Comparison of clinical characteristics of COVID-19 in pregnant women between the Delta and Omicron variants of concern predominant periods

Background: Information regarding effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant strains on clinical manifestations and outcomes of coronavirus disease 2019 (COVID-19) in pregnant women is limited. Methods: A retrospective observational study was conducted using the data from the nationwide COVID-19 registry in Japan. We identified pregnant patients with symptomatic COVID-19 hospitalized during the study period. The Delta and Omicron variants of concern (VOC) predominant periods were defined as August 1 to December 31, 2021 and January 1 to May 31, 2022, respectively. Clinical characteristics were compared between the patients in the Delta and Omicron VOC periods. In addition, logistic regression analysis was performed to identify risk factors for developing moderate-to-severe COVID-19. Results: During the study period, 310 symptomatic COVID-19 cases of pregnant women were identified;111 and 199 patients were hospitalized during the Delta and Omicron VOC periods, respectively. Runny nose and sore throat were more common, and fatigue, dysgeusia, and olfactory dysfunction were less common manifestations observed in the Omicron VOC period. In the multivariable logistic regression analysis, onset during the later stage of pregnancy (OR: 2.08 [1.24–3.71]) and onset during the Delta VOC period (OR: 2.25 [1.08–4.90]) were independently associated with moderate-to-severe COVID-19, whereas two doses of SARS-CoV-2 vaccine were protective against developing moderate-to-severe COVID-19 (OR: 0.34 [0.13–0.84]). Conclusions: Clinical manifestations of COVID-19 in pregnant women differed between the Delta and Omicron VOC periods. SARS-CoV-2 vaccination was still effective in preventing severe COVID-19 throughout the Delta and Omicron VOC periods. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Arterial Thrombus in a Neonate with Covid-19 Positive Mother

Thrombotic disease in newborns is uncommon;its incidence is reported as 3-5 per 1,00,000 live births. Most of them are venous thromboembolisms accounting for 2/3rd of reported cases and arterial thrombosis is 1/3rd of the lot. Newborns are at a higher risk for bleeding as well as thrombotic tendency due to immature and low levels of procoagulant and anticoagulant proteins in a predisposed setting. We present a case with vertical transmission of SARS-COV2 infection and the coagulopathy therewith presenting as arterial thrombus at birth which was, effectively treated with anticoagulation therapy.

[Cohort of pregnant and postpartum women with COVID-19. Comparative analysis between two pandemic waves]

INTRODUCTION: The clinical presentation of pregnant women with COVID-19 varied according to the time of the pandemic.

COVID-19 Prevalence and Outcomes in Postpartum Women and Newborns in a Community Hospital System...Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Convention, 25-29 June, 2022, Aurora, Colorado

The article offers information about the Covid-19 prevalence and outcomes in postpartum women and newborns in a community hospital system. It mentions that pregnant women are at a significantly increased risk for severe illness, pregnancy complications, and preterm delivery if they are infected with Covid-19.

[Experience with REGEN-COV for COVID-19 complicated pregnancies.]

妊娠はcoronavirus disease 2019(COVID-19)の重症化リスクとされるが、胎児への影響から使用できる治療薬に限りがある。本邦で特例承認として薬事承認を受けたカシリビマブ及びイムデビマブ(REGEN-COV)は軽症から中等症Iの発症早期の患者に対して有用である。今回当院でCOVID-19合併妊娠11例に対してREGEN-COVを使用した。非使用群11例と比較し、臨床症状の改善までの期間や退院基準を満たすまでの期間を短縮した。また投与に伴う有害事象は認めなかった。REGEN-COVはCOVID-19合併妊娠に対して有用であった。(著者抄録)

Morphologic findings in placenta associated with SARS-CoV-2 infection

SARS-CoV-2 infection in pregnancy can cause a number of serious complications, including fetal growth restriction or intrauterine fetal death. It appears that transplacental transmission of infection is rare and the arising complications are due to damage of placental parenchyma. The aim of this article is to summarize the results of recent publications dealing with placental changes in COVID-19 disease, with special consideration to the morphology of the newly defined SARS-CoV-2 placentitis.

Was rooming-in a safe approach to newborns from SARS-CoV-2 positive mothers?

