Pregnancy during a pandemic: How stress affects pregnant women and the development of their babies during COVID-19

Prenatal maternal distress has a negative impact on the course of pregnancy, fetal development, offspring development, and later psychopathologies. The study aimed to understand the guidelines and recommendations related to the prevention and management of the prenatal distress and psychiatric symptomatology of pregnant women during COVID-19 Pandemic. This paper is a review based on information found in specialty literature. The analysis was limited to English language articles and guidelines published between January 1, 2003 and October 14, 2020 on PubMed using the next keywords: perinatal mental health, anxiety, coronavirus disease 2019, depression, mental health, pregnancy, prenatal, post-traumatic stress disorder. In this review we discuss about the association between the COVID-19 pandemic and an uptrend in psychological distress and psychiatric symptomatology in pregnant women. Pregnant women are experiencing substantially elevated anxiety and depression symptoms during the COVID-19 pandemic that are in a close relationship to COVID-19 specific problems about threats to their own lives, their baby's health, not getting enough prenatal care, and social isolation. A significant number of studies correlate maternal stress during pregnancy with atypical fetal development, in a way that increases susceptibility to disease and maladaptation in children. Several research groups have used elevated prenatal anxiety as an indicator to suggest prenatal stress, relating to the correlation with cognitive, behavioral, and neurological disorders in children. Protective resilience factors can be social support and physical activity. There is an urgent need to support pregnant women during this critical time to mitigate long-term negative outcomes, given the known effects of stress in pregnancy, infant and child outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Romanian) Stresul matern prenatal are un impact negativ asupra evolutiei sarcinii, dezvoltarii fetale, dezvoltarii copilului si psihopatologiilor ulterioare. Studiul a urmarit sa inteleaga liniile directoare si recomandarile legate de prevenirea si gestionarea stresului prenatal si a simptomatologiei psihiatrice a femeilor insarcinate in timpul pandemiei COVID-19. Aceasta lucrare este o recenzie bazata pe informatiile din literatura de specialitate. Analiza s-a limitat la articolele si ghidurile in limba engleza publicate in perioada 1 ianuarie 2003 - 14 octombrie 2020 pe PubMed folosind urmatoarele cuvinte-cheie: sanatate mintala perinatala, anxietate, boala coronavirus 2019, depresie, sanatate mintala, sarcina, prenatal, tulburare de stres posttraumatica. In aceasta revizuire, discutam despre asocierea dintre pandemia COVID-19 si o tendinta ascendenta a stresului psihologic si a simptomatologiei psihiatrice la femeile gravide. Femeile gravide se confrunta cu simptome crescute de anxietate si depresie in timpul pandemiei COVID-19, care sunt intr-o relatie stransa cu problemele specifice COVID-19 legate de amenintarile la adresa vietii lor, sanatatea bebelusului lor, neacordarea unei ingrijiri prenatale suficiente si izolarea sociala. Un numar insemnat de studii coreleaza stresul matern din timpul sarcinii cu dezvoltarea atipica fetala, intr-o maniera in care creste sensibilitatea la boli si inadaptarea, la copii. Mai multe grupuri de cercetare au folosit nivelul crescut de anxietate prenatala ca indicator pentru a sugera stresul prenatal, raportandu-se la corelatia cu tulburarile cognitive, comportamentale si neurologice la copii. Factorii protectivi, de rezilienta pot fi sprijinul social si activitatea fizica. Exista o nevoie urgenta de a sprijini femeile insarcinate in acest moment critic, pentru a atenua rezultatele negative pe termen lung, avand in vedere efectele cunoscute ale stresului in sarcina, pentru fat si, ulterior, pentru copil. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Potential Benefit of Hydroxychloroquine in Chronic Placental Inflammation of Unknown Etiology Associated with Adverse Pregnancy Outcomes.

The placenta is the site of connection between maternal and fetal circulation, and the liaison is established early in pregnancy. A large variety of pregnancy complications such as preterm birth, fetal growth restriction, or pregnancy loss have placental expression and can be accompanied in some cases of acute or chronic identifiable placental inflamatory lesions. Chronic placental inflammatory (CPI) lesions include chronic villitis of unknow etiology (CVUE), chronic intervillositis of unknown etiology, CIUE (also described as chronic histiocytic intervillositis, CHI), and chronic deciduits. Hydroxychloroquine (HCQ) has been prescribed with good results during pregnancy to prevent adverse perinatal outcomes in maternal autoimmune conditions. Its success has paved the way to its use in CPI as CIUE/CHI; however, to date, there are no prospective, informatively designed, controlled studies on its value in these setting. This review aims to explore the potential role of HCQ in CPI of unknown etiology. Ideally, properly designed, probably multicentric studies should be undertaken to fully understand HCQ's role for prevention of adverse pregnancy outcomes after a chronic placental inflammation.

The Relationship between the Infertility Specialist and the Patient during the COVID-19 Pandemic.

The doctor-patient relationship is fundamental in the treatment of infertility, due to the emotional implications of fertilization procedures. However, insufficient data are available specifically for this relationship. The general objective of the study is to establish the associations between the fundamental concepts that define the doctor-patient relationship: communication, empathy, trust, collaboration, compliance and satisfaction. A cross-sectional study was conducted between May and June 2020 and followed the methods of a quantitative analysis, collecting the data using questionnaires. The research plan was specific to path analysis with the mediation effect, in which the hypotheses were tested. The research group consisted of 151 women diagnosed with infertility, voluntarily recruited through online support communities. Findings demonstrate that affective empathy mediates the relationship between communication and trust in the doctor. In conclusion, this study draws attention to the importance of basic concepts in the relationship of infertility specialists with infertile patients. Thus, it is necessary for health care providers in assisted human reproduction to participate in programs for the continuous training of empathic communication skills, given the sensitivity of this diagnosis.

Asthma in Pregnancy. Review of Current Literature and Recommendations.

Background:Asthma is the most common respiratory disorder affecting women during pregnancy. Although it is a reversible disease, it may adversely affect maternal quality of life and perinatal outcomes, especially in severe and inappropriately managed cases. Conversely, pregnancy influences the course of asthma through the physiological respiratory, hormonal, and immune system changes. Exacerbations are a key feature of asthma, representing a significant problem if severe, requiring aggressive medical intervention, hospital and even ICU admission. Purpose: The purpose of this article is to summarize the current knowledge and to provide a comprehensive overview of asthma in pregnancy. We also want rising awareness among patients and clinicians on the importance of proper asthma management during pregnancy. Data sources: A comprehensive literature search in PubMed, Medline, and Taylor& Francis was performed. We have searched for review articles as well as prospective and retrospective studies published in English, investigating the bilateral relationship between asthma and pregnancy, using the key words mentioned bellow. Manual search through both national and international guidelines as well as relevant journals and publications on the topic has been also conducted. Conclusion:Optimal asthma control, preventing, detecting, and treating the exacerbations are of the utmost importance to minimize the adverse effects for both the mother and fetus/neonate. Guidelines recommend active asthma management during pregnancy. Strong support prior and throughout the pregnancy and individualized treatment, guided by a multidisciplinary team, is suggested. Education on the importance of anti-asthmatic therapy, avoiding triggers, frequent and accurate monitoring are essential for good asthma management. Considering the pandemic, we are facing and the potential impact of COVID-19 on asthma, Global Initiative for Asthma (GINA) guideline recommendations for physicians are mentioned in the present article.

The Psychological Impact of the COVID-19 Pandemic on Pregnant Women.

BACKGROUND: The COVID-19 pandemic has meant significant precautions and changes in delivering healthcare services. The aim of the study was to explore the lifestyle changes of pregnant women during the COVID-19 pandemic in Romania, the changes in prenatal care and delivery during the pandemic and the psychological impact on women and to determine how healthcare providers can help them to overcome this period. METHODS: A cross-sectional survey was conducted anonymously and distributed among pregnancy-related groups from Romania, recruiting 559 study participants, between May and October 2020. A total of 559 pregnant women completed an online 26-item questionnaire but we only validated 557 responses for study. The survey included basic demographic questions, pregnancy-related questions, questions regarding the pregnant women's lifestyle changes during the pandemic and their perception of the COVID-19 pandemic and questions which evaluated the impact of the pandemic on prenatal care and delivery in Romania. RESULTS: The pandemic restrictions affected women's routine activities regarding professional, familial and social life. Therefore, for pregnant women who were emotionally vulnerable, these restrictions had a great impact on their mental health. The majority of the study participants (78.8%, N = 439) were emotionally affected by the pandemic. The fear related to the possibility of having their pregnancy affected by the virus was dominant in the group (45.8%). A high number of women (69.5%) felt safe when they accessed health services, but private hospitals were considered safer (53.1%) compared to public hospitals (14.4%). The majority of participants (53.7%) used to have prenatal care in a private healthcare system. During the pandemic, preventive measures were associated with low confidence in the healthcare system. Of the total group of participants, 123 women (22.1%) gave birth during the pandemic. Of these, a majority of the study participants considered that it was very difficult for them to cope without their partner during the hospitalization and labor period. CONCLUSIONS: The main anxiety of pregnant women were related to threats to their lives and their baby's health because of the uncertainty caused by pandemic. It is important to know that the restrictions and the changes in maternity care had a negative impact on them. This conclusion must be taken into account when preventive measures will be decided for helping them to get through such a period. Additionally, psychological support will be essential for improving the mental health of pregnant women and for preventing a negative outcome of the pregnancy. These feelings must be taken into account when preventive measures will be established during pandemic and a psychological support will be essential for improving their mental health for preventing negative outcome of pregnancy.