SARS CoV-2 infection as a risk factor of preeclampsia and pre-term birth. An interplay between viral infection, pregnancy-specific immune shift and endothelial dysfunction may lead to negative pregnancy outcomes.

BACKGROUND: Since SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) was first identified as the cause of Coronavirus disease 19 (COVID-19) it has caused over 649,147,421 infections and over 6,730,382 deaths worldwide. SARS-CoV-2 presents higher infectivity than other coronaviridae (MERS-CoV and SARS-CoV). Pregnant patients, according to previous studies are at high risk of severe COVID-19 course and negative pregnancy outcomes (pre-term birth, low birth weight, preeclampsia, operative delivery and ICU admission with need for mechanical ventilation). METHODS: In this review we focus on the pathophysiology of subcellular changes in COVID-19 and try bring to light the aspects that occur in physiological pregnancy that may cause higher risk of SARS-CoV-2 infection and severe COVID-19 course. RESULTS: Knowledge of potential interplay between viral infection and physiological changes in pregnancy may point us in the direction of future prophylaxis and treatment in this special population.Key MessagesSARS-CoV-2 having affinity to ACE-2 and causing it's downregulation receptor may cause endothelial injury leading to compliment activation and formation of NETs, together with RAS dysregulation this may cause preeclampsia to develop in pregnant patients.PTB may occur in patients as an effect of SARS-CoV-2 infection in first or second trimester as an effect of TLR4 pathway dysregulation with lower levels of IFNß.

Description of Neutrophil-to-lymphocyte Ratio, C-reactive Protein, and Procalcitonin Levels in Pregnancy with COVID-19 at Sanglah General Hospital Period of April 2020–April 2021

Background: Theoretically, pregnant women are more susceptible to infection of coronavirus disease 2019 (COVID-19) and severe pneumonia due to presentation of physiological changes adaptation and immunosuppression during pregnancy. Based on the immune clock theory, if pregnant women had COVID-19 in the first and third it can appearance of cytokine storm due to hyperinflammation state, and lead to poor maternal and neonatal outcomes. Hyperinflammation state is characterized by an increase in inflammatory biomarkers in the serum, including the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin levels. This study aims to determine the characteristic of NLR, CRP, and procalcitonin in pregnancy with COVID-19 at Sanglah General Hospital, Denpasar, Bali, Indonesia. Methods: This study is a cross-sectional descriptive study using secondary data from patient’s medical records and is conducted in the delivery room and medical record department at Sanglah General Hospital, Denpasar from April 2020 to April 2021. Result: Pregnancy cases with COVID-19 in this study were in the 26–30-year age group, as much as 26 cases (37.14%) with most common comorbidities found were preeclampsia and electrolyte imbalance, as much as nine cases each (12.86%). Most of the neonates born at term, with birth weight 2,500 gm, and vigorous baby. The highest median NLR value was found in pregnant women with COVID-19 in comorbid with obesity, 6.79 (2.88–9.14). In this study, the cases with a length of stay more than or 10 days had a median NLR value of 6.93 (2.57–20.69), CRP 59.83 (1.60–151.56), and procalcitonin 0.145 (0.03–2.56), which are all higher than those whose length of stay was less than 10 days. Conclusion: NLR, CRP, and procalcitonin values are affected by the trimester of pregnancy, the maternal comorbidities, the commonly found chest X-ray features, the length of hospital stay, the prognostic value to be determined to find the disease severity, the needs of oxygen supplementation, and the intensive care treatment, and also they could be the predictors for neonatal outcome in pregnancy with COVID-19.

Comparison of the Prevalence of Gestational Diabetes Pre-COVID-19 Pandemic Versus During COVID-19

INTRODUCTION: Recent studies suggest that the rate of gestational diabetes (GDM) diagnosis has increased following the onset of the COVID-19 pandemic. This study investigated the prevalence of GDM among patients delivering at a single academic institution, prior to and after the onset of the COVID-19 pandemic. METHODS: This was a retrospective study of patients with a singleton, full-term birth who delivered pre-COVID-19 (January 2019-May 2020) and during the COVID-19 pandemic (June 2020- July 2021). Institutional review board approval was obtained. Data collected included diagnosis of GDM, maternal age, prepregnancy BMI, and gestational weight gain (GWG). Chi-square tests assessed the relationship between GDM diagnosis (yes, no) and time (pre-COVID- 19, during COVID-19). Binary regression further evaluated this relationship, controlling for confounding factors. RESULTS: Among the 7,653 patients included in analysis, 58.6% delivered pre-COVID-19 and 41.1% delivered during COVID-19. During COVID-19, 12.5% of patients were diagnosed with GDM, compared to 9.0% pre-COVID-19 (P<.001). When stratified by prepregnancy weight status, the significantly increased prevalence of GDM during COVID-19 remained among those with a lean, overweight, and obese prepregnancy BMI (underweight, 6.2% versus 3.8%, P=.40;lean, 7.4% versus 5.0%, P<.01;overweight, 10.9% versus 7.4%, P<.01;obese, 21.1% versus 17.2%, P=.02). When controlling for maternal age, prepregnancy BMI, and GWG, time (related to COVID- 19) remained a significant predictor of GDM diagnosis (P<.001). CONCLUSION: This study demonstrates a 38.9% increase in the prevalence of GDM delivering at a single academic institution during the COVID-19 pandemic, compared to pre-COVID-19. Future research is needed to determine the underlying mechanisms potentially contributing to hyperglycemia in pregnancy.

