Characteristics of cardiotocography in pregnant women with mild COVID-19 in the third trimester.

Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Findings from the ECHO Cohorts Regarding the Effects of the COVID-19 Pandemic

Background: Studies suggest perinatal infection with SARSCoV- 2 can induce adverse birth outcomes, but studies published to date have substantial limitations. Most have identified cases based upon their presentation for clinical care, and very few have examined pandemic-related stress which may also impact adverse birth outcomes. Objective(s): To evaluate the relationships between SARSCoV- 2 infection in pregnancy and pandemic-related stress with birth outcomes. Study Design: We conducted an observational study of 211 mother-newborn dyads in three urban cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program. Serology for SARS-CoV-2 was assessed in a convenience sample of prenatal maternal, cord serum or dried blood spots from births occurring between January 2020-September 2021. Specimens were assessed for IgG, IgM, and IgA antibodies to nucleocapsid, S1 spike, S2 spike, and receptor-binding domain. A Pandemic-related Traumatic Stress (PTS) scale was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Acute Stress Disorder criteria. Result(s): 36% were positive for at least one antibody type, chiefly IgG. Self-report of infection was not significantly correlated with combined serology. There were no differences in gestational age (GA), birth weight, preterm birth (PTB), or low birth weight (LBW) among seropositive mothers. However, IgM seropositive mothers had children with lower BW (434g, 95% CI: 116- 752), BW Z score-for-GA (0.73 SD, 95% CI 0.10-1.36) and were more likely to deliver preterm (OR 8.75, 95% CI 1.22-62.4). Associations with LBW sustained in sensitivity analyses limited to pre-vaccine samples, and PTS symptoms were not associated with birth outcomes. The addition of PTS did not substantially change associations with BW, although associations with PTB attenuated to near-significance. Conclusion(s): We identified decreased birth weight and increased prematurity in mothers IgM seropositive to SARS-CoV-2, independent of PTS. Though there are limits to interpretation, the data support efforts to prevent SARS-CoV-2 infections in pregnancy.

Management and care of pregnant women in their third trimester with COVID-19 at Tangerang Hospital, Indonesia: a comprehensive approach

COVID-19 is a widespread contagious viral infection that can severely affect the respiratory system. Although many people recover from using the disease without special care or treatment, pregnant women are particularly vulnerable to pulmonary infections due to their hangers systems system and physiology. To investigate the treatment provided to pregnant women who are PCR-positive for COVID-19 in their early three months of pregnancy, a reanalyzed analyzed data from 84 participants who received treatment at Tangerang Regional Hospital in 2 study was the study conducted based on an ases of observational investigation with a cross-sectional approach. It assembled the data for analysis of the chi-square test. The results showed that 92.9% of participants underwent a cesarean section, while the remaining 7.1% were discharged after giving birth typically or recovering. Additionally, the study did not find any correlation between factors such as age, education, work, gravida, ANC visit, and the impact of COVID-19 on the third trimester of pregnancy at Tangerang Hospital in 2022. The study recommends that pregnant women seek information about pregnancy care from healthcare providers, particularly midwives, posyandu officers, and the media, to make well-known decisions about their health and well-being during this critical period, ensuring a safe and healthy pregnancy outcome.

