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1.
Gac Med Mex ; 157(6): 599-603, 2021.
Article in English | MEDLINE | ID: covidwho-1761583

ABSTRACT

INTRODUCTION: In Mexico, there is a syndemic in pregnant women, where the epidemic of obesity and chronic diseases coexists with that of coronavirus disease 2019 (COVID-19), which has been associated with a higher risk of maternal mortality. OBJECTIVE: To evaluate the association of comorbidities during pregnancy with maternal mortality from COVID-19 in Mexico. MATERIAL AND METHODS: SISVER COVID-19 databases and epidemiological surveillance reports on maternal mortality were used. Multivariate logistic regression models were used to evaluate the association of comorbidities with maternal deaths from COVID-19. RESULTS: A total of 29,416 pregnant women were evaluated, out of which 39% were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the risk of maternal mortality was 3.24 times higher (p < 0.01) for positive in comparison with negative women. COVID-19 is the leading cause of maternal death since July 2020 and explains more than 50% of total deaths in 2021. Chronic kidney disease (odds ratio [OR]: 4.11; p < 0.01) and diabetes (OR: 2.53; p < 0.01) were the two main comorbidities that were positively associated with maternal death from COVID-19. CONCLUSION: Comorbidities during pregnancy that are possibly associated with an increase in the inflammatory response and an alteration of the immune response increase the risk of maternal death from COVID-19 in Mexican pregnant women.


INTRODUCCIÓN: En México existe una sindemia en las mujeres gestantes, donde coexiste la epidemia de obesidad y enfermedades crónicas con la de enfermedad por coronavirus 2019 (COVID-19), lo que se ha asociado con un mayor riesgo de mortalidad. OBJETIVO: Evaluar la asociación de las comorbilidades en la mortalidad materna por COVID-19 en México. MATERIAL Y MÉTODOS: Se utilizaron las bases de datos de COVID-19 del SISVER y los reportes de vigilancia epidemiológica de muertes maternas. Se utilizaron modelos de regresión logística multivariante para evaluar la asociación de las comorbilidades durante la gestación con mortalidad materna por COVID-19. RESULTADOS: Se evaluaron 29,416 mujeres embarazadas, el 39% fueron positivas para coronavirus 2 del síndrome respiratorio agudo grave, el riesgo de mortalidad materna fue 3.24 veces mayor (p < 0.01) para las mujeres positivas en comparación con las negativas. La COVID-19 es la primera causa de muerte materna desde julio del 2020 y explica más del 50% del total de muertes en el 2021. La enfermedad renal crónica (razón de momios [RM]: 4.11; p < 0.01) y la diabetes (RM: 2.53; p < 0.01) fueron las dos principales comorbilidades asociadas positivamente a la mortalidad materna por COVID-19. CONCLUSIÓN: Las comorbilidades durante el embarazo posiblemente asociadas con un incremento de la respuesta inflamatoria y alteración de la respuesta inmunitaria incrementan el riesgo de muerte materna por COVID-19 en mujeres gestantes mexicanas.


Subject(s)
COVID-19 , Pregnancy Complications , Female , Humans , Maternal Mortality , Mexico/epidemiology , Pregnancy , Pregnancy Complications/epidemiology , SARS-CoV-2
3.
PLoS One ; 17(3): e0265021, 2022.
Article in English | MEDLINE | ID: covidwho-1724866

ABSTRACT

BACKGROUND: The prevalence of anxiety and depression in pregnant women has significantly increased after the spread of COVID-19 throughout the world. We carried out this meta-analysis to reveal the information about risk factors for depression and anxiety in pregnant women during the COVID-19 pandemic. METHODS: We searched the PubMed, Embase and CNKI (China National Knowledge Infrastructure) databases for all articles. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the risk factors for mental health. The statistical heterogeneity among studies was assessed with the Q-test and I2 statistics. RESULTS: We collected 17 studies including 15,050 pregnant women during the COVID-19 pandemic. Our results found that factors including decrease in the perception of general support and difficulties in household finances have damage effects on anxiety, and factors including undereducated, unemployed during pregnancy, with a chronic physical illness before pregnancy, decrease in the perception of general support, difficulties in household finances, disobey the isolation rules, and smoking during pregnancy have increased risk of depression. CONCLUSION: Our meta-analysis revealed some risk factors for mental health in pregnant women during COVID-19 pandemic. Mental health interventions in pregnant women may involve targeted methods individually.


