a decrease in preterm births and low birth weight, no change in stillbirths, and a rise in the admission rates of mothers to the ICU during the initial Covid-19 lockdown period compared to pre-Covid-19 lockdown period. Further research will be needed to devise plan for immediate post-pandemic care and future health care crises.
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Affiliation(s)
- Fahimeh Ranjbar
- Reproductive Health, Nursing Care Research Centre, Iran University of Medical Sciences, P.O. Box 19395-4798, Rashid Yasemi St., Valiasr Ave., Tehran, Iran
| | - Leila Allahqoli
- Reproductive Health, Nursing Care Research Centre, Iran University of Medical Sciences, P.O. Box 19395-4798, Rashid Yasemi St., Valiasr Ave., Tehran, Iran
| | - Soheila Ahmadi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Robab Mousavi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Gharacheh
- Reproductive Health, Nursing Care Research Centre, Iran University of Medical Sciences, P.O. Box 19395-4798, Rashid Yasemi St., Valiasr Ave., Tehran, Iran.
| | - Nooshin Eshraghi
- Department of Perinatology, Shahid Akbarabadi hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy. Campus Kiel, University Hospitals Schleswig-Holstein, Kiel, Germany
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20
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Setti PEL, Cirillo F, Immediata V, Morenghi E, Canevisio V, Ronchetti C, Baggiani A, Albani E, Patrizio P. First trimester pregnancy outcomes in a large IVF center from the Lombardy County (Italy) during the peak COVID-19 pandemic. Sci Rep 2021; 11:16529. [PMID: 34400730 PMCID: PMC8368203 DOI: 10.1038/s41598-021-96134-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/05/2021] [Indexed: 01/02/2023] Open
Abstract
At the beginning of 2020, the Italian Lombardy region was hit by an "epidemic tsunami" which was, at that point in time, one of the worst pandemics ever. At that moment the effects of SARS-COV 2 were still unknown. To evaluate whether the pandemic has influenced ART (Assisted Reproduction Techniques) outcomes in an asymptomatic infertile population treated at one of the major COVID-19 epicentres during the weeks immediately preceding lockdown. All ART procedures performed during two time periods were compared: November 1st, 2018 to February 28th, 2019 (non-COVID-19 risk) and November 1st, 2019 to February 29th, 2020 (COVID-19 risk). In total 1749 fresh cycles (883 non-COVID-19 risk and 866 COVID-19 risk) and1166 embryos and 63 oocytes warming cycles (538 and 37 during non-COVID and 628 and 26 during COVID-19 risk, respectively) were analysed. Clinical pregnancies per cycle were not different: 370 (25.38%) in non-COVID versus 415 (27.30%) (p = 0.237) during COVID-19 risk. There were no differences in biochemical pregnancy rates 52 (3.57%) versus 38 (2.50%) (p = 0.089) nor in ectopic pregnancies 4 (1.08%) versus 3 (0.72%) (p = 0.594), spontaneous miscarriages 84 (22.70%) versus 103 (24.82%) p = 0.487, nor in intrauterine ongoing pregnancies 282 (76.22%) versus 309 (74.46%) p = 0.569. A multivariate analysis investigating differences in spontaneous miscarriage rate showed no differences between the two timeframes. Our results support no differences in asymptomatic infertile couples' ART outcomes between the pre COVID and COVID-19 periods in one of the earliest and most severe pandemic areas.
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Affiliation(s)
- P E Levi- Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
| | - F Cirillo
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - V Immediata
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - E Morenghi
- Biostatistics Unit, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - V Canevisio
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - C Ronchetti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - A Baggiani
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - E Albani
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - P Patrizio
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT, USA
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21
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Kornitzer J, Johnson J, Yang M, Pecor KW, Cohen N, Jiang C, Ming X. A Systematic Review of Characteristics Associated with COVID-19 in Children with Typical Presentation and with Multisystem Inflammatory Syndrome. Int J Environ Res Public Health 2021; 18:8269. [PMID: 34444014 DOI: 10.3390/ijerph18168269] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022]
Abstract
Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C.
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22
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Heydarifard Z, Yavarian J, Malekshahi SS, Zadheidar S, Mokhtari-Azad T, Shafiei-Jandaghi NZ. SARS-CoV-2: an imperative maternal-fetal concern. Iran J Microbiol 2021; 13:427-433. [PMID: 34557269 PMCID: PMC8421575 DOI: 10.18502/ijm.v13i4.6963] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a newly emerged virus which belongs to Coronaviridae family within the betacoronavirus genus. Previous reports demonstrated that other betacoronaviruses were responsible for adverse outcomes during pregnancy in human. Due to inadequate data, the consequences of a SARS-CoV-2 infection during pregnancy is still a public health concern in the second year of SARS-CoV-2 circulation in human population. Herein, we aimed to review the probable risk of intrauterine vertical transmission of SARS-CoV-2 infection to the fetus, its adverse outcomes during pregnancy for both mother and the fetus and maternal risk factors which affect the severity Coronavirus disease 2019 (COVID-19.
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Affiliation(s)
- Zahra Heydarifard
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sevrin Zadheidar
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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23
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Lye P, Dunk CE, Zhang J, Wei Y, Nakpu J, Hamada H, Imperio GE, Bloise E, Matthews SG, Lye SJ. ACE2 Is Expressed in Immune Cells That Infiltrate the Placenta in Infection-Associated Preterm Birth. Cells 2021; 10:1724. [PMID: 34359894 DOI: 10.3390/cells10071724] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 02/07/2023] Open
Abstract
COVID-19 is associated with increased incidence of preterm birth (PTB). We assessed pathways by which SARS-CoV-2 could access the placenta. Placentae, from PTB with or without chorioamnionitis (ChA), or from term pregnancies (n = 12/13/group) were collected. Peripheral blood was collected from healthy pregnant women (n = 6). Second trimester placental explants (16–20 weeks, n = 5/group) were treated with lipopolysaccharide (LPS, to mimic bacterial infection) and ACE2, CCL2, IL-6/8 and TNFα mRNA was assessed. ChA-placentae exhibited increased ACE2 and CCL2 mRNA expression (p < 0.05). LPS increased cytokine and ACE2 mRNA in placental explants. Placental ACE2 protein localized to syncytiotrophoblast, fetal endothelium, extravillous trophoblast and in immune cells-subsets (M1/M2 macrophage and neutrophils) within the villous stroma. Significantly increased numbers of M1 macrophage and neutrophils were present in the ChA-placenta (p < 0.001). Subsets of peripheral immune cells from pregnant women express the ACE2 mRNA and protein. A greater fraction of granulocytes was positive for ACE2 protein expression compared to lymphocytes or monocytes. These data suggest that in pregnancies complicated by ChA, ACE2 positive immune cells in the maternal circulation have the potential to traffic SARS-CoV-2 virus to the placenta and increase the risk of vertical transmission to the placenta/fetus.
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Abstract
BACKGROUND In December 2019, a novel coronavirus disease (COVID-19) emerged in Wuhan, China, with an incredible contagion rate. However, the vertical transmission of COVID-19 is uncertain. OBJECTIVES This is a systematic review of published studies concerning pregnant women with confirmed COVID-19 and their neonates. SEARCH STRATEGY We carried out a systematic search in multiple databases, including PubMed, Web of Science, Google Scholar, Scopus, and WHO COVID-19 database using the following keywords: (Coronavirus) OR (novel coronavirus) OR (COVID-19) OR (COVID19) OR (COVID 19) OR (SARS-CoV2) OR (2019-nCoV)) and ((pregnancy) OR (pregnant) OR (vertical transmission) OR (neonate) OR (newborn) OR (placenta) OR (fetus) OR (Fetal)). The search took place in April 2020. SELECTION CRITERIA Original articles published in English were eligible if they included pregnant patients infected with COVID-19 and their newborns. DATA COLLECTION AND ANALYSES The outcomes of interest consisted of clinical manifestations of COVID-19 in pregnant patients with COVID-19 and also the effect of COVID-19 on neonatal and pregnancy outcomes. MAIN RESULTS 37 articles involving 364 pregnant women with COVID-19 and 302 neonates were included. The vast majority of pregnant patients were in their third trimester of pregnancy, and only 45 cases were in the first or second trimester (12.4%). Most mothers described mild to moderate manifestations of COVID-19. Of 364 pregnant women, 25 were asymptomatic at the time of admission. The most common symptoms were fever (62.4%) and cough (45.3%). Two maternal deaths occurred. Some pregnant patients (12.1%) had a negative SARS-CoV-2 test but displayed clinical manifestations and abnormalities in computed tomography (CT) scan related to COVID-19. Twenty-two (6.0%) pregnant patients developed severe pneumonia. Two maternal deaths occurred from severe pneumonia and multiple organ dysfunction. Studies included a total of 302 neonates from mothers with COVID-19. Of the studies that provided data on the timing of birth, there were 65 (23.6%) preterm neonates. One baby was born dead from a mother who also died from COVID-19. Of the babies born alive from mothers with COVID-19, five newborns faced critical conditions, and two later died. A total of 219 neonates underwent nasopharyngeal specimen collection for SARS-CoV-2, of which 11 tested positive (5%). Seventeen studies examined samples of the placenta, breast milk, umbilical cord, and amniotic fluid, and all tested negative except one amniotic fluid sample. CONCLUSIONS A systematic review of published studies confirm that the course of COVID-19 in pregnant women resembles that of other populations. However, there is not sufficient evidence to establish an idea that COVID-19 would not complicate pregnancy.
