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Amone A, Wavamunno P, Gabagaya G, Rukundo G, Namale-Matovu J, Malamba SS, Lubega I, Homsy J, King R, Nakabiito C, Nolan M, Fowler MG, Musoke P. HIV genotypic resistance among pregnant women initiating ART in Uganda: a baseline evaluation of participants in the Option B+ clinical trial. Afr Health Sci 2022; 22:428-434. [PMID: 37092059 PMCID: PMC10117495 DOI: 10.4314/ahs.v22i4.48] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Background: Pre-treatment HIV drug resistance is a threat to elimination of mother to child HIV transmission and could lead to virological failure among HIV-positive pregnant women. We analysed genotypic HIV drug resistance (HIVDR) of baseline samples of participants enrolled in the Option B+ clinical trial in Uganda.Methods: HIV-infected pregnant women attending antenatal care were enrolled from Uganda’s National Referral Hospital (Mulago) and Mityana District general hospital and surrounding health centers (HCs). Genotypic HIV testing was performed on blood samples from the first 135 enrolled women out of a subset of 136 participants (25%) who had a baseline VL>1000 copies/mL as one sample failed to amplify.Results: 159/540 (29.4%) had a VL < 1000 copies/ml and 381/540 (70.6%) had a VL >1,000 copies/ml. Of the women with VL>1000 copies/ml, 32 (23.7%) had resistance mutations including 29/135 (21.5%) NNRTI mutations, 6/135 (4.4%) NRTI mutations and 3/135 (2.2%) had both NNRTI and NRTI mutations. The most common NNRTI resistance mutations were: K103KN (5), K103N (5), V179T (4) and E138A (4).Conclusions: One quarter of the HIV-infected pregnant women in this trial at baseline had NNRTI genotypic resistance mutations. Our findings support new WHO guidelines for first-line ART that were changed to dolutegravir-based regimens.
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Affiliation(s)
- Alexander Amone
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Priscilla Wavamunno
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Grace Gabagaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gordon Rukundo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Irene Lubega
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Monica Nolan
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Torres‐Torres J, Espino‐y‐Sosa S, Poon LC, Solis‐Paredes JM, Estrada‐Gutierrez G, Espejel‐Nuñez A, Juarez‐Reyes A, Etchegaray‐Solana A, Alfonso‐Guillen Y, Aguilar‐Andrade L, Hernández‐Pacheco JA, Villafan‐Bernal JR, Martinez‐Portilla RJ. Increased levels of soluble fms-like tyrosine kinase-1 are associated with adverse outcome in pregnant women with COVID-19. Ultrasound Obstet Gynecol 2022; 59:202-208. [PMID: 34664753 PMCID: PMC8661924 DOI: 10.1002/uog.24798] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 06/02/2023]
Abstract
OBJECTIVE In addition to the lungs, the placenta and the endothelium can be affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are markers of endothelial dysfunction and could potentially serve as predictors of severe coronavirus disease 2019 (COVID-19). We aimed to investigate the association of serum concentrations of sFlt-1 and PlGF with the severity of COVID-19 in pregnancy. METHODS This was a prospective cohort study carried out in a tertiary care hospital in Mexico City, Mexico. Symptomatic pregnant women with a positive reverse-transcription quantitative polymerase chain reaction test for SARS-CoV-2 infection who fulfilled the criteria for hospitalization were included. The primary outcome was severe pneumonia due to COVID-19. Secondary outcomes were intensive care unit (ICU) admission, viral sepsis and maternal death. sFlt-1 levels were expressed as multiples of the median (MoM). The association between sFlt-1 and each adverse outcome was explored by logistic regression analysis, adjusted for gestational age for outcomes occurring in more than five patients, and the predictive performance was assessed by receiver-operating-characteristics-curve analysis. RESULTS Among 113 pregnant women with COVID-19, higher sFlt-1 MoM was associated with an increased probability of severe pneumonia (adjusted odds ratio (aOR), 1.817 (95% CI, 1.365-2.418)), ICU admission (aOR, 2.195 (95% CI, 1.582-3.047)), viral sepsis (aOR, 2.318 (95% CI, 1.407-3.820)) and maternal death (unadjusted OR, 5.504 (95% CI, 1.079-28.076)). At a 10% false-positive rate, sFlt-1 MoM had detection rates of 45.2%, 66.7%, 83.3% and 100% for severe COVID-19 pneumonia, ICU admission, viral sepsis and maternal death, respectively. PlGF values were similar between women with severe and those with non-severe COVID-19 pneumonia. CONCLUSION sFlt-1 MoM is higher in pregnant women with severe COVID-19 and has the capability to predict serious adverse pregnancy events, such as severe pneumonia, ICU admission, viral sepsis and maternal death. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. Torres‐Torres
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
| | - S. Espino‐y‐Sosa
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
| | - L. C. Poon
- Chinese University of Hong KongHong Kong SAR
| | | | | | - A. Espejel‐Nuñez
- Immunobiochemistry DepartmentNational Institute of PerinatologyMexico CityMexico
| | - A. Juarez‐Reyes
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - A. Etchegaray‐Solana
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - Y. Alfonso‐Guillen
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - L. Aguilar‐Andrade
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
| | | | | | - R. J. Martinez‐Portilla
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
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Abstract
BACKGROUND The unresolved COVID-19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID-19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow-up, and outcome prediction. AIM This narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID-19 infection, highlighting the diagnostic and prognostic significance. METHODS Literature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID-19 using the following key words: "hematological," "complete blood count," "lymphopenia," "blood indices," "markers" "platelet" OR "thrombocytopenia" AND "COVID-19," "coronavirus2019," "2019-nCoV," OR "SARS-CoV-2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included. RESULTS Hematological changes are not reported in asymptomatic or presymptomatic COVID-19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D-dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome. CONCLUSION Monitoring hematological changes in patients with COVID-19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID-19 as compared to global data.
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Affiliation(s)
| | - Marwa Ali Abdulnabi
- Department of pathology, Al-Kindy College of Medicine University of Baghdad, Baghdad, Iraq
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Velasco I, Soldevila B, Julián T, García‐Riaño N, Puig‐Domingo M. Euglycemic diabetic ketoacidosis and COVID-19: A combination to foresee in pregnancy. J Diabetes 2022; 14:88-89. [PMID: 34729932 PMCID: PMC9060032 DOI: 10.1111/1753-0407.13237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Inés Velasco
- Obstetrics & Gynecology DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
- Germans Trias i Pujol Research InstituteBadalonaSpain
- Medicine DepartmentAutonomous University of BarcelonaBarcelonaSpain
- Endocrinology and Nutrition DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Berta Soldevila
- Germans Trias i Pujol Research InstituteBadalonaSpain
- Medicine DepartmentAutonomous University of BarcelonaBarcelonaSpain
- Endocrinology and Nutrition DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Teresa Julián
- Germans Trias i Pujol Research InstituteBadalonaSpain
- Medicine DepartmentAutonomous University of BarcelonaBarcelonaSpain
- Endocrinology and Nutrition DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Natalia García‐Riaño
- Obstetrics & Gynecology DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
- Germans Trias i Pujol Research InstituteBadalonaSpain
- Medicine DepartmentAutonomous University of BarcelonaBarcelonaSpain
| | - Manel Puig‐Domingo
- Germans Trias i Pujol Research InstituteBadalonaSpain
- Medicine DepartmentAutonomous University of BarcelonaBarcelonaSpain
- Endocrinology and Nutrition DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
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Conti MG, Terreri S, Piano Mortari E, Albano C, Natale F, Boscarino G, Zacco G, Palomba P, Cascioli S, Corrente F, Capponi C, Mirabella M, Salinas AF, Marciano A, De Luca F, Pangallo I, Quaranta C, Alteri C, Russo C, Galoppi P, Brunelli R, Perno CF, Terrin G, Carsetti R. Immune Response of Neonates Born to Mothers Infected With SARS-CoV-2. JAMA Netw Open 2021; 4:e2132563. [PMID: 34730817 PMCID: PMC8567114 DOI: 10.1001/jamanetworkopen.2021.32563] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 12/25/2022] Open
Abstract
IMPORTANCE Although several studies have provided information on short-term clinical outcomes in children with perinatal exposure to SARS-CoV-2, data on the immune response in the first months of life among newborns exposed to the virus in utero are lacking. OBJECTIVE To characterize systemic and mucosal antibody production during the first 2 months of life among infants who were born to mothers infected with SARS-CoV-2. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study enrolled 28 pregnant women who tested positive for SARS-CoV-2 infection and who gave birth at Policlinico Umberto I in Rome, Italy, from November 2020 to May 2021, and their newborns. Maternal and neonatal systemic immune responses were investigated by detecting spike-specific antibodies in serum, and the mucosal immune response was assessed by measuring specific antibodies in maternal breastmilk and infant saliva 48 hours after delivery and 2 months later. EXPOSURES Maternal infection with SARS-CoV-2 in late pregnancy. MAIN OUTCOMES AND MEASURES The systemic immune response was evaluated by the detection of SARS-CoV-2 IgG and IgA antibodies and receptor binding domain-specific IgM antibodies in maternal and neonatal serum. The mucosal immune response was assessed by measuring spike-specific antibodies in breastmilk and in infant saliva, and the presence of antigen-antibody spike IgA immune complexes was investigated in breastmilk samples. All antibodies were detected using an enzyme-linked immunosorbent assay. RESULTS In total, 28 mother-infant dyads (mean [SD] maternal age, 31.8 [6.4] years; mean [SD] gestational age, 38.1 [2.3] weeks; 18 [60%] male infants) were enrolled at delivery, and 21 dyads completed the study at 2 months' follow-up. Because maternal infection was recent in all cases, transplacental transfer of virus spike-specific IgG antibodies occurred in only 1 infant. One case of potential vertical transmission and 1 case of horizontal infection were observed. Virus spike protein-specific salivary IgA antibodies were significantly increased (P = .01) in infants fed breastmilk (0.99 arbitrary units [AU]; IQR, 0.39-1.68 AU) vs infants fed an exclusive formula diet (0.16 AU; IQR, 0.02-0.83 AU). Maternal milk contained IgA spike immune complexes at 48 hours (0.53 AU; IQR, 0.25-0.39 AU) and at 2 months (0.09 AU; IQR, 0.03-0.17 AU) and may have functioned as specific stimuli for the infant mucosal immune response. CONCLUSIONS AND RELEVANCE In this cohort study, SARS-CoV-2 spike-specific IgA antibodies were detected in infant saliva, which may partly explain why newborns are resistant to SARS-CoV-2 infection. Mothers infected in the peripartum period appear to not only passively protect the newborn via breastmilk secretory IgA but also actively stimulate and train the neonatal immune system via breastmilk immune complexes.
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Affiliation(s)
- Maria Giulia Conti
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Sara Terreri
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eva Piano Mortari
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Christian Albano
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Natale
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giulia Zacco
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Patrizia Palomba
- Diagnostic Immunology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Italy
| | - Simona Cascioli
- Research Laboratories, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesco Corrente
- Diagnostic Immunology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Italy
| | - Claudia Capponi
- Diagnostic Immunology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Italy
| | - Mattia Mirabella
- Diagnostic Immunology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Italy
| | - Ane Fernandez Salinas
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Marciano
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Francesca De Luca
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ida Pangallo
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Cecilia Quaranta
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudia Alteri
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Cristina Russo
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Galoppi
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Carlo Federico Perno
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Rita Carsetti
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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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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Lee ACC, Cherkerzian S, Olson IE, Ahmed S, Chowdhury NH, Khanam R, Rahman S, Andrews C, Baqui AH, Fawzi W, Inder TE, Nartey S, Nelson CA, Oken E, Sen S, Fichorova R. Maternal Diet, Infection, and Risk of Cord Blood Inflammation in the Bangladesh Projahnmo Pregnancy Cohort. Nutrients 2021; 13:3792. [PMID: 34836049 PMCID: PMC8623045 DOI: 10.3390/nu13113792] [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] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Inflammation may adversely affect early human brain development. We aimed to assess the role of maternal nutrition and infections on cord blood inflammation. In a pregnancy cohort in Sylhet, Bangladesh, we enrolled 251 consecutive pregnancies resulting in a term livebirth from July 2016-March 2017. Stillbirths, preterm births, and cases of neonatal encephalopathy were excluded. We prospectively collected data on maternal diet (food frequency questionnaire) and morbidity, and analyzed umbilical cord blood for interleukin (IL)-1α, IL-1β, IL-6, IL-8 and C-reactive protein. We determined associations between nutrition and infection exposures and cord cytokine elevation (≥75% vs. <75%) using logistic regression, adjusting for confounders. One-third of mothers were underweight (BMI < 18.5 kg/m2) at enrollment. Antenatal and intrapartum infections were observed among 4.8% and 15.9% of the sample, respectively. Low pregnancy intakes of B vitamins (B1, B2, B3, B6, B9 (folate)), fat-soluble vitamins (D, E), iron, zinc, and linoleic acid (lowest vs. middle tertile) were associated with higher risk of inflammation, particularly IL-8. There was a non-significant trend of increased risk of IL-8 and IL-6 elevation with history of ante-and intrapartum infections, respectively. In Bangladesh, improving micronutrient intake and preventing pregnancy infections are targets to reduce fetal systemic inflammation and associated adverse neurodevelopmental outcomes.
