Pregnancy and risk of COVID-19: a Norwegian registry-linkage study

Objective

To compare the risk of acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and contact with specialist healthcare services for coronavirus disease 2019 (COVID‐19) between pregnant and non‐pregnant women.

Population or sample

All women ages 15–45 living in Norway on 1 March 2020 (n = 1 033 699).

Methods

We linked information from the national birth, patient, communicable diseases and education databases using unique national identifiers.

Main outcome measure

We estimated hazard ratios (HR) among pregnant compared to non‐pregnant women of having a positive test for SARS‐CoV‐2, a diagnosis of COVID‐19 in specialist healthcare, or hospitalisation with COVID‐19 using Cox regression. Multivariable analyses adjusted for age, marital status, education, income, country of birth and underlying medical conditions.

Results

Pregnant women were not more likely to be tested for or to a have a positive SARS‐CoV‐2 test (adjusted HR 0.99; 95% CI 0.92–1.07). Pregnant women had higher risk of hospitalisation with COVID‐19 (HR 4.70, 95% CI 3.51–6.30) and any type of specialist care for COVID‐19 (HR 3.46, 95% CI 2.89–4.14). Pregnant women born outside Scandinavia were less likely to be tested, and at higher risk of a positive test (HR 2.37, 95% CI 2.51–8.87). Compared with pregnant Scandinavian‐born women, pregnant women with minority background had a higher risk of hospitalisation with COVID‐19 (HR 4.72, 95% CI 2.51–8.87).

Conclusion

Pregnant women were not more likely to be infected with SARS‐CoV‐2. Still, pregnant women with COVID‐19, especially those born outside of Scandinavia, were more likely to be hospitalised.

Tweetable abstract

Pregnant women are at increased risk of hospitalisation for COVID‐19.

Pregnant women are at increased risk of hospitalisation for COVID‐19.

Lifetime prevalence of infertility and infertility treatment in the UK: results from a population-based survey of reproduction

BACKGROUND

The aim of this study was to investigate the prevalence of infertility and the use of infertility treatment among women aged 40-55 years.

METHODS

Population-based postal questionnaire survey of UK women. Over 60,000 women randomly sampled from the 2001 electoral roll were sent a questionnaire, and those aged 55 years and under who had ever been pregnant or tried to achieve a pregnancy (n = 6584) were asked to provide a reproductive history.

RESULTS

Overall, 2.4% of women aged 40-55 years had unresolved infertility with no pregnancies, and a further 1.9% had been pregnant but not achieved a live birth. The prevalence of unresolved fertility did not differ among birth cohorts. Sixteen percent of women reported ever consulting a doctor because of infertility and 8% reported receiving treatment to conceive. Across the whole sample, 4.2% of women reported that they had achieved at least one pregnancy as a result of treatment. Compared with earlier birth cohorts, women born later were more likely to report consultations (18% versus 13%) and treatment (9% versus 6%) for infertility, and pregnancies as a result of infertility treatment (6.7% versus 2.7%). Among those who reported medical consultations, women born more recently first consulted at a later age compared with those born earlier.

CONCLUSIONS

Although both the number of women seeking medical care for infertility and the proportion reporting pregnancies as a result of infertility treatment has increased, there is no evidence to support an overall increase in unresolved infertility over the past 15 years. The vast majority of women aged 40-55 who reported difficulties conceiving did have a child, or children, at some point in their lives.

Predicting the impact of in vitro fertilisation and other forms of assisted conception on perinatal and infant mortality in England and Wales: examining the role of multiplicity

The increased risk of perinatal and infant mortality observed among in vitro fertilisation (IVF) births and other assisted conception births is thought to be largely attributable to multiplicity. Using mortality statistics and estimates of the proportion of births following infertility treatment, we predicted the excess stillbirths and infant deaths associated with twins and higher order births resulting from assisted conception in England and Wales. According to our results, approximately 73 deaths could have been avoided in 2001 if all IVF infants had been born as singletons or as naturally occurring monozygotic twins, equating to a population attributable risk fraction of around 1% for perinatal and infant deaths. If we include all types of assisted conception, this figure was estimated to be around 4% of deaths-more than 220 perinatal and infant deaths in 2001. We confirm the public health importance of multiple births associated with assisted conception.

Association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth

OBJECTIVE

To determine the association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth.

DESIGN

Multicentre prospective cohort study.

SETTING

Ten European centres offering prenatal screening for toxoplasmosis.

POPULATION

Deliveries after 23 weeks of gestation in 386 women with singleton pregnancies who seroconverted to toxoplasma infection before 20 weeks of gestation. Deliveries after 36 weeks in 234 women who seroconverted at 20 weeks or later, and tested positive before 37 weeks.

METHODS

Comparison of infected and uninfected births, adjusted for parity and country of birth.

MAIN OUTCOME MEASURES

Differences in gestational age at birth, birthweight and birthweight centile.