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Affiliation(s)
- Mona Mirbeyk
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Children's Medical Center Hospital, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
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Lassi ZS, Ali A, Das JK, Salam RA, Padhani ZA, Irfan O, Bhutta ZA. A systematic review and meta-analysis of data on pregnant women with confirmed COVID-19: Clinical presentation, and pregnancy and perinatal outcomes based on COVID-19 severity. J Glob Health 2021; 11:05018. [PMID: 34221361 PMCID: PMC8248750 DOI: 10.7189/jogh.11.05018] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We determined the clinical presentation, risk factors, and pregnancy and perinatal outcomes in pregnant women with confirmed COVID-19 and identified if these are different based on COVID-19 severity. METHODS We included all observational studies on pregnant women with confirmed COVID-19 reporting clinical presentation, risk factors, and pregnancy and perinatal outcomes. We included all studies published between Dec/2019-Feb/2021 in Medline, Embase, the WHO COVID-19 databases, and clinicaltrials.gov. The methodological quality of cohort and case-series was assessed using NHLBI criteria. RESULTS 31 016 pregnant women from 62 studies were included. Women were an average of 30.9 years of age, most (77.7%) were in the third trimester, and 16.4% developed severe COVID-19. Nearly half were asymptomatic, while the most commonly reported symptoms were cough, fever, fatigue, and anosmia/ageusia. About 7% were admitted to the intensive care unit (ICU), 8% required mechanical ventilation, and 2% of the women died. Almost 80% of women delivered; 48.4% had cesarean births. Among newborns, 23.4% were preterm (<37 weeks), 16.6% were low birth weight, and 23.7% were admitted to neonatal ICU. A total of 21 stillbirths (1.6%) and 24 neonatal deaths (1.6%) were recorded, while 50 babies (3.5%) were COVID-19 positive. Studies comparing pregnant women with severe and non-severe COVID-19 showed that women with severe COVID-19 were 3.7 years older and the risk of severe COVID-19 was 1.5 times higher among women >35 years. The risk of severe COVID-19 was significantly higher among women who were obese, had smoked, diabetic, and had pre-eclampsia. The risk of preterm birth was almost 2.4 folds among women with severe COVID-19. CONCLUSIONS Our review suggests a heightened risk of COVID-19 severity and adverse pregnancy and perinatal outcomes among women with certain demographic and health profiles. These findings can inform the formation of current guidelines; however, these should be constantly updated as the global COVID-19 scenario unfolds. REGISTRATION PROSPERO: CRD42020182048.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, the University of Adelaide, Adelaide, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
| | - Anna Ali
- Robinson Research Institute, the University of Adelaide, Adelaide, Australia
- Adelaide Medical School, the University of Adelaide, Adelaide, Australia
| | - Jai K Das
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zahra A Padhani
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Omar Irfan
- Centre for Global Child Health, the Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, the Hospital for Sick Children (SickKids), Toronto, Canada
- Centre of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Godoi APN, Bernardes GCS, Nogueira LS, Alpoim PN, Pinheiro MDB. Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times. Rev Bras Ginecol Obstet 2021; 43:384-394. [PMID: 34182583 PMCID: PMC10303011 DOI: 10.1055/s-0041-1729145] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period. METHODS In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2. RESULTS The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission. CONCLUSION Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.
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Taghavi SA, Heidari S, Jahanfar S, Amirjani S, Aji-ramkani A, Azizi-Kutenaee M, Bazarganipour F. Obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran: a retrospective, case-control study. Middle East Fertil Soc J 2021; 26:17. [PMID: 34149282 PMCID: PMC8202219 DOI: 10.1186/s43043-021-00059-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/31/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the present study was to evaluate obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran. RESULTS A case-control study was conducted on 55 COVID-19 as the case and 55 matched control pregnant women in Hormozgan, Iran. Patients were considered to be cases if they had a positive COVID-19 test plus a positive chest X-ray result. Our measures were COVID-19 symptoms, including laboratory evaluations, clinical symptoms, and maternal and neonatal outcomes.The most prevalent symptoms related to COVID-19 were fever (69.09%) and cough (58.18%). Less common symptoms included fatigue, diarrhea, shortness of breath, sore throat, and myalgia. Hydroxychloroquine/chloroquine (58.18%) and antibiotic therapy (45.45%) were the most prevalent management in COVID-19 patients. Based on our findings, maternal and obstetric outcomes-neonatal in case groups-such as mode of delivery, premature rupture of membrane, postpartum hemorrhage, perineal resection rate, neonates' birth weight, Apgar score, and neonatal asphyxia rate were similar to pregnant women without COVID-19. We observed a higher incidence rate of premature delivery in COVID-19 cases (25 vs. 10%) (p < 0.05). In the present study, we found that women with COVID-19 had a more than twofold increased odds of preterm labor. History of preterm delivery was also associated with high twofold odds of preterm labor. CONCLUSION We observed a higher incidence rate of premature delivery in COVID-19 cases. Women with COVID-19 had a more than twofold increased odds of preterm labor. Considering prematurity has high morbidity and is regarded as the primary cause of mortality in children under 5 years old, more case-control studies are needed to ascertain the results.
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Affiliation(s)
- Seyed-Abdolvahab Taghavi
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Solmaz Heidari
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MI USA
| | - Shakiba Amirjani
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Amireh Aji-ramkani
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Azizi-Kutenaee
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Fatemeh Bazarganipour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. Incidence de la COVID-19 sur les issues de grossesse: examen systématique et méta-analyse. CMAJ 2021; 193:E813-E822. [PMID: 34059502 PMCID: PMC8177934 DOI: 10.1503/cmaj.202604-f] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
Contexte: La nature exacte des répercussions de la maladie à coronavirus 2019 (COVID-19) sur la santé maternelle et néonatale reste à préciser. Nous avons cherché à évaluer l’association entre l’infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) pendant la grossesse et les issues défavorables de la grossesse. MÉTHODES: Nous avons réalisé une revue systématique et une méta-analyse d’études observationnelles fournissant des données comparatives sur l’infection par le SRAS-CoV-2 et la gravité de la COVID-19 pendant la grossesse. Nous avons sélectionné les études admissibles à partir des bases de données MEDLINE, Embase, ClinicalTrials.gov , medRxiv et Cochrane au 29 janvier 2021, en utilisant les Medical Subject Headings (vedettes matière en médecine) et les expressions clés « severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2 OR coronavirus disease 2019 OR COVID-19 » (coronavirus du syndrome respiratoire aigu sévère 2 ou SRAS-CoV-2 ou maladie à coronavirus 2019 ou COVID-19) AND « pregnancy » (grossesse). Nous avons ensuite évalué la qualité méthodologique de toutes les études retenues avec l’échelle de Newcastle–Ottawa. Les issues primaires étaient la prééclampsie et la naissance prématurée. Les issues secondaires incluaient la mortinaissance et le diabète gestationnel, ainsi que d’autres issues de grossesse. Nous avons calculé des rapports de cotes (RC) sommaires ou des différences moyennes pondérées avec des intervalles de confiance (IC) à 95 % par méta-analyse à effets aléatoires. RÉSULTATS: Nous avons retenu 42 études portant sur 438 548 personnes enceintes. Comparativement à une absence d’infection par le SRAS-CoV-2 pendant la grossesse, le diagnostic de COVID-19 a été associé à la prééclampsie (RC 1,33; IC à 95 % 1,03–1,73), à la naissance prématurée (RC 1,82; IC à 95 % 1,38–2,39) et à la mortinaissance (RC 2,11; IC à 95 % 1,14–3,90). Par rapport à la COVID-19 légère, la COVID-19 grave était fortement associée à la prééclampsie (RC 4,16; IC à 95 % 1,55–11,15), à la naissance prématurée (RC 4,29; IC à 95 % 2,41–7,63), au diabète gestationnel (RC 1,99; IC à 95 % 1,09–3,64) et au faible poids à la naissance (RC 1,89; IC à 95 % 1,14–3,12). INTERPRÉTATION: La COVID-19 pourrait être associée à un risque accru de prééclampsie, de naissance prématurée et d’autres issues défavorables de la grossesse.