Covid-19: Is the placenta a safe space

Problem: Several large studies have demonstrated that COVID-19 pregnant individuals are at a significant risk for severe disease and adverse pregnancy outcomes. The mechanisms underlying these phenomena remain to be elucidated and are the focus of our project. Although fetal and placental infection is rare, placental abnormalities and adverse pregnancy outcomes associated with placental dysfunction in COVID-19 cases have been widely reported. In particular, placental thrombosis and lesions consistent with maternal vascular malperfusion (MVM) of the placenta are common in individuals with COVID-19. Since thrombotic complications have been associated with COVID-19, it is not surprising that pregnant individuals with COVID- 19 are at risk for placental thrombosis. Method of Study: Placentas were evaluated histologically. Extracellular vesicles were isolated by serial centrifugation. Result(s): Adverse pregnancy outcomes associated with these placental lesions, including hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), small for gestational age (SGA, birthweight < 10th percentile for gestational age), and preterm birth (PTB, < 37 weeks) are significantly increased among pregnant individuals with COVID-19. Placental infection with SARSCoV- 2 is uncommon, but multiple inflammatory and metabolic factors are likely to affect the placenta, including circulating extracellular vesicles (EVs) derived from various organs that have been associated with COVID-19 pathology and disease severity.We have analyzed over 500 placentas from COVID-19 pregnancies and found marked changes in placental morphology, characterized by abnormal maternal and fetal vessels, intervillous thrombi, and fibrin deposition, even in the face of mild or asymptomatic disease. We detected increased levels of small EVs in maternal serum from COVID-19 cases compared to controls and increased levels of mitochondrial DNA in EVs from COVID-19 cases. In in vitro experiments, we found increased oxidative stress in uterine endothelial cells and primary trophoblasts. Syncytialization of trophoblast cells following exposure to EVs from pregnant COVID-19 patients was markedly reduced. RNAseq of trophoblast cells exposed to EVs from pregnant COVID-19 patients revealed disruption of multiple pathways related to mitochondria function, oxidative stress, coagulation defects, and inflammation. Timing of infection during pregnancy (first, second, and third trimester) altered EV size distribution, cargo content, and functional consequences of trophoblast EV exposure. Conclusion(s): Our studies show that COVID-19 infection during pregnancy has profound effects on placenta morphology and function. It remains to be determined what the long-term consequences are on the offspring.

Pregnancy Outcomes in Women with Sickle Cell Disease in Ireland: A Retrospective Review

Background: Sickle cell disease (SCD) is one of the most common single gene disorders worldwide and is characterised by significant morbidity and early mortality.[1] Pregnancy in SCD is associated with an increased risk of maternal and foetal complications.[2,3] The 2011 RCOG and the 2021 BSH guidelines[5,6] on the management of pregnancy in SCD have provided the basis for best practice care in the UK over the past decade and is the guidance which we follow in Ireland. To date, there is no published data on outcomes for pregnant women with SCD in Ireland. The number of Irish patients with SCD has risen over the past 20 years. Without a national database, the exact prevalence is not known but currently there are at least 600 adults and children with SCD in Ireland, whose population is just over 5 million.[4] Aims: Our study assesses outcomes of pregnant patients with SCD from 2015 to 2022. Our aims were to: * Assess adherence to current guidelines * Assess pregnancy outcomes and maternal complications * Assess transfusion rates amongst our patient cohort. Method(s): This is a retrospective cohort study. We do not have a directly matched cohort, but have compared our findings to published data on Irish pregnancy outcomes from the Irish Maternity Indicator System National Report and have correlated our findings with studies of women with SCD who were managed in UK centres.[8,9,10] Results: We reviewed outcomes of 29 pregnancies in 19 women over a 7-year period. The median age was 29 (range 20-41) and the predominant maternal sickle genotype was HbSS (65.5%). Before conception, 55.2% of cases had pre-existing complications of SCD, including acute chest syndrome (ACS), pulmonary hypertension (PHTN) and prior stroke. In accordance with current guidelines, 100% of women (n=29) were prescribed folic acid, penicillin, and aspirin prophylaxis. 51.7% (n=15) of women had documented maternal complications during pregnancy, including ACS (34%), vaso-occlusive crisis (34%), gestational diabetes (10%), VTE (3%) and UTI (3%). Two women (7%) developed Covid-19 pneumonitis despite vaccination. There was one case of maternal bacteraemia (3%). 65.5% of cases (n=19) required blood transfusion during pregnancy. One woman was already on a blood transfusion programme for disease modification prior to pregnancy. In 6 cases (20.6%), a transfusion programme was commenced during pregnancy due to prior pregnancy complications or intrauterine growth restriction. During pregnancy, 27.6% (n=8) of women required emergency red cell exchange for ACS. Prior studies have suggested that between 30% and 70% of pregnant women with SCD require at least one blood transfusion during pregnancy.[8,9,10] By comparison, only 2.6% of the Irish general obstetric population required transfusion during pregnancy.[7] 20.6% (n=6) of births were preterm at <37 weeks' gestation. There was one live preterm birth (3%) at <34 weeks and one intrauterine death (3%) at 23 weeks' gestation. Similar to UK data[9], 31% of women required critical care stay (n=9) during pregnancy, in comparison with 1.44% nationwide in 2020.[7] Conclusion(s): It is well established that pregnancy in SCD is high risk, and despite adherence to current guidelines, we have shown very high rates of critical care admission, significant transfusion requirement and hospital admissions. Our findings are comparable to published UK outcomes and they further support the need for a comprehensive specialist care setting for this patient cohort.