Introduction: Since the emergence of coronavirus disease 2019, known as COVID-19, there are limited data describing the risks and specific effects of severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, in pregnant women and their neonates. To date, there is scarce evidence of in utero transmission, and the risk of perinatal transmission and consequent neonate risk of developing COVID-19 during the perinatal period are also unknown. Methods: Since April 2020, universal screening of all pregnant women presenting in labor has been implemented in our hospital. To those who are positive for SARS-CoV-2, the possibility to room-in with the neonate is given. Neonates are tested for SARS-CoV-2 within the first 24 hours and again at 48 hours of life. We made a prospective cohort analysis of all neonates born of mothers positive for SARS-CoV-2 in our hospital from April to November 2020. Demographics, neonatal and maternal symptoms at the delivery, during hospitalization and once discharged, perinatal routine care and SARS-CoV-2 reverse transcription polymerase chain reaction results were studied. Results: We analyzed 23 mothers positive for SARS-CoV-2. Only eight declared having symptoms, mainly headaches, anosmia, and ageusia/dysgeusia. The 23 neonates were negative for SARS-CoV-2 in both reverse transcription polymerase chain reaction tests performed. All of the neonates were born and remained asymptomatic during the 14 days of surveillance time and all of them were breastfed. Discussion: According to our results, rooming-in was safe for newborns of SARS-CoV-2 positive mothers since there was no evidence of perinatal infection. This practice is a well-known way to promote early breastfeeding and encourage maternal-infant bonding. © Author(s) (or their employer(s)) and Portuguese Journal of Pediatrics 2021.

COVID-19 and pregnancy: A scoping review on pregnancy characteristics and outcomes.

AIM: The study aim was to map clinical characteristics and the evolution of pregnancies in pregnant women with confirmed diagnosis of SARS-CoV-2 infection. METHODS: Searching four databases, studies were investigated that described the evolution of pregnancies in women diagnosed with SARS-CoV-2 infection through laboratory tests. A scoping review was undertaken, including 35 articles published in English. Two pairs of independent researchers synthesized the data. RESULTS: Most studies were case studies or case series and had a low risk of bias. A predominance of cases was found in women over the age of 30 years who got infected in the third term of pregnancy and who had comorbidities. The prematurity index varied with the heterogeneity of the samples, and the cases of abortion occurred in combination with severe forms of infection. Caesarean section deliveries predominated, indicated mainly by respiratory decompensation caused by infection. Most women were discharged. CONCLUSION: Based on the reviewed studies, the profile and evolution of pregnant women infected with COVID-19 could be evaluated.

Death of a neonate born to a critically ill mother with COVID-19: a case report / 中华围产医学杂志

We report a critically ill pregnant woman in the third trimester with severe pneumonia due to COVID-19 who presented to Xiaolan People's Hospital of Zhongshan in February 2020. The 32-year-old patient was admitted at 35 +2 gestational weeks with a 4-day history of a sore throat and a fever for three hours. The patient had been to Xiaogan City, Hubei Province, and the symptoms occurred during a period of self-isolation after back home. The condition of the patient deteriorated rapidly, with left-sided chest and back pain, shortness of breath, dizziness, progressing to respiratory failure and septic shock 7 hours after her admission. In view of her critical condition and a history of two previous cesarean sections, an emergency cesarean section was performed. Blood gas analysis of the mother before the operation suggested respiratory failure, respiratory acidosis, and metabolic acidosis. During the operation, a baby boy was born. The Apgar score of the boy, birth weight of 2 700 g, was one at 1, 5 and 10 minutes despite the resuscitation efforts. The neonate died after withdrawing treatment. The patient was treated with tracheal intubation ventilator and other supportive treatments after the operation. The result of the new coronavirus nucleic acid test, taken on admission, but which was reported after delivery, was positive. The patient was transferred to the designated hospital for further treatment and was recovering with the withdrawal of extracorporeal membrane oxygenation and ventilation support at 26 and 36 days after surgery, respectively.