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Affiliation(s)
- Shu Qin Wei
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont
| | - Marianne Bilodeau-Bertrand
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont
| | - Shiliang Liu
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont
| | - Nathalie Auger
- Département d'obstétrique-gynécologie (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Département de médecine sociale et préventive (Auger), École de santé publique, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Qc; Centre de surveillance et de recherche appliquée (Liu), Agence de la santé publique du Canada, Ottawa, Ont.
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Saadaoui M, Kumar M, Al Khodor S. COVID-19 Infection during Pregnancy: Risk of Vertical Transmission, Fetal, and Neonatal Outcomes. J Pers Med 2021; 11:483. [PMID: 34071251 PMCID: PMC8227688 DOI: 10.3390/jpm11060483] [Citation(s) in RCA: 15] [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: 02/18/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/18/2022] Open
Abstract
The COVID-19 pandemic is a worldwide, critical public health challenge and is considered one of the most communicable diseases that the world had faced so far. Response and symptoms associated with COVID-19 vary between the different cases recorded, but it is amply described that symptoms become more aggressive in subjects with a weaker immune system. This includes older subjects, patients with chronic diseases, patients with immunosuppression treatment, and pregnant women. Pregnant women are receiving more attention not only because of their altered physiological and immunological function but also for the potential risk of viral vertical transmission to the fetus or infant. However, very limited data about the impact of maternal infection during pregnancy, such as the possibility of vertical transmission in utero, during birth, or via breastfeeding, is available. Moreover, the impact of infection on the newborn in the short and long term remains poorly understood. Therefore, it is vital to collect and analyze data from pregnant women infected with COVID-19 to understand the viral pathophysiology during pregnancy and its effects on the offspring. In this article, we review the current knowledge about pre-and post-natal COVID-19 infection, and we discuss whether vertical transmission takes place in pregnant women infected with the virus and what are the current recommendations that pregnant women should follow in order to be protected from the virus.
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Affiliation(s)
| | | | - Souhaila Al Khodor
- Research Department, Sidra Medicine, Doha P.O. Box 26999, Qatar; (M.S.); (M.K.)
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Ayele AD, Mihretie GN, Belay HG, Teffera AG, Kassa BG, Amsalu BT. Knowledge and practice to prevent COVID-19 and its associated factors among pregnant women in Debre Tabor Town Northwest Ethiopia, a community-based cross-sectional study. BMC Pregnancy Childbirth 2021; 21:397. [PMID: 34020600 PMCID: PMC8139538 DOI: 10.1186/s12884-021-03877-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Coronavirus disease is now a global concern with the non-availability of antiviral treatment and attacks all groups of the population. Hence, applying preventive measures is the most critical intervention to control the infection. Pregnant women are particularly susceptible to respiratory pathogens because of their immunosuppressive state and physiological adaptive change during pregnancy. Therefore, this study was aimed to assess knowledge and practice to prevent coronavirus disease and its associated factors among pregnant women in Debre Tabor Town. Methods Community-based cross-sectional study was conducted among 422 participants from May 25–June 15, 2020. A simple random sampling technique was employed. Data were collected by face-to-face interview using a structured and pre-tested questionnaire and analysis using SPSS version 23. Bivariable and multivariable logistic regression analysis was carried out and p-value < 0.05 at 95% CI were considered as statistically significant. Results Overall 46.8 and 47.6% of women were knowledgeable and had good practice to prevent coronavirus respectively. Women’s age (15–24 years) (AOR = 4.85, 95% CI: 1.34–5.42), educational status (AOR:3.70; 95% CI: 1.16–5.40) being civil servant (AOR:2.84; 95% CI: 1.55–5.21), wanted pregnancy (AOR:3.37; 95% CI: 1.20–9.45), antenatal care follow-up (AOR:2.07; 95% CI: 1.03–4.13) were significantly associated with COVID-19 knowledge, whereas educational status (AOR:3.78; 95% CI: 1.19–5.11), number of children (AOR:2.89; 95% CI: 1.29–6.45) and knowledge (AOR:8.42;95% CI: 4.50–15.85), were also found to be statistically significant with practice. Conclusions Most of the participants had poor knowledge and inappropriate practice. Increasing health education programs via different media, coordinated and combined efforts of authorities and all individuals will be needed to battles the spread of the infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03877-4.
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Affiliation(s)
- Alemu Degu Ayele
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
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Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the etiological agent of coronavirus disease 2019 (COVID-19), is similar to two other coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), in causing life-threatening respiratory infections and systemic complications in both children and adults. As the COVID-19 pandemic has continued to spread globally, increasing numbers of pregnant women have become infected, raising concern not only for their health but also for the health of their infants. This chapter discusses the effects of coronavirus infections, e.g., MERS, SARS, and COVID 19, on pregnancy and describes the evolving knowledge of COVID 19 among pregnant women. The physiological changes that occur in pregnancy, especially changes in the immune system, are reviewed in terms of their effect on susceptibility to infectious diseases. The effects of COVID-19 on the placenta, fetus, and neonate are also reviewed, including potential clinical outcomes and issues relating to testing and diagnosis. The potential mechanisms of vertical transmission of the virus between pregnant women and their infants are analyzed, including intrauterine, intrapartum, and postpartum infections. Several recent studies have reported the detection of SARS-CoV-2 in tissues from the fetal side of the placenta, permitting the diagnosis of transplacental infection of the fetus by SARS-CoV-2. Placentas from infected mothers in which intrauterine transplacental transmission of SARS-CoV-2 has occurred demonstrate an unusual combination of pathology findings which may represent risk factors for placental as well as fetal infection.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Tolu LB, Ezeh A, Feyissa GT. Vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2: A scoping review. PLoS One 2021; 16:e0250196. [PMID: 33886645 PMCID: PMC8062014 DOI: 10.1371/journal.pone.0250196] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/30/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The evidence for vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not well established. Therefore, the objective of this review is to summarize emerging evidence on the vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2. METHODS We conducted a systematic search in PubMed, CINAHL, Web of Science, SCOPUS, and CENTRAL. Likewise, a search for preprint publications was conducted using MedRxiv and Research Square. Studies that addressed vertical transmission of SARS-CoV-2 (concept) among pregnant women infected by Covid-19 (population) in any setting (community, hospital, or home) in any country or context were considered for inclusion. Any types of studies or reports published between December 2019 and September 2020 addressing the effects of SARS-CoV-2 on pregnant women and their newborn babies were included. Studies were screened for eligibility against the inclusion criteria for the review by two reviewers. RESULTS We identified 51 studies reporting 336 newborns screened for COVID-19. From the 336 newborns screened for COVID-19, only 15 (4.4%) were positive for throat swab RT-PCR. All neonates with positive throat swab RT-PCR were delivered by cesarean section. Among neonates with throat swab SARS-CoV-2 positive only five (33.3%) had concomitant placenta, amniotic fluid, and cord blood samples tested, of which only one amniotic fluid sample is positive for RT PCR. Five neonates had elevated IgG and IgM but without intrauterine tissue tested. Four neonates had chest imaging suggestive of COVID-19 pneumonia. CONCLUSION Currently there is not enough evidence on vertical virologic transmission of COVID-19 infection during the third trimester of pregnancy. Additionally, there is no evidence to support cesarean delivery, abstaining from breast feeding nor mother and infant separation. Further research involving an adequate sample size of breast milk, placenta, amniotic fluid, and cord blood to ascertain the possibility of vertical transmission and breast milk transfer is needed.