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Affiliation(s)
- Anne CC Lee
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Ingrid E Olson
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Banani, Dhaka 1213, Bangladesh; (S.A.); (N.H.C.); (S.R.)
| | | | - Rasheda Khanam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (R.K.); (A.H.B.)
| | - Sayedur Rahman
- Projahnmo Research Foundation, Banani, Dhaka 1213, Bangladesh; (S.A.); (N.H.C.); (S.R.)
| | - Chloe Andrews
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
| | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (R.K.); (A.H.B.)
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Stephanie Nartey
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA 02115, USA;
| | - Charles A Nelson
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
- Boston Children’s Hospital, Boston, MA 02115, USA
- Harvard Graduate School of Education, Boston, MA 02138, USA
| | - Emily Oken
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA; (S.C.); (I.E.O.); (C.A.); (T.E.I.); (S.S.)
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
| | - Raina Fichorova
- Harvard Medical School, Boston, MA 02115, USA; (C.A.N.); (E.O.); (R.F.)
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA 02115, USA;
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Faverio P, Ornaghi S, Stainer A, Invernizzi F, Borelli M, Brunetti F, La Milia L, Paolini V, Rona R, Foti G, Luppi F, Vergani P, Pesci A. Feasibility of CPAP application and variables related to worsening of respiratory failure in pregnant women with SARS-CoV-2 pneumonia: Experience of a tertiary care centre. PLoS One 2021; 16:e0258754. [PMID: 34665818 PMCID: PMC8525751 DOI: 10.1371/journal.pone.0258754] [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: 06/06/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Continuous positive airway pressure (CPAP) has been successfully applied to patients with COVID-19 to prevent endotracheal intubation. However, experience of CPAP application in pregnant women with acute respiratory failure (ARF) due to SARS-CoV-2 pneumonia is scarce. This study aimed to describe the natural history and outcome of ARF in a cohort of pregnant women with SARS-CoV-2 pneumonia, focusing on the feasibility of helmet CPAP (h-CPAP) application and the variables related to ARF worsening. A retrospective, observational study enrolling 41 consecutive pregnant women hospitalised for SARS-CoV-2 pneumonia in a tertiary care center between March 2020 and March 2021. h-CPAP was applied if arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) was inferior to 200 and/or patients had respiratory distress despite adequate oxygen supplementation. Characteristics of patients requiring h-CPAP vs those in room air or oxygen only were compared. Twenty-seven (66%) patients showed hypoxemic ARF requiring oxygen supplementation and h-CPAP was needed in 10 cases (24%). PaO2/FiO2 was significantly improved during h-CPAP application. The device was well-tolerated in all cases with no adverse events. Higher serum C reactive protein and more extensive (≥3 lobes) involvement at chest X-ray upon admission were observed in the h-CPAP group. Assessment of temporal distribution of cases showed a substantially increased rate of CPAP requirement during the third pandemic wave (January-March 2021). In conclusion, h-CPAP was feasible, safe, well-tolerated and improved oxygenation in pregnant women with moderate-to-severe ARF due to SARS-CoV-2 pneumonia. Moderate-to-severe ARF was more frequently observed during the third pandemic wave.
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Affiliation(s)
- Paola Faverio
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- * E-mail:
| | - Sara Ornaghi
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Anna Stainer
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Francesca Invernizzi
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Mara Borelli
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federica Brunetti
- Department of Obstetrics and Gynaecology, Desio Hospital, ASST Monza, Desio, Italy
| | - Laura La Milia
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Valentina Paolini
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Roberto Rona
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Giuseppe Foti
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Fabrizio Luppi
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Patrizia Vergani
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Alberto Pesci
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
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9
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Sinaci S, Ocal DF, Yucel Yetiskin DF, Uyan Hendem D, Buyuk GN, Goncu Ayhan S, Tanacan A, Ozgu-Erdinc AS, Moraloglu Tekin O, Sahin D. Impact of vitamin D on the course of COVID-19 during pregnancy: A case control study. J Steroid Biochem Mol Biol 2021; 213:105964. [PMID: 34390830 PMCID: PMC8356729 DOI: 10.1016/j.jsbmb.2021.105964] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We aimed to evaluate the vitamin D status of pregnant women with COVID-19, and the association between vitamin D level and severity of COVID-19. METHODS In this case control study, 159 women with a single pregnancy and tested positive for SARS-CoV-2, and randomly selected 332 healthy pregnant women with similar gestational ages were included. COVID-19 patients were classified as mild, moderate, and severe. Vitamin D deficiency was defined as 25-hydroxycholecalciferol <20 ng/mL (50 nmol/L), and 25-OH D vitamin <10 ng/mL was defined as severe vitamin D deficiency, also 25-OH D vitamin level between 20-29 ng/mL (525-725 nmol/L) was defined as vitamin D insufficiency. RESULTS Vitamin D levels of the pregnant women in the COVID-19 group (12.46) were lower than the control group (18.76). 25-OH D vitamin levels of those in the mild COVID-19 category (13.69) were significantly higher than those in the moderate/severe category (9.06). In terms of taking vitamin D supplementation, there was no statistically significant difference between the groups. However, it was observed that all of those who had severe COVID-19 were the patients who did not take vitamin D supplementation. CONCLUSION The vitamin D levels are low in pregnant women with COVID-19. Also, there is a significant difference regarding to vitamin D level and COVID-19 severity in pregnant women. Maintenance of adequate vitamin D level can be useful as an approach for the prevention of an aggressive course of the inflammation induced by this novel coronavirus in pregnant women.
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Affiliation(s)
- Selcan Sinaci
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey.
| | - Doga Fatma Ocal
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | | | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Gul Nihal Buyuk
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey; University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey; University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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10
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Olmos-Ortiz A, Olivares-Huerta A, García-Quiroz J, Avila E, Halhali A, Quesada-Reyna B, Larrea F, Zaga-Clavellina V, Díaz L. Cord Serum Calcitriol Inversely Correlates with Maternal Blood Pressure in Urinary Tract Infection-Affected Pregnancies: Sex-Dependent Immune Implications. Nutrients 2021; 13:nu13093114. [PMID: 34578991 PMCID: PMC8467737 DOI: 10.3390/nu13093114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infections (UTI) during pregnancy are frequently associated with hypertensive disorders, increasing the risk of perinatal morbidity. Calcitriol, vitamin D3’s most active metabolite, has been involved in blood pressure regulation and prevention of UTIs, partially through modulating vasoactive peptides and antimicrobial peptides, like cathelicidin. However, nothing is known regarding the interplay between placental calcitriol, cathelicidin, and maternal blood pressure in UTI-complicated pregnancies. Here, we analyzed the correlation between these parameters in pregnant women with UTI and with normal pregnancy (NP). Umbilical venous serum calcitriol and its precursor calcidiol were significantly elevated in UTI. Regardless of newborn’s sex, we found strong negative correlations between calcitriol and maternal systolic and diastolic blood pressure in the UTI cohort (p < 0.002). In NP, this relationship was observed only in female-carrying mothers. UTI-female placentas showed higher expression of cathelicidin and CYP27B1, the calcitriol activating-enzyme, compared to male and NP samples. Accordingly, cord-serum calcitriol from UTI-female neonates negatively correlated with maternal bacteriuria. Cathelicidin gene expression positively correlated with gestational age in UTI and with newborn anthropometric parameters. Our results suggest that vitamin D deficiency might predispose to maternal cardiovascular risk and perinatal infections especially in male-carrying pregnancies, probably due to lower placental CYP27B1 and cathelicidin expression.
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Affiliation(s)
- Andrea Olmos-Ortiz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
| | - Alberto Olivares-Huerta
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Janice García-Quiroz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Euclides Avila
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Ali Halhali
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Braulio Quesada-Reyna
- División de Obstetricia, UMAE Hospital de Gineco-Obstetricia No. 4 “Luis Castelazo Ayala”, IMSS, Rio de la Magdalena 289, Tizapán San Ángel, Progreso Tizapán, Álvaro Obregón, Ciudad de Mexico 01090, Mexico;
| | - Fernando Larrea
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Verónica Zaga-Clavellina
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
- Correspondence: (V.Z.-C.); (L.D.)
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Correspondence: (V.Z.-C.); (L.D.)
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11
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Donadono V, Saccone G, Sarno L, Esposito G, Mazzarelli LL, Sirico A, Guida M, Martinelli P, Zullo F, Maruotti GM. Association between lymphadenopathy after toxoplasmosis seroconversion in pregnancy and risk of congenital infection. Eur J Clin Microbiol Infect Dis 2021; 41:45-51. [PMID: 34458947 DOI: 10.1007/s10096-021-04337-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022]
Abstract
The aim of the study was to describe the pregnancy outcome of a large cohort of women with toxoplasmosis seroconversion in pregnancy and to investigate the relation between maternal lymphadenopathy and risk of congenital toxoplasmosis (CT). This was a retrospective study involving women with confirmed toxoplasmosis seroconversion in pregnancy between 2001 and 2017. Women were clinically evaluated for lymphadenopathy and classified as follows: lymphadenopathy absent (L-) or lymphadenopathy present (L+). The mothers were treated and followed-up according to local protocol, and neonates were monitored at least for 1 year in order to diagnose CT. A total of 218 women (one twin pregnancy) were included in the analysis. Pregnancy outcome was as follows: 149 (68%) of children not infected, 62 (28.3%) infected, 4 (1.8%) first trimester termination of pregnancy, 2 (0.9%) first trimester miscarriages, and 3 (1.4%) stillbirths (of which one already counted in the infected cohort). 13.8% of women were L+ , and they were nearly three times more likely to have a child with CT compared to L- women (aOR, 2.90; 95%CI, 1.28-6.58). Moreover, the result was still statistically significant when the analysis was restricted to 81 children whose mothers were clinically examined and received treatment within 5 weeks from estimated time of infection. In conclusion, there is a positive association between L+ status in pregnant women, and risk of CT also confirmed when restricting the analysis to women with early diagnosis of seroconversion and treatment. This data could be very useful in counselling pregnant women with toxoplasmosis seroconversion and lead to direct a more specific therapeutic and diagnostic protocol.
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MESH Headings
- Adult
- Antibodies, Protozoan/blood
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/parasitology
- Infectious Disease Transmission, Vertical
- Lymphadenopathy/blood
- Lymphadenopathy/diagnosis
- Lymphadenopathy/parasitology
- Male
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/parasitology
- Pregnancy Outcome
- Prenatal Exposure Delayed Effects/diagnosis
- Prenatal Exposure Delayed Effects/parasitology
- Retrospective Studies
- Seroconversion
- Toxoplasmosis/blood
- Toxoplasmosis/diagnosis
- Toxoplasmosis/parasitology
- Toxoplasmosis/transmission
- Toxoplasmosis, Congenital/diagnosis
- Toxoplasmosis, Congenital/parasitology
- Young Adult
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Affiliation(s)
- Vera Donadono
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Laura Sarno
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Giuseppina Esposito
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Laura L Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Angelo Sirico
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Giuseppe M Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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12
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Smithmyer ME, Mabula-Bwalya CM, Mwape H, Chipili G, Spelke BM, Kasaro MP, De Paris K, Vwalika B, Sebastião YV, Stringer JSA, Price JT. Circulating angiogenic factors and HIV among pregnant women in Zambia: a nested case-control study. BMC Pregnancy Childbirth 2021; 21:534. [PMID: 34320947 PMCID: PMC8317322 DOI: 10.1186/s12884-021-03965-5] [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: 10/15/2020] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal HIV increases the risk of adverse birth outcomes including preterm birth, fetal growth restriction, and stillbirth, but the biological mechanism(s) underlying this increased risk are not well understood. We hypothesized that maternal HIV may lead to adverse birth outcomes through an imbalance in angiogenic factors involved in the vascular endothelial growth factor (VEGF) signaling pathway. METHODS In a case-control study nested within an ongoing cohort in Zambia, our primary outcomes were serum concentrations of VEGF-A, soluble endoglin (sEng), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFLT-1). These were measured in 57 women with HIV (cases) and 57 women without HIV (controls) before 16 gestational weeks. We used the Wilcoxon rank-sum and linear regression controlling for maternal body mass index (BMI) and parity to assess the difference in biomarker concentrations between cases and controls. We also used logistic regression to test for associations between biomarker concentration and adverse pregnancy outcomes (preeclampsia, preterm birth, small for gestational age, stillbirth, and a composite of preterm birth or stillbirth). RESULTS Compared to controls, women with HIV had significantly lower median concentrations of PlGF (7.6 vs 10.2 pg/mL, p = 0.02) and sFLT-1 (1647.9 vs 2055.6 pg/mL, p = 0.04), but these findings were not confirmed in adjusted analysis. PlGF concentration was lower among women who delivered preterm compared to those who delivered at term (6.7 vs 9.6 pg/mL, p = 0.03) and among those who experienced the composite adverse birth outcome (6.2 vs 9.8 pg/mL, p = 0.02). Median sFLT-1 concentration was lower among participants with the composite outcome (1621.0 vs 1945.9 pg/mL, p = 0.04), but the association was not significant in adjusted analysis. sEng was not associated with either adverse birth outcomes or HIV. VEGF-A was undetectable by Luminex in all specimens. CONCLUSIONS We present preliminary findings that HIV is associated with a shift in the VEGF signaling pathway in early pregnancy, although adjusted analyses were inconclusive. We confirm an association between angiogenic biomarkers and adverse birth outcomes in our population. Larger studies are needed to further elucidate the role of HIV on placental angiogenesis and adverse birth outcomes.