Perinatal aspects of sars-cov-2 infection during pregnancy: A potential cause for concern

Ever since the beginning of COVID-19 pandemic, uncertainty regarding clinical presentation and differences among various subpopulations exist. With more than 209,870,000 confirmed cases and more than 4,400,000 deaths worldwide, we are facing the new era of health crisis which will undoubtedly impair global health, economic and social circumstances. In the past year, numerous genetic mutations which code SARS-CoV-2 proteins led to the occurrence of new viral strains, with higher transmission rates. Apart from the implementation of vaccination, the effect of SARS-CoV-2 on pregnancy outcome and maternal fetal transmission remains an important concern. Although neonates diagnosed with COVID-19 were mostly asymptomatic or presented with mild disease, the effect on early pregnancy is yet to be evident. While positive finding of SARS-CoV-2 RNA in some samples such as amniotic fluid, placental tissue, cord blood and breast milk exists, additional research should confirm its association with transplacental transmission.Copyright © 2022, Dr. Mladen Stojanovic University Hospital. All rights reserved.

GDM diagnosis criteria: Standard and Covid-19 criteria

Aim: Standard diagnosis of gestational diabetes (GDM) is based on the Oral Glucose Tolerance test (OGTT). During the Covid-19 outbreak, due to Covid restrictions, criteria were modified i.e Fasting Blood Glucose >=5.3 and/ or HbA1c >= 39 for diagnosis of GDM. After the lifting of the Covid restrictions, the standard criteria were reimplemented and on analyzing the data, it was highlighted that some of the patients could have tested negative for GDM based on Covid Criteria. Method(s): We analyzed the data of 43 patients based on standard criteria (OGTT and HbA1c) after Covid restrictions, with the following results. Result(s): 11/43(28%) patients who were diagnosed on the basis of standard criteria could have been missed based on Covid criteria. Out of 11 deliveries, 2 babies with weight above 4 kg. There were no admissions to NICU. One patient had postpartum hemorrhage with 670 mL of blood loss. Conclusion(s): This was a retrospective study in which we analyzed the data of 45 pregnant females diagnosed with GDM based on testing using the Covid criteria and compared this to 43 pregnant females who were diagnosed with GDM on the basis of OGTT based on GOLD standard NICE criteria. In addition, we also examined maternal and obstetric outcomes in both groups such as the mode of delivery, the baby's birth weight, the incidence of shoulder dystocia, mean blood loss (MBL), and NICU admission. We understand that Covid GDM diagnosis was a necessity of time. In this study, we want to learn what could have been missed with that diagnostic criteria. For future pandemics, we need to revise our diagnostic criteria to avoid the risk of underdiagnosing GDM and associated complications.

SARS-CoV-2 infection disrupts trophoblast function and placental syncytial barrier integrity via its accessory protein, ORF3a

