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1.
Ultrasound in Obstetrics & Gynecology ; n/a(n/a), 2022.
Article in English | Wiley | ID: covidwho-1819400

ABSTRACT

Objective Because pregnancy involves dynamic changes in the maternal immune system, the present work investigates whether gestational age is associated with in-hospital COVID-19 mortality and morbidity. Method Data of pregnant women with SARS-CoV-2 in different gestational age groups (subdivided in trimesters) were collected and analyzed from a Brazilian nationwide database. Multivariate logistic and Cox regression were used to identify in-hospital independent risk factors for in-hospital COVID-19 related mortality and morbidity, measured by time to recovery. Results A total of 7,461 cases were included in the study (9.3%, 28.4%, and 62.3% in 1st, 2nd, and 3rd trimester, respectively). After the adjustment for sociodemographic factors, epidemiologic and clinical characteristics, and intervention related variables, gestational age was not associated with mortality and morbidity. It is also suggested that obstetric centers and social organization healthcare can reduce the risk for mortality and morbidity, respectively. Conclusion Despite higher percentage of women admitted in the third trimester, we found no association between gestational age and COVID-19 mortality and morbidity. Therefore, the observed difference in the mortality and morbidity is explained by the different distribution of risk factors per gestational age. This article is protected by copyright. All rights reserved.

2.
JA Clinical Reports ; 8(1), 2022.
Article in English | ProQuest Central | ID: covidwho-1817286

ABSTRACT

BackgroundIn category-1 emergency cesarean section, decision-to-delivery interval (DDI) is an important indicator for evaluating the quality of maternity care. I thus evaluated DDI and neonatal outcome in category-1 emergency cesarean section in our institution.Case presentationI collected data from the six patients undergoing category-1 emergency cesarean section performed between October 1, 2019, and December 31, 2021. The average age and gestational age were 32 years old (range, 21–42) and 34 weeks (range, 26–40), respectively. Three patients suffered from abruptio placenta and the others fetal distress. All the surgeries were performed under general anesthesia, and the average DDI was 21 min (range, 10–29). The morality was 25% in neonates whose gestational ages of >35 weeks, and that was 67% in neonates whose gestational ages of <27 weeks.ConclusionsDDI was achieved within 30 min in all the patients, and the mortality of neonate might depend on gestational age.

3.
Pakistan Armed Forces Medical Journal ; 72(1):288, 2022.
Article in English | ProQuest Central | ID: covidwho-1812580

ABSTRACT

Objective: To assess outcomes of neonates born to mothers who were COVID-19 positive. Study Design: Prospective observational study. Place and Duration of Study: Secondary and Tertiary Care Hospitals of the Armed Forces, Pakistan, from Apr to Aug 2020. Methodology: We studied 106 pregnant women who tested positive for SARS-CoV-2. Stable asymptomatic newborn babies were kept in SARS-CoV-2 specified incubators, at specially designated areas for observation. Nasopharyngeal swabs were taken at first 24 hours and if negative, babies were handed over to clinically stable mothers who were educated regarding use of facemasks and proper hand washing. Neonates who tested positive for SARS-CoV-2 were evaluated for SARS-CoV-2 again at 48 hours and then every 48-72 hours, until found to be negative. Results: Total 106 women were found to be SARS-CoV-2 positive during the study period. All the women delivered singleton babies. Of the 106 babies, 5 (4.71%) were found to be positive for SARS-CoV-2 at 24 hours and only 1 (0.94%) baby was found to be positive at 48 hours and then tested negative at 7th day. Conclusion: Babies born to SARS-CoV-2 mothers were mostly asymptomatic and there was no increased risk of morbidity or mortality to the neonates suffering from the infection.

4.
Indian Journal of Ophthalmology ; 70(2):702-703, 2022.
Article in English | MEDLINE | ID: covidwho-1810689
5.
American Journal of Obstetrics and Gynecology ; 2022.
Article in English | ScienceDirect | ID: covidwho-1797270

ABSTRACT

Background The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes has been reported;however, a detailed understanding of the effect of maternal positivity, delivery mode and perinatal practices on fetal and neonatal outcomes is urgently needed. Objective To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of the mode of delivery, breastfeeding and early neonatal care practices on the risk of mother-to-child transmission. Study Design In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-exposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding and hospital neonatal care practices. Results A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean section (52.8% compared to 38.5% for those without COVID-19 diagnosis, p<0.01) and pregnancy related complications such as hypertensive disorders of pregnancy and fetal distress, all with p-value < 0.001, compared to women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (p ≤0.001) and lower neonatal weight (p ≤0.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in-utero exposure was significantly correlated to the risk of the neonate testing positive (OR, 4.5;95% CI 2.2-9.4 for length of in-utero exposure > 14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean section was a risk factor for them testing positive for COVID-19 (OR 2.4, 95% CI 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of Intensive Care Unit admission, fever, gastrointestinal and respiratory symptoms and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis, as well as hospital neonatal care practices including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. Conclusions In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean section was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother to child skin-to-skin contact, rooming-in and direct breastfeeding did not represent risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

