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Ribeiro RS, Sasaki NSGMDS, Queiroz AMDA, Ferreira ACM, Segura GDS, Santos MDLSG, Souza LHD, Lourenção LG. Factors influencing the positivity of diagnostic tests for congenital syphilis. Rev Assoc Med Bras (1992) 2024; 70:e20231006. [PMID: 38656062 DOI: 10.1590/1806-9282.20231006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The objective of this study was to analyze the factors that influence the positivity of treponemal and non-treponemal tests in cases of congenital syphilis. METHODS This cross-sectional and correlational study was carried out from the analysis of the database of Disease and Notification Information System (SINAN, in Portuguese) using the data obtained through the Epidemiological Surveillance Group 29, with 639 notifications of congenital syphilis between 2007 and 2018. The data were analyzed by a descriptive and inferential analysis from logistic regression with a significance level of 5% (p≤0.05). RESULTS The positivity of the treponemal test was higher by 4.5 times in infants living in rural areas and 19.6 times among those whose mothers obtained the diagnosis of syphilis after birth. The treponemal test showed positivity 3.2 times higher for the variable "having been diagnosed between 2007 and 2015" and 5.5 times higher for the variable "having been diagnosed with maternal syphilis in the postpartum period." CONCLUSION This study shows that testing during prenatal care is essential for early diagnosis and prevention of syphilis complications.
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Affiliation(s)
| | | | | | | | | | | | - Lara Helk de Souza
- Faculty of Medicine of São José do Rio Preto - São José do Rio Preto (SP), Brazil
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Quadros Santos MM, Gomes do Carmo BA, Barbosa Rodrigues T, Leite Dias BR, Abreu Martins C, Oliveira Naiff Ferreira GR, Tavares Parente A, Yollete Urbano Pauxis Aben-Atha C, Isse Polaro SH, Pinheiro Botelho E. Spatial variability of mother-to-child human immunodeficiency virus transmission in a province in the Brazilian Rainforest: An ecological study. Geospat Health 2022; 17. [PMID: 36468599 DOI: 10.4081/gh.2022.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/10/2022] [Indexed: 06/17/2023]
Abstract
The mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a serious public health problem in the Brazilian Rainforest. This study aimed to spatially analyze this type of infection between 2007 and 2018 in Pará, which is the second-largest Brazilian state in the Brazilian Rainforest and also has the highest MTCT of HIV in Brazil. We analyzed the incidence rates of HIV (including the acquired immunodeficiency syndrome (AIDS) by MTCT as the main route of infection in children younger than 13 years old and whose mothers live in Pará. We employed spatial autocorrelation, spatial scanning, and geographic-weighted spatial regression techniques. In the period of this study, 389 new HIV/AIDS were noted, with territorial expansion of the incidence rates in the municipalities in northern and southern Pará having the highest rates. São Francisco do Pará had high spatial risk and high-spatiotemporal risk clusters comprising municipalities in western and south-western Pará between 2013 and 2016. The spatial variability of HIV/AIDS incidence rates was found to be common in the number of men and women with formal jobs; unemployed ≥18 years old people; elementary school pupils; and families enrolled in the "Single Registry for Social Programs". The social equity approach in Pará guarantee pregnant women access to preventive, diagnostic and treatment health services and their children should be supported to eliminate the MTCT of HIV in Pará.
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Affiliation(s)
| | | | | | | | - Cleyton Abreu Martins
- Graduate Nursing Program, Federal University of Pará, Complexo da Saúde - Guamá, Belém, Pará.
| | | | | | | | | | - Eliã Pinheiro Botelho
- Graduate Nursing Program, Federal University of Pará, Complexo da Saúde - Guamá, Belém, Pará.
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3
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Adelekan B, Harry-Erin B, Okposo M, Aliyu A, Ndembi N, Dakum P, Sam-Agudu NA. Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria. PLoS One 2022; 17:e0263921. [PMID: 35157737 PMCID: PMC8843197 DOI: 10.1371/journal.pone.0263921] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/23/2021] [Accepted: 01/29/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction While antiretroviral therapy (ART) coverage for pregnant women has undergone steady scale-up, Nigeria’s final mother- to-child transmission of HIV (MTCT) rate remains unacceptably high at 10%. This study aimed to determine final outcomes (MTCT rates) and their correlates among HIV-exposed infants (HEI) in nine states and the Federal Capital Territory, Nigeria. Methods This retrospective, cross-sectional study was conducted at 96 primary, secondary and tertiary health facilities supported by the Institute of Human Virology Nigeria. Data was abstracted for a birth cohort of HEI born between October 30, 2014 and April 30, 2015 whose 18–24 month final outcome was assessed by October 30, 2016. Only infants with a six-week first DNA PCR result, and a rapid HIV antibody test result at age 18 to 24 months were included. Multivariate logistic regression (adjusted odds ratios [aORs]) evaluated for predictors of HIV positivity at ≥18 months. Results After testing at ≥18 months, 68 (2.8%) of the 2,405 exposed infants in the birth cohort were HIV-positive. After a minimum of 18 months of follow-up, 51 (75%) HIV-positive infants were alive on ART; 7 (10%) had died, 5 (7.3%) were lost to follow-up and 5 (7.3%) were transferred out. Rural maternal residence, lack of maternal ART/ARV prophylaxis, mixed infant feeding and infant birth weight less than 2.5 kg correlated with an HIV-positive status for infant final outcomes. Conclusion The final HIV positivity rate of 2.8% is encouraging, but is not population-based. Nevertheless, supported by our findings, we recommend continued programmatic focus on early access to quality prenatal care and maternal ART for pregnant women, especially for women living with HIV in rural areas. Furthermore, implementation of nationwide sensitization and education on six-months’ exclusive infant breastfeeding with concurrent maternal ART should be strengthened and sustained to reduce MTCT rates.
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Affiliation(s)
- Babatunde Adelekan
- Strategic Information, Institute of Human Virology Nigeria, Abuja, Nigeria
- * E-mail:
| | - Bidemi Harry-Erin
- Strategic Information, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Martha Okposo
- Strategic Information, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Ahmad Aliyu
- Strategic Information, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Nicaise Ndembi
- Laboratory Research, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Patrick Dakum
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Prevention, Care and Treatment Unit, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Nadia A. Sam-Agudu
- Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Prevention, Care and Treatment Unit, Institute of Human Virology Nigeria, Abuja, Nigeria
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
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Liu Y, Zhang Y, Pang L. Analysis of Related Factors of Mother-to-Child Transmission of AIDS and Evaluation of Measures to Prevent Mother-to-Child Transmission. Comput Math Methods Med 2022; 2022:3190370. [PMID: 35035518 PMCID: PMC8754668 DOI: 10.1155/2022/3190370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
AIDS is still a major public health facing the world. With the implementation of AIDS prevention projects and the continuous maturity of technology, more and more HIV-positive women choose to have children. However, the children born to these women are a special group. Exposure to HIV and antiviral drugs during the fetal period can increase the success rate of children's elimination of the mother, which is worthy of attention and research. This article focuses on the analysis of the related factors of mother-to-child transmission of AIDS and the evaluation of mother-to-child blocking measures, using the method of field research to conduct experiments on AIDS patients in this city who are pregnant and provide them with antidrug treatment and some barrier measures. Then, the mother-to-child transmission rate was recorded, and the experimental results showed that the antidrug treatment plan is related to mother-to-child transmission. After antidrug treatment, the transmission rate of single-drug treatment is reduced by 5%, and the transmission rate of combined drug treatment is reduced by 10%. It can be seen from this that antidrug treatment is an effective measure to block mothers and babies.
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Affiliation(s)
- Yuhuan Liu
- Pediatric Department, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing 100015, China
| | - Yulan Zhang
- Pediatric Department, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing 100015, China
| | - Lin Pang
- Hospital Management, People's Hospital of Deyang City, Deyang, Sichuan 618000, China
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5
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Gilmour LS, Best EJ, Duncanson MJ, Wheeler BJ, Sherwood J, Thirkell CE, Walls T. High Incidence of Congenital Syphilis in New Zealand: A New Zealand Pediatric Surveillance Unit Study. Pediatr Infect Dis J 2022; 41:66-71. [PMID: 34889872 DOI: 10.1097/inf.0000000000003233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Syphilis, a disease once in decline, has made a resurgence worldwide. New Zealand has had increasing syphilis rates since enhanced syphilis surveillance was initiated in 2013. This study reports epidemiologic, descriptive and treatment data on management of infants prenatally exposed or vertically infected with syphilis across New Zealand as reported by pediatricians. METHODS Over a 26-month period from April 2018 to May 2020 (inclusive), pediatricians throughout New Zealand notified potential, probable and confirmed cases of congenital syphilis to the New Zealand Pediatric Surveillance Unit. National reporting numbers were concurrently ascertained to demonstrate reporting accuracy. RESULTS Thirty-two cases were notified, comprised of 25 infants born to women with positive antenatal syphilis serology (5 whom developed congenital syphilis), and 7 infants diagnosed with congenital syphilis after birth where syphilis was not diagnosed in pregnancy. There were 12 cases of congenital syphilis; an incidence rate of 9.4 cases per 100,000 live births. Nine of the 12 infants had clinical features of congenital syphilis. One-third of maternal infections were early syphilis, and the women who gave birth to infected infants were less likely to have received antenatal care, adequate treatment and follow-up monitoring of treatment for syphilis during pregnancy. CONCLUSIONS This study quantifies an important burden of disease from congenital syphilis in our population. Case finding and treatment of syphilis in pregnancy are critical to prevent this. Our findings support the urgent need for measures such as repeat maternal syphilis screening in early third trimester; whether by affected region or instituted for all, in the context of rising cases.
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Affiliation(s)
| | - Emma Joanne Best
- Department of Paediatric Infectious Diseases, Starship Children's Health, Auckland
- Department of Paediatrics: Child and Youth Health
- National Immunisation Advisory Centre, University of Auckland
| | - Mavis Joy Duncanson
- New Zealand Paediatric Surveillance Unit, Women's and Children's Health, Otago Medical School Dunedin Campus, University of Otago
| | - Benjamin John Wheeler
- New Zealand Paediatric Surveillance Unit, Women's and Children's Health, Otago Medical School Dunedin Campus, University of Otago
| | - Jill Sherwood
- New Zealand Institute of Environmental Science and Research Limited (ESR)
| | | | - Tony Walls
- From the Department of Paediatrics, Christchurch Public Hospital
- Department of Paediatrics, University of Otago, Christchurch
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Suhren JT, Meinardus A, Hussein K, Schaumann N. Meta-analysis on COVID-19-pregnancy-related placental pathologies shows no specific pattern. Placenta 2022; 117:72-77. [PMID: 34773743 PMCID: PMC8525005 DOI: 10.1016/j.placenta.2021.10.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia rarely occurs in pregnant women. Case reports indicate that fibrin and lymphohistiocytic lesions in placentas may be typical. However, a meta-analysis to clarify whether there is a COVID-19-associated pattern of placental lesions has not yet been conducted. Systematic literature search with meta-analysis of publications on 10 or more cases of pregnancy with SARS-CoV-2 infection and placenta examination (30 publications from 2019 to 2021; 1452 placenta cases) was performed. The meta-analysis did not reveal any COVID-19-specific placenta changes. The incidence of both vascular and inflammatory lesions was mainly comparable to that of non-COVID-19 pregnancies. Transplacental viral transmission is very rare and there are no typical placental changes. The most important prognostic factor seems to be maternal-fetal hypoxia in the context of pneumonia.
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Affiliation(s)
| | | | - Kais Hussein
- Institute of Pathology, Hannover Medical School, Germany
| | - Nora Schaumann
- Institute of Pathology, Hannover Medical School, Germany.
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7
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Osório D, Munyangaju I, Nacarapa E, Muhiwa A, Nhangave AV, Ramos JM. Mother-to-child transmission of HIV infection and its associated factors in the district of Bilene, Gaza Province-Mozambique. PLoS One 2021; 16:e0260941. [PMID: 34890430 PMCID: PMC8664209 DOI: 10.1371/journal.pone.0260941] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Mother-to-child transmission of HIV infection is a significant problem in Mozambique. This study aims to determine the risk factors associated with mother-to-child transmission of HIV in rural Mozambique. Methods Retrospective case-control study in a rural area of Bilene District, on the coast of southern Mozambique, performed from January 2017 to June 2018. The analysis considered the clinical data of HIV exposed children with definitive HIV positive results and their respective infected mothers (cases), and the data of HIV exposed children with definitive HIV negative results and their respective infected mothers (controls) registered in At Risk Child Clinics from 1st January 2017 to 30th June 2018 at the Macia and Praia de Bilene health facilities in Bilene district, Gaza province–Mozambique. Results Ninety pregnant women with HIV were involved in the study, including 30 who had transmitted the infection to their children and 60 who had not. Statistical analysis, adjusted for maternal age and gestational age at first antenatal care visit, showed that independent risk factors for transmission were gestational age at first visit (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.05–1.36), non-adherence to combination antiretroviral therapy (56.7% vs. 5%; aOR 14.12, 95% CI 3.15–63.41); a viral load of 1000 copies/mL or more (90% vs. 5%; aOR: 156, 95% CI 22.91–1,062) and female sex of the neonate (80% vs. 51.7%; aOR: 4.43, 95% CI 1.33–15.87). Conclusion A high viral load and non-adherence to antiretroviral therapy are important predictors of mother-to-child HIV transmission.
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Affiliation(s)
- Dulce Osório
- General Medicine Department, Macia Health Center, Macia, Gaza, Mozambique
| | - Isabelle Munyangaju
- Tinpswalo Association – Vincentian Association to Fight AIDS and TB, Maputo, Gaza, Mozambique
- * E-mail:
| | - Edy Nacarapa
- Tinpswalo Association – Vincentian Association to Fight AIDS and TB, Maputo, Gaza, Mozambique
- Internal Medicine Department, Carmelo Hospital, Chokwe, Gaza, Mozambique
| | - Argentina Muhiwa
- Tinpswalo Association – Vincentian Association to Fight AIDS and TB, Maputo, Gaza, Mozambique
| | | | - Jose Manuel Ramos
- Internal Medicine Department, General University Hospital of Alicante and University Miguel Hernandez de Elche, Alicante, Spain
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8
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Badran EF, Darwish RM, Khader Y, AlMasri R, Al Jaberi M, AlMasri M, AlSa'di F, Yosef LA, Al-Badaineh N. Adverse pregnancy outcomes during the COVID-19 lockdown. A descriptive study. BMC Pregnancy Childbirth 2021; 21:761. [PMID: 34758778 PMCID: PMC8579176 DOI: 10.1186/s12884-021-04221-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The ongoing spread coronavirus disease worldwide has caused major disruptions and led to lockdowns. Everyday lifestyle changes and antenatal care inaccessibility during the coronavirus disease 2019 (COVID-19) pandemic have variable results that affect pregnancy outcomes. This study aimed to assess the alterations in stillbirth, neonatal-perinatal mortality, preterm birth, and birth weight during the COVID-19 national lockdown. METHODS We used the data from the Jordan stillbirths and neonatal death surveillance system to compare pregnancy outcomes (gestational age, birth weight, small for gestational age, stillbirth, neonatal death, and perinatal death) between two studied periods (11 months before the pandemic (May 2019 to March 2020) vs. 9 months during the pandemic (April 2020 to March 1st 2020). Separate multinomial logistic and binary logistic regression models were used to compare the studied outcomes between the two studied periods after adjusting for the effects of mother's age, income, education, occupation, nationality, health sector, and multiplicity. RESULTS There were 31106 registered babies during the study period; among them, 15311 (49.2%) and 15795 (50.8%) births occurred before and during the COVID-19 lockdown, respectively. We found no significant differences in preterm birth and stillbirth rates, neonatal mortality, or perinatal mortality before and during the COVID-19 lockdown. Our findings report a significantly lower incidence of extreme low birth weight (ELBW) infants (<1kg) during the COVID-19 lockdown period than that before the lockdown (adjusted OR 0.39, 95% CI 0.3-0.5: P value <0.001) CONCLUSIONS: During the COVID-19 lockdown period, the number of infants born with extreme low birth weight (ELBW) decreased significantly. More research is needed to determine the impact of cumulative socio-environmental and maternal behavioral changes that occurred during the pandemic on the factors that contribute to ELBW infants.
