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1.
BMC Pregnancy Childbirth ; 22(1): 33, 2022 Jan 14.
Article in English | MEDLINE | ID: covidwho-1622218

ABSTRACT

BACKGROUND: COVID-19 vaccines are advised for pregnant women in the United Kingdom (UK) however COVID-19 vaccine uptake among pregnant women is inadequate. METHODS: An online survey and semi-structured interviews were used to investigate pregnant women's views on COVID-19 vaccine acceptability for themselves when pregnant, not pregnant and for their babies. One thousand one hundred eighty-one women, aged over 16 years, who had been pregnant since 23rd March 2020, were surveyed between 3rd August-11th October 2020. Ten women were interviewed. RESULTS: The majority of women surveyed (81.2%) reported that they would 'definitely' or were 'leaning towards' accepting a COVID-19 vaccine when not pregnant. COVID-19 vaccine acceptance was significantly lower during pregnancy (62.1%, p < 0.005) and for their babies (69.9%, p < 0.005). Ethnic minority women were twice as likely to reject a COVID-19 vaccine for themselves when not pregnant, pregnant and for their babies compared to women from White ethnic groups (p < 0.005). Women from lower-income households, aged under 25-years, and from some geographic regions were more likely to reject a COVID-19 vaccine when not pregnant, pregnant and for their babies. Multivariate analysis revealed that income and ethnicity were the main drivers of the observed age and regional differences. Women unvaccinated against pertussis in pregnancy were over four times more likely to reject COVID-19 vaccines when not pregnant, pregnant and for their babies. Thematic analysis of the survey freetext responses and interviews found safety concerns about COVID-19 vaccines were common though wider mistrust in vaccines was also expressed. Trust in vaccines and the health system were also reasons women gave for accepting COVID-19 vaccines. CONCLUSION: Safety information on COVID-19 vaccines must be clearly communicated to pregnant women to provide reassurance and facilitate informed pregnancy vaccine decisions. Targeted interventions to promote COVID-19 vaccine uptake among ethnic minority and lower-income women may be needed.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Patient Acceptance of Health Care/psychology , Pregnancy Complications, Infectious/prevention & control , Vaccination/psychology , Adult , /statistics & numerical data , Female , Humans , Income , Mothers/psychology , Pregnancy , Pregnant Women/psychology , SARS-CoV-2/immunology , Surveys and Questionnaires , United Kingdom/epidemiology
3.
J Coll Physicians Surg Pak ; 32(1): 119-121, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1591380

ABSTRACT

The goal of this study was to investigate the maternal death rate among admitted pregnant patients with SARS-COV-2 during its 4th wave in Pakistan. It was a cross-sectional analytical study, carried on pregnant patients admitted due to COVID-19, in Sadiq Abbasi Hospital from 15th August to 15th September, 2021. Thirty-three PCR confirmed and HRCT suggestive patients were included with mean age of 28 ± 4.5 years and mean gestational age of 28.5 ± 6 weeks. Twenty-seven (81%) were non-vaccinated, 22 (66%) were admitted with severe disease, 13 (39.4%) and 11 (33.3%) were on non-invasive and invasive ventilator support, respectively. Only nine (27%) patients could continue their pregnancy. Fifteen (45%) patients had severe oligohydramnios. Twenty-two (66.7%) patients were died, all were unvaccinated. Regression analysis for maternal mortality predicted by severity and vaccination status was significant with R2=.68, F (1, 31) =66.6, p <.001 CI (-.69, -.42) and R2=.44, F (1, 31) = 24.8, p <.001 CI (-1.14, -.48), respectively. There was substantial mortality in the admitted and non-vaccinated pregnant patients with COVID-19. Key Words: Pregnancy, Vaccination, Severe COVID, Maternal outcome.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Vaccines , Adult , Cross-Sectional Studies , Female , Humans , Infant , Maternal Mortality , Pakistan/epidemiology , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome , SARS-CoV-2 , Young Adult
5.
Prenat Diagn ; 41(8): 1018-1035, 2021 07.
Article in English | MEDLINE | ID: covidwho-1544371

