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2.
Nat Med ; 27(10): 1693-1695, 2021 10.
Article in English | MEDLINE | ID: covidwho-1526092

ABSTRACT

To evaluate the effectiveness of the BNT162b2 messenger RNA vaccine in pregnant women, we conducted an observational cohort study of pregnant women aged 16 years or older, with no history of SARS-CoV-2, who were vaccinated between 20 December 2020 and 3 June 2021. A total of 10,861 vaccinated pregnant women were matched to 10,861 unvaccinated pregnant controls using demographic and clinical characteristics. Study outcomes included documented infection with SARS-CoV-2, symptomatic COVID-19, COVID-19-related hospitalization, severe illness and death. Estimated vaccine effectiveness from 7 through to 56 d after the second dose was 96% (95% confidence interval 89-100%) for any documented infection, 97% (91-100%) for infections with documented symptoms and 89% (43-100%) for COVID-19-related hospitalization. Only one event of severe illness was observed in the unvaccinated group and no deaths were observed in either group. In summary, the BNT162b2 mRNA vaccine was estimated to have high vaccine effectiveness in pregnant women, which is similar to the effectiveness estimated in the general population.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Pregnancy Complications, Infectious/prevention & control , Adolescent , Adult , COVID-19/epidemiology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Cohort Studies , Female , Humans , Incidence , Pregnancy , SARS-CoV-2/isolation & purification , Young Adult
4.
J Matern Fetal Neonatal Med ; : 1-6, 2021 Jun 28.
Article in English | MEDLINE | ID: covidwho-1286514

ABSTRACT

PURPOSE: To investigate the effect of the COVID-19 pandemic on healthcare utilization related to labor and delivery and to assess the effect of the COVID-19 pandemic on intra-partum and delivery complications. METHODS: This retrospective study was performed at a university-affiliated, tertiary medical center. It included women admitted to the delivery room from 1 March 2020 to 23 July 2020 during the first wave of the COVID-19 pandemic. They were compared against women who were admitted to the delivery room during the same time period in 2019. The outcomes of 2701 deliveries during the pre-pandemic period were compared to those of 2668 deliveries during the pandemic period. Main outcomes were pregnancy and delivery outcomes. RESULTS: The mean number of emergency department visits before admission for delivery was higher in the pre-pandemic period than in the pandemic period (2.3 ± 1.5 and 2.1 ± 1.3 visits, respectively; p < .01). There were no significant differences in other intra- and postpartum complications. The incidence of a prolonged third stage of labor was higher in the pre-pandemic than in the pandemic period (225 (10%) and 182 (8.1%), respectively; p = .03). The mean duration of post-partum maternal hospitalization was longer in the pre-pandemic than in the pandemic period (3.6 ± 0.9 and 3.4 ± 1.0 days, respectively; p < .01). Neonatal outcomes were comparable for Apgar scores, birth weight, and newborn intensive care unit admission for both periods; however, the mean duration of neonatal hospitalization was longer in the pre-pandemic than in the pandemic period (3.5 ± 3.2 and 3.2 ± 1.1 days, respectively; p < .01). CONCLUSIONS: In our study population, in the presence of public and accessible obstetric medicine, the first wave of the COVID-19 pandemic did not affect pregnancy or early delivery outcomes.

5.
Eur Psychiatry ; 64(1): e34, 2021 05 04.
Article in English | MEDLINE | ID: covidwho-1270941

ABSTRACT

BACKGROUND: New recommendations regarding the use of personal protective equipment (PPE) during delivery have changed the maternal birth experience. In this study, we investigated the mental perceived impact of PPE use during delivery on the development of maternal postpartum depression (PPD) and post-traumatic stress symptoms (PTSS). METHODS: This was a multicenter, retrospective cohort study concerning women who delivered during the COVID-19 pandemic first lockdown period in Israel. Postpartum women were approached and asked to complete a comprehensive online questionnaire. Impact of PPE was graded on a scale of 1-5, and Impact of PPE ≥4 was considered high. PPD and PTSS were assessed using the EPDS and City BiTS questionnaires. RESULTS: Of 421 parturients, 36 (9%) reported high Impact of PPE. Parturients with high Impact of PPE had significantly higher PPD and PTSS scores)EPDS 8.4 ± 5.8 vs. 5.7 ± 5.3; City BiTS 9.2 ± 10.3 vs. 5.8 ± 7.8, p < 0.05 for both). Following adjustment for socio-demographic and delivery confounders and fear of COVID-19 (using Fear of COVID19 scale), Impact of PPE remained positively correlated with PPD symptoms (ß = 0.103, 95% confidence intervals [CI] 0.029-1.006, p = 0.038). CONCLUSION: When examining the risk factors for developing postpartum PTSS-experiences during labor and PPE were found to be significant variables. As the use of PPE is crucial in this era of COVID-19 pandemic in order to protect both parturients and caregivers, creative measures should be taken in order to overcome the communication gap it poses.