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Affiliation(s)
- Eman F Badran
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan.
| | - Rula M Darwish
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Rama AlMasri
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Mira Al Jaberi
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Mohammad AlMasri
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Farah AlSa'di
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Leen Abu Yosef
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Noor Al-Badaineh
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
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Zambrano H, Anchundia K, Aviles D, Andaluz R, Calderon N, Torres E, Gonzalez-Granda N, Maxwell A, Chen K, Gonik B, Mor G. Seroprevalence of SARS-CoV-2 immunoglobulins in pregnant women and neonatal cord blood from a highly impacted region. Placenta 2021; 115:146-150. [PMID: 34626893 PMCID: PMC8492380 DOI: 10.1016/j.placenta.2021.10.001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 11/20/2022]
Abstract
There is inadequate screening for SARS-COV-2 during pregnancy. We aimed to determine the impact of maternal and neonatal cord blood SARS-COV-2 antibodies and placental transfer ratios in a region with a low screening plan. We performed a blind study in one of the SARS-CoV-2 epicenters in South America. 32% of pregnant women were serological positive. Importantly, there is an efficient passive immunization of the fetus to SARS-CoV-2. We report high incidence of SARS-CoV-2 infection during pregnancy, which is higher than officially reported. Therefore the need of active immunization to enhance maternal protection and fetal passive immunization.
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Affiliation(s)
| | | | | | | | | | | | | | - Anthony Maxwell
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Kang Chen
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Bernard Gonik
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Gil Mor
- C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.
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Cosma S, Carosso AR, Cusato J, Borella F, Carosso M, Gervasoni F, Stura I, Preti M, Ghisetti V, Di Perri G, Benedetto C. Preterm birth is not associated with asymptomatic/mild SARS-CoV-2 infection per se: Pre-pregnancy state is what matters. PLoS One 2021; 16:e0254875. [PMID: 34351922 PMCID: PMC8341509 DOI: 10.1371/journal.pone.0254875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/05/2021] [Indexed: 01/10/2023] Open
Abstract
Evidence for the real impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on preterm birth is unclear, as available series report composite pregnancy outcomes and/or do not stratify patients according to disease severity. The purpose of the research was to determine the real impact of asymptomatic/mild SARS-CoV-2 infection on preterm birth not due to maternal respiratory failure. This case-control study involved women admitted to Sant Anna Hospital, Turin, for delivery between 20 September 2020 and 9 January 2021. The cumulative incidence of Coronavirus disease-19 was compared between preterm birth (case group, n = 102) and full-term delivery (control group, n = 127). Only women with spontaneous or medically-indicated preterm birth because of placental vascular malperfusion (pregnancy-related hypertension and its complications) were included. Current or past SARS-CoV-2 infection was determined by nasopharyngeal swab testing and detection of IgM/IgG antibodies in blood samples. A significant difference in the cumulative incidence of Coronavirus disease-19 between the case (21/102, 20.5%) and the control group (32/127, 25.1%) (P= 0.50) was not observed, although the case group was burdened by a higher prevalence of three known risk factors (body mass index > 24.9, asthma, chronic hypertension) for severe Coronavirus disease-19. Logistic regression analysis showed that asymptomatic/mild SARS-CoV-2 infection was not an independent predictor of spontaneous and medically-indicated preterm birth due to pregnancy-related hypertension and its complications (0.77; 95% confidence interval, 0.41-1.43). Pregnant patients without comorbidities need to be reassured that asymptomatic/mild SARS-CoV-2 infection does not increase the risk of preterm delivery. Preterm birth and severe Coronavirus disease-19 share common risk factors (i.e., body mass index > 24.9, asthma, chronic hypertension), which may explain the high rate of indicated preterm birth due to maternal conditions reported in the literature.
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Affiliation(s)
- Stefano Cosma
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Andrea Roberto Carosso
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
- * E-mail:
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Marco Carosso
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Fiammetta Gervasoni
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Ilaria Stura
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Mario Preti
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Sant Anna University Hospital, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
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11
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Ferrer-Oliveras R, Mendoza M, Capote S, Pratcorona L, Esteve-Valverde E, Cabero-Roura L, Alijotas-Reig J. Immunological and physiopathological approach of COVID-19 in pregnancy. Arch Gynecol Obstet 2021; 304:39-57. [PMID: 33945026 PMCID: PMC8093597 DOI: 10.1007/s00404-021-06061-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 11/20/2020] [Accepted: 03/31/2021] [Indexed: 12/18/2022]
Abstract
Coronavirus disease-2019 (COVID-19) related to Coronavirus-2 (SARS-CoV-2) is a worldwide health concern. Despite the majority of patients will evolve asymptomatic or mild-moderate upper respiratory tract infections, 20% will develop severe disease. Based on current pathogenetic knowledge, a severe COVID-19 form is mainly a hyperinflammatory, immune-mediated disorder, triggered by a viral infection. Due to their particular immunological features, pregnant women are supposed to be particularly susceptible to complicate by intracellular infections as well as immunological disturbances. As an example, immune-thrombosis has been identified as a common immune-mediated and pathogenic phenomenon both in COVID-19, in obstetric diseases and in COVID-19 pregnant women. According to extensive published clinical data, is rationale to expect an interference with the normal development of pregnancy in selected SARS-CoV-2-infected cases, mainly during third trimester.This manuscript provides insights of research to elucidate the potential harmful responses to SARS-CoV-2 and /or other coronavirus infections, as well as bidirectional interactions between COVID-19 and pregnancy to improve their respective management.
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Affiliation(s)
- Raquel Ferrer-Oliveras
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain.
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Sira Capote
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
| | - Laia Pratcorona
- Department of Obstetrics, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Enrique Esteve-Valverde
- Department of Internal Medicine, Althaia Network Health. Manresa, Barcelona, Spain
- Universitat Central de Catalunya, Barcelona, Catalonia, Spain
| | - Lluis Cabero-Roura
- Department of Obstetrics and Gynaecology, Hospital Universitari Quironsalud Barcelona, Barcelona, Catalonia, Spain
- Prof. Emeritus of Obsterics and Gynaecology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit. Department of Internal Medicine-1, Vall d' Hebron University Hospital, Barcelona, Spain.
- Systemic Autoimmune Research Unit, Vall d'Hebron Reseacrh Institute, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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12
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Steffen HA, Swartz SR, Jackson JB, Kenne KA, Ten Eyck P, Merryman AS, Castaneda C, Marsden K, Maxwell T, Merrill AE, Krasowski MD, Rysavy MB. SARS-CoV-2 Infection during Pregnancy in a Rural Midwest All-delivery Cohort and Associated Maternal and Neonatal Outcomes. Am J Perinatol 2021; 38:614-621. [PMID: 33611783 PMCID: PMC11071687 DOI: 10.1055/s-0041-1723938] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. STUDY DESIGN This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. RESULTS In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26-33 years) and body mass index was 31.75 kg/m2 (IQR 27.7-37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. CONCLUSION In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. KEY POINTS · SARS-CoV-2 seroprevalence rate in pregnant population in Iowa is 5.8%.. · Infections are higher among minorities, non-English speakers, and patients without private insurance.. · No increased adverse maternal/neonatal outcomes observed for SARS-CoV-2 infected mothers..
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Affiliation(s)
| | | | | | - Kimberly A. Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA
| | - Abbey S. Merryman
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
| | | | | | - Timothy Maxwell
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | - Mary B. Rysavy
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
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13
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da Costa Faria NR, Chaves-Filho AB, Alcantara LCJ, de Siqueira IC, Calcagno JI, Miyamoto S, de Filippis AMB, Yoshinaga MY. Plasma lipidome profiling of newborns with antenatal exposure to Zika virus. PLoS Negl Trop Dis 2021; 15:e0009388. [PMID: 33930014 PMCID: PMC8115770 DOI: 10.1371/journal.pntd.0009388] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/12/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
The 2015–2016 Zika virus (ZIKV) outbreak in Brazil was remarkably linked to the incidence of microcephaly and other deleterious clinical manifestations, including eye abnormalities, in newborns. It is known that ZIKV targets the placenta, triggering an inflammatory profile that may cause placental insufficiency. Transplacental lipid transport is delicately regulated during pregnancy and deficiency on the delivery of lipids such as arachidonic and docosahexaenoic acids may lead to deficits in both brain and retina during fetal development. Here, plasma lipidome profiles of ZIKV exposed microcephalic and normocephalic newborns were compared to non-infected controls. Our results reveal major alterations in circulating lipids from both ZIKV exposed newborns with and without microcephaly relative to controls. In newborns with microcephaly, the plasma concentrations of hydroxyoctadecadienoic acid (HODE), primarily as 13-HODE isomer, derived from linoleic acid were higher as compared to normocephalic ZIKV exposed newborns and controls. Total HODE concentrations were also positively associated with levels of other oxidized lipids and several circulating free fatty acids in newborns, indicating a possible plasma lipidome signature of microcephaly. Moreover, higher concentrations of lysophosphatidylcholine in ZIKV exposed normocephalic newborns relative to controls suggest a potential disruption of polyunsaturated fatty acids transport across the blood-brain barrier of fetuses. The latter data is particularly important given the neurocognitive and neurodevelopmental abnormalities observed in follow-up studies involving children with antenatal ZIKV exposure, but normocephalic at birth. Taken together, our data reveal that plasma lipidome alterations associated with antenatal exposure to ZIKV could contribute to identification and monitoring of the wide spectrum of clinical phenotypes at birth and further, during childhood. Antenatal exposure to Zika virus (ZIKV) is linked to a wide range of clinical presentations at birth, from asymptomatic cases to microcephaly, and other neurocognitive and neurodevelopmental abnormalities manifested in the early childhood. Stratification of these clinical phenotypes in newborns with suspected antenatal ZIKV exposure is challenging, but critical to improve early assessment of rehabilitative interventions. In this study, plasma lipidome profiling of 274 lipid species was performed in both normocephalic and microcephalic newborns with antenatal ZIKV exposure and compared to non-infected controls. Multiple lipid species were independent predictors of antenatal ZIKV exposure. More specifically, microcephaly was strongly associated with an oxidized free fatty acid and ZIKV exposed normocephalic newborns exhibited higher plasma concentrations of lysophosphatidylcholine relative to controls. These findings emphasize the need for studies focused on the role of individual lipids in neuropathogenesis of ZIKV and raise the potential of plasma lipidome profiling for early diagnosis of newborns with suspected antenatal ZIKV exposure. To validate the predictive ability of this approach, prospective studies with a larger cohort of newborns are now required.
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Affiliation(s)
| | | | | | | | - Juan Ignacio Calcagno
- Maternidade Prof. José Maria de Magalhães Netto, State Health Secretary (Salvador), Bahia, Brazil
| | - Sayuri Miyamoto
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | | | - Marcos Yukio Yoshinaga
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
- * E-mail:
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14
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Ruiz-Saez B, García MMB, de Aragon AM, Gil-Correa M, Melero H, Malpica NA, de Ory SJ, Zamora B, Guillen S, Rojo P, Falcon-Neyra L, Alvarez A, Fernandez P, Lorente-Jareño ML, Ramos JT, Sainz T, Velo C, Navarro ML, Gonzalez-Tomé MI. Effects of perinatal HIV-infection on the cortical thickness and subcortical gray matter volumes in young adulthood. Medicine (Baltimore) 2021; 100:e25403. [PMID: 33847637 PMCID: PMC8051971 DOI: 10.1097/md.0000000000025403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance.A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan-Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented.Fifty participants were included (60% females, median age 20 years [interquartile range, IQR 19-23], 64% Whites). No differences regarding neuropsychological tests or psychopathological symptoms were found between groups (all P > .05). All participants presented an average performance in the Fluid Intelligence (FI) test (PHIV mean: -0.12, HIV- mean: 0.24), When comparing CT, PHIV-infected patients showed thinner cortices compared with their peers in fusiform gyrus (P = .000, P = .009), lateral-orbitofrontal gyrus (P = .006, P = .0024), and right parsobitalis gyrus (P = .047). Regarding subcortical GM volumes, PHIV patients showed lower right amygdala (P = .014) and left putamen (P = .016) volumes when compared with HIV- controls. Within the PHIV group, higher CD4 count was associated with higher volumes in right putamen (B = 0.00000038, P = .045). Moreover, increased age at cART initiation and lower nadir CD4 count was associated with larger volumes in left accumbens (B = 0.0000046, P = .033; B = -0.00000008, P = .045, respectively).PHIV patients showed thinner cortices of areas in temporal, orbito-frontal and occipital lobes and lower volumes of subcortical GM volumes when compared with the HIV- control group, suggesting cortical and subcortical brain alterations in otherwise neuroasymptomatic patients. Nevertheless, larger and longitudinal studies are required to determine the impact of HIV on brain structure in PHIV patients and to further identify risk and protective factors that could be implicated.