6.
BJOG ; 2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1794791

ABSTRACT

OBJECTIVE: To determine the impact of maternal coronavirus disease 2019 (COVID-19) on prematurity, birthweight and obstetric complications. DESIGN: Nationwide, population-based retrospective cohort study. SETTING: National Programme de Médicalisation des Systèmes d'Information database in France. POPULATION: All single births from March to December 2020: 510 387 deliveries, including 2927 (0.6%) with confirmed COVID-19 in the mother and/or the newborn. METHODS: The group with COVID-19 was compared with the group without COVID-19 using the chi-square test or Fisher's exact test, and the Student's t test or Mann-Whitney U test. Logistic regressions were used to study the effect of COVID-19 on the risk of prematurity or macrosomia (birthweight ≥4500 g). MAIN OUTCOME MEASURES: Prematurity less than 37, less than 28, 28-31, or 32-36 weeks of gestation; birthweight; obstetric complications. RESULTS: In singleton pregnancies, COVID-19 was associated with obstetric complications such as hypertension (2.8% versus 2.0%, p < 0.01), pre-eclampsia (3.6% versus 2.0%, p < 0.01), diabetes (18.8% versus 14.4%, p < 0.01) and caesarean delivery (26.8% versus 19.7%, p < 0.01). Among pregnant women with COVID-19, there was more prematurity between 28 and 31 weeks of gestation (1.3% versus 0.6%, p < 0.01) and between 32 and 36 weeks of gestation (7.7% versus 4.3%, p < 0.01), and more macrosomia (1.0% versus 0.7%, p = 0.04), but there was no difference in small-for-gestational-age newborns (6.3% versus 8.7%, p = 0.15). Logistic regression analysis for prematurity showed an adjusted odds ratio (aOR) of 1.77 (95% CI 1.55-2.01) for COVID-19. For macrosomia, COVID-19 resulted in non-significant aOR of 1.38 (95% CI 0.95-2.00). CONCLUSIONS: COVID-19 is a risk factor for prematurity, even after adjustment for other risk factors.

7.
Pakistan Journal of Medical and Health Sciences ; 16(2):318-320, 2022.
Article in English | EMBASE | ID: covidwho-1780507

ABSTRACT

Apart from the physical effects of Covid-19, psychological effects are seen as well in the general population. In pregnant females, psychological impact leads to adverse pregnancy and neonatal outcomes. Due to limited data, the mental health of COVID-19 positive pregnant patients is not clear especially in relation to isolation in hospital, treatment, time and mode of delivery. Objective: To determine and compare frequency of anxiety and depression in pregnant women with and without COVID-19. Material and Methods: It was a comparative cross-sectional study that was conducted in the department of Obstetrics and Gynaecology, SGRH, Lahore. 60 pregnant females were enrolled and underwent nasopharyngeal swab for PCR and had HRCT to determine Covid-19 status. HADS was applied on all pregnant females to assess depression and anxiety and findings were subjected to statistical analysis. Results: The mean age, gestational age, anxiety scores and depression scores were 29.93±4.15, 31.1±6.28, 10.56±3.29 and 10.02±2.72 respectively. There were 60% Covid positive pregnant females, depression was present in 31.7% and anxiety was present in 65% females. Comparison of pregnant females with or without Covid infection in terms of depression and anxiety using independent T-test revealed that anxiety was significantly associated with Covid positive status (p=0.032), however, no significant association was seen between depression and covid status (p=0.641) (table 3). Conclusion: Covid-19 was frequently seen in pregnant females and was significantly associated with high frequency of anxiety. Depression was less commonly seen and was not significantly associated with Covid-19 infection.

8.
Biological Psychiatry ; 91(9):S25-S26, 2022.
Article in English | EMBASE | ID: covidwho-1777990

ABSTRACT

Background: Poor sleep during pregnancy is very common and is associated with increased risk of adverse maternal and infant outcomes. Maternal psychosocial stress has been found to negatively impact sleep. The recent outbreak of COVID-19 has exposed many individuals to an unprecedented level of stress, that will continue for an unknown period of time. Studies are showing that all these factors may not only increase levels of stress, but also influence sleep health. Methods: From March 2020-May 2021, participants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) study at Columbia University. Survey data on maternal depression (PHQ-9), perceived stress (PSS), COVID-related stress, and sleep health (Pittsburgh Sleep Quality Index, PSQI) were collected. For this analysis, we excluded mothers identified as depressed based on PHQ9. Regressions analyses were implemented to estimate the associations between PSS and COVID-related stress and multiple domains of sleep, accounting for covariates (maternal age, education, gestational age covid infection in pregnancy, time of the pandemic). Results: Our sample consisted of N=155 women;Gestational age at assessment: 30.6±5.8 weeks;Age: 32.2±5.0 years;non-Hispanic White=66, non-Hispanic Black=12, Hispanic=56, Asian=16, Other=5;69% 4-year college/graduate degree. Mean PSS was 18.3±7.0 and COVID-related stress was 3.9±1.6. COVID-related stress negatively affected subjective sleep quality (β=0.3±0.1, p<0.01), latency (β=0.4±0.1, p<0.001) and sleep disturbances (β=0.5±0.2, p=0.003). Increased PSS negatively affected sleep duration (β=0.09±0.2, p<0.001), efficiency (β=0.08±0.02, p<0.001), and daytime dysfunction (β=0.08±0.03, p=0.01). Conclusions: Our results suggest that stress related to the current COVID-19 pandemic is uniquely affecting maternal sleep health during pregnancy. Funding Source: R01MH126531;Eunice Kennedy Shriver National Institute of Child Health and Human Development under grant number P2CHD058486, awarded to the Columbia Population Research Center Keywords: Sleep, Perceived Stress, COVID-19, Pregnancy

