ABSTRACT
Pregnant women are an interesting population to study in the context of the current Coronavirus Disease 2019 (COVID-19);studies are still controversial in concluding if pregnancy is a protective condition or a risk factor for a more severe form of the illness. We estimated rate of positive serology for SARS-CoV-2 in a population of healthy pregnant women, compared to a population of non-pregnant women of the same age and geographic area. We also made a comparison between the two groups in terms of previous symptoms and lifestyle. This is a transversal study including pregnant women, above 18 weeks of gestation, aged between 18 and 40 years. The control group consisted of 588 non pregnant women from the same area and the same age group. A total of 344 pregnant women and 588 non pregnant women were recruited. The rate of positive serology for SARS-CoV-2 was significantly lower in the pregnant group: 9/344 (2.6%) versus 75/588 (12.8%) in the non-pregnant group (p < 0.0001). The two groups were similar in terms of occupation and in the self-re-ported habit to leave the house during the lockdown. Our hypothesis to explain this result is that pregnant women might have adopted a more prudential lifestyle, due to their special condition, which may have led them to behave with more caution, i.e., concerning the responsibility of wearing all the disposable personal protective equipment, and keeping the recommended 6 feet distance from other people.
ABSTRACT
INTRODUCTION Pregnant women are an interesting population to study in the context of the current Coronavirus Disease 2019 (COVID-19);studies are still controversial in concluding if pregnancy is a protective condition or a risk factor for a more severe form of the illness particularly when the cardiorespiratory system is affected [1,2]. Some theories support the hypothesis that, since COVID-19 is an immune condition marked by reduced lymphocytes and elevated selected proinflammatory cytokines, and similar immune expression has been demonstrated in pregnancy, pregnant women might be on higher risk for a severe form of the illness [3]. Pregnancy itself can be considered an immunological paradox: the woman must develop an immunological tolerance towards a semi-allogenic fetus, which has exposed pregnant women in history to an increased risk of infection, especially viral with maternal and neonatal unfavourable outcomes [4,5]. According to other authors, immunomodulatory mechanisms employed by the pregnant status may mitigate violent immune response, may soften cytokine storm, tightly associated with severely ill COVID-19 patients, and potentially reduce SARS-CoV-2 transmission [6]. We estimated the rate of positive serology for SARS-CoV-2 in a population of healthy pregnant women, compared to a population of non-pregnant women of the same age and geographic area. We also made a comparison between the two groups in terms of previous symptoms and lifestyle. METHODS This is a transversal study including 344 pregnant women, above 18 weeks of gestation, aged between 18 and 40, attending the obstetrical clinic of the 'Maggiore della Carità' Hospital-Novara. The control group consisted of 588 non-pregnant women from the same area and the same age group. Women consented to participate in the study after being informed on the nature of the research and data managing and processing;an informed consent was therefore signed. Recruitment period was from 27th April 2020 to 1st July 2020. RESULTS A total of 344 pregnant women and 588 non-pregnant women were recruited. The rate of positive serology for SARS-CoV-2 was significantly lower in the pregnant group: 9/ 344 (2.6%) vs 75/588 (12.8%) in the non-pregnant group (p < .0001). The two groups were similar in terms of occupation and in the self-reported habit to leave the house during the lockdown. Furthermore, our study does not demonstrate important differences between pregnant and non-pregnant in symptomatology except that pregnant women mostly have fever and cough while symptoms for non-pregnant women were more varied. CONCLUSIONS Pregnant women are less infected than the equivalent female population. This could be either a better immunological response or due to a more prudential lifestyle. Pregnant women might have adopted a more prudential lifestyle, due to their special condition, which may have lead them to behave with more caution, concerning the responsibility of wearing all the disposable personal protective equipment, and keeping the recommended 6 feet distance from other people.
ABSTRACT
INTRODUCTION One of the main implemented provisions to contain the spread of COVID-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. The lifestyle of pregnant women has a fundamental impact on maternal health and fetal development. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. Stressful situations, such as those caused by this new confinement, could be also the cause of overeating and of weight gain. Indeed, some studies suggested that psychological and emotional responses to the COVID-19 outbreak may have also increased the risk of developing dysfunctional eating behaviors and overeating as a consequence of boredom. Moreover, Body Mass Index (BMI) and maternal weight gain during pregnancy could be related to a higher rate of breech presentations. Fetal malpresentation is one of the main causes of the high rate of cesarean delivery. This pandemic could also influence women's attitude to routine checkups and pregnancy scans, antenatal appointments and consultations. METHODS This is a retrospective study including all consecutive patients who delivered at University Hospital Maggiore della Carità in Novara, Italy, in April-May 2017 (group 1, n=294), a period prior to the pandemic, and during the same months in 2020 (group 2, n=256) during and immediately after lockdown. Clinical data were extracted from The Report 'Childbirth Assistance Certificate (CedAP) - Birth Event Analysis'. RESULTS Demographic characteristics were similar between the two study groups, except for a decreased number of married couples in group 2 (p-value .018) and an increased percentage of patients with clinical checkups at Family Planning facilities in 2020 (p-value .04). The number of hospitalizations during pregnancy was 26 (8.9%) vs 10 (3.9%) with a significative reduction during 2020 (p-value .004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs 35.9%;p-value . 002), a reduction of amniorrhexis (11.3% vs 5.5% p-value .015), a reduction of supine positions with an increase of vertical and all fours positions in 2020 (49.3% vs 61.9% and 9.5% vs 12.4% respectively, p .023), and a reduction of left occipito-anterior presented part (63.2% vs 55.4%) in favor of right occipito-anterior (34.7% vs 41.2%, p-value .019) as shown in Table 1. CONCLUSIONS It is the first time in modern, age that humankind faces a lockdown, so the short- and long-term effects are unknown. There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate possible psychological, behavioral, and epigenetic effects on obstetric outcomes.