ABSTRACT

There are over 50 SARS-CoV-2 candidate vaccines undergoing Phase II and III clinical trials. Several vaccines have been approved by regulatory authorities and rolled out for use in different countries. Due to concerns of potential teratogenicity or adverse effect on maternal physiology, pregnancy has been a specific exclusion criterion for most vaccine trials with only two trials not excluding pregnant women. Thus, other than limited animal studies, gradually emerging development and reproductive toxicity data, and observational data from vaccine registries, there is a paucity of reliable information to guide recommendations for the safe vaccination of pregnant women. Pregnancy is a risk factor for severe COVID-19, especially in women with comorbidities, resulting in increased rates of preterm birth and maternal morbidity. We discuss the major SARS-CoV-2 vaccines, their mechanisms of action, efficacy, safety profile and possible benefits to the maternal-fetal dyad to create a rational approach towards maternal vaccination while anticipating and mitigating vaccine-related complications. Pregnant women with high exposure risks or co-morbidities predisposing to severe COVID-19 infection should be prioritised for vaccination. Those with risk factors for adverse effects should be counselled accordingly. It is essential to support patient autonomy by shared decision-making involving a risk-benefit discussion with the pregnant woman.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2/immunology , COVID-19/immunology , Female , Humans , Pregnancy , Pregnancy Complications, Infectious/immunology , Vaccination/ethics
6.
Nat Med ; 27(10): 1693-1695, 2021 10.
Article in English | MEDLINE | ID: covidwho-1526092

ABSTRACT

To evaluate the effectiveness of the BNT162b2 messenger RNA vaccine in pregnant women, we conducted an observational cohort study of pregnant women aged 16 years or older, with no history of SARS-CoV-2, who were vaccinated between 20 December 2020 and 3 June 2021. A total of 10,861 vaccinated pregnant women were matched to 10,861 unvaccinated pregnant controls using demographic and clinical characteristics. Study outcomes included documented infection with SARS-CoV-2, symptomatic COVID-19, COVID-19-related hospitalization, severe illness and death. Estimated vaccine effectiveness from 7 through to 56 d after the second dose was 96% (95% confidence interval 89-100%) for any documented infection, 97% (91-100%) for infections with documented symptoms and 89% (43-100%) for COVID-19-related hospitalization. Only one event of severe illness was observed in the unvaccinated group and no deaths were observed in either group. In summary, the BNT162b2 mRNA vaccine was estimated to have high vaccine effectiveness in pregnant women, which is similar to the effectiveness estimated in the general population.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Pregnancy Complications, Infectious/prevention & control , Adolescent , Adult , COVID-19/epidemiology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Cohort Studies , Female , Humans , Incidence , Pregnancy , SARS-CoV-2/isolation & purification , Young Adult
8.
BMC Pregnancy Childbirth ; 21(1): 745, 2021 Nov 03.
Article in English | MEDLINE | ID: covidwho-1501992

ABSTRACT

BACKGROUND: Seasonal influenza can circulate in parallel with coronavirus disease (COVID-19) in winter. In the context of COVID-19 pandemic, the risk of co-infection and the burden it poses on healthcare system calls for timely influenza vaccination among pregnant women, who are the priority population recommended for vaccination. We aimed to evaluate the acceptance of influenza vaccination and associated factors among pregnant women during COVID-19 pandemic, provide evidence to improve influenza vaccination among pregnant women, help reduce the risk of infection and alleviate the burden of healthcare system for co-infected patients. METHODS: We conducted a multi-center cross-sectional study among pregnant women in China. Sociodemographic characteristics, health status, knowledge on influenza, attitude towards vaccination, and health beliefs were collected. Locally weighted scatterplot smoothing regression analysis was used to evaluate the trends in the acceptance of influenza vaccine. Logistic regression was applied to identify factors associated with vaccination acceptance. RESULTS: The total acceptance rate was 76.5% (95%CI: 74.8-78.1%) among 2568 pregnant women enrolled. Only 8.3% of the participants had a history of seasonal influenza vaccination. In the logistic regression model, factors associated with the acceptance of influenza vaccine were western region, history of influenza vaccination, high knowledge of influenza infection and vaccination, high level of perceived susceptibility, perceived benefit, cues to action and low level of perceived barriers. Among 23.5% of the participants who had vaccine hesitancy, 48.0% of them were worried about side effect, 35.6% of them lacked confidence of vaccine safety. CONCLUSIONS: Our findings highlighted that tailored strategies and publicity for influenza vaccination in the context of COVID-19 pandemic are warranted to reduce pregnant women's concerns, improve their knowledge, expand vaccine uptake and alleviate pressure for healthcare system.