9.
Am J Obstet Gynecol MFM ; : 100637, 2022 Apr 07.
Article in English | MEDLINE | ID: covidwho-1777925

ABSTRACT

BACKGROUND: COVID-19 during pregnancy is associated with adverse outcomes for mother and fetus. SARS-CoV-2 vaccination has significantly reduced the risk of symptomatic disease. Several studies have reported the safety of SARS-CoV-2 vaccination during pregnancy, with no adverse effect on obstetric outcomes. However, obstetric outcomes following a booster dose of the SARS CoV-2 vaccination during pregnancy have yet been published. OBJECTIVE: To examine the association between booster dose of the SARS CoV-2 vaccination during pregnancy and obstetric outcomes. METHODS: A retrospective cohort study of women who delivered between July and October 2021 at a large tertiary medical center. We compared women who received the booster vaccine during pregnancy to women who were not vaccinated and to those who had only received two vaccines. Primary outcomes were the incidence of preterm labor and of small for gestational age. Secondary outcomes were other maternal and neonatal complications. A secondary analysis investigating the association between the timing from vaccination to delivery and outcomes was also performed. Multivariable logistic regression models were used to adjust for potential confounders. RESULTS: There were 6507 women who met the inclusion criteria: 294 women received three vaccines, 2,845 women received only two vaccines and 3,368 were unvaccinated. Patients receiving three vaccines were older and more likely to smoke compared to unvaccinated patients. No differences were noted between triple-vaccinated, twice-vaccinated and unvaccinated groups with regards to preterm birth and small for gestational age. Regarding secondary outcomes, women in the triple vaccine group had higher rates of PPH (9.5 vs 3.21%, P<0.001), gestational diabetes (12.2 vs. 8.3 %, p=0.02), and were less likely to have hypertensive disorders of pregnancy (0% vs 1.4%, p=0.041) compared to the unvaccinated group. Compared to twice-vaccinated patients, patients with three vaccines were more likely to experience PPH (9.5 vs. 3.5%, p<0.001), and were less likely to have a low umbilical artery pH (0.7 vs 6.1%, p<0.001). In the sensitivity analysis comparing patients delivered within 2 weeks of the third vaccination (n=53) to those delivered at least 6 weeks after vaccination (n=96), there were no differences in the rates of SGA, preterm birth, PPH, or cesarean delivery. CONCLUSION: The booster dose of the SARS-CoV-2 vaccine during pregnancy was not associated with adverse obstetric outcomes compared to unvaccinated or twice-vaccinated women. However, higher rates of PPH were observed. Further studies on a larger scale are needed to confirm these findings.

10.
Front Public Health ; 9: 707078, 2021.
Article in English | MEDLINE | ID: covidwho-1775823

ABSTRACT

Background: Small for gestational age (SGA) is a key contributor to premature deaths and long-term complications in life. Improved characterization of maternal risk factors associated with this adverse outcome is needed to inform the development of interventions, track progress, and reduce the disease burden. This study aimed to identify socioeconomic, demographic, and clinical factors associated with SGA in Mexico. Methods: We analyzed administrative data from 1,841,477 singletons collected by the National Information Subsystem of Livebirths during 2017. Small-for-gestational-age was defined as being <10th centiles according to the INTERGROWTH-21st standards. The comparison group was defined as being in ≥10th centiles. We fitted logistic regression models to determine odds ratios for the maternal factors associated with SGA. Results: Among the 1,841,477 singletons, 51% were male, 6.7% were SGA, 6.1% were term-SGA, and 0.5% were preterm-SGA. Maternal education presented a protective gradient of being SGA among mothers who achieved 1 to 6 years of education (adjusted odds ratio (aOR)0.95; 95% CI:0.91,0.99), 7 to 9 years (aOR 0.86; 95% CI:0.83,0.89), 10 to 12 years (aOR 0.75; 95% CI: 0.72, 0.79) and > 12 years (aOR 0.63; 95% CI:0.6,0.66) compared with those without education. SGA was particularly likely to occur among primiparous (aOR 1.42; 95% CI: 1.39, 1.43), mothers living in very high deprivation localities (aOR 1.39; 95% CI: 1.36, 1.43), young (aOR 1.04; 95% CI: 1.02, 1.06), advanced age (aOR 1.14; 95% CI 1.09, 1.19), and mothers living in areas above 2,000 m (aOR 1.69; 95% CI: 1.65, 1.73). Antenatal care was associated with a reduced risk of SGA by 30% (aOR 0.7; 95% CI:0.67,0.73), 23% (OR 0.77; 95% CI:0.74,0.8), and 21% (OR 0.79; 95% CI:0.75,0.83), compared with those mothers who never received antenatal care, when women visited the clinic at the first, second and third trimester, respectively. Conclusion: Almost 7% of live births were found to be SGA. Parity, maternal age, education, place of residence, and social deprivation were significantly associated with this outcome. Antenatal care was protective. These findings imply that interventions focusing on early and adequate contact with health care facilities, reproductive health counseling, and maternal education should reduce SGA in Mexico.