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Affiliation(s)
- Megan E Smithmyer
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Humphrey Mwape
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
| | - Gabriel Chipili
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
| | - Bridget M Spelke
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret P Kasaro
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Kristina De Paris
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Yuri V Sebastião
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey S A Stringer
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
| | - Joan T Price
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
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13
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Fenizia C, Saulle I, Di Giminiani M, Vanetti C, Trabattoni D, Parisi F, Biasin M, Savasi V. Unlikely SARS-CoV-2 Transmission During Vaginal Delivery. Reprod Sci 2021; 28:2939-2941. [PMID: 34296422 PMCID: PMC8298043 DOI: 10.1007/s43032-021-00681-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/25/2021] [Indexed: 01/23/2023]
Abstract
Pregnant women display a higher risk of progression to disease and higher viral loads during infections due to their more permissive, tolerogenic immune system. However, only few studies have focused on SARS-CoV-2 intrapartum vertical transmission via vaginal secretions or faeces. The aim of this study was to investigate the presence of the virus in vaginal, rectal and blood specimens from pregnant women characterized by different COVID-19 disease severity. We enrolled 56 SARS-CoV-2-positive pregnant women, of which 46 (82%) were in the third trimester of pregnancy, 6 (10%) in the second and 4 (7%) in the first. QPCR was performed to detect the virus in vaginal and rectal swabs and in plasma samples. SARS-CoV-2 was detected in 27% of rectal swabs of pregnant women in the third trimester, while no virus particles were detected in vaginal swabs of the same patients. Furthermore, only 4% plasma samples tested positive to SARS-CoV-2. No virus was detected in newborn’s nasopharyngeal swabs. Despite the low number of subjects enrolled, our data suggest that, while theoretically possible, intrapartum vaginal or orofecal SARS-CoV-2 transmission seems to be unlikely.
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Affiliation(s)
- Claudio Fenizia
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy.
| | - Irma Saulle
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Maria Di Giminiani
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences L. Sacco, University of Milan, 20157, Milan, Italy
| | - Claudia Vanetti
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
| | - Daria Trabattoni
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
| | - Francesca Parisi
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences L. Sacco, University of Milan, 20157, Milan, Italy
| | - Mara Biasin
- Department of Biomedical and Clinical Sciences, University of Milan, 20157, Milan, Italy
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences L. Sacco, University of Milan, 20157, Milan, Italy
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14
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Saulle I, Garziano M, Fenizia C, Cappelletti G, Parisi F, Clerici M, Cetin I, Savasi V, Biasin M. MiRNA Profiling in Plasma and Placenta of SARS-CoV-2-Infected Pregnant Women. Cells 2021; 10:1788. [PMID: 34359957 PMCID: PMC8305278 DOI: 10.3390/cells10071788] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
MicroRNAs are gene expression regulators associated with several human pathologies, including those generated by viral infections. Their role in SARS-CoV-2 infection and COVID-19 has been investigated and reviewed in many informative studies; however, a thorough miRNA outline in SARS-CoV-2-infected pregnant women (SIPW), at both systemic and placental levels, is missing. To fill this gap, blood and placenta biopsies collected at delivery from 15 asymptomatic SIPW were immediately analysed for: miRNA expression (n = 84) (QPCR array), antiviral/immune mRNA target expression (n = 74) (QGene) and cytokine/chemokines production (n = 27) (Multiplex ELISA). By comparing these results with those obtained from six uninfected pregnant women (UPW), we observed that, following SARS-CoV-2 infection, the transcriptomic profile of pregnant women is significantly altered in different anatomical districts, even in the absence of clinical symptoms and vertical transmission. This characteristic combination of miRNA and antiviral/immune factors seems to control both the infection and the dysfunctional immune reaction, thus representing a positive correlate of protection and a potential therapeutic target against SARS-CoV-2.
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Affiliation(s)
- Irma Saulle
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; (I.S.); (M.G.); (C.F.); (G.C.); (I.C.); (V.S.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Micaela Garziano
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; (I.S.); (M.G.); (C.F.); (G.C.); (I.C.); (V.S.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Claudio Fenizia
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; (I.S.); (M.G.); (C.F.); (G.C.); (I.C.); (V.S.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Gioia Cappelletti
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; (I.S.); (M.G.); (C.F.); (G.C.); (I.C.); (V.S.)
| | - Francesca Parisi
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy; (F.P.)
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Irene Cetin
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; (I.S.); (M.G.); (C.F.); (G.C.); (I.C.); (V.S.)
- Department of Woman, Mother and Neonate Buzzi Children’s Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Valeria Savasi
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; (I.S.); (M.G.); (C.F.); (G.C.); (I.C.); (V.S.)
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy; (F.P.)
| | - Mara Biasin
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; (I.S.); (M.G.); (C.F.); (G.C.); (I.C.); (V.S.)
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15
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Abstract
AIM To discuss available information on the opportunity for pregnant women affected by diabetes/obesity to receive COVID-19 vaccine. DATA SYNTHESIS Pregnant women with SARS-CoV-2 (COVID-19) infection are at high risk for severe acute respiratory syndrome and adverse outcomes. Pregnant women with severe COVID-19 present increased rates of preterm delivery (<37 gestational weeks), cesarean delivery and neonatal admissions to the intensive care unit. Comorbidity such as diabetes (pregestational or gestational) or obesity further increased maternal and fetal complications. It is known that diabetic or obese patients with COVID-19 present an unfavorable course and a worse prognosis, with a direct association between worse outcome and suboptimal glycol-metabolic control or body mass index (BMI) levels. Critical COVID-19 infection prevention is important for both mother and fetus. Vaccination during pregnancy is a common practice. Vaccines against COVID-19 are distributed across the world with some population considered to have a priority. Since pregnant women are excluded from clinical trials very little information are available on safety and efficacy of COVD-19 vaccines during pregnancy. However, it is well known the concept of passive immunization of the newborn obtained with transplacental passage of protective antibodies into the fetal/neonatal circulation after maternal infection or vaccination. Moreover, it has been reported that COVID-19 vaccine-induced IgG pass to the neonates through breastmilk. Therefore, maternal vaccination can protect mother, fetus and baby. CONCLUSIONS After an individual risk/benefit evaluation pregnant and lactating women should be counselled to receive COVID-19 vaccines.
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MESH Headings
- Antibodies, Viral/blood
- Biomarkers/blood
- Blood Glucose/metabolism
- Body Mass Index
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19/virology
- COVID-19 Vaccines/administration & dosage
- COVID-19 Vaccines/adverse effects
- Clinical Decision-Making
- Diabetes, Gestational/blood
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/therapy
- Female
- Glycemic Control
- Humans
- Immunity, Maternally-Acquired
- Lactation
- Maternal-Fetal Exchange
- Milk, Human/immunology
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Complications, Infectious/virology
- Pregnancy in Diabetics/blood
- Pregnancy in Diabetics/diagnosis
- Pregnancy in Diabetics/therapy
- Prenatal Care
- Risk Assessment
- Risk Factors
- SARS-CoV-2/immunology
- SARS-CoV-2/pathogenicity
- Vaccination/adverse effects
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Affiliation(s)
- Maria Angela Sculli
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; UOC Diabetologia e Endocrinologia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Gloria Formoso
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, Ex CeSIMet) G. d'Annunzio University Chieti-Pescara, Italy.
| | - Laura Sciacca
- Interassociative Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Italian Society of Diabetology (SID), Rome, Italy; Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy
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16
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Jacobson DL, Neri D, Gaskins A, Yee L, Mendez AJ, Hendricks K, Siminski S, Zash R, Hyzy L, Jao J. Maternal anemia and preterm birth among women living with HIV in the United States. Am J Clin Nutr 2021; 113:1402-1410. [PMID: 35104854 PMCID: PMC9034117 DOI: 10.1093/ajcn/nqaa441] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Women living with HIV (WLHIV) have a higher prevalence of anemia than women without HIV, possibly related to the effects of HIV and antiretroviral medications. OBJECTIVES To estimate the prevalence of anemia in the third trimester of pregnancy and the effect of anemia on preterm births in WLHIV in the longitudinal, US-based Pediatric HIV/AIDS Cohort Study (PHACS). METHODS During the third trimester, we obtained up to three 24-hour dietary recalls to estimate daily intakes of nutrients and measured serum concentrations of iron, vitamin B6, vitamin B12, zinc, folate, ferritin, total iron-binding capacity (TIBC), and high sensitivity C-reactive protein. Third trimester anemia was defined as hemoglobin < 11 g/d and iron-deficiency anemia (IDA) was defined as low ferritin, high TIBC, and low transferrin saturation. A preterm birth was defined as birth at < 37 completed weeks of gestation, regardless of etiology. We fit separate modified Poisson regression models for each outcome (anemia, preterm birth) and each main exposure, adjusted for confounders, and report adjusted prevalence ratios (aPR) and 95% CIs. RESULTS Of the 267 WLHIV, 50% were anemic in the third trimester, of whom 43.5% (n = 57/131) had IDA. On average, women with anemia were younger, were more likely to be black, started antiretroviral medications in the second trimester, had a low CD4 count (<200 cells/mm3) early in pregnancy, and were less likely to meet recommended intakes for iron, B6, and folate. The prevalence of anemia was greater in WLHIV with a low CD4 count (aPR = 1.65; 95% CI: 1.20-2.27) and high HIV viral load (>10,000 copies/mL; aPR = 1.38; 95% CI: 1.02-1.87). In total, 16% of women delivered preterm. Anemia was associated with a 2-fold (aPR = 2.04; 95% CI: 1.12-3.71) higher prevalence of preterm births. CONCLUSIONS Anemia is common in pregnant WLHIV, highlighting the need to address the underlying factors and clinical outcomes of anemia in this population.
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Affiliation(s)
- Denise L Jacobson
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Daniela Neri
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Audrey Gaskins
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lynn Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Armando J Mendez
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Leonard M Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Kristy Hendricks
- Dartmouth Medical School, Department of Pediatrics, Lebanon, NH, USA
| | - Suzanne Siminski
- Frontier Science Technology Research Foundation INC, Amherst Office, NY, USA
| | - Rebecca Zash
- Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Laurie Hyzy
- Frontier Science Technology Research Foundation INC, Amherst Office, NY, USA
| | - Jennifer Jao
- Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Adult Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Martinez Manfio V, Tasca KI, Garcia JL, de Oliveira Góis J, Correa CR, de Souza LDR. Redox imbalance is related to HIV and pregnancy. PLoS One 2021; 16:e0251619. [PMID: 34019550 PMCID: PMC8139510 DOI: 10.1371/journal.pone.0251619] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/29/2021] [Indexed: 12/05/2022] Open
Abstract
Redox imbalance may compromise the homeostasis of physiological processes indispensable to gestational development in HIV-infected women. The present study aims to evaluate markers of the redox system in the development of pregnancy of these women. HIV-positive pregnant women, HIV-negative pregnant women and non-pregnant were studied. Redox markers superoxide dismutase (SOD), catalase (CAT), protein carbonylation and malondialdehyde (MDA) were assessed at first or second trimester, third trimester and postpartum from pregnant and from non-pregnant women. According to the longitudinal analysis model, CAT activity was increased in the postpartum in HIV-positive women and before delivery in HIV-negative women. Increased carbonylation was observed in the pre-delivery period of HIV-negative pregnant women and MDA concentrations were higher in HIV-positive pregnant women compared to those non-infected by HIV at all times. According to the factorial model, higher SOD and CAT activities were observed in HIV-positive women in the initial months of pregnancy and in non-pregnant women. Carbonylation at third trimester was more evident in HIV-negative pregnant women. MDA levels were higher in HIV-positive pregnant women. Increased oxidative stress may occur in HIV-infected pregnant women. Nevertheless, the HIV virus is not solely responsible for this process; instead, mechanisms inherent to the pregnancy seem to play a role in this imbalance.