Subject(s)
Anxiety/psychology , COVID-19/psychology , Depression/psychology , Pregnancy Complications/psychology , Pregnant Women/psychology , SARS-CoV-2 , Adult , Anxiety/epidemiology , COVID-19/epidemiology , Depression/epidemiology , Female , Humans , Pregnancy , Pregnancy Complications/epidemiology , Risk Factors
4.
BMC Pregnancy Childbirth ; 22(1): 54, 2022 Jan 21.
Article in English | MEDLINE | ID: covidwho-1643118

ABSTRACT

BACKGROUND: A hospital-based retrospective study was conducted to examine the effect of initial COVID-19 outbreak during first trimester on pregnancy outcome in Wuxi, China. METHODS: Women who delivered children at our hospital during June 2020 to July 2020 (control group), and October 2020 to December 2020 (exposure group) were recruited in the present study. All of the participants were not infected with COVID-19. The last menstrual period (LMP) of the exposure group was between January 24th, 2020 and March 12th, 2020, whilst in the control group, the LMP was between May 12th and October 31st, 2019. RESULTS: There were 1,456 women in the exposure group and 1,816 women in the control group. Women in the exposure group were more susceptible to hypertension during pregnancy (HDP, P = 0.004, OR[95%CI] = 1.90[1.22-2.95]) and gestational diabetes mellitus (GDM, P = 0.008, OR[95%CI] = 1.31[1.08-1.60]) compared to those in the control group. Mothers diagnosed with HDP were more likely to deliver premature infants, leading to a higher rate of low birth weight (all P < 0.05). The other common outcomes of pregnancy showed no statistical differences between the two groups. CONCLUSIONS: The initial COVID-19 outbreak might increase the incidence rates of HDP and GDM among pregnant women whose first trimesters were during that period, resulting in higher percentages of premature delivery and low birth weight. These results should be confirmed by studies from other hospitals or cities.


Subject(s)
COVID-19/epidemiology , Maternal Exposure , Pregnancy Complications/epidemiology , Pregnancy Trimester, First , SARS-CoV-2 , Adult , China/epidemiology , Diabetes, Gestational/epidemiology , Female , Humans , Hypertension, Pregnancy-Induced/epidemiology , Incidence , Infant, Low Birth Weight , Pregnancy , Premature Birth , Retrospective Studies
5.
Obstet Gynecol ; 138(4): 603-615, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1591562

ABSTRACT

OBJECTIVE: To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES: A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION: We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction. TABULATION, INTEGRATION, AND RESULTS: Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth. CONCLUSION: Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.


Subject(s)
Delivery of Health Care/methods , Prenatal Care/methods , COVID-19/epidemiology , Diabetes, Gestational/epidemiology , Female , Humans , Hypertension, Pregnancy-Induced/epidemiology , Infant, Newborn , Michigan , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Randomized Controlled Trials as Topic , SARS-CoV-2 , Telemedicine/methods
7.
PLoS Med ; 18(11): e1003857, 2021 11.
Article in English | MEDLINE | ID: covidwho-1542163