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Affiliation(s)
- Lemi Belay Tolu
- Saint Paul’s Hospital Millennium Medical College, Department of Obstetrics and Gynaecology, Addis Ababa, Ethiopia
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Garumma Tolu Feyissa
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
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Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ 2021; 193:E540-E548. [PMID: 33741725 PMCID: PMC8084555 DOI: 10.1503/cmaj.202604] [Citation(s) in RCA: 392] [Impact Index Per Article: 130.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) on maternal and newborn health is unclear. We aimed to evaluate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and adverse pregnancy outcomes. METHODS We conducted a systematic review and meta-analysis of observational studies with comparison data on SARS-CoV-2 infection and severity of COVID-19 during pregnancy. We searched for eligible studies in MEDLINE, Embase, ClinicalTrials.gov, medRxiv and Cochrane databases up to Jan. 29, 2021, using Medical Subject Headings terms and keywords for "severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2 OR coronavirus disease 2019 OR COVID-19" AND "pregnancy." We evaluated the methodologic quality of all included studies using the Newcastle-Ottawa Scale. Our primary outcomes were preeclampsia and preterm birth. Secondary outcomes included stillbirth, gestational diabetes and other pregnancy outcomes. We calculated summary odds ratios (ORs) or weighted mean differences with 95% confidence intervals (CI) using random-effects meta-analysis. RESULTS We included 42 studies involving 438 548 people who were pregnant. Compared with no SARS-CoV-2 infection in pregnancy, COVID-19 was associated with preeclampsia (OR 1.33, 95% CI 1.03 to 1.73), preterm birth (OR 1.82, 95% CI 1.38 to 2.39) and stillbirth (OR 2.11, 95% CI 1.14 to 3.90). Compared with mild COVID-19, severe COVID-19 was strongly associated with preeclampsia (OR 4.16, 95% CI 1.55 to 11.15), preterm birth (OR 4.29, 95% CI 2.41 to 7.63), gestational diabetes (OR 1.99, 95% CI 1.09 to 3.64) and low birth weight (OR 1.89, 95% CI 1.14 to 3.12). INTERPRETATION COVID-19 may be associated with increased risks of preeclampsia, preterm birth and other adverse pregnancy outcomes.
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Affiliation(s)
- Shu Qin Wei
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont
| | - Marianne Bilodeau-Bertrand
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont
| | - Shiliang Liu
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont
| | - Nathalie Auger
- Department of Obstetrics and Gynecology (Wei), Centre hospitalier universitaire Sainte-Justine; Centre de recherche du Centre hospitalier de l'Université de Montréal, Department of Social and Preventive Medicine (Auger), School of Public Health, Université de Montréal; Bureau d'information et d'études en santé des populations (Wei, Bilodeau-Bertrand, Auger), Institut national de santé publique du Québec, Montréal, Que.; Centre for Surveillance and Applied Research (Liu), Public Health Agency of Canada, Ottawa, Ont.
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Martinez-Perez O, Prats Rodriguez P, Muner Hernandez M, Encinas Pardilla MB, Perez Perez N, Vila Hernandez MR, Villalba Yarza A, Nieto Velasco O, Del Barrio Fernandez PG, Forcen Acebal L, Orizales Lago CM, Martinez Varea A, Muñoz Abellana B, Suarez Arana M, Fuentes Ricoy L, Martinez Diago C, Janeiro Freire MJ, Alférez Alvarez-Mallo M, Casanova Pedraz C, Alomar Mateu O, Lesmes Heredia C, Wizner de Alva JC, Bernardo Vega R, Macia Badia M, Alvarez Colomo C, Sanchez Muñoz A, Pratcorona Alicart L, Alonso Saiz R, Lopez Rodriguez M, Del Carmen Barbancho Lopez M, Meca Casbas MR, Vaquerizo Ruiz O, Moran Antolin E, Nuñez Valera MJ, Fernandez Fernandez C, Tubau Navarra A, Cano Garcia AM, Baena Luque C, Soldevilla Perez S, Gastaca Abasolo I, Adanez Garcia J, Teulon Gonzalez M, Puertas Prieto A, Ostos Serna R, Del Pilar Guadix Martin M, Catalina Coello M, Ferriols Perez E, Caño Aguilar A, De la Cruz Conty ML, Sainz Bueno JA. The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis. BMC Pregnancy Childbirth 2021; 21:273. [PMID: 33794829 PMCID: PMC8016158 DOI: 10.1186/s12884-021-03742-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/22/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity. METHODS We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes. MAIN OUTCOME MEASURES Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions. RESULTS Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p < 0.001) was also observed in positive mothers. CONCLUSION This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.
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Affiliation(s)
- Oscar Martinez-Perez
- Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain.
| | - Pilar Prats Rodriguez
- Department Reproductive Medicine and Gynaecology, Obstetrics, Dexeus University Hospital, Barcelona, Catalunya, Spain
| | - Marta Muner Hernandez
- Department Gynaecology and Obstetrics, La Paz University Hospital. Madrid, Madrid, Spain
| | - Maria Begoña Encinas Pardilla
- Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain
| | - Noelia Perez Perez
- Department Gynaecology and Obstetrics, San Carlos University Hospital. Madrid, Madrid, Spain
| | | | - Ana Villalba Yarza
- Department Gynaecology and Obstetrics, University Hospital of Salamanca, Salamanca, Castilla y León, Spain
| | - Olga Nieto Velasco
- Department Obstetrics and Gynaecology, Quironsalud Madrid University Hospital. Madrid, Madrid, Spain
| | | | - Laura Forcen Acebal
- Department Gynaecology and Obstetrics, Doce de Octubre University Hospital, Comunidad de Madrid, Madrid, Spain
| | | | - Alicia Martinez Varea
- Department Gynaecology and Obstetrics, La Fe University and Polytechnic Hospital, Comunidad Valenciana, Valencia, Spain
| | - Begoña Muñoz Abellana
- Department Obstetrics and Gynaecology, Sant Joan de Reus University Hospital, Reus, Catalunya, Spain
| | - Maria Suarez Arana
- Department Gynaecology and Obstetrics, Regional University Hospital of Malaga, Malaga, Andalucía, Spain
| | - Laura Fuentes Ricoy
- Department Obstetrics and Gynaecology, University Hospital of Ferrol, Ferrol, A Coruña, Spain
| | - Clara Martinez Diago
- Department Gynaecology and Obstetrics, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain
| | | | | | - Cristina Casanova Pedraz
- Department Gynaecology and Obstetrics, University Hospital of Torrejon, Torrejon de Ardoz, Madrid, Spain
| | - Onofre Alomar Mateu
- Department Obstetrics and Gynaecology, Regional Hospital of Inca, Inca, Illes Balears, Spain
| | | | | | - Rut Bernardo Vega
- Department Gynaecology and Obstetrics, Rio Hortega University Hospital, Valladolid, Castilla y León, Spain
| | - Montserrat Macia Badia
- Department Gynaecology and Obstetrics, Arnau de Vilanova University Hospital, Lleida, Catalunya, Spain
| | - Cristina Alvarez Colomo
- Department Gynaecology and Obstetrics, Valladolid University Hospital, Valladolid, Castilla y León, Spain
| | - Antonio Sanchez Muñoz
- Department Gynaecology and Obstetrics, General University Hospital of Ciudad Real, Ciudad Real, Castilla-La Mancha, Spain
| | - Laia Pratcorona Alicart
- Department Obstetrics and Gynaecology, Germans Trias i Pujol University Hospital, Barcelona, Catalunya, Spain
| | - Ruben Alonso Saiz
- Department Gynaecology and Obstetrics, University Hospital of Burgos, Burgos, Castilla y León, Spain
| | - Monica Lopez Rodriguez
- Department Obstetrics and Gynaecology, Joan XXIII University Hospital of Tarragona, Tarragona, Catalunya, Spain
| | | | - Marta Ruth Meca Casbas
- Department Obstetrics and Gynaecology, Poniente Hospital of Almería, El Ejido, Andalucía, Spain
| | - Oscar Vaquerizo Ruiz
- Department Obstetrics and Gynaecology, University Hospital of Cabueñes, Gijon, Asturias, Spain
| | - Eva Moran Antolin
- Department Obstetrics and Gynaecology, Son Espases University Hospital, Palma de Mallorca, Illes Balears, Spain
| | - Maria Jose Nuñez Valera
- Department Obstetrics and Gynaecology, Virgen de la Luz Hospital, Cuenca, Castilla-La Mancha, Spain
| | - Camino Fernandez Fernandez
- Department Gynaecology and Obstetrics, University Assistance Complex of Leon, Leon, Castilla y Leon, Spain
| | - Albert Tubau Navarra
- Department Obstetrics and Gynaecology, Son Llatzer University Hospital, Palma de Mallorca, Illes Balears, Spain
| | | | - Carmen Baena Luque
- Department Gynaecology and Obstetrics, Infanta Margarita Hospital, Andalucía, Cabra, Spain
| | - Susana Soldevilla Perez
- Department Obstetrics and Gynaecology, University Hospital of Jerez de la Frontera, Jerez de la Frontera, Andalucía, Spain
| | - Irene Gastaca Abasolo
- Department Obstetrics and Gynaecology, Txagorritxu University Hospital of Araba, Vitoria-Gasteiz, País Vasco, Spain
| | - Jose Adanez Garcia
- Department Obstetrics and Gynaecology, Central University Hospital of Asturias, Oviedo, Asturias, Spain
| | - Maria Teulon Gonzalez
- Department Gynaecology and Obstetrics, University Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Alberto Puertas Prieto
- Department Obstetrics and Gynaecology, Virgen de las Nieves University Hospital, Granada, Andalucía, Spain
| | - Rosa Ostos Serna
- Department Gynaecology and Obstetrics, Virgen de Valme University Hospital, Sevilla, Andalucía, Spain
| | | | - Monica Catalina Coello
- Department Gynaecology and Obstetrics, Virgen de la Concha Hospital, Zamora, Castilla y León, Spain
| | - Elena Ferriols Perez
- Department Gynaecology and Obstetrics, Parc de Salut Mar University Hospital, Barcelona, Catalunya, Spain
| | - Africa Caño Aguilar
- Department Obstetrics and Gynaecology, San Cecilio University Hospital of Granada, Granada, Andalucía, Spain
| | - Maria Luisa De la Cruz Conty
- Fundación de Investigación Biomédica, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain
| | - Jose Antonio Sainz Bueno
- Department Gynaecology and Obstetrics, University of Seville, G. Chacon (Viamed Santa Angela de la Cruz Hospital), Sevilla, Andalucia, Spain
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Patnaik N, Bhatia V, Mishra KG, Sukumar M. Effects of COVID-19 on Pregnant women: Evidence-based review. J Family Med Prim Care 2021; 10:1530-1533. [PMID: 34123887 PMCID: PMC8144763 DOI: 10.4103/jfmpc.jfmpc_1557_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/05/2022] Open
Abstract
Corona virus infection (COVID-19) is increasing exponentially globally. It is also affecting pregnant women among others. Complications arising during pregnancy because of COVID-19 must be considered a health issue. The objective of the study was to analyse symptoms of pregnant women affected with COVID-19 based on the available literature. The articles were searched from Medline/PubMed, Scopus which were published till June 2020 and reviewed for the determined outcomes. The review demonstrated that common symptoms were fever, cough, nausea and myalgia. Vertical transmission of Corona virus infection was not found in any of the articles reviewed. Multicenter studies are important to better understand the pathogenesis and treatment planning for COVID-19 affected pregnant women.