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Affiliation(s)
- Beatriz Ruiz-Saez
- Immunobiology Department, Hospital Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM)
| | - Manuela Martín-Bejarano García
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12)
| | | | - Mario Gil-Correa
- Laboratorio de Análisis de Imagen Médica y Biometría (LAIMBIO), Universidad Rey Juan Carlos
| | - Helena Melero
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento - Universidad Complutense de Madrid, Spain, y Laboratorio de Análisis de Imagen Médica y Biometría (LAIMBIO), Universidad Rey Juan Carlos
| | | | - Santiago Jimenez de Ory
- Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IisGM)
| | - Berta Zamora
- Paediatric Neuropsychology Department. Hospital Universitario 12 De Octubre, Madrid
| | - Sara Guillen
- Paediatric Infectious Diseases Department, Hospital Universitario de Getafe, Translational Research Network in Pediatric Infectious Diseases (RITIP)
| | - Pablo Rojo
- Paediatric Infectious Diseases Department. Hospital Universitario 12 De Octubre, Madrid, 28041, Spain. Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid
| | - Lola Falcon-Neyra
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Sevilla
| | | | - Pilar Fernandez
- Radiology Department. Hospital Universitario Gregorio Marañón
| | | | - Jose Tomas Ramos
- Paediatric Infectious Diseases Department, Hospital Clínico San Carlos, Madrid, 28040, Spain, Translational Research Network in Pediatric Infectious Diseases (RITIP)
| | - Talía Sainz
- Paediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz. Hospital La Paz Institute For Health Research (Idipaz), Translational Research Network in Pediatric Infectious Diseases (RITIP)
| | - Carlos Velo
- Department of Paediatric Infectious Diseases, Hospital Universitario 12 de Octubre; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12)
| | - Maria Luisa Navarro
- Paediatric Infectious Diseases Department. Hospital Gregorio Marañon, Translational Research Network in Pediatric Infectious Diseases (RITIP)
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15
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Angelidou A, Sullivan K, Melvin PR, Shui JE, Goldfarb IT, Bartolome R, Chaudhary N, Vaidya R, Culic I, Singh R, Yanni D, Patrizi S, Hudak ML, Parker MG, Belfort MB. Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts. JAMA Netw Open 2021; 4:e217523. [PMID: 33890989 PMCID: PMC8065376 DOI: 10.1001/jamanetworkopen.2021.7523] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The incidence of mother-to-newborn SARS-CoV-2 transmission appears low and may be associated with biological and social factors. However, data are limited on the factors associated with neonatal clinical or viral testing outcomes. OBJECTIVE To ascertain the percentage of neonates who were born to mothers with positive SARS-CoV-2 test results during the birth hospitalization, the clinical and sociodemographic factors associated with neonatal test result positivity, and the clinical and virological outcomes for newborns during hospitalization and 30 days after discharge. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study included 11 academic or community hospitals in Massachusetts and mother-neonate dyads whose delivery and discharge occurred between March 1, 2020, and July 31, 2020. Eligible dyads were identified at each participating hospital through local COVID-19 surveillance and infection control systems. Neonates were born to mothers with positive SARS-CoV-2 test results within 14 days before to 72 hours after delivery, and neonates were followed up for 30 days after birth hospital discharge. EXPOSURES Hypothesized maternal risk factors in neonatal test result positivity included maternal COVID-19 symptoms, vaginal delivery, rooming-in practice, Black race or Hispanic ethnicity, and zip code-derived social vulnerability index. Delivery indicated by worsening maternal COVID-19 symptoms was hypothesized to increase the risk of adverse neonatal health outcomes. MAIN OUTCOMES AND MEASURES Primary outcomes for neonates were (1) positive SARS-CoV-2 test results, (2) indicators of adverse health, and (3) clinical signs and viral testing. Test result positivity was defined as at least 1 positive result on a specimen obtained by nasopharyngeal swab using a polymerase chain reaction-based method. Clinical and testing data were obtained from electronic medical records of nonroutine health care visits within 30 days after hospital discharge. RESULTS The cohort included 255 neonates (mean [SD] gestational age at birth, 37.9 [2.6] weeks; 62 [24.3%] with low birth weight or preterm delivery) with 250 mothers (mean [SD] age, 30.4 [6.3] years; 121 [48.4%] were of Hispanic ethnicity). Of the 255 neonates who were born to mothers with SARS-CoV-2 infection, 225 (88.2%) were tested for SARS-CoV-2 and 5 (2.2%) had positive results during the birth hospitalization. High maternal social vulnerability was associated with higher likelihood of neonatal test result positivity (adjusted odds ratio, 4.95; 95% CI, 1.53-16.01; P = .008), adjusted for maternal COVID-19 symptoms, delivery mode, and rooming-in practice. Adverse outcomes during hospitalization were associated with preterm delivery indicated by worsening maternal COVID-19 symptoms. Of the 151 newborns with follow-up data, 28 had nonroutine clinical visits, 7 underwent SARS-CoV-2 testing, and 1 had a positive result. CONCLUSIONS AND RELEVANCE The findings emphasize the importance of both biological and social factors in perinatal SARS-CoV-2 infection outcomes. Newborns exposed to SARS-CoV-2 were at risk for both direct and indirect adverse health outcomes, supporting efforts of ongoing surveillance of the virus and long-term follow-up.
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MESH Headings
- Adult
- COVID-19/diagnosis
- COVID-19/epidemiology
- COVID-19/transmission
- COVID-19 Testing/methods
- COVID-19 Testing/statistics & numerical data
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Female
- Gestational Age
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/virology
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Male
- Massachusetts/epidemiology
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Outcome/epidemiology
- Premature Birth/epidemiology
- Risk Factors
- SARS-CoV-2/isolation & purification
- Socioeconomic Factors
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Affiliation(s)
- Asimenia Angelidou
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Katherine Sullivan
- UMass Memorial Health Center, University of Massachusetts Medical School, Worcester
| | - Patrice R Melvin
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica E Shui
- Department of Pediatrics, Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ilona Telefus Goldfarb
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ruby Bartolome
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Neha Chaudhary
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ruben Vaidya
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield
| | - Ivana Culic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rachana Singh
- Division of Newborn Medicine, Tufts Children's Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Diana Yanni
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Silvia Patrizi
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark L Hudak
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | - Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, Playle R, Perry A, Bourne T, Lees CC. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021; 57:573-581. [PMID: 33620113 PMCID: PMC8014713 DOI: 10.1002/uog.23619] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal-Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. METHODS This was an analysis of data from the PAN-COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP-SONPM National Perinatal COVID-19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP-SONPM). For obstetric outcomes, in PAN-COVID overall and in those with confirmed infection in PAN-COVID and AAP-SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (< 37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.1% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP-SONPM. Extreme preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP-SONPM. Neonatal SARS-CoV-2 infection was reported in 0.9% of all deliveries in PAN-COVID overall, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP-SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a small-for-gestational-age (SGA) neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP-SONPM. Mean gestational-age-adjusted birth-weight Z-scores were -0.03 in PAN-COVID and -0.18 in AAP-SONPM. CONCLUSIONS The findings from the UK and USA registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy. Copyright © 2021 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E. Mullins
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - M. L. Hudak
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Banerjee
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Getzlaff
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Townson
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - K. Barnette
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - R. Playle
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - A. Perry
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Bourne
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - C. C. Lees
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
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Park HW, Cho MH, Bae SH, Lee R, Kim KS. Incidence of Postnatal CMV Infection among Breastfed Preterm Infants: a Systematic Review and Meta-analysis. J Korean Med Sci 2021; 36:e84. [PMID: 33783146 PMCID: PMC8007418 DOI: 10.3346/jkms.2021.36.e84] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We performed a systematic review and meta-analysis to evaluate the incidence of breast milk-acquired cytomegalovirus (CMV) infection in preterm infants born to CMV-seropositive mothers. METHODS PubMed, Embase, and Cochrane Library databases were searched using the terms: ("breast feeding" or "breast milk" or "human milk" or "breast") and ("HCMV" or "cytomegalovirus") and ("infant, extremely premature" or "premature birth" or "newborn" or "neonate" or "low birth weight" or "very low birth weight" or "premature" or "preterm infant"). Studies that had information on CMV status and breast feeding were included in the meta-analysis. RESULTS A total of 2,502 newborns from 19 studies were included in this meta-analysis. The rate of postnatally acquired CMV infection among breastfed infants with CMV-seropositive mothers was 16.5% (95% confidence interval [CI], 0.10-0.26; P < 0.001). The infection rate was 26% with fresh breast milk, 8% with a combined diet of fresh and freeze-thawed breast milk, and 11% with freeze-thawed breast milk. Among cases where the CMV status of breast milk was determined, CMV shedding into breast milk occurred in 80.5% (95% CI, 0.71-0.87; P < 0.001) of CMV seropositive mothers. The breast milk-acquired CMV infection rate among infants fed CMV-positive breast milk was 20.7% (95% CI, 0.14-0.30; P < 0.001). CONCLUSION This meta-analysis examined the rate of breast milk-acquired CMV infections in preterm infants with CMV-seropositive mothers; the CMV infection rate was higher in preterm infants fed fresh breast milk. Until further data are available, we cautiously suggest the use of freeze-thawed breast milk, rather than fresh breast milk, for preterm infants or very low birth weight infants.
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Affiliation(s)
- Hye Won Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Konkuk University School of Medicine, Seoul, Korea.
| | - Myung Hyun Cho
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sun Hwan Bae
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Konkuk University School of Medicine, Seoul, Korea
| | - Ran Lee
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
- Konkuk University School of Medicine, Seoul, Korea
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Korea
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18
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Ogamba I, Kliss A, Rainville N, Chuang L, Panarelli E, Petrini J, Zilberman D. Initial review of pregnancy and neonatal outcomes of pregnant women with COVID-19 infection. J Perinat Med 2021; 49:263-268. [PMID: 33141109 DOI: 10.1515/jpm-2020-0446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/10/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Data regarding the pathogenesis and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, however, there's limited data in regard to maternal and neonatal outcomes. Therefore, we conducted a retrospective analysis of all pregnant women who tested positive for SARS-CoV-2 within Nuvance Health system. METHODS Data were abstracted from the medical records of each patient and descriptive analysis was performed. Variables included demographics, COVID testing results, symptoms, management, labor course, neonatal information, and complications. RESULTS Total of 40 patients were identified. Average age was 29.6 years old, 35% were Hispanic, and approximately one in three patients had comorbidities. Of the patients who had repeated testing, the average number of days between first positive test and negative test was 36.8 days (± 19.9 days). Three out of four women reported symptoms. Of the 40 pregnant women who were positive for SARS-CoV-2, 25 of them delivered. About 84% of the women delivered after 37 weeks. Twelve percent of the women delivered under 33 and 6/7 weeks. Most patients had vaginal deliveries (68%) and the remaining had cesarean deliveries. Neonatal outcomes included: mean 1 and 5 min Apgar scores of 8 and 8.8, respectively and the mean birth weight was 3212 g. Twenty neonates were tested for SARS-CoV-2 and were all found to be negative. CONCLUSIONS Overall, with routine prenatal care and preventive measures, pregnant patients and neonates in our study had good outcomes. At this time, there appears to be no evidence of vertical transmission.
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Affiliation(s)
- Ifeoma Ogamba
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Andrea Kliss
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Nicole Rainville
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury and Norwalk Hospital, Danbury/Norwalk, CT, USA
| | - Erin Panarelli
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Joann Petrini
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Dimitry Zilberman
- Department of Obstetrics and Gynecology, Danbury and Norwalk Hospital, Danbury/Norwalk, CT, USA
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Brandenburger D, Ambrosino E. The impact of antenatal syphilis point of care testing on pregnancy outcomes: A systematic review. PLoS One 2021; 16:e0247649. [PMID: 33765040 PMCID: PMC7993761 DOI: 10.1371/journal.pone.0247649] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/23/2020] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
Background Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth, disproportionally affecting women in low-resource settings where syphilis prevalence rates are high and testing rates low. Recently developed syphilis point-of-care tests (POCTs) are promising alternatives to conventional laboratory screening in low-resource settings as they do not require a laboratory setting, intensive technical training and yield results in 10–15 minutes thereby enabling both diagnosis and treatment in a single visit. Aim of this review was to provide clarity on the benefits of different POCTs and assess whether the implementation of syphilis POCTs is associated with decreased numbers of syphilis-related adverse pregnancy outcomes. Methods Following the PRISMA guidelines, three electronic databases (PubMed, Medline (Ovid), Cochrane) were systematically searched for intervention studies and cost-effectiveness analyses investigating the association between antenatal syphilis POCT and pregnancy outcomes such as congenital syphilis, low birth weight, prematurity, miscarriage, stillbirth as well as perinatal, fetal or infant death. Results Nine out of 278 initially identified articles were included, consisting of two clinical studies and seven modelling studies. Studies compared the effect on pregnancy outcomes of treponemal POCT, non-treponemal POCT and dual POCT to laboratory screening and no screening program. Based on the clinical studies, significantly higher testing and treatment rates, as well as a significant reduction (93%) in adverse pregnancy outcomes was reported for treponemal POCT compared to laboratory screening. Compared to no screening and laboratory screening, modelling studies assumed higher treatment rates for POCT and predicted the most prevented adverse pregnancy outcomes for treponemal POCT, followed by a dual treponemal and non-treponemal POCT strategy. Conclusion Implementation of treponemal POCT in low-resource settings increases syphilis testing and treatment rates and prevents the most syphilis-related adverse pregnancy outcomes compared to no screening, laboratory screening, non-treponemal POCT and dual POCT. Regarding the benefits of dual POCT, more research is needed. Overall, this review provides evidence on the contribution of treponemal POCT to healthier pregnancies and contributes greater clarity on the impact of diverse diagnostic methods available for the detection of syphilis.
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MESH Headings
- Abortion, Spontaneous/diagnosis
- Abortion, Spontaneous/economics
- Abortion, Spontaneous/prevention & control
- Cost-Benefit Analysis
- Developing Countries
- Female
- Humans
- Infant
- Infant Mortality/trends
- Infant, Low Birth Weight
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Point-of-Care Testing/economics
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/economics
- Pregnancy Complications, Infectious/prevention & control
- Prenatal Diagnosis/economics
- Prenatal Diagnosis/methods
- Stillbirth
- Syphilis/diagnosis
- Syphilis/economics
- Syphilis/prevention & control
- Syphilis Serodiagnosis/economics
- Syphilis Serodiagnosis/methods
- Treponema pallidum/immunology
- Treponema pallidum/pathogenicity
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Affiliation(s)
- Dana Brandenburger
- Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Elena Ambrosino
- Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Development), Institute for Public Health Genomics (IPHG), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
- * E-mail:
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Llenas-García J, Wikman-Jorgensen P, Gil-Anguita C, Ramos- Sesma V, Torrús-Tendero D, Martínez-Goñi R, Romero-Nieto M, García-Abellán J, Esteban-Giner MJ, Antelo K, Navarro-Cots M, Buñuel F, Amador C, García-García J, Gascón I, Telenti G, Fuentes-Campos E, Torres I, Gimeno-Gascón A, Ruíz-García MM, Navarro M, Ramos-Rincón JM. Chagas disease screening in pregnant Latin American women: Adherence to a systematic screening protocol in a non-endemic country. PLoS Negl Trop Dis 2021; 15:e0009281. [PMID: 33760816 PMCID: PMC8021187 DOI: 10.1371/journal.pntd.0009281] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/02/2020] [Revised: 04/05/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is a chronic parasitic disease caused by Trypanosoma cruzi and is endemic to continental Latin America. In Spain, the main transmission route is congenital. We aimed to assess adherence to regional recommendations of universal screening for CD during pregnancy in Latin American women in the province of Alicante from 2014 to 2018. METHODOLOGY/PRINCIPAL FINDINGS Retrospective quality study using two data sources: 1) delivery records of Latin American women that gave birth in the 10 public hospitals of Alicante between January 2014 and December 2018; and 2) records of Chagas serologies carried out in those centers between May 2013 and December 2018. There were 3026 deliveries in Latin American women during the study period; 1178 (38.9%) underwent CD serology. Screening adherence ranged from 17.2% to 59.3% in the different health departments and was higher in Bolivian women (48.3%). Twenty-six deliveries (2.2%) had a positive screening; CD was confirmed in 23 (2%) deliveries of 21 women. Bolivians had the highest seroprevalence (21/112; 18.7%), followed by Colombians (1/333; 0.3%) and Ecuadorians (1/348; 0.3%). Of 21 CD-positive women (19 Bolivians, 1 Colombian, 1 Ecuadorian), infection was already known in 12 (57.1%), and 9 (42.9%) had already been treated. Only 1 of the 12 untreated women (8.3%) was treated postpartum. Follow-up started in 20 of the 23 (87.0%) neonates but was completed only in 11 (47.8%); no cases of congenital transmission were detected. Among the 1848 unscreened deliveries, we estimate 43 undiagnosed cases of CD and 1 to 2 undetected cases of congenital transmission. CONCLUSIONS/SIGNIFICANCE Adherence to recommendations of systematic screening for CD in Latin American pregnant women in Alicante can be improved. Strategies to strengthen treatment of postpartum women and monitoring of exposed newborns are needed. Currently, there may be undetected cases of congenital transmission in our province.