ABSTRACT

BACKGROUND: To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic. METHODS AND FINDINGS: We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (±5.9) years old versus 30.5 (±5.4) years old, respectively, p < 0.001), obesity (0.7% versus 0.3%, respectively, p < 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, p < 0.001), and history of hypertension (0.9% versus 0.3%, respectively, p < 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, p < 0.001) and primiparity (0.3% versus 0.4%, respectively, p < 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis (p = 0.28). When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, p < 0.001), mortality (0.2% versus 0.005%, p < 0.001), preeclampsia/eclampsia (4.8% versus 2.2%, p < 0.001), gestational hypertension (2.3% versus 1.3%, p < 0.03), postpartum hemorrhage (10.0% versus 5.7%, p < 0.001), preterm birth at <37 weeks of gestation (16.7% versus 7.1%, p < 0.001), <32 weeks of gestation (2.2% versus 0.8%, p < 0.001), <28 weeks of gestation (2.4% versus 0.8%, p < 0.001), induced preterm birth (5.4% versus 1.4%, p < 0.001), spontaneous preterm birth (11.3% versus 5.7%, p < 0.001), fetal distress (33.0% versus 26.0%, p < 0.001), and cesarean section (33.0% versus 20.2%, p < 0.001). Rates of pregnancy terminations ≥22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected. CONCLUSIONS: We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women.


Subject(s)
COVID-19/epidemiology , Cesarean Section/statistics & numerical data , Pandemics , Pregnancy Complications/epidemiology , Pregnancy Outcome , Premature Birth/epidemiology , Adult , Diabetes, Gestational/epidemiology , Female , Fetal Distress/epidemiology , France/epidemiology , Humans , Hypertension, Pregnancy-Induced/epidemiology , Infant, Newborn , Intensive Care Units , Logistic Models , Maternal Mortality , Obesity/epidemiology , Postpartum Hemorrhage/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy , Pregnant Women , Retrospective Studies , SARS-CoV-2
8.
BMC Pregnancy Childbirth ; 21(1): 768, 2021 Nov 12.
Article in English | MEDLINE | ID: covidwho-1528682

ABSTRACT

BACKGROUND: Pregnant and postpartum women face unique challenges and concerns during the COVID-19 pandemic. Thus far, no studies have explored the factors associated with increased levels of worry in this population globally. The current study sought to assess the frequency and sources of worry during the COVID-19 pandemic in an international sample of pregnant and postpartum women. METHODS: We conducted an anonymous, online, cross-sectional survey in 64 countries between May and June 2020. The survey was available in 12 languages and hosted on the Pregistry platform for COVID-19 studies. Participants were sought mainly on social media platforms and online parenting forums. The survey included questions related to demographics, level of worry, support, stress, COVID-19 exposure, frequency of media usage, and mental health indicators. RESULTS: The study included 7561 participants. Eighty-three percent of all participants indicated that they were either 'somewhat' or 'very' worried. Women 13-28 weeks pregnant were significantly more likely to indicate that they were 'very worried' compared to those who were postpartum or at other stages of pregnancy. When compared with women living in Europe, those in Africa, Asia and Pacific, North America and South/Latin America were more likely to have increased levels of worry, as were those who more frequently interacted with social media. Different forms of support and stress also had an impact upon level of worry, while indicators of stress and anxiety were positively associated with worry level. CONCLUSION: Pregnant and postpartum women are vulnerable to the changes in societal norms brought about by the COVID-19 pandemic. Understanding the factors associated with levels of worry within this population will enable society to address potential unmet needs and improve the current and future mental health of parents and children.


Subject(s)
Anxiety/etiology , COVID-19/psychology , Pregnancy Complications/etiology , Adolescent , Adult , Anxiety/epidemiology , Anxiety/psychology , Cross-Sectional Studies , Female , Global Health/statistics & numerical data , Health Surveys , Humans , Logistic Models , Odds Ratio , Postpartum Period/psychology , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/psychology , Risk Factors , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Stress, Psychological/psychology , Young Adult
9.
J Perinat Med ; 49(6): 656-663, 2021 Jul 27.
Article in English | MEDLINE | ID: covidwho-1496585

