ABSTRACT
There is limited information on the effects of COVID-19 early in pregnancy on the risk of major congenital malformations (MCMs). Initial research has been limited by small samples, lack of attention to the timing of infection during pregnancy, lack of an appropriate control group, and biased selection of participants. The International Registry of Coronavirus Exposure in Pregnancy (IRCEP) was designed to estimate the relative risk of adverse perinatal outcomes among women with COVID-19 at specific times during gestation. Adult women were eligible to enroll if they had a SARS-CoV-2 test, regardless of the results, or clinically confirmed COVID-19 during pregnancy. Self-administered questionnaires collected data on the infection, pregnancy outcomes, and potential confounders. The analysis of MCMs included women with either a positive SARS-CoV-2 PCR test or a clinical diagnosis of COVID-19 during the first trimester (exposed group) or a negative SARS-CoV-2 test (reference) that enrolled while pregnant. Of 17,163 participants enrolled between June 2020 and July 2021, 1,727 had a SARS-CoV-2 infection during the first trimester and 10,235 had a negative test during pregnancy. Restriction to participants with complete follow-up reduced the sample size to 92 exposed and 292 unexposed reference pregnancies. MCMs were reported in three (3.3%) exposed and eight (2.7%) unexposed (RR 1.2;95% CI 0.32-4.2) newborns. No specific pattern of malformations was observed. The accumulated evidence is most compatible with no major teratogenic effects associated with maternal SARS-CoV-2 infection. Multiple biases need to be considered and addressed when estimating and interpreting the effects of COVID-19 early in pregnancy. The biggest methodological challenges for IRCEP were retention of participants enrolled in early pregnancy, and the potential bias introduced when participants enroll after pregnancy outcomes are known. Studies that allow enrollment after the outcome is known may select pregnancies with the outcome;those that exclude them would select survivors.
ABSTRACT
Background and aim: Recent studies on SARS-CoV-2 have shown that the incidence of liver injury varies between 14.8% and 53%, mainly demonstrable by abnormal ALT / AST levels accompanied by slightly elevated bilirubin levels. Reports of autopsies around the word of patients that death from COVID-19 shows severe liver damage ranging from 58.06% to 78% of the cases. There is evidence that the elevation of transaminases (ALT / AST) translates into a more serious clinical profile. Besides, the elevation of AST is related with a high risk of mortality, so it must be monitored during hospitalization. Thus, it is important to know the behavior of liver injury and mortality in our population. Aim(s): To determine transaminase levels in patients with SARS-Cov-2 and its relationship with mortality. Methods. All the patients admitted with a positive SARS-Cov-2 PCR test were analyzed, the mean and standard deviation of AST, ALT, and other variables of the liver biochemistry, hemoglobin, leukocyte, fibrinogen, and TP were obtained. A Kapplan Meier curve was made for survival to compare patients with and without transaminases elevation. Result(s): We studied a total of 92 patients: 79 (86%) were male, age 56.62 +/- 13.70 years, weight 72.5 +/- 14.30 kg, height 1.63 +/- 0.10 m, BMI 27.09 +/- 5.04 kg / m2. Of the 92 patients, 68 (73%) had an elevation of transaminases at admission. Patient's whit elevation of transaminases (68): 63 (93%) were males, the mean values at admission of AST and ALT were 74.91 +/- 5.83 and 72.75 +/- 5.74, respectively. The average hospital stay was 6.1 +/- 4.1 days in de group with no elevation of transaminases and 7.25 +/- 5.3 days for the group with elevation. Other variables of liver biochemistry, hemoglobin, leukocyte, fibrinogen, and TP are presented in Table 1. The data referring to the probability of requiring ICU income. And probability of requiring mechanical ventilation are presented in Table 2. The group without and with elevated transaminases were compared to observe if elevation of transaminases could influence mortality, obtaining a non-statistically significant p. (x2 = 0.087, p = 0.782). Conclusion(s): In the studied population, the predominant gender was male, the population with elevated transaminases had a 3.82 risk of entering the ICU and 2.02 times more of requiring mechanical ventilation. The elevation of transaminases does not influence survival. The analysis of the entire database will have to be done, since this is a preliminary study (Fig. 1). Conflicts of interest: The authors have no conflicts of interest to declare. Copyright © 2020