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Aims: The Covid-19 pandemic and subsequent restrictions impacted both health outcomes and clinical practice. We explored the impact on the diabetes antenatal clinic (DANC) attendance and outcomes. Method(s): Pre and during pandemic periods were defined as January 2019 to February 2020 and March 2020 to March 2022, respectively. DANC attendance, maternal and perinatal data were analysed. Adverse neonatal outcomes included stillbirth, neonatal hypoglycaemia, jaundice, shoulder dystocia and respiratory distress. Result(s): DANC attendance increased in the pandemic compared to the pre-pandemic period (297 (Interquartile range (IQR) 269-358) vs 196 (IQR 176-211) monthly, p < 0.001) with 36.7% (IQR 33-49) virtual appointments, representing a 34% overall increase. Body mass index (BMI) increased (29.7 kg/m2 (IQR 26.4-32.2) vs 31.4 kg/ m2 (IQR 26.5-34.2)) during the pandemic (p = 0.007), but maternal age and parity remained unchanged. There was no difference in gestational age at delivery;however, induction rates reduced from 58.5% to 37.5% (p = 0.0009) and spontaneous vaginal deliveries increased from 13.7% to 34.5% during the pandemic (p = 0.0004). Instrumental deliveries reduced from 21.5% to 11.3% (p = 0.03) but there was no change in number of caesarean sections including emergency ones. There was no difference in the rates of macrosomia or neonatal admissions. There was an overall reduction in adverse neonatal outcomes (37/102 (36.2%) vs 33/142 (23.2%) p = 0.03). Conclusion(s): Clinic numbers and maternal BMI increased during the pandemic. However, delivery and perinatal outcomes improved. Out data are reassuring and align with other studies indicating maternity outcomes did not deteriorate during the pandemic, possibly explained by improved care provision and organisation culture under crisis.
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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.
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Case Report: Since the beginning of the Coronavirus Disease 2019 (COVID-19) pandemic, there has been much work to understand the negative effects of SARS-CoV-2 on tissues expressing the Angiotensin Converting Enzyme-2 (ACE2) receptor, including the placenta. However, there is limited information regarding placental pathology findings in mothers with COVID-19 and the effects of SARS-CoV-2 on the placenta. The available research reports effects on the fetus ranging from minimal to intrauterine fetal demise. Case Description: A 4680g baby boy was born at 38+1 weeks of gestation to 36y old G4P1021 female via repeat cesarian section. The pregnancy was complicated by advanced maternal age, chronic hypertension with superimposed pre-eclampsia with severe features, BMI of 80, and SARS-CoV-2 infection. The mother had mild COVID-19 symptoms and did not require hospitalization or oxygen support. Prenatal ultrasounds were limited due to body habitus. At the time of delivery, there was clear amniotic fluid. Upon delivery the infant was cyanotic and limp and was brought to the warmer immediately. Non-invasive positive pressure ventilation was initiated at 5 minutes of life with improvement in infant color and oxygen saturation. He was then admitted to the Neonatal Intensive Care Unit (NICU). APGARs were 2, 3, 5, and 7 at 1, 5, 10, and 15 minutes respectively. Cord gases showed severe metabolic acidosis. The patient was diagnosed with hypoxic-ischemic encephalopathy (HIE) and therapeutic hypothermia was initiated. Both the NICU and obstetric teams were unable to identify a clear perinatal cause of HIE in this patient. Later, the placenta pathology report revealed a large placenta for estimated gestational age corresponding to the 75th percentile, villous parenchyma with focal chorangiosis and thrombi, with unremarkable fetal membrane and three vessel umbilical cord. The cause of HIE was then thought to be due to the placental thrombi likely caused by SARS-CoV-2 infection. Discussion(s): Fetal vascular malperfusion and fetal vascular thrombus have been noted as a common finding in the placentas of pregnant women who test positive for SARS-CoV-2. There are various causes of HIE, from maternal, placental and fetal factors. This patient had no clinically evident hypoxic event, but information was limited due to the lack of monitoring of the fetus in utero. Given the mother's SARS-CoV-2 infection and the placental pathology findings, it is likely that the cause of this patient's HIE was related to the effects on the placenta from SARS-CoV-2. Conclusion(s): As more information comes to light about the effects of SARS-CoV-2 on the placenta, it is important to consider a maternal SARS-CoV-2 infection during pregnancy as a cause of HIE in a newborn.
