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INTRODUCTION: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to an unprecedented global health crisis. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The objective of this study was to summarize the clinical manifestations and maternal and perinatal outcomes of COVID-19 during pregnancy. MATERIAL AND METHODS: We searched databases for all case reports and series from 12 February to 4 April 2020. Multiple terms and combinations were used including COVID-19, pregnancy, maternal mortality, maternal morbidity, complications, clinical manifestations, neonatal morbidity, intrauterine fetal death, neonatal mortality and SARS-CoV-2. Eligibility criteria included peer-reviewed publications written in English or Chinese and quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR-confirmed SARS-CoV-2 infection. Unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, cases with suspected COVID-19 that were not confirmed by a laboratory test, and unreported maternal or perinatal outcomes were excluded. Data on clinical manifestations, maternal and perinatal outcomes including vertical transmission were extracted and analyzed. RESULTS: Eighteen articles reporting data from 108 pregnancies between 8 December 2019 and 1 April 2020 were included in the current study. Most reports described women presenting in the third trimester with fever (68%) and coughing (34%). Lymphocytopenia (59%) with elevated C-reactive protein (70%) was observed and 91% of the women were delivered by cesarean section. Three maternal intensive care unit admissions were noted but no maternal deaths. One neonatal death and one intrauterine death were also reported. CONCLUSIONS: Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 and perinatal deaths were reported. Vertical transmission of the COVID-19 could not be ruled out. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.
Subject(s)
Betacoronavirus/isolation & purification , Cesarean Section/statistics & numerical data , Coronavirus Infections , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Female , Humans , Infant , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Maternal Mortality , Pandemics/statistics & numerical data , Perinatal Mortality , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pregnancy , Pregnancy Complications, Infectious/mortality , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , SARS-CoV-2ABSTRACT
INTRODUCTION: The overdose crisis is increasingly revealing disparities in opioid use disorder (OUD) outcomes by race and ethnicity. Virginia, like other states, has witnessed drastic increases in overdose deaths. However, research has not described how the overdose crisis has impacted pregnant and postpartum Virginians. We report the prevalence of OUD-related hospital use during the first year postpartum among Virginia Medicaid members in the years preceding the COVID-19 pandemic. We secondarily assess how prenatal OUD treatment is associated with postpartum OUD-related hospital use. METHODS: This population-level retrospective cohort study used Virginia Medicaid claims data for live infant deliveries between July 2016 and June 2019. The primary outcome of OUD-related hospital use included overdose events, emergency department visits, and acute inpatient stays. Independent variables of interest were prenatal receipt of medication for OUD (MOUD) and receipt of non-MOUD treatment components in line with a comprehensive care approach (e.g., case management, behavioral health). Both descriptive and multivariate analyses were performed for all deliveries and stratified by White and Black non-Hispanic individuals to bring attention to the devastating impacts of the overdose crisis within communities of color. RESULTS: The study sample included 96,649 deliveries. Over a third were by Black birthing individuals (n = 34,283). Prenatally, 2.5 % had evidence of OUD, which occurred more often among White (4 %) than Black (0.8 %) non-Hispanic birthing individuals. Postpartum OUD-related hospital use occurred in 10.7 % of deliveries with OUD, more commonly after deliveries by Black, non-Hispanic birthing individuals with OUD (16.5 %) than their White, non-Hispanic counterparts (9.7 %), and this disparity persisted in the multivariable analysis (Black AOR 1.64, 95 % CI 1.14-2.36). Postpartum OUD-related hospital events were less frequent for individuals receiving versus not receiving postpartum MOUD within 30 days prior to the event. Prenatal OUD treatment, including MOUD, was not associated with decreased odds of postpartum OUD-related hospital use in the race-stratified models. CONCLUSION: Postpartum individuals with OUD are at high risk for mortality and morbidity, especially Black individuals not receiving MOUD after delivery. An urgent need remains to effectively address the systemic and structural drivers of racial disparities in transitions of OUD care through the one-year postpartum period.
