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1.
BMJ ; 378: e069741, 2022 Aug 10.
Article in English | MEDLINE | ID: covidwho-1986354

ABSTRACT

Pregnancy is an independent risk factor for severe covid-19. Vaccination is the best way to reduce the risk for SARS-CoV-2 infection and limit its morbidity and mortality. The current recommendations from the World Health Organization, Centers for Disease Control and Prevention, and professional organizations are for pregnant, postpartum, and lactating women to receive covid-19 vaccination. Pregnancy specific considerations involve potential effects of vaccination on fetal development, placental transfer of antibodies, and safety of maternal vaccination. Although pregnancy was an exclusion criterion in initial clinical trials of covid-19 vaccines, observational data have been rapidly accumulating and thus far confirm that the benefits of vaccination outweigh the potential risks. This review examines the evidence supporting the effectiveness, immunogenicity, placental transfer, side effects, and perinatal outcomes of maternal covid-19 vaccination. Additionally, it describes factors associated with vaccine hesitancy in pregnancy. Overall, studies monitoring people who have received covid-19 vaccines during pregnancy have not identified any pregnancy specific safety concerns. Additional information on non-mRNA vaccines, vaccination early in pregnancy, and longer term outcomes in infants are needed. To collect this information, vaccination during pregnancy must be prioritized in vaccine research.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Infant , Lactation , Placenta , Pregnancy , SARS-CoV-2 , Vaccination/adverse effects
2.
Women's Health Issues ; 2022.
Article in English | ScienceDirect | ID: covidwho-1984227

ABSTRACT

Background In response to the COVID-19 pandemic, health systems quickly implemented changes in care delivery with a goal of balancing patient-focused obstetric care with the need to protect pregnant persons and healthcare providers from infection. Yet, there is no consensus within the scientific community on the impact these measures have on obstetric outcomes in vulnerable populations. Objective We aimed to assess the impact of the COVID-19 pandemic on rates of obstetric procedures and severe maternal morbidity among births at an urban safety-net institution. Study design We used an interrupted time series design to calculate risk ratios (RRs) and 95% confidence intervals (CIs) comparing monthly rates of labor induction, cesarean births (overall and among nulliparous, term, singleton, vertex (NTSV) births), operative vaginal births, and severe maternal morbidity (SMM) among births occurring at a public hospital before (March 1, 2016-February 29, 2020) and during (March 1, 2020-May 31, 2021) the COVID-19 pandemic. Results There were 10,714 and 2,736 births in the pre-pandemic and post-pandemic periods, respectively. Overall, rates of obstetric interventions and SMM were constant over the two time periods. There were no significant differences in rates of labor induction (42% during pre-pandemic period vs 45% during pandemic period, RR 1.12, 95% CI 0.93-1.34), operative vaginal births (5% vs 6%, RR 1.24, 95% CI 0.88-1.76), cesarean births (28% vs 33%, RR 1.10, 95% CI 0.94-1.28), or NTSV cesarean births (24% vs 31%, RR 1.27, 95% CI 0.92-1.74). Rates of SMM (7% vs 8%, RR 1.19, 95% CI 0.86-1.65) were also unchanged. Conclusions Our findings indicate that the rapid implementation of measures to reduce viral transmission in the labor and delivery setting did not materially affect routine clinical management or rates of serious maternal complications.

3.
Am J Obstet Gynecol ; 223(6): 957-958, 2020 12.
Article in English | MEDLINE | ID: covidwho-1382169
4.
J Infect Dis ; 2022 Jun 29.
Article in English | MEDLINE | ID: covidwho-1978234

ABSTRACT

We examined the relationship between placental histopathology and transplacental antibody transfer in pregnant patients following SARS-CoV-2 infection. Differences in plasma concentrations of anti-Receptor Biding Domain (RBD) Immunoglobulin (Ig) G antibodies in maternal and cord blood were analyzed according to presence of placental injury. Median [IQR] anti-RBD IgG concentrations in cord blood with placental injury (n = 7) did not differ significantly from those without injury (n= 16) [(2.7 [1.8,3.6] vs 2.7[2.4, 2.9], p= 0.59). However, they were associated with lower transfer ratios (median [IQR] 0.77[0.61, 0.97] vs. 0.97[0.80, 1.01], p = 0.05) suggesting that SARS-CoV-2 placental injury mediates reduced maternal-fetal antibody transfer.

