ABSTRACT
BACKGROUND: An increased incidence of hypertensive disorders of pregnancy (HDP) has been reported among pregnant women infected by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the pathogen behind coronavirus disease-19 (COVID-19). Although it is primarily a respiratory infection, the extra-pulmonary manifestations of COVID-19 mimic those found in preeclampsia (PE). Moreover, the two conditions share common risk factors and pathological mechanisms, hindering the ability to understand the interaction between them. Current literature on this topic is controversial and as there is an overlap of clinical and laboratory findings, HDP can be an overreported outcome in pregnant women with COVID-19. The aim of our study is to assess whether there is an association between maternal SARS-CoV-2 infection and HDP. METHODS: We designed a multicenter retrospective cohort study with data collected from five maternity hospitals in Almada, Porto, Lisboa, Penafiel and Coimbra, Portugal, between March 2020 and March 2021. We obtained a sample of 789 pregnant women who were followed up or delivered their babies in one of the participating centers. Each pregnant woman who tested positive for SARS-CoV-2 on a real-time polymerase chain reaction test -- exposure group (n= 263), was paired with two negative pregnant women (1:2), who received the same antenatal care and had similar gestational age and parity -- control group (n=526). Data were collected on maternal characteristics, medical history, obstetric outcomes, and delivery. Outcomes: The primary outcome of our study is to assess the incidence of HDP in pregnant women infected and not infected by SARS-CoV-2. The secondary outcomes of our study are to assess the incidence of HDP across all COVID-19 severity subgroups and to assess whether SARS-CoV-2 infection in pregnancy modified the odds of a set of risk factors developing HDP. Results: There was a slightly increased, but not statistically significant, incidence of PE (relative risk, RR, 1.33; 95% confidence interval, CI 0.68-2.57) in the SARS-CoV-2 positive group. There was no statistically significant association between having COVID-19 in pregnancy and developing PE/eclampsia/ hemolysis, elevated liver enzymes, and low platelets, HELLP syndrome [X2(1) = 0.732; p = 0.392] as well as developing gestational hypertension (GH) [X2(1) = 0.039; p = 1]. There was no statistically significant association [X2(2) = 0.402; p = 0.875), [X2(2) = 1.529; p = 0.435] between COVID-19 severity and incidence of HDP. The SARS-CoV-2 infection did not modify the odds of each maternal risk factor causing HDP. Conclusion: Our study did not demonstrate an association between maternal COVID-19 and HDP. We did not observe a significantly increased incidence of HDP in pregnant women infected by SARS-CoV-2. As current literature is controversial on this topic, clinicians should be aware that HDP is a possible complication of maternal SARS-CoV-2 infection and further research studies urge to better assess the association between COVID-19 in pregnancy and HDP.
ABSTRACT
Objective - Mental health services have been clearly affected by the pandemic and its restrictions. In our day hospital units users attended on fewer days, group therapy was drastically reduced, the number of users in groups was limited and individual and group teletherapy was initiated. This study evaluates the impact of these changes on clinical and functional outcomes.Methods - This is a descriptive study prospectively comparing two cohorts of users: those admitted and discharged from our day hospitals before or during the pandemic. All users received a multidisciplinary assessment at admission and discharge including clinician and user-rated scales on psychopathology, daily living skills, quality of life and caregiver burdens. Improvement in both groups was compared.Results - Both cohorts were homogenous at admission. Length of admission was not different for the two groups, but users admitted during the pandemic attended the day hospital on significantly fewer days. Improvement observed in most scales was equivalent in both groups, suggesting a similar evolution of both cohorts.Conclusions - Despite the reduction in assistance days and group therapeutic interventions no major changes were found in the outcomes of both groups. This study shows that careful adaptations and availability, even in critical situations, can result in equally effective treatments. Further research is essential to determine which of these adaptations should be maintained beyond the pandemic.