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Affiliation(s)
- Nabnita Patnaik
- Department of Obstetrics and Gynaecology, AIIMS, Bibinagar, Hyderabad, Telangana, India
| | - Vikas Bhatia
- Executive Director, AIIMS, Bibinagar, Hyderabad, Telangana, India
| | - Kumar G. Mishra
- Community Medicine and Family Medicine, AIIMS, Bibinagar, Hyderabad, Telangana, India
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Trombetta A, Comar M, Tommasini A, Canton M, Campisciano G, Zanotta N, Cason C, Maso G, Risso FM. SARS-CoV-2 Infection and Inflammatory Response in a Twin Pregnancy. Int J Environ Res Public Health 2021; 18:3075. [PMID: 33802696 PMCID: PMC8002573 DOI: 10.3390/ijerph18063075] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022]
Abstract
There is growing literature about the SARS-CoV-2 pathogenetic effects exerted during pregnancy and whether vertical transmission or premature birth is possible. It is not well known whether changes in the immune system of pregnant women may lead to a marked susceptibility to infectious processes and the risk of adverse maternal and neonatal complications such as preterm birth, spontaneous abortion, hospitalization in an intensive care unit, transmission to the fetus or newborns, and fetal mortality are poorly understood. Along with this ongoing debate, it is not well defined whether, during pregnancy, the role of host susceptibility in producing a specific inflammatory response to SARS-CoV-2 may represent distinctive markers of risk of vertical transmission. Furthermore, SARS-CoV-2 impact on the vaginal microbiome has not yet been described, despite mounting evidence on its possible effect on the gastrointestinal microbiome and its influence on infectious diseases and preterm labor. This report describes the impact of SARS-CoV-2 on a twin pregnancy diagnosed with infection at the third trimester of gestation including tissue infections, inflammatory response, antibody production, cytokine concentration, and vaginal microbiome composition. We identified a pattern of cytokines including IL1-Ra, IL-9 G-CSF, IL-12, and IL-8 differently expressed, already associated with previously infected patients. We detected a similar concentration of almost all the cytokines tested in both twins, suggesting that the SARS-CoV-2-induced cytokine storm is not substantially impaired during the placental passage. The analysis of the vaginal microbiome did not show relevant signs of dysbiosis, similar to other healthy pregnant women and twin healthy pregnancies. The aim of this report was to analyze the immunological response against SARS-CoV-2 infection and virus tissue tropism in a twin pregnancy.
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Affiliation(s)
- Andrea Trombetta
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Piazzale Europa, 1, 34127 Trieste, Italy; (A.T.); (M.C.); (M.C.); (C.C.)
| | - Manola Comar
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Piazzale Europa, 1, 34127 Trieste, Italy; (A.T.); (M.C.); (M.C.); (C.C.)
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, via Dell’istria 65/1, 34124 Trieste, Italy; (G.C.); (N.Z.); (G.M.); (F.M.R.)
| | - Alberto Tommasini
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Piazzale Europa, 1, 34127 Trieste, Italy; (A.T.); (M.C.); (M.C.); (C.C.)
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, via Dell’istria 65/1, 34124 Trieste, Italy; (G.C.); (N.Z.); (G.M.); (F.M.R.)
| | - Melania Canton
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Piazzale Europa, 1, 34127 Trieste, Italy; (A.T.); (M.C.); (M.C.); (C.C.)
| | - Giuseppina Campisciano
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, via Dell’istria 65/1, 34124 Trieste, Italy; (G.C.); (N.Z.); (G.M.); (F.M.R.)
| | - Nunzia Zanotta
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, via Dell’istria 65/1, 34124 Trieste, Italy; (G.C.); (N.Z.); (G.M.); (F.M.R.)
| | - Carolina Cason
- Department of Medical, Surgical, and Health Sciences, University of Trieste, Piazzale Europa, 1, 34127 Trieste, Italy; (A.T.); (M.C.); (M.C.); (C.C.)
| | - Gianpaolo Maso
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, via Dell’istria 65/1, 34124 Trieste, Italy; (G.C.); (N.Z.); (G.M.); (F.M.R.)
| | - Francesco Maria Risso
- Institute for Maternal and Child Health “IRCCS Burlo Garofolo”, via Dell’istria 65/1, 34124 Trieste, Italy; (G.C.); (N.Z.); (G.M.); (F.M.R.)
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Abstract
The maternal-fetal/newborn unit is established at risk for COVID-19 infection. This narrative review summarizes the contemporary and cumulative publications which detail maternal infection, antenatal and newborn infections, and maternal/fetal/newborn management and prevention. There is a wide spectrum of maternal disease, but the potential for severe disease albeit in a minority is confirmed. COVID-19 carries risk for preterm delivery. Pregnant females can suffer multisystem disease, and co-morbidities play a significant role in risk. Congenital infection has been supported by several anecdotal reports, but strong confirmatory data are few. No typical congenital dysmorphisms are evident. Nevertheless, placental vascular compromise must be considered a risk for the fetus during advanced maternal infections. Clinical manifestations of newborn infection have been mild to moderate and relatively uncommon. Proven antiviral therapy is of yet lacking. The mode of delivery is a medical decision that must include patient risk assessment and patient directives. Both presymptomatic and asymptomatic mothers and offspring can complicate infection control management with the potential for spread to others in several regards. In the interim, infections of the maternal-fetal-newborn unit must be taken seriously both for the disease so caused and the potential for further dissemination of disease.