5.
Infect Dis Clin North Am ; 36(2): 423-433, 2022 06.
Article in English | MEDLINE | ID: covidwho-1977324

ABSTRACT

Pregnancy seems to be a risk factor for severe disease with COVID-19. Although SARS-CoV-2 intrauterine transmission seems to be rare, most studies show COVID-19 during pregnancy increases the risk for pregnancy complications, with higher risk among those with severe disease compared with those mildly affected. Studies suggest that COVID-19 vaccination during pregnancy is safe and effective. Antibodies to SARS-CoV-2 have been found in umbilical cord blood and breast milk following maternal vaccination, which might provide protection to the infant. However, vaccination rates during pregnancy remain low. Studies are needed to understand ways to address SARS-CoV-2 vaccine hesitancy among pregnant persons.


Subject(s)
COVID-19 , Viral Vaccines , COVID-19 Vaccines/adverse effects , Female , Humans , Pregnancy , SARS-CoV-2 , Vaccination
7.
Clin Infect Dis ; 73(9): e2810-e2813, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1501000

ABSTRACT

Infant outcomes after maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not well described. In a prospective US registry of 263 infants, maternal SARS-CoV-2 status was not associated with birth weight, difficulty breathing, apnea, or upper or lower respiratory infection through 8 weeks of age.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Premature Birth , Female , Humans , Infant , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Prospective Studies , Registries , SARS-CoV-2
8.
Am J Obstet Gynecol ; 226(2): 177-186, 2022 02.
Article in English | MEDLINE | ID: covidwho-1482415

ABSTRACT

Physiological, mechanical, and immunologic alterations in pregnancy could potentially affect the susceptibility to and the severity of COVID-19 during pregnancy. Owing to the lack of comparable incidence data and the challenges with disentangling differences in the susceptibility from different exposure risks, the data are insufficient to determine whether pregnancy increases the susceptibility to SARS-CoV-2 infection. The data support pregnancy as a risk factor for severe disease associated with COVID-19; some of the best evidence comes from the United States Centers for Disease Control and Prevention COVID-19 surveillance system, which reported that pregnant persons were more likely to be admitted to an intensive care unit, require invasive ventilation, require extracorporeal membrane oxygenation, and die than nonpregnant women of reproductive age. Although the intrauterine transmission of SARS-CoV-2 has been documented, it appears to be rare. It is possibly related to low levels of SARS-CoV-2 viremia and the decreased coexpression of angiotensin-converting enzyme 2 and transmembrane serine protease 2 needed for SARS-CoV-2 entry into cells in the placenta. Evidence is accumulating that SARS-CoV-2 infection during pregnancy is associated with a number of adverse pregnancy outcomes including preeclampsia, preterm birth, and stillbirth, especially among pregnant persons with severe COVID-19 disease. In addition to the direct impact of COVID-19 on pregnancy outcomes, there is evidence that the pandemic and its effects on healthcare systems have had adverse effects such as increased stillbirths and maternal deaths on the pregnancy outcomes. These trends may represent widening disparities and an alarming reversal of recent improvements in maternal and infant health. All the 3 COVID-19 vaccines currently available in the United States can be administered to pregnant or lactating persons, with no preference for the vaccine type. Although the safety data in pregnancy are rapidly accumulating and no safety signals in pregnancy have been detected, additional information about the birth outcomes, particularly among persons vaccinated earlier in pregnancy, are needed.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy Complications, Infectious/epidemiology , Premature Birth/epidemiology , Stillbirth/epidemiology , COVID-19/physiopathology , COVID-19/prevention & control , COVID-19/therapy , Disease Susceptibility , Female , Healthcare Disparities , Humans , Infectious Disease Transmission, Vertical , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/therapy , Risk Factors , SARS-CoV-2 , Severity of Illness Index
9.
Obstet Gynecol ; 138(2): 189-197, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1364849