RESULTS

Infected babies were born or delivered earlier than uninfected babies: the mean difference for seroconverters before 20 weeks was -5.4 days (95% CI: -1.4, -9.4), and at 20 weeks or more, -2.6 days (95% CI: -0.5, -4.7). Congenital infection was associated with an increased risk of preterm delivery when seroconversion occurred before 20 weeks (OR 4.71; 95% CI: 2.03, 10.9). No significant differences were detected for birthweight or birthweight centile.

CONCLUSION

Babies with congenital toxoplasmosis were born earlier than uninfected babies but the mechanism leading to shorter length of gestation is unknown. Congenital infection could precipitate early delivery or prompt caesarean section or induction of delivery. We found no evidence for a significant association between congenital toxoplasmosis and reduced birthweight or small for gestational age birth.

Interventions for promoting smoking cessation during pregnancy

BACKGROUND

Smoking remains one of the few potentially preventable factors associated with low birthweight, preterm birth and perinatal death.

OBJECTIVES

To assess the effects of smoking cessation programs implemented during pregnancy on the health of the fetus, infant, mother, and family.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Tobacco Addiction Group trials register (July 2003), MEDLINE (January 2002 to July 2003), EMBASE (January 2002 to July 2003), PsychLIT (January 2002 to July 2003), CINAHL (January 2002 to July 2003), and AUSTHEALTH (January 2002 to 2003). We contacted trial authors to locate additional unpublished data. We handsearched references of identified trials and recent obstetric journals.

SELECTION CRITERIA

Randomised and quasi-randomised trials of smoking cessation programs implemented during pregnancy.

DATA COLLECTION AND ANALYSIS

Four reviewers assessed trial quality and extracted data independently.

MAIN RESULTS

This review included 64 trials. Fifty-one randomised controlled trials (20,931 women) and six cluster-randomised trials (over 7500 women) provided data on smoking cessation and/or perinatal outcomes. Despite substantial variation in the intensity of the intervention and the extent of reminders and reinforcement through pregnancy, there was an increase in the median intensity of both 'usual care' and interventions over time. There was a significant reduction in smoking in the intervention groups of the 48 trials included: (relative risk (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.95), an absolute difference of six in 100 women continuing to smoke. The 36 trials with validated smoking cessation had a similar reduction (RR 0.94, 95% CI 0.92 to 0.95). Smoking cessation interventions reduced low birthweight (RR 0.81, 95% CI 0.70 to 0.94) and preterm birth (RR 0.84, 95% CI 0.72 to 0.98), and there was a 33 g (95% CI 11 g to 55 g) increase in mean birthweight. There were no statistically significant differences in very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power. One intervention strategy, rewards plus social support (two trials), resulted in a significantly greater smoking reduction than other strategies (RR 0.77, 95% CI 0.72 to 0.82). Five trials of smoking relapse prevention (over 800 women) showed no statistically significant reduction in relapse.

REVIEWERS' CONCLUSIONS

Smoking cessation programs in pregnancy reduce the proportion of women who continue to smoke, and reduce low birthweight and preterm birth. The pooled trials have inadequate power to detect reductions in perinatal mortality or very low birthweight.

Proposed preliminary core set measures for disease outcome assessment in adult and juvenile idiopathic inflammatory myopathies

In order to develop a preliminary core set of disease outcome measures for use in clinical trials of idiopathic inflammatory myopathies (IIM), we evaluated those measures used in previous trials, assessed the validation of published instruments and discussed these at an international consensus conference. The initial proposals were further refined by a multidisciplinary group of adult and paediatric specialists experienced in IIM using the Delphi method. The proposed preliminary core set of disease activity measures consists of five domains: physician and patient/parent global assessments of disease activity; muscle strength; physical function; serum activity of muscle enzymes; and an assessment tool to capture extra-skeletal muscle disease activity. The group recommended further development of a core set of disease damage measures for assessment of persistent changes in anatomy, pathology and function of at least 6 months' duration. The group recommended that patient-reported outcomes should include generic health-related quality of life assessments using the Medical Outcomes Study 36-item Short Form (SF-36) health survey in adult IIM patients and a validated quality of life instrument for paediatric patients. We propose the core set of outcome measures as a minimum group of assessments to include in all IIM therapeutic studies. The use of this core set should assist in standardizing outcome measurement and in optimizing therapeutic trials in myositis.

Membrane interiorization by phagocytosing macrophages--an ultrastructural morphometric approach

Stereological methods have been used to quantify selected membrane compartments of normal and activated rat peritoneal macrophages, before and after phagocytosis of latex beads. Despite being rounder, activated cells are more efficient phagocytes: 30 min after latex challenge they suffer a greater nett depletion of plasma membrane and sequester more and larger phagocytic vacuoles. However, phagocytosis of latex is not the major route of membrane interiorization.