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Affiliation(s)
- Vanessa Martinez Manfio
- Department of Tropical Diseases- São Paulo State University–UNESP/Botucatu-Brazil, Botucatu, São Paulo, Brazil
| | - Karen Ingrid Tasca
- Department of Microbiology and Immunology- São Paulo State University–UNESP/Botucatu-Brazil, Botucatu, São Paulo, Brazil
| | - Jessica Leite Garcia
- Department of Medical Clinics- São Paulo State University–UNESP/Botucatu-Brazil, Botucatu, São Paulo, Brazil
| | - Janaina de Oliveira Góis
- Department of Tropical Diseases- São Paulo State University–UNESP/Botucatu-Brazil, Botucatu, São Paulo, Brazil
| | - Camila Renata Correa
- Department of Medical Clinics- São Paulo State University–UNESP/Botucatu-Brazil, Botucatu, São Paulo, Brazil
| | - Lenice do Rosário de Souza
- Department of Tropical Diseases- São Paulo State University–UNESP/Botucatu-Brazil, Botucatu, São Paulo, Brazil
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18
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Mabry-Hernandez I, O'Dowd N. Screening for Hepatitis B Virus Infection in Adolescents and Adults. Am Fam Physician 2021; 103:493-494. [PMID: 33856170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Iris Mabry-Hernandez
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
| | - Nolan O'Dowd
- Johns Hopkins Bloomberg School of Public Health, USA
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19
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Screening for Hepatitis B Virus Infection in Adolescents and Adults: Recommendation Statement. Am Fam Physician 2021; 103:495-501. [PMID: 33856166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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20
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Ottoni MP, Ricciardone JD, Nadimpalli A, Singh S, Katsomya AM, Pokoso LM, Petrucci R. Ebola-negative neonates born to Ebola-infected mothers after monoclonal antibody therapy: a case series. Lancet Child Adolesc Health 2021; 4:884-888. [PMID: 33217357 DOI: 10.1016/s2352-4642(20)30278-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few fetuses survive childbirth when the mother is positive for Ebola virus, with almost all being miscarried or stillborn, or dying shortly after birth. Before 2019, only two infants had been reported surviving past 28 days, of whom one tested positive for Ebola virus and subsequently received experimental therapies. Little is understood regarding the care of surviving neonates born to Ebola virus-positive mothers in the postnatal period and how novel anti-Ebola virus therapies might affect neonatal outcomes. METHODS In this case series, we report on two neonates liveborn during the 2018-20 North Kivu Ebola epidemic in the Democratic Republic of the Congo who, along with their Ebola virus-positive mothers, received investigational monoclonal antibody treatment (mAB114 or REGN-EB3) as part of a randomised controlled trial (NCT03719586). FINDINGS Both infants were born Ebola-negative and progressed well while in the Ebola Treatment Centre. Neither neonate developed evidence of Ebola virus disease during the course of the admission, and both were Ebola-negative at 21 days and remained healthy at discharge. INTERPRETATION To our knowledge these neonates are the first documented as Ebola virus-negative at birth after being born to Ebola virus-positive mothers, and only the third and fourth neonates ever documented to have survived into infancy. Although no conclusions can be drawn from this small case series, and further research is required to investigate the neonatal effects of antibody therapies, these cases warrant review regarding whether post-delivery antibody therapy should be considered for all liveborn neonates of Ebola virus-positive mothers. In the context of a low resource setting, where survival of low-birthweight infants is poor, these cases also highlight the importance of adequate neonatal care. FUNDING None.
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21
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Viñuela MC, De León-Luis JA, Alonso R, Catalán P, Lizarraga S, Muñoz P, Bouza E. SARS-CoV-2 screening of asymptomatic women admitted for delivery must be performed with a combination of microbiological techniques: an observational study. Rev Esp Quimioter 2020; 33:415-421. [PMID: 32945157 PMCID: PMC7712338 DOI: 10.37201/req/088.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to assess the value of systematic screening in asymptomatic women admitted for spontaneous delivery with a combination of reverse transcription polymerase chain reaction (RT-PCR) and cycle threshold (Ct) and serum antibodies. METHODS Since May 6 all women admitted for spontaneous delivery underwent RT-PCR in nasopharyngeal swabs and specific antibodies IgG of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in serum that were performed as part of routine clinical care in our institution. Ct of the PCR was recorded. We analyzed the first 100 women consecutively admitted for spontaneous delivery at our institution. RESULTS Nine women were positive for SARS-CoV-2 in nasopharyngeal samples (9%) and 13 (13%) presented positive specific antibodies of the coronavirus. Overall, SARS-CoV-2 prior exposure was 15%. The Ct determination (RT-PCR test) of our 9 positive patients ranged from 36 to 41 cycles with a median of 40. Vaginal delivery occurred in 94% of the cases and only 6% underwent a cesarean section, always for obstetric reasons. No fetal transmission was observed and maternal and neonatal prognosis was excellent. CONCLUSIONS During epidemic episodes in asymptomatic women in labor, universal testing with RT-PCR (considering Ct determination), and the detection of antibodies, permits a better interpretation of the results and avoid unnecessary isolation procedures.
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Affiliation(s)
- M C Viñuela
- Maria Carmen Viñuela, Department of Obstetrics and Gynecology. University Hospital Gregorio Marañón, School of Medicine, Complutense University of Madrid. O'Donnell Street 48, 28009 Madrid, Spain.
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22
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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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23
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Caparros-Gonzalez RA, Pérez-Morente MA, Hueso-Montoro C, Álvarez-Serrano MA, de la Torre-Luque A. Congenital, Intrapartum and Postnatal Maternal-Fetal-Neonatal SARS-CoV-2 Infections: A Narrative Review. Nutrients 2020; 12:E3570. [PMID: 33233867 PMCID: PMC7700345 DOI: 10.3390/nu12113570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/16/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is inconclusive evidence regarding congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections during the COVID-19 pandemic. A narrative review was conducted with the aim of guiding clinicians on the management of pregnant women with respect to congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections and breastfeeding during the COVID-19 pandemic. METHODS Searches were conducted in Web of Science, PubMed, Scopus, Dialnet, CUIDEN, Scielo, and Virtual Health Library to identify observational, case series, case reports, and randomized controlled trial studies assessing the transmission of SARS-CoV-2 from mother to baby and/or through breastfeeding during the COVID-19 pandemic. RESULTS A total of 49 studies was included in this review, comprising 329 pregnant women and 331 neonates (two pregnant women delivered twins). The studies were performed in China (n = 26), USA (n = 7), Italy (n = 3), Iran (n = 2), Switzerland (n = 1), Spain (n = 1), Turkey (n = 1), Australia (n = 1), India (n = 1), Germany (n = 1), France (n = 1), Canada (n = 1), Honduras (n = 1), Brazil (n = 1), and Peru (n = 1). Samples from amniotic fluid, umbilical cord blood, placenta, cervical secretion, and breastmilk were collected and analyzed. A total of 15 placental swabs gave positive results for SARS-CoV-2 ribonucleic acid (RNA) on the fetal side of the placenta. SARS-CoV-2 RNA was found in seven breastmilk samples. One umbilical cord sample was positive for SARS-CoV-2. One amniotic fluid sample tested positive for SARS-CoV-2. CONCLUSIONS This study presents some evidence to support the potential of congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections during the COVID-19 pandemic. Mothers should follow recommendations including wearing a facemask and hand washing before and after breastfeeding.
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Affiliation(s)
- Rafael A. Caparros-Gonzalez
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18006 Granada, Spain; (R.A.C.-G.); (C.H.-M.)
- Mind, Brain and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada, 18011 Granada, Spain
| | | | - Cesar Hueso-Montoro
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18006 Granada, Spain; (R.A.C.-G.); (C.H.-M.)
- Mind, Brain and Behavior Research Center (CIMCYC), Faculty of Psychology, University of Granada, 18011 Granada, Spain
| | | | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- Center for Biomedical Research in Mental Health (CIBERSAM), 28029 Madrid, Spain
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Kadir RA, Kobayashi T, Iba T, Erez O, Thachil J, Kazi S, Malinowski AK, Othman M. COVID-19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry-Communication from the ISTH SSC for Women's Health. J Thromb Haemost 2020; 18:3086-3098. [PMID: 32846051 PMCID: PMC7461532 DOI: 10.1111/jth.15072] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 04/22/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Novel coronavirus (SARS-CoV-2), which causes COVID-19, has thus far affected more than 15 million individuals, resulting in more than 600 000 deaths worldwide, and the number continues to rise. In a large systematic review and meta-analysis of the literature including 2567 pregnant women, 7% required intensive care admission, with a maternal mortality ~1% and perinatal mortality below 1%. There has been a rapid increase in publications on COVID-19-associated coagulopathy, including disseminated intravascular coagulopathy and venous thromboembolism, in the non-pregnant population, but very few reports of COVID-19 coagulopathy during pregnancy; leaving us with no guidance for care of this specific population. METHODS This is a collaborative effort conducted by a group of experts that was reviewed, critiqued, and approved by the International Society on Thrombosis and Haemostasis Subcommittee for Women's Health Issues in Thrombosis and Hemostasis. A structured literature search was conducted, and the quality of current and emerging evidence was evaluated. Based on the published studies in the non-pregnant and pregnant population with a moderate to high risk of bias as assessed by Newcastle-Ottawa scale and acknowledging the absence of data from randomized clinical trials for management of pregnant women infected with SARS-CoV-2, a consensus in support of a guidance document for COVID-19 coagulopathy in pregnancy was identified. RESULTS AND CONCLUSIONS Specific hemostatic issues during pregnancy were highlighted, and preliminary recommendations to assist in the care of COVID-19-affected pregnant women with coagulopathy or thrombotic complications were developed. An international registry to gather data to support the management of COVID-19 and associated coagulopathy in pregnancy was established.
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Affiliation(s)
- Rezan Abdul Kadir
- Katharine Dormandy Haemophilia and Thrombosis Centre and Department of Obstetrics and Gynaecology, The Royal Free NHS Foundation Hospital, London, UK
- University College, London, UK
| | - Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Shizuoka, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | | | - Ann Kinga Malinowski
- Division of Maternal Fetal Medicine Mount Sinai Hospital, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Maha Othman
- Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
- School of Baccalaureate Nursing, St Lawrence College, Kingston, ON, Canada
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25
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Vakili S, Savardashtaki A, Jamalnia S, Tabrizi R, Nematollahi MH, Jafarinia M, Akbari H. Laboratory Findings of COVID-19 Infection are Conflicting in Different Age Groups and Pregnant Women: A Literature Review. Arch Med Res 2020; 51:603-607. [PMID: 32571605 PMCID: PMC7287430 DOI: 10.1016/j.arcmed.2020.06.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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: 05/23/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
Coronavirus disease 2019 (COVID-19), a new type and rapidly spread viral pneumonia, is now producing an outbreak of pandemic proportions. The clinical features and laboratory results of different age groups are different due to the general susceptibility of the disease. The laboratory findings of COVID-19 in pregnant women are also conflicting. Para-clinical investigations including laboratory tests and radiologic findings play an important role in early diagnosis and treatment monitoring of COVID-19. The majority of previous reports on the COVID-19 laboratory results were based on data from the general population and limited information is available based on age difference and pregnancy status. This review aimed to describe the COVID-19 laboratory findings in neonates, children, adults, elderly and pregnant women altogether for the first time. The most attracting and reliable markers of COVID-19 in patients were: normal C-reactive protein (CRP) and very different and conflicting laboratory results regardless of clinical symptoms in neonates, normal or temporary elevated CRP, conflicting WBC count results and procalcitonin elevation in children, lymphopenia and elevated lactate dehydrogenase (LDH) in adult patients, lymphopenia and elevated CRP and LDH in the elderly people, leukocytosis and elevated neutrophil ratio in pregnant women.
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Affiliation(s)
- Sina Vakili
- Biochemistry Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Savardashtaki
- Biotechnology Department, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sheida Jamalnia
- Medical Journalism Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Nematollahi
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran; Department of Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Morteza Jafarinia
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Akbari
- Department of Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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26
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Lumley SF, Eyre DW, McNaughton AL, Howarth A, Hoosdally S, Hatch SB, Kavanagh J, Chau KK, Downs LO, Cox S, Dunn L, Justice A, Wareing S, Dingle K, Rudkin J, Auckland K, Fyfe A, Bolton J, Paton R, Mentzer AJ, Jeffery K, Andersson MI, James T, Peto TEA, Marsden BD, Screaton G, Cornall RJ, Klenerman P, Ebner D, Stuart DI, Crook DW, Stoesser N, Kennedy SH, Thompson C, Gupta S, Matthews PC. SARS-CoV-2 antibody prevalence, titres and neutralising activity in an antenatal cohort, United Kingdom, 14 April to 15 June 2020. Euro Surveill 2020; 25:2001721. [PMID: 33094717 PMCID: PMC7651878 DOI: 10.2807/1560-7917.es.2020.25.41.2001721] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022] Open
Abstract
SARS-CoV-2 IgG screening of 1,000 antenatal serum samples in the Oxford area, United Kingdom, between 14 April and 15 June 2020, yielded a 5.3% seroprevalence, mirroring contemporaneous regional data. Among the 53 positive samples, 39 showed in vitro neutralisation activity, correlating with IgG titre (Pearson's correlation p<0.0001). While SARS-CoV-2 seroprevalence in pregnancy cohorts could potentially inform population surveillance, clinical correlates of infection and immunity in pregnancy, and antenatal epidemiology evolution over time need further study.