Subject(s)
COVID-19/epidemiology , Influenza A virus/immunology , Influenza Vaccines/pharmacology , Influenza, Human/prevention & control , Pandemics , Pregnancy Complications, Infectious/prevention & control , Vaccination/methods , Adult , China/epidemiology , Comorbidity , Cross-Sectional Studies , Female , Health Belief Model , Health Knowledge, Attitudes, Practice , Humans , Influenza, Human/epidemiology , Patient Acceptance of Health Care , Pregnancy , Pregnancy Complications, Infectious/epidemiology , SARS-CoV-2 , Seasons , Surveys and Questionnaires
10.
Pediatr Clin North Am ; 68(5): 1055-1070, 2021 10.
Article in English | MEDLINE | ID: covidwho-1482855

ABSTRACT

COVID-19 has afflicted the health of children and women across all age groups. Since the outbreak of the pandemic in December 2019, various epidemiologic, immunologic, clinical, and pharmaceutical studies have been conducted to understand its infectious characteristics, pathogenesis, and clinical profile. COVID-19 affects pregnant women more seriously than nonpregnant women, endangering the health of the newborn. Changes have been implemented to guidelines for antenatal care of pregnant women, delivery, and newborn care. We highlight the current trends of clinical care in pregnant women and newborns during the COVID-19 pandemic.


Subject(s)
COVID-19/diagnosis , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome/epidemiology , Prenatal Care/methods , COVID-19/transmission , Delivery, Obstetric/statistics & numerical data , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy
13.
Curr Opin Pediatr ; 33(2): 181-187, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1455408

ABSTRACT

PURPOSE OF REVIEW: To provide an update on the consequences of severe acute respiratory syndrome (SARS)-CoV-2 infection on the health and perinatal outcomes of pregnant women and their infants. RECENT FINDINGS: The severity of SARS-CoV-2 infection is greater in pregnant compared to nonpregnant women as measured by rates of admission to intensive care units, mechanical ventilation, mortality, and morbidities including myocardial infarction, venous thromboembolic and other thrombotic events, preeclampsia, preterm labor, and preterm birth. The risk of transmission from mother-to-infant is relatively low (1.5-5%) as quantitated by neonatal SARS-CoV-2 testing. Infants appear to be at higher risk of testing positive for SARS-CoV-2 if the mother has tested positive within 1 week of delivery or is herself symptomatic at the time of maternity admission. The rate of positivity is not higher in infants who room in with the mother compared to infants who are initially separated and cared for in a SARS-CoV-2-free environment. Infants who test positive in the hospital have no or mild signs of disease, most of which may be attributable to prematurity, and rarely require readmission for clinical signs consistent with COVID-19. SUMMARY: Pregnant women should take precautions to avoid infection with SARS-CoV-2. Infants born to mothers who test positive for SARS-CoV-2 can receive normal neonatal care in-hospital with their mothers if mother and staff adhere to recommended infection control practices.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Pandemics , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome , Premature Birth/epidemiology , SARS-CoV-2
14.
Curr Opin Pediatr ; 33(6): 618-624, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1437854

ABSTRACT

PURPOSE OF REVIEW: To evaluate the available literature regarding effects of coronavirus disease 2019 (COVID-19) on newborns, ranging from effects related to in utero and perinatal exposure to maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, to pandemic-related stress and socioeconomic changes. RECENT FINDINGS: Several large studies and national registries have shown that the risk of vertical transmission from SARS-CoV-2-infected mothers to newborns is rare and does not appear to be related to postnatal care policies such as mother-newborn separation and breastfeeding. Newborns exposed to SARS-CoV-2 in utero are at higher risk for preterm delivery for reasons still under investigation. When newborns do acquire SARS-CoV-2 infection, their disease course is usually mild. Long-term follow-up data are lacking, but preliminary reports indicate that, similarly to prior natural disasters, being born during the pandemic may be associated with developmental risk. SUMMARY: Although risk of vertical or perinatal transmission is low across a range of postnatal care practices, early indicators suggest developmental risk to the generation born during the pandemic. Long-term follow-up data are critically needed to determine the developmental impact of in utero and early life exposure to SARS-CoV-2 and the COVID-19 pandemic.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Pandemics , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2
17.
Early Hum Dev ; 162: 105460, 2021 11.
Article in English | MEDLINE | ID: covidwho-1427832

