Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 10 de 10
Filter
1.
Journal of Clinical Medicine ; 11(8):2212, 2022.
Article in English | MDPI | ID: covidwho-1792643

ABSTRACT

The outbreak of a pandemic has negative psychological effects. We aimed to determine the impact of the SARS-CoV-2 pandemic during pregnancy and identify the risk factors for maternal well-being. A multicenter, prospective, population-based study was carried out that included women (n = 1320) who were pregnant during the SARS-CoV-2 pandemic in Barcelona (Spain) compared against a pre-pandemic cohort (n = 345). Maternal well-being was assessed using the validated World Health Organization Well-Being Index Questionnaire (WHO-5 Index). Pregnant women attended during the COVID-19 pandemic showed worst WHO-5 well-being scores (median (IQR) of 56 (36–72) for the pandemic cohort vs. 64 (52–76) for the pre-pandemic cohort p < 0.001), with 42.8% of women presenting a poor well-being score vs. 28% for the pre-pandemic cohort (p < 0.001). Presence of a previous psychiatric disorder (OR 7.1;95% CI 2.6–19, p < 0.001), being in the third trimester of pregnancy (OR 1.7;95% CI 1.5–2, p < 0.001), or requiring hospital admission for COVID-19 (OR 4.7;95% CI 1.4–16.7, p = 0.014), significantly contributed to low maternal well-being during the COVID-19 pandemic (multivariate analysis). Being infected by SARS-CoV-2 was not associated with a lower well-being score. We conclude that, during the COVID-19 pandemic, there were higher rates of poor maternal well-being;the infection of SARS-CoV-2 itself did not worsen maternal well-being, but other factors as psychiatric disorders, being in the third trimester of pregnancy or hospital admission for COVID-19 disease did.

2.
Am J Obstet Gynecol ; 2022 Mar 26.
Article in English | MEDLINE | ID: covidwho-1757079

ABSTRACT

BACKGROUND: COVID-19 presents a spectrum of signs and symptoms in pregnant women that might resemble preeclampsia. Differentiation between severe COVID-19 and preeclampsia is difficult in some cases. OBJECTIVE: To study biomarkers of endothelial damage, coagulation, innate immune response and angiogenesis in preeclampsia and COVID-19 in pregnancy in addition to in vitro alterations in endothelial cells exposed to sera from pregnant women with preeclampsia and COVID-19. METHODS: Plasma and sera samples were obtained from pregnant women with COVID-19 infection classified into mild (n=10) or severe (n=9) in addition to normotensive pregnancies as controls (n=10) and patients with preeclampsia (n=13). A panel of plasmatic biomarkers was assessed including vascular cell adhesion molecule-1 (VCAM-1), soluble TNF-receptor I (sTNFRI), heparan sulfate (HS), von Willebrand factor (VWF) antigen, activity and multimeric pattern, α2-antiplasmin (α2AP), C5b9, neutrophil extracellular traps (NETS), placental growth factor (PlGF), fms-like tyrosine kinase-1 (sFlt-1) and angiopoietin 2 (Ang2). Additionally, microvascular endothelial cells were exposed patient's serum, and changes in the cell expression of intercellular adhesion molecule 1 (ICAM-1) on cell membrane and VWF release to the extracellular matrix were evaluated through immunofluorescence. Changes in inflammation cell signaling pathways were also assessed by of P38MAPK phosphorylation. Statistical analysis included univariate and multivariate methods. RESULTS: Biomarker profiles in mild COVID-19 were similar to controls. Both preeclampsia and severe COVID-19 showed significant alterations in the majority of circulating biomarkers with distinctive profiles. While severe COVID-19 exhibited higher concentrations of VCAM-1, sTNFR-I, HS, VWF antigen and NETS with a significant reduction of PlGF as compared to controls; preeclampsia presented a marked increase in VCAM-1, sTNFR-I (significantly increased compared to controls and to severe COVID-19) with a striking reduction in VWF antigen, VWF activity and α2AP. As expected, reduced PlGF, increased sFlt-1 and Ang2 and a very high sFlt-1/PlGF ratio were also observed in preeclampsia. In addition, a significant increase in C5b9 and NETS was also detected in preeclampsia compared to controls. The principal component analysis demonstrated a clear separation between preeclampsia and the rest of groups (first and second components explained 42.2% and 13.5% of the variance), mainly differentiated by variables related to VWF, sTNFRI, HS and sFlt-1. VWF multimeric analysis revealed the absence of VWF high-molecular-weight multimers in preeclampsia (similar profile to von Willebrand disease type 2A) whereas in healthy pregnancies and COVID-19 patients, VWF multimeric pattern was normal. Sera from both preeclampsia and severe COVID-19 patients induced an overexpression of ICAM-1 and VWF in endothelial cells in culture compared to controls. However, the effect of preeclampsia was less pronounced than the one triggered by severe COVID-19. Immunoblots of lysates from endothelial cells exposed to mild and severe COVID-19, and preeclampsia sera showed an increase in p38MAPK phosphorylation. Severe COVID-19 and preeclampsia were statistically different from controls, suggesting that both severe COVID-19 and preeclampsia sera can activate inflammatory signaling pathways. CONCLUSION: While similar in vitro endothelial dysfunction, preeclampsia and severe COVID-19 exhibit distinctive profiles of circulating biomarkers related to endothelial damage, coagulopathy and angiogenic imbalance that could aid in the differential diagnosis of these entities.