ABSTRACT

OBJECTIVES: The impact of the COVID-19 pandemic and the public health measures introduced to control it, on mental health, is largely unknown. Research conducted during past epidemics found that pregnant women are more vulnerable psychologically. The aim of this study was to investigate antenatal depressive and anxiety symptoms during this pandemic in Greece. METHODS: All women receiving routine antenatal care, during a three-month period, starting one week after the total lockdown in Greece, in a University department, were asked to fill in two questionnaires, the Edinburg Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). RESULTS: Overall, 505 women (93.3% of the eligible population) agreed to participate. The prevalence of antenatal depression (EPDS score≥13) in the population of the study was 13.5%. Unplanned pregnancy (OR: 2.447; 95% CI: 1.235-4.846), smoking (OR: 2.268; 95% CI: 1.166-4.411) and antenatal anxiety (OR: 5.074; 95% CI: 2.898-8.883) increased the risk of antenatal depression during the COVID-19 pandemic. State (current)-anxiety affected 34.1% of the participants, whereas Trait (lifetime)-anxiety affected 15.8%. The State-anxiety score (median) was significantly higher than the Trait-anxiety (median) (41 vs. 36; p<0.001), revealing an increase in the levels of anxiety in the pandemic, while there was also a positive linear correlation between the two scales (rho=0.592; p<0.001). CONCLUSIONS: The unprecedented situation of the COVID-19 pandemic has increased anxiety, but not depression levels of pregnant women in Greece. Population level interventions to address adverse effects on anxiety status in the initial phases of similar situations may be helpful in the future.


Subject(s)
Anxiety/epidemiology , COVID-19 , Depression/epidemiology , Pregnancy Complications/psychology , Adult , Cross-Sectional Studies , Female , Greece/epidemiology , Humans , Pregnancy , Pregnancy Complications/epidemiology , Risk Factors
13.
J Psychosom Obstet Gynaecol ; 42(2): 108-114, 2021 06.
Article in English | MEDLINE | ID: covidwho-1373503

ABSTRACT

OBJECTIVE: The coronavirus disease (COVID-19) pandemic has negatively affected many people's mental health with increased symptoms of stress, anxiety and depression in the general population. Anxiety and depression can have negative effects on pregnant women and result in poor neonatal outcomes. Therefore, we analyzed stress, anxiety and depression in pregnant women during the COVID-19 pandemic. MATERIALS AND METHODS: Cohort study of pregnant women during COVID-19 compared to pregnant women before COVID-19. Pregnant women were recruited through social media platforms from 21 May 2020 to 22 June 2020. Pregnant women ≥ 18 years of age, who master the Dutch language were included. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10) were analyzed. Demographic features were summarized using descriptive statistics. Possible differences in demographic variables between groups were compared using Mann Whitney U test and Chi-squared test. Significant demographic differences between groups were controlled for using logistical regression analysis or an independent one-way analysis of covariance. RESULTS: Thousand hundred and two pregnant women completed the questionnaires during COVID-19, and 364 pregnant women before COVID-19. We found no differences in clinically high levels of anxiety (HADS-A ≥ 8) and depression (HADS-D ≥ 8) in women during COVID-19 (19.5% and 13.2%, respectively) and women before COVID-19 (23.1% and 15.7%, respectively). A question was implemented whether participants related their stress level to COVID-19. Women who related their stress to the COVID-19 pandemic reported significantly higher overall stress levels on the PSS-10 compared to women with stress unrelated to COVID-19 (mean, 15.62; standard deviation [SD], 6.44 vs. mean, 10.28; SD, 5.48; p < 0.001). CONCLUSION: In contrast to previous studies, COVID-19 did not increase anxiety and depression levels in Dutch pregnant women. Women who related their perceived stress to the COVID-19 pandemic experienced higher stress levels than women who did not relate their stress to the COVID-19 pandemic, suggesting that interventions that specifically aim to reduce COVID-19 stress, may help to reduce overall stress levels in pregnant women during the pandemic.