Subject(s)
COVID-19 , Colubridae , Drug Overdose , Infant , United States/epidemiology , Female , Pregnancy , Animals , Humans , Medicaid , Pandemics , Retrospective Studies , Virginia , Postpartum Period , HospitalsABSTRACT
Introduction: The management of the obstetric patient is a matter of great importance, since it is necessary to guarantee the termination of the pregnancy with satisfactory results for the mother and the child, thus avoiding possible maternal or infant deaths. The general objective of our study was to describe obstetric morbidity and mortality in the emergency department of the Ambato Regional Teaching Hospital during the peak of the COVID-19 pandemic. Methodology: Hospital emergency care records were studied in the period January-September 2020, through an observational, retrospective, descriptive study. In this work, emphasis is placed on the obstetric patient in the period during pregnancy and around childbirth, including the immediate puerperium. Results and Conclusion(s): it was evidenced that in the emergency service of the Ambato Regional Teaching Hospital of a total of 1082 patients treated in the emergency room, 92 of these corre-sponded to obstetric patients. The highest morbidity corre-sponded to eutocic deliveries with 39 patients. In the emergency department, 126 Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests were performed, 92 of them on all the obstetric patients seen in the emergency department, resulting in the virus being identified in 46 patients. The most affected age group in COVID patients was 18 to 33 years old, with overall age of 27 years. COVID morbidity predominated in obstetric patients, in the third trimester of pregnancy, 11 of them with fetal distress. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
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BACKGROUND: Maternal mental disorders are considered a leading complication of childbirth and a common contributor to maternal death. In addition to undermining maternal welfare, untreated postpartum psychopathology can result in child emotional and physical neglect and associated significant pediatric health costs. Some women may experience traumatic childbirth and develop posttraumatic stress disorder symptoms after delivery (childbirth-related posttraumatic stress disorder). Although women are routinely screened for postpartum depression in the United States, there is no recommended protocol to inform the identification of women who are likely to experience childbirth-related posttraumatic stress disorder. Advancements in computational methods of free text have shown promise in informing the diagnosis of psychiatric conditions. Although the language in narratives of stressful events has been associated with posttrauma outcomes, whether the narratives of childbirth processed via machine learning can be useful for childbirth-related posttraumatic stress disorder screening is unknown. OBJECTIVE: This study aimed to examine the use of written narrative accounts of personal childbirth experiences for the identification of women with childbirth-related posttraumatic stress disorder. To this end, we developed a model based on natural language processing and machine learning algorithms to identify childbirth-related posttraumatic stress disorder via the classification of birth narratives. STUDY DESIGN: Overall, 1127 eligible postpartum women who enrolled in a study survey during the COVID-19 pandemic provided short written childbirth narrative accounts in which they were instructed to focus on the most distressing aspects of their childbirth experience. They also completed a posttraumatic stress disorder symptom screen to determine childbirth-related posttraumatic stress disorder. After the exclusion criteria were applied, data from 995 participants were analyzed. A machine learning-based Sentence-Transformers natural language processing model was used to represent narratives as vectors that served as inputs for a neural network machine learning model developed in this study to identify participants with childbirth-related posttraumatic stress disorder. RESULTS: The machine learning model derived from natural language processing of childbirth narratives achieved good performance (area under the curve, 0.75; F1 score, 0.76; sensitivity, 0.8; specificity, 0.70). Moreover, women with childbirth-related posttraumatic stress disorder generated longer narratives (t test results: t=2.30; p=.02) and used more negative emotional expressions (Wilcoxon test: sadness: p=8.90e-04; W=31,017; anger: p=1.32e-02; W=35,005.50) and death-related words (Wilcoxon test: p=3.48e-05; W=34,538) in describing their childbirth experience than those with no childbirth-related posttraumatic stress disorder. CONCLUSION: This study provided proof of concept that personal childbirth narrative accounts generated in the early postpartum period and analyzed via advanced computational methods can detect with relatively high accuracy women who are likely to endorse childbirth-related posttraumatic stress disorder and those at low risk. This suggests that birth narratives could be promising for informing low-cost, noninvasive tools for maternal mental health screening, and more research that used machine learning to predict early signs of maternal psychiatric morbidity is warranted.
Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Pregnancy , Female , Humans , United States , Child , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Natural Language Processing , Pandemics , Delivery, Obstetric/psychology , COVID-19/complicationsABSTRACT
BACKGROUND: Unsafe abortion remains a leading cause of maternal mortality and morbidity, especially in developing countries with restrictive abortion laws. Disease containment measures during the COVID-19 pandemic have reduced access to contraception and safe abortion care, potentially increasing rates of unintended pregnancies and unsafe abortion. OBJECTIVE: To evaluate the morbidity and mortality burden of unsafe abortion before the COVID-19 pandemic. METHODS: A six-year analytical retrospective study of unsafe abortion at the Federal Medical Centre, Lokoja, Nigeria. All case records of unsafe abortion managed within the study period were retrieved, and relevant data extracted using a purpose-designed proforma. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Associations between categorical independent and outcome variables were assessed using the Chi square test at 95% confidence level. A p-value of <0.05 was considered statistically significant. RESULTS: The prevalence of unsafe abortion was 8.6 per 1,000 deliveries. More than one-half (37, 52.9%) were medical abortions using misoprostol tablets. The mean age of the women was 23.15+ 3.96 years, and most of them were single (49, 70%), with primary/ secondary education (42, 60%), and of low socioeconomic status (67, 95.7%). Nearly one-half (33, 47.1%) had either never used any modern contraceptive (9, 12.9%) or only used emergency contraception (24, 34.3%). The predominant complications of unsafe abortion included retained product of conception (69, 98.6%), haemorrhagic shock (22,31.4%), and sepsis (19, 27.1%). There were two maternal deaths, giving a case fatality rate of 2.9%. CONCLUSION: Unsafe abortion remains a significant cause of maternal mortality and morbidity in our setting. Improving access to effective modern contraceptives and liberalizing our abortion laws may reduce maternal morbidity and mortality from unsafe abortion.