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Affiliation(s)
- Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Clinical Medicine Department, University Miguel Hernández, Elche, Spain
- * E-mail:
| | - Philip Wikman-Jorgensen
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Internal Medicine Department, University Hospital San Juan de Alicante, San Juan de Alicante, Spain
| | | | | | - Diego Torrús-Tendero
- Reference Unit of Imported Diseases and International Health, Alicante General University Hospital, Alicante, Spain
- Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
- Parasitology Area, University Miguel Hernández, Elche, Spain
| | | | - Mónica Romero-Nieto
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Clinical Medicine Department, University Miguel Hernández, Elche, Spain
- Internal Medicine Department, Elda General University Hospital, Elda, Spain
| | - Javier García-Abellán
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Infectious Diseases Unit. Elche General University Hospital, Elche, Spain
| | | | | | - María Navarro-Cots
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, Hospital Vega Baja, Orihuela, Spain
| | - Fernando Buñuel
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, University Hospital San Juan de Alicante, San Juan de Alicante, Spain
| | - Concepción Amador
- Internal Medicine Department, Hospital Marina Baixa, Villajoyosa, Spain
| | | | - Isabel Gascón
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, Elda General University Hospital, Elda, Spain
| | - Guillermo Telenti
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Infectious Diseases Unit. Elche General University Hospital, Elche, Spain
| | | | | | - Adelina Gimeno-Gascón
- Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
- Microbiology Department, Alicante General University Hospital, Alicante, Spain
| | - María Montserrat Ruíz-García
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Valencia, Spain
- Microbiology Department, Elche General University Hospital, Elche, Spain
| | - Miriam Navarro
- Department of Public Health, Science History and Gynaecology, University Miguel Hernández, Elche, Spain
| | - José-Manuel Ramos-Rincón
- Clinical Medicine Department, University Miguel Hernández, Elche, Spain
- Reference Unit of Imported Diseases and International Health, Alicante General University Hospital, Alicante, Spain
- Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
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Gengler C, Dubruc E, Favre G, Greub G, de Leval L, Baud D. SARS-CoV-2 ACE-receptor detection in the placenta throughout pregnancy. Clin Microbiol Infect 2021; 27:489-490. [PMID: 33022363 PMCID: PMC7532787 DOI: 10.1016/j.cmi.2020.09.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/14/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Carole Gengler
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Estelle Dubruc
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Center for Research on Intracellular Bacteria, Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, CH-1011, Lausanne, Switzerland
| | - Laurence de Leval
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Garofoli F, Civardi E, Zanette S, Angelini M, Perotti G, Zecca M, Lombardi G. Literature Review and an Italian Hospital Experience about Post-Natal CMV Infection Acquired by Breast-Feeding in Very Low and/or Extremely Low Birth Weight Infants. Nutrients 2021; 13:nu13020660. [PMID: 33670693 PMCID: PMC7921952 DOI: 10.3390/nu13020660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/11/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022] Open
Abstract
Breastfeeding is recommended for all neonates due to a known variety of beneficial effects, but infants can be infected by cell-associated bacteria and viruses from breast milk, such as cytomegalovirus (CMV). The majority of CMV-seropositive breastfeeding women have a viral, self-restricted reactivation, can shed the virus in the milk for about 12 weeks after delivery, and can transmit the infection to their offspring. Post-natal CMV-infected term infants are mainly asymptomatic, while very low birth weight (VLBW, <1500 g) and extremely low birth weight (ELBW, <1000 g) infants may present with severe disease, short-term sequelae ranging from abnormalities in laboratory indexes to sepsis-like syndrome, and long-term sequelae such as developmental problems. Thus, the use of thermally treated maternal milk for VLBW/ELBW infants may be indicated to prevent/reduce the risk of CMV transmission. Different techniques, with varying efficacy in eradicating CMV and maintaining the activity of biological compounds in milk are available: long/short pasteurization, freeze-thawing, the use of microwaves, and ultraviolet-C irradiation. In our NICU, the use of maternal raw milk is always strongly recommended for term/preterm infants, but to reduce risk of CMV transmission, freeze-thawing mother's own milk is used in neonates with GA ≤ 30 weeks or/and weight ≤ 1000 g, usually regardless of serological maternal condition, as CMV screening is not routinely offered to pregnant women and the milk of seroimmune mothers is not evaluated for CMV reactivation, as its rate is similar to seroprevalence. Over the last 4 years, we had 10 VLBW/ELBW newborns in our NICU with late-onset sepsis and negative cultures. In these cases, the research of CMV DNA in neonatal urine or saliva, for the diagnosis of post-natal symptomatic infection (once congenital transmission has been excluded) may be useful and not invasive. The take-home message we would like to share is that acquired CMV infection should be considered in VLBW/ELBW infants breastfed by seropositive mothers and presenting severe symptoms-particularly sepsis with negative cultures. This could allow pediatricians to make better-quality diagnoses, perform supportive therapy, provide antiviral treatment if needed, or establish a "pre-emptive" therapy for these high-risk neonates.
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23
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Shah B, Dande V, Rao S, Prabhu S, Bodhanwala M. Outcome of Covid-19 Positive Newborns Presenting to a Tertiary Care Hospital. Indian Pediatr 2021; 58:177-179. [PMID: 33632951 PMCID: PMC7926062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Neonatal data regarding SARS-CoV-2 is sparse from India. On review of hospital records from April- August, 2020, 18/423 (4.25%) neonates were SARS-CoV-2 RT-PCR positive. 15 (83.3%) neonates recovered and 3 (16.6%) succumbed. Only 50% of the positive babies had positive mothers/ caretakers, a contact could not be traced in others.
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Affiliation(s)
- Bhavya Shah
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Vaidehi Dande
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Sudha Rao
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
| | - Sanjay Prabhu
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Minnie Bodhanwala
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
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Chi J, Gong W, Gao Q. Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review. Arch Gynecol Obstet 2021; 303:337-345. [PMID: 33258995 PMCID: PMC7706177 DOI: 10.1007/s00404-020-05889-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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: 06/01/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE This systematic review summarizes the clinical features and maternal-infant outcomes of 230 pregnant women (154 patients gave birth) infected with COVID-19 and their 156 infants, including the possibility and evidence of vertical transmission. METHODS An electronic search of PubMed, Embase, Medline, MedRxiv, CNKI, and the Chinese Medical Journal Full Text Database following PRISMA guidelines was performed through April 18, 2020. Search terms included COVID-19, SARS-CoV-2, pregnant women, infants, and vertical transmission. RESULTS A total of 230 women with COVID-19 (154 deliveries, 66 ongoing pregnancies, and 10 abortions) and 156 newborns from 20 eligible studies were included in this systematic review. A total of 34.62% of the pregnant patients had obstetric complications, and 59.05% of patients displayed fever. Lymphopenia was observed in 40.71% of patients. A total of 5.19% of women received mechanical ventilation. Seven women were critically ill. One mother and two newborns died. A total of 24.74% of newborns were premature. Five newborns' throat swab tests of SARS-CoV-2 were positive, all of which were delivered by cesarean section. For eight newborns with negative throat swab tests, three had both elevated IgM and IgG against SARS-CoV-2. Nucleic acid tests of vaginal secretions, breast milk, amniotic fluid, placental blood, and placental tissues were negative. CONCLUSION Most pregnant patients were mildly ill. The mortality of pregnant women with COVID-19 was lower than that of overall COVID-19 patients. Cesarean section was more common than vaginal delivery for pregnant women with COVID-19. Premature delivery was the main adverse event for newborns. The vertical transmission rate calculated by SARS-CoV-2 nucleic acid tests was 3.91%. Serum antibodies against SARS-CoV-2 should be tested more frequently, and multiple samples should be included in pathogenic testing.
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Affiliation(s)
- Jianhua Chi
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, Hubei, China
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenjian Gong
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, Hubei, China
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qinglei Gao
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, Hubei, China.
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Elenga N, Djossou F, Nacher M. Association between maternal human immunodeficiency virus infection and preterm birth: A matched case-control study from a pregnancy outcome registry. Medicine (Baltimore) 2021; 100:e22670. [PMID: 33530154 PMCID: PMC7850744 DOI: 10.1097/md.0000000000022670] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/10/2020] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the relationships between different types of antiretroviral therapy (ART) and preterm birth.Preterm birth was studied among all singleton pregnancies and compared between human immunodeficiency virus (HIV)-infected and uninfected women.We performed a matched case-control study from the pregnancy outcome registry of Cayenne Hospital. HIV-infected and uninfected women who delivered in the maternity ward of Cayenne Hospital from January 1, 2013 to December 31, 2015 were studied. We conducted an initial analysis to determine the risk factors for preterm birth among HIV-infected pregnant women. We also evaluated associations between exposure to antiretroviral therapy (ART) and preterm birth.There were 8682 deliveries; of these, 117 involved HIV-infected women, representing a prevalence of 1.34%. There were 470 controls. The sociodemographic characteristics were comparable. HIV-infected women were more likely to experience preterm birth (adjusted odds ratio [AOR] = 3.9, 95% confidence interval [CI] 1.5-9.9). Overall, 95.73% of the women received antiretroviral therapy before becoming pregnant, and they were in good clinical condition. The median CD4 count at the beginning of pregnancy was 500 cells/mm3 (357-722). Additionally, 53% of HIV-infected women had an undetectable viral load count (<20 copies/mL). Their median haemoglobin level was 120 g/L (100-120). There were 2 human immunodeficiency virus-infected babies. A higher rate of preterm birth was associated with protease inhibitor-based ART than a reverse transcriptase inhibitor-based ART regimen. The sample size being small this result would be considered with caution.The preterm birth rate among HIV-infected pregnant women was twice that of the general population; this trend was not explained by sociodemographic characteristics. Preterm birth was independently associated with combination ART, especially with ritonavir-boosted protease inhibitor therapy during pregnancy.
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Affiliation(s)
| | | | - Mathieu Nacher
- Centre d’Investigation Clinique Antilles-Guyane, Inserm 1424, Andrée Rosemon Regional Hospital, Rue des flamboyants, Cayenne Cedex, French Guiana
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Banerjee J, Mullins E, Townson J, Playle R, Shaw C, Kirby N, Munnery K, Bourne T, Teoh TG, Dhanjal M, Poon L, Wright A, Lees C. Pregnancy and neonatal outcomes in COVID-19: study protocol for a global registry of women with suspected or confirmed SARS-CoV-2 infection in pregnancy and their neonates, understanding natural history to guide treatment and prevention. BMJ Open 2021; 11:e041247. [PMID: 33514576 PMCID: PMC7849873 DOI: 10.1136/bmjopen-2020-041247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Previous novel COVID-19 pandemics, SARS and middle east respiratory syndrome observed an association of infection in pregnancy with preterm delivery, stillbirth and increased maternal mortality. COVID-19, caused by SARS-CoV-2 infection, is the largest pandemic in living memory.Rapid accrual of robust case data on women in pregnancy and their babies affected by suspected COVID-19 or confirmed SARS-CoV-2 infection will inform clinical management and preventative strategies in the current pandemic and future outbreaks. METHODS AND ANALYSIS The pregnancy and neonatal outcomes in COVID-19 (PAN-COVID) registry are an observational study collecting focused data on outcomes of pregnant mothers who have had suspected COVID-19 in pregnancy or confirmed SARS-CoV-2 infection and their neonates via a web-portal. Among the women recruited to the PAN-COVID registry, the study will evaluate the incidence of: (1) miscarriage and pregnancy loss, (2) fetal growth restriction and stillbirth, (3) preterm delivery, (4) vertical transmission (suspected or confirmed) and early onset neonatal SARS-CoV-2 infection.Data will be centre based and collected on individual women and their babies. Verbal consent will be obtained, to reduce face-to-face contact in the pandemic while allowing identifiable data collection for linkage. Statistical analysis of the data will be carried out on a pseudonymised data set by the study statistician. Regular reports will be distributed to collaborators on the study research questions. ETHICS AND DISSEMINATION This study has received research ethics approval in the UK. For international centres, evidence of appropriate local approval will be required to participate, prior to entry of data to the database. The reports will be published regularly. The outputs of the study will be regularly disseminated to participants and collaborators on the study website (https://pan-covid.org) and social media channels as well as dissemination to scientific meetings and journals. STUDY REGISTRATION NUMBER ISRCTN68026880.