Problem: Although it is rare for a SARS-CoV-2 infection to transmit vertically to the fetus during pregnancy, there is a significantly increased risk of adverse pregnancy outcomes due to maternalCOVID- 19. However, there is a poor understanding of such risks because mechanistic studies on how SARS-CoV-2 infection disrupts placental homeostasis are significantly lacking. The SARS-CoV-2 proteome includes multiple structural and non-structural proteins, including the non-structural accessory proteinORF3a. The roles of these proteins in mediating placental infection remain undefined. We and others have shown that autophagy activity in placental syncytium is essential for barrier function and integrity. Here, we have used clinical samples and cultured trophoblast cells to evaluate syncytial integrity of placenta exposed to SARS-CoV-2. The objective of our study was to investigate potential mechanisms through which SARS-CoV-2 impairs placental homeostasis and causes adverse pregnancy outcomes. We tested the central hypothesis that an essential SARS-CoV-2 non-structural and accessory protein, ORF3a, uniquely (amongst multiple viral proteins tested) with a novel three-dimensional structure andwith no homology to any other proteins is a key modulator of placental trophoblast cell dynamics via autophagy and intracellular trafficking of a tight junction protein (TJP), ZO-1. Method(s): We used clinical samples and cultured trophoblast cells to evaluate syncytial integrity of placentas exposed to SARS-CoV- 2. Autophagic flux was measured in placental villous biopsies from SARS-CoV-2-exposed and unexposed pregnant women by quantifying the expression of autophagy markers, LC3 and P62. Trophoblast cells (JEG-3, Forskolin-treated JEG-3, HTR8/SVneo, or primary human trophoblasts (PHTs)) were transfected with expression plasmids encoding SARS-CoV-2 proteins including ORF3a. Using western blotting, multi-label immunofluorescence, and confocal imaging, we analyzed the effect of ORF3a on the autophagy, differentiation, invasion, and intracellular trafficking of ZO-1 in trophoblasts. Using coimmunoprecipitation assays, we tested ORF3a interactions with host proteins. t-tests and one-way analyses of variance (ANOVAs) with post hoc tests were used to assess the data, with significance set at P < .05. Result(s): We discovered :1) increased activation of autophagy, but incomplete processing of autophagosome-lysosomal degradation;2) accumulation of protein aggregates in placentas exposed to SARS-CoV- 2. Mechanistically, we showed that the SARS-CoV-2 ORF3a protein, uniquely 3) blocks the autophagy-lysosomal degradation process;4) inhibits maturation of cytotrophoblasts into syncytiotrophoblasts (STBs);5) reduces production ofHCG-beta, a key pregnancy hormone that is also essential for STB maturation;and 6) inhibits trophoblast invasive capacity. Furthermore, ORF3a harbors an intrinsically disordered C-terminus withPDZ-bindingmotifs.We show for the first time that, 7) ORF3a binds to and co-localizes with the PDZ domain of ZO-1, a junctional protein that is essential for STB maturation and the integrity of the placental barrier. Conclusion(s): Our work outlines a new molecular and cellular mechanism involving the SARS-CoV-2 accessory protein ORF3a that may drive the virus's ability to infect the placenta and damage placental syncytial integrity. This implies that the mechanisms facilitating viral maturation, such as the interaction of ORF3a with host factors, can be investigated for additional functionality and even targeted for developing new intervention strategies for treatment or prevention of SARS-CoV-2 infection at the maternal-fetal interface.

Study of the Effect of Covid 19 Vaccination in Antenatal Women on Maternal and Fetal Outcome in Tertiary Care Teaching Hospital in Andhra Pradesh, India

Background: SARS-Cov-2 infection during pregnancy causes adverse effects on the maternal and foetal outcome. In order to minimize the adverse outcomes of COVID-19 infection, Government of India recommends COVID-19 vaccination during antenatal period with Covaxin and Covishield. Despite the recommendation of vaccination by the Government of India, there are few clinical trials and still there exists a gap in the knowledge and awareness of outcome of pregnant women after COVID-19 vaccination during pregnancy. Material(s) and Method(s): This is a prospective observational study conducted in 50 antenatal women who were already vaccinated at a tertiary care hospital in Southern India from August 2021 to October 2021. All antenatal women who were already vaccinated and attending the OPD were considered for further follow-up. Result(s): This study was conducted among 50 antenatal women who received COVID-19 vaccination during pregnancy. Among these antenatal women, 27 (54%) were multigravida, 23(46%) were primigravida, 32(64 %) completed 2 doses of covid vaccination, and 18(36%) took a single dose in antenatal period. Among the vaccinated 27(54%) pregnant women had no symptoms after vaccination. Though 23(46%) women had symptoms after vaccination, symptoms are mild and resolved within 48 hours. All vaccinated antenatal women were observed till delivery, among them 46 (92%) had term deliveries, 4(8%) had preterm deliveries and 8[16%] new-born babies required NICU admission. Conclusion(s): COVID-19 vaccination was not associated with adverse immediate pregnancy outcomes or new born complications. Hence COVID-19 vaccination is strongly recommended in antenatal period.Copyright © 2023 Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.

