The impact of trimester of COVID-19 infection on pregnancy outcomes after recovery.

OBJECTIVES: Many physiological adaptations occur during pregnancy. It is not currently known how timing of COVID-19 infection impacts pregnancy. We hypothesize that maternal and neonatal outcomes are different if COVID-19 infection occurs in different trimesters of pregnancy. METHODS: This retrospective cohort study was conducted from 3/2020 to 6/2022. Pregnant patients with a positive COVID-19 infection more than 10 days before delivery (COVID-recovered) were identified and grouped by trimester of infection. Demographics and maternal, obstetric, and neonatal outcomes were analyzed. ANOVA, Wilcoxon rank-sum test, Pearson's chi-squared test, and Fisher's exact test were used to compare continuous and categorical data. RESULTS: 298 COVID-recovered pregnant patients were identified. Of those, 48 (16 %) were infected in the 1st trimester, 123 (41 %) in the 2nd, and 127 (43 %) in the 3rd. There were no significant demographic differences between the study groups. Vaccination status was similar. Hospital admission rate and the need for oxygen therapy while infected were significantly higher in patients with 2nd or 3rd trimester infection (18 % & 20 % vs. 2 % and 13 % & 14 % vs. 0 %, respectively). Rates of preterm birth (PTB) and extreme PTB were higher in the 1st trimester infection group. Infants born to mothers infected in the 2nd trimester had more neonatal sepsis workups (22 % vs. 12 % & 7 %). Other outcomes were similar between groups. CONCLUSIONS: First trimester COVID-recovered patients were more likely to have a preterm birth despite having lower rates of hospital admission and oxygen supplementation while infected than patients who recovered from a 2nd or 3rd trimester infection.

Temporal Trend of COVID-19 Clinical Severity and the Ethnic/Racial Disparity: A Report from the Maryland Study Group.

OBJECTIVES: This study aimed to evaluate the temporal trend of novel coronavirus disease 2019 (COVID-19) symptoms and severity of clinical outcomes among pregnant women over a calendar year in the State of Maryland and compare clinical outcomes between different ethnic and racial groups. STUDY DESIGN: We conducted a retrospective, multicenter observational study of the temporal trend of COVID-19 clinical presentation during pregnancy in the State of Maryland. We reviewed consecutive charts of adult pregnant females, aged 18 to 55 years, with laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection between March 1, 2020, and February 28, 2021, and managed within the University of Maryland Medical System and Johns Hopkins Medicine. We excluded cases with insufficient data for assessing the COVID-19 diagnosis, pregnancy status, or clinical outcomes. We evaluated the evolution of COVID-19 symptoms at the time of presentation. Also, we compared COVID-19 infection rate, hospitalization rate, oxygen use, and intensive care unit (ICU) admission rates between different ethnic and racial groups. RESULTS: We included 595 pregnant women with laboratory-confirmed COVID-19 over the study period. The prevalence of respiratory and systemic symptoms decreased over time with incidence rate ratios (IRRs) of 0.91 per month (95% confidence interval [CI]: 0.88-0.95) and 0.87 per month (95% CI: 0.83-0.95), respectively. The prevalence of hospitalization, O2 requirement, and ICU admission decreased over time with IRRs of 0.86 per month (95% CI: 0.82-0.91), 0.91 per month (95% CI: 0.84-0.98), and 0.70 per month (95% CI: 0.57-0.85), respectively. The Hispanic and Black populations had a higher COVID-19 infection rate and hospitalization rate than the non-Hispanic White population (p = 0.004, p < 0.001, and p < 0.001, respectively). CONCLUSION: Understanding the concepts of viral evolution could potentially help the fight against pandemics like COVID-19. Moreover, this might improve the knowledge of how pandemics affect disadvantaged populations and help close the gap in health care inequities. KEY POINTS: · A trade-off between virulence and transmissibility is determined by the natural selection of viruses.. · Understanding the concepts of viral evolution can help the fight against pandemics like COVID-19.. · Evolution of SARS-CoV-2 over time resulted in decreased virulence and increased infectivity..

All-cause excess mortality and COVID-19-related deaths in Iran.

Background: Iran reported its first COVID-19 deaths on February 19, 2020 and announced 1284 deaths with a laboratory-confirmed SARS-CoV-2 infection by March 19, 2020 (end of the winter 1398 SH). We estimated all-cause excess mortality, compared to the historical trends, to obtain an indirect estimate of COVID-19-related deaths. Methods: We assembled time series of the seasonal number of all-cause mortalities from March 21, 2013 (spring of 1392 SH) to March 19, 2020 (winter 1398 SH) for each province of Iran and nationwide with the vital statistics data from the National Organization for Civil Registration (NOCR). We estimated the expected seasonal mortality and excess mortality (the difference between the number of registered and expected deaths). Moreover, we reviewed the provincial number of confirmed cases of COVID-19 to assess their association with excess deaths. Results: The results of our analysis showed around 7507 (95% CI: 3,350 - 11,664) and 5180 (95% CI: 1,023 - 9,337) all-cause excess mortality in fall and winter, respectively. There were 3778 excess deaths occurred in Qom, Gilan, Mazandaran, and Golestan provinces in the winter, all among the COVID-19 epicenters based on the number of confirmed cases. Conclusion: We think most of the excess deaths in the winter were related to COVID-19. Also, we think the influenza epidemic might have been the main reason for the excess mortality in the fall and parts of excess deaths in the winter of 1398 SH. Moreover, a review of all available clinical and paraclinical records and through analyses of the surveillance data for severe acute respiratory infections (SARI) can help to obtain a more accurate estimate of COVID-19 mortality.