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Porpora MG, Merlino L, Masciullo L, D’Alisa R, Brandolino G, Galli C, De Luca C, Pecorini F, Fonsi GB, Mingoli A, Franchi C, Oliva A, Manganaro L, Mastroianni CM, Piccioni MG. Does Lung Ultrasound Have a Role in the Clinical Management of Pregnant Women with SARS COV2 Infection? Int J Environ Res Public Health 2021; 18:ijerph18052762. [PMID: 33803223 PMCID: PMC7967479 DOI: 10.3390/ijerph18052762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is a major health threat. Pregnancy can lead to an increased susceptibility to viral infections. Although chest computed tomography (CT) represents the gold standard for the diagnosis of SARS-CoV-2 pneumonia, lung ultrasound (LUS) could be a valid alternative in pregnancy. The objectives of this prospective study were to assess the role of LUS in the diagnosis of lung involvement and in helping the physicians in the management of affected patients. Thirty pregnant women with SARS-CoV-2 infection were admitted at the obstetrical ward of our Hospital. Mean age was 31.2 years, mean gestational age 33.8 weeks. Several LUS were performed during hospitalization. The management of the patients was decided according to the LUS score and the clinical conditions. Mean gestational age at delivery was at 37.7 weeks, preterm birth was induced in 20% of cases for a worsening of the clinical conditions. No neonatal complications occurred. In 9 cases with a high LUS score, a chest CT was performed after delivery. CT confirmed the results of LUS, showing a significant positive correlation between the two techniques. LUS seems a safe alternative to CT in pregnancy and may help in the management of these patients.
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Affiliation(s)
- Maria Grazia Porpora
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Lucia Merlino
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Luisa Masciullo
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Rossella D’Alisa
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Gabriella Brandolino
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Cecilia Galli
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
- Correspondence:
| | - Casimiro De Luca
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Francesco Pecorini
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
| | - Giovanni Battista Fonsi
- Department of Surgery, “Pietro Valdoni”, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.F.); (A.M.)
| | - Andrea Mingoli
- Department of Surgery, “Pietro Valdoni”, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.F.); (A.M.)
| | - Cristiana Franchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (C.F.); (A.O.); (C.M.M.)
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (C.F.); (A.O.); (C.M.M.)
| | - Lucia Manganaro
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy;
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (C.F.); (A.O.); (C.M.M.)
| | - Maria Grazia Piccioni
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy; (M.G.P.); (L.M.); (L.M.); (R.D.); (G.B.); (C.D.L.); (F.P.); (M.G.P.)
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Oltean I, Tran J, Lawrence S, Ruschkowski BA, Zeng N, Bardwell C, Nasr Y, de Nanassy J, El Demellawy D. Impact of SARS-CoV-2 on the clinical outcomes and placental pathology of pregnant women and their infants: A systematic review. Heliyon 2021; 7:e06393. [PMID: 33688585 PMCID: PMC7923950 DOI: 10.1016/j.heliyon.2021.e06393] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/18/2020] [Revised: 11/18/2020] [Accepted: 02/25/2021] [Indexed: 01/08/2023] Open
Abstract
Pregnant women are susceptible to viral infections due to physiological changes such as cell-mediated immunity. No severe adverse pregnancy or neonatal outcomes have been consistently reported in 2019 novel coronavirus disease (COVID-19) positive pregnancy cases. There are controversies around the role of COVID-19 in pregnancy. A systematic review was conducted to examine clinical maternal and neonatal clinical outcomes. Studies were included if they reported SARS-CoV-2 infection among pregnant women and/or COVID-19 positive neonates as validated by positive antibody testing or viral testing using polymerase chain reaction. Case series, case reports, case-control studies, and comparative studies were included. Eight hundred and thirty-seven records were identified, resulting in 525 records for level I screening. Forty-one were included after full-text review. Results suggest elevated rates of intensive care unit (ICU) admission, gestational diabetes, preeclampsia, C-sections, pre-term birth, and C-reactive protein (CRP) in comparison to pregnant women without SARS-CoV-2. Careful monitoring of pregnancies with SARS-CoV-2 is recommended.
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Affiliation(s)
- Irina Oltean
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
| | - Jason Tran
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Sarah Lawrence
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
| | | | - Na Zeng
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Cameron Bardwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Youssef Nasr
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
| | - Joseph de Nanassy
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
- Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
| | - Dina El Demellawy
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, K1H 8L1, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5 Canada
- Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1, Canada
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Askary E, Poordast T, Shiravani Z, Ali MA, Hashemi A, Naseri R, Moradialamdarloo S, Karimi Z, Izanloo E, Najib FS. Coronavirus disease 2019 (COVID-19) manifestations during pregnancy in all three trimesters: A case series. Int J Reprod Biomed 2021; 19:191-204. [PMID: 33718763 PMCID: PMC7922300 DOI: 10.18502/ijrm.v19i2.8477] [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: 06/18/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the susceptibility amongst different groups of the population. Pregnant women are one such group. This study was conducted to investigate the effect of COVID-19 on pregnancy and maternal/neonatal outcomes. Case presentation This case series was conducted on 16 pregnant women with COVID-19 from March 21 to May 11, 2020. Clinical characteristics, pregnancy complications, medication used, maternal/neonatal outcomes, and fatality rate were investigated through this study. The mean age of the patients was 30.06 yrs. Patients from all three trimesters were included (1 in first, 5 in second, and 10 in the third trimesters). The most common clinical symptoms were shortness of breath (n = 10), dry cough (n = 10), myalgia (n = 8), and chills (n = 7). Also, three cases had papulosquamous skin lesions with fissuring. The most common laboratory results were leukocytosis (n = 8), increased liver enzymes (n = 6), elevated CRP (n = 5), and thrombocytopenia (n = 4). There was one case of maternal mortality, five of premature labor pain (PLP), two of preeclampsia, and two of placenta accreta. Twelve pregnancies were terminated (nine cesarean sections, three vaginal deliveries). Among neonates, we had 6 cases of preterm labor. All neonates had negative PCR results. Conclusion Clinical manifestations and paraclinical results were similar to non-pregnant patients. There was no evidence of vertical transmission. PLP and premature rupture of membranes (PROM) were the most common complications in the second and third trimesters of pregnant COVID-19 women, which can lead to rupture of the uterus. Termination and delivery should be planned individually.
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Affiliation(s)
- Elham Askary
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ashraf Ali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefeh Hashemi
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Naseri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shaghayegh Moradialamdarloo
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zinat Karimi
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Izanloo
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sadat Najib
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Cuñarro-López Y, Pintado-Recarte P, Cueto-Hernández I, Hernández-Martín C, Payá-Martínez MP, Muñóz-Chápuli MDM, Cano-Valderrama Ó, Bravo C, Bujan J, Álvarez-Mon M, Ortega MA, De León-Luis JA. The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature. J Clin Med 2021; 10:360. [PMID: 33477946 DOI: 10.3390/jcm10020360] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2 is the novel member of coronavirus responsible for the worldwide pandemic COVID-19, affecting all types of people. In this context, established research identified pregnant women as a susceptible group of SARS-CoV-2 infection, although there is still limited data regarding the real impact of COVID-19 in this group. With that purpose, we conducted a systematic review describing the maternal-fetal results of pregnant women infected by SARS-CoV-2, in aim to analyze the profile of the obstetric patients according to the country of origin of the publication. A total of 38 articles were included in this systematic review with 2670 patients from 7 countries, with 20 works published from China (52.6%). We reported significative differences according to the median maternal age, with Spain as the country with the highest age (34.6 years); The percentage of tabaquism; proportion of symptomatic patients in the triage; type of radiological exam (China and France conduct CT scans on all their patients in comparison to the use of chest X-Ray in the rest of the countries studied); percentages of C-sections (83.9% in China; 35.9% Spain, p < 0.001); maternal mortality rate, proportion of patients who need treatments, the use of antivirals, antibiotics, and anticoagulants as well as measurements of the newborns. Perinatal results are favorable in the majority of countries, with very low rates of vertical transmission in the majority of works. The studies collected in this review showed moderate to high index of quality. The different works describe the affectation during the first wave of the pandemic, where the pregnant woman with SARS-CoV-2 infection is generally symptomatic during the third trimester of gestation along with other factors associated with worse prognosis of the disease, such as higher age, body mass index, and further comorbidities developed during pregnancy. In the obstetric patient, proportion of C-sections are elevated together with prematurity, increasing maternal perinatal morbimortality. Differences found between countries could be based on the proper profile of the patient in each region, the period of the pandemic directly affecting how it was managed, and the variations regarding in situ medical attention.
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Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, Critchley HOD. Pregnancy and COVID-19. Physiol Rev 2021; 101:303-318. [PMID: 32969772 PMCID: PMC7686875 DOI: 10.1152/physrev.00024.2020] [Citation(s) in RCA: 295] [Impact Index Per Article: 98.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
There are many unknowns for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe SARS-CoV-2 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation. These may have positive or negative effects on COVID-19 disease progression. The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management. Besides the direct impacts of the disease, a plethora of indirect consequences of the pandemic adversely affect maternal health, including reduced access to reproductive health services, increased mental health strain, and increased socioeconomic deprivation. In this review, we explore the current knowledge of COVID-19 in pregnancy and highlight areas for further research to minimize its impact for women and their children.