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Affiliation(s)
- Jayanta Banerjee
- Department of Neonatology, Imperial College Healthcare NHS Trust, London, UK
- Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Edward Mullins
- Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, South Glamorgan, UK
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, South Glamorgan, UK
| | - Caroline Shaw
- Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nigel Kirby
- Centre for Trials Research, Cardiff University, Cardiff, South Glamorgan, UK
| | - Kim Munnery
- Centre for Trials Research, Cardiff University, Cardiff, South Glamorgan, UK
| | - Tom Bourne
- Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - T G Teoh
- Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Women, Children and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
| | - Mandish Dhanjal
- Women, Children and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
| | - Liona Poon
- Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alison Wright
- Obstetrics and Gynaecology, Royal Free London NHS Foundation Trust, London, UK
| | - Christoph Lees
- Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Women, Children and Clinical Support, Imperial College Healthcare NHS Trust, London, UK
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Bhuiyan MU, Stiboy E, Hassan MZ, Chan M, Islam MS, Haider N, Jaffe A, Homaira N. Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis. Vaccine 2021; 39:667-677. [PMID: 33342635 PMCID: PMC7833125 DOI: 10.1016/j.vaccine.2020.11.078] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [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: 08/25/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Emerging evidence suggests young children are at greater risk of COVID-19 infection than initially predicted. However, a comprehensive understanding of epidemiology of COVID-19 infection in young children under five years, the most at-risk age-group for respiratory infections, remain unclear. We conducted a systematic review and meta-analysis of epidemiological and clinical characteristics of COVID-19 infection in children under five years. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses , we searched several electronic databases (Pubmed, EMBASE, Web of Science, and Scopus) with no language restriction for published epidemiological studies and case-reports reporting laboratory-confirmed COVID-19 infection in children under five years until June 4, 2020. We assessed pooled prevalence for key demographics and clinical characteristics using Freeman-Tukey double arcsine random-effects model for studies except case-reports. We evaluated risk of bias separately for case-reports and other studies. RESULTS We identified 1,964 articles, of which, 65 articles were eligible for systematic review that represented 1,214 children younger than five years with laboratory-confirmed COVID-19 infection. The pooled estimates showed that 50% young COVID-19 cases were infants (95% CI: 36% - 63%, 27 studies); 53% were male (95% CI: 41% - 65%, 24 studies); 43% were asymptomatic (95% CI: 15% - 73%, 9 studies) and 7% (95% CI: 0% - 30%, 5 studies) had severe disease that required intensive-care-unit admission. Of 139 newborns from COVID-19 infected mothers, five (3.6%) were COVID-19 positive. There was only one death recorded. DISCUSSION This systematic review reports the largest number of children younger than five years with COVID-19 infection till date. Our meta-analysis shows nearly half of young COVID-19 cases were asymptomatic and half were infants, highlighting the need for ongoing surveillance to better understand the epidemiology, clinical pattern, and transmission of COVID-19 to develop effective preventive strategies against COVID-19 disease in young paediatric population.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia.
| | - Eunice Stiboy
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Md Zakiul Hassan
- Program for Emerging Infections, Infectious Diseases Division, icddr,b, Bangladesh
| | - Mei Chan
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Md Saiful Islam
- Program for Emerging Infections, Infectious Diseases Division, icddr,b, Bangladesh; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Najmul Haider
- The Royal Veterinary College, University of London, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Adam Jaffe
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Nusrat Homaira
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Suy A, Garcia-Ruiz I, Carbonell M, Garcia-Manau P, Rodo C, Maiz N, Sulleiro E, Anton A, Esperalba J, Fernández-Hidalgo N, Frick MA, Camba F, Pumarola T, Carreras E. Gestation and COVID-19: clinical and microbiological observational study (Gesta-COVID19). BMC Pregnancy Childbirth 2021; 21:78. [PMID: 33482757 PMCID: PMC7820822 DOI: 10.1186/s12884-021-03572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) is a novel disease which has been having a worldwide affect since December 2019. Evidence regarding the effects of SARS-CoV-2 during pregnancy is conflicting. The presence of SARS-CoV-2 has been demonstrated in biological samples during pregnancy (placenta, umbilical cord or amniotic fluid); however, maternal and fetal effects of the virus are not well known. METHODS Descriptive, multicentre, longitudinal, observational study in eight tertiary care hospitals throughout Spain, that are referral centres for pregnant women with COVID-19. All pregnant women with positive SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction during their pregnancy or 14 days preconception and newborns born to mothers infected with SARS-CoV-2 will be included. They will continue to be followed up until 4 weeks after delivery. The aim of the study is to investigate both the effect of COVID-19 on the pregnancy, and the effect of the pregnancy status with the evolution of the SARS-CoV-2 disease. Other samples (faeces, urine, serum, amniotic fluid, cord and peripheral blood, placenta and breastmilk) will be collected in order to analyse whether or not there is a risk of vertical transmission and to describe the behaviour of the virus in other fluids. Neonates will be followed until 6 months after delivery to establish the rate of neonatal transmission. We aim to include 150 pregnant women and their babies. Ethics approval will be obtained from all the participating centres. DISCUSSION There is little information known about COVID-19 and its unknown effects on pregnancy. This study will collect a large number of samples in pregnant women which will allow us to demonstrate the behaviour of the virus in pregnancy and postpartum in a representative cohort of the Spanish population.
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Affiliation(s)
- Anna Suy
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Itziar Garcia-Ruiz
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Melchor Carbonell
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pablo Garcia-Manau
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlota Rodo
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nerea Maiz
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Elena Sulleiro
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Andres Anton
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juliana Esperalba
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie Antoinette Frick
- Department of Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Fatima Camba
- Department of Neonatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Tomas Pumarola
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Elena Carreras
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Yu K, Rodriguez M, Paul Z, Gordon E, Gu T, Rice K, Triplett EW, Keller-Wood M, Wood CE. Transfer of oral bacteria to the fetus during late gestation. Sci Rep 2021; 11:708. [PMID: 33436911 PMCID: PMC7804304 DOI: 10.1038/s41598-020-80653-y] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
The fetus develops in a privileged environment, as the placenta serves as both a gateway for nutrients and a barrier for pathogen transfer to the fetus. Regardless, recent evidence suggests the presence of bacterial DNA in both placenta and fetus, and we have reported that DNA and protein from small numbers of bacteria gain access to the fetus from the maternal bloodstream. Other routes of environmental bacterial transfer from the mother to fetus remain unknown, as well as the physiological relevance of their presence. In these experiments, we examine multiple routes by which bacterial cellular components can enter the fetus and the fetal response to influx of bacterial DNA and protein. We inoculated maternal sheep with genetically-labeled S. aureus (Staphylococcus aureus) using three routes: intravenously, orally, and intra-vaginally. The inoculum did not produce sepsis or fever in the ewes, therefore mimicking incidental exposure to bacteria during pregnancy. 3-5 days post inoculation, we assessed the presence of bacterial components in the fetal tissues and analyzed fetal brain tissue to identify any alterations in gene expression. Our results demonstrate that components of bacteria that were introduced into the maternal mouth were detected in the fetal brain and that they stimulated changes in gene expression. We conclude that an oral route of transmission is relevant for transfer of bacterial cellular components to the fetus.
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Affiliation(s)
- Kevin Yu
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, 1345 Center Drive, Room M552, Gainesville, FL, 32610, USA
| | - Michelle Rodriguez
- Department of Microbiology and Cell Science, University of Florida Institute of Food and Agricultural Sciences, Gainesville, USA
| | - Zubin Paul
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, 1345 Center Drive, Room M552, Gainesville, FL, 32610, USA
| | - Elizabeth Gordon
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, 1345 Center Drive, Room M552, Gainesville, FL, 32610, USA
| | - Tongjun Gu
- Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, USA
| | - Kelly Rice
- Department of Microbiology and Cell Science, University of Florida Institute of Food and Agricultural Sciences, Gainesville, USA
| | - Eric W Triplett
- Department of Microbiology and Cell Science, University of Florida Institute of Food and Agricultural Sciences, Gainesville, USA
| | - Maureen Keller-Wood
- Department of Pharmacodynamics, University of Florida College of Pharmacy, Gainesville, USA
| | - Charles E Wood
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, 1345 Center Drive, Room M552, Gainesville, FL, 32610, USA.
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Papapanou M, Papaioannou M, Petta A, Routsi E, Farmaki M, Vlahos N, Siristatidis C. Maternal and Neonatal Characteristics and Outcomes of COVID-19 in Pregnancy: An Overview of Systematic Reviews. Int J Environ Res Public Health 2021; 18:E596. [PMID: 33445657 PMCID: PMC7828126 DOI: 10.3390/ijerph18020596] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 12/19/2022]
Abstract
(1) Background: A considerable number of systematic reviews, with substantial heterogeneity regarding their methods and included populations, on the impact of COVID-19 on infected pregnant women and their neonates, has emerged. The aim was to describe the obstetric-perinatal and neonatal outcome of infected pregnant women and their newborns during the COVID-19 pandemic; (2) Methods: Three bibliographical databases were searched (last search: September 10, 2020). Quality assessment was performed using the AMSTAR-2 tool. Primary outcomes included mode of delivery, preterm delivery/labor, premature rupture of membranes (PROM/pPROM) and abortions/miscarriages. Outcomes were mainly presented as ranges. A separate analysis, including only moderate and high-quality systematic reviews, was also conducted. The protocol was registered with PROSPERO (CRD42020214447); (3) Results: Thirty-nine reviews were analyzed. Reported rates, regarding both preterm and term gestations, varied between 52.3 and 95.8% for cesarean sections; 4.2-44.7% for vaginal deliveries; 14.3-63.8% specifically for preterm deliveries and 22.7-32.2% for preterm labor; 5.3-12.7% for PROM and 6.4-16.1% for pPROM. Maternal anxiety for potential fetal infection contributed to abortion decisions, while SARS-CoV-2-related miscarriages could not be excluded. Maternal ICU admission and mechanical ventilation rates were 3-28.5% and 1.4-12%, respectively. Maternal mortality rate was <2%, while stillbirth, neonatal ICU admission and mortality rates were <2.5%, 3.1-76.9% and <3%, respectively. Neonatal PCR positivity rates ranged between 1.6% and 10%. After accounting for quality of studies, ranges of our primary outcomes remained almost unchanged, while among our secondary outcomes, maternal ICU admission (3-10%) and mechanical ventilation rates (1.4-5.5%) were found to be relatively lower; (4) Conclusions: Increased rates of cesarean sections and preterm birth rates were found, with iatrogenic reasons potentially involved. In cases of symptomatic women with confirmed infection, high maternal and neonatal ICU admission rates should raise some concerns. The probability of vertical transmission cannot be excluded. Further original studies on women from all trimesters are warranted.
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Affiliation(s)
- Michail Papapanou
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Maria Papaioannou
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Aikaterini Petta
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Eleni Routsi
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Maria Farmaki
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece
| | - Charalampos Siristatidis
- Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece; (M.P.); (M.P.); (A.P.); (E.R.); (M.F.); (N.V.)
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion Hospital”, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 76, 11528 Athens, Greece
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Janssen O, Thompson M, Milburn S, Green R, Wagner B, Bianco A, Stroustrup A. The impact of perinatal severe acute respiratory syndrome coronavirus 2 infection during the peripartum period. Am J Obstet Gynecol MFM 2021; 3:100267. [PMID: 33103098 PMCID: PMC7574715 DOI: 10.1016/j.ajogmf.2020.100267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Olivia Janssen
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Thompson
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah Milburn
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Green
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian Wagner
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Angela Bianco
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annemarie Stroustrup
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Neonatology, Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, 269-01 76 Ave., CH 344, New Hyde Park, NY 11040.
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Bellos I, Pandita A, Panza R. Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 256:194-204. [PMID: 33246205 PMCID: PMC7664337 DOI: 10.1016/j.ejogrb.2020.11.038] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [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: 06/21/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
Evidence concerning coronavirus disease-19 (covid-19) in pregnancy is still scarce and scattered. This meta-analysis aims to evaluate maternal and neonatal outcomes in covid-19 pregnancies and identify factors associated with perinatal viral transmission. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched to 3 June 2020. Overall, 16 observational studies and 44 case reports/series were included. Fever was the most frequent maternal symptom, followed by cough and shortness of breath, while about 15 % of infected were asymptomatic. Severe disease was estimated to occur in 11 % of women in case reports/series and in 7 % (95 % CI: 4 %-10 %) in observational studies. Two maternal deaths were reported. The rate of neonatal transmission did not differ between women with and without severe disease (OR: 1.94, 95 % CI: 0.50-7.60). Preterm birth occurred in 29.7 % and 16 % (95 % CI: 11 %-21 %) in data obtained from case series and observational studies, respectively. Stillbirth occurred in 3 cases and 2 neonatal deaths were observed. Vertical transmission was suspected in 4 cases. Fever was the most common neonatal symptom (40 %), followed by shortness of breath (28 %) and vomiting (24 %), while 20 % of neonates were totally asymptomatic. In conclusion, the maternal and neonatal clinical course the infection is typically mild, presenting low mortality rates. The risk of vertical transmission is suggested to be low and may not be affected by the severity of maternal disease. Further large-scale studies are needed to clarify the risk factors associated with viral transmission and severe infection in the neonatal population.
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Affiliation(s)
- Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece
| | - Aakash Pandita
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Raffaella Panza
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Section, Policlinico Hospital, University of Bari Aldo Moro, Bari, Italy
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Novoa RH, Quintana W, Llancarí P, Urbina-Quispe K, Guevara-Ríos E, Ventura W. Maternal clinical characteristics and perinatal outcomes among pregnant women with coronavirus disease 2019. A systematic review. Travel Med Infect Dis 2021; 39:101919. [PMID: 33220455 PMCID: PMC7674121 DOI: 10.1016/j.tmaid.2020.101919] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 06/03/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the maternal clinical characteristics, maternal and perinatal outcomes in COVID-19-positive pregnant women. METHODS Articles in all languages on the SARS-CoV-2 infection in pregnant women were sought from MEDLINE, EMBASE, Cochrane Library and LILACS; China National Knowledge Infrastructure Database (CNKI), Chinese Science and Technology Periodical Database (VIP) and Wan Fang Data between December 1, 2019 and April 27, 2020. Bulletins and national reports were also searched. RESULTS From 12,168 retrieved articles, 143 were selected for full-text assessment; 33 for descriptive analyses, and 4 case-controls for meta-analysis. In 322 infected pregnant women, aged 20-45 years, the most frequent maternal comorbidity was obesity (24.2%). Forty-two (28.4%) were asymptomatic at admission. Cough (n = 148,59.7%) and fever (n = 147,59.3%) were the most prevalent symptoms. In the meta-analysis, fever (OR: 0.13,95% CI 0.05 to 0.36) and cough (0.26,95% CI 0.11 to 0.59) were lower in pregnant women with COVID-19 than non-pregnant women with COVID-19.195 (60.6%) delivered, and 125 (38.8%) remained pregnant during the study. Cesarean was reported in 99 (50.8%) women and vaginal delivery in 64 (32.8%). The main adverse obstetric outcome was premature birth (n = 37,18.9%). Thirty patients (10.3%) with COVID-19-related complications required intensive care, one (0.3%) died. SARS-CoV-2 was absent in breast milk, amniotic fluid, placenta or umbilical cord blood. CONCLUSIONS The maternal clinical characteristics of COVID-19-positive pregnant include frequently fever and cough; however significantly less frequently than non-pregnant women with COVID-19. Iatrogenic preterm birth is the main adverse obstetric outcome. Current data does not support vertical transmission in the third trimester.
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Affiliation(s)
- Rommy H Novoa
- High-Risk Pregnancy Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Willy Quintana
- High-Risk Pregnancy Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Pedro Llancarí
- Residency Training Program in Obstetrics & Gynecology, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Katherine Urbina-Quispe
- Residency Training Program in Obstetrics & Gynecology, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Enrique Guevara-Ríos
- High-Risk Pregnancy Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Walter Ventura
- Maternal & Fetal Medicine Unit, Department of Obstetrics and Perinatology, Instituto Nacional Materno Perinatal, Lima, Peru; Fetal Medicine Unit, Clínica Angloamericana, British Medical Hospital, Lima, Peru.