The Impact of COVID-19 Pandemic on Stress and Anxiety of Non-infected Pregnant Mothers.

BACKGROUND: The newly emerging COVID-19 has caused severe anxiety around the world and it is infecting more people each day since there is no preventive measure or definite therapy for the diseases. The present study aimed to evaluate its effect on anxiety and stress of pregnant mothers during perinatal care. METHODS: Three-hundred pregnant mothers without COVID-19 infection who were referred to the hospitals affiliated to Iran University of Medical Sciences for delivery during April 2020, based on negative clinical symptoms and the results of polymerase chain reaction (rt-PCR) for COVID-19, were recruited by census method and asked to complete the Persian version of the perceived stress scale (PSS); participants views about their anxiety level and the role of COVID-19 as the source of their stress and worries were recorded. Women who refused to continue the study were excluded. The frequency of variables and mean scores were calculated using SPSS v. 21. RESULTS: Mean age of mothers was 30.20±16.19 years; 31.3% were primigravida and mean gestational age was 38.00±4.14 weeks. Moreover, 16.3% asked for earlier pregnancy termination and 39% requested Cesarean section (C/S). Assessing the mothers' anxiety revealed a high/very high level of anxiety in 51.3%. The majority felt worried and frustrated because of COVID-19 (86.4%). Social media had a great impact on the level of stress among these mothers (60.3%). CONCLUSION: COVID-19 pandemic is an important source for the increased anxiety and stress among healthy pregnant mothers.

Clinical characteristics, outcomes, & mortality in pregnant women with COVID-19 in Maharashtra, India: Results from PregCovid registry.

Background & objectives: The PregCovid registry was established to document the clinical presentations, pregnancy outcomes and mortality of pregnant and post-partum women with COVID-19. Methods: The PregCovid registry prospectively collects information in near-real time on pregnant and post-partum women with a laboratory-confirmed diagnosis of SARS-CoV-2 from 19 medical colleges across the State of Maharashtra, India. Data of 4203 pregnant women collected during the first wave of the COVID-19 pandemic (March 2020-January 2021) was analyzed. Results: There were 3213 live births, 77 miscarriages and 834 undelivered pregnancies. The proportion of pregnancy/foetal loss including stillbirths was six per cent. Five hundred and thirty-four women (13%) were symptomatic, of which 382 (72%) had mild, 112 (21%) had moderate, and 40 (7.5%) had severe disease. The most common complication was preterm delivery (528, 16.3%) and hypertensive disorders in pregnancy (328, 10.1%). A total of 158 (3.8%) pregnant and post-partum women required intensive care, of which 152 (96%) were due to COVID-19 related complications. The overall case fatality rate (CFR) in pregnant and post-partum women with COVID-19 was 0.8 per cent (34/4203). Higher CFR was observed in Pune (9/853, 1.1%), Marathwada (4/351, 1.1%) regions as compared to Vidarbha (9/1155, 0.8%), Mumbai Metropolitan (11/1684, 0.7%), and Khandesh (1/160, 0.6%) regions. Comorbidities of anaemia, tuberculosis and diabetes mellitus were associated with maternal deaths. Interpretation & conclusions: The study demonstrates the adverse outcomes including severe COVID-19 disease, pregnancy loss and maternal death in women with COVID-19 in Maharashtra, India.

Risk of pre-term births and major birth defects resulting from paternal intake of COVID-19 medications prior to conception.

OBJECTIVE: With the ongoing COVID-19 pandemic, large numbers of people will receive one of the several medications proposed to treat COVID-19, including patients of reproductive age. Given that some medications have shown adverse effects on sperm quality, there might be a transgenerational concern. We aim at examining the association between drugs proposed to treat COVID-19 when taken by the father around conception and any pre-term birth or major birth defects in offspring in a nation-wide cohort study using Danish registry data. Offspring whose father filled at least one prescription of the following medications in the 3 months preceding conception were considered exposed: chloroquine, hydroxychloroquine, losartan, azithromycin, naproxen, dexamethasone and prednisone. RESULTS: For azithromycin and naproxen, large numbers of offspring were exposed (> 1800 offspring), and we found no association with adverse birth outcomes. For chloroquine, losartan and dexamethasone, exposure was intermediate (~ 900 offspring), and there was no statistically significant association with birth defects. For hydroxychloroquine and prednisone, exposure was limited (< 300 offspring). Our evidence suggests that azithromycin and naproxen are safe with respect to pre-term birth and birth defects. For the other drugs investigated larger exposures are needed for conclusive statements.