COVID-19 during Pregnancy: Prevalence, Predictors, and Impact on the Newborn

Background: The recent pandemic prompted a number of clinical trials to assess the efficacy and safety of medication use for the treatment for COVID-19. As pregnant women are excluded or vastly underrepresented in clinical research, there is a paucity of data on how pregnancy and perinatal outcomes are impacted by such medications. Considering that pregnant women are at increased risk for COVID-19 infection and that pregnancy is also associated with an increased risk of developing severe COVID-19, it is of utmost importance to assess the effect of gestational medications use for COVID-19 on pregnancy outcomes. Objective(s): The aims of this systematic review were to (1) determine and quantify COVID-19-specific and repurposed medication use during pregnancy, and (2) provide an overview of the pregnancy and neonatal outcomes that have occurred in COVID-19-positive pregnant women exposed to COVID-19-specific or repurposed medications compared to use in pregnant women without COVID-19;neonatal outcomes compared between COVID-19 positive pregnant women treated and untreated with these medications. Method(s): A systematic literature search was conducted in Ovid and executed in the following databases: MEDLINE, Embase, and Global Health. Search strategies applied combined database-specific subject headings and keywords relevant to the topic. Some subject headings used in databases were pregnancy outcome, COVID-19, SARS-CoV-2, pharmaceutical preparations, drugs, and prescription. Some keywords used for the searches were pregnancy outcome, neonatal outcome, coronavirus disease 2019, drug, medication, and treatment. For each database, keywords were searched within the , keyword heading word or heading words, and title fields. Restrictions were applied regarding the date of publication and searches were limited to English publications. Study selection was accomplished by two independent investigators (NSK, NAB). Only original research articles were considered for inclusion. Included studies investigated pregnancy or neonatal outcomes in women with COVID-19 receiving medication to treat COVID-19. A standardized extraction form was used to independently extract relevant information. Result(s): The literature search yielded a total of 344 records. After deduplication, 69 records were removed. The title and of 275 publications were screened.

Comparison of Immediate Adverse Effects of COVID-19 Vaccine (COVAXIN BBV152) in Pregnant vs Nonpregnant Women

Aims and objectives: The aim of this study was to compare the immediate adverse effects of the coronavirus disease 2019 (COVID-19) vaccine (COVAXIN) in a pregnant woman with that of a nonpregnant woman. Material(s) and Method(s): It is a prospective observational study done at Vanivilas Hospital, Bangalore Medical College & Research Institute (BMCRI) for 2 months. The sample size was 100 pregnant and 100 nonpregnant women. Telephonically, patients were followed-up, and details of the side/adverse effects were collected in a proforma after 2 and 14 days. Data collected from both groups were analyzed using the Chi-square test or Fisher's exact test. Result(s): The majority of women were in the age group of <=25 years (64.0% and 36.0%, respectively) with a mean age of 25.01 +/- 3.71 years among the pregnant and 28.52 +/- 6.00 years among nonpregnant women. About 25.0% of pregnant women and 38.0% of nonpregnant women reported side effects. About 15.0% and 22.0% had taken treatment for side effects among pregnant women and nonpregnant women, respectively. Among the pregnant women, the common side effects reported were injection site pain (17) followed by fever (5), fatigue (4), and myalgia (03). Whereas among the nonpregnant women, the common side effects reported were injection site pain (28) followed by fever (6), myalgia (3), headache (2), and fatigue (1). Conclusion(s): Side effects reported following the administration of Covaxin in pregnant and nonpregnant women are fever, fatigue, injection site pain, myalgia, and headache. The proportion of side effects was not significantly different in the pregnant and nonpregnant women following Covaxin administration. Clinical significance: Covaxin is an inactivated killed vaccine against COVID-19 by Bharat Biotech. The vaccine has been recommended for pregnant women by the Government of India during corona pandemic. Studies are lacking regarding the difference in adverse events in pregnant versus nonpregnant women, after vaccine administration.Copyright © The Author(s).

The Association of COVID-19 Severity with Laboratory Parameters, Radiologic Findings, Maternal and Neonatal Outcomes in Pregnant Women: A Multicenter Study in Indonesia

Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.