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Affiliation(s)
- Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
| | - David W Eyre
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Anna L McNaughton
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- These authors contributed equally to this work
| | - Alison Howarth
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sarah Hoosdally
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stephanie B Hatch
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - James Kavanagh
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kevin K Chau
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Louise O Downs
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stuart Cox
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Laura Dunn
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Anita Justice
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Susan Wareing
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kate Dingle
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Justine Rudkin
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Kathryn Auckland
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander Fyfe
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Jai Bolton
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Robert Paton
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Alexander J Mentzer
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katie Jeffery
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Monique I Andersson
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Tim E A Peto
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Brian D Marsden
- Structural Genomics Consortium, Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Headington, Oxford, United Kingdom
- The Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building, Roosevelt Dr, Headington, Oxford, United Kingdom
- Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Old Road Campus, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Gavin Screaton
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Richard J Cornall
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Roosevelt Drive, Headington, Oxford, United Kingdom
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Daniel Ebner
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - David I Stuart
- Structural Genomics Consortium, Nuffield Department of Medicine, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Headington, Oxford, United Kingdom
- The Division of Structural Biology, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building, Roosevelt Dr, Headington, Oxford, United Kingdom
- Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Big Data Institute, Old Road Campus, Oxford, United Kingdom
| | - Derrick W Crook
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nicole Stoesser
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Craig Thompson
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Sunetra Gupta
- Department of Zoology, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, United Kingdom
- Department of Microbiology/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- These authors contributed equally to this work
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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27
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Bierhoff M, Rijken MJ, Yotyingaphiram W, Pimanpanarak M, van Vugt M, Angkurawaranon C, Nosten F, Ehrhardt S, Thio CL, McGready R. Tenofovir for prevention of mother to child transmission of hepatitis B in migrant women in a resource-limited setting on the Thailand-Myanmar border: a commentary on challenges of implementation. Int J Equity Health 2020; 19:156. [PMID: 32912268 PMCID: PMC7488314 DOI: 10.1186/s12939-020-01268-3] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this manuscript is to highlight challenges in the implementation of maternal tenofovir disoproxil fumarate (tenofovir) for prevention of mother to child transmission (PMTCT) of hepatitis B virus (HBV) in resource limited setting. Current preventive strategies in resource-limited settings fail mainly due to prohibitive costs of hepatitis B immunoglobulin (HBIG) and a high proportion of homebirths, meaning both HBIG and hepatitis B birth dose vaccine are not given. A new strategy for PMTCT without the necessity of HBIG, could be daily tenofovir commenced early in gestation. Implementation challenges to early tenofovir for PMTCT can provide insight to elimination strategies of HBV as the burden of disease is high in resource-limited settings. METHODS Challenges encountered during implementation of a study of tenofovir for PMTCT before 20 weeks gestation in rural and resource-limited areas on the Thailand-Myanmar border were identified informally from trial study logbooks and formally from comments from patients and staff at monthly visits. ClinicalTrials.gov Identifier: NCT02995005. MAIN BODY During implementation 171 pregnant women were hepatitis B surface antigen (HBsAg) positive by point of-care test over 19 months (May-2018 until Dec-2019). In this resource-limited setting where historically no clinic has provided tenofovir for PMTCT of HBV, information provided by staff resulted in a high uptake of study screening (95.5% (84/88) when offered to pregnant women. False positive point-of-care rapid tests hinder a test and treat policy for HBV and development of improved rapid tests that include HBeAg and/or HBV DNA would increase efficiency. Integrated care of HBV to antenatal care, transport assistance and local agreements to facilitate access, could increase healthcare at this critical stage of the life course. As safe storage of medication in households in resource-limited setting may not be ideal, interactive counseling about this must be a routine part of care. CONCLUSION Despite challenges, results from the study to date suggest tenofovir can be offered to HBV-infected women in resource-limited settings before 20 weeks gestation with a high uptake of screening, high drug accountability and follow-up, with provision of transportation support. This commentary has highlighted practical implementation issues with suggestions for strategies that support the objective of PMTCT and the World Health Organization goal of HBV elimination by 2030.
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Affiliation(s)
- M Bierhoff
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand.
- Division of Infectious Diseases, Academic UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - M J Rijken
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Julius Global Health, The Julius Centre for Health Sciences, University Medical Centre Utrecht, Utrecht, Netherlands
| | - W Yotyingaphiram
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand
| | - M Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand
| | - M van Vugt
- Division of Infectious Diseases, Academic UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - F Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - S Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C L Thio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, 63110, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
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28
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Ronnje L, Länsberg JK, Vikhareva O, Hansson SR, Herbst A, Zaigham M. Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery. BMC Pregnancy Childbirth 2020; 20:511. [PMID: 32887569 PMCID: PMC7472409 DOI: 10.1186/s12884-020-03172-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/12/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It has been proposed that pregnant women and their fetuses may be particularly at risk for poor outcomes due to the coronavirus (COVID-19) pandemic. From the few case series that are available in the literature, women with high risk pregnancies have been associated with higher morbidity. It has been suggested that pregnancy induced immune responses and cardio-vascular changes can exaggerate the course of the COVID-19 infection. CASE PRESENTATION A 26-year old Somalian woman (G2P1) presented with a nine-day history of shortness of breath, dry cough, myalgia, nausea, abdominal pain and fever. A nasopharyngeal swab returned positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Her condition rapidly worsened leading to severe liver and coagulation impairment. An emergency Caesarean section was performed at gestational week 32 + 6 after which the patient made a rapid recovery. Severe COVID-19 promptly improved by the termination of the pregnancy or atypical HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelet Count) exacerbated by concomitant COVID-19 infection could not be ruled out. There was no evidence of vertical transmission. CONCLUSIONS This case adds to the growing body of evidence which raises concerns about the possible negative maternal outcomes of COVID-19 infection during pregnancy and advocates for pregnant women to be recognized as a vulnerable group during the current pandemic.
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MESH Headings
- Adult
- Antithrombin III/metabolism
- Apgar Score
- Betacoronavirus
- Blood Coagulation Disorders/blood
- Blood Coagulation Disorders/etiology
- COVID-19
- Cesarean Section
- Coronavirus Infections/blood
- Coronavirus Infections/complications
- Coronavirus Infections/diagnostic imaging
- Coronavirus Infections/physiopathology
- Diagnosis, Differential
- Female
- Fibrin Fibrinogen Degradation Products/metabolism
- HELLP Syndrome/diagnosis
- Humans
- Infant, Newborn
- Infant, Premature
- L-Lactate Dehydrogenase/blood
- Liver Diseases/blood
- Liver Diseases/etiology
- Lung/diagnostic imaging
- Male
- Obesity, Maternal
- Pandemics
- Partial Thromboplastin Time
- Platelet Count
- Pneumonia, Viral/blood
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/physiopathology
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/physiopathology
- SARS-CoV-2
- Sweden
- Tomography, X-Ray Computed
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Affiliation(s)
- Louise Ronnje
- Department of Obstetrics & Gynaecology, Skåne University Hospital, Malmö/Lund, Sweden
| | - John-Kalle Länsberg
- Department of Clinical Sciences Lund, Paediatrics/Neonatology, Lund University, Skåne University Hospital, Malmö/Lund, Sweden
| | - Olga Vikhareva
- Department of Obstetrics & Gynaecology, Institute of Clinical Sciences Lund, Lund University and Skåne University Hospital, 205 01, Malmö/Lund, Sweden
| | - Stefan R Hansson
- Department of Obstetrics & Gynaecology, Institute of Clinical Sciences Lund, Lund University and Skåne University Hospital, 205 01, Malmö/Lund, Sweden
| | - Andreas Herbst
- Department of Obstetrics & Gynaecology, Institute of Clinical Sciences Lund, Lund University and Skåne University Hospital, 205 01, Malmö/Lund, Sweden
| | - Mehreen Zaigham
- Department of Obstetrics & Gynaecology, Institute of Clinical Sciences Lund, Lund University and Skåne University Hospital, 205 01, Malmö/Lund, Sweden.
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29
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Anjorin AAA, Nwammadu JE. Seroepidemiology of seasonal influenza virus among unvaccinated pregnant women in Lagos, Nigeria. Infez Med 2020; 28:407-415. [PMID: 32920577] [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] [Indexed: 06/11/2023]
Abstract
Nigeria is the most populous African nation in the world having a population of over 200 million with little or no data on maternal influenza and its co-morbidities. In most developing countries, there is paucity of data for prioritization of strategies for the prevention and control of influenza with possible co-morbidities common in pregnancy. We therefore investigated recent infection of seasonal influenza virus with co-infection of malaria parasitaemia and typhoid fever in pregnant women in Lagos State, Nigeria. A descriptive hospital-based cross-sectional study was designed according to the Consortium for the Standardization of Influenza Seroepidemiology (CONSISE) guideline in 6 public health institutions between July 2016 and October 2018. Enzyme Immunoassay (Demeditec, Germany) was used to detect IgM specific antibodies to influenza A (H1N1) and (H3N2). P-values were determined with Chi-square using GraphPad Prism, USA. Demographic characteristics of the patients showed median age of 29 (mean 29.3; mode, 28; and range, 18-45) years. Out of 182 pregnant women screened, 103 (56.6%) were IgM seropositive for influenza A. Patients with underlying diseases accounted for 72%, approximately three-times higher compared to 28% without underlying disease. Co-infection was detected with malaria parasitaemia (54%), typhoid fever (50.5%), and malaria and typhoid fever (33%). The most commonly reported symptoms were fever, cold, dizziness, swollen legs, and cough. Age group 21-30 years was the most affected while patients from densely populated area had the highest seroprevalence. This study revealed that seasonal influenza circulates with co-morbidities in pregnant women in Lagos. This may exacerbate their immunosuppressed state and lead to complication in pregnancy. Apt treatment of influenza-like illness should be considered in such women. Furthermore, there is need for enhanced surveillance including monitoring of the potential transmissibility of influenza to the foetus and newborns. We therefore recommend sturdy advocacy on preventing exposure to influenza virus, its optimal early diagnosis, vaccination and disease management in pregnancy.
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Affiliation(s)
| | - Juliet Ebere Nwammadu
- Department of Microbiology (Virology Research), Lagos State University, Ojo, Lagos, Nigeria
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30
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Abstract
This review evaluates whether pregnancy is a risk factor for COVID-19 by looking at the expression of immune markers such as immune cells and cytokines in order to have a better understanding on the pathophysiology of the disease, thus reducing maternal deaths. Pregnant women are more at risk of contracting COVID-19 due to their weakened immune system. Studies demonstrate that COVID-19 is an immune condition which is marked by reduced lymphocytes and elevated selected proinflammatory cytokines. Similar immune expression has been demonstrated in pregnancy by several studies. In addition, the placenta has been shown to possess ACE2 receptors on the villous cytotrophoblast and the syncytiotrophoblast and findings suggest that the coronavirus enters the host cells via these ACE2 receptors. The immune response in pregnancy increases the risk of contracting COVID-19. Both normal pregnancy and COVID-19 are marked by decreased lymphocytes, NKG2A inhibitory receptors, and increased ACE2, IL-8, IL-10, and IP-10 it therefore safer to conclude that pregnancy is a risk factor for COVID-19 development. Furthermore, the presence of the ACE2 receptors in the placenta may increase the risk of mother to baby transmission of the virus. Therefore, more studies investigating the link between pregnancy and COVID-19 are needed.
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Affiliation(s)
- Wendy N Phoswa
- Department of Life and Consumer Sciences, University of South Africa (UNISA), Science Campus, Private Bag X6, Florida, Roodepoort, 1710, South Africa.
| | - Olive P Khaliq
- Department of Obstetrics and Gynaecology and Women's Health and HIV Research Group, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
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31
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Kinsey KE, Ganz E, Khalil S, Brustman L. Intraoperative coagulopathy during cesarean section as an unsuspected initial presentation of COVID-19: a case report. BMC Pregnancy Childbirth 2020; 20:481. [PMID: 32838744 PMCID: PMC7444175 DOI: 10.1186/s12884-020-03140-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/11/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values. CASE The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets. CONCLUSION There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.
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MESH Headings
- Adult
- Antifibrinolytic Agents/therapeutic use
- Betacoronavirus
- Blood Coagulation Disorders/blood
- Blood Coagulation Disorders/drug therapy
- Blood Coagulation Disorders/metabolism
- Blood Loss, Surgical
- Breech Presentation/surgery
- C-Reactive Protein/metabolism
- COVID-19
- Cautery
- Cesarean Section
- Coronavirus Infections/blood
- Coronavirus Infections/diagnosis
- Coronavirus Infections/metabolism
- Female
- Fibrin Fibrinogen Degradation Products/metabolism
- Fibrinogen/metabolism
- Hemostasis, Surgical
- Humans
- International Normalized Ratio
- Methylergonovine/therapeutic use
- Oligohydramnios
- Oxytocics/therapeutic use
- Oxytocin/therapeutic use
- Pandemics
- Platelet Count
- Pneumonia, Viral/blood
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/metabolism
- Pregnancy
- Pregnancy Complications, Hematologic/blood
- Pregnancy Complications, Hematologic/drug therapy
- Pregnancy Complications, Hematologic/metabolism
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/metabolism
- Prothrombin Time
- SARS-CoV-2
- Tranexamic Acid/therapeutic use
- Uterine Inertia/drug therapy
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Affiliation(s)
- Kelly Elizabeth Kinsey
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, NY, New York, USA.
| | - Eric Ganz
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, 1000 10th Avenue, NY, New York, USA
| | - Susan Khalil
- Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Icahn School of Medicine, New York, USA
| | - Lois Brustman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, New York, USA
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Tindall AM, Schall JI, Seme B, Ratshaa B, Tolle M, Nnyepi MS, Mazhani L, Rutstein RM, Steenhoff AP, Stallings VA. Vitamin D status, nutrition and growth in HIV-infected mothers and HIV-exposed infants and children in Botswana. PLoS One 2020; 15:e0236510. [PMID: 32790765 PMCID: PMC7425960 DOI: 10.1371/journal.pone.0236510] [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: 02/26/2020] [Accepted: 07/07/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Poor vitamin D status is a global health problem and common in patients with human immunodeficiency virus (HIV) in high-income countries. There is less evidence on prevalence of vitamin D deficiency and nutrition and growth in HIV-infected and -exposed children in low- and middle-income countries. OBJECTIVES To determine the vitamin D status in Batswana HIV-infected mothers and their children, differences among HIV-infected mothers and between HIV-exposed and -infected infants and children, and associations between vitamin D and disease-related outcomes, nutrition, and growth. METHODS This was a cross-sectional study of HIV+ mothers and HIV-exposed infants and unrelated children (1-7.9 years). Serum 25-hydroxyvitamin D (25(OH)D) was measured, among other nutritional indicators, for mothers, infants and children. Vitamin D status for HIV-infected mothers and children, and an immune panel was assessed. History of HIV anti-retroviral medications and breastfeeding were obtained. Data were collected prior to universal combination antiretroviral therapy in pregnancy. RESULTS Mothers (n = 36) had a mean serum 25(OH)D of 37.2±12.4ng/mL; 11% had insufficient (<20ng/mL), 17% moderately low (20.0-29.9ng/mL) and 72% sufficient (≥30ng/mL) concentrations. No infants (n = 36) or children (n = 48) were vitamin D insufficient; 22% of HIV- and no HIV+ infants had moderately low concentrations and 78% of HIV- and 100% of HIV+ infants had sufficient status, 8% of HIV- and no HIV+ children had moderately low concentrations and 92% of HIV- and 100% HIV+ children had sufficient concentrations. HIV+ children had significantly lower length/height Z scores compared to HIV- children. Length/height Z score was positively correlated with serum 25(OH)D in all children (r = 0.33, p = 0.023), with a stronger correlation in the HIV+ children (r = 0.47 p = 0.021). In mothers, serum 25(OH)D was positively associated with CD4% (r = 0.40, p = 0.016). CONCLUSIONS Results showed a low prevalence of vitamin D insufficiency in Botswana. Growth was positively correlated with vitamin D status in HIV-exposed children, and HIV+ children had poorer linear growth than HIV- children.