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Affiliation(s)
- Elizabeth A N Wastnedge
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sara R van Boeckel
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah J Stock
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona C Denison
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacqueline A Maybin
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Hilary O D Critchley
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Centeno‐Tablante E, Medina‐Rivera M, Finkelstein JL, Rayco‐Solon P, Garcia‐Casal MN, Rogers L, Ghezzi‐Kopel K, Ridwan P, Peña‐Rosas JP, Mehta S. Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci 2021; 1484:32-54. [PMID: 32860259 PMCID: PMC7970667 DOI: 10.1111/nyas.14477] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full-text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID-19 cases based on RT-PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID-19 were positive for SARS-CoV-2 RNA; of the exposed infants, four were positive and two were negative for COVID-19. Currently, there is no evidence of SARS-CoV-2 transmission through breast milk. Studies are needed with longer follow-up periods that collect data on infant feeding practices and on viral presence in breast milk.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn,
Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | - Lisa Rogers
- Department of Nutrition and Food
SafetyWorld Health OrganizationGenevaSwitzerland
| | | | - Pratiwi Ridwan
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| | | | - Saurabh Mehta
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
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Kumar P, Fadila, Prasad A, Akhtar A, Chaudhary BK, Tiwari LK, Chaudhry N. Vertical transmission and clinical outcome of the neonates born to SARS-CoV-2-positive mothers: a tertiary care hospital-based observational study. BMJ Paediatr Open 2021; 5:e001193. [PMID: 34697599 PMCID: PMC8526519 DOI: 10.1136/bmjpo-2021-001193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/30/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neonatal transmission of SARS-CoV-2 from positive mothers to their babies has been a real concern, opening the arena of research in this area. OBJECTIVE To detect the possibility of vertical transmission of SARS-CoV-2 from COVID-19-positive mothers to their neonates and the clinicopathological outcome in them. DESIGN A single-centre, prospective, observational study involving 47 COVID-19-positive mothers and their neonates. SETTING A tertiary care hospital in Eastern India. PARTICIPANTS Neonates born to SARS-CoV-2-infected mothers. MAIN OUTCOME MEASURES We investigated the SARS-CoV-2 positivity rate by real-time reverse transcriptase-PCR (RT-PCR) done twice (on admission and after 24 hours of admission) in neonates born to SARS-CoV-2-positive mothers, who tested RT-PCR positive for this virus in their nasopharyngeal swab. Clinical outcome was also assessed in these neonates during their hospital stay. RESULTS Out of 47 neonates born to SARS-CoV-2-positive mothers, four were SARS-CoV-2 positive by RT-PCR. All the neonates in our study were discharged home in stable condition after management of acute complications. None of them required readmission. CONCLUSION Vertical transmission occurs in neonates born to COVID-19-positive mothers; however, the risk is small. Majority of the neonates remain asymptomatic with good clinical outcome.
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Affiliation(s)
- Pradeep Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Fadila
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Arun Prasad
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ambrin Akhtar
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | | | - Lokesh Kumar Tiwari
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Neha Chaudhry
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Kouhsari E, Azizian K, Sholeh M, Shayestehpour M, Hashemian M, Karamollahi S, Yaghoubi S, Sadeghiifard N. Clinical, epidemiological, laboratory, and radiological characteristics of novel Coronavirus (2019-nCoV) in retrospective studies: A systemic review and meta-analysis. Indian J Med Microbiol 2021; 39:104-115. [PMID: 33610239 PMCID: PMC7667392 DOI: 10.1016/j.ijmmb.2020.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND In December 2019, a novel pneumonia related to the 2019 coronavirus unexpectedly developed in Wuhan, China. We aimed to review data of the novel Coronavirus (2019-nCoV) by analyzing all the published retrospective studies on the clinical, epidemiological, laboratory, and radiological characteristics of patients with 2019-nCoV. METHODS We searched in four bibliographic databases PubMed, Scopus, Embase, and Web of Science) for studies March 10, 2020 focused on the clinical, epidemiological, laboratory, and radiological characteristics of patients with 2019-nCoV for meta-analysis. The Newcastle-Ottawa Scale was used to quality assessment, and publication bias was analyzed by Egger's test. In the meta-analysis, a random-effects model with Stata/SE software, v.14.1 (StataCorp, College Station, TX) was used to obtain a pooled incidence rate. RESULTS Fifty studies were included in this systematic review and meta-analysis with 8815 patients and the mean age was 46 years and 4647 (52.7%) were male. The pooled incidences rate of clinical symptoms were: fever (83%, 95% CI: 0.77, 0.89), cough (59%, 95% CI: 0.48, 0.69), myalgia or fatigue (31%, 95% CI: 0.23, 0.39), sputum production (29%, 95% CI: 0.21, 0.39), and dyspnea (19%, 95% CI: 0.12, 0.26). The pooled incidence rate of acute respiratory distress syndrome (ARDS) was (22%, 95% CI: 0.00, 0.60). CONCLUSION The results of this systemic review and meta-analysis present a quantitative pooled incidence rate of different characters of 2019-nCoV and has great potential to develop diagnosis and patient's stratification in 2019-nCoV. However, this conclusions of this study still requisite to be warranted by more careful design, larger sample size multivariate studies to corroborate the results of this meta-analysis.
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Affiliation(s)
- Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran; Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Khalil Azizian
- Department of Lab Science, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shayestehpour
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran; Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Marzieh Hashemian
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Somayeh Karamollahi
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iranshahr, Iran.
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Abstract
Context: Evidence regarding the vertical transmission of COVID-19 from infected pregnant women to the fetus are not sufficient. Methods: The current study intended to systematically assess the possibility of vertical transmission of COVID-19 in published literature. We systematically searched international bibliographic databases, including PubMed, SCOPUS, and Google Scholar, to identify relevant studies from the time of inception of these databases until July 2020. The search strategy was finalized based on the results of the primary search in PubMed. All observational studies, including cross-sectional, cohort, case-control, case reports, and case series, published in peer-reviewed journals in any language. Editorials, commentaries, and letters to editors were excluded. Twenty articles (6 retrospective studies, 2 prospective, one cohort, 9 case reports, and 2 case series) with a total of 145 subjects were eligible for the review. Data were collected based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Results: Methods of assessing COVID-19 included polymerase chain reaction (PCR) analysis of naso/oropharyngeal, vaginal, rectal, urine secretions and gastric and amniotic fluid samples, and serum immunoglobulin (Ig) assays. Vertical transmission was reported in 6 neonates (< 10%), based on PCR, and three were positive based on Ig assays. Conclusions: According to the evidence, the possibility for vertical transmission of COVID-19 is rare.
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Ayed A, Embaireeg A, Benawadh A, Al-Fouzan W, Hammoud M, Al-Hathal M, Alzaydai A, Ahmad A, Ayed M. Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait. BMC Pregnancy Childbirth 2020; 20:754. [PMID: 33267785 PMCID: PMC7709095 DOI: 10.1186/s12884-020-03461-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 08/11/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
Background The effect of SARS-CoV-2 infection in pregnant women and newborns is incompletely understood. Preliminary data shows a rather fluctuating course of the disease from asymptomatic or mild symptoms to maternal death. However, it is not clear whether the disease increases the risk of pregnancy-related complications. The aim of the study is to describe the maternal and neonatal clinical characteristics and outcome of pregnancies with SARS-CoV-2 infection. Methods In this retrospective national-based study, we analyzed the medical records of all pregnant women infected with SARS-CoV-2 and their neonates who were admitted to New-Jahra Hospital (NJH), Kuwait, between March 15th 2020 and May 31st 2020. During the study period and as part of the public health measures, a total of 185 pregnant women infected with SARS-CoV-2, regardless of symptoms, were hospitalized at NJH, and were included. Maternal and neonatal clinical manifestations, laboratory tests and treatments were collected. The outcomes of pregnancies included miscarriage, intrauterine fetal death (IUFD), preterm birth and live birth were assessed until the end date of the outcomes follow-up (November 10th 2020). Results A total of 185 pregnant women infected with SARS-CoV-2 were enrolled with a median age of 31 years (interquartile range, IQR: 27.5–34), and median gestational age at diagnosis of SARS-CoV2 infection was 29 weeks (IQR: 18–34). The majority (88%) of these women had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). At the time of the analysis, out of the 185, 3 (1.6%) of the pregnant women had a miscarriage, 1 (0.54%) had IUFD which was not related to COVID-19, 16 (8.6%) had ongoing pregnancies and 165 (89%) had a live birth. Only 2 (1.1%) of these women developed severe pneumonia and required intensive care. A total of 167 neonates with two sets of twins were born with median gestational age at birth was 38 (IQR: 36–39) weeks. Most of the neonates were asymptomatic, and only 2 of them tested positive on day 5 by nasopharyngeal swab testing. Conclusions In this national-based study, most of the pregnant women infected with SARS-CoV-2 showed mild symptoms. Although mother-to-child vertical transmission of SARS-CoV-2 is possible, COVID-19 infection during pregnancy may not lead to unfavorable maternal and neonatal outcomes. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12884-020-03461-2.