Vaginal delivery after 37 days of a convalescent pregnant woman with COVID-19: a case report / 中华围产医学杂志

We present a case report of a healthy neonate born by vaginal delivery to a woman who had recovered from COVID-19 after 37 days of discharge. The pregnant woman had fever, cough, and chills at 33 +1 gestational weeks and was diagnosed with COVID-19 by coronavirus nucleic acid test one day later. She recovered and was discharged after a series of treatment, and the 2019 novel coronavirus nucleic acid test and pulmonary CT were negative at the 2nd and 4th weeks after being discharged. The patient was admitted in early labor at 38 +4 gestational weeks and delivered a healthy newborn vaginally at that day. Both the mother and the baby were in good condition. All the maternal or neonatal specimens taken immediately after birth in the delivery room for 2019 novel coronavirus nucleic acid tests were negative, including the maternal pharynx, rectal and cervical secretions, amniotic fluid, an neonatal pharynx and rectal swabs. The qualitative examination of 2019 novel coronavirus antibodies in the maternal venous blood test showed that both IgG and IgM were positive. While the same test for neonatal cord blood and femoral vein blood showed negative results. No inflammatory reaction was found in the placenta and immunohistochemistry detection of novel coronavirus N protein was negative. The mother and newborn were observed postnatally and treated in the same ward, neither of them had fever, cough or fatigue, and were discharged three days after delivery. The qualitative examination of 2019 novel coronavirus antibodies (IgM and IgG) in the femoral vein blood of the nenonate 27 days old showed negative results.

Asymptomatic COVID-19 infection in pregnant woman in the third trimester: a case report / 中华围产医学杂志

We report a case of asymptomatic COVID-19 infection in a pregnant woman in the third trimester with good maternal and infant outcomes. The patient was admitted to the Second People's Hospital of Hefei on February 11, 2020, because of a "positive novel coronavirus nucleic acid test result for one day" at 38 weeks of gestation. No abnormality was observed during her previous regular prenatal examinations. A throat swab sample was obtained from the patient four days before admission due to the diagnosis of COVID-19 infection in her husband and sister on the 14th and 7th day before her admission, and the new coronavirus nucleic acid test showed positive. The patient reported no discomfort before admission. Chest CT on the 3rd after admission showed a small amount of bilateral pleural effusion. Irregular contractions occurred three days after admission and labor was considered to be imminent. An emergency cesarean section was performed and the patient delivered a live baby girl. No tests were performed on amniotic fluid, cord blood or placenta for new coronavirus nuclei acid. The patient was isolated from the infant without breastfeeding after surgery. All medical staff involved in the cesarean section were isolated after surgery. Neonatal peripheral blood and nasopharyngeal swabs were collected for the new coronavirus nucleic acid tests on the day of birth and one day of age respectively, and nasopharyngeal swabs and anal suabs were taken at nine days after birth. All test results were negative. The patient recovered well after surgery with stable vital signs. Chest CT on the 8th after operation showed a small amount of bilateral pleural effusion, while the new coronavirus nucleic acid test results of the pharyngeal swabs were positive on the 11th and 12th day after operation. The throat swabs of all medical staff involved in the operation were negative 14 days after the operation. The mother and baby were discharged 14 days after the Cesarean section.

How to obtain evidence of vertical transmission in viral infected pregnant women: Reflection on COVID-19 epidemic / 中华围产医学杂志

During the COVID-19 epidemic, there have been many misconceptions concerning vertical transmission between the mother and fetus/baby, which has caused much discussion and controversy. However, there is no strong evidence to indicate that this novel coronavirus could be vertically transmitted from infected mothers to their fetuses/infants. Several easily confused concepts are clarified in this paper, including vertical transmission, intrauterine transmission, mother-to-infant transmission, intrapartum or postpartum transmission. Well-designed protocols and a disciplined research team are essential for both basic and clinical research, in order to contribute to obtaining more scientific evidence for better understanding of the characteristics of this novel coronavirus. Proper handling and disposal of the body fluids and tissue are critical for safety. We highlight the significant value of relevant research, and suggest future research directions, such as investigating the impact of COVID-19 in different trimesters. Furthermore, China has the most experience of treating pregnant women exposed to the COVID-19 virus, and it would be a great service to the rest of the world, for all centers in China to collaborate to report this collective experience.

Asymptomatic COVID-19 in pregnant woman with typical chest CT manifestation: a case report / 中华围产医学杂志

We report a case of maternal asymptomatic COVID-19 in a patient with typical CT image of pneumonia in the third trimester, and both the mother and baby were well. The patient, a 30-year-old female, was transferred to Yichun People's Hospital at 37 +3 gestational weeks because of a positive 2019 novel coronavirus nucleic acid result over seven hours. Her husband and mother-in-law were diagnosed with COVID-19 eight days before her admission and on the same day, respectively. The patient reported no discomfort before admission, and there were no abnormalities in the prenatal course during her pregnancy. On February 13 (the second day of admission), a patchy blurred shadow was observed in the lower lobe of the right lung in chest CT scan, and a live baby girl was delivered by a precaution-based emergent cesarean section because of suspected fetal distress shown in electrical fetal heart monitoring. Both the mother and the newborn were isolated separately after the operation without etiological examination of amniotic fluid, umbilical cord blood, placenta, etc. All the medical staff involved in the cesarean section were isolated as well. The mother was healthy and remained asymptomatic after delivery, while antiviral and anti-inflammatory treatment was offered. COVID-19 nucleic acid tests of pharyngeal swab were negative on the 4 th and 6 th day after operation. Chest CT on the 5 th day after delivery showed inflammation in the lower lobe of the right lung, and reexamination on the 8 th day showed a slight absorption of the inflammation. Samples of peripheral blood and pharynx swab were obtained from the newborn on the day of birth and four and seven days after birth and novel coronavirus nucleic acid test were all negative. The mother and baby dyad were discharged nine days after operation. And novel coronavirus nucleic acid tests were all negative in all medical staff involved.

Clinical characteristics of COVID-19 in pregnancy: analysis of nine cases / 中华围产医学杂志

Objective@#To evaluate the clinical characteristics and pregnant outcomes of gravidae with COVID-19.@*Methods@#This study involved nine gravidae with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 22 to February 1, 2020. Their clinical data, including epidemiological history, clinical symptoms, laboratory examinations, chest CT, treatment, delivery mode, and pregnancy outcomes, were analyzed retrospectively. Descriptive analysis was applied in this study.@*Results@#(1) Among the nine cases, five were admitted in the third trimester and four in the second trimester. The median incubation period of COVID-19 was 8 (1-14) d. Fever was presented in all cases on admission, and the other commonly seen symptoms were cough (seven cases) and diarrhea (five cases). Other signs and symptoms were also reported, including shortness of breath, myalgia and fatigue (four cases in each), nasal obstruction, pharyngalgia, chest pain, and headache/dizziness (three cases in each), rash (two cases), and chills and expectoration (one case in each). The most common laboratory abnormalities were a decreased number of lymphocytes (seven cases) and elevated C-reactive protein (six cases). Chest CT scans were performed in seven women, and all showed patchy areas or ground-glass opacity in both lungs. Oligohydramnios was detected in only one case at 37+5 weeks, which was 7 d after the diagnosis of COVID-19. (2) All nine cases received empiric antibiotic and antiviral therapy with Chinese medicine as adjuvant treatment. Eight patients required oxygen inhalation, and seven were treated with glucocorticoid. One case received immunotherapy due to worsening conditions. (3) Four of the nine cases had delivered, including three cesarean sections and one spontaneous vaginal preterm birth after premature rupture of membranes, and the mother was transferred to the intensive care unit 2 d after delivery due to acute respiratory distress syndrome. One case was terminated at 26 gestational weeks. Of the four neonates, there were two term and two premature babies, and one preterm babies was small-for-gestational-age. No neonatal asphyxia was observed. Serial real-time quantitative reverse transcription-polymerase chain reaction showed negative results in the detection of 2019-novel coronavirus in all samples obtained from amniotic fluid, umbilical cord blood, neonatal nasopharynx, breast milk, and vagina. Maternal conditions were all stable in all cases, including the four continuing pregnancy, and the terminated ones, except the case mentioned above.@*Conclusions@#There is no distinguishable clinical feature between pregnant and non-pregnant COVID-19 patients. Currently, the evidence for vertical transmission of COVID-19 needs further studies with larger size of examples, but pregnancy may deteriorate COVID-19. Given that COVID-19 may have adverse effects on perinatal outcomes, it's recommended to take positive and effective measures for COVID-19 women in the third trimester.