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Affiliation(s)
- Alyssa M. Tindall
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Joan I. Schall
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | | | - Michael Tolle
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Maria S. Nnyepi
- Department of Nutrition, University of Botswana, Gaborone, Botswana
| | - Loeto Mazhani
- Department of Pediatrics and Adolescent Health, School of Medicine, University of Botswana, Gaborone, Botswana
| | - Richard M. Rutstein
- General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andrew P. Steenhoff
- Botswana-UPenn Partnership, Gaborone, Botswana
- Department of Pediatrics and Adolescent Health, School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
- Divisions of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Virginia A. Stallings
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
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Ahmed I, Eltaweel N, Antoun L, Rehal A. Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection. BMJ Case Rep 2020; 13:e237521. [PMID: 32784239 PMCID: PMC7418688 DOI: 10.1136/bcr-2020-237521] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.
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Affiliation(s)
- Irshad Ahmed
- Obstetrics and Gynaecology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nashwa Eltaweel
- Obstetrics and Gynaecology, Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
| | - Lina Antoun
- Obstetrics and Gynaecology, Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
| | - Anoop Rehal
- Obstetrics and Gynaecology, Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
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Llau JV, Ferrandis R, Sierra P, Hidalgo F, Cassinello C, Gómez-Luque A, Quintana M, Amezaga R, Gero M, Serrano A, Marcos P. SEDAR-SEMICYUC consensus recommendations on the management of haemostasis disorders in severely ill patients with COVID-19 infection. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:391-399. [PMID: 32591185 PMCID: PMC7245242 DOI: 10.1016/j.redar.2020.05.007] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 01/08/2023]
Abstract
The infection by the coronavirus SARS-CoV-2, which causes the disease called COVID-19, mainly causes alterations in the respiratory system. In severely ill patients, the disease often evolves into an acute respiratory distress syndrome that can predispose patients to a state of hypercoagulability, with thrombosis at both venous and arterial levels. This predisposition presents a multifactorial physiopathology, related to hypoxia as well as to the severe inflammatory process linked to this pathology, including the additional thrombotic factors present in many of the patients. In view of the need to optimise the management of hypercoagulability, the working groups of the Scientific Societies of Anaesthesiology-Resuscitation and Pain Therapy (SEDAR) and of Intensive, Critical Care Medicine and Coronary Units (SEMICYUC) have developed a consensus to establish guidelines for actions to be taken against alterations in haemostasis observed in severely ill patients with COVID-19. These recommendations include prophylaxis of venous thromboembolic disease in these patients, and in the peripartum, management of patients on long-term antiplatelet or anticoagulant treatment, bleeding complications in the course of the disease, and the interpretation of general alterations in haemostasis.
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Affiliation(s)
- J V Llau
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitari Doctor Peset, SEDAR, Valencia, España.
| | - R Ferrandis
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, SEDAR, Valencia, España
| | - P Sierra
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Fundació Puigvert, SEDAR , Barcelona, España
| | - F Hidalgo
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Clínica Universidad de Navarra, SEDAR, Pamplona, Navarra, España
| | - C Cassinello
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Miguel Servet, SEDAR, Zaragoza, España
| | - A Gómez-Luque
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen de la Victoria, SEDAR, Málaga, España
| | - M Quintana
- Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, SEMICYUC, Madrid, España
| | - R Amezaga
- Servicio de Medicina Intensiva, Hospital Universitario Son Espases, SEMICYUC, Palma de Mallorca, Baleares, España
| | - M Gero
- Servicio de Medicina Intensiva, Hospital Universitario, SEMICYUC, Burgos, España
| | - A Serrano
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, SEMICYUC, Valencia, España
| | - P Marcos
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, SEMICYUC, Badalona, Barcelona, España
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35
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Flannery DD, Gouma S, Dhudasia MB, Mukhopadhyay S, Pfeifer MR, Woodford EC, Gerber JS, Arevalo CP, Bolton MJ, Weirick ME, Goodwin EC, Anderson EM, Greenplate AR, Kim J, Han N, Pattekar A, Dougherty J, Kuthuru O, Mathew D, Baxter AE, Vella LA, Weaver J, Verma A, Leite R, Morris JS, Rader DJ, Elovitz MA, Wherry EJ, Puopolo KM, Hensley SE. SARS-CoV-2 seroprevalence among parturient women in Philadelphia. Sci Immunol 2020; 5:eabd5709. [PMID: 32727884 PMCID: PMC7594018 DOI: 10.1126/sciimmunol.abd5709] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [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: 06/29/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
Abstract
Limited data are available for pregnant women affected by SARS-CoV-2. Serological tests are critically important for determining SARS-CoV-2 exposures within both individuals and populations. We validated a SARS-CoV-2 spike receptor binding domain serological test using 834 pre-pandemic samples and 31 samples from COVID-19 recovered donors. We then completed SARS-CoV-2 serological testing of 1,293 parturient women at two centers in Philadelphia from April 4 to June 3, 2020. We found 80/1,293 (6.2%) of parturient women possessed IgG and/or IgM SARS-CoV-2-specific antibodies. We found race/ethnicity differences in seroprevalence rates, with higher rates in Black/non-Hispanic and Hispanic/Latino women. Of the 72 seropositive women who also received nasopharyngeal polymerase chain reaction testing during pregnancy, 46 (64%) were positive. Continued serologic surveillance among pregnant women may inform perinatal clinical practices and can potentially be used to estimate exposure to SARS-CoV-2 within the community.
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MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Betacoronavirus/immunology
- Betacoronavirus/isolation & purification
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques/methods
- Clinical Laboratory Techniques/statistics & numerical data
- Cohort Studies
- Coronavirus Infections/blood
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/immunology
- Coronavirus Infections/virology
- Female
- Health Status Disparities
- Hispanic or Latino/statistics & numerical data
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Immunoglobulin M/blood
- Immunoglobulin M/immunology
- Pandemics
- Philadelphia/epidemiology
- Pneumonia, Viral/blood
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/immunology
- Pneumonia, Viral/virology
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/virology
- Protein Domains/immunology
- SARS-CoV-2
- Seroepidemiologic Studies
- Spike Glycoprotein, Coronavirus/immunology
- Young Adult
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Affiliation(s)
- Dustin D Flannery
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sigrid Gouma
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Miren B Dhudasia
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sagori Mukhopadhyay
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Madeline R Pfeifer
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Emily C Woodford
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jeffrey S Gerber
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Claudia P Arevalo
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Marcus J Bolton
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Madison E Weirick
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Eileen C Goodwin
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Elizabeth M Anderson
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Allison R Greenplate
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Justin Kim
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Nicholas Han
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Ajinkya Pattekar
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jeanette Dougherty
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Oliva Kuthuru
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Divij Mathew
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Amy E Baxter
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Laura A Vella
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - JoEllen Weaver
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Anurag Verma
- Departments of Genetics and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rita Leite
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jeffrey S Morris
- Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Rader
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Departments of Genetics and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michal A Elovitz
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - E John Wherry
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
| | - Karen M Puopolo
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Scott E Hensley
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Abstract
Pregnancy comprises a unique immunological condition, to allow fetal development and to protect the host from pathogenic infections. Viral infections during pregnancy can disrupt immunological tolerance and may generate deleterious effects on the fetus. Despite these possible links between pregnancy and infection-induced morbidity, it is unclear how pregnancy interferes with maternal response to some viral pathogens. In this context, the novel coronavirus (SARS-CoV-2) can induce the coronavirus diseases-2019 (COVID-19) in pregnant women. The potential risk of vertical transmission is unclear, babies born from COVID-19-positive mothers seems to have no serious clinical symptoms, the possible mechanisms are discussed, which highlights that checking the children's outcome and more research is warranted. In this review, we investigate the reports concerning viral infections and COVID-19 during pregnancy, to establish a correlation and possible implications of COVID-19 during pregnancy and neonatal's health.
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MESH Headings
- Betacoronavirus
- COVID-19
- Child, Preschool
- Coronavirus Infections/blood
- Coronavirus Infections/immunology
- Coronavirus Infections/transmission
- Coronavirus Infections/virology
- Cytokines/blood
- Female
- Fetal Development/immunology
- Humans
- Infant
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Mothers
- Pandemics
- Pneumonia, Viral/blood
- Pneumonia, Viral/immunology
- Pneumonia, Viral/transmission
- Pneumonia, Viral/virology
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/virology
- SARS-CoV-2
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Affiliation(s)
- Ricardo Wesley Alberca
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Nátalli Zanete Pereira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Luanda Mara Da Silva Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | - Maria Notomi Sato
- Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Vlachodimitropoulou Koumoutsea E, Vivanti AJ, Shehata N, Benachi A, Le Gouez A, Desconclois C, Whittle W, Snelgrove J, Malinowski AK. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost 2020; 18:1648-1652. [PMID: 32302459 PMCID: PMC9770955 DOI: 10.1111/jth.14856] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [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: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/17/2023]
Abstract
We present a putative link between maternal COVID-19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS-CoV-2 has already resulted in high numbers of critically ill patients and deaths in the non-pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID-19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D-dimers, prothrombin time, and platelet count in all patients presenting with COVID-19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS-CoV-2-positive pregnant women are vital, as their derangement may signal a more severe COVID-19 infection, and may warrant pre-emptive admission and consideration of delivery to achieve maternal stabilization.
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MESH Headings
- Adult
- Betacoronavirus/pathogenicity
- Blood Coagulation
- Blood Coagulation Tests
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques
- Coronavirus Infections/blood
- Coronavirus Infections/diagnosis
- Coronavirus Infections/virology
- Disseminated Intravascular Coagulation/blood
- Disseminated Intravascular Coagulation/diagnosis
- Disseminated Intravascular Coagulation/therapy
- Disseminated Intravascular Coagulation/virology
- Female
- Host-Pathogen Interactions
- Humans
- Pandemics
- Pneumonia, Viral/blood
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/virology
- Pregnancy
- Pregnancy Complications, Hematologic/blood
- Pregnancy Complications, Hematologic/diagnosis
- Pregnancy Complications, Hematologic/therapy
- Pregnancy Complications, Hematologic/virology
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/therapy
- Pregnancy Complications, Infectious/virology
- Pregnancy Trimester, Third/blood
- SARS-CoV-2
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Evangelia Vlachodimitropoulou Koumoutsea
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- Division of Hematology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Nadine Shehata
- Division of Hematology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Agnes Le Gouez
- Anaesthesia and Critical Care Department, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Celine Desconclois
- Biological Hematology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Saclay, Clamart, France
| | - Wendy Whittle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - John Snelgrove
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ann Kinga Malinowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND This study investigated whether higher maternal choline levels mitigate effects of marijuana on fetal brain development. Choline transported into the amniotic fluid from the mother activates α7-nicotinic acetylcholine receptors on fetal cerebro-cortical inhibitory neurons, whose development is impeded by cannabis blockade of their cannabinoid-1(CB1) receptors. METHODS Marijuana use was assessed during pregnancy from women who later brought their newborns for study. Mothers were informed about choline and other nutrients, but not specifically for marijuana use. Maternal serum choline was measured at 16 weeks gestation. RESULTS Marijuana use for the first 10 weeks gestation or more by 15% of mothers decreased newborns' inhibition of evoked potentials to repeated sounds (d' = 0.55, p < 0.05). This effect was ameliorated if women had higher gestational choline (rs = -0.50, p = 0.011). At 3 months of age, children whose mothers continued marijuana use through their 10th gestational week or more had poorer self-regulation (d' = -0.79, p < 0.05). This effect was also ameliorated if mothers had higher gestational choline (rs = 0.54, p = 0.013). Maternal choline levels correlated with the children's improved duration of attention, cuddliness, and bonding with parents. CONCLUSIONS Prenatal marijuana use adversely affects fetal brain development and subsequent behavioral self-regulation, a precursor to later, more serious problems in childhood. Stopping marijuana use before 10 weeks gestational age prevented these effects. Many mothers refuse to cease use because of familiarity with marijuana and belief in its safety. Higher maternal choline mitigates some of marijuana's adverse effects on the fetus.