3.
Fetal Diagn Ther ; 2022 Mar 09.
Article in English | MEDLINE | ID: covidwho-1736174

ABSTRACT

OBJECTIVE: Second and third trimester SARS-CoV-2 infections may have an increased risk of obstetric complications. However, data on first-trimester infections are scarce. We sought to characterize the clinical and inflammatory presentation, and pregnancy outcomes of first-trimester infections. METHODS: A population-based multicenter study including 817 singleton pregnancies with SARS-CoV-2 serologic testing at 8-14 weeks between March and May 2020. Blood count, uterine artery Doppler and pregnancy-associated plasma protein A (PAPP-A) were performed in all women. Placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), IL-6 and ferritin were determined in positive women. Obstetric outcomes were evaluated. RESULTS: The prevalence of first-trimester infection was 15.2% (n=124). 72.6% of positive women were asymptomatic. Symptomatic women had higher rates of lymphopenia (1.91x109/L vs 2.16x109/L, P=0.017), and increased levels of IL-6 (9.1% vs 1.2%, P=0.051), but lower rates of decreased ferritin (6.3% vs 19.8%, P=0.015). PAPP-A was higher in symptomatic women compared with asymptomatic and negative women (1.44 (IQR 0.90-1.82) vs 1.08 (IQR 0.66-1.61) P=0.014, vs 1.08 (IQR 0.77-1.55) P=0.019, respectively). Obstetric outcomes were not increased. CONCLUSIONS: First-trimester SARS-CoV-2 infections are mostly asymptomatic, with a mild increase of inflammatory markers in symptomatic women. Obstetric complications were not increased, but PAPP-A levels were higher in symptomatic women.