Subject(s)
Infant, Small for Gestational Age , Female , Humans , Infant, Newborn , Male , Maternal Age , Mexico/epidemiology , Pregnancy , Risk Factors
11.
Journal of the American College of Cardiology ; 79(9):2229, 2022.
Article in English | EMBASE | ID: covidwho-1768639

ABSTRACT

Background: A 35-year-old G1P1 woman with a history of bioprosthetic mitral valve (MVR) and aortic valve (AVR) replacements and a tricuspid valve annuloplasty for presumed rheumatic heart disease who presented at 35 weeks gestational age with COVID-19 ARDS and shock. Case: The patient arrived with ARDS requiring intubation and distributive shock. Transthoracic echocardiogram (TTE) revealed a small left ventricular (LV) cavity with LV hypertrophy, MVR with mean gradient of 14 mmHg, and a mid-peaking transaortic gradient of 96 mmHg consistent with fixed obstruction. This gradient was likely due to LV outflow tract obstruction (LVOTO) from the combination of a small LV cavity and septal angulation of the MVR struts rather than AVR dysfunction. The patient underwent emergent cesarean section. Decision-making: The maternal and fetal risks of ARDS and distributive shock were primary considerations in undergoing cesarean section. Decisions regarding management thereafter were driven by three elements of her clinical presentation - anticipated peripartum hemodynamic shifts, multivalvular disease, and ARDS. The increased plasma volume from postpartum autotransfusion risked worsening her ARDS but also potentially benefited the LVOTO through increased preload. The effect of lower postpartum cardiac output and heart rate on valvular obstruction in series also had to be considered. To balance these hemodynamic demands, after delivery, her vasopressors were switched from norepinephrine to phenylephrine, and she was judiciously diuresed. A postpartum TTE demonstrated improved transmitral gradients (mean 5 mmHg) but ongoing LVOTO. Higher filling pressures than otherwise ideal in ARDS were tolerated given persistent gradients. She was liberated from hemodynamic and ventilator support and transferred out of ICU care. Though she died of infectious complications weeks later, close collaboration between the critical care, obstetrical, and cardiovascular teams were essential to her care. Conclusion: Care of the peripartum patient with cardiovascular disease, especially valvular disease, must take into consideration both their cardiac pathology and expected peripartum hemodynamic shifts.

12.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-331114

ABSTRACT

Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-tochild transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice.