CONTEXTE: L'avortement à risque reste l'une des principales causes de mortalité et de morbidité maternelles, en particulier dans les pays en développement où les lois sur l'avortement sont restrictives. Les mesures de confinement de la maladie pendant la pandémie de COVID-19 ont réduit l'accès à la contraception et aux soins d'avortement sûrs, augmentant potentiellement les taux de grossesses non désirées et d'avortements à risque. OBJECTIF: Évaluer le fardeau de morbidité et de mortalité de l'avortement à risque avant la pandémie de COVID-19. METHODES: Une étude rétrospective analytique de six ans sur l'avortement à risque au Fédéral Médical Center, Lokoja, Nigeria. Tous les dossiers de tous les cas d'avortement à risque pris en charge au cours de la période d'étude ont été récupérés et les données pertinentes extraites à l'aide d'un formulaire conçu à cet effet. Les données obtenues ont été analysées à l'aide d'IBM SPSS Statistiques pour Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Les associations entre les variables indépendantes catégorielles et les variables de résultat ont été évaluées à l'aide du test du chi carré à un niveau de confiance de 95 %. Une valeur de p <0,05 était considérée comme statistiquement significative. RESULTATS: L'prévalence des avortements à risque était de 8,6 pour 1000 accouchements. Plus de la moitié (37, 52,9%) étaient des avortements médicamenteux utilisant comprimés de misoprostol. L'âge moyen des femmes était de 23,15+ 3,96 ans, et la plupart d'entre elles étaient célibataires (49, 70%), avec une éducation primaire/secondaire (42, 60%) et de statut socio-économique bas (67, 95,7%). Près de la moitié (33, 47,1%) n'avaient jamais utilisé de contraceptif moderne (9,12,9%) ou n'avaient utilisé qu'une contraception d'urgence (24, 34,3%). Les complications prédominantes comprenaient la rétention du produit de conception (69, 98,6 %), le choc hémorragique (22, 31,4 %) et la septicémie (19, 27,1 %). Il y a eu deux décès maternels, soit un taux de létalité de 2,9 %. CONCLUSION: L'avortement à risque reste une cause importante de mortalité et de morbidité maternelles dans notre contexte. L'amélioration de l'accès à des contraceptifs modernes efficaces et la libéralisation de nos lois sur l'avortement réduiront la morbidité et la mortalité maternelles dues à l'avortement à risque. Mots-clés: Planification familiale, Avortement illégal/criminel, morbidité et mortalité maternelles, Produit de la conception retenu, Besoin non satisfait.