ABSTRACT

OBJECTIVE: To characterize maternal immune response after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and quantify the efficiency of transplacental antibody transfer. METHODS: We conducted a prospective cohort study of pregnant patients who tested positive for SARS CoV-2 infection at any point in pregnancy and collected paired maternal and cord blood samples at the time of delivery. An enzyme-linked immunosorbent assay (ELISA) and neutralization assays were performed to measure maternal plasma and cord blood concentrations and neutralizing potency of immunoglobulin (Ig)G, IgA, and IgM antibodies directed against the SARS-CoV-2 spike protein. Differences in concentrations according to symptomatic compared with asymptomatic infection and time from positive polymerase chain reaction (PCR) test result to delivery were analyzed using nonparametric tests of significance. The ratio of cord to maternal anti-receptor-binding domain IgG titers was analyzed to assess transplacental transfer efficiency. RESULTS: Thirty-two paired samples were analyzed. Detectable anti-receptor-binding domain IgG was detected in 100% (n=32) of maternal and 91% (n=29) of cord blood samples. Functional neutralizing antibody was present in 94% (n=30) of the maternal and 25% (n=8) of cord blood samples. Symptomatic infection was associated with a significant difference in median (interquartile range) maternal anti-receptor-binding domain IgG titers compared with asymptomatic infection (log 3.2 [3.5-2.4] vs log 2.7 [2.9-1.4], P=.03). Median (interquartile range) maternal anti-receptor-binding domain IgG titers were not significantly higher in patients who delivered more than 14 days after a positive PCR test result compared with those who delivered within 14 days (log 3.3 [3.5-2.4] vs log 2.67 [2.8-1.6], P=.05). Median (range) cord/maternal antibody ratio was 0.81 (0.67-0.88). CONCLUSIONS: These results demonstrate robust maternal neutralizing and anti-receptor-binding domain IgG response after SARS-CoV-2 infection, yet a lower-than-expected efficiency of transplacental antibody transfer and a significant reduction in neutralization between maternal blood and cord blood. Maternal infection does confer some degree of neonatal antibody protection, but the robustness and durability of protection require further study.


Subject(s)
Antibody Formation , COVID-19/immunology , Maternal-Fetal Exchange , Pregnancy Complications, Infectious/immunology , SARS-CoV-2/immunology , Adult , Antibodies, Neutralizing , Asymptomatic Infections , Female , Humans , Pregnancy , Prospective Studies , Young Adult
11.
Emerg Infect Dis ; 27(5): 1505-1508, 2021 05.
Article in English | MEDLINE | ID: covidwho-1262597

ABSTRACT

We evaluated nucleic acid amplification testing (NAAT) for Zika virus on whole-blood specimens compared with NAAT on serum and urine specimens among asymptomatic pregnant women during the 2015-2016 Puerto Rico Zika outbreak. Using NAAT, more infections were detected in serum and urine than in whole blood specimens.


Subject(s)
Pregnancy Complications, Infectious , Zika Virus Infection , Zika Virus , Disease Outbreaks , Female , Humans , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Puerto Rico , Zika Virus Infection/epidemiology
13.
Obstet Gynecol ; 136(1): 192-193, 2020 07.
Article in English | MEDLINE | ID: covidwho-619669
14.
Obstet Gynecol ; 137(3): 408-414, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1066433

ABSTRACT

Coronavirus disease 2019 (COVID-19) vaccines have begun to be distributed across the United States and to be offered initially to priority groups including health care personnel and persons living in long-term care facilities. Guidance regarding whether pregnant persons should receive a COVID-19 vaccine is needed. Because pregnant persons were excluded from the initial phase 3 clinical trials of COVID-19 vaccines, limited data are available on their efficacy and safety during pregnancy. After developmental and reproductive toxicology studies are completed, some companies are expected to conduct clinical trials in pregnant persons. Until then, pregnant persons and their obstetricians will need to use available data to weigh the benefits and risks of COVID-19 vaccines. Issues to be considered when counseling pregnant persons include data from animal studies and inadvertently exposed pregnancies during vaccine clinical trials when available, potential risks to pregnancy of vaccine reactogenicity, timing of vaccination during pregnancy, evidence for safety of other vaccines during pregnancy, risk of COVID-19 complications due to pregnancy and the pregnant person's underlying conditions, and risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and potential for risk mitigation. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine have each issued guidance supportive of offering COVID-19 vaccine to pregnant persons. As additional information from clinical trials and from data collected on vaccinated pregnant persons becomes available, it will be critical for obstetricians to keep up to date with this information.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Health Knowledge, Attitudes, Practice , Pregnancy Complications, Infectious/prevention & control , COVID-19/transmission , Centers for Disease Control and Prevention, U.S. , Clinical Trials as Topic , Female , Humans , Infectious Disease Transmission, Vertical , Practice Guidelines as Topic , Pregnancy , SARS-CoV-2 , Societies, Medical , United States , Vaccination
16.
Obstet Gynecol ; 136(6): 1117-1125, 2020 12.
Article in English | MEDLINE | ID: covidwho-1020290