COVID-19 in Early Pregnancy. Clinical Implications and Methodological Considerations

There is limited information on the effects of COVID-19 early in pregnancy on the risk of major congenital malformations (MCMs). Initial research has been limited by small samples, lack of attention to the timing of infection during pregnancy, lack of an appropriate control group, and biased selection of participants. The International Registry of Coronavirus Exposure in Pregnancy (IRCEP) was designed to estimate the relative risk of adverse perinatal outcomes among women with COVID-19 at specific times during gestation. Adult women were eligible to enroll if they had a SARS-CoV-2 test, regardless of the results, or clinically confirmed COVID-19 during pregnancy. Self-administered questionnaires collected data on the infection, pregnancy outcomes, and potential confounders. The analysis of MCMs included women with either a positive SARS-CoV-2 PCR test or a clinical diagnosis of COVID-19 during the first trimester (exposed group) or a negative SARS-CoV-2 test (reference) that enrolled while pregnant. Of 17,163 participants enrolled between June 2020 and July 2021, 1,727 had a SARS-CoV-2 infection during the first trimester and 10,235 had a negative test during pregnancy. Restriction to participants with complete follow-up reduced the sample size to 92 exposed and 292 unexposed reference pregnancies. MCMs were reported in three (3.3%) exposed and eight (2.7%) unexposed (RR 1.2;95% CI 0.32-4.2) newborns. No specific pattern of malformations was observed. The accumulated evidence is most compatible with no major teratogenic effects associated with maternal SARS-CoV-2 infection. Multiple biases need to be considered and addressed when estimating and interpreting the effects of COVID-19 early in pregnancy. The biggest methodological challenges for IRCEP were retention of participants enrolled in early pregnancy, and the potential bias introduced when participants enroll after pregnancy outcomes are known. Studies that allow enrollment after the outcome is known may select pregnancies with the outcome;those that exclude them would select survivors.

The Impact of Prenatal Maternal Mental Health during the COVID-19 Pandemic on Birth Outcomes: A Study within CONCEPTION Cohort

Background: External natural events, such as hurricanes, floods, and the COVID-19 pandemic can contribute to increased populational stress, especially for pregnant persons. Exposure to crises can produce short- and longterm health effects on pregnant persons and their offspring. There has been much interest in the association between maternal depression, anxiety, and stress during pregnancy and perinatal outcomes such as preterm birth (PTB) and low birth weight (LBW), before and since the COVID-19 pandemic, however results are controversial. Objective(s): Assess the association between prenatal mental health during the COVID-19 pandemic and preterm birth (delivery <37 weeks gestation) and low birthweight (<2,500 grams). Method(s): Pregnant individuals, >18 years, were recruited in Canada and provided data through a web-based questionnaire. We analyzed data on persons recruited between 06/2020-08/2021 who completed questionnaires while pregnant and two months post-partum. Data on maternal sociodemographics, comorbidities, medication use, mental health (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress), pandemic hardship (CONCEPTION - Assessment of Stress from COVID-19), and on gestational age at delivery and birth weight, were selfreported. Crude and adjusted relative risks (aRR) with 95% confidence interval (95%CI) were calculated to quantify the association between PTB/LBW and maternal mental health. Result(s): A total of 1,265 and 1,233 participants were included in the analyses of PTB and LBW, respectively. No associations between PTB and prenatal mental health (depression [aRR 1.01, 95%CI 0.91-1.11], anxiety [aRR 1.04, 95%CI 0.93-1.17], stress [aRR 0.88, 95%CI 0.71-1.10], nor hardship [aRR 1.00, 95%CI 0.96-1.04]) after adjusting for potential confounders. The risk of PTB was increased with nonwhite ethnicity/race (aRR 3.85, 95%CI 1.35-11.00), consistently with the literature. Similar findings were observed for LBW (depression [aRR 1.03, 95%CI 0.96- 1.13], anxiety [aRR 1.05, 95%CI 0.95-1.17], COVID stress [aRR 0.92, 95%CI 0.77-1.09], or overall hardship [aRR 0.97, 95%CI 0.94-1.01]). Conclusion(s): No association was found between prenatal mental health nor hardship during the COVID-19 pandemic and the risk of PTB or LBW. However, it is imperative to continue the follow-up of mothers and their offspring to detect long-term health problems early.

Maternal and neonatal outcomes of Covid infections

SARS-CoV-2 was first detected in December 2019 and rapidly spread to become a pandemic. The disease associated with this infection (COVID-19) disproportionally affect pregnant people and their offspring, making them a high-risk group for morbidity and mortality. Infection with SARS-CoV-2 in pregnancy is associated with increased risk of progression to severe/critical disease and maternal death. It is also associated with adverse pregnancy outcomes including hypertensive disorders and prematurity. While vaccination is one of the most effective approaches to stem the COVID-19 pandemic, pregnant people were originally excluded from all randomized vaccine trials. Following studies examining the effects of COVID vaccine in pregnancy have focused on three general areas: maternal and fetal antibody production, short-term fetal safety, and overall pregnancy outcomes. In this presentation, we will summarize the COVID-19 disease phenotype in pregnancy, describe the association between COVID-19 and adverse pregnancy outcomes, and describe the safety and efficacy of COVID-19 therapeutics and vaccines in pregnancy.