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Affiliation(s)
- M. Camille Hoffman
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
- Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
| | - Sharon K. Hunter
- Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
| | - Kathleen Noonan
- Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
| | - Anna Wyrwa
- Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
| | - Robert Freedman
- Department of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA
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Ma Z, Li S, He D, Wang Y, Jiang H, Zhou H, Jin J, Lin N. Rapid quantification of tenofovir in umbilical cord plasma and amniotic fluid in hepatitis B mono-infected pregnant women during labor by ultra-performance liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom 2020; 34:e8728. [PMID: 31960519 DOI: 10.1002/rcm.8728] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
RATIONALE Tenofovir (TFV) is a first-line antiviral agent against hepatitis B virus (HBV) and is recommended for the prevention of mother-to-infant transmission of HBV. To study the distribution of TFV in umbilical cord plasma and amniotic fluid of HBV-infected pregnant women, a rapid and sensitive method for TFV determination was developed and validated. METHODS The quantification method was developed using liquid chromatography coupled to tandem mass spectrometry (LC/MS/MS). The analytes were separated on an Acquity UPLC HSS T3 column under gradient elution with methanol and 0.01% ammonia solution in 10 mM ammonium acetate/water. This is the first reported method for the determination of TFV using alkaline rather than acidic mobile phases. Linearity, accuracy, precision, limit of quantification, specificity and stability were assessed. RESULTS Detection of TFV was achieved within 4 min. The calibration curves for TFV quantification showed excellent linearity in the range of 1-500 ng/mL. The intra- and interbatch precision and accuracy ranged from -4.35% to 6.92%. This method was successfully applied to determination of samples from 50 HBV mono-infected women undergoing tenofovir disoproxil fumarate therapy. The mean concentrations of TFV in the umbilical cord and amniotic fluid samples were 29.2 (4.6-86) and 470.9 (156-902) ng/mL, respectively, which showed a moderate positive correlation (r = 0.5299, P<0.001). CONCLUSIONS A simple, rapid but sensitive bioanalytical method to determine TFV concentration in both umbilical cord plasma and amniotic fluid using LC/MS/MS was developed and applied to HBV-infected women during labor who were undergoing TDF therapy, which will help us understand the efficacy and safety of tenofovir during pregnancy.
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Affiliation(s)
- Zhiyuan Ma
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Siying Li
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Daqiang He
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Yuqing Wang
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Huidi Jiang
- Laboratory of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Zhejiang, Hangzhou, P.R. China
| | - Hui Zhou
- Laboratory of Pharmaceutical Analysis and Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Zhejiang, Hangzhou, P.R. China
| | - Jie Jin
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Nengming Lin
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
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Abstract
This case report describes birth of an infant with elevated anti–SARS-CoV-2 IgM antibodies and cytokine levels to a mother with polymerase chain reaction–confirmed coronavirus disease 2019 (COVID-19) despite no physical contact.
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Affiliation(s)
- Lan Dong
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jinhua Tian
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Songming He
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chuchao Zhu
- Department of Obstetrics and Gynecology, General Hospital of Central Command Theater in PLA, Wuhan, Hubei, China
| | - Jian Wang
- Department of Radiology, First Affiliated Hospital to Army Medical University, Chongqing, China
| | - Chen Liu
- Department of Radiology, First Affiliated Hospital to Army Medical University, Chongqing, China
| | - Jing Yang
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Stone EF, Shaz BH. Zika virus and its implications on cord blood banking and transplantation. Transfusion 2020; 60:889-891. [PMID: 32208533 DOI: 10.1111/trf.15771] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
Umbilical cord blood is an important cellular therapy product used for hematopoietic stem cell transplantation, but the US Food and Drug Administration guidance regarding donor screening to reduce the risk of Zika transmission has decreased the number of licensed, eligible cord blood units available for transplantation. There is a crucial need for updated travel risk assessment for Zika virus transmission, validated screening tests for Zika virus in umbilical cord blood, and further research on Zika virus transmissibility due to umbilical cord blood products to ensure that umbilical cord blood and related tissues are safe and available for transplantation.
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Affiliation(s)
| | - Beth H Shaz
- New York Blood Center, New York, New York, USA
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Iqbal SN, Overcash R, Mokhtari N, Saeed H, Gold S, Auguste T, Mirza MU, Ruiz ME, Chahine JJ, Waga M, Wortmann G. An Uncomplicated Delivery in a Patient with Covid-19 in the United States. N Engl J Med 2020; 382:e34. [PMID: 32237670 PMCID: PMC7153431 DOI: 10.1056/nejmc2007605] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sara N Iqbal
- MedStar Washington Hospital Center, Washington, DC
| | | | | | | | - Stacey Gold
- MedStar Washington Hospital Center, Washington, DC
| | | | | | | | | | - Masashi Waga
- MedStar Washington Hospital Center, Washington, DC
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Putri ND, Dhenni R, Handryastuti S, Johar E, Ma’roef CN, Fadhilah A, Perma Iskandar AT, Prayitno A, Karyanti MR, Satari HI, Jumiyanti N, Aprilia YY, Sriyani IY, Dewi YP, Yudhaputri FA, Safari D, Hadinegoro SR, Rosenberg R, Powers AM, Aye Myint KS. Absence of Evidence of Zika Virus Infection in Cord Blood and Urine from Newborns with Congenital Abnormalities, Indonesia. Am J Trop Med Hyg 2020; 102:876-879. [PMID: 32043460 PMCID: PMC7124925 DOI: 10.4269/ajtmh.19-0593] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/20/2019] [Indexed: 11/07/2022] Open
Abstract
Zika virus (ZIKV) has recently been confirmed as endemic in Indonesia, but no congenital anomalies (CA) related to ZIKV infection have been reported. We performed molecular and serological testing for ZIKV and other flaviviruses on cord serum and urine samples collected in October 2016 to April 2017 during a prospective, cross-sectional study of neonates in Jakarta, Indonesia. Of a total of 429 neonates, 53 had CA, including 14 with microcephaly. These 53, and 113 neonate controls without evidence of CA, were tested by ZIKV-specific real-time reverse transcription polymerase chain reaction (RT-PCR), pan-flavivirus RT-PCR, anti-ZIKV and anti-DENV IgM ELISA, and plaque reduction neutralization test. There was no evidence of ZIKV infection among neonates in either the CA or non-CA cohorts, except in three cases with low titers of anti-ZIKV neutralizing antibodies. Further routine evaluation throughout Indonesia of pregnant women and their newborns for exposure to ZIKV should be a high priority for determining risk.
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Affiliation(s)
- Nina Dwi Putri
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rama Dhenni
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Setyo Handryastuti
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Edison Johar
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Chairin Nisa Ma’roef
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Araniy Fadhilah
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Adhi Teguh Perma Iskandar
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ari Prayitno
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mulya Rahma Karyanti
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hindra Irawan Satari
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Niphidiah Jumiyanti
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yuni Yudha Aprilia
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ida Yus Sriyani
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Yora Permata Dewi
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | - Dodi Safari
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Sri Rezeki Hadinegoro
- Department of Paediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ronald Rosenberg
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Ann M. Powers
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Khin Saw Aye Myint
- Emerging Virus Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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Zahir H, Arsalane L, Elghouat G, Mouhib H, Elkamouni Y, Zouhair S. Seroprevalence of rubella in pregnant women in Southern Morocco. Pan Afr Med J 2020; 35:10. [PMID: 32373261 PMCID: PMC7195913 DOI: 10.11604/pamj.supp.2020.35.1.18496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/06/2020] [Indexed: 11/27/2022] Open
Abstract
Rubella is a generally benign but dangerous viral infection in early pregnancy, due to the teratogenic potential of the virus. Indeed, it causes spontaneous abortions, in-utero fetal death, premature labor and congenital malformations known as congenital rubella syndrome. The purpose of this study is to determine the immune status of rubella in pregnant women in southern Morocco. A prospective, multicentre study was conducted in 2017 for the detection of rubella IgG and IgM antibodies in 380 pregnant women aged 17 to 46 years, using the Architect i1000 chemiluminescent microparticle immunoassay. Eigthy for percent (84.7%) of women were seropositive. Ten percent of multiparous women remained seronegative despite recommendations for vaccination after delivery. Preventive measures against congenital rubella need to be strengthened, and vaccination is needed in non-immunized women. Vaccination awareness campaigns, especially among non-immunized multiparous women, remain essential.
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Affiliation(s)
- Hanane Zahir
- Laboratoire de Microbiologie-Virologie et Biologie Moléculaire, Hôpital Militaire Avicenne, Centre Hospitalier Universitaire Mohammed VI de Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, avenue Ibn Sina, BP 2360 Marrakech-principal, Maroc
| | - Lamiae Arsalane
- Laboratoire de Microbiologie-Virologie et Biologie Moléculaire, Hôpital Militaire Avicenne, Centre Hospitalier Universitaire Mohammed VI de Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, avenue Ibn Sina, BP 2360 Marrakech-principal, Maroc
| | - Ghita Elghouat
- Laboratoire de Microbiologie-Virologie et Biologie Moléculaire, Hôpital Militaire Avicenne, Centre Hospitalier Universitaire Mohammed VI de Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, avenue Ibn Sina, BP 2360 Marrakech-principal, Maroc
| | - Hanane Mouhib
- Laboratoire de Microbiologie-Virologie et Biologie Moléculaire, Hôpital Militaire Avicenne, Centre Hospitalier Universitaire Mohammed VI de Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, avenue Ibn Sina, BP 2360 Marrakech-principal, Maroc
| | - Youssef Elkamouni
- Laboratoire de Microbiologie-Virologie et Biologie Moléculaire, Hôpital Militaire Avicenne, Centre Hospitalier Universitaire Mohammed VI de Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, avenue Ibn Sina, BP 2360 Marrakech-principal, Maroc
| | - Said Zouhair
- Laboratoire de Microbiologie-Virologie et Biologie Moléculaire, Hôpital Militaire Avicenne, Centre Hospitalier Universitaire Mohammed VI de Marrakech, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, avenue Ibn Sina, BP 2360 Marrakech-principal, Maroc
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Yang S, Reid G, Challis JR, Gloor GB, Asztalos E, Money D, Seney S, Bocking AD. Effect of Oral Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on the Vaginal Microbiota, Cytokines and Chemokines in Pregnant Women. Nutrients 2020; 12:nu12020368. [PMID: 32019222 PMCID: PMC7071157 DOI: 10.3390/nu12020368] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/19/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Spontaneous preterm birth is associated with vaginal microbial dysbiosis. As certain strains of lactobacilli help restore homeostasis in non-pregnant women, the goal was to determine the effect of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 administered orally, twice daily for 12 weeks on the vaginal microbiota, cytokines and chemokines of low-risk pregnant women. A double-blind, placebo-controlled, randomized trial comparing probiotic lactobacilli to placebo daily was performed in 86 asymptomatic pregnant women who had an Intermediate or Bacterial Vaginosis Nugent score at 13 weeks. After drop outs, 32 women receiving probiotics and 34 receiving placebo completed the study. The Nugent score returned to normal in 30% of the women in both groups at 28 weeks and was maintained until 35 weeks. The majority of subjects had normal pregnancy outcomes. Ninety-three bacterial species were detected at 13 weeks, with Lactobacillus iners, Lactobacillus crispatus, Gardnerella vaginalis and Atopobium vaginae being the most abundant across pregnancy. There was no difference in the Shannon diversity index between the probiotic and placebo groups at 13, 28 or 35 weeks. Almost all subjects consumed fermented foods and many of the organisms in the vagina are also known to be present in fermented foods. Interleukin-4 in the placebo group and Interleukin-10 in both probiotic and placebo groups increased slightly at 28 weeks but were not different at 35 weeks when compared to 13 weeks. In conclusion, this study showed no adverse issues resulting from 12 week use of probiotic Lactobacillus strains GR-1 and RC-14 during pregnancy in women at low risk for premature birth. The vaginal microbiota demonstrated flux irrespective of this oral probiotic administration.
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Affiliation(s)
- Siwen Yang
- Departments of Physiology and Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada; (S.Y.); (J.R.G.C.); (A.D.B.)
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5G 1X5, Canada
| | - Gregor Reid
- Departments of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 5C1, Canada
- Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A 4V2, Canada; (G.B.G.); (S.S.)
- Correspondence: ; Tel.: +1-519-854-3022
| | - John R.G. Challis
- Departments of Physiology and Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada; (S.Y.); (J.R.G.C.); (A.D.B.)
- Western Australian Health Translation Network, Perth, WA 6009, Australia
| | - Gregory B. Gloor
- Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A 4V2, Canada; (G.B.G.); (S.S.)
- Department of Biochemistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - Elizabeth Asztalos
- Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M5A 1B2, Canada;
| | - Deborah Money
- Department of Obstetrics and Gynecology, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada;
| | - Shannon Seney
- Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A 4V2, Canada; (G.B.G.); (S.S.)
| | - Alan D. Bocking
- Departments of Physiology and Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada; (S.Y.); (J.R.G.C.); (A.D.B.)
