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.

Maternal and Neonatal Outcomes in Pregnant Women With COVID-19 Admitted to Imam Khomeini Hospital of Sari, Iran, 2019-2020

Background: The COVID-19 infection may adversely affect both the mother and baby. Evaluation and identification of aggravating factors can help prevent adverse outcomes.Objectives: The present study aimed to examine pregnant women with COVID-19 infection and evaluate the disease outcomes inMethods: The present case series study was performed on 17 pregnant women hospitalized for COVID-19 in Sari. A convenience sampling method was used. First, the researcher took the demographic information and medical history and obtained informed consent from all participants. Then, the selected subjects were examined for inclusion and exclusion criteria, and a throat swab sample was taken from eligible ones for PCR. The PCR was performed for amniotic fluid and neonatal throat samples at pregnancy termination. Six weeks after delivery, the status of rehospitalization of the baby, breastfeeding status, rehospitalization of the mother due to COVID-19, and the state of depression of the mother were evaluated by a 21-item questionnaire over the phone. The collected data were analyzed in SPSS version 23 using the Chi-square test.Results: Out of 19 participants, 17 (68%) had positive results for COVID-19 laboratory tests. The prevalence of preterm labor, admission to the neonatal intensive care unit, and vertical transmission were significantly high in pregnant women with COVID-19 and positive PCR results for amniotic fluid (P < 0.050). The frequency of admission to the ICU was significantly higher in pregnant women with diabetes infected with COVID-19 (P = 0.025). There was no rehospitalization of the mother and newborn due to COVID-19, but one case of postpartum depression (9.5%) and two cases of formula feeding (11.8%) were reported.Conclusions: Due to the high risk of maternal and neonatal outcomes of COVID-19 during pregnancy and the high probability of vertical transmission, it is recommended to take special precautions to prevent the disease during this period.

Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection.

BACKGROUND: Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. METHODS: We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies. DISCUSSION: We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.

COVID-19 and Gestational Diabetes: The Role of Nutrition and Pharmacological Intervention in Preventing Adverse Outcomes.

Pregnant women with GDM affected by COVID-19 seem to be at higher risk of adverse maternal and neonatal outcomes, especially those with overweight or obesity. Good glycemic control seems to be the most effective measure in reducing the risk of GDM and severe COVID-19. For such purposes, the Mediterranean diet, micronutrient supplementation, and physical activity are considered the first line of treatment. Failure to achieve glycemic control leads to the use of insulin, and this clinical scenario has been shown to be associated with an increased risk of adverse maternal and neonatal outcomes. In this review, we explore the current evidence pertaining to the pathogenesis of SARS-CoV-2 leading to the main complications caused by COVID-19 in patients with GDM. We also discuss the incidence of complications caused by COVID-19 in pregnant women with GDM according to their treatment.

COVID-19 and perinatal outcomes among pregnant women admitted to isolation unit at Suez Canal university hospital, Egypt: A cross-sectional study

This study described the maternal and perinatal outcomes of pregnant women infected with COVID-19. A cross-sectional descriptive design was used in this study of 75 women diagnosed with COVID-19 in the isolation unit of Obstetrics and Gynecology Department at Suez Canal University hospital. Data was collected by a structured interview questionnaire and assessment of patients' records in the period from April 26, 2021, to October 31, 2021. This study found that 7/29 (24.14%) of women had abortions, 9/46 (19.57%) had preterm labor, 2/19 (10.53%) had both postpartum hemorrhage and puerperal pyrexia, 2/46 (4.35%) had an antepartum hemorrhage, and 2/52 (3.85%) had preeclampsia. Regarding fetal complications, 2/46 (4.35%) had intrauterine fetal distress, and 2/52 (3.85%) had a stillbirth. Concerning neonatal outcomes, 31.25% of cases needed NICU admission, 12.5% required mechanical ventilation and developed ARDS, 18.75% had low birth weight, and only 6.25% of all cases died. This study concluded that pregnant women with COVID-19 seem to have a high risk of abortion and preterm birth. Their neonates are at high risk of NICU admission and low birth weight.

Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth.

BACKGROUND: Despite the mainly reassuring outcomes for pregnant women with coronavirus disease 2019 reported by previous case series with small sample sizes, some recent reports of severe maternal morbidity requiring intubation and of maternal deaths show the need for additional data about the impact of coronavirus disease 2019 on pregnancy outcomes. OBJECTIVE: This study aimed to report the maternal characteristics and clinical outcomes of pregnant women with coronavirus disease 2019. STUDY DESIGN: This retrospective, single-center study includes all consecutive pregnant women with confirmed (laboratory-confirmed) or suspected (according to the Chinese management guideline [version 7.0]) coronavirus disease 2019, regardless of gestational age at diagnosis, admitted to the Strasbourg University Hospital (France) from March 1, 2020, to April 3, 2020. Maternal characteristics, laboratory and imaging findings, and maternal and neonatal outcomes were extracted from medical records. RESULTS: The study includes 54 pregnant women with confirmed (n=38) and suspected (n=16) coronavirus disease 2019. Of these, 32 had an ongoing pregnancy, 1 had a miscarriage, and 21 had live births: 12 vaginal and 9 cesarean deliveries. Among the women who gave birth, preterm deliveries were medically indicated for their coronavirus disease 2019-related condition for 5 of 21 women (23.8%): 3 (14.3%) before 32 weeks' gestation and 2 (9.5%) before 28 weeks' gestation. Oxygen support was required for 13 of 54 women (24.1%), including high-flow oxygen (n=2), noninvasive (n=1) and invasive (n=3) mechanical ventilation, and extracorporeal membrane oxygenation (n=1). Of these, 3, aged 35 years or older with positive test result for severe acute respiratory syndrome coronavirus 2 using reverse transcription polymerase chain reaction, had respiratory failure requiring indicated delivery before 29 weeks' gestation. All 3 women were overweight or obese, and 2 had an additional comorbidity. CONCLUSION: Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth. Its association with other well-known risk factors for severe maternal morbidity in pregnant women with no infection, including maternal age above 35 years, overweight, and obesity, suggests further studies are required to determine whether these risk factors are also associated with poorer maternal outcome in these women.