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Patel F, Shiau S, Strehlau R, Shen Y, Burke M, Paximadis M, Shalekoff S, Schramm D, Technau KG, Sherman GG, Coovadia A, Tiemessen CT, Abrams EJ, Kuhn L. Low Pretreatment Viral Loads in Infants With HIV in an Era of High-maternal Antiretroviral Therapy Coverage. Pediatr Infect Dis J 2021; 40:55-59. [PMID: 32925542 PMCID: PMC7722046 DOI: 10.1097/inf.0000000000002897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND With expansion of antiretroviral therapy (ART) programs, transmission rates are low but new infant infections still occur. We investigated predictors of pre-ART viral load (VL) and CD4+ T-cell counts and percentages in infants diagnosed with HIV at birth in a setting with high coverage of maternal ART and infant prophylaxis. METHODS As part of an early treatment study, 97 infants with confirmed HIV-infection were identified at a hospital in Johannesburg, South Africa. Infant VL and CD4+ T-cell parameters were measured before ART initiation. Data were collected on maternal characteristics, including VL, CD4+ T-cell counts and ART, and infant characteristics, including sex, birth weight, and mode of delivery. RESULTS Pre-ART, median infant VL was 28,405 copies/mL [interquartile range (IQR): 2515-218,150], CD4+ T-cell count 1914 cells/mm (IQR: 1474-2639) and percentage 40.8% (IQR: 32.2-51.2). Most (80.4%) infants were born to mothers who received ART during pregnancy and 97.9% of infants received daily nevirapine prophylaxis until ART initiation at median of 2 days of age (IQR: 1-7). Infant pre-ART VL was more likely to be ≥1000 copies/mL when their mothers had VL ≥1000 copies/mL [Odds Ratio (OR): 6.88, 95% confidence interval (CI): 2.32-20.41] and was higher in boys than girls (OR: 3.29, 95% CI: 1.07-9.95). Lower maternal CD4+ T-cell count (<350 cells/mm) was associated with lower infant CD4+ T-cell count (<1500 cells/mm) (OR: 3.59, 95% CI: 1.24-10.43). CONCLUSIONS Pre-ART VL and CD4+ T-cell parameters of intrauterine-infected infants were associated with VL and CD4+ T-cell counts of their mothers. Maternal ART during pregnancy may begin treatment of intrauterine infection and may mask the severity of disease in infected infants identified in the current era with high-maternal ART coverage.
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Affiliation(s)
- Faeezah Patel
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yanhan Shen
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria Paximadis
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharon Shalekoff
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diana Schramm
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karl-Günter Technau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gayle G. Sherman
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline T. Tiemessen
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elaine J. Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Louise Kuhn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Abstract
Neonatal data regarding SARS-CoV-2 is sparse from India. On review of hospital records from April- August, 2020, 18/423 (4.25%) neonates were SARS-CoV-2 RT-PCR positive. 15 (83.3%) neonates recovered and 3 (16.6%) succumbed. Only 50% of the positive babies had positive mothers/ caretakers, a contact could not be traced in others.
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Affiliation(s)
- Bhavya Shah
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Vaidehi Dande
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Sudha Rao
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
| | - Sanjay Prabhu
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Minnie Bodhanwala
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
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Solís-García G, Gutiérrez-Vélez A, Pescador Chamorro I, Zamora-Flores E, Vigil-Vázquez S, Rodríguez-Corrales E, Sánchez-Luna M. [Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection]. An Pediatr (Barc) 2020; 94:173-178. [PMID: 33431332 PMCID: PMC7833088 DOI: 10.1016/j.anpedi.2020.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.
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Affiliation(s)
- Gonzalo Solís-García
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Ana Gutiérrez-Vélez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | - Elena Zamora-Flores
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Sara Vigil-Vázquez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Manuel Sánchez-Luna
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Edlow AG, Li JZ, Collier ARY, Atyeo C, James KE, Boatin AA, Gray KJ, Bordt EA, Shook LL, Yonker LM, Fasano A, Diouf K, Croul N, Devane S, Yockey LJ, Lima R, Shui J, Matute JD, Lerou PH, Akinwunmi BO, Schmidt A, Feldman J, Hauser BM, Caradonna TM, De la Flor D, D’Avino P, Regan J, Corry H, Coxen K, Fajnzylber J, Pepin D, Seaman MS, Barouch DH, Walker BD, Yu XG, Kaimal AJ, Roberts DJ, Alter G. Assessment of Maternal and Neonatal SARS-CoV-2 Viral Load, Transplacental Antibody Transfer, and Placental Pathology in Pregnancies During the COVID-19 Pandemic. JAMA Netw Open 2020; 3:e2030455. [PMID: 33351086 PMCID: PMC7756241 DOI: 10.1001/jamanetworkopen.2020.30455] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Importance Biological data are lacking with respect to risk of vertical transmission and mechanisms of fetoplacental protection in maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objective To quantify SARS-CoV-2 viral load in maternal and neonatal biofluids, transplacental passage of anti-SARS-CoV-2 antibody, and incidence of fetoplacental infection. Design, Setting, and Participants This cohort study was conducted among pregnant women presenting for care at 3 tertiary care centers in Boston, Massachusetts. Women with reverse transcription-polymerase chain reaction (RT-PCR) results positive for SARS-CoV-2 were recruited from April 2 to June 13, 2020, and follow-up occurred through July 10, 2020. Contemporaneous participants without SARS-CoV-2 infection were enrolled as a convenience sample from pregnant women with RT-PCR results negative for SARS-CoV-2. Exposures SARS-CoV-2 infection in pregnancy, defined by nasopharyngeal swab RT-PCR. Main Outcomes and Measures The main outcomes were SARS-CoV-2 viral load in maternal plasma or respiratory fluids and umbilical cord plasma, quantification of anti-SARS-CoV-2 antibodies in maternal and cord plasma, and presence of SARS-CoV-2 RNA in the placenta. Results Among 127 pregnant women enrolled, 64 with RT-PCR results positive for SARS-CoV-2 (mean [SD] age, 31.6 [5.6] years) and 63 with RT-PCR results negative for SARS-CoV-2 (mean [SD] age, 33.9 [5.4] years) provided samples for analysis. Of women with SARS-CoV-2 infection, 23 (36%) were asymptomatic, 22 (34%) had mild disease, 7 (11%) had moderate disease, 10 (16%) had severe disease, and 2 (3%) had critical disease. In viral load analyses among 107 women, there was no detectable viremia in maternal or cord blood and no evidence of vertical transmission. Among 77 neonates tested in whom SARS-CoV-2 antibodies were quantified in cord blood, 1 had detectable immunoglobuilin M to nucleocapsid. Among 88 placentas tested, SARS-CoV-2 RNA was not detected in any. In antibody analyses among 37 women with SARS-CoV-2 infection, anti-receptor binding domain immunoglobin G was detected in 24 women (65%) and anti-nucleocapsid was detected in 26 women (70%). Mother-to-neonate transfer of anti-SARS-CoV-2 antibodies was significantly lower than transfer of anti-influenza hemagglutinin A antibodies (mean [SD] cord-to-maternal ratio: anti-receptor binding domain immunoglobin G, 0.72 [0.57]; anti-nucleocapsid, 0.74 [0.44]; anti-influenza, 1.44 [0.80]; P < .001). Nonoverlapping placental expression of SARS-CoV-2 receptors angiotensin-converting enzyme 2 and transmembrane serine protease 2 was noted. Conclusions and Relevance In this cohort study, there was no evidence of placental infection or definitive vertical transmission of SARS-CoV-2. Transplacental transfer of anti-SARS-CoV-2 antibodies was inefficient. Lack of viremia and reduced coexpression and colocalization of placental angiotensin-converting enzyme 2 and transmembrane serine protease 2 may serve as protective mechanisms against vertical transmission.
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Affiliation(s)
- Andrea G. Edlow
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston
| | - Jonathan Z. Li
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ai-ris Y. Collier
- Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
| | - Kaitlyn E. James
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Adeline A. Boatin
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kathryn J. Gray
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evan A. Bordt
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lydia L. Shook
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lael M. Yonker
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alessio Fasano
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Khady Diouf
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Natalie Croul
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Samantha Devane
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Laura J. Yockey
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rosiane Lima
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jessica Shui
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Juan D. Matute
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Paul H. Lerou
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Babatunde O. Akinwunmi
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aaron Schmidt
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts
| | - Jared Feldman
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
| | - Blake M. Hauser
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
| | - Timothy M. Caradonna
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
| | - Denis De la Flor
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Paolo D’Avino
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
| | - James Regan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heather Corry
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kendyll Coxen
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse Fajnzylber
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Pepin
- Pediatric Surgical Research Laboratories, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michael S. Seaman
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Dan H. Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
| | - Bruce D. Walker
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
| | - Xu G. Yu
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anjali J. Kaimal
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Drucilla J. Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, Massachusetts
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Chatzakis C, Ville Y, Makrydimas G, Dinas K, Zavlanos A, Sotiriadis A. Timing of primary maternal cytomegalovirus infection and rates of vertical transmission and fetal consequences. Am J Obstet Gynecol 2020; 223:870-883.e11. [PMID: 32460972 DOI: 10.1016/j.ajog.2020.05.038] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cytomegalovirus infection is the most frequent congenital infection and a major cause of long-term neurologic morbidity. The aim of this meta-analysis was to calculate the pooled rates of vertical transmission and fetal impairments according to the timing of primary maternal infection. DATA SOURCES From inception to January 2020, MEDLINE, Scopus, Cochrane Library, and gray literature sources were used to search for related studies. STUDY ELIGIBILITY CRITERIA Cohort and observational studies reporting the timing of maternal cytomegalovirus infections and rate of vertical transmission or fetal impairments were included. The primary outcomes were vertical transmission and fetal insult, defined as either prenatal findings from the central nervous system leading to termination of pregnancy or the presence of neurologic symptoms at birth. The secondary outcomes included sensorineural hearing loss or neurodevelopmental delay at follow-up and prenatal central nervous system ultrasonography findings. STUDY APPRAISAL AND SYNTHESIS METHODS The pooled rates of the outcomes of interest with their 95% confidence intervals (CI) were calculated for primary maternal infection at the preconception period, periconception period, first trimester, second trimester, and third trimester. RESULTS A total of 17 studies were included. The pooled rates of vertical transmission (10 studies, 2942 fetuses) at the preconception period, periconception period, first trimester, second trimester, and third trimester were 5.5% (95% CI, 0.1-10.8), 21.0% (95% CI, 8.4-33.6), 36.8% (95% CI, 31.9-41.6), 40.3% (95% CI, 35.5-45.1), and 66.2% (95% CI, 58.2-74.1), respectively. The pooled rates of fetal insult in case of transmission (10 studies, 796 fetuses) were 28.8% (95% CI, 2.4-55.1), 19.3% (95% CI, 12.2-26.4), 0.9% (95% CI, 0-2.4%), and 0.4% (95% CI, 0-1.5), for maternal infection at the periconception period, first trimester, second trimester, and third trimester, respectively. The pooled rates of sensorineural hearing loss for maternal infection at the first, second, and third trimester were 22.8% (95% CI, 15.4-30.2), 0.1% (95% CI, 0-0.8), and 0% (95% CI, 0-0.1), respectively. CONCLUSION Vertical transmission after maternal primary cytomegalovirus infection increases with advancing pregnancy, starting from the preconception period. However, severe fetal impairments are rare after infection in the first trimester of pregnancy.
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Affiliation(s)
- Christos Chatzakis
- Faculty of Medicine, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Greece
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Paris Descartes University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - George Makrydimas
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Dinas
- Faculty of Medicine, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Greece
| | - Apostolos Zavlanos
- Faculty of Medicine, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Greece
| | - Alexandros Sotiriadis
- Faculty of Medicine, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Greece.
