ABSTRACT
Objective. Whilst most cases of COVID-19 in pregnancy evolve uneventfully, some others have a poor outcome, such as preterm birth and HDP. The effect of COVID-19 on fetal growth still has to be addressed and appears controversial. Our study aims to focus on fetal growth velocity across the trimesters in pregnancy affected with COVID-19. Materials and Methods. This is a multicentric prospective observational study on data from COVID-19 pregnancies referred to the centers of Careggi University Hospital and S. Stefano Hospital in Prato from 2020 to 2022, included in the local branch of ItOSS surveillance. Fetal growth was evaluated across the three trimesters of pregnancy by abdominal circumference (AC) and expected fetal weight (EFW). Both AC, and EFW plus birthweight were used to calculate growth velocity (Vannuccini et al., 2017). Results. Data from a cohort of 211 cases was collected. The majority (80%) of COVID-19 cases occurred in the third trimester. Of note, the percentage of gestational diabetes (12.3%) and preterm births (7.1%) was comparable to the general population. Mean birthweight was 3259 +/- 509 g. The percentage of cesarean sections was acceptable (13.7%). Concerning the velocity of growth, AC decreased from the second to third trimester to reach values < 10th centile in 24% of cases and < 5th percentile in 17% of cases, even in presence of 2% of hypertensive disorders (HDP). Fetal growth restriction according to Gordjin et al. (2015) was antenatally identified in 4.7% of cases. Fetal growth > 95th centile occurred in 5.7% of cases. At birth, the cumulative percentage of small for gestational age newborns defined as birth weight < 2500 g resulted 5.2%. A significant percentage of newborns required NICU assistance (7.8%). Conclusions. Regardless of the association and prevalence of preterm birth, SGA and HDP in pregnant women, fetal growth appears to be affected by COVID-19 with a higher incidence of impaired growth velocity compared to the general population.
ABSTRACT
Radiologic imaging in the evaluation of pregnant patients has significantly grown with the outbreak of the severe acute respiratory syndrome related to SARS-CoV-2 pandemic. Lung ultrasound is an emerging non-invasive bedside technique used to diag-nose interstitial lung syndrome through evaluation and quantitation of the number of B-lines, pleural irregularities and nodules or consolidations. In pregnant COVID-19 patients, lung ultrasound should be considered on ac-count of its various strengths, such as its being easily carried out bedside by trained sonographers for the monitoring of lung involvement in follow-ups, and its repeatability and affordability. However, pregnant patients could need chest radiography or computed tomo-graphic (CT) examinations for the diagnosis of pneumonia. Concerns and mis-conceptions about potential radiation-related risks for the embryo or fetus are still widespread among clinicians and can lead to excessive anxiety among pa-tients. Several well-recognized guidance documents were published in the last years as to the safety of a single-phase CT or an X-ray chest and related carcino-genic and teratogenic risk. This paper summarizes the safety of radiological examination for pneumonia in pregnant women affected by COVID 19, based on the estimated embryo-fetal radiation absorption per procedure (mGy).
ABSTRACT
INTRODUCTION Pertussis and influenza immunization in pregnancy is proven to be safe and effective in protecting mother and fetus. National Immunization Plan 2017-2019 recommends both as part of the free routine pregnancy care. Despite that national vaccination coverage among pregnant women is still negligible. The COVID-19 pandemic has globally challenged healthcare services including immunization. Our study evaluates if COVID-19 pandemic changed positively the attitude of pregnant women toward recommended vaccinations in pregnancy. METHODS We conducted a prospective observational study among women who delivered between June and August 2020 at the Maternity Unit of Prato. These patients experienced their first or second trimester during the 2019-2020 influenza seasonal epidemic (before COVID-19 pandemic) and their third trimester during COVID-19 pandemic and Italian lock-down. This study group represents a unique model to evaluate how the novel Coronavirus outbreak might have changed pregnant patients' attitude towards vaccination. Data were collected from a self-completed questionnaire about vaccination uptake, main motivations to be vaccinated or not, influence of COVID-19 on other immunizations. Data were analysed with descriptive statistics: frequencies, percentages, and mean with standard deviations were calculated for each question. RESULTS The survey focused on 195 women who returned complete questionnaire (on 520 patients eligible). Of these 70.2% were Italian, 11.8% Chinese, 3.6% Pakistani and 14.4% of other ethnicities. 8.7% reported vaccinated against influenza and 50.8% against pertussis. Of all these 6.7% received both vaccines during pregnancy. All women vaccinated against influenza were Italian, as well as the majority (87, 88%) of those who received the Tdap vaccine. For both vaccines the main motivation to be vaccinated was the vaccine to be recommended by an healthcare provider, as well as the main motivation not to be vaccinated was the lack of this recommendation. 26.1% women stated that lockdown measures reduced their access to vaccines. Of these women, 70.6% declared they would accept to be vaccinated if the vaccine was administered during a prenatal visit/hospitalization. 95.4% women declared they planned to have their newborns vaccinated following the national schedules for immunization in childhood. DISCUSSION In our sample in the pre-COVID-19 era less than 20% of the women were recommended to get the influenza vaccine, and only 9% were actually administered it. During the COVID-19 pandemic 60% were recommended to get Tdap vaccine, and more than 50% were actually administered it. The possible explanation of this difference in vaccine uptake in the same women might be a different sensitivity of women toward infectious disease complications and measures to prevent them. Our data suggest also that vaccinations are perceived as an essential care especially if recommended by obstetrical team and services. CONCLUSIONS Awareness of infectious disease threats have changed positively the attitude of pregnant women toward vaccination. While COVID-19 cases are steadily increasing globally, it is of upmost importance to reduce the burden of other preventable viral diseases. To avoid fear of contracting COVID-19 prevent immunization, as well as to minimize patient movements and therefore SARS-CoV-2 circulation, vaccination during routine prenatal care must be organized and encouraged.