Comparison of Obstetric Outcomes in First and Second COVID-19 Waves: Analysis from a COVID-19-dedicated Tertiary Care Hospital

Introduction: The physiological changes in the respiratory and cardiovascular systems in the immunosuppressed state of pregnancy may exacerbate clinical features and deteriorate outcomes due to COVID-19 infection. We aimed to compare the maternal and neonatal adverse effects in the first and second COVID-19 waves. Methodology: This study was a prospective cohort study conducted in a tertiary care COVID-19-dedicated hospital. In total, 104 (group A) and 96 (group B) COVID-19-positive pregnant women admitted during the first and second waves, respectively, were included in the study. Data on baseline variables, associated comorbidities, clinical presentations, management strategies, and neonatal and maternal outcomes were collected and compared using parametric and nonparametric tests and analyzed. Result(s): Around 2.08% in group A and 6.72% in group B of COVID-19-infected pregnant women, respectively, had moderate-to-severe disease and required intensive care unit stay. Almost 1.04% in group A and 3.84% in group B had maternal mortality, 13.4% and 19.8% babies of groups A and B required admission in neonatal intensive care units, and 8.6% and 7.3% of newborns in groups A and B had COVID-19-positive reports by reverse transcriptase polymerase chain reaction (RT-PCR) at birth, respectively. Of them, 2.1% newborns in group B had RT-PCR positive on day 7 of life and beyond, whereas none had positive RT-PCR reports on 7 days and beyond in group A. Conclusion(s): Dreadful maternal outcomes like requirement of ICU and mechanical ventilator and persistence of neonatal infections were higher during the second wave.Copyright © The Author(s). 2023.

Paxlovid Prophylaxis or Treatment in Pregnancy: Data from the Organization of Teratology Information Specialists (OTIS) Pregnancy Registry

Background: The US Food and Drug Administration under an Emergency Use Authorization approved use of Paxlovid (nirmatrelavir and ritonavir) for the treatment of mild-to-moderate COVID-19 in adults and children with a positive test for SARS-Co-2 and who are at high risk for progression to severe COVID-19. Pregnant women are at increased risk of severe complications resulting from COVID-19 infection;however, minimal data on the safety of Paxlovid in human pregnancy are available. Objective(s): The objectives of this study are to assess risks of major congenital malformations, spontaneous abortion, elective termination, stillbirth, preterm delivery, small for gestational age infants at birth, or infants who were small for age at one year in pregnancies/infants prenatally exposed to Paxlovid in pregnancy compared to individuals who did not receive this treatment. Design(s): This study involves prospective data from the Organization of Teratology Information Specialists (OTIS) Pregnancy Registry which enrolls pregnant women residing in the US or Canada and captures data through maternal interviews and ion of medical records. Result(s): Among pregnant women participating in the OTIS Pregnancy Registry as of February 1, 2023, 59 reported exposure to Paxlovid in pregnancy;25.4% exposed within 30 days prior to the last menstrual period and through the first trimester, 42.4% exposed in second trimester, and 32.2% exposed in the third trimester. As of January 2023, 17 of those enrolled have completed pregnancy outcomes. One was lost to follow-up. Of the remainder, there were no adverse pregnancy outcomes reported. Conclusion(s): Very limited data are available on this potentially beneficial treatment in pregnancy. To date, no serious signals for this exposure have been detected.