ABSTRACT
Objetivo - Los servicios de salud mental se han visto claramente afectados por la pandemia y sus restricciones. En nuestras unidades de hospital de día los usuarios acudieron en menos días, la terapia de grupo se redujo drásticamente, el número de usuarios en grupos fue limitado y se iniciaron terapias individuales y grupales en formato online. Este estudio evalúa el impacto de estos cambios en los resultados clínicos y funcionales. Métodos - Se trata de un estudio descriptivo que compara prospectivamente dos cohortes de usuarios: los ingresados y dados de alta de nuestros hospitales de día antes o durante la pandemia. Todos los usuarios recibieron una evaluación multidisciplinaria al ingreso y al alta, incluyendo escalas auto y heteroadministradas de psicopatología, habilidades de la vida diaria, calidad de vida y cargas del cuidador. Se comparó la mejoría en ambos grupos. Resultados - Ambas cohortes eran homogéneas al ingreso. La duración del ingreso no fue diferente para los dos grupos, pero los usuarios ingresados durante la pandemia asistieron al hospital de día significativamente menos días. La mejoría observada en la mayoría de las escalas fue equivalente en ambos grupos, lo que sugiere una evolución similar de ambas cohortes. Conclusiones - A pesar de la reducción de los días de asistencia y las intervenciones terapéuticas grupales, no se encontraron cambios importantes en los resultados de ambos grupos. Este estudio muestra que las adaptaciones cuidadosas y la disponibilidad continuada, incluso en situaciones críticas, pueden facilitar tratamientos igualmente efectivos. Es esencial continuar investigando para determinar cuáles de estas adaptaciones deberían mantenerse más allá de la pandemia.
ABSTRACT
INTRODUCTION: Even though the risk of COVID-19 in pregnancy may be increased, large-scale studies are needed to better understand the impact of the infection in this population. The aim of this study is to describe obstetric complications and the rate of vertical transmission in pregnant women with SARS-CoV-2 infection. MATERIAL AND METHODS: Detected cases of SARS-CoV-2 infection in pregnancy were registered in Portuguese hospitals by obstetricians. Epidemiological, pregnancy and childbirth data were collected. RESULTS: There were 630 positive cases in 23 Portuguese maternity hospitals, most at term (87.9%) and asymptomatic (62.9%). The most frequent maternal comorbidity was obesity. The rates of preterm birth and small-to-gestational-age were 12.1% and 9.9%, respectively. In the third trimester, 2.9% of pregnant women required respiratory support. There were eight cases (1.5%) of fetal death, including two cases of vertical transmission. There were five cases of postpartum respiratory degradation, but no maternal deaths were recorded. The caesarean section rate was higher in the first than in the second wave (68.5% vs 31.5%). RT-PCR SARS-CoV-2 positivity among newborns was 1.3%. CONCLUSION: SARS-Cov-2 infection in pregnancy may carry increased risks for both pregnant women and the fetuses. Individualized surveillance and the prophylaxis of this population with vaccination. is recommended in these cases.
Introdução: Apesar do risco da COVID-19 na gravidez poder ser acrescido, são necessários estudos em larga escala para o melhor conhecimento do impacto desta infeção nesta população. O objetivo deste estudo é descrever as complicações obstétricas e a taxa de transmissão vertical em grávidas com infeção a SARS-CoV-2. Material e Métodos: Os casos conhecidos de infeção por SARS-CoV-2 na gravidez foram registados nos hospitais portugueses por obstetras. Foram recolhidos dados epidemiológicos, da gravidez e do parto. Resultados: Registaram-se 630 casos positivos em 23 maternidades portuguesas, a maioria no termo (87,9%) e assintomática (62,9%). A comorbilidade materna mais frequente foi a obesidade. A taxa de parto pré-termo e de leves para a idade gestacional foi de 12,1% e 9,9%, respectivamente. No terceiro trimestre, 2,9% das grávidas necessitaram de suporte respiratório. Verificou-se uma taxa de 1,5% de morte fetal, incluindo dois casos de transmissão vertical. Houve cinco casos de degradação respiratória no pós-parto, mas sem mortes maternas registadas. A taxa de cesarianas foi mais elevada na primeira do que na segunda vaga (68,5% vs 31,5%). A positividade do RT-PCR SARS-CoV-2 entre os recém-nascidos foi de 1,3%. Conclusão: A infeção pelo SARS-Cov-2 na gravidez pode acarretar riscos aumentados para as grávidas e fetos. Recomenda-se uma vigilância individualizada nestes casos e a profilaxia desta população com a vacinação.