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OBJECTIVE: SARS-CoV-2 is more likely to cause severe cases in pregnant women. They were part of the priority groups since April 2021 to benefit from SARS-CoV-2 vaccination before its extent to general population. This contribution aims to evaluate, in the postpartum period, the achievement of COVID-19 vaccination and factors associated in women during their pregnancy. MATERIAL AND METHOD: Multicenter cross-sectional survey study conducted from September to December 2021 with online self-questionnaire. All postpartum patients hospitalized in one of the 6 participating maternity hospitals were invited to answer. The questionnaire asked patients about their demographic characteristics, vaccination modalities, vaccine tolerance, and their general perception of vaccination. RESULTS: Of the 371 women who responded, the vaccination rate was 65.7% (IC95% [60.8-70.4]), whom 98.8% entirely during pregnancy. Associated factors with vaccination during pregnancy were older age, higher socio-professional category, and prior information provided by health professionals. Factors that appear to motivate vaccination were personal protection and protection of the newborn. Finally, main factors negatively influencing the vaccination process were the fear of vaccine side effects and the negative perception of vaccines in general. DISCUSSION: Acceptability and information about the vaccine by health professionals is in constant improvement. Information campaigns should be continued to improve the acceptability of vaccination, in light of the accumulating data.
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BACKGROUND: SARS-CoV-2 can lead to several types of complications during pregnancy. Variant surges are associated with different severities of disease. Few studies have compared the clinical consequences of specific variants on obstetrical and neonatal outcomes. Our goal was to evaluate and compare disease severity in pregnant women and obstetrical or neonatal complications between variants of SARS-CoV-2 that have circulated in France over a two-year period (2020-2022). METHOD: This retrospective cohort study included all pregnant women with a confirmed SARS-CoV-2 infection (positive naso-pharyngeal RT-PCR test) from March 12, 2020 to January 31, 2022, in three tertiary maternal referral obstetric units in the Paris metropolitan area, France. We collected clinical and laboratory data for mothers and newborns from patients' medical records. Variant identification was either available following sequencing or extrapolated from epidemiological data. RESULTS: There were 234/501 (47%) Wild Type (WT), 127/501 (25%) Alpha, 98/501 (20%) Delta, and 42/501 (8%) Omicron. No significative difference was found regarding two composite adverse outcomes. There were significantly more hospitalizations for severe pneumopathy in Delta variant than WT, Alpha and Omicron respectively (63% vs 26%, 35% and 6%, p<0.001), more frequent oxygen administration (23% vs 12%, 10% and 5%, p = 0,001) and more symptomatic patients at the time of testing with Delta and WT (75% and 71%) versus Alpha and Omicron variants (55% and 66% respectively, p<0.01). Stillbirth tended to be associated with variants (p = 0.06): WT 1/231 (<1%) vs 4/126 (3%), 3/94 (3%), and 1/35 (3%) in Alpha, Delta and Omicron cases respectively. No other difference was found. CONCLUSION: Although the Delta variant was associated with more severe disease in pregnant women, we found no difference regarding neonatal and obstetrical outcomes. Neonatal and obstetrical specific severity may be due to mechanisms other than maternal ventilatory and general infection.
Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Infant, Newborn , Pregnancy , Humans , Female , SARS-CoV-2/genetics , COVID-19/epidemiology , Retrospective Studies , Mothers , Pregnancy Complications, Infectious/epidemiologyABSTRACT
Déclaration de liens d’intérêts: Les auteurs déclarent ne pas avoir de liens d’intérêts.
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Objectif : Le SARS-CoV-2 est plus à risque d’engendrer des formes graves chez les femmes enceintes. Ces dernières faisaient partie des groupes prioritaires dès avril 2021 pour bénéficier de la vaccination anti-SARS-CoV-2 avant sa généralisation. Cet article vise à évaluer en post-partum la réalisation de la vaccination contre la COVID-19 et les facteurs associés chez les femmes pendant leur grossesse. Matériel & méthode : Enquête transversale multicentrique réalisée de septembre à décembre 2021 par auto-questionnaire en ligne. Toutes les patientes en suites de couches hospitalisées dans une des 6 maternités participantes étaient invitées à y répondre. Le questionnaire collectait leur caractéristiques démographiques, les modalités de vaccination, la tolérance du vaccin et leur perception générale des vaccins. Résultats : Sur les 371 femmes ayant répondu, un taux de vaccination de 65,8 % (IC95% [60,8-70,4]) était observé dont 98,8 % entièrement pendant la grossesse. Les facteurs associés à la vaccination pendant la grossesse étaient un âge plus élevé, la catégorie socio-professionnelle supérieure et l’information préalable délivrée par des professionnels de santé. Les facteurs semblant motiver la vaccination étaient la protection personnelle et celle du nouveau-né. Les principaux facteurs influençant péjorativement la démarche vaccinale étaient la peur des effets secondaires du vaccin ainsi que la perception négative des vaccins en général. Discussion : Une amélioration constante des connaissances sur le vaccin est un facteur déterminant de l’amélioration de l’information délivrée aux patientes par les professionnels de santé. Cette progression doit être renforcée par les campagnes de sensibilisation afin d’améliorer l’acceptabilité de la vaccination, à la lumière de l’accumulation des données.
Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Angiotensin-Converting Enzyme 2 , Counseling , Female , Humans , Infant, Newborn , Pregnancy , Prenatal Care , SARS-CoV-2ABSTRACT
Background: Potential effects of infection with SARS-CoV-2 in pregnant women are still conflicted. Initial symptoms for COVID-19 are often unspecific, it is thus clinically relevant to know if a positive naso-pharyngeal real time reverse transcription PCR (RT-PCR) for SARS-CoV-2 at evaluation is predictive of perinatal outcomes. Our objective was to determine the impact of SARS-CoV-2 infection among women presenting with symptoms indicating a virological test. Methods: We conducted a retrospective study including all pregnant women tested for SARS-CoV-2 by RT-PCR in respiratory tract samples from March 12-May 1st in two tertiary referral obstetric units in the Paris metropolitan area. Indication for tests were one or more of the following symptoms: fever (>38°C), coughing, dyspnea, anosmia, myalgia, rhinorrhea, nausea and vomiting or diarrhea. Clinical and biological characteristics at initial evaluation and perinatal outcomes were compared with student test Chi2 or Fisher tests as appropriate. Results: 123 patients were tested for SARS-CoV-2, 55 were positive (45%). Pregnancy outcomes were available for 93% (N=114). Mean gestationalage at testing was similar between the groups (29.2 vs 30.1WG, p=0.53). The symptoms which were more frequent in women with positive PCR were anosmia: 22% (12/55) vs 9% (6/68), p=0.05, and myalgia: 33% vs 17%, p=0.04. Concerning biological characteristics, women with positive PCR were more often of blood type A (vs type O;p=0.004), more often lymphopenic (47% vs 5%, p<0.001), there was a trend towards more abnormal aPTT ratio (>1.2) (p=0.07). Hospitalization rates were higher for women tested positive: 41.8% vs 21.5%, p=0.02. All 8 women hospitalized in intensive unit care were tested positive. Preterm birth (<37WG) was higher in the group of women tested positive (30.2 vs 13.3%, p=0.029) and there was a similar trend for severe preterm (<32WG) birth (15.1% vs 5.0%, p=0.07). Among the 78 women not delivered 15 days after the test, the rate of preterm birth was similar in both groups: 17.1% (6/35) vs 11.6% (5/43), p=0.47. We found no difference in the rate of preeclampsia (4% vs 5%) or post-partum hemorrhage (15.1% vs 9.8%, p=0.41). Birthweight Z-score did not differ between the groups (-0.3 vs-0.1, p=0.32). Conclusion: In a symptomatic pregnant population tested positive for SARS-CoV-2 compared to negative patients with same characteristics, COVID-19 infection seemed to increase medically indicated preterm births, especially during the 15 days after the RT-PCR result. (Figure Presented).
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BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection. Approximately 1 % of newborns are congenitally infected and in up to 10 % of them the consequences are severe. Antenatal and postnatal treatments, although promising, are still under evaluation. Hygiene counseling to prevent CMV infection is important and should be systematic. OBJECTIVE: To evaluate health care providers' awareness of CMV maternal and congenital infection in France. STUDY DESIGN: A questionnaire on CMV infection was sent in 2018 by e-mail to obstetricians, pediatricians, midwives and laboratory physicians, and members of medical or midwifery associations. We evaluated their knowledge concerning CMV epidemiology, transmission, symptoms in adults, newborns and long-term effects (scores from 0 to 30) and compared the results with those of our 2012 published study. RESULTS: Of the 597 respondents who completed the questionnaire, 91 % were unaware of the precise transmission route of CMV, 33 % wrongly thought thatin utero therapy for congenital CMV infection was a current standard of care in France, and less than half were familiar with the HAS (Haute Autorité de Santé) and CNGOF (Collège National des Gynécologues et Obstétriciens Français) recommendations. When respondents' knowledge of CMV was greater, patients were given more hygiene counseling. Between 2011 and 2018, knowledge improved among doctors and midwives concerning the route of transmission, the symptoms in adults, and the long-term effects of CMV infection. CONCLUSIONS: Knowledge is improving among healthcare providers, but gaps remain. To bridge these gaps, health care providers should improve their knowledge about congenital CMV by various means: medical reviews, continuing medical education, meetings, conferences, the Internet. Moreover, greater knowledge will allow for more effective counseling of pregnant women, as recommended by HCSP and CNGOF in France.