Subject(s)
Anxiety/epidemiology , COVID-19 , Depression/epidemiology , Pregnancy Complications/epidemiology , Pregnant Women , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Adolescent , Adult , Cohort Studies , Female , Humans , Netherlands/epidemiology , Pregnancy , Young Adult
14.
J Psychosom Obstet Gynaecol ; 42(2): 91-99, 2021 06.
Article in English | MEDLINE | ID: covidwho-1373502

ABSTRACT

BACKGROUND: COVID-19 has started to spread within China since the end of December 2019. As a special population, the pregnant and delivery women maybe influenced both in physical and psychological aspects. The meta-analysis was conducted about mental health in pregnant and delivery women. METHODS: We searched both MEDLINE, EMBASE, Cochrane Library in English and CBM, CNKI, WANFANG and CSSCI in Chinese to find literature from December 2019 to 31 July 2020 related to COVID-19 and mental health in patient with pregnancy and delivery, among which results such as comments, letters, reviews and case reports were excluded. The prevalence of anxiety and depression in the population was synthesized and discussed. RESULTS: A total of 11,187 subjects were included in 15 studies. Random effect model is used to account for the data by Revman 5.2. The results showed that the prevalence of depression was 30% (95% CI: 0.23-0.37), the prevalence of anxiety was 34% (95% CI: 0.26-0.43) and prevalence of both anxiety and depression was 18% (95% CI: 0.09-0.29). The prevalence of anxiety (OR = 2.15, 95% CI: 1.39-3.31, Z = 3.47, p=.0005), depression (OR = 1.95, 95% CI: 1.07-3.56, Z = 2.19, p=.03) were higher than that of controls. Significant heterogeneity was detected across studies regarding these prevalence estimates. Subgroup analysis was taken according to assessment tools, and sensitivity analysis was done to explore the sources of heterogeneity. CONCLUSIONS: The higher prevalence of depression, anxiety, both depression and anxiety in women with pregnancy and delivery during COVID-19 pandemic although the significant heterogeneity detected in studies. We must interpret the results with caution and also put attention to this result. As the epidemic is ongoing, it is vital to set up a comprehensive crisis prevention system.


Subject(s)
Anxiety/epidemiology , COVID-19 , Depression/epidemiology , Pregnancy Complications/epidemiology , Pregnant Women , Adult , China/epidemiology , Comorbidity , Female , Humans , Pregnancy
15.
Malawi Med J ; 33(1): 54-58, 2021 03.
Article in English | MEDLINE | ID: covidwho-1369850

ABSTRACT

Background: Several studies have been published on the topic of COVID-19 and pregnancy over recent months. However, few studies have evaluated the impact of this pandemic on maternal mental health, particularly in low-resource settings. Aim: To determine the prevalence and predictors of COVID-19-related depression, anxiety and stress symptoms among pregnant women. Methods: This was a cross-sectional study that involved 456 pregnant women attending prenatal care at Abakaliki, Nigeria, during the COVID-19 lockdown. These patients were screened for psychological morbidities using the Depression Anxiety and Stress Scale-21 (DASS-21). Results: Severe and extremely severe depression were reported in 7.2% (n=33) and 6.4% (n=29) of participants, respectively. Analysis also revealed that 3.3% (n=15) and 7.7% (n=35) of women had severe and extremely severe anxiety, respectively. In total, 23% (n=105) of the participating women had severe stress while 16.7% (n=76) reported extremely severe stress. Multiparity (2-4) and occupation, such as trading and farming, were predictors of depression whereas grand-multiparity, urban residence, and trading, were identified as predictors of anxiety and stress. Conclusion: Symptoms of depression, anxiety and stress were relatively common among pregnant women during the COVID-19 lockdown in Abakaliki, Nigeria. There is a clear need to integrate screening for depression, anxiety and stress, in existing antenatal care programs so as to identify and prevent long-term adverse psychological outcomes related to the COVID-19 pandemic.