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Affiliation(s)
- Amal Ayed
- Obstetrics and Gynecology Department, Farwaniya Hospital, Sabah Al Nasser, Kuwait
| | - Alia Embaireeg
- Paediatric Department, Farwaniya Hospital, Sabah Al Nasser, Kuwait
| | - Asmaa Benawadh
- Obstetrics and Gynecology Department, Farwaniya Hospital, Sabah Al Nasser, Kuwait
| | - Wadha Al-Fouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Majdeda Hammoud
- Paediatrics Department, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Monif Al-Hathal
- Neonatal Department, Maternity Hospital, Kuwait City, Kuwait
| | - Abeer Alzaydai
- Obstetrics and Gynaecology Department, Al-Adan Hospital, Hadiya, Kuwait
| | - Ashraf Ahmad
- Obstetrics and Gynecology Department, Farwaniya Hospital, Sabah Al Nasser, Kuwait
| | - Mariam Ayed
- Neonatal Department, Farwaniya Hospital, Subah An Nasser, 81400, Kuwait City, Kuwait.
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Alsohime F, Temsah MH, Al-Nemri AM, Somily AM, Al-Subaie S. COVID-19 infection prevalence in pediatric population: Etiology, clinical presentation, and outcome. J Infect Public Health 2020; 13:1791-1796. [PMID: 33127335 PMCID: PMC7574780 DOI: 10.1016/j.jiph.2020.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022] Open
Abstract
Novel COVID-19 infections caused major morbidity and mortality globally in the adult age group. Likewise, SARS-COV-2 infections in children are highly risky in the selected patient population. We performed a focused literature search of published reports from December 1, 2019, till August 20, 2020. The aim was to explore the etiology, clinical presentations, and outcome of pediatric COVID-19 patients. Viral respiratory infections are associated with high societal costs for children. In addition, children with asymptomatic SARS-COV-2 infections can be a source of COVID-19 spread to parents and caregivers. The major reported risk factors for pediatric COVID-19 cases were close contact with a SARS-COV-2 positive family member, a history of travel, and/or living in endemic areas. Children with COVID-19 who required ICU care had various comorbidities, such as malignancy. As the pandemic evolved, multiple cases of multisystem inflammatory syndrome in children and adolescents temporarily related to covid-19 (MIS-C) were reported. A unique population is neonates born to COVID-19 affected mothers, as there is an urgent need to optimize their management and outcome during this rapidly evolving pandemic. The early identification of SARS-COV-2 infection in infants and children has important direct management effects in these children and public health implications because of the effects on disease transmission control measures.
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Affiliation(s)
- Fahad Alsohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pediatric, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pediatric, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman M Al-Nemri
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pediatric, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali M Somily
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pathology and Laboratory Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sarah Al-Subaie
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pediatric, King Saud University Medical City, Riyadh, Saudi Arabia.
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Shmakov RG, Prikhodko A, Polushkina E, Shmakova E, Pyregov A, Bychenko V, Priputnevich TV, Dolgushin GO, Yarotskaya E, Pekarev O, Bolibok N, Degtyarev D, Sukhikh GT. Clinical course of novel COVID-19 infection in pregnant women. J Matern Fetal Neonatal Med 2020; 35:4431-4437. [PMID: 33249969 PMCID: PMC7711745 DOI: 10.1080/14767058.2020.1850683] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/27/2022]
Abstract
OBJECTIVES Evaluation of clinical course of COVID-19 during pregnancy and maternal and perinatal outcomes of this pregnancy. METHODS 66 women with polymerase chain reaction (PCR) - confirmed SARS-CoV-2 and their 42 neonates were included in the prospective observational study. Demographic, epidemiological, clinical, laboratory and instrumental data of pregnancy, delivery, postpartum period, including pharmacotherapy and neonatal outcomes were analyzed. RESULTS 15 (22.7%) women were asymptomatic, 25 (38%) had mild disease, while moderate and severe forms were detected in 20 (30.2%) and 6 (9.1%) cases, respectively. Additional oxygenation was required in 6 (9%) cases: 4 (6%) received CPAP therapy and 2 (3%) - mechanical ventilation. Main clinical symptoms were cough (51.5%), anosmia (34.9%), and hyperthermia (33.3%). Laboratory changes included increased levels of lactate dehydrogenase (LDH), creatinine, d-dimer, and C-reactive protein (CRP), anemia, and leukopenia. All pregnant women received low molecular weight heparin and interferon alfa-2b according to the National clinical recommendations. Antimicrobial drugs included Amoxicillin/Clavulanic acid (46%) and macrolides (28%) or carbapenems in severe cases of disease. Spontaneous abortion was reported in 6.1% of cases. Eight preterm (19%) and 34 term deliveries (81%) occurred. The mean weight of neonates was (3283 ± 477) g, 1- and 5-min Apgar score was (7.8 ± 0.6) and (8.7 ± 0.5), respectively. No cases of neonatal COVID-19 infection were reported. CONCLUSIONS Mostly, the manifestations of COVID-19 were mild. However, 9% of cases were severe, and could contribute to preterm delivery or maternal morbidity. Main predictors of severe COVID-19 course in pregnant women were a decrease in the levels of erythrocytes and lymphocytes and increase in the levels of alanine aminotransferase and CRP. Elimination of the virus in pregnant women required more time due to altered immunity. No evidence of vertical transmission during pregnancy and delivery was found. However, the possibility of this cannot be excluded.
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Affiliation(s)
- Roman G Shmakov
- Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Andrey Prikhodko
- Department of Maternity, Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Evgeniya Polushkina
- Department of Maternity, Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Elena Shmakova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Aleksey Pyregov
- Institute of Anesthesiology and Intensive Care National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Vladimir Bychenko
- Department of Radiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Tatyana V Priputnevich
- Department of Microbiology and Clinical Pharmacology and Epidemiology National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Grigory O Dolgushin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Ekaterina Yarotskaya
- Department of International Cooperation National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Oleg Pekarev
- Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Nikolai Bolibok
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Dmitriy Degtyarev
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Gennady T Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
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50
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Abstract
OBJECTIVE We aimed to conduct a systematic review of the available literature to determine the effects of confirmed cases of COVID-19 in pregnant women from the foetal perspective by estimation of mother to child transmission, perinatal outcome and possible teratogenicity. METHODS Data sources: eligible studies between 1 November 2019 and 10 August 2020 were retrieved from PubMed, Embase, LitCovid, Google Scholar, EBSCO MEDLINE, CENTRAL, CINAHL, MedRXiv, BioRXiv and Scopus collection databases. English language case reports, case series and cohort studies of SARS-CoV-2 confirmed pregnant women with data on perinatal outcome, congenital anomalies and mother to child transmission were analysed. RESULTS 38 case reports, 34 cohort and case series describing 1408 neonates were included for evidence acquisition of mother to child transmission. 29 case reports and 31 case series and cohort studies describing 1318 foetuses were included for the evaluation of perinatal outcome and congenital anomalies. A pooled proportion of 3.67% neonates had positive SARS-CoV-2 viral RNA nasopharyngeal swab results and 7.1% had positive cord blood samples. 11.7% of the placenta, 6.8% of amniotic fluid, 9.6% of faecal and rectal swabs and none of the urine samples were positive. The rate of preterm labour was 26.4% (OR=1.45, 95% CI 1.03 to 2.03 with p=0.03) and caesarean delivery (CS) was 59.9% (OR=1.54, 95% CI 1.17 to 2.03 with p=0.002). The most common neonatal symptom was breathing difficulty (1.79%). Stillbirth rate was 9.9 per 1000 total births in babies born to COVID-19 mothers. CONCLUSION Chances of mother to child transmission of the SARS-CoV-2 virus is low. The perinatal outcome for the foetus is favourable. There is increased chances of CS but not preterm delivery. The stillbirth and neonatal death rates are low. There are no reported congenital anomalies in babies born to SARS CoV-2 positive mothers.
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Affiliation(s)
- Rajani Dube
- Obstetrics and Gynaecology, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Subhranshu Sekhar Kar
- Paediatrics, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, UAE
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