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2.
Annali dell'Istituto Superiore di Sanita ; 57(4):272-285, 2021.
Article in English | ProQuest Central | ID: covidwho-1733123

ABSTRACT

Introduction. This study aimed to estimate the incidence of SARS-CoV-2 infection among pregnant women during the first pandemic wave in Italy, and to describe COVID-19 disease characteristics and maternal and perinatal outcomes. Materials and methods. National population-based prospective cohort study collecting information on women with SARS-CoV-2 diagnosis, confirmed within 7 days from hospital admission. Results. The national SARS-CoV-2 rate was 6.04 per 1,000 births (95% CI 5.62-6.49) among pregnant women and 7.54 (95% CI 7.47-7.61) among women in reproductive age. 72.1% of the cohort developed mild COVID-19 disease without pneumonia nor need for ventilatory support. Severe disease was significantly associated with women’s previous comorbidities (OR 2.55;95% CI 0.98-6.90), obesity (OR 4.76;95% CI 1.79-12.66) and citizenship from High Migration Pressure Countries (OR 3.43;95% CI 1.27-9.25). Conclusions. During the first pandemic wave in Italy, the SARS-CoV-2 rate among pregnant women was lower compared to that detected among women of reproductive age, and risks of severe COVID-19 disease and adverse maternal and perinatal outcomes were rare.

3.
Case Rep Womens Health ; 34: e00389, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1648754
4.
Eur J Contracept Reprod Health Care ; 27(1): 34-38, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1338597

ABSTRACT

PURPOSE: The COVID-19 pandemic and national lockdown from 9 March to 4 May 2020 changed social, familial, and sexual relationships, as well as how citizens interact with the health services. How these profound changes have affected sexuality, contraception and voluntary terminations of pregnancy is still largely undescribed. The main objective of this study was therefore to find out whether the COVID-19 pandemic and ensuing lockdown affected the demand for legal abortion. MATERIAL AND METHODS: The study period was divided into three phases: the pre-pandemic (January and February 2020); lockdown (March and April); and post-lockdown (May and June). The number and characteristics of women requesting pregnancy termination each month during that time were compared with the stats for the same months in the preceding three years (2017-2019). RESULTS: Immediately after national lockdown, the number of voluntary abortions markedly declined (-40.45%). The effect was more evident in women below 20 years of age (-66.67%), employed versus unemployed women (-42.71% vs. -21.05), and non-Italian versus Italian citizens (-53.01 vs. -32.85). No difference was found in the mean time from request to execution of the procedure, or in the type of the procedure used. CONCLUSION(S): National lockdown reduced the number of unwanted pregnancies, especially in younger women. The Italian health service's response to the demand appears to have been unaffected by the pandemic. However, as the demand for abortion is still high, probably due to unplanned pregnancies among cohabitants within a stable relationship, contraception guidance should be improved among women traditionally deemed low-risk in terms of sexual behaviour.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Female , Humans , Italy/epidemiology , Pregnancy , SARS-CoV-2
5.
Am J Obstet Gynecol MFM ; 3(4): 100329, 2021 07.
Article in English | MEDLINE | ID: covidwho-1198585

ABSTRACT

BACKGROUND: It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS: A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION: High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Pregnancy Outcome , Asia , Australia , Europe , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome/epidemiology , Retrospective Studies , SARS-CoV-2 , South America
6.
J Med Virol ; 93(3): 1758-1760, 2021 03.
Article in English | MEDLINE | ID: covidwho-1196463

ABSTRACT

Data from both New York and London report a high prevalence of the asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant patients admitted for delivery, raising questions on the possible correlated dangers (ie, contacts with healthcare workers; the possible creation of an intrahospital outbreak at birth; and conflicting evidence on vertical transmission). For this study, results from SARS-CoV-2 screening via nasopharyngeal swab from maternity wards of the four hospitals of Genoa, Italy, were collected during a month of complete lockdown from 1 April to 30 April 2020. Out of 333 tested women, only 9 were symptomatic. Only one symptomatic patient (0.3%) and six asymptomatic ones (1.8%) tested positive. Out of the six positive asymptomatic patients, five were from the most disadvantaged neighborhood of the city (assessed by postal code). In conclusion, even if Italy was badly affected by coronavirus disease 2019 in the studied month, the reported prevalence of SARS-CoV-2 infections in asymptomatic pregnant patients at term was lower than the ones reported in the literature.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , Adult , COVID-19/virology , Communicable Disease Control/methods , Disease Outbreaks/statistics & numerical data , Female , Health Personnel , Hospitalization/statistics & numerical data , Humans , Infectious Disease Transmission, Vertical/statistics & numerical data , Italy/epidemiology , London/epidemiology , Mass Screening/methods , New York/epidemiology , Pregnancy , Prevalence , SARS-CoV-2/pathogenicity
7.
Eur J Contracept Reprod Health Care ; 26(1): 87-88, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066134
9.
Menopause ; 28(5): 573-575, 2021 01 11.
Article in English | MEDLINE | ID: covidwho-1028141

ABSTRACT

OBJECTIVE: To evaluate whether the rates of COVID-19 infection and death in women versus men differ with age. METHODS: From data provided by the Italian National Institute of Statistics, we calculated the respective proportions of women among COVID-infected versus noninfected populations and male versus female infection and death rates, stratifying the results into 10-year age groups. RESULTS: The prevalence of COVID-19 infection was 3.6% higher in women than in the general population from 20 to 59 years of age, then decreased to -13.3% below that of the general population between 60 and 89 years of age. Death rates among infected women showed the opposite age-related trend. In infected women, the mortality rate was -77.4% lower than that of men aged 20 to 59 years. Between 60 and 89 years of age, the difference in women decreases to -34.5% below that of men. CONCLUSIONS: Our results indicate opposing age-related trends among women in infection and death rates due to COVID-19. Further studies are needed to examine the contribution of the phases of the female reproductive cycle to the observed variations.


Subject(s)
COVID-19 , Adolescent , Adult , Female , Humans , Italy , Male , Middle Aged , Mortality , Postmenopause , Prevalence , SARS-CoV-2 , Young Adult
10.
J Perinat Med ; 48(9): 950-958, 2020 11 26.
Article in English | MEDLINE | ID: covidwho-797424

ABSTRACT

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.


Subject(s)
Abortion, Spontaneous/epidemiology , Betacoronavirus , Coronavirus Infections/complications , Fetal Death , Perinatal Death , Pneumonia, Viral/complications , Pregnancy Complications, Infectious/virology , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , COVID-19 Vaccines , Clinical Laboratory Techniques , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Infectious Disease Transmission, Vertical/statistics & numerical data , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Reverse Transcriptase Polymerase Chain Reaction , Risk Factors , SARS-CoV-2
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