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COVID-19 has affected the population worldwide drastically with a tremendous impact on obstetric population which has led to serious concerns regarding maternal and fetal outcomes. Although there are recommended guidelines regarding delivery and management of complications, due to changes in characteristics of COVID-19 infection, they are constantly changing and evolving. Method(s): Prospective cohort study done during the covid pandemic from 1st April 2020 to 15th Feb 2022 in the department of Obstetrics & Gynecology, SKIMS MCH Srinagar J&K. The parameters measured were severity of covid disease, maternal age, gestational age, parity, blood investigations, mode of delivery, APGAR score, neonatal infection status and post-delivery complications. Result(s): A total of 311 pregnant covid 19 positive patients were included in the study who were actively managed.239 (76.85%) were delivered by casearean section and 72 (23.15%) by NVD. 92% patients had mild symptoms only, 8% had severe symptoms with 1.6% rate of ICU admission and 1.2% mortality rate. 83% delivered at term, 17% had preterm deliveries.8% patients had pneumonitis with positive findings on CT scan.24% patients had anemia, 12% had GDM, 10% had PIH, 10% had IHCOP, 5% had PPH, 1.6% had APH. All the neonates were negative for covid 19. 80% babies had an APGAR score of >= 8/10 at 1 min of birth with a mean birth weight of 2400 g +/- 500. No postdelivery complication was noted. Conclusion(s): Our study concludes that SARS-CoV-2 infection can lead to unfavorable maternal and perinatal outcomes.
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Introduction-The purpose of this study was to determine the relative impact of modifiable and non-modifiable risk factors in the development of gestational diabetes mellitus (GDM), with a particular focus on maternal preconception body mass index (BMI) and age, two important determinants of insulin resistance. Understanding the factors that contribute most to the current escalation of GDM rates in pregnant women could help to inform prevention and intervention strategies, particularly in areas where this female endocrine disorder has an elevated prevalence. Methods-A retrospective, contemporary, large population of singleton pregnant women from southern Italy who underwent 75 g OGTT for GDM screening was enrolled at the Endocrinology Unit, "Pugliese Ciaccio" Hospital, Catanzaro. Relevant clinical data were collected, and the characteristics of women diagnosed with GDM or with normal glucose tolerance were compared. The effect estimates of maternal preconception BMI and age as risk factors for GDM development were calculated through correlation and logistic regression analysis by adjusting for potential confounders. Results-Out of the 3856 women enrolled, 885 (23.0%) were diagnosed with GDM as per IADPSG criteria. Advanced maternal age (≥35 years), gravidity, reproductive history of spontaneous abortion(s), previous GDM, and thyroid and thrombophilic diseases, all emerged as non-modifiable risk factors of GDM, whereas preconception overweight or obesity was the sole potentially modifiable risk factor among those investigated. Maternal preconception BMI, but not age, had a moderate positive association with fasting glucose levels at the time of 75 g OGTT (Pearson coefficient: 0.245, p < 0.001). Abnormalities in fasting glucose drove the majority (60%) of the GDM diagnoses in this study. Maternal preconception obesity almost tripled the risk of developing GDM, but even being overweight resulted in a more pronounced increased risk of developing GDM than advanced maternal age (adjusted OR for preconception overweight: 1.63, 95% CI 1.320-2.019; adjusted OR for advanced maternal age: 1.45, 95% CI 1.184-1.776). Conclusions-Excess body weight prior to conception leads to more detrimental metabolic effects than advanced maternal age in pregnant women with GDM. Thus, in areas in which GDM is particularly common, such as southern Italy, measures aiming to counteracting maternal preconception overweight and obesity may be efficient in reducing GDM prevalence.