Subject(s)
Abortion, Induced , COVID-19 , Pregnancy , Female , Humans , Young Adult , Adult , Retrospective Studies , Abortion, Criminal , Tertiary Care Centers , Pandemics , COVID-19/epidemiology , Abortion, Induced/adverse effects , Maternal MortalityABSTRACT
BACKGROUND: COVID-19 infection is associated with increased morbidity in pregnancy and adverse maternal and neonatal outcomes. Little is currently known about how the timing of infection during pregnancy affects these outcomes. OBJECTIVE: This study aimed to evaluate the effect of trimester of COVID-19 infection on disease progression and severity in pregnant patients. STUDY DESIGN: This was a prospective cohort study of pregnant patients diagnosed with COVID-19 infection who delivered at a single urban hospital. Universal testing for SARS-CoV-2 was performed at hospital admission and for symptomatic patients in inpatient, emergency department, and outpatient settings. Disease severity was defined as asymptomatic, mild, moderate, severe, or critical on the basis of National Institutes of Health criteria. We evaluated disease progression from asymptomatic to symptomatic infection and from asymptomatic or mild infection to moderate, severe, or critical illness, and stratified by trimester of COVID-19 diagnosis. Primary outcomes included progression of COVID-19 disease severity and a composite obstetrical outcome, which included delivery at <37 weeks, preeclampsia with severe features, abruption, excess blood loss at delivery (>500 mL for vaginal or >1000 mL for cesarean delivery), and stillbirth. RESULTS: From March 18, 2020 to September 30, 2021, 1326 pregnant patients were diagnosed with COVID-19 and delivered at our institution, including 103 (8%) first-, 355 (27%) second-, and 868 (65%) third-trimester patients. First-trimester patients were older and had more medical comorbidities; 86% of patients in all trimesters were Hispanic. Among patients admitted within 14 days of a positive test, 3 of 18 (17%) first-trimester, 20 of 47 (43%) second-trimester, and 34 of 574 (6%) third-trimester patients were admitted for the indication of COVID-19 illness. Across all trimesters, 1195 (90%) of 1326 COVID-19 infections were asymptomatic or mild, and 45 (10%) of 436 initially asymptomatic patients developed symptoms. Of patients with asymptomatic or mild symptoms at diagnosis, 4 (4%) of 93 first-, 18 (5%) of 337 second-, and 49 (6%) of 836 third-trimester patients developed moderate, severe, or critical illness (P=.80). There was no significant difference in composite obstetrical outcome with respect to trimester of COVID-19 diagnosis (24% first-trimester, 28% second-trimester, 28% third-trimester patients; P=.69). CONCLUSION: Moderate, severe, or critical illness develops in almost 10% of pregnant patients. The frequency of COVID-19 disease progression in pregnancy does not differ by trimester of diagnosis.
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BACKGROUND: Although the increased risk for severe illness and adverse pregnancy outcomes associated with SARS-CoV-2 infection during pregnancy is well described, the association of infection with severe maternal morbidity has not been well characterized. OBJECTIVE: This study aimed to evaluate the risk for severe maternal morbidity associated with SARS-CoV-2 infection during pregnancy. STUDY DESIGN: This was a multicenter retrospective cohort study of all pregnant patients who had a SARS-CoV-2 test done and who delivered in a New York health system between March 1, 2020 and March 1, 2021. Patients with missing test results were excluded. The primary outcome of severe maternal morbidity, derived from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine example list of diagnoses and complications, was compared between the following 2 groups: patients who tested positive for SARS-CoV-2 during pregnancy and patients who tested negative. Secondary outcomes included subgroups of severe maternal morbidity. Multivariable logistic regression was used to adjust for potential confounders such as maternal demographics, neighborhood socioeconomic status, hospital location, and pregnancy-related complications. A subanalysis was performed to determine if the risk for severe obstetrical hemorrhage and hypertension-associated or neurologic morbidity differed based on the timing of SARS-CoV-2 infection between those who tested positive for SARS-CoV-2 at their delivery hospitalization (ie, active infection) and those who tested positive during pregnancy but negative at their delivery hospitalization (ie, resolved infection). RESULTS: Of the 22,483 patients included, 1653 (7.4%) tested positive for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were more commonly Black, multiracial, Hispanic, non-English speaking, used Medicaid insurance, were multiparous, and from neighborhoods with a lower socioeconomic status. Patients with SARS-CoV-2 infection were at an increased risk for severe maternal morbidity when compared with those without infection (9.3 vs 6.5%; adjusted odds ratio, 1.52; 95% confidence interval, 1.21-1.88). Patients with SARS-CoV-2 infection were also at an increased risk for severe obstetrical hemorrhage (1.1% vs 0.5%; adjusted odds ratio, 1.78; 95% confidence interval, 1.04-2.88), pulmonary morbidity (2.0% vs 0.5%; adjusted odds ratio, 3.90; 95% confidence interval, 2.52-5.89), and intensive care unit admission (1.8% vs 0.5%; adjusted odds ratio, 3.29; 95% confidence interval, 2.09-5.04) when compared with those without infection. The risk for hypertension-associated or neurologic morbidity was similar between the 2 groups. The timing of SARS-CoV-2 infection (whether active or resolved at time of delivery) was not associated with the risk for severe obstetrical hemorrhage or hypertension-associated or neurologic morbidity when compared with those without infection. CONCLUSION: SARS-CoV-2 infection during pregnancy was associated with an increased risk for severe maternal morbidity, severe obstetrical hemorrhage, pulmonary morbidity, and intensive care unit admission. These data highlight the need for obstetrical unit preparedness in caring for patients with SARS-CoV-2 infection, continued public health efforts aimed at minimizing the risk for infection, and support in including this select population in investigational therapy and vaccine trials.