13.
Genetics in Medicine ; 24(3):S284-S285, 2022.
Article in English | EMBASE | ID: covidwho-1768097

ABSTRACT

Background: Freeman-Sheldon syndrome [distal arthrogryposis type 2A (OMIM #193700), DA2A, Freeman-Burian syndrome] is a rare autosomal dominant multiple pterygium syndrome caused by alterations in MYH3. The phenotypic features, particularly of the face, are distinct and easily recognizable, and the diagnosis can be confirmed with molecular gene analysis. Fetal ultrasound imaging may provide important diagnostic clues to facilitate the diagnostic process. Informed consent and parental permission were provided by the parents. Case presentation: The infant’s mother presented for a Maternal Fetal Medicine genetic counseling telehealth appointment (due to COVID-19 pandemic restrictions) as a G7P2132, 32-year old female who had insulin-dependent diabetes and thrombocytosis. Her partner was a 24-year old male with a history of hearing loss, a V-shaped palate, and a lower lip cleft. Gestational age was 14 4/7 weeks and the indications were: increased nuchal translucency, paternal complex medical history, maternal G6PD heterozygote, and recurrent pregnancy loss. During the genetic counseling session, the following were addressed: 1) Maternal heterozygote status for G6PD indicated that if the fetus was male, there was a 50% chance he would be affected with G6PD-deficiency;2) Increased nuchal translucency on fetal ultrasound (US) with measurement at 98th percentile is associated with an increased risk of chromosomal abnormalities, microdeletion/duplications, and Noonan syndrome. The patient reportedly had low risk cell-free DNA but results were not available to the counselor at the time of consult. The option for additional genetic screening and diagnostic testing was declined;3) Three first trimester pregnancy losses with the father of this baby (FOB) were addressed, and parents deferred chromosome analyses at the time;4) Mother shared FOB’s complex history of bilateral sensorineural hearing loss, V-shaped cleft palate, lower lip cleft, and micrognathia. However, father was not present during the telehealth encounter. Mother was counseled regarding the possibility of an autosomal dominant condition with the potential risk to the pregnancy of up to 50%. It was recommended that the FOB have a clinical genetics evaluation, which could potentially provide a specific diagnosis and inform recurrence risk and management guidance. Follow-up MFM genetic counseling telephone visit occurred with the mother at 31 6/7 weeks gestation due to multiple congenital anomalies evident on fetal ultrasound. A 25 week fetal ultrasound revealed hypotelorism and a thickened nuchal translucency. A repeat study at 29 weeks revealed a V-shaped palate with a possible cleft, micrognathia, and midline mandibular cleft. FOB’s history was revisited. It was determined that he had 3 previous “no shows” to Genetics clinic appointments and did not pursue evaluation after the last counseling appointment. Again, it was emphasized that in order to best make a diagnosis for the family, an affected person would need to undergo a thorough evaluation, including medical and family history review, physical examination, and any indicated genetic testing. The parents were comfortable with the likelihood that the baby had the same condition as the father, but variable expressivity and broad range pf phenotypic presentation were explained. Recommendations for postnatal evaluation of the infant and pertinent genetic testing were provided. Consultative Genetics evaluation of the infant at 2 days of age revealed a short, broad forehead with supraorbital fullness leading to a horizontal brow indentation;mask-like facial appearance;hypotelorism;very deep set eyes with blepharophimosis;deep, creased nasal bridge;small, upturned nose with hypoplastic alae and narrow nares;microstomia with pursed lips;glossoptosis;micrognathia;2 deep vertical chin creases;short neck with excess nuchal skin;inverted and wide spaced nipples;clenched hands with 5th digits overlying 4th and 2nd overlying 3rd, bilaterally;bilateral vertical talus;2nd toes longer and overlying rd toes;clinodactyly of 4th and 5th toes bilaterally;and deep gluteal crease with no visible sinus. There were no evident contractures. The father has a complex history with no medical assessments prior to age 18. He reported that he did “not look like anyone else” in his family. He has a diagnosis of autistic spectrum disorder, a submucous cleft, vision issues, hearing loss necessitating a hearing aid on the left, and a history of cholesteatomas and of mastoidectomy. On brief examination, he had a mask-like face, blepharophimosis, left microphthalmia, left esotropia, narrowing of his midface, deep vertical crease on the mandibular region, microstomia, broad great toes, single flexor creases on the thumbs, and contracture of right thumb. Maxillofacial CT of the infant revealed hypoplastic mandibular body, ramus, and condyles bilaterally with micrognathia and retrognathia;hypoplastic maxilla bilaterally;and enophthalmos with retracted appearance of globes in the bony orbits bilaterally. Multiple facial bone abnormalities were seen, including microsomia, micrognathia, retrognathia, orbital hypotelorism and enophthalmos Genetic testing was performed via a custom Whole Exome Slice at GeneDx laboratories and included the MYH3 and TNNI2 genes. Results revealed a heterozygous pathogenic change in MYH3 (c.2015 G>A;p. R6724) consistent with the diagnosis of Freeman-Sheldon syndrome. Conclusion: The presentation of “midline mandibular cleft” on fetal ultrasound was the most specific prenatal finding. This is a very rare fetal finding. Thus, it should prompt further evaluation to assess for true clefting versus ridging or creasing. Additionally, targeted assessment for other findings or clinical clues for Freeman-Sheldon syndrome, such as contractures, “windmill vane” hand, and mouth size, could aid in the differential diagnosis considerations and the diagnostic process. Admittedly, these are position and quality dependent, and are challenging to assess even in ideal situations. The phenotype of the father was immediately recognizable. However, due to COVID-19 pandemic restrictions, prior to the infant’s birth, only telehealth visits were conducted and the father’s participation was by telephone. This limited the ability to narrow the differential diagnosis without visualization of his distinct phenotypic features. Finally, missed opportunities to diagnose the father prior to this pregnancy occurred. Many clinics send “no show” letters to referring providers and patients, as we do. Emphasizing the importance of diagnosis prior to pregnancy for individuals concerned about having a genetic disorder should be considered as part of the information shared in these letters.

14.
American Journal of Obstetrics and Gynecology ; 226(1):S36-S37, 2022.
Article in English | EMBASE | ID: covidwho-1757065

ABSTRACT

Objective: The impact of maternal COVID-19 infection on fetal health remains to be determined. Using targeted metabolomic analysis of newborn umbilical cord blood, we aimed to evaluate the biological consequences of maternal infection on the fetus and develop metabolite biomarkers for the identification of newborn intrauterine exposure. Study Design: Cord blood serum samples from 23 COVID-19 cases (mother infected/ newborn negative) and 23 gestational age-matched controls were analyzed using nuclear magnetic spectroscopy and direct injection liquid chromatography mass spectrometry-mass spectrometry. Logistic regression models were developed using metabolites to predict intrauterine exposure with Area under the Receiver Operating Characteristics curve [AUC (95% CI)], sensitivity, and specificity. Metabolite set enrichment analysis was used to evaluate altered biochemical pathways to highlight biological mechanisms of COVID-19 intrauterine exposure. Results: There were no significant differences in gestational age at delivery between groups (p >0.05). All neonates tested negative for COVID-19 infection. Significant concentration differences (p-value < 0.05 or -log10=1.301) were observed in 19 metabolites between groups. The top metabolite model [cortisol and Ceramide (d18:1/20:0)] achieved an AUC (95% CI) = 0.839 (0.722 - 0.956) with a sensitivity of 91% and specificity of 69% (Table 1). Enrichment analysis revealed significantly (p< 0.05) altered metabolic pathway of steroidogenesis and gluconeogenesis (Figure 1). Cortisol is the stress hormone that increases glucose production through gluconeogenesis resulting in higher oxidative metabolism and energy generation. Ceramides are known to have anti-inflammatory properties. Elevated hypoxanthine has also been correlated with tissue hypoxia and inflammation. Conclusion: We found evidence of intrauterine stress, altered energy metabolism and inflammation in fetal life in cases of maternal COVID-19 infection but ultimately negative newborn culture. Elucidation of long-term consequences is imperative considering the large number of exposures in the population. [Formula presented] [Formula presented]

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S345, 2021.
Article in English | EMBASE | ID: covidwho-1746508