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BACKGROUND: In Indonesia, the stunting prevalence has reached 24.4% in 2021. AIM: The study aims to examine the determinants of stunting among children under five of age during the COVID-19 pandemic in the working area of the Liwuto-Primary Public Health Center, Baubau city. METHOD(S): A community-based unmatched case-control study was conducted from January 10, to March 10, 2022, on a sample of 94, cases (n = 21), and controls (n = 73) of children aged 0-59 months with their respective mothers. Data were collected using a face-to-face interviewer-administered questionnaire and physical measurements standard. The data were analyzed using SPSS version 17. The variables were entered into the multivariable model using the backward stepwise regression approach. Multivariable logistic regression analysis was used to identify factors associated with stunting. Adjusted odds ratio (AOR) with a 95% confidence interval (95% CI) and p < 0.05 was used to declare the significance. RESULT(S): There are 22% of the stunting become in children under 5 years. Stunting children under 5 years was associated with maternal age (AOR = 5.71, 95%, CI: 1.91-17.03). While family income (AOR = 1.78, 95%, CI: 0.17-18.86), exclusive breastfeeding (AOR = 3.95, 95%, CI: 0.14-112.72), complementary feeding (AOR = 1.24, 95%, CI: 0.18-8.55), formal education (AOR = 0.74, 95%, CI: 0.36-1.53), and occupation (AOR = 2.98, 95%, CI: 0.24-36.55) were not associated with the stunting. CONCLUSION(S): Young mother under 30 years old was an important risk factor on the incidence of stunting in children under 5 years during the COVID-19 pandemic.Copyright © 2023 Jumadi Muhammadong, Ridwan Malimpo, Dahmar Karim, Yusman Muriman, Andi Tenri Mahmud.
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The coronavirus disease 2019 (Covid-19), that was later declared pandemic by World Health Organization, had led to panic and fear worldwide. Like many outbreaks caused by viruses, in cheif reason for fear was the infectious agent's potential to be transmitted from pregnant women to their fetuses and newborns. In our study, the hospital records of 117 pregnant women who delivered stillbirths in our clinic between 01.01.2015 and 31.12.2020 were examined. The pregnancy characteristics and perinatal outcomes were examined by making retrospective analysis of the records. Considering six year of the study data, it was observed that the stillbirth rates increased in the pandemic period. One hundred seventeen stillbirth cases that occurred in the last six years were analyzed. The mean age of the pregnant women was 29.64+6 (18-44) and parity was 2.54+1.58 (1-8). Body mass index was calculated as 21.36+3.40 (16-27) average and smoking consumption rate was 9.40% (11/117). Maternal diabetes was detected in 8.54% of the patients (10/117) and pregnancies were complicated by maternal hypertension in 5.12% of the patients (6/117). The average birth weight was 1597+1038 (500-4700) gram. Sixty percent of the deliveries (n=71) were performed by vaginally. Fetal sex was 52.1% male (n=61). The number of deliveries in the past six years was 11780. Almost 1% of the deliveries occurred as stillbirths (117/11780). The unusual stillbirth ratio during the pandemic was 3.1 times higher than the average of pre-pandemic period (2.5vs0.80). In our study, we investigated stillbirth rates before and during the pandemic. Although vertical transmission of Covid-19 has not been reported, the adverse pregnancy and neonatal outcomes have been provided in many studies. Undoubtedly, in obstetrical practice stillbirth is one of the most destructive consequences for pregnant women. Considering the increase in stillbirth rates, we think that pregnant women with adverse perinatal outcomes should be routinely tested for Covid-19, especially during the outbreak.Copyright © 2021 Necati Ozpinar. All rights reserved.