Subject(s)
COVID-19/psychology , Depression, Postpartum/etiology , Personal Protective Equipment/adverse effects , Postpartum Period/psychology , Stress Disorders, Post-Traumatic/etiology , Adult , COVID-19/epidemiology , Communicable Disease Control , Depression, Postpartum/diagnosis , Depression, Postpartum/psychology , Fear , Female , Humans , Israel , Pregnancy , Retrospective Studies , Risk Factors , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires
6.
J Clin Invest ; 131(13)2021 07 01.
Article in English | MEDLINE | ID: covidwho-1236496

ABSTRACT

BACKGROUNDThe significant risks posed to mothers and fetuses by COVID-19 in pregnancy have sparked a worldwide debate surrounding the pros and cons of antenatal SARS-CoV-2 inoculation, as we lack sufficient evidence regarding vaccine effectiveness in pregnant women and their offspring. We aimed to provide substantial evidence for the effect of the BNT162b2 mRNA vaccine versus native infection on maternal humoral, as well as transplacentally acquired fetal immune response, potentially providing newborn protection.METHODSA multicenter study where parturients presenting for delivery were recruited at 8 medical centers across Israel and assigned to 3 study groups: vaccinated (n = 86); PCR-confirmed SARS-CoV-2 infected during pregnancy (n = 65), and unvaccinated noninfected controls (n = 62). Maternal and fetal blood samples were collected from parturients prior to delivery and from the umbilical cord following delivery, respectively. Sera IgG and IgM titers were measured using the Milliplex MAP SARS-CoV-2 Antigen Panel (for S1, S2, RBD, and N).RESULTSThe BNT162b2 mRNA vaccine elicits strong maternal humoral IgG response (anti-S and RBD) that crosses the placenta barrier and approaches maternal titers in the fetus within 15 days following the first dose. Maternal to neonatal anti-COVID-19 antibodies ratio did not differ when comparing sensitization (vaccine vs. infection). IgG transfer ratio at birth was significantly lower for third-trimester as compared with second trimester infection. Lastly, fetal IgM response was detected in 5 neonates, all in the infected group.CONCLUSIONAntenatal BNT162b2 mRNA vaccination induces a robust maternal humoral response that effectively transfers to the fetus, supporting the role of vaccination during pregnancy.FUNDINGIsrael Science Foundation and the Weizmann Institute Fondazione Henry Krenter.


Subject(s)
Antibodies, Viral/blood , COVID-19 Vaccines/immunology , COVID-19 Vaccines/pharmacology , COVID-19/immunology , COVID-19/prevention & control , Maternal-Fetal Exchange/immunology , SARS-CoV-2/immunology , Adult , Cohort Studies , Female , Fetal Blood/immunology , Humans , Immunization, Passive , Immunoglobulin G/blood , Infant, Newborn , Male , Pregnancy , Young Adult
9.
Arch Gynecol Obstet ; 303(6): 1401-1405, 2021 06.
Article in English | MEDLINE | ID: covidwho-893273

ABSTRACT

KEY MESSAGE: Among SARS-CoV-2-infected mothers, vaginal delivery rates were high and associated with favorable outcomes with no cases of neonatal COVID-19. PURPOSE: To investigate the mode of delivery and its impact on immediate neonatal outcome in SARS-CoV-2-infected women. METHODS: A prospective study following pregnant women diagnosed with COVID-19 who delivered between March 15th and July 4th in seven university affiliated hospitals in Israel. RESULTS: A total of 52 women with a confirmed diagnosis of COVID-19 delivered in the participating centers during the study period. The median gestational age at the time of delivery was 38 weeks, with 16 (30.8%) cases complicated by spontaneous preterm birth. Forty-three women (82.7%) underwent a trial of labor. The remaining 9 women underwent pre-labor cesarean delivery mostly due to obstetric indications, whereas one woman with a critical COVID-19 course underwent urgent cesarean delivery due to maternal deterioration. Among those who underwent a trial of labor (n = 43), 39 (90.7%) delivered vaginally, whereas 4 (9.3%) cases resulted in cesarean delivery. Neonatal RT-PCR nasopharyngeal swabs tested negative in all cases, and none of the infants developed pneumonia. No maternal and neonatal deaths were encountered. CONCLUSIONS: In this prospective study among SARS-CoV-2-infected mothers, vaginal delivery rates were high and associated with favorable outcomes with no cases of neonatal COVID-19. Our findings underscore that delivery management among SARS-CoV-2-infected mothers should be based on obstetric indications and may potentially reduce the high rates of cesarean delivery previously reported in this setting.


Subject(s)
COVID-19/diagnosis , Delivery, Obstetric/adverse effects , Delivery, Obstetric/methods , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy Complications, Infectious/diagnosis , Pregnant Women , SARS-CoV-2 , Adult , COVID-19/epidemiology , Cesarean Section/statistics & numerical data , Female , Gestational Age , Humans , Infant, Newborn , Israel/epidemiology , Pandemics , Perinatal Death , Pregnancy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Premature Birth/epidemiology , Premature Birth/virology , Prospective Studies , Vagina , Young Adult
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