4.
Clin Infect Dis ; 73(10): 1768-1775, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1522134

ABSTRACT

BACKGROUND: We performed a population-based study to describe the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on pregnancy outcomes. METHODS: This prospective, population-based study included pregnant women who consecutively presented at first/second trimester visits or at delivery at 3 hospitals in Barcelona, Spain. SARS-CoV-2 antibodies (immunoglobulin [Ig] G and IgM/IgA) were measured in all participants, and nasopharyngeal real-time polymerase chain reaction (RT-PCR) was performed at delivery. The primary outcome was a composite of pregnancy complications in SARS-CoV-2-positive vs negative women that included miscarriage, preeclampsia, preterm delivery, perinatal death, small-for-gestational-age newborn, or neonatal admission. Secondary outcomes were components of the primary outcome plus abnormal fetal growth, malformation, or intrapartum fetal distress. Outcomes were also compared between positive symptomatic and positive asymptomatic SARS-CoV-2 women. RESULTS: Of 2225 pregnant women, 317 (14.2%) were positive for SARS-CoV-2 antibodies (n = 314, 99.1%) and/or RT-PCR (n = 36, 11.4%). Among positive women, 217 (68.5%) were asymptomatic, 93 (29.3%) had mild coronavirus disease 2019 (COVID-19), and 7 (2.2%) had pneumonia, of whom 3 required intensive care unit admission. In women with and without SARS-CoV-2 infection, the primary outcome occurred in 43 (13.6%) and 268 (14%), respectively (risk difference, -0.4%; 95% confidence interval, -4.1% to 4.1). Compared with noninfected women, those with symptomatic COVID-19 had increased rates of preterm delivery (7.2% vs 16.9%, P = .003) and intrapartum fetal distress (9.1% vs 19.2%, P = .004), while asymptomatic women had rates that were similar to those of noninfected cases. Among 143 fetuses from infected mothers, none had anti-SARS-CoV-2 IgM/IgA in cord blood. CONCLUSIONS: The overall rate of pregnancy complications in women with SARS-CoV-2 infection was similar to that of noninfected women. However, symptomatic COVID-19 was associated with modest increases in preterm delivery and intrapartum fetal distress.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Prospective Studies , SARS-CoV-2
6.
Sci Rep ; 11(1): 18984, 2021 09 23.
Article in English | MEDLINE | ID: covidwho-1437691

ABSTRACT

Serological diagnostic of the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is a valuable tool for the determination of immunity and surveillance of exposure to the virus. In the context of an ongoing pandemic, it is essential to externally validate widely used tests to assure correct diagnostics and epidemiological estimations. We evaluated the performance of the COVID-19 ELISA IgG and the COVID-19 ELISA IgM/A (Vircell, S.L.) against a highly specific and sensitive in-house Luminex immunoassay in a set of samples from pregnant women and cord blood. The agreement between both assays was moderate to high for IgG but low for IgM/A. Considering seropositivity by either IgG and/or IgM/A, the technical performance of the ELISA was highly imbalanced, with 96% sensitivity at the expense of 22% specificity. As for the clinical performance, the negative predictive value reached 87% while the positive predictive value was 51%. Our results stress the need for highly specific and sensitive assays and external validation of diagnostic tests with different sets of samples to avoid the clinical, epidemiological and personal disturbances derived from serological misdiagnosis.


Subject(s)
COVID-19 Serological Testing/methods , Enzyme-Linked Immunosorbent Assay/methods , SARS-CoV-2/immunology , Antibodies, Viral/blood , COVID-19/diagnosis , COVID-19 Serological Testing/trends , Female , Fetal Blood/immunology , Humans , Immunoassay/methods , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Pandemics , Pregnancy , Sensitivity and Specificity , Serologic Tests/methods
7.
Arch Dis Child Fetal Neonatal Ed ; 107(2): 216-221, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1367412

ABSTRACT

OBJECTIVES: To develop and validate a specific protocol for SARS-CoV-2 detection in breast milk matrix and to determine the impact of maternal SARS-CoV-2 infection on the presence, concentration and persistence of specific SARS-CoV-2 antibodies. DESIGN AND PATIENTS: This is a prospective, multicentre longitudinal study (April-December 2020) in 60 mothers with SARS-CoV-2 infection and/or who have recovered from COVID-19. A control group of 13 women before the pandemic were also included. SETTING: Seven health centres from different provinces in Spain. MAIN OUTCOME MEASURES: Presence of SARS-CoV-2 RNA in breast milk, targeting the N1 region of the nucleocapsid gene and the envelope (E) gene; presence and levels of SARS-CoV-2-specific immunoglobulins (Igs)-IgA, IgG and IgM-in breast milk samples from patients with COVID-19. RESULTS: All breast milk samples showed negative results for presence of SARS-CoV-2 RNA. We observed high intraindividual and interindividual variability in the antibody response to the receptor-binding domain of the SARS-CoV-2 spike protein for each of the three isotypes IgA, IgM and IgG. Main Protease (MPro) domain antibodies were also detected in milk. 82.9% (58 of 70) of milk samples were positive for at least one of the three antibody isotypes, with 52.9% of these positive for all three Igs. Positivity rate for IgA was relatively stable over time (65.2%-87.5%), whereas it raised continuously for IgG (from 47.8% for the first 10 days to 87.5% from day 41 up to day 206 post-PCR confirmation). CONCLUSIONS: Our study confirms the safety of breast feeding and highlights the relevance of virus-specific SARS-CoV-2 antibody transfer. This study provides crucial data to support official breastfeeding recommendations based on scientific evidence. Trial registration number NCT04768244.