Stillbirth Rates before and during the COVID-19 Pandemic in Manitoba (Canada) and Japan

Background: Conflicting evidence exists on the impact of the COVID-19 pandemic restrictions on stillbirth rates in developed countries. We aimed to examine and compare the incidence rates of stillbirth before and after the implementation of COVID-19 measures in Canada and Japan. Method(s): We conducted two populationbased studies using mother-infant linked data from JMDC hospitalizations database (JMDC Inc.) in Japan and administrative health databases in Manitoba, Canada, from October 2016 to March 2021. We used interrupted time series analysis (generalized linear models) to investigate the immediate change in level and rebound change in quarterly rates of stillbirth (fetal death > 20 weeks of gestation). We modeled the forecasted trends based on prepandemic data via autoregressive moving average models. Result(s): We included 70,931 and 169,883 pregnancies in Manitoba and Japan during the study period, respectively. On average, stillbirth rates were 0.66% in Manitoba and 0.31% in Japan. The pandemic restrictions were associated with an immediate relative increase in stillbirths in Japan by 19.19% (beta2=0.05;p=0.5693) and in Manitoba by 18.6% (beta2=0.12;p=0.4434). However, the quarterly stillbirth rates decreased (beta3=0.1625, p=0.5066) in Japan and Manitoba (beta3=0.011, p=0.8296) during the pandemic period. During the first quarter of 2021, the absolute differences in the observed and forecasted rates in Manitoba and Japan were 0.04% and -0.05%, respectively. Conclusion(s): Although various approaches were implemented to address the pandemic in Manitoba (Canada) and Japan, we found no evidence of a significant increase in the incidence of stillbirth rates during the first year of the pandemic. Healthcare services in Canada and Japan have experienced substantial changes since the start of the COVID-19 pandemic, with little influence on stillbirth rates at population level. This study will further examine the effect of the pandemic measures on other adverse pregnancy outcomes in both countries.

Evaluation of Maternal Fetal Outcomes of Pregnant Women and Mothers with Suspected Infection by SARS-CoV-2 Treated at the Municipal Hospital of São Bernardo do Campo (HMU-SBC), Brazil.

OBJECTIVES: The impact of Covid-19 infection on pregnancy and perinatal outcomes is not fully known. To describe the risk factors and perinatal outcome of pregnant women with suspected COVID-19 infection. METHODS: We evaluated medical records of women with suspected or confirmed SARS-CoV-2 infection who received health care services at the University Hospital of São Bernardo do Campo from March 1 to July 31, 2020, and personal, clinical, and laboratory data of these women and their newborns. RESULTS: Of the 219 women identified, 29% were asymptomatic. Considering the total population, 26% and 17% had obesity and hypertensive syndrome, respectively. Fever measured in the emergency room was the main reason for hospitalization. The presence or not of flu-like symptoms did not impact on perinatal outcomes. Pregnant women requiring hospitalization had newborns with lower birth weight (p < 0.01), shorter length (p = 0.02), and smaller head circumference (p = 0.03), and, in these cases, a higher number of cesarean section deliveries was observed. CONCLUSION: COVID-19 infection did not affect the prognosis of pregnancy and newborns. However, the worst clinical outcome, requiring hospitalization, had an impact on the anthropometric measurements of newborns.

What is already known on this subject?The SARS-CoV-2 infection is not fully undestood, specially during pregnancy and puerperae. There are conflicted information about this in the literature so far. However, it is known that respiratory infections such as influenza and SARS can develop unfavorably in pregnant women, since pregnancy changes the women's physiological condition, including altered immunity to tolerate placenta and fetus proper development.What this study adds?COVID-19 did not affect the prognosis of pregnancy and newborns in this study, but, the worst clinical outcome (hospitalization), impacted the anthropometric measurements of newborns.

Impact of COVID-19 Vaccination on Women During Pregnancy and Breastfeeding.

Rapid development of anti-SARS-CoV-2 vaccinations in the late 2020s has significantly altered the trajectory in which the virus affects various patient demographics, especially the most susceptible ones. In light of ethical and conceptual safety considerations, pregnant women were initially barred from participating in clinical studies for the coronavirus disease 2019 (COVID-19) vaccination programs. However, the steady accumulation of reliable observational data from cohorts of pregnant women who received vaccinations enabled the research establishments to quickly address a number of open questions. Still, more than a year after vaccines were widely available, the safety concerns of expectant or nursing mothers are cited as the primary justification for refusing COVID-19 vaccination, and notably, the rate of vaccination in the said populations is known to be consistently lower than those of the general populace. In light of such a scenario, we have made an attempt to garner relevant studies that evaluated the effect of COVID-19 vaccination on pregnant and lactating mothers which may prove to be supporting evidence for its wide usage among the said population.