Subject(s)
Anxiety Disorders/epidemiology , COVID-19/epidemiology , Depression/epidemiology , Maternal Health , Pregnancy Complications/epidemiology , Quarantine , Stress, Psychological/epidemiology , Adult , Anxiety Disorders/etiology , COVID-19/complications , Cross-Sectional Studies , Depression/etiology , Female , Humans , Nigeria/epidemiology , Pandemics , Pregnancy , Prevalence , Psychiatric Status Rating Scales , Retrospective Studies , SARS-CoV-2 , Stress, Psychological/etiology
18.
J Gynecol Obstet Hum Reprod ; 50(10): 102199, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1333599

ABSTRACT

OBJECTIVE: COVID-19 pandemic caused a dramatic decline in the gynecology emergency department (ED) visits. The Israeli government took a determined step of quarantine to suppress and control the spread. This study evaluates the effect of the COVID -19 quarantine on gynecology emergency department (ED) visits compared to the previous year. MATERIALS AND METHODS: A retrospective case-control study was conducted during the first half-year of the COVID-19 pandemic and focused on the quarantine during April. In order to identify differences in the population's epidemiology and changes in the amount and type of emergency gynecological visits and surgeries, we compared patients during April 2020 (COVID-19 quarantine) to those who visited the gynecology ED during April 2019. RESULTS: During January-June 2020 period, there was an overall 3707 patient visits in the gynecology ED, which represents a 22.8% decrease in patient visits compared to the previous year (2019, 4803 patients). There was a 36% decrease in the gynecology ED visits during the quarantine period. Patient demographics were similar between groups. Visits of nulliparous women were more common in the study group (p = .0001) and self-referral (p = .017). More post-operative complications and fewer patients with abdominal pain were admitted to the study group (p = .034 and p = .054, respectively). During the study, the hospitalization rate did not change 18.2% vs. 17.5% (p = 0.768). Hospitalization duration was significantly longer in the COVID-19 quarantine (2.8 ± 1.3 vs. 3.1 ± 1.5, p < 0.001). There was no significant difference among surgical procedure incidents. CONCLUSION: Visits in the gynecology ED service decreased during the COVID-19 quarantine without compromising the treatment of gynecology emergencies. Many gynecologic complaints can be managed in community care settings without referral to an ED.


Subject(s)
COVID-19 , Emergency Service, Hospital/statistics & numerical data , Quarantine , Adult , Case-Control Studies , Cohort Studies , Female , Gynecologic Surgical Procedures , Hospitalization/statistics & numerical data , Humans , Israel/epidemiology , Laparoscopy , Parity , Postoperative Complications/epidemiology , Pregnancy , Pregnancy Complications/epidemiology , Retrospective Studies
20.
Pharmacol Res ; 171: 105786, 2021 09.
Article in English | MEDLINE | ID: covidwho-1322311

ABSTRACT

Women of childbearing age are largely affected by several autoimmune disorders (the estimates range between 1.5 and 10 per 10,000). The increasing number of effective biological agents has dramatically revolutionized the treatment of these clinical conditions, ameliorating the patient's quality of life. The use of these agents by women during pregnancy is growing to ensure the disease activity control and avoid adverse health outcomes. However, for many newer biological agents, the degree of information concerning their use in pregnancy is often incomplete to perform a conclusive risk assessment on fetal and maternal health given the exclusion of this specific population from pharmacological clinical trials. More recently, the COVID-19 pandemic has confirmed the unacceptable inequities of pharmacological research and medical treatment for pregnant and lactating women, exacerbating the need for filling the gaps of quantitative and qualitative pharmacology data in this sensitive population. ere we summarize (i) what is already known about safety and effectiveness of biological agents in this understudied population (with specific focus on pregnancy-related health outcomes), and what we are going to learn from the on-going studies among pregnant women treated with biological agents; (ii) the methodological and ethical considerations that characterize the pharmacological research in pregnancy, also discussing emerging evidence on the use of therapeutic drug monitoring (TDM) in this clinical setting.


Subject(s)
Autoimmune Diseases/drug therapy , Biological Factors/therapeutic use , Pregnancy Complications/drug therapy , Pregnancy Outcome , Pregnant Women , Autoimmune Diseases/epidemiology , Autoimmune Diseases/immunology , Female , Humans , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/immunology , Pregnancy Outcome/epidemiology
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