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39
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Di Mascio D, Sen C, Saccone G, Galindo A, Grünebaum A, Yoshimatsu J, Stanojevic M, Kurjak A, Chervenak F, Rodríguez Suárez MJ, Gambacorti-Passerini ZM, Baz MDLAA, Aguilar Galán EV, López YC, De León Luis JA, Hernández IC, Herraiz I, Villalain C, Venturella R, Rizzo G, Mappa I, Gerosolima G, Hellmeyer L, Königbauer J, Ameli G, Frusca T, Volpe N, Luca Schera GB, Fieni S, Esposito E, Simonazzi G, Di Donna G, Youssef A, Della Gatta AN, Di Donna MC, Chiantera V, Buono N, Sozzi G, Greco P, Morano D, Bianchi B, Lombana Marino MG, Laraud F, Ramone A, Cagnacci A, Barra F, Gustavino C, Ferrero S, Ghezzi F, Cromi A, Laganà AS, Laurita Longo V, Stollagli F, Sirico A, Lanzone A, Driul L, Cecchini D F, Xodo S, Rodriguez B, Mercado-Olivares F, Elkafrawi D, Sisti G, Esposito R, Coviello A, Cerbone M, Morlando M, Schiattarella A, Colacurci N, De Franciscis P, Cataneo I, Lenzi M, Sandri F, Buscemi R, Gattei G, Sala FD, Valori E, Rovellotti MC, Done E, Faron G, Gucciardo L, Esposito V, Vena F, Giancotti A, Brunelli R, Muzii L, Nappi L, Sorrentino F, Vasciaveo L, Liberati M, Buca D, Leombroni M, Di Sebastiano F, Di Tizio L, Gazzolo D, Franchi M, Ianniciello QC, Garzon S, Petriglia G, Borrello L, Nieto-Calvache AJ, Burgos-Luna JM, Kadji C, Carlin A, Bevilacqua E, Moucho M, Pinto PV, Figueiredo R, Morales Roselló J, Loscalzo G, Martinez-Varea A, Diago V, Jimenez Lopez JS, Aykanat AY, Cosma S, Carosso A, Benedetto C, Bermejo A, May Feuerschuette OH, Uyaniklar O, Ocakouglu SR, Atak Z, Gündüz R, Haberal ET, Froessler B, Parange A, Palm P, Samardjiski I, Taccaliti C, Okuyan E, Daskalakis G, Moreira de Sa RA, Pittaro A, Gonzalez-Duran ML, Guisan AC, Genç ŞÖ, Zlatohlávková B, Piqueras AL, Oliva DE, Cil AP, Api O, Antsaklis P, Ples L, Kyvernitakis I, Maul H, Malan M, Lila A, Granese R, Ercoli A, Zoccali G, Villasco A, Biglia N, Madalina C, Costa E, Daelemans C, Pintiaux A, Cueto E, Hadar E, Dollinger S, Brzezinski Sinai NA, Huertas E, Arango P, Sanchez A, Schvartzman JA, Cojocaru L, Turan S, Turan O, Di Dedda MC, Molpeceres RG, Zdjelar S, Premru-Srsen T, Cerar LK, Druškovič M, De Robertis V, Stefanovic V, Nupponen I, Nelskylä K, Khodjaeva Z, Gorina KA, Sukhikh GT, Maruotti GM, Visentin S, Cosmi E, Ferrari J, Gatti A, Luvero D, Angioli R, Puri L, Palumbo M, D'Urso G, Colaleo F, Chiara Rapisarda AM, Carbone IF, Mollo A, Nazzaro G, Locci M, Guida M, Di Spiezio Sardo A, Panici PB, Berghella V, Flacco ME, Manzoli L, Bifulco G, Scambia G, Zullo F, D'Antonio F. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. J Perinat Med 2020; 48:950-958. [PMID: 32975205 DOI: 10.1515/jpm-2020-0355] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cihat Sen
- Perinatal Medicine Foundation and Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Amos Grünebaum
- Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jun Yoshimatsu
- Department of Perinatology and Gynaecology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Milan Stanojevic
- Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
| | - Asım Kurjak
- Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
| | - Frank Chervenak
- Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | | | - María de Los Angeles Anaya Baz
- Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
- University of Castilla-La Mancha, Ciudad Real, Spain
| | - Esther Vanessa Aguilar Galán
- Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
- University of Castilla-La Mancha, Ciudad Real, Spain
| | - Yolanda Cuñarro López
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Juan Antonio De León Luis
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Cueto Hernández
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Roberta Venturella
- Department of Obstetrics and Gynaecology, School of Medicin, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Rizzo
- University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
- Department of Obstetrics and Gynaecology The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
| | - Giovanni Gerosolima
- Department of Obstetrics and Gynaecology, Ospedale AOSG Moscati, Avellino, Italy
| | - Lars Hellmeyer
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Josefine Königbauer
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Giada Ameli
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Tiziana Frusca
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Nicola Volpe
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | | | - Stefania Fieni
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Eutalia Esposito
- Department of Obstetrics and Gynaecology, Ospedale di San Leonardo, Castellammare di Stabia, Italy
| | - Giuliana Simonazzi
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Gaetana Di Donna
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Aly Youssef
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Anna Nunzia Della Gatta
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | | | - Vito Chiantera
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Natalina Buono
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Giulio Sozzi
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Danila Morano
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Beatrice Bianchi
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Lombana Marino
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Federica Laraud
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Arianna Ramone
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Claudio Gustavino
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Valentina Laurita Longo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
- Queen Margaret University,Institute for Global Health and Development, Edinburgh, UK
| | - Francesca Stollagli
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Sirico
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy
| | | | - Serena Xodo
- Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy
| | - Brian Rodriguez
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Felipe Mercado-Olivares
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Deena Elkafrawi
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Giovanni Sisti
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Rosanna Esposito
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Coviello
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marco Cerbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ilaria Cataneo
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Marinella Lenzi
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Fabrizio Sandri
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Riccardo Buscemi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Giorgia Gattei
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesca Della Sala
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Eleonora Valori
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Hospital Castelli, Verbania, Italy
| | | | - Elisa Done
- UZ Brussel, Universitair Ziekenhuis, Brussel, Belgium
| | - Gilles Faron
- UZ Brussel, Universitair Ziekenhuis, Brussel, Belgium
| | | | | | - Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Nappi
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Felice Sorrentino
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lorenzo Vasciaveo
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Marco Liberati
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Danilo Buca
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Martina Leombroni
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Francesca Di Sebastiano
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Luciano Di Tizio
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, University of Chieti, ChietiItaly
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | | | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Giuliano Petriglia
- Maternal and Child Health Department, Santa Maria Hospital, Terni, Italy
| | - Leonardo Borrello
- Maternal and Child Health Department, Santa Maria Hospital, Terni, Italy
| | - Albaro Josè Nieto-Calvache
- Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
- Postgraduate Department, Universidad Icesi, Cali, Colombia
| | - Juan Manuel Burgos-Luna
- Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
- Postgraduate Department, Universidad Icesi, Cali, Colombia
| | - Caroline Kadji
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Bevilacqua
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marina Moucho
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Pedro Viana Pinto
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Rita Figueiredo
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - José Morales Roselló
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alicia Martinez-Varea
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vincente Diago
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Alicia Yeliz Aykanat
- Department of Obstetrics and Gynaecology, Istanbul University-Cerrahpasa Medical School, Istanbul, Turkey
| | - Stefano Cosma
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Andrea Carosso
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | | | | | | | | | | | - Reyhan Gündüz
- Department of Obstetrics and Gynaecology, University of Dicle, Diyarbakır, Turkey
| | | | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Anupam Parange
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Peter Palm
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Igor Samardjiski
- University Clinic of Obstetrics and Gynaecology, Skopje, North Macedonia
| | - Chiara Taccaliti
- Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Italy
| | - Erhan Okuyan
- Batman Maternity and Child Health Hospital, Batman, Turkey
| | - George Daskalakis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece
| | | | | | | | | | | | - Blanka Zlatohlávková
- Department of Obstetrics and Gynaecology, Division of Neonatology, General Hospital in Prague and First Faculty of Medicine,Charles University, Prague, Czech Republic
| | | | | | | | - Olus Api
- American Hospital, Istanbul, Turkey
| | - Panos Antsaklis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece
| | - Liana Ples
- Department of Obstetrics and Gynaecology, Saint John Hospital, UMF Carol Davila, Bucharest, Romania
| | | | - Holger Maul
- Asklepios Hospital Barmbek, Hamburg, Germany
| | | | - Albert Lila
- Regional Hospital Gjakova, Kosovo, Republic of Kosovo
| | - Roberta Granese
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Giuseppe Zoccali
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Andrea Villasco
- Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Ciuhodaru Madalina
- Universitatea de Medicină și Farmacie Grigore T. Popa Iași, Iasi, Romania
| | - Elena Costa
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | - Caroline Daelemans
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | - Axelle Pintiaux
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | | | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sarah Dollinger
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noa A Brzezinski Sinai
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Pedro Arango
- Instituto Nacional Materno Perinatal, Lima, Peru
| | | | | | - Liviu Cojocaru
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ozhan Turan
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | | | | | | | - Tanja Premru-Srsen
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druškovič
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Vedran Stefanovic
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Irmeli Nupponen
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Nelskylä
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Zulfiya Khodjaeva
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Ksenia A Gorina
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Gennady T Sukhikh
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Silvia Visentin
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Erich Cosmi
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Jacopo Ferrari
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | | | | | | | - Ludovica Puri
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giusella D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Colaleo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | | | | | - Giovanni Nazzaro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Attilio Di Spiezio Sardo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Berghella
- Maternal Fetal Medicine Division, Sidney Kimmel Medical College at Thomas Jefferson University, Obstetrics and Gynaecology Department, Philadelphia, PA, USA
| | | | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco D'Antonio
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
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Schwartz DA, Morotti D. Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2. Viruses 2020; 12:v12111308. [PMID: 33203131 PMCID: PMC7697563 DOI: 10.3390/v12111308] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [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: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023] Open
Abstract
The mechanism(s) by which neonates testing positive for coronavirus disease 2019 (COVID-19) acquire their infection has been largely unknown. Transmission of the etiological agent, SARS-CoV-2, from mother to infant has been suspected but has been difficult to confirm. This communication summarizes the spectrum of pathology findings from pregnant women with COVID-19 based upon the infection status of their infants and addresses the potential interpretation of these results in terms of the effects of SARS-CoV-2 on the placenta and the pathophysiology of maternal-fetal infection. Placentas from pregnant women with COVID-19 and uninfected neonates show significant variability in the spectrum of pathology findings. In contrast, placentas from infected maternal-neonatal dyads are characterized by the finding of mononuclear cell inflammation of the intervillous space, termed chronic histiocytic intervillositis, together with syncytiotrophoblast necrosis. These placentas show prominent positivity of syncytiotrophoblast by SARS-CoV-2, fulfilling the published criteria for transplacental viral transmission as confirmed in fetal cells through identification of viral antigens by immunohistochemistry or viral nucleic acid using RNA in situ hybridization. The co-occurrence of chronic histiocytic intervillositis and trophoblast necrosis appears to be a risk factor for placental infection with SARS-CoV-2 as well as for maternal-fetal viral transmission, and suggests a potential mechanism by which the coronavirus can breach the maternal-fetal interface.
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Affiliation(s)
- David A. Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
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Woodworth KR, Olsen EO, Neelam V, Lewis EL, Galang RR, Oduyebo T, Aveni K, Yazdy MM, Harvey E, Longcore ND, Barton J, Fussman C, Siebman S, Lush M, Patrick PH, Halai UA, Valencia-Prado M, Orkis L, Sowunmi S, Schlosser L, Khuwaja S, Read JS, Hall AJ, Meaney-Delman D, Ellington SR, Gilboa SM, Tong VT. Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy - SET-NET, 16 Jurisdictions, March 29-October 14, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1635-1640. [PMID: 33151917 PMCID: PMC7643898 DOI: 10.15585/mmwr.mm6944e2] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Adhikari EH, Moreno W, Zofkie AC, MacDonald L, McIntire DD, Collins RRJ, Spong CY. Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Netw Open 2020; 3:e2029256. [PMID: 33211113 PMCID: PMC7677755 DOI: 10.1001/jamanetworkopen.2020.29256] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). OBJECTIVES To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. EXPOSURES SARS-CoV-2 infection during pregnancy. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described. RESULTS From March 18 through August 22, 2020, 3374 pregnant women (mean [SD] age, 27.6 [6] years) tested for SARS-CoV-2 were delivered, including 252 who tested positive for SARS-CoV-2 and 3122 who tested negative. The cohort included 2520 Hispanic (75%), 619 Black (18%), and 125 White (4%) women. There were no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2. SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001). There was no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. There were no placental pathologic differences by illness severity. Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed severe or critical illness. Fourteen women (6%) were hospitalized for the indication of COVID-19. CONCLUSIONS AND RELEVANCE In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes. Neonatal infection may be as high as 3% and may occur predominantly among asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women.
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Affiliation(s)
- Emily H. Adhikari
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas
- Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas
| | - Wilmer Moreno
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas
- Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas
| | - Amanda C. Zofkie
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas
- Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas
| | - Lorre MacDonald
- Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas
| | - Donald D. McIntire
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas
| | - Rebecca R. J. Collins
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas
| | - Catherine Y. Spong
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas
- Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas
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Kyle MH, Glassman ME, Khan A, Fernández CR, Hanft E, Emeruwa UN, Scripps T, Walzer L, Liao GV, Saslaw M, Rubenstein D, Hirsch DS, Keown MK, Stephens A, Mollicone I, Bence ML, Gupta A, Sultan S, Sibblies C, Whittier S, Abreu W, Akita F, Penn A, Orange JS, Saiman L, Welch MG, Gyamfi-Bannerman C, Stockwell MS, Dumitriu D. A review of newborn outcomes during the COVID-19 pandemic. Semin Perinatol 2020; 44:151286. [PMID: 32826081 PMCID: PMC7376345 DOI: 10.1016/j.semperi.2020.151286] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
As the COVID-19 pandemic continues to spread worldwide, it is crucial that we determine populations that are at-risk and develop appropriate clinical care policies to protect them. While several respiratory illnesses are known to seriously impact pregnant women and newborns, preliminary data on the novel SARS-CoV-2 Coronavirus suggest that these groups are no more at-risk than the general population. Here, we review the available literature on newborns born to infected mothers and show that newborns of mothers with positive/suspected SARS-CoV-2 infection rarely acquire the disease or show adverse clinical outcomes. With this evidence in mind, it appears that strict postnatal care policies, including separating mothers and newborns, discouraging breastfeeding, and performing early bathing, may be more likely to adversely impact newborns than they are to reduce the low risk of maternal transmission of SARS-CoV-2 or the even lower risk of severe COVID-19 disease in otherwise healthy newborns.
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Affiliation(s)
- Margaret H Kyle
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, NY USA
| | - Melissa E Glassman
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Adrita Khan
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Cristina R Fernández
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Erin Hanft
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Ukachi N Emeruwa
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY USA
| | - Tessa Scripps
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Lauren Walzer
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Grace V Liao
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Minna Saslaw
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - David Rubenstein
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Daniel S Hirsch
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - M Kathleen Keown
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Ashley Stephens
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Isabelle Mollicone
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Mary L Bence
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Archana Gupta
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Sally Sultan
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Caroline Sibblies
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Susan Whittier
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY USA
| | - Wanda Abreu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA
| | - Francis Akita
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Anna Penn
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Jordan S Orange
- NewYork-Presbyterian Hospital, New York, NY USA; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Lisa Saiman
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Martha G Welch
- Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, NY USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY USA; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Cynthia Gyamfi-Bannerman
- NewYork-Presbyterian Hospital, New York, NY USA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY USA
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA; Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY USA
| | - Dani Dumitriu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA; Division of Developmental Neuroscience, Psychiatry Department, Columbia University Irving Medical Center, New York, NY USA; NewYork-Presbyterian Hospital, New York, NY USA; Sackler Institute, Zuckerman Institute, and the Columbia Population Research Center, Columbia University, New York, NY USA.
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Popofsky S, Noor A, Leavens-Maurer J, Quintos-Alagheband ML, Mock A, Vinci A, Magri E, Akerman M, Noyola E, Rigaud M, Pak B, Lighter J, Ratner AJ, Hanna N, Krilov L. Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth. J Pediatr 2020; 226:64-70. [PMID: 32791077 PMCID: PMC7416110 DOI: 10.1016/j.jpeds.2020.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the impact of separation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-positive mother-newborn dyads on breastfeeding outcomes. STUDY DESIGN This observational longitudinal cohort study of mothers with SARS-CoV-2 PCR-and their infants at 3 NYU Langone Health hospitals was conducted between March 25, 2020, and May 30, 2020. Mothers were surveyed by telephone regarding predelivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to coronavirus disease-2019 (COVID-19). RESULTS Of the 160 mother-newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. There was no significant difference in the predelivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads both in the hospital (P < .001) and at home (P = .012). Only 2 mothers in each group reported expressed breast milk as the hospital feeding source (5.6% of unseparated vs 4.1% of separated). COVID-19 was more commonly cited as the reason for change in the separated group (49.0% vs 16.7%; P < .001). When the dyads were further stratified by symptom status into 4 groups-asymptomatic separated, asymptomatic unseparated, symptomatic separated, and symptomatic unseparated-the results remained unchanged. CONCLUSIONS In the setting of COVID-19, separation of mother-newborn dyads impacts breastfeeding outcomes, with lower rates of breastfeeding both during hospitalization and at home following discharge compared with unseparated mothers and infants. No evidence of vertical transmission was observed; 1 case of postnatal transmission occurred from an unmasked symptomatic mother who held her infant at birth.
