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1.
BMC Pregnancy Childbirth ; 21(1): 658, 2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1770502

ABSTRACT

BACKGROUND: Whilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population. METHODS: A case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020. RESULTS: Although Pregnant women presented with fewer symptoms such as fever, cough, sore throat, and shortness of breath compared to non-pregnant women; yet they ran a much more severe course of illness. On admission, 12/79 (15.2%) Vs 2/85 (2.4%) had a chest radiograph score [on a scale 1-6] of ≥3 (p-value = 0.0039). On discharge, 6/79 (7.6%) Vs 1/85 (1.2%) had a score ≥3 (p-value = 0.0438). They also had much higher levels of laboratory indicators of severity with values above reference ranges for C-Reactive Protein [(28 (38.3%) Vs 13 (17.6%)] with p < 0.004; and for D-dimer [32 (50.8%) Vs 3(6%)]; with p < 0.001. They required more ICU admissions: 10/79 (12.6%) Vs 1/85 (1.2%) with p=0.0036; and suffered more complications: 9/79 (11.4%) Vs 1/85 (1.2%) with p=0.0066; of Covid-19 infection, particularly in late pregnancy. CONCLUSIONS: Pregnant women presented with fewer Covid-19 symptoms but ran a much more severe course of illness compared to non-pregnant women with the disease. They had worse chest radiograph scores and much higher levels of laboratory indicators of disease severity. They had more ICU admissions and suffered more complications of Covid-19 infection, such as risk for miscarriage and preterm deliveries. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy and requires management by an obstetric and medical multidisciplinary team.


Subject(s)
COVID-19 , Intensive Care Units/statistics & numerical data , Pregnancy Complications, Infectious , Premature Birth , Radiography, Thoracic , Symptom Assessment , Abortion, Spontaneous/epidemiology , Abortion, Spontaneous/etiology , C-Reactive Protein/analysis , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , COVID-19/transmission , Case-Control Studies , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Male , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome/epidemiology , Pregnancy, High-Risk , Premature Birth/epidemiology , Premature Birth/etiology , Radiography, Thoracic/methods , Radiography, Thoracic/statistics & numerical data , SARS-CoV-2/isolation & purification , Severity of Illness Index , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , United Arab Emirates/epidemiology
2.
Eur J Pediatr ; 181(3): 1175-1184, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1516855

ABSTRACT

Using provisional or opportunistic data, three nationwide studies (The Netherlands, the USA and Denmark) have identified a reduction in preterm or extremely preterm births during periods of COVID-19 restrictions. However, none of the studies accounted for perinatal deaths. To determine whether the reduction in extremely preterm births, observed in Denmark during the COVID-19 lockdown, could be the result of an increase in perinatal deaths and to assess the impact of extended COVID-19 restrictions, we performed a nationwide Danish register-based prevalence proportion study. We examined all singleton pregnancies delivered in Denmark during the COVID-19 strict lockdown calendar periods (March 12-April 14, 2015-2020, N = 31,164 births) and the extended calendar periods of COVID-19 restrictions (February 27-September 30, 2015-2020, N = 214,862 births). The extremely preterm birth rate was reduced (OR 0.27, 95% CI 0.07 to 0.86) during the strict lockdown period in 2020, while perinatal mortality was not significantly different. During the extended period of restrictions in 2020, the extremely preterm birth rate was marginally reduced, and a significant reduction in the stillbirth rate (OR 0.69, 0.50 to 0.95) was observed. No changes in early neonatal mortality rates were found.Conclusion: Stillbirth and extremely preterm birth rates were reduced in Denmark during the period of COVID-19 restrictions and lockdown, respectively, suggesting that aspects of these containment and control measures confer an element of protection. The present observational study does not allow for causal inference; however, the results support the design of studies to ascertain whether behavioural or social changes for pregnant women may improve pregnancy outcomes. What is Known: • The aetiologies of preterm birth and stillbirth are multifaceted and linked to a wide range of socio-demographic, medical, obstetric, foetal, psychosocial and environmental factors. • The COVID-19 lockdown saw a reduction in extremely preterm births in Denmark and other high-income countries. An urgent question is whether this reduction can be explained by increased perinatal mortality. What is New: • The reduction in extremely preterm births during the Danish COVID-19 lockdown was not a consequence of increased perinatal mortality, which remained unchanged during this period. • The stillbirth rate was reduced throughout the extended period of COVID-19 restrictions.


Subject(s)
COVID-19 , Perinatal Death , Premature Birth , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Denmark/epidemiology , Female , Humans , Infant Mortality , Infant, Newborn , Pregnancy , Premature Birth/epidemiology , Premature Birth/etiology , SARS-CoV-2 , Stillbirth/epidemiology
3.
BMC Pregnancy Childbirth ; 21(1): 767, 2021 Nov 12.
Article in English | MEDLINE | ID: covidwho-1511733

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to regional or nationwide lockdowns as part of risk mitigation measurements in many countries worldwide. Recent studies suggest an unexpected and unprecedented decrease in preterm births during the initial COVID-19 lockdowns in the first half of 2020. The objective of the current study was to assess the effects of the two months of the initial national COVID-19 lockdown period on the incidence of very and extremely preterm birth in the Netherlands, stratified by either spontaneous or iatrogenic onset of delivery, in both singleton and multiple pregnancies. METHODS: Retrospective cohort study using data from all 10 perinatal centers in the Netherlands on very and extremely preterm births during the initial COVID-19 lockdown from March 15 to May 15, 2020. Incidences of very and extremely preterm birth were calculated using an estimate of the total number of births in the Netherlands in this period. As reference, we used data from the corresponding calendar period in 2015-2018 from the national perinatal registry (Perined). We differentiated between spontaneous versus iatrogenic onset of delivery and between singleton versus multiple pregnancies. RESULTS: The incidence of total preterm birth < 32 weeks in singleton pregnancies was 6.1‰ in the study period in 2020 versus 6.5‰ in the corresponding period in 2015-2018. The decrease in preterm births in singletons was solely due to a significant decrease in iatrogenic preterm births, both < 32 weeks (OR 0.71; 95%CI 0.53 to 0.95) and < 28 weeks (OR 0.53; 95%CI 0.29 to 0.97). For multiple pregnancies, an increase in preterm births < 28 weeks was observed (OR 2.43; 95%CI 1.35 to 4.39). CONCLUSION: This study shows a decrease in iatrogenic preterm births during the initial COVID-19-related lockdown in the Netherlands in singletons. Future studies should focus on the mechanism of action of lockdown measures and reduction of preterm birth and the effects of perinatal outcome.


Subject(s)
COVID-19/prevention & control , Labor, Induced/trends , Premature Birth/epidemiology , Premature Birth/etiology , Female , Health Policy , Humans , Iatrogenic Disease/epidemiology , Incidence , Infant, Extremely Premature , Infant, Newborn , Logistic Models , Netherlands/epidemiology , Pregnancy , Prenatal Care/methods , Prenatal Care/trends , Protective Factors , Retrospective Studies , Risk Factors
4.
BMC Pregnