ABSTRACT
ImportancePregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER- Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. MethodsRECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. DiscussionRECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero. RegistrationNCT05172024
Subject(s)
COVID-19 , Severe Acute Respiratory SyndromeABSTRACT
Several studies have already explored individual and environmental risk factors for COVID-19 morality, however most study populations consisted of the overall population and mainly from China or the US. Our study focused on COVID-19 mortality in the elderly in seven European cities. Long-term exposure to air pollution was estimated through annual pollutant concentrations at the residential address averaged over the last two years of the study period between February and May 2020. We focused on the main outdoor air pollutants PM10, PM2.5, NO2 and O3. Short-term variations in air pollutants and weather parameters (e.g. temperature, UV, relative humidity) were also examined through a 20-day period before the confirmed PCR diagnostic of COVID-19. Individual risk factors such as smoking status, sex, body mass index (BMI), ischemic heart disease, diabetes, hypertension, chronic renal failure, history of cancer, COPD, and lung fibrosis, were taken into account. We found positive associations for diabetes and COVID-19 mortality (OR 2.2 CI 95% :1.1, 4.4). Using a multivariate logistic regression model adjusted for all patient characteristics and city, we fail to reject the null hypothesis of no association between COVID-19 mortality and long-term and short-term increase in PM2.5, PM10, NO2 and O3. Our study suffers from the fact that patient profiles strongly differ between high-polluted and less-polluted cities. Strong differences in COVID-19 mortalities were observed between cities, which could be due to differences in COVID-19 management and treatment, such as accessibility to reanimation and intensive units between cities. Overall, our study highlights the need to improve estimation of individual exposure to air pollution. Indeed, even with the high-efficiency modelisation systems used in our study, we were unable to estimate the effect of air pollution within each city, because variations in air pollution exposure were too small. Individual markers of air pollution exposure such as recently demonstrated with urinary black carbon or passive individual samplers, would be most suitable for future explorations. Concerning weather parameters, although previous studies concluded that increase in temperature and UV index could decrease COVID-19 morality, our data did not allow us to reject the null hypotheses.