Impact of Novel Coronavirus (COVID-19) on Pregnant Women: A Review

The novel coronavirus infection (COVID-19) is a global public health emergency. Since its outbreak in Wuhan, China in December 2019, the infection has spread at an alarming rate across the globe and humans have been locked down to their countries, cities and homes. As of now, the virus has affected over 20 million people globally and has inflicted over 7 lac deaths. Nevertheless, the recovery rate is improving with each passing day and over 14 million people have recuperated so far. The statistics indicate that nobody is immune to the disease as the virus continues to spread among all age groups, newborns to the elders, and all compartments including pregnant women. However, pregnant women may be more susceptible to this infection as they are, in general, highly vulnerable to respiratory infections. There is no evidence for vertical transmission of the COVID-19 virus among pregnant women, but an increased prevalence of preterm deliveries. Be-sides this, the COVID-19 may alter immune response at the maternal-fetal interface and affect the well-being of mothers as well as infants. Unfortunately, there is limited evidence available in the open literature regarding coronavirus infection during pregnancy and it now appears that certain pregnant women have been infected during the present 2019-nCoV pandemic. In this perspective, we study the impact of the COVID-19 infection on vertical transmission and fetal outcomes among pregnant women.Copyright © 2022 Bentham Science Publishers.

Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai.

INTRODUCTION: Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm of higher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment of juvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring its role in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes in critical COVID-19 pregnant women. METHODOLOGY: A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine. RESULT: On treatment with tocilizumab, improvement was seen in the number of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by the end of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during the course of the disease. No fetal adverse effects were noted. CONCLUSION: Based on the encouraging response and as tocilizumab did not impart any adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to critical COVID-19 pregnant women in their second and third trimesters.

Maternal and Perinatal Outcomes of COVID-19-Positive Pregnant Women.

Background The risks of adverse maternal and perinatal outcomes are not very clear in coronavirus disease 2019 (COVID-19)-positive pregnant women. Therefore, this study aimed to determine the maternal and fetal outcomes in COVID-19-positive pregnancies. Methodology This prospective, cohort study was conducted in a tertiary care center over the period of one year. The study group comprised pregnant patients who presented with COVID-19 in the first and second waves of the pandemic. Maternal symptoms due to COVID-19 infection, comorbidities, number of admissions to the intensive care unit (ICU), and maternal mortality were noted for every patient. Perinatal outcomes were recorded in the form of intrauterine growth retardation (IUGR), mode of delivery, preterm deliveries, birth weight of newborns, neonatal intensive care unit (NICU) admissions, and neonatal mortality. Data analysis was done in the form of a variable percentage and mean ± standard deviation (SD). Results COVID-19-positive pregnant patients were mostly asymptomatic (48.07%). Term deliveries (37-40 weeks) were seen in 44 (89.8%) patients. The percentage of normal vaginal delivery was 74% and cesarean section was 24%. Out of 52 patients, two (3.8%) patients were admitted to the high dependency unit (HDU), one (1.9%) patient was admitted to the ICU, and 49 (94.3%) patients were in the isolation ward. Of the 49 live births, four (8.16%) newborns were admitted to the NICU. No neonatal death was recorded. Conclusions In this study, COVID-19-pregnant women were mostly asymptomatic. Neonates of COVID-19-infected women also mostly tested COVID-19 negative. More studies are needed with larger sample sizes to determine the effect of COVID-19 infection in pregnant women and neonates.

Clinical Profile and Outcome of Covid Positive Obstetric Patients in a Tertiary Care Hospital - A Retrospective Study

Objective: To study clinical profile, maternal and fetal outcome in covid positive pregnancies. Methods: A retrospective observational study was done at Lalla Ded hospital, Kashmir, a tertiary care centre. 70 covid positive pregnant women who were admitted from May 2020 to January 2021 were included in the study. Results: The incidence of Covid positive patients in our study was 11.47%. 60% of patients in our study belonged to 26-30 years age group. 50% patients were primigravida, 20% were second gravida. Among the study population, 31(44.3%) patients were term while 22 (31.4%) were preterm. Most patients were asymptomatic (61.4%). Among symptomatic patients, maximum had fever (17.1%) followed by cough (10%) and shortness of breath (4.3%). Associated comorbidity was seen in 33 patients (47.1%). Hypertensive disorders of pregnancy were seen in majority i.e.15.7%, followed by anaemia (11.4%), GDM (8.5%) and hypothyroidism (7.1%). Out of total study population of 70, emergency caesarean delivery (LSCS) was done in 29 patients (41.5%). 21 patients delivered vaginally (30%). Two post-LSCS patients were shifted to designated Covid Intensive care unit (ICU). One patient from the study group died. There were total of 50 deliveries, 10 babies had Neonatal ICU admission (20%), Low birth weight in 9 (18%). Low APGAR score was in 6 (12%). There were 2 stillbirths in the study population. Conclusion: Covid presents as milder disease in pregnancy, but it may be severe in those with associated comorbidities. More studies on susceptibility of pregnant women to infection by Covid-19 are required © 2021,Online Journal of Health and Allied Sciences.All Rights Reserved

Clinical Features and Outcomes of COVID-19 Infection among Pregnant Women in South Africa.

