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1.
J Immunol ; 208(8): 1857-1872, 2022 04 15.
Article in English | MEDLINE | ID: covidwho-1776405

ABSTRACT

Pregnant women are at increased risk of adverse outcomes, including preeclampsia and preterm birth, that may result from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Pregnancy imprints specific maternal immune responses that can modulate host susceptibility to microbial infection; therefore, recent studies have focused on the humoral response against SARS-CoV-2 in pregnant women. However, the pregnancy-specific cellular immune responses triggered by SARS-CoV-2 infection are poorly understood. In this study, we undertook an extensive in vitro investigation to determine the cellular immune responses to SARS-CoV-2 particles and proteins/peptides in pregnant women. First, we show that SARS-CoV-2 particles do not alter the pregnancy-specific oxidative burst of neutrophils and monocytes. Yet, SARS-CoV-2 particles/proteins shift monocyte activation from the classical to intermediate states in pregnant, but not in nonpregnant, women. Furthermore, SARS-CoV-2 proteins, but not particles or peptide pools, mildly enhance T cell activation during pregnancy. As expected, B cell phenotypes are heavily modulated by SARS-CoV-2 particles in all women; yet, pregnancy itself further modified such responses in these adaptive immune cells. Lastly, we report that pregnancy itself governs cytokine responses in the maternal circulation, of which IFN-ß and IL-8 were diminished upon SARS-CoV-2 challenge. Collectively, these findings highlight the differential in vitro responses to SARS-CoV-2 in pregnant and nonpregnant women and shed light on the immune mechanisms implicated in coronavirus disease 2019 during pregnancy.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Premature Birth , Female , Humans , Immunity, Cellular , Infant, Newborn , Pregnancy , Pregnancy Outcome , Pregnant Women , SARS-CoV-2
2.
Am J Obstet Gynecol ; 226(3): 327-334, 2022 03.
Article in English | MEDLINE | ID: covidwho-1734133
3.
Critical Times ; 4(3):595-616, 2021.
Article in English | ProQuest Central | ID: covidwho-1714682

ABSTRACT

Texto curatorial por Paula Berbert and Roberto Romero Quando a ameaça da Covid-19 alcançou os Tikmũ’ũn, em março de 2020, a memória das histórias dos antigos e de como, no passado, eles quase foram dizimados pelas doenças trazidas pelos brancos imediatamente vieram à tona. Habitantes milenares das florestas de Mata Atlântica que cobriam todo o leito dos rios Pardo, Jequitinhonha e Mucuri, os Tikmũ’ũn, mais conhecidos como Maxakali, chegaram a ser contados em apenas 49 pessoas no início da década de 1940. Desse modo, a necessidade de se proteger de uma pandemia não chegou a eles propriamente como uma novidade. Diante dessa urgência, Isael Maxakali—artista, cineasta, professor e uma das mais jovens e proeminentes lideranças de seu povo—, reuniu os homens e mulheres de sua comunidade para iniciar a quarentena. Juntos fixaram uma placa na entrada de Aldeia Verde com os dizeres: “Yãmĩyxop yã ka'ok! (Os yãmĩyxop...

4.
Am J Obstet Gynecol ; 226(2S): S844-S866, 2022 02.
Article in English | MEDLINE | ID: covidwho-1705227

ABSTRACT

Preeclampsia is one of the "great obstetrical syndromes" in which multiple and sometimes overlapping pathologic processes activate a common pathway consisting of endothelial cell activation, intravascular inflammation, and syncytiotrophoblast stress. This article reviews the potential etiologies of preeclampsia. The role of uteroplacental ischemia is well-established on the basis of a solid body of clinical and experimental evidence. A causal role for microorganisms has gained recognition through the realization that periodontal disease and maternal gut dysbiosis are linked to atherosclerosis, thus possibly to a subset of patients with preeclampsia. The recent reports indicating that SARS-CoV-2 infection might be causally linked to preeclampsia are reviewed along with the potential mechanisms involved. Particular etiologic factors, such as the breakdown of maternal-fetal immune tolerance (thought to account for the excess of preeclampsia in primipaternity and egg donation), may operate, in part, through uteroplacental ischemia, whereas other factors such as placental aging may operate largely through syncytiotrophoblast stress. This article also examines the association between gestational diabetes mellitus and maternal obesity with preeclampsia. The role of autoimmunity, fetal diseases, and endocrine disorders is discussed. A greater understanding of the etiologic factors of preeclampsia is essential to improve treatment and prevention.


Subject(s)
Pre-Eclampsia/etiology , Pre-Eclampsia/physiopathology , Female , Humans , Pregnancy
5.
EuropePMC;
Preprint in Portuguese | EuropePMC | ID: ppcovidwho-328039

ABSTRACT

Objetivos: Determinar los factores asociados a la automedicación con fármacos relacionados con COVID-19 en estudiantes de ciencias de la salud. Material y métodos: Estudio observacional, analítico transversal, en estudiantes de ciencias de la salud de Tacna-Perú. Mediante un cuestionario virtual se recolectaron variables socioeducativas, prácticas, características de automedicación y exposición a COVID-19. El resultado fue automático en los últimos 3 meses con al menos 1 de 14 fármacos. Se calcularon las razones de prevalencia mediante los modelos lineales generalizados. Resultados:De los 718 estudiantes, el 51,3% se había automedicado. 62,2% se automedicó por presentar dos o más síntomas respiratorios siendo los fármacos más utilizados los antipiréticos, analgésicos y corticoides. Tuvieron mayor frecuencia de automedicación los estudiantes con pareja sentimental (RP: 1,33;IC95%: 1,16-1,53), de una universidad particular (RP: 1,36;IC95%: 1,10-1,69 ), que sus padres o familiares se automediquen algunas veces o siempre (RP: 2,34;IC95%: 1,58–3,47) y en los que se realizaron una prueba de tamizaje para COVID-19 (RP: 1, 47;IC95%: 1,14-1,89). Conclusiones:Encontramos una alta prevalencia de automedicación. Tuvieron mayor frecuencia de automedicación quienes tenían una pareja sentimental, proceden de una universidad particular, que sus padres o familiares se automediquen y en quienes se realizaron una prueba de tamizaje para COVID-19, lo cual podría ser utilizado para promover el uso racional de medicamentos .

6.
Nat Commun ; 13(1): 320, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1632529

ABSTRACT

Pregnant women represent a high-risk population for severe/critical COVID-19 and mortality. However, the maternal-fetal immune responses initiated by SARS-CoV-2 infection, and whether this virus is detectable in the placenta, are still under investigation. Here we show that SARS-CoV-2 infection during pregnancy primarily induces unique inflammatory responses at the maternal-fetal interface, which are largely governed by maternal T cells and fetal stromal cells. SARS-CoV-2 infection during pregnancy is also associated with humoral and cellular immune responses in the maternal blood, as well as with a mild cytokine response in the neonatal circulation (i.e., umbilical cord blood), without compromising the T-cell repertoire or initiating IgM responses. Importantly, SARS-CoV-2 is not detected in the placental tissues, nor is the sterility of the placenta compromised by maternal viral infection. This study provides insight into the maternal-fetal immune responses triggered by SARS-CoV-2 and emphasizes the rarity of placental infection.


Subject(s)
COVID-19/immunology , Immunity/immunology , Infectious Disease Transmission, Vertical , Placenta/immunology , Pregnancy Complications, Infectious/immunology , SARS-CoV-2/immunology , Adult , COVID-19/blood , COVID-19/virology , Cytokines/blood , Cytokines/immunology , Cytokines/metabolism , Female , Humans , Immunoglobulin G/blood , Immunoglobulin G/immunology , Immunoglobulin M/blood , Immunoglobulin M/immunology , Infant, Newborn , Placenta/virology , Pregnancy , Pregnancy Complications, Infectious/blood , Pregnancy Complications, Infectious/virology , RNA, Viral/genetics , RNA, Viral/metabolism , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , SARS-CoV-2/physiology , Young Adult
7.
Am J Obstet Gynecol ; 225(6): 593.e1-593.e9, 2021 12.
Article in English | MEDLINE | ID: covidwho-1439825

ABSTRACT

Pregnant individuals infected with SARS-CoV-2 have higher rates of intensive care unit admission, oxygen requirement, need for mechanical ventilation, and death than nonpregnant individuals. Increased COVID-19 disease severity may be associated with an increased risk of viremia and placental infection. Maternal SARS-CoV-2 infection is also associated with pregnancy complications such as preeclampsia and preterm birth, which can be either placentally mediated or reflected in the placenta. Maternal viremia followed by placental infection may lead to maternal-fetal transmission (vertical), which affects 1% to 3% of exposed newborns. However, there is no agreed-upon or standard definition of placental infection. The National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a group of experts to propose a working definition of placental infection to inform ongoing studies of SARS-CoV-2 during pregnancy. Experts recommended that placental infection be defined using techniques that allow virus detection and localization in placental tissue by one or more of the following methods: in situ hybridization with antisense probe (detects replication) or a sense probe (detects viral messenger RNA) or immunohistochemistry to detect viral nucleocapsid or spike proteins. If the abovementioned methods are not possible, reverse transcription polymerase chain reaction detection or quantification of viral RNA in placental homogenates, or electron microscopy are alternative approaches. A graded classification for the likelihood of placental infection as definitive, probable, possible, and unlikely was proposed. Manuscripts reporting placental infection should describe the sampling method (location and number of samples collected), method of preservation of tissue, and detection technique. Recommendations were made for the handling of the placenta, examination, and sampling and the use of validated reagents and sample protocols (included as appendices).


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Placenta Diseases/diagnosis , Placenta Diseases/virology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/virology , SARS-CoV-2 , COVID-19 Nucleic Acid Testing , Consensus , Female , Guidelines as Topic , Humans , Immunohistochemistry , In Situ Hybridization , Microscopy, Electron , National Institute of Child Health and Human Development (U.S.) , Pregnancy , United States/epidemiology
10.
Am J Obstet Gynecol ; 226(1): 68-89.e3, 2022 01.
Article in English | MEDLINE | ID: covidwho-1321954

ABSTRACT

OBJECTIVE: To examine the relationship between SARS-CoV-2 infection during pregnancy and the risk for preeclampsia. DATA SOURCES: MEDLINE, Embase, POPLINE, CINAHL, LILACS, and the World Health Organization COVID-19, Chinese, and preprint databases (all from December 1, 2019, to May 31, 2021). Google Scholar, bibliographies, and conference proceedings were also searched. STUDY ELIGIBILITY CRITERIA: Observational studies that assessed the association between SARS-CoV-2 infection during pregnancy and preeclampsia and that reported unadjusted and/or adjusted risk estimates and 95% confidence intervals or data to calculate them. STUDY APPRAISAL AND SYNTHESIS METHODS: The primary outcome was preeclampsia. Secondary outcomes included preeclampsia with severe features, preeclampsia without severe features, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Two reviewers independently reviewed studies for inclusion, assessed their risk of bias, and extracted data. Pooled unadjusted and adjusted odds ratios with 95% confidence intervals, and 95% prediction interval were calculated. Heterogeneity was quantified using the І2 statistic, for which І2≥30% indicated substantial heterogeneity. Subgroup and sensitivity analyses were performed to test the robustness of the overall findings. RESULTS: A total of 28 studies comprising 790,954 pregnant women, among which 15,524 were diagnosed with SARS-CoV-2 infection, met the inclusion criteria. The meta-analysis of unadjusted odds ratios showed that the odds of developing preeclampsia were significantly higher among pregnant women with SARS-CoV-2 infection than among those without SARS-CoV-2 infection (7.0% vs 4.8%; pooled odds ratio, 1.62; 95% confidence interval, 1.45-1.82; P<.00001; І2=17%; 26 studies; 95% prediction interval of the odds ratio, 1.28-2.05). The meta-analysis of adjusted odds ratios also showed that SARS-CoV-2 infection during pregnancy was associated with a significant increase in the odds of preeclampsia (pooled odds ratio, 1.58; 95% confidence interval, 1.39-1.80; P<.0001; І2=0%; 11 studies). There was a statistically significant increase in the odds of preeclampsia with severe features (odds ratio, 1.76; 95% confidence interval, 1.18-2.63; І2=58%; 7 studies), eclampsia (odds ratio, 1.97; 95% confidence interval, 1.01-3.84; І2=0%, 3 studies), and HELLP syndrome (odds ratio, 2.10; 95% confidence interval, 1.48-2.97; 1 study) among pregnant women with SARS-CoV-2 infection when compared to those without the infection. Overall, the direction and magnitude of the effect of SARS-CoV-2 infection during pregnancy on preeclampsia was consistent across most prespecified subgroup and sensitivity analyses. Both asymptomatic and symptomatic SARS-CoV-2 infections significantly increased the odds of developing preeclampsial; however, it was higher among patients with symptomatic illness (odds ratio, 2.11; 95% confidence interval, 1.59-2.81) than among those with asymptomatic illness (odds ratio, 1.59; 95% confidence interval, 1.21-2.10). CONCLUSION: SARS-CoV-2 during pregnancy is associated with higher odds of preeclampsia.


Subject(s)
COVID-19/complications , Pre-Eclampsia/etiology , Pregnancy Complications, Infectious , SARS-CoV-2 , Female , Humans , Pregnancy , Public Health , Risk
11.
Elife ; 92020 07 14.
Article in English | MEDLINE | ID: covidwho-646829

ABSTRACT

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 10 million people, including pregnant women. To date, no consistent evidence for the vertical transmission of SARS-CoV-2 exists. The novel coronavirus canonically utilizes the angiotensin-converting enzyme 2 (ACE2) receptor and the serine protease TMPRSS2 for cell entry. Herein, building upon our previous single-cell study (Pique-Regi et al., 2019), another study, and new single-cell/nuclei RNA-sequencing data, we investigated the expression of ACE2 and TMPRSS2 throughout pregnancy in the placenta as well as in third-trimester chorioamniotic membranes. We report that co-transcription of ACE2 and TMPRSS2 is negligible in the placenta, thus not a likely path of vertical transmission for SARS-CoV-2. By contrast, receptors for Zika virus and cytomegalovirus, which cause congenital infections, are highly expressed by placental cell types. These data show that the placenta minimally expresses the canonical cell-entry mediators for SARS-CoV-2.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/virology , Placenta/metabolism , Placenta/virology , Pneumonia, Viral/transmission , Receptors, Virus/metabolism , Serine Endopeptidases/metabolism , Virus Internalization , Angiotensin-Converting Enzyme 2 , Betacoronavirus/metabolism , COVID-19 , Coronavirus Infections/metabolism , Coronavirus Infections/transmission , Female , Humans , Pandemics , Peptidyl-Dipeptidase A/genetics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/metabolism , Pneumonia, Viral/virology , Pregnancy , Receptors, Virus/genetics , SARS-CoV-2 , Serine Endopeptidases/genetics , Zika Virus , Zika Virus Infection
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