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5G 1X5, Canada
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Barlinn R, Trogstad L, Rollag H, Frøen F, Magnus P, Dudman SG. Parvovirus B19 DNAemia in pregnant women in relation to perinatal death: A nested case-control study within a large population-based pregnancy cohort. Acta Obstet Gynecol Scand 2020; 99:856-864. [PMID: 31925774 DOI: 10.1111/aogs.13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/24/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Parvovirus B19 (B19V) is the infectious cause of exanthema infectiosum. In Europe around 40% of pregnant women are susceptible to infection. Having small children at home is the main risk factor for contracting an infection during pregnancy. The association between B19V-infection and perinatal death is not yet settled. The aims of the study were to estimate the association between maternal parvovirus B19 infection in pregnancy and perinatal death, and to assess the significance of a positive B19V PCR in pregnancy. MATERIAL AND METHODS The study population consists of women included in the Norwegian Mother and Child Cohort Study, a prospective population-based pregnancy cohort of nearly 100 000 women. Blood samples were obtained during weeks 17-18 in pregnancy (M1), at birth, and in umbilical cord blood. Within participants in the pregnancy cohort, 138 cases of perinatal death and 1350 controls with live-born children were included in a nested case-control study. Samples were analyzed with B19V serology and B19V PCR according to a predefined test algorithm. For cases, medical records and laboratory results from hospitals were combined with the results of B19V serology and PCR. The reported causes of perinatal death were categorized using the classification system: Causes Of Death and Associated Conditions (CODAC). RESULTS The B19V seroconversion rates were 9.8% for cases and 6.8% for control mothers. The odds ratio for maternal B19V infection in cases compared with controls was 1.28 (95% CI 0.35-4.70), adjusted for age, parity, body mass index and tobacco use. B19V-PCR-positive samples were detected at weeks 17-18 of gestation in both cases and controls. The proportion of positive samples was similar in cases and controls, 24% and 28.2%, respectively. Mothers with PCR-positive M1 samples transmitted B19V vertically in 9.1% of cases and in 11.9% of the controls. Of all perinatal deaths, 53% were attributed to placental pathology or unknown causes. CONCLUSIONS B19V PCR positivity was high and similar in both cases and controls. In our study B19V DNAemia was not seen to be associated with fatal outcome of pregnancy. The clinical significance of B19V DNA detection during pregnancy is uncertain. Caution is needed when diagnosing a B19V infection based only on B19V DNAemia.
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Affiliation(s)
- Regine Barlinn
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Lill Trogstad
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Halvor Rollag
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Fredrik Frøen
- Division for Health Care Services, Norwegian Institute of Public Health, Oslo, Norway
- University of Bergen, Bergen, Norway
| | - Per Magnus
- University of Oslo, Oslo, Norway
- Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Susanne G Dudman
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
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de Beer S, Kalk E, Kroon M, Boulle A, Osler M, Euvrard J, Timmerman V, Davies M. A longitudinal analysis of the completeness of maternal HIV testing, including repeat testing in Cape Town, South Africa. J Int AIDS Soc 2020; 23:e25441. [PMID: 31997583 PMCID: PMC6989397 DOI: 10.1002/jia2.25441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/05/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The virtual elimination of mother-to-child transmission of HIV cannot be achieved without complete maternal HIV testing. The World Health Organization recommends that women in high HIV prevalent settings repeat HIV testing in the third trimester, and at delivery or directly thereafter. The Western Cape Province (South Africa) prevention of mother-to-child transmission (PMTCT) guidelines recommend a repeat maternal HIV test between 32 and 34 weeks gestation and at delivery in addition to testing at the first antenatal visit (ideally <20 weeks gestation). There are few published longitudinal studies on the uptake of initial and repeated maternal HIV testing programmes in sub-Saharan Africa. We aimed to investigate the implementation of initial and repeat maternal HIV testing guidelines in Cape Town, South Africa. METHODS Between 2013 and 2016 we established an electronic PMTCT register that consolidated routine data from a primary healthcare facility and its secondary and tertiary referral sites in Cape Town. This provided a longitudinal record for each participant, from first antenatal visit to delivery. Utilizing these data, we conducted a retrospective analysis investigating the completeness of maternal HIV testing according to the PMTCT HIV testing guidelines in Cape Town, and predictors of complete testing, from 2014 to 2016. RESULTS Among 8558 enrolled pregnant women, 7213 (84%) were not known to be HIV positive at their first visit and thus eligible for HIV testing; 91% of them received ≥1 HIV test during pregnancy/delivery. Testing at the first visit was 98% among the 85% of women who attended antenatal care. Among women eligible to receive all three recommended HIV tests, only 11% achieved all three tests. Delivery HIV testing completion among all women without an HIV-positive diagnosis was 23%. HIV prevalence at delivery was 21% and HIV incidence between first visit and delivery in those with ≥2 HIV tests was 0.2%. Women who enrolled after 2014 were more likely to receive the three recommended tests (aOR: 1.41; 95% CI: 1.10 to 1.81) and retest at delivery (aOR: 1.20; 95% CI: 1.05 to 1.39). CONCLUSIONS Implementation of maternal HIV testing in Cape Town improved between 2014 and 2016 but major gaps remain, particularly at delivery.
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Affiliation(s)
- Shani de Beer
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Max Kroon
- Department of PaediatricsMowbray Maternity HospitalUniversity of Cape TownCape TownSouth Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- Health Impact Assessment Provincial Government of the Western CapeCape TownSouth Africa
| | - Meg Osler
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Venessa Timmerman
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Mary‐Ann Davies
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- Health Impact Assessment Provincial Government of the Western CapeCape TownSouth Africa
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Weinberg A, Huo Y, Kacanek D, Patel K, Watts DH, Wara D, Hoffman RM, Klawitter J, Christians U. Brief Report: Markers of Spontaneous Preterm Delivery in Women Living With HIV: Relationship With Protease Inhibitors and Vitamin D. J Acquir Immune Defic Syndr 2019; 82:181-187. [PMID: 31513074 PMCID: PMC6760328 DOI: 10.1097/qai.0000000000002111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women living with HIV (WLHIV) have increased risk of spontaneous preterm delivery (SPTD). We sought to identify plasma predictors of SPTD and their correlations with factors that increase the risk of SPTD, such as vitamin D deficiency and use of protease inhibitors. DESIGN Plasma was obtained from 103 WLHIV with SPTD (≤35 weeks gestation) and 205 controls with term deliveries (TDs; ≥37 weeds) matched to cases 2:1 by race and gestational age at blood draw. TNFα, IFNγ, IL6, IL8, IL1β, IL18, IL17, granulocyte colony stimulating factor (GCSF), MCP1, IP10, sIL2Rα, sCD14, vascular endothelial factor a, monocyte colony stimulation factor, GROα, MMP9, IL10, TGFβ, sCTLA4, and eicosanoids were compared between cases adjusting for known SPTD risk factors. RESULTS Participants had similar demographic characteristics, but cases had higher plasma HIV RNA, lower CD4 cells, and more advanced HIV disease compared with controls. High sIL2Rα was associated with increased risk of SPTD. High sCD14, GCSF, PGF2α, and 5-HEPE were marginally associated with increased risk of SPTD. Women who initiated protease inhibitors-containing antiretroviral treatment before or during the first trimester had higher levels of GCSF and 5-HEPE compared with women without such exposure before plasma collection. Vitamin D insufficiency was associated with higher inflammatory sCD14 and PGF2α, and lower anti-inflammatory 5-HEPE. CONCLUSIONS The best plasma predictor of SPTD in WLHIV was sIL2Rα, a marker of T-cell activation. Markers of monocyte activation and eicosanoids were marginally increased in WLHIV and SPTD, suggesting that they may also play a role in the pathogenesis of this disorder.
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Affiliation(s)
- Adriana Weinberg
- Department of Pediatrics, Medicine and Pathology, Anschutz Medical Center, University of Colorado Denver, Aurora, CO 80045
| | - Yanling Huo
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Kunjal Patel
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - D. Heather Watts
- National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Risa M. Hoffman
- University of California San Francisco, San Francisco, CA
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles. Los Angeles, CA
| | - Jelena Klawitter
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Uwe Christians
- iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
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Hawkins-Villarreal A, Moreno-Espinosa AL, Eixarch E, Marcos MA, Martinez-Portilla RJ, Salazar L, Garcia-Otero L, Lopez M, Borrell A, Figueras F, Goncé A. Blood parameters in fetuses infected with cytomegalovirus according to the severity of brain damage and trimester of pregnancy at cordocentesis. J Clin Virol 2019; 119:37-43. [PMID: 31473566 DOI: 10.1016/j.jcv.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/09/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Cytomegalovirus (CMV) remains a major cause of congenital infection and disease. During pregnancy, symptomatic cases can be detected through ultrasound (US) features, nevertheless, prognostic assessment is difficult. The aim of this study was to assess the predictive value of specific blood parameters in CMV infected fetuses. STUDY DESIGN Twenty-eight CMV-infected fetuses in which a cordocentesis had been performed were included. Fetuses were considered severely or mildly affected according to prenatal US/MRI brain damage. Fetal blood parameters were assessed for the prediction of severe brain abnormalities, and compared according to the trimester of pregnancy. Logistic regression and receiver operating curve analysis were performed. RESULTS Thrombocytopenia (≤100,000/mm3; p:0.03) and high levels of gamma-glutamyl transpeptidase (GGT) (≥151 IU/L; p:0.02) signaled severity. For the prediction of brain damage, GGT levels ≥ 183 UI/l achieved 71% sensitivity, 83% specificity (AUC: 0.78), and OR of 2.05 (95% CI: 1.22-3.43) per 100 IU/l increase, adjusted for gestational age. However, thrombocytopenia (91% vs 50%; p: 0.04), β2 microglobulin >10.4 mg/l (60% vs 0% p: 0.03), CMV-DNA >50,000 copies/ml (80% vs 25%; p: 0.02), and positive IgM (70% vs 17%; p: 0.04) were observed significantly more often in severely damaged fetuses sampled ≤28 weeks than thereafter. CONCLUSION In CMV infected fetuses, thrombocytopenia and high levels of GGT are associated with severe US/MRI brain abnormalities. Nevertheless, among severely affected fetuses, blood parameters, with exception of GGT, change according to gestational age. Fetal blood could be less predictive of brain damage in the third trimester.
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Affiliation(s)
- Ameth Hawkins-Villarreal
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Fetal Medicine Service, Obstetrics Department, Hospital "Santo Tomás", University of Panama, Panama City, Panamá in behalf of the Iberoamerican Research Network in Translational, Molecular and Maternal Fetal Medicine
| | - Ana L Moreno-Espinosa
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Fetal Medicine Service, Obstetrics Department, Hospital "Santo Tomás", University of Panama, Panama City, Panamá in behalf of the Iberoamerican Research Network in Translational, Molecular and Maternal Fetal Medicine
| | - Elisenda Eixarch
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - M Angeles Marcos
- Department of Clinical Microbiology, Hospital Clinic, University of Barcelona, Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Raigam J Martinez-Portilla
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Laura Salazar
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Laura Garcia-Otero
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marta Lopez
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Antoni Borrell
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Francesc Figueras
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Anna Goncé
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain.
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50
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Gabriel B, Medin C, Alves J, Nduati R, Bosire RK, Wamalwa D, Farquhar C, John-Stewart G, Lohman-Payne BL. Analysis of the TCR Repertoire in HIV-Exposed but Uninfected Infants. Sci Rep 2019; 9:11954. [PMID: 31420576 PMCID: PMC6697688 DOI: 10.1038/s41598-019-48434-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/05/2018] [Accepted: 08/02/2019] [Indexed: 01/10/2023] Open
Abstract
Maternal human immunodeficiency virus (HIV) infection has been shown to leave profound and lasting impacts on the HIV-exposed uninfected (HEU) infant, including increased mortality and morbidity, immunological changes, and developmental delays compared to their HIV-unexposed (HU) counterparts. Exposure to HIV or antiretroviral therapy may influence immune development, which could increase morbidity and mortality. However, a direct link between the increased mortality and morbidity and the infant's immune system has not been identified. To provide a global picture of the neonatal T cell repertoire in HEU versus HU infants, the diversity of the T cell receptor beta chain (TRB) expressed in cord blood samples from HEU infants was determined using next-generation sequencing and compared to healthy (HU) infants collected from the same community. While the TRB repertoire of HU infants was broadly diverse, in line with the expected idea of a naïve T cell repertoire, samples of HEU infants showed a significantly reduced TRB diversity. This study is the first to demonstrate differences in TRB diversity between HEU and HU cord blood samples and provides evidence that maternal HIV, in the absence of transmission, influences the adaptive immune system of the unborn child.
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Affiliation(s)
- Benjamin Gabriel
- Institute for Immunology and Informatics, Department of Cell and Molecular Biology, University of Rhode Island, Providence, RI, 02903, USA
| | - Carey Medin
- Institute for Immunology and Informatics, Department of Cell and Molecular Biology, University of Rhode Island, Providence, RI, 02903, USA
| | - Jeremiah Alves
- Institute for Immunology and Informatics, Department of Cell and Molecular Biology, University of Rhode Island, Providence, RI, 02903, USA
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, 30197, Kenya
| | - Rose Kerubo Bosire
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, 17177, Sweden
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, 30197, Kenya
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, 98104, USA
- Departments of Medicine, University of Washington, Seattle, Washington, 98104, USA
- Departments of Epidemiology, University of Washington, Seattle, Washington, 98104, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, 98104, USA
- Departments of Medicine, University of Washington, Seattle, Washington, 98104, USA
- Departments of Epidemiology, University of Washington, Seattle, Washington, 98104, USA
- Departments of Pediatrics, University of Washington, Seattle, Washington, 98104, USA
| | - Barbara L Lohman-Payne
- Institute for Immunology and Informatics, Department of Cell and Molecular Biology, University of Rhode Island, Providence, RI, 02903, USA.
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