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Objectives: to determine the clinical and genetic determinants of the severe course of COVID-19 in pregnant women in order to identify a risk group and search for therapeutic targets. Materials and methods. 21 patients (group 1) with a severe course of COVID-19 who required intensive care in the Anesthesiology and Intensive Care Unit (AICU) and 126 pregnant women with moderate severity treated in the Infectious-Obstetrics Unit (IOCU) were examined (group 2). Genomic DNA for molecular genetic analysis of gene variants ACE (I/D, rs 4340), PGR (Alu insertion), ESR1 (A351G, rs 9340799), PON1 (C108T, rs 705379) was isolated from the peripheral blood of patients using a commercial Quick-DNA Miniprep Plus Kit (Zymo Research, USA). Variants of ACE and PGR genes were determined using allele-specific polymerase chain reaction;polymerase chain reaction followed by restriction analysis was used to determine ESR1 and PON1 gene variants. Results. Severe course of COVID-19 is observed in 18.2% of pregnant women, critical condition in 7.5%. A third of AICU patients are over 35 years old. Somatic anamnesis was complicated in 23.8% of patients;thyroid gland pathology (14.3%) and varicose disease (19.0%) prevailed. A significant factor in the severe course of COVID-19 is obesity of the III-IV degree in 28.5% cases. The severe course of the disease was associated with complications of pregnancy (oligohydramnios - 52.4%, ahydramnios - 14.3%, fetal growth retardation syndrome - 33.3%, circulatory disorders - 57.1%, fetal distress - 47.6%, preeclampsia - 14.3%), labor (caesarean section - 57.1%, premature birth - 28.6%), disorders of newborns state (asphyxia - 35.6%). These patients are characterized by anemia (58.7%), thrombocytopenia (23.8%), leukocytosis (33.3%), lymphopenia (90.5%), a shift of the leukocyte formula to the left (an increase of rod-nuclear leukocytes by 85.7%). There were significantly increased levels of transaminases: alanine aminotransferase in 47.6%, aspartate aminotransferase in 76.2%. Prothrombotic changes are indicated by a decrease in prothrombin time and activated partial thromboplastin time in 66.7%, which is confirmed by an increase in D-dimer in 85.7% of patients up to the maximum 15,000 ng/ml in 9.5% of women. An increase in inflammation markers (C-reactive protein and interleukin-6 in all AICU patients, procalcitonin in 66.7%) is a reflection of the destructive effect of inflammatory processes. The genetic determinants of the severe course of COVID-19 in pregnant women can be the ID genotype of the ACE I/D rs4340 polymorphism (81.0%), the T2/T2 PROGINS genotype (19.0%), the ESR1 A351G rs9340799 GG genotype (28.5%). Conclusions. The use of separate clinical, laboratory and genetic indicators in pregnant women with COVID-19 will contribute to the selection of the risk group of a coronavirus severe course and the determination of targets of therapeutic impact.Copyright © 2022 Trylyst. All rights reserved.
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Obesity, defined as body mass index (BMI) > 30 kg/m2, complicates maternal and neonatal outcomes. Bariatric surgery (BS) is an option for weight reduction in several populations, including reproductive-aged women. However, there is a lack of consensus regarding the ideal time interval between BS and pregnancy. We report the case of a 43-year-old Hispanic female who underwent an initial Roux-en-Y gastric bypass (RYGB) in 2011, followed by a revision eight years later in 2019. The revision entailed the reduction of the gastric pouch size and the excision of the remnant stomach. It occurred sixteen months before the conception of her second pregnancy. Despite advanced maternal age and nutritional challenges following BS, this patient delivered a healthy male neonate and maintained a net weight loss compared to her preoperative weight. Factors leading to this positive outcome included the patient's adherence to dietary recommendations following the procedure and using weight loss adjuncts (phentermine and topiramate) to promote post-procedure weight loss. Sixteen months between RYGB revision and conception can lead to positive pregnancy outcomes, even in women of advanced maternal age and multiple prior BS. Further studies are required to understand better the optimal interval to reduce maternal and neonatal complications following RYGB specifically and the use of medications as weight loss adjuncts.
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Background: Diabetes mellitus (DM) represents one of the most common metabolic diseases in the world, with rising prevalence in recent decades. Most cases are generally classified into two major pathophysiological categories: type 1 diabetes mellitus (DM1), which progresses with absolute insulin deficiency and can be identified by genetic and pancreatic islet autoimmunity markers, and type 2 diabetes mellitus (DM2), which is the most prevalent form and involves a combination of resistance to the action of insulin with an insufficient compensatory response of insulin secretion. In the last two decades, in parallel with the increase in childhood obesity, there has also been an increase in the incidence of DM2 in young people in some populations. Other forms of diabetes may affect children and adolescents, such as monogenic diabetes (neonatal diabetes, MODY – maturity onset diabetes of the young, mitochondrial diabetes, and lipoatrophic diabetes), diabetes secondary to other pancreatic diseases, endocrinopathies, infections and cytotoxic drugs, and diabetes related to certain genetic syndromes, which may involve different treatments and prognoses. DM1 is considered an immuno-mediated disease that develops as a result of gradual destruction of insulin-producing pancreatic beta cells that eventually results in their total loss and complete dependence on exogenous insulin. Clinical presentation can occur at any age, but most patients will be diagnosed before the age of 30 years
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Rationale: Recruitment for a NIH/ECHO-supported multi-center birth cohort, "Childhood Allergy and the NeOnatal Environment” (CANOE) stopped due to the COVID-19 pandemic. Redesign of study procedures emphasized virtual and socially distanced activities. We hypothesized that "virtual” recruitment methods (social media, websites, email) would surpass "traditional” methods (in-clinic, telephone, flyers/print materials) and increase enrollment of families from diverse backgrounds and communities. Methods: Pregnant women (n=439, target 500) were recruited from four academic medical centers in Detroit MI, Madison WI, Nashville TN, and St. Louis MO. We collected demographic and social information by questionnaires and examined race, ethnicity, age, parity, and employment status in relation to recruitment method using chi-square tests. Results: In-clinic and telephone recruitment comprised 55% of enrollment, followed by print materials (17%), and social media and email (15%). The cohort includes families self-identifying as Caucasian/White (63%), African American/Black (27%), Hispanic/Latino (3.3%), Asian (3.5%), and mixed races (1.2%). This reflects site demographics for White and Black patients, while other populations are not as well recruited into this cohort. Recruitment method success did not vary by race, ethnicity, maternal age, or employment status (p=ns for each comparison). Most (63%) multigravida mothers (9.1% of participants) were recruited in clinic, while primigravida participants were recruited more evenly via all methods. Conclusions: "Virtual” recruitment methods comprised a smaller proportion of cohort enrollment than hypothesized and study recruitment method did not vary by race/ethnicity;however, consideration of combined, varied, and novel recruitment methods may add to the development of best practices for more representative research study recruitment.
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Objective：To analyze the influencing factors of vitamin D in pregnant women in three stages of pre⁃outbreak，post⁃outbreak and normalization of COVID ⁃19 pandemic. Methods：The pregnant women who received prenatal examination in the First Hospital of Shanxi Medical University from May 2018 to May 2021 were selected as the research objects to detect vitamin D level，and analyze the effects of different pregnancy methods，delivery methods，age，gestational age，parity，number of parities and season on vitamin D level. Results：Totally 1 679 pregnant women were involved，the level of serum 25（OH）D in pregnant women was 18. 70（ 12. 60，27. 20）ng/mL. The rate of vitamin D deficiency was 24. 41%，51. 01% and 34. 23% of three stages of pre⁃outbreak，post⁃outbreak and normalization of COVID ⁃ 19 pandemic，the difference was statistically significant（P<0. 001）. Orderly multiple Logistic regression analysis showed that early pregnancy［ OR=0. 359，95%CI（0. 257，0. 502）］，maternal age <35 years old［ OR=0. 766，95%CI（0. 598，0. 980）］，winter ［OR=0. 388，95%CI（0. 290，0. 520）］，spring［OR=0. 350，95%CI（0. 258，0. 475）］ and summer ［OR=1. 533，95%CI（1. 166， 2. 014）］ had an effect on vitamin D deficiency in pregnant women. Conclusion：The rate of vitamin D deficiency in pregnant women is high. Pregnancy，season and age are independent influencing factors of vitamin D deficiency in pregnant women. After the normaliza⁃ tion of COVID⁃19 pandemic，pregnant women should supplement vitamins scientifically and individually，strengthen the education of nutrition during pregnancy，and regularly monitor the level of vitamin D. 目的:分析新型冠状病毒肺炎疫情前、疫情暴发到疫情常态化3 个阶段孕妇维生素D 水平及其影响因素。方法:选取2 0 1 8 年 5 月--2021 年5 月在山西医科大学第一医院产检的孕妇作为研究对象，检测维生素D 水平，分析不同怀孕方式、分娩方式、年龄、孕 周、胎次、胎数、季节等对维生素D 水平的影响。结果:共纳入1 679 例孕妇，血清25（OH）D 水平为18. 70（12. 60，27. 20）ng/mL。疫 情前维生素D 缺乏率为24. 41%，疫情暴发期间维生素D 缺乏率为51. 01%，疫情常态化后维生素D 缺乏率为34. 23%，差异有统计 学意义（P<0. 001）;有序多分类Logistic 回归分析显示，孕早期［OR=0. 359，95%CI（0. 257，0. 502）］、孕妇年龄<35 岁［OR= 0. 766，95%CI（0. 598，0. 980）］、冬季［OR=0. 388，95%CI（0. 290，0. 520）］、春季［OR=0. 350，95%CI（0. 258，0. 475）］及夏季［OR= 1. 533，95%CI（1. 166，2. 014）］对孕妇维生素D 缺乏有影响。结论:孕妇维生素D 缺乏率较高，孕期、季节、年龄是孕妇维生素D 缺乏 的独立影响因素。提示孕妇应科学、个性化地补充维生素，加强孕期营养，定期监测维生素D 水平.
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OBJECTIVE: The current study investigated the immune response of maternal coronavirus disease 2019 (COVID-19) vaccination and vertical transmission of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) and nucleocapsid (N) proteins. STUDY DESIGN: This retrospective study included pregnant women in Bahrain Defense Force Hospital from March 2021 to September 2021 who were vaccinated with Sinopharm or Pfizer/BioNTech. Testing of anti-N and -S levels from paired samples of maternal and umbilical cord blood was performed at the time of delivery. The immune response to vaccination, association with maternal and fetal factors, and vertical transmission of antibodies were studied. RESULTS: The current study included 79 pregnant women. The median gestational age for those vaccinated with Sinopharm was 28 weeks and those vaccinated with Pfizer was 31 weeks, with 100% of the vaccinated population generating antibodies and showing vertical transmission. The anti-N and -S titers and interval frequencies varied in both vaccinations. The anti-N and -S and transfer ratio statistically correlated with maternal age, gestational age at delivery, latency period, and birth weight of the neonates differently in both vaccines. In addition, the peak level of antibodies and transfer ratios varied. CONCLUSION: Although variations are exhibited in both types of vaccination, the vaccinated pregnant population generated a significant level of anti-N and -S and showed vertical transmission.
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Background: The emergence of coronavirus disease 19 (COVID-19) as a novel zoonotic disease has been of international concern, with recent studies highlighting the potential association of COVID-19 with placental vascular dysfunction.1,2 Because the increased incidence of histopathological lesions could imply an aetiologic relationship with SARS-CoV-2 infection, this study aims to audit the spectrum of subacute placental disease occurring in COVID-19 positive mothers. Method(s): Histopathological reports were obtained from Liverpool Hospital from 18 March 2020 to 18 March 2022 and subjected to retrospective histopathological report audit. Three hundred and five placentas from mothers with history of COVID-19 infection during pregnancy were compared with 305 randomly selected controls with no reported COVID-19 infection. Information obtained included maternal age, fetal gestation at delivery, macroscopic measurements and 12 histopathological variables. Missing data was imputed using a random forest algorithm, with downstream multivariate statistical analysis. Validation of findings was performed via non-linear principal component analysis (NLPCA). Result(s): A significant increase in mean placental weight was observed in mothers with a history of COVID-19 (COVID-19 cohort 480g, control cohort 423g, p < 0.0001). Median gestation was significantly increased within the COVID-19 cohort at 38.2 weeks compared to 36.5 weeks in controls (p <0.0001). Surprisingly, there was no increase in histopathological lesions within the COVID-19 cohort. Similar findings were confirmed with NLPCA. These findings highlight the possible resistance of the placental disc to COVID-19 infection and the utility of utilising imputation and NLPCA in the study of potential new pathological entities. References 1. Wong YP, Khong TY, Tan GC. The Effects of COVID-19 on placenta and pregnancy: what do we know so far? Diagnostics 2021;11: 94. 2. Boyraz B, James K, Hornick J, et al. Placental pathology from COVID-19 recovered (nonacute) patients. Human Pathology 2022;125: 18-22.
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Although the global population continues to increase, the total fertility rate in many high-income countries (HICs) is below replacement, a trend apparent over several decades. The timing and pace of this change will shape the age distribution in these countries, leading to an increasing proportion of older people. The well-established links of the "demographic transition" between improving female education and improved access to contraception continue to drive down the fertility rates in low-/middle-income countries. However, changes in the age distribution will not be as marked as in HICs in the coming decades. These relationships may now be changing in some HICs with greater prosperity at both the personal (in some sectors of society) and national levels, linked to an increase in the total fertility rates despite continuing trends toward older age at first birth. Key drivers in these countries include improved provision of free/low-cost childcare, paid parental leave, and higher paternal contributions to childcare. However, there is also an increase in the number of women who do not have children or who may be unable to complete their family plans. Coronavirus disease 2019 and environmental factors, including the increasing prevalence of obesity, add to pressures on the fertility rates. Variable knowledge of the realities of female reproductive aging, particularly by men, is also a contributing factor, and this complex mix has fueled the increase in the number of elective egg freezing.
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Small for gestational age (SGA) births are a significant clinical and public health issue. The objective of this review was to summarize maternal biological and socio-demographic factors and preventive strategies used to reduce the risk of SGA births. A literature search encompassing data from the last 15 years was conducted using electronic databases MEDLINE/PubMed, Google Scholar and Scopus to review risk factors and preventive strategies for SGA. Current evidence shows that primiparity, previous stillbirths, maternal age ≤24 and ≥35 years, single motherhood, low socio-economic status, smoking and cannabis use during pregnancy confer a significant risk of SGA births. Studies on alcohol consumption during pregnancy and SGA birth weight are inconclusive. Beneficial and preventive factors include the "Mediterranean diet" and dietary intake of vegetables. Periconceptional folic acid supplementation, maternal 25-hydroxyvitamin D, zinc and iron levels are partly associated with birth weight. No significant associations between COVID-19 vaccinations and birthweight are reported. A midwifery-led model based on early and extensive prenatal care reduces the risk of SGA births in women with low socio-economic status. Major preventive measures relate to the awareness of modifiable and non-modifiable risk factors of SGA, leading to changes in parents' lifestyles. These data support that education, monitoring during pregnancy, and implementing preventive strategies are as important as biological determinants in risk reduction of SGA births.
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BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has had consequences on the pregnant population, as disease severity is associated with the quality of maternal health and pregnancy complications, increasing maternal and neonatal morbidity. Worldwide descriptive data help describe risk factors that could predict symptomatic and severe COVID-19 in pregnancy. OBJECTIVES: To describe demographic features and risk factors of pregnant women with COVID-19 in Qatar and compare symptomatic versus asymptomatic disease. STUDY DESIGN AND METHODOLOGY: Clinical characteristics and risk factors of pregnant women with COVID-19 in Qatar from March 2020 to March 2021 was retrospectively reviewed, comparing the cohort with the general pregnant population. Crude and adjusted odds ratios (aORs) were computed, comparing symptomatic versus asymptomatic infection. RESULTS: Of the 500 women, 347 reported at least one symptom at diagnosis (347/500; 69.4%). The majority fell in the 30-39 years age group (241/500; 48%), with more than half in the obese body mass index (BMI) category. The cohort was 66% (332/500) Qatari women, compared with the 26% expected in the population (26.4% vs 66.4% p < 0.001). Compared with the 2019 national statistics, the number of women was higher in the >40 years age group (5% vs 7.6%, p = 0.027) and grand multiparous group (5.4% vs 13.6%, p < 0.001). The symptom most commonly reported by the symptomatic group was cough (276/500; 55%), followed by fever, fatigue, and myalgia. In the adjusted analysis, the symptomatic group had 2.7 times higher odds of being asthmatic (OR = 2.67, 95% CI 1.1-6.7, p = 0.037). Women aged >40 years had 6.6 times higher odds of symptomatic disease (aOR = 6.6, 95% CI 1.08-39.73, p = 0.041). A history of contact with a patient with symptomatic COVID and earlier gestational age at diagnosis increased the odds (aOR = 2.06, 95% CI 1.2-3.54, p = 0.009; aOR = 0.73 95% CI 0.57-0.96; p = 0.017). CONCLUSIONS: This study cohort included significantly more Qatari women, older women, grand multiparous women, a higher proportion with pre-existing and gestational diabetes, and higher BMI than national data. In addition, contact to a patient with symptomatic disease, history of asthma, older age, and earlier gestational age at diagnosis were significantly associated with symptomatic disease.
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Introduction: The pandemic of COVID-19 has spread a wave of insecurity, fear and anxiety because of unknown facts about the pathogen. To have a better understanding about this infection, a systematic study is required by the principles of epidemiology with detailed investigations and researches from different angles. Hence, we are undertaking the study of seroprevalence of IgG antibody to get the idea about herd immunity in pregnant patients coming for delivery and their newborns. Objective(s): To find out the correlation between subclinical attack / mild attack of COVID 19 in the antenatal period. Method(s): This Cross-sectional study was conducted after getting cleared from Board of Studies and Ethical committee. The study population was calculated to be of 500 serum samples of both mother and newborns each. Result(s): The maternal age was 20-25 years among 230 (36.0%), 26-30 years among 164 (32.8%), 31-35 years among 88 (17.6%) and > 35 years among 18 (3.6%) patients. The maternal gestational age was <37 weeks 0 days at the time of delivery in 82 (16.4%) and that of >= 37 weeks was 418 (83.6%) patients. The exposure of COVID 19 virus and/or even the asymptomatic carriers, led to a data showing 18% (90 patients) of the study population being affected in 2nd trimester, 48.6% (243 patients) in 3rd trimester and 33.4% (167 patients) not affected at all in the pregnancy. IgG in mother at delivery was present among 21.4 % mothers. IgG in cord blood was present among 12.0% newborns. Conclusion(s): Although even at the time of diagnosis, asymptomatic pregnant women are able to reliably build a powerful IgG for receptor binding domain with neutralising response to COVID 19, as our results reveal. In addition, our findings indicate that this reaction was long-lasting, which lends credence to the notion that immunisation in this population will be successful. And after extensive research studies, pregnant females were allowed to be vaccinated against COVID 19. Copyright © 2022 Authors. All rights reserved.
ABSTRACT
Introduction: The pandemic of COVID-19 has spread a wave of insecurity, fear and anxiety because of unknown facts about the pathogen. To have a better understanding about this infection, a systematic study is required by the principles of epidemiology with detailed investigations and researches from different angles. Hence, we are undertaking the study of sero prevalence of IgG antibody to get the idea about herd immunity in pregnant patients coming for delivery and their newborns. Objective(s): To find out the correlation between subclinical attack/ mild attack of COVID 19 in the antenatal period. Method(s): This Cross-sectional study was conducted after getting cleared from Board of Studies and Ethical committee. The study population was calculated to be of 500 serum samples of both mother and newborns each. Result(s): The maternal age was 20-25 years among 179 (35.8%), 26-30 years among 129 (25.8%), 31-35 years among 118 (23.6%) and > 35 years among 74 (14.8%)patients. The maternal gestational age was 32-34 weeks among 59 (11.8%), 34.1-38 weeks among 98 (19.6%), 38.1-40 weeks among 275 (55.0%) and > 40 weeks among 68 (13.6%) patients. The Trimester with COVID-19 was 2nd among 152 (30.4%) and 3rd among 348 (69.6%) patients. IgG in mother at delivery was present among 59.0% mothers and IgG in cord blood was present among 54.0% newborns. Conclusion(s): Even at the time of diagnosis, aymptomatic pregnant women are able to reliably build a powerful IgG for receptor binding domain with neutralising response to COVID 19, as our results reveal. Although with opposition, majority of studies suggest that earlier the COVID 19 infection in pregnancy, better the transfer of IgG to fetus. As it is an evolving disease, extensive researches need to be established for a better result. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Background: At the onset of Covid-19 pandemic, it was an unknown entity in terms of risk status of the pregnant women for fetomaternal outcome. Both fetus and pregnant women were considered as groups under special concern due to their unique physiological characteristics. Method(s): A retrospective study was conducted in department of Obstetrics & Gynaecology along with Paediatrics department in Maharishi Markandeshwar Medical College and Hospital, Solan on pregnant females admitted to the Covid-19 Ward/ ICU over a period from August 2020 till 31st March 2022. Participants were included into 3 waves of pandemic based upon time of presentation and these 3 groups were further studied for the various fetomaternal parameters such as maternal age, symptom status, need for respiratory support, maternal mortality, abortions, still births, gestational age and weight of newborn and other morbidity and mortality in newborns. Result(s): A total of 171 pregnant were included in the study, of whom 47, 64 and 60 were seen in 1st, 2nd and 3rd waves respectively. Majority of subjects were asymptomatic in 1st, 2nd & 3rd wave, (p=0.30). Age wise distribution of the patients showed majority subjects in the age group of 20-30 years (p= 0.94). LSCS rates in 3 waves were not different significantly (p = 0.67). Maternal mortality rates and need for respiratory support were in similar proportions in all 3 waves (p=0.71) and (p=0.73) respectively. No significant difference was seen in maternal morbidity and neonatal outcome. Conclusion(s): The study showed no significant difference between the waves of Covid-19 pandemic in terms of fetomaternal outcome except no maternal mortality in 3rd wave. Copyright © 2022 Ubiquity Press. All rights reserved.