ABSTRACT

The outbreak and spread of the coronavirus disease 2019 pandemic has led to an unprecedented wealth of literature on the impact of human coronaviruses on pregnancy. The number of case studies and publications alone are several orders of magnitude larger than those published in all previous human coronavirus outbreaks combined, enabling robust conclusions to be drawn from observations for the first time. However, the importance of learning from previous human coronavirus outbreaks cannot be understated. In this narrative review, we describe what we consider to the major learning points arising from the SARS-CoV-2 pandemic in relation to pregnancy, and where these confound what might have been expected from previous coronavirus outbreaks.


Subject(s)
COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Female , Humans , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome/epidemiology , Vaccination/statistics & numerical data
18.
JAMA ; 326(8): 728-735, 2021 08 24.
Article in English | MEDLINE | ID: covidwho-1427006

ABSTRACT

Importance: Data on BNT162b2 messenger RNA (mRNA) vaccine (Pfizer-BioNTech) effectiveness and safety in pregnancy are currently lacking because pregnant women were excluded from the phase 3 trial. Objective: To assess the association between receipt of BNT162b2 mRNA vaccine and risk of SARS-CoV-2 infection among pregnant women. Design, Setting, and Participants: This was a retrospective cohort study within the pregnancy registry of a large state-mandated health care organization in Israel. Pregnant women vaccinated with a first dose from December 19, 2020, through February 28, 2021, were 1:1 matched to unvaccinated women by age, gestational age, residential area, population subgroup, parity, and influenza immunization status. Follow-up ended on April 11, 2021. Exposures: Exposure was defined by receipt of the BNT162b2 mRNA vaccine. To maintain comparability, nonexposed women who were subsequently vaccinated were censored 10 days after their exposure, along with their matched pair. Main Outcomes and Measures: The primary outcome was polymerase chain reaction-validated SARS-CoV-2 infection at 28 days or more after the first vaccine dose. Results: The cohort included 7530 vaccinated and 7530 matched unvaccinated women, 46% and 33% in the second and third trimester, respectively, with a mean age of 31.1 years (SD, 4.9 years). The median follow-up for the primary outcome was 37 days (interquartile range, 21-54 days; range, 0-70). There were 118 SARS-CoV-2 infections in the vaccinated group and 202 in the unvaccinated group. Among infected women, 88 of 105 (83.8%) were symptomatic in the vaccinated group vs 149 of 179 (83.2%) in the unvaccinated group (P ≥ .99). During 28 to 70 days of follow-up, there were 10 infections in the vaccinated group and 46 in the unvaccinated group. The hazards of infection were 0.33% vs 1.64% in the vaccinated and unvaccinated groups, respectively, representing an absolute difference of 1.31% (95% CI, 0.89%-1.74%), with an adjusted hazard ratio of 0.22 (95% CI, 0.11-0.43). Vaccine-related adverse events were reported by 68 patients; none was severe. The most commonly reported symptoms were headache (n = 10, 0.1%), general weakness (n = 8, 0.1%), nonspecified pain (n = 6, <0.1%), and stomachache (n = 5, <0.1%). Conclusions and Relevance: In this retrospective cohort study of pregnant women, BNT162b2 mRNA vaccination compared with no vaccination was associated with a significantly lower risk of SARS-CoV-2 infection. Interpretation of study findings is limited by the observational design.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnant Women , Adult , COVID-19/immunology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/immunology , Case-Control Studies , Confidence Intervals , Female , Gestational Age , Humans , Incidence , Israel/epidemiology , Kaplan-Meier Estimate , Pregnancy , Pregnancy Complications, Infectious/immunology , Pregnancy Complications, Infectious/prevention & control , Regression Analysis , Retrospective Studies , Risk , Time Factors , Vaccination/statistics & numerical data
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