Subject(s)
COVID-19/epidemiology , COVID-19/immunology , Milk, Human/immunology , Adult , Antibodies, Viral/analysis , Coronavirus Envelope Proteins/analysis , Coronavirus Nucleocapsid Proteins/analysis , Female , Humans , Immunoglobulins/analysis , Longitudinal Studies , Phosphoproteins/analysis , Prospective Studies , RNA, Viral/analysis , SARS-CoV-2 , Spain
8.
Minerva Obstet Gynecol ; 73(4): 471-481, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1348831

ABSTRACT

Fetal growth restriction is one of the most common obstetric complications, affecting 7-10% of all pregnancies. Affected fetuses are exposed to an adverse environment in utero during a critical time of development and may face long-term health consequences such as increased cardiovascular risk in adulthood. Growth restricted fetuses develop remodeled hearts with signs of systolic and diastolic dysfunction. Cardiac adaptations are more evident in early severe cases, but also present in late onset fetal growth restriction. Cardiovascular remodeling persists into postnatal life, from the neonatal period to adolescence, encompassing an increased susceptibility to adult disease. In this review, we summarize the current evidence on cardiovascular programming associated to fetal growth restriction, its postnatal consequences and potential strategies to reduce their cardiovascular risk.


Subject(s)
Cardiovascular System , Fetal Growth Retardation , Adolescent , Adult , Female , Fetus , Heart , Humans , Infant, Newborn , Pregnancy , Ventricular Remodeling
9.
Sci Rep ; 11(1): 2909, 2021 02 03.
Article in English | MEDLINE | ID: covidwho-1062773

ABSTRACT

The identification of factors predisposing to severe COVID-19 in young adults remains partially characterized. Low birth weight (LBW) alters cardiovascular and lung development and predisposes to adult disease. We hypothesized that LBW is a risk factor for severe COVID-19 in non-elderly subjects. We analyzed a prospective cohort of 397 patients (18-70 years) with laboratory-confirmed SARS-CoV-2 infection attended in a tertiary hospital, where 15% required admission to Intensive Care Unit (ICU). Perinatal and current potentially predictive variables were obtained from all patients and LBW was defined as birth weight ≤ 2.500 g. Age (adjusted OR (aOR) 1.04 [1-1.07], P = 0.012), male sex (aOR 3.39 [1.72-6.67], P < 0.001), hypertension (aOR 3.37 [1.69-6.72], P = 0.001), and LBW (aOR 3.61 [1.55-8.43], P = 0.003) independently predicted admission to ICU. The area under the receiver-operating characteristics curve (AUC) of this model was 0.79 [95% CI, 0.74-0.85], with positive and negative predictive values of 29.1% and 97.6% respectively. Results were reproduced in an independent cohort, from a web-based survey in 1822 subjects who self-reported laboratory-positive SARS-CoV-2 infection, where 46 patients (2.5%) needed ICU admission (AUC 0.74 [95% CI 0.68-0.81]). LBW seems to be an independent risk factor for severe COVID-19 in non-elderly adults and might improve the performance of risk stratification algorithms.


Subject(s)
COVID-19/pathology , Infant, Low Birth Weight , Adolescent , Adult , Aged , Area Under Curve , COVID-19/virology , Female , Humans , Intensive Care Units/statistics & numerical data , Logistic Models , Male , Middle Aged , Prospective Studies , ROC Curve , Risk Factors , SARS-CoV-2/isolation & purification , Self Report , Severity of Illness Index , Surveys and Questionnaires , Tertiary Care Centers , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL