Hypertensive disorders of pregnancy and severe acute respiratory syndrome coronavirus-2 infection.

OBJECTIVES: We aimed to determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with an increased risk of hypertensive disorders of pregnancy (HDP). METHODS: A multicenter retrospective cohort study of all pregnant patients who had SARS-CoV-2 testing and delivered in a large health system between March 2020 and March 2021. Cases were stratified into two groups: patients who tested positive for SARS-CoV-2 during pregnancy vs. patients who tested negative. The primary outcome of HDP, defined as a composite of gestational hypertension, preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP Syndrome), and eclampsia by standard criteria, was compared between the two groups. Statistical analysis included multivariable logistic regression to adjust for potential confounders such as maternal demographics and comorbidities. Patient ZIP codes were linked to neighborhood-level data from the US Census Bureau's American Community Survey. RESULTS: Of the 22,438 patients included, 1,653 (7.4%) tested positive for SARS-CoV-2 infection. Baseline demographics such as age, body mass index, race, ethnicity, insurance type, neighborhood-built environmental and socioeconomic status, nulliparity, and pregestational diabetes differed significantly between the two groups. SARS-CoV- 2 infection in pregnancy was not associated with an increased risk of HDP compared to those without infection (14.9 vs. 14.8%; aOR 1.06 95% CI 0.90-1.24). CONCLUSIONS: In this large cohort that included a universally-tested population with several socioeconomic indicators, SARS-CoV-2 infection in pregnancy was not associated with an increased risk of HDP.

Clinical Profile, Maternal and Perinatal Outcome in Sars-Cov2 Infection in Pregnancy

Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Maternal physiological adaptations in pregnancy, and the physiological state of relative immune suppression, place pregnant women at increased risk of infection [1,2]. The present study is important due to the tremendous impact Covid 19 has on people at large, especially expectant mothers. In our study, we collected information on pregnant women with confirmed SARS-CoV-2 infection. Aim and Objective: 1) To estimate clinical features, maternal and perinatal outcome of Covid 19, during first, second and third wave of covid pandemic 2) To compare the Obstetric outcome in first and second wave with third wave. 3) To estimate vertical transmission to new born child in this institution as evidenced by test positivity. Method(s): Retrospective observational study was designed to examine the clinical characteristics and outcome of covid positive pregnancies admitted in our institution. Result(s): In our study of 266 pregnant women with covid, it was noticed that the mean age of the patients was found to be 27.55 years with a standard deviation of +/-4.99 years. 55.64% of cases belonged to category B1, 33.08% in B2 and 11.28% in C. 2nd wave had more patients in category C. Gestational diabetes complicated 28.95% and hypertension in 17.29% of study population. Inflammatory markers were more elevated in 2nd and 3rd wave. There was a total maternal death of 11 patients. Out of this, 10 was (91%) due to covid pneumonia and ARDS. Breast feeding was given for 88.7% of the babies and for 88% of the babies rooming in was practiced. Only 2.6% of the babies turned positive within a week. Conclusion(s): Our study shows that expectant mothers were more severely affected in the second wave. Maternal mortality was associated with increased maternal age (> 35 years), raised CRP levels (> 75mg/L) and higher D dimer levels (> 3000 ng/ml) and is found to be statistically significant. There is no evidence to show any vertical transmission of the disease as only 2.1% of the neonates (7nos) were affected within a week. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Management of SARS-CoV-2 infection in pregnancy

The SARS-CoV-2 infection, which originated from a market in Wuhan, China, spread rapidly, so on March 11, 2020, the WHO decreed that the outbreak became a pandemic. Over 90% of people infected with SARS-CoV-2 are either asymptomatic or have mild symptoms. However, there are cases that develop severe forms of the disease, from acute respiratory distress syndrome to septic shock with multiorgan failure and exitus. However, reports of pregnant women diagnosed with Covid-19 are low. Changes in the maternal organism in pregnancy, including immunity, respiratory system and hypercoagu-lability, but also various comorbidities, could be a risk factor for pregnant women to develop complications associated with COVID-19, with increased morbidity and mortality compared to the general population. The effects of SARS-CoV-2 infection on pregnancy are not sufficiently understood, nor are the effects of pregnancy on disease progression. Although the existence of the virus has been shown in biological samples such as the placenta, umbilical cord, or amniotic fluid, the maternal and fetal effects of the virus are not well known. Recent studies confirm the possibility of intrauterine maternal-fetal transmission of the virus, but also of specific antibodies. The possibility of infection by breastfeeding is not yet sufficiently investigated. We looked for data on the treatment and prophylaxis of SARS-CoV-2 infection during pregnancy, as well as on the choice of the optimal birth pathway in these women. The aim of this paper was to conduct a systematic review of the literature on pregnancy and birth management in patients infected with SARS-CoV-2 that could lead to an improvement in the quality of their medical care. © 2021, Amaltea Medical Publishing House. All rights reserved.

Considerations and Recommendations for Care of Black Pregnant Patients During COVID-19.

Black pregnant patients experience perinatal morbidity and mortality rates greater than other ethnic groups. These health disparities exist primarily because of systemic racism, bias, and discriminatory acts within the health care system. The COVID-19 pandemic has reinforced health disparities experienced by all vulnerable populations in the United States, including black pregnant patients. This article highlights some of the factors that may impact the experience of black people as they navigate the COVID-19 pandemic and presents strategies that every provider can implement to minimize the detrimental effects of this devastating virus during pregnancy.

Transmitted Fetal Immune Response in Cases of SARS-CoV-2 Infections during Pregnancy.

(1) Background: Little is known about the effects of SARS-CoV-2 on the placenta, and whether the maternal inflammatory response is transmitted vertically. This research aims to provide information about the effects of SARS-CoV-2 infection on maternal and fetal immunity. (2) Methods: We have studied placental changes and humoral and cellular immunity in maternal and umbilical cord blood (UCB) samples from a group of pregnant women delivering after the diagnosis of SARS-CoV-2 infection during pregnancy. IgG and IgM SARS-CoV-2 antibodies, Interleukin 1b (IL1b), Interleukin 6 (IL6), and gamma-Interferon (IFN-γ), have been studied in the UCB samples. Lymphocyte subsets were studied according to CD3, CD8, CD4, CD34, and invariant natural Killer T cells (iNKT) markers. We used in situ hybridization techniques for the detection of viral RNA in placentas. (3) Results: During the study period, 79 pregnant women and their corresponding newborns were recruited. The main gestational age at the time of delivery was 39.1 weeks (SD 1.3). We did not find traces of the SARS-CoV-2 virus RNA in any of the analyzed placental samples. Detectable concentrations of IgG anti-SARS-CoV-2 antibodies, IL1b, IL6, and IFN-γ, in UCB were found in all cases, but IgM antibodies anti-ARS-CoV-2 were systematically undetectable. We found significant correlations between fetal CD3+ mononuclear cells and UCB IgG concentrations. We also found significant correlations between UCB IgG concentrations and fetal CD3+/CD4+, as well as CD3+/CD8+ T cells subsets. We also discovered that fetal CD3+/CD8+ cell counts were significantly higher in those cases with placental infarctions. (4) Conclusion: we have not verified the placental transfer of SARS-CoV-2. However, we have discovered that a significant immune response is being transmitted to the fetus in cases of SARS-CoV-2 maternal infection.

Asymptomatic SARS-CoV-2 infections in pregnant patients in an Italian city during the complete lockdown.

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.

Clinical update on COVID-19 in pregnancy: A review article.

The data pertaining to the COVID-19 pandemic has been rapidly evolving since the first confirmed case in December 2019. This review article presents a comprehensive analysis of the current data in relation to COVID-19 and its effect on pregnant women, including symptoms, disease severity and the risk of vertical transmission. We also review the recommended management of pregnant women with suspected or confirmed COVID-19 and the various pharmacological agents that are being investigated and may have a role in the treatment of this disease. At present, it does not appear that pregnant women are at increased risk of severe infection than the general population, although there are vulnerable groups within both the pregnant and nonpregnant populations, and clinicians should be cognizant of these high-risk groups and manage them accordingly. Approximately 85% of women will experience mild disease, 10% more severe disease and 5% critical disease. The most common reported symptoms are fever, cough, shortness of breath and diarrhea. Neither vaginal delivery nor cesarean section confers additional risks, and there is minimal risk of vertical transmission to the neonate from either mode of delivery. We acknowledge that the true effect of the virus on both maternal and fetal morbidity and mortality will only be evident over time. We also discuss the impact of social isolation can have on the mental health and well-being of both patients and colleagues, and as clinicians, we must be mindful of this and offer support as necessary.