ABSTRACT

OBJECTIVE: To describe the clinical presentation, symptomology, and disease course of coronavirus disease 2019 (COVID-19) in pregnancy. METHODS: The PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) study is an ongoing nationwide prospective cohort study of people in the United States who are pregnant or up to 6 weeks postpregnancy with known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed the clinical presentation and disease course of COVID-19 in participants who tested positive for SARS-CoV-2 infection and reported symptoms at the time of testing. RESULTS: Of 991 participants enrolled from March 22, 2020, until July 10, 2020, 736 had symptoms of COVID-19 at the time of testing; 594 tested positive for SARS-CoV-2 infection and 142 tested negative in this symptomatic group. Mean age was 31.3 years (SD 5.1), and 37% will nulliparous. Ninety-five percent were outpatients. Participants who tested positive for SARS-CoV-2-infection were a geographically diverse cohort: 34% from the Northeast, 25% from the West, 21% from the South, and 18% from the Midwest. Thirty-one percent of study participants were Latina, and 9% were Black. The average gestational age at enrollment was 24.1 weeks, and 13% of participants were enrolled after pregnancy. The most prevalent first symptoms in the cohort of patients who tested positive for SARS-CoV-2 infection were cough (20%), sore throat (16%), body aches (12%), and fever (12%). Median time to symptom resolution was 37 days (95% CI 35-39). One quarter (25%) of participants who tested positive for SARS-CoV-2 infection had persistent symptoms 8 or more weeks after symptom onset. CONCLUSION: COVID-19 has a prolonged and nonspecific disease course during pregnancy and in the 6 weeks after pregnancy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04323839.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adult , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Female , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/virology , Prospective Studies , Risk Factors , SARS-CoV-2 , Symptom Assessment , United States/epidemiology , Young Adult
18.
Fertil Steril ; 115(4): 824-830, 2021 04.
Article in English | MEDLINE | ID: covidwho-1002525

ABSTRACT

COVID-19 was officially declared a pandemic in March 2020. Since then, our understanding of its effects on pregnancy have evolved rapidly. Emerging surveillance data and large cohort studies suggest that pregnancy is associated with an increased risk of intensive care unit hospitalization, invasive ventilation, and death. Pregnancies complicated by SARS-CoV-2 infection are associated with increased likelihood of cesarean delivery and preterm birth. Intrauterine transmission occurs, but seems to be rare. Critical gaps remain, and rigorous high-quality data are needed to better ascertain pregnancy risks and to inform antenatal and obstetrical management.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/epidemiology , Reproductive Medicine/trends , COVID-19/prevention & control , Cohort Studies , Female , Humans , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome/epidemiology , Reproductive Medicine/methods
19.
Obstet Gynecol ; 137(3): 408-414, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-998491

ABSTRACT

Coronavirus disease 2019 (COVID-19) vaccines have begun to be distributed across the United States and to be offered initially to priority groups including health care personnel and persons living in long-term care facilities. Guidance regarding whether pregnant persons should receive a COVID-19 vaccine is needed. Because pregnant persons were excluded from the initial phase 3 clinical trials of COVID-19 vaccines, limited data are available on their efficacy and safety during pregnancy. After developmental and reproductive toxicology studies are completed, some companies are expected to conduct clinical trials in pregnant persons. Until then, pregnant persons and their obstetricians will need to use available data to weigh the benefits and risks of COVID-19 vaccines. Issues to be considered when counseling pregnant persons include data from animal studies and inadvertently exposed pregnancies during vaccine clinical trials when available, potential risks to pregnancy of vaccine reactogenicity, timing of vaccination during pregnancy, evidence for safety of other vaccines during pregnancy, risk of COVID-19 complications due to pregnancy and the pregnant person's underlying conditions, and risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and potential for risk mitigation. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine have each issued guidance supportive of offering COVID-19 vaccine to pregnant persons. As additional information from clinical trials and from data collected on vaccinated pregnant persons becomes available, it will be critical for obstetricians to keep up to date with this information.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Health Knowledge, Attitudes, Practice , Pregnancy Complications, Infectious/prevention & control , COVID-19/transmission , Centers for Disease Control and Prevention, U.S. , Clinical Trials as Topic , Female , Humans , Infectious Disease Transmission, Vertical , Practice Guidelines as Topic , Pregnancy , SARS-CoV-2 , Societies, Medical , United States , Vaccination
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