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Affiliation(s)
- Stephanie Popofsky
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Asif Noor
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY; Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY.
| | | | | | - Ann Mock
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Alexandra Vinci
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Eileen Magri
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Meredith Akerman
- Department of Biostatistics, NYU Long Island School of Medicine, Mineola, NY
| | - Estela Noyola
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Mona Rigaud
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Billy Pak
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Jennifer Lighter
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Grossman School of Medicine, New York, NY
| | - Adam J Ratner
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Grossman School of Medicine, New York, NY; Department of Microbiology, NYU Grossman School of Medicine, New York, NY
| | - Nazeeh Hanna
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY; Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Leonard Krilov
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY; Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
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45
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Zhou J, Wang Y, Zhao J, Gu L, Yang C, Wang J, Zhang H, Tian Y, Tuo H, Li D, Wei M, He B. The metabolic and immunological characteristics of pregnant women with COVID-19 and their neonates. Eur J Clin Microbiol Infect Dis 2020; 40:565-574. [PMID: 33006691 PMCID: PMC7530551 DOI: 10.1007/s10096-020-04033-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/22/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
Our aim was to investigate whether SARS-CoV-2 infection raised high risks of late pregnancy complications, and posed health problems in fetuses and neonates. We analyzed the data of COVID-19 pregnant women with COVID-19 during late pregnancy and their neonates. Eleven out of 16 (69%) pregnant women with COVID-19 had ++ or +++ of ketone body in urine. The blood uric acid of pregnant patients was 334 μmol/L (IQR, 269–452). D-dimer and FDP in pregnant patients were 3.32 mg/L (IQR, 2.18–4.21) and 9.6 mg/L (IQR, 5.9–12.4). Results of blood samples collected at birth showed that 16 neonates had leukocytes (15.7 × 109/L (IQR, 13.7–17.2)), neutrophils (11.1 × 109/L (IQR, 9.2–13.2)), CK (401 U/L (IQR, 382–647)), and LDH (445 U/L (IQR, 417–559)). Twenty-four hours after birth, a neonate from COVID-19 woman had fever and positive of SARS-CoV-2 gene. Another woman had strongly positive for SARS-CoV-2 gene (+++) for 4 weeks, and delivered one neonate who had SARS-CoV-2 IgM (46 AU/mL) and IgG (140 AU/mL) on day 1 after birth. In the third trimester, COVID-19 infection in pregnant patients raised high risks of ketonuria, hypercoagulable state, and hyperfibrinolysis, which may lead to severe complications. COVID-19 increased the inflammatory responses of placenta, and fetuses and neonates had potential organ dysregulation and coagulation disorders. There was a potential intrauterine transmission while pregnant women had high titer of SARS-CoV-2, but it is necessary to detect SARS-CoV-2 in the blood cord, placenta, and amniotic fluid to further confirm intrauterine infection of fetuses.
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Affiliation(s)
- Jingjiao Zhou
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Yudie Wang
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Juan Zhao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Lixing Gu
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Cheng Yang
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Jun Wang
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Heng Zhang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Yu Tian
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Hu Tuo
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Dan Li
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Min Wei
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Bing He
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China.
- Department of Pediatrics, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China.
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46
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Tiam A, Gill MM, Machekano R, Tukei V, Mokone M, Viana S, Letsie M, Tsietso M, Seipati I, Khachane C, Nei M, Mohai F, Tylleskär T, Guay L. 18-24-month HIV-free survival as measurement of the effectiveness of prevention of mother-to-child transmission in the context of lifelong antiretroviral therapy: Results of a community-based survey. PLoS One 2020; 15:e0237409. [PMID: 33002002 PMCID: PMC7529246 DOI: 10.1371/journal.pone.0237409] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Population-based HIV-free survival at 18–24 months of age among HIV-exposed infants in high prevalence settings in the era of treatment for all is largely unknown. We conducted a community-based survey to determine outcomes of HIV-exposed infants at 18–24 months in Lesotho. Methods Between November 2015 and December 2016, we conducted a survey among households with a child born 18–24 months prior to data collection. Catchment areas from 25 health facilities in Butha-Buthe, Maseru, Mohale’s Hoek and Thaba-Tseka districts were randomly selected using probability proportional to size sampling. Consecutive households were visited and eligible consenting caregivers and children were enrolled. Rapid HIV antibody testing was performed on mothers of unknown HIV status (never tested or tested HIV-negative >3 months prior) and their children, and to children born to known HIV-positive mothers. Information on demographics, health-seeking behavior, HIV, and mortality were captured for mothers and children, including those who died. The difference in survival between subgroups was determined using the log-rank test. Results Of the 1,852 mothers/caregivers enrolled, 570 mothers were HIV-positive. The mother-to-child HIV transmission rate was 5.7% [95% CI: 4.0–8.0]. The mortality rate was 2.6% [95% CI: 1.6–4.2] among HIV-exposed children compared to 1.4% (95% CI: 0.9–2.3) among HIV-unexposed children. HIV-free survival was 91.8% [95% CI: 89.2–93.8] among HIV-exposed infants. Disclosure of mother’s HIV status (aOR = 4.9, 95% CI: 1.3–18.2) and initiation of cotrimoxazole prophylaxis in the child (aOR = 3.9, 95% CI: 1.2–12.6) were independently associated with increased HIV-free survival while child growth problems (aOR = 0.2, 95% CI: 0.09–0.5) were independently associated with reduced HIV-free survival. Conclusion Even in the context of lifelong antiretroviral therapy among pregnant and breastfeeding women, HIV has a significant effect on survival among HIV-exposed children compared to unexposed children. Lesotho has not reached elimination of HIV transmission from mother to child.
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Affiliation(s)
- Appolinaire Tiam
- Centre for International Health, University of Bergen, Bergen, Norway
- Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C., United State of America
- * E-mail:
| | - Michelle M. Gill
- Centre for International Health, University of Bergen, Bergen, Norway
- Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C., United State of America
| | - Rhoderick Machekano
- Centre for International Health, University of Bergen, Bergen, Norway
- Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C., United State of America
| | - Vincent Tukei
- Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
- Ministry of Health, Maseru, Lesotho
| | | | - Shannon Viana
- Centre for International Health, University of Bergen, Bergen, Norway
- Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C., United State of America
| | - Mosilinyane Letsie
- Milken Institute School of Public Health, The George Washington University, Washington D.C., United States of America
| | - Mots’oane Tsietso
- Milken Institute School of Public Health, The George Washington University, Washington D.C., United States of America
| | - Irene Seipati
- Milken Institute School of Public Health, The George Washington University, Washington D.C., United States of America
| | - Cecilia Khachane
- Milken Institute School of Public Health, The George Washington University, Washington D.C., United States of America
| | | | | | | | - Laura Guay
- Centre for International Health, University of Bergen, Bergen, Norway
- Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C., United State of America
- Milken Institute School of Public Health, The George Washington University, Washington D.C., United States of America
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47
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Sheth S, Shah N, Bhandari V. Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review. Am J Perinatol 2020; 37:1208-1216. [PMID: 32736407 PMCID: PMC7645816 DOI: 10.1055/s-0040-1714719] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Novel coronavirus disease 2019 (COVID-19) seems to affect adults and pediatric patients differently. While neonates are a special population, little is known about the neonatal outcomes. This study aimed to investigate the outcomes in COVID-19 positive neonates and incidence of vertical transmission of the virus by reviewing available literature. STUDY DESIGN This study is a narrative review of available literature on "COVID-19 in neonates," for which PubMed and Google Scholar were used to search the published articles. RESULTS We summarized the data from 39 published studies that are comprised of 326 COVID-19 positive peripartum mothers with respective neonatal outcomes. Twenty-three neonates have been reported to be COVID-19 positive. Male neonates were affected significantly more (79%) than female neonates. Approximately 3% neonates acquired infection through suspected vertical transmission. Strict infection prevention measures during the perinatal time can significantly reduce the chance of horizontal transmission of the virus. Overall, neonates were asymptomatic or mildly symptomatic regardless of gestational age at birth and required only supportive measures. There was 0% mortality in COVID-19 positive neonates. CONCLUSION From available published data to date, we can conclude that the prognosis of COVID-19 positive neonates is good with no mortality. There appears to be minimal vertical transmission of the infection. KEY POINTS · Majority of COVID-19 positive neonates showed mild clinical signs and symptoms with no mortality.. · Most COVID-19 positive neonates require only supportive measures.. · Possibility of viral vertical transmission is very low..
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Affiliation(s)
- Sudip Sheth
- Division of Neonatology, Department of Pediatrics, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Nidhi Shah
- Department of Pediatrics, Greater Philadelphia Health Action (GPHA), Philadelphia, Pennsylvania
| | - Vineet Bhandari
- Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, Camden, New Jersey
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48
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Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul‐Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. Int J Gynaecol Obstet 2020; 151:7-16. [PMID: 32816307 PMCID: PMC9087651 DOI: 10.1002/ijgo.13329] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [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: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women represent a potentially high-risk population in the COVID-19 pandemic. OBJECTIVE To summarize clinical characteristics and outcomes among pregnant women hospitalized with COVID-19. SEARCH STRATEGY Relevant databases were searched up until May 29, 2020. SELECTION CRITERIA Case series/reports of hospitalized pregnant women with laboratory-confirmed COVID-19. DATA COLLECTION AND ANALYSIS PRISMA guidelines were followed. Methodologic quality was assessed via NIH assessment tools. MAIN RESULTS Overall, 63 observational studies of 637 women (84.6% in third trimester) with laboratory-confirmed SARS-CoV-2 infection were included. Most (76.5%) women experienced mild disease. Maternal fatality, stillbirth, and neonatal fatality rates were 1.6%, 1.4%, and 1.0%, respectively. Older age, obesity, diabetes mellitus, and raised serum D-dimer and interleukin-6 were predictive of poor outcomes. Overall, 33.7% of live births were preterm, of which half were iatrogenic among women with mild COVID-19 and no complications. Most women underwent cesarean despite lacking a clear indication. Eight (2.0%) neonates had positive nasopharyngeal swabs after delivery and developed chest infection within 48 hours. CONCLUSIONS Advanced gestation, maternal age, obesity, diabetes mellitus, and a combination of elevated D-dimer and interleukin-6 levels are predictive of poor pregnancy outcomes in COVID-19. The rate of iatrogenic preterm birth and cesarean delivery is high; vertical transmission may be possible but has not been proved.
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Affiliation(s)
- Ozlem Turan
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
| | - Amir Hakim
- National Heart and Lung InstituteImperial College LondonLondonUK
- Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Pradip Dashraath
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Wong Jing Lin Jeslyn
- Department of Obstetrics and GynecologyYong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Alison Wright
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
| | - Rezan Abdul‐Kadir
- Department of Obstetrics and GynecologyRoyal Free Hospital NHS TrustLondonUK
- EGA Institute for Women’s HealthUniversity College LondonLondonUK
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49
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Lackey KA, Pace RM, Williams JE, Bode L, Donovan SM, Järvinen KM, Seppo AE, Raiten DJ, Meehan CL, McGuire MA, McGuire MK. SARS-CoV-2 and human milk: What is the evidence? Matern Child Nutr 2020; 16:e13032. [PMID: 32472745 PMCID: PMC7300480 DOI: 10.1111/mcn.13032] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022]
Abstract
The novel coronavirus SARS-CoV-2 has emerged as one of the most compelling and concerning public health challenges of our time. To address the myriad issues generated by this pandemic, an interdisciplinary breadth of research, clinical and public health communities has rapidly engaged to collectively find answers and solutions. One area of active inquiry is understanding the mode(s) of SARS-CoV-2 transmission. Although respiratory droplets are a known mechanism of transmission, other mechanisms are likely. Of particular importance to global health is the possibility of vertical transmission from infected mothers to infants through breastfeeding or consumption of human milk. However, there is limited published literature related to vertical transmission of any human coronaviruses (including SARS-CoV-2) via human milk and/or breastfeeding. Results of the literature search reported here (finalized on 17 April 2020) revealed a single study providing some evidence of vertical transmission of human coronavirus 229E; a single study evaluating presence of SARS-CoV in human milk (it was negative); and no published data on MERS-CoV and human milk. We identified 13 studies reporting human milk tested for SARS-CoV-2; one study (a non-peer-reviewed preprint) detected the virus in one milk sample, and another study detected SARS-CoV-2 specific IgG in milk. Importantly, none of the studies on coronaviruses and human milk report validation of their collection and analytical methods for use in human milk. These reports are evaluated here, and their implications related to the possibility of vertical transmission of coronaviruses (in particular, SARS-CoV-2) during breastfeeding are discussed.
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Affiliation(s)
- Kimberly A. Lackey
- Margaret Ritchie School of Family and Consumer SciencesUniversity of IdahoMoscowIdahoUSA
| | - Ryan M. Pace
- Margaret Ritchie School of Family and Consumer SciencesUniversity of IdahoMoscowIdahoUSA
| | - Janet E. Williams
- Department of Animal and Veterinary SciencesUniversity of IdahoMoscowIdahoUSA
| | - Lars Bode
- Department of Pediatrics and Larsson‐Rosenquist Foundation Mother‐Milk‐Infant Center of Research Excellence (MOMI CORE)University of CaliforniaSan DiegoCaliforniaUSA
| | - Sharon M. Donovan
- Department of Food Science and Human Nutrition and Institute of Genomic BiologyUniversity of IllinoisUrbanaIllinoisUSA
| | - Kirsi M. Järvinen
- Department of Pediatrics, Division of Allergy and ImmunologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Antti E. Seppo
- Department of Pediatrics, Division of Allergy and ImmunologyUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Daniel J. Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Courtney L. Meehan
- Department of AnthropologyWashington State UniversityPullmanWashingtonUSA
| | - Mark A. McGuire
- Department of Animal and Veterinary SciencesUniversity of IdahoMoscowIdahoUSA
| | - Michelle K. McGuire
- Margaret Ritchie School of Family and Consumer SciencesUniversity of IdahoMoscowIdahoUSA
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Abstract
Vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and possible induction of pregnancy complications, including miscarriage, fetal malformations, fetal growth restriction and/or stillbirth, are serious concerns for pregnant individuals with COVID-19. According to clinical information, the incidence of vertical transmission of SARS-CoV-2 is limited to date. However, even if a neonate tests negative for SARS-CoV-2, frequent abnormal findings, including fetal and maternal vascular malperfusion, have been reported in cases of COVID-19-positive mothers. Primary receptor of SARS-CoV-2 is estimated as angiotensin-converting enzyme 2 (ACE2). It is highly expressed in maternal-fetal interface cells, such as syncytiotrophoblasts, cytotrophoblasts, endothelial cells, and the vascular smooth muscle cells of primary and secondary villi. However other route of transplacental infection cannot be ruled out. Pathological examinations have demonstrated that syncytiotrophoblasts are often infected with SARS-CoV-2, but fetuses are not always infected. These findings suggest the presence of a placental barrier, even if it is not completely effective. As the frequency and molecular mechanisms of intrauterine vertical transmission of SARS-CoV-2 have not been determined to date, intensive clinical examinations by repeated ultrasound and fetal heart rate monitoring are strongly recommended for pregnant women infected with COVID-19. In addition, careful investigation of placental samples after delivery by both morphological and molecular methods is also strongly recommended.
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Affiliation(s)
- Shihoko Komine-Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan.
| | - Kazuhide Takada
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
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