BACKGROUND AND OBJECTIVE: Studies among COVID positive pregnant women are limited. Previous studies reported high rate of symptoms, comorbidities and poor fetal/neonatal outcome among women of different ethnicity. To date, no study was reported among pregnant African women. This study was conducted to determine the clinical features and outcomes of COVID-19 positive pregnant women in Ekurhuleni District in South Africa. METHODS: Retrospective record review of 103 COVID-19 infected pregnant women during the period of April to September 2020 was done. Clinical features, symptoms, comorbidities, laboratory results, maternal and neonatal outcomes were analyzed. Descriptive statistics (mean + standard deviation, number and percentages) and inferential statistics (Chi-square test) were calculated. Ethical clearance was obtained from the Human Research Ethics Committee of the University of Witwatersrand, South Africa. RESULTS: Majority (90%) were of African ethnicity and symptomatic (53%). The commonest symptom, comorbidity and laboratory abnormality was cough (62%), hypertension (23%) and high LDH (20%), respectively. Thrombocytopenia and lymphocytopenia occurred among 9% and 15% of the women, respectively. Although association was not significant, symptoms were more common among comorbid, HIV positive and women with abnormal results. Commonest complications were preterm labor (8%) and macerated stillbirths (6%). Six (6%) mothers died. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: COVID positive pregnant South African women were commonly symptomatic but incidence of adverse fetal outcomes was low. High rate of preterm labor, macerated stillbirths and maternal deaths was a concern. This study has several strengths. It included all COVID positive women over a 6 months' period at all level of healthcare facilities such as clinics, community health centers/midwifery units, and district, regional and tertiary hospitals, conducted in an African country. Previous studies included mainly hospitals raising a high probability of including mainly severely ill women. The study might benefit the health care workers in other African countries.

Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study.

A novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus causing coronavirus disease 2019 (COVID-19) disease, which emerged as a global pandemic. Data regarding the implications of COVID-19 disease at early gestation on fetal and obstetric outcomes is scarce. Thus, our aim was to investigate the effect of first and second trimester maternal COVID-19 disease on fetal and perinatal outcomes. This was a prospective cohort study of pregnant women with a laboratory-proven SARS-COV-2 infection contracted prior to 26 weeks gestation. Women were followed at a single tertiary medical center by serial sonographic examinations every 4-6 weeks to assess fetal well-being, growth, placental function, anatomic evaluation and signs of fetal infection. Amniocentesis was offered to assess amniotic fluid SARS-COV-2-PCR (polymerase chain reaction) and fetal brain magnetic resonance imaging (MRI) was offered at 30-32 weeks gestation. Demographic, obstetric and neonatal data were collected from history intake, medical charts or by telephone survey. Perinatal outcomes were compared between women infected at first vs. second trimester. 55 women with documented COVID-19 disease at early gestation were included and followed at our center. The mean maternal age was 29.6 ± 6.2 years and the mean gestational age at viral infection was 14.2 ± 6.7 weeks with 28 (51%) women infected at the first trimester and 27 (49%) at the second trimester. All patients but one experienced asymptomatic to mild symptoms. Of 22 patients who underwent amniocentesis, none had evidence of vertical transmission. None of the fetuses exhibited signs of central nervous system (CNS) disease, growth restriction and placental dysfunction on serial ultrasound examinations and fetal MRI. Pregnancies resulted in perinatal survival of 100% to date with mean gestational age at delivery of 38.6 ± 3.0 weeks and preterm birth <37 weeks rate of 3.4%. The mean birthweight was 3260 ± 411 g with no cases of small for gestational age infants. The obstetric and neonatal outcomes were similar among first vs. second trimester infection groups. We conclude SARS-CoV-2 infection at early gestation was not associated with vertical transmission and resulted in favorable obstetric and neonatal outcomes.

COVID-19 infection in pregnant women: Review of maternal and fetal outcomes.

Pregnant women, their fetuses, and newborns are likely to represent a high-risk population during the current coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Literature on the outcomes of COVID-19 infections during pregnancy is slowly building up. The aim of the present review was to gather evidence from relevant articles published in English from January to August 2020 in Medline and Google Scholar. The review revealed that pregnant women who become COVID-19-positive are usually either asymptomatic or mild-to-moderately symptomatic, similar to non-pregnant women. Pneumonia is one of the most common outcomes in pregnant women with COVID-19. However, it cannot be conclusively said that SARS-CoV-2 infection increases the risk of maternal, fetal, and neonatal complications. Pregnant women with COVID-19 with co-morbidities have increased risks of complications: there are regional variations in the rates of adverse outcomes reported. Though uncommon, the review shows that vertical transmission is possible. Additionally, the third trimester seems to be the most vulnerable period of infection. This aspect needs to be researched further to activate surveillance programs at the end of second trimester. Overall, it is necessary to monitor pregnant women before and after delivery, and their infants, during this pandemic.