ABSTRACT

Background. Antenatal care is a unique opportunity to assess SARS-CoV-2 seroprevalence and antibody response in pregnant people, including those with previously unknown infection. Methods. Pregnant people were screened for SARS-CoV-2 IgG during antenatal care or delivery in Seattle, Washington with Abbott Architect chemiluminescent immunoassay which provides quantitative index (positive ≥1.4). Participants with IgG+ results or identified with RT-PCR+ results via medical records were invited to enroll in a longitudinal evaluation of antibody responses. We report preliminary results of an ongoing seroprevalence and longitudinal study with planned 18-month follow-up. Results. Between September 9, 2020-May 7, 2021, we screened 1304 pregnant people;62 (4.8%) tested SARS-CoV-2 IgG+, including 28 (45%) with known prior SARS-CoV-2 infection. Among participants testing IgG+, median age was 32 years (interquartile range [IQR] 26-35) and median gestational age was 21 weeks (IQR 12-38) at screening;median IgG index was 3.2 (IQR 2.1-4.9, range 1.4-9.9), including 3.9 (IQR 2.3-5.8) among those with vs. 2.7 (IQR 1.9-4.2) among those without prior RT-PCR+ results (p=0.05 by Wilcoxon rank-sum). Of 30 longitudinal study participants enrolled, 24 tested IgG+ at baseline (75% with prior RT-PCR+ result) and 6 tested IgG- on enrollment but were identified as previously RT-PCR+ via medical records;24/30 (80%) reported previous symptoms. Of 24 participants testing IgG+ at baseline, 14 (58%) had first follow-up IgG results at median of 66 days (IQR 42-104) since initial testing, with median IgG index of 2.0 (IQR 1.0-3.8). 9/14 (64%) participants with repeat IgG testing remained IgG+ at first follow-up (≤280 days after first RT-PCR+ result for those with and ≥104 days after first IgG detection for those without prior RT-PCR+ results), while 5/14 (26%) had a negative Abbott IgG test at a median of 81 days (IQR 75-112) since initial testing. Conclusion. Nearly half of pregnant people testing SARS-CoV-2 IgG+ reported no known prior SARS-CoV-2 diagnosis or symptoms. SARS-CoV-2 IgG antibody response and durability in pregnancy has implications for maternal and neonatal protection and susceptibility and highlights potential benefits of vaccination in this population.

16.
Current Women's Health Reviews ; 17(4):365-367, 2021.
Article in English | EMBASE | ID: covidwho-1736622

ABSTRACT

Introduction: There are a limited number of studies about COVID-19 during delivery and postpartum. Case Presentation: A 38-years-old G3p2 woman at 35 weeks and 4 days of gestation was referred with the chief complaints of dyspnea, cough, headache, and fever. Pharyngeal swab polymerase chain reaction (PCR) was negative for COVID-19;however, in chest Computed Tomography (CT) angiography, ground glass was observed in the basal lobe of the left lung. The infant was born via cesarean section with a gestational age of 36 weeks and an Apgar score of 8/9. No infant document was found about COVID-19 and other infections in several days after delivery. The patient died eight days after the onset of symptoms due to cardiovascular collapse. Discussion: we reported the first postpartum maternal death with COVID-19 and a healthy baby with no evidence of COVID-19 and a gestational age of 36 weeks. Conclusion: Physicians should be aware that pregnant women with symptoms of respiratory infection and pulse negative PCR test should be followed for infection with COVID-19. This infection may lead to maternal death.

17.
Zeitschrift fur Geburtshilfe und Neonatologie ; 225(SUPPL 1):e37-e38, 2021.
Article in English | EMBASE | ID: covidwho-1735327

ABSTRACT

Background Critical illness during pregnancy puts mother and fetus at serious risks. Current literature regarding the effect of coronavirus 2 (SARS-CoV-2) describes an increased risk for maternal mortality as well as high rates of preterm delivery, however data vary and depend on the respective health care system. We aimed to describe maternal characteristics and clinical presentation of SARS-CoV-2 positive pregnant and postpartum women requiring intensive care treatment for COVID-19 in Germany, in order to explore risk factors for severe COVID-19 courses as well as to provide an overview on treatments applied. Methods COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS), an ongoing prospective multicenter registry for SARS-CoV-2 positive pregnant women from 150 centres in Germany was analyzed with respect to intensive care treatment for COVID-19. We extracted information for all women requiring intensive care treatment for COVID-19 and compared maternal characteristics, course of disease, as well as maternal and neonatal outcomes. Results Out of 2445 cases in CRONOS registry, 96 women (4%) had a documented intensive care unit (ICU) stay and were analyzed. While 75 (78%) women were pregnant when receiving ICU treatment, 21 (22%) were admitted post-delivery. Median maternal age was 33 (IQR, 30-36) years. COVID-19 was diagnosed at a median gestational age of 32 (IQR, 28-35) weeks. We observed the following interventions as highest form of treatment required for COVID-19: continuous monitoring of vital signs (n=6 (6%)), insufflation of oxygen (n=32 (33%)), non-invasive ventilation (n=17 (18%)), invasive ventilation (n=29 (30%)) and escalation to extracorporeal membrane oxygenation (ECMO, n=12 (13%)). Maternal characteristics such as maternal age, ethnicity, body mass index at admission, history of smoking, comorbidities and concomitant medication, as well as gestational age were analyzed. No significant differences between patients receiving different forms of respiratory therapy for COVID-19 could be identified. Preterm delivery was observed in 45 women (47%). Two women (2%) died of COVID-19 and four fetuses (4%) were stillborn. Conclusions Our cohort shows that progression of COVID-19 in pregnant and postpartum women requiring ICU treatment is rare. Preterm birth rate is high and COVID-19 requiring respiratory support is not necessarily related to poor maternal or neonatal outcome. But, as one in ten patients admitted to ICU might require ECMO therapy, all pregnant women suffering from COVID-19 should be closely monitored. In future studies, detail about obstetric women requiring intensive care treatment for COVID-19 should be further evaluated.

18.
Zeitschrift fur Geburtshilfe und Neonatologie ; 225(SUPPL 1):e17, 2021.
Article in English | EMBASE | ID: covidwho-1735326

ABSTRACT

Introduction A higher risk for adverse pregnancy outcome has been described in association with SARS-CoV-2 infection, which partially could be explained through alteration of the placental function. However, no significant placental damage in SARS-CoV-2-positive women could be found to date, as no histopathological 'footprint' in association with SARS-CoV-2 is yet available. Birthweight/placental weight ratio (b/p ratio), also defined as gram fetus per gram placenta, is a marker of placental efficiency. A high b/p ratio seems to be associated with adverse obstetrical outcome, revealing an increased nutrient transfer to the fetus, who despite its normal weight, seems to be at risk by 'outgrowing' its placenta. Given the inconsistency of data regarding placental histopathology, we decided for evaluation of the placental weight after SARS-CoV2 infection during pregnancy, by performing a case-control analysis. Methods We included in our study data originating from 153 women who suffered from SARS-CoV-2 infection during pregnancy and delivered since May 2020 at three large obstetrical centres in Switzerland. Placental weight was assessed in a standard manner. Placental weight and b/p ratio were compared to published reference charts (Thompson et al, BJOG 2007). Crude odds ratio (OR) was estimated using simple logistic regression depending on pregnancy trimester at diagnosis of SARS-CoV-2 infection. Results Placental weight was inferior or equal to the 10th centile in 42% (65/153) and inferior or equal to 3rd centile in 19% (29/153) of the cases. The risk of placental low weight was not significantly different between each trimester of infection. Multiparty was the only significant associated factor to the risk of low placental weight. Incidence of fetal growth restriction (FGR) was 11.6% (18/153), whereas presence of preeclampsia was noted in 0.03% of the cases (5/153). Gestational diabetes was present in 19.60% of the cases (30/153). B/p ratio was>50th centile in 80.4% of the cases and>90th centile in 31.37% of the cases. Discussions In our study, the absolute rate of low placentas weight was critically increased, leading to an elevated the b/p ratio, which raises concerns about the stability of the placental/fetal unity in these cases. The upregulated nutrient transfer capacity could be a sign that presumably low-risk fetuses are actually at high risk, and that SARS-CoV-2 could act as a 'promoter' for the destabilisation of the placental-fetal dyad in these pregnancies. Moreover, given the unexplained elevated GDM rate in our population, it remains open if this as well could be partially explained through an 'upregulation' attempt of the placenta, in order to provide more energy to the fetus at risk. This could be particularly relevant for the yet controversial issue of increased stillbirth rate in SARS-CoV-2 infection during pregnancy. In this regard, intensified fetal surveillance could be a reasonable option in these cases.

19.
Molecular Genetics and Metabolism ; 132:S320-S321, 2021.
Article in English | EMBASE | ID: covidwho-1735103

ABSTRACT

Introduction: The Coronavirus Disease (COVID-19) pandemic has changed the landscape of both inpatient and outpatient healthcare. During the height of the pandemic, most elective and many nonelective procedures were halted. Prenatal care services including ultrasound and genetic screening and testing remained active (given gestational age dependence) while shifting from in-person towards telehealth counseling. NewYork Citywas at the epicenter of the pandemic fromMarch through June 2020. Elective procedures at Montefiore Medical Center, which serves a diverse urban population in the Bronx, NY,were cancelled from March 16, 2020 to June 20, 2020. Prenatal ultrasound shifted from a dating ultrasound and a nuchal translucency ultrasound to one first trimester ultrasound and anatomy scans were scheduled at 20–22 weeks gestation rather than 18–20 weeks. The majority of counseling sessions were conducted via telehealth and prenatal diagnostic procedures (including amniocentesis and chorionic villus sampling [CVS]) were performed with a limited team to adhere to COVID-19 protocols. We examined the impact of this shift on rates of prenatal genetic screening and diagnostic procedures before and during the COVID-19 pandemic. Previous literature has revealed that since the advent of noninvasive prenatal screening (NIPS), prenatal genetic diagnostic procedures rates have been on the decline.We hypothesized that the rate of genetic diagnostic procedure rates would decrease and NIPS would increase as compared to the similar period in 2019. Methods: Retrospective analysis of data collected in a secure institutional logbook at Montefiore Medical Center Department of Obstetrics & Gynecology and Women’s Health (Division of Reproductive and Medical Genetics and Division of Fetal Medicine and Ultrasound) from January 1, 2019–December 31, 2020. Collected data included number of procedures, gestational age, and indication for procedure (categorized as advanced maternal age (AMA), ultrasound anomalies, positive screening test, hereditary disease in the family possibly affecting fetus (including family history or genetic carrier), or other. Procedures for multiple gestations were considered as a single procedure.. Results: 503 diagnostic procedures (359 amniocenteses and 144 CVS) were included. Most common indication (ultrasound anomaly) and average gestational age (13 weeks for CVS and 19 weeks for amniocentesis) were the same in 2019 and 2020. In total, 275 procedures were performed in 2019 as compared to 228 in 2020 (20.6% decrease) ( p = 0.018). Specifically, amniocentesis decreased from 187 to 172 (8% decrease) ( p = 0.214) and CVS decreased from 88 to 56 (36% decrease) ( p = 0.004). NIPS increased from 1,312 tests in 2019 to 1727 tests in 2020 (31.6%) ( p < 0.001). The same data points were then analyzed during the four-month period at the height of the pandemic in New York City. We compared numbers of procedures from the period March 1, 2019–June 30, 2019 to March 1, 2020–June 30, 2020. Total prenatal diagnostic procedures during this period were 91 in 2019 and 81 in 2020 (12.3% decrease). This included 59 amniocenteses compared with 60 in the same period in 2020 (1.6% increase) and 32 CVS in 2019 compared to 21 in 2020 (34.3% decrease). Noninvasive prenatal screening increased from 348 to 510 (increase of 46.5%) during this period. Discussion: At Montefiore Medical Center in the Bronx, NY, prenatal genetic diagnostic procedures decreased while NIPS rates increased during the pandemic. This trend may reflect patient’s concerns for a COVID-19 exposure during in-office procedures, shift to telehealth counseling, or be reflective of the overall trends seen since the widespread offering of NIPS to prenatal patients. The decrease in CVS may be explained by an intentional system delay of combining ultrasound and blood draw to a single visit at the end of the first trimester. Future studies should investigate how access to care and gestational age at the time of presentation influenced prenatal genetic screening and testing cho ces during the pandemic, in order to better explain the identified trends.

20.
Molecular Genetics and Metabolism ; 132:S301-S302, 2021.
Article in English | EMBASE | ID: covidwho-1735102

ABSTRACT

he recent and persistent COVID-19 pandemic highlights the mounting published data on health disparities in the United States, including higher mortality in minority communities due to systemic racism embedded in our society. Throughout history, “race” has been supposition as a biological variable instead of a social and political construct that has changed throughout history. Using race and ethnicity as variables in human genomic research has had negative consequences for how the research is translated into clinical practice, incorporated into public health programs, and implemented in public policy. Newborn screening (NBS) is one of few public health programs that does not target a particular population and is available to every infant born in the United States regardless of race or socioeconomic status. Each year during the process of screening 4 million newborns for over 80 disorders, state-based public health programs collect a variety of demographic and birth-related data. The potential to leverage the data collected could improve our understanding of diseases and interventions, and in time, could transform healthcare by reducing the health disparity gap. However, inaccuracies or misuse of non-biological variables such as race or ethnicity can lead to social harms and unvalidated conclusions. NBS disorders are screened using a combination of biological and physiological assessments and are conducted either in the birthing hospital or in a state public health laboratory. The laboratory measurements are performed using a blood sample collected on filter paper card. These dried blood spot (DBS) cards also list demographic and birth data that is vital to interpreting test results. Although the list of data collected varies across state programs, most programs collect sex, birth weight, gestational age, the use of antibiotics, feeding type, and/or transfusion status. Residual DBS are a valuable resource and state programs store them for use in program improvement activities and research. Over two-thirds of state programs store residual DBS for longer than one year, and at least 18 include consent for research as one of the collected data points. While NBS research studies often rely on data collected on the DBS card for reliable variables, some of the data represents demographic information provided by the parents and collected at the birthing center. It is not uncommon for healthcare professionals who collect the DBS specimen to infer the newborn’s ascriptive race and/or ethnicity. This leads to potentially inaccurate data that has been used in NBS research studies to characterize study populations and provide conclusions about rare mendelian disorders in specific racial and ethnic populations. The accurate representation of race and ethnicity is always important, especially when a condition is added to nationwide screening. In 2010, NBS for severe combined immunodeficiency (SCID), a life-threating disorder caused by the lack of T-cells, was recommended for nationwide screening. Prior to screening, diagnosed patients that were followed long-term were predominately white (81%). However, a recent publication of screening results from 3.25 million California infants reported that SCID did not occur more frequently in any ethnic group, and found no predominant founder mutation. SCID frequently occurred because of homozygous autosomal recessive inheritance, and 80% of cases have no family history. Accurate representation of race and ethnicity could be used to assess health outcomes and disparities across all racial groups and other biological variables such as genetic ancestry should be considered to help advance the understanding of etiology of SCID.This presentation will exam how race and ethnicity is collected from NBS programs in the United States and how race is used in published NBS literature. Additionally, we will explore the lack of standardized language used to collect information on race and ethnicity in NBS and the incorrect assumption that race and ethnic information is based on parent report. We wil discuss the impact of these practices on NBS research, propose best practices for reporting race and/or ethnicity to ensure accurate evaluation of health outcomes and disparities, and recommend that NBS researchers use other biological variables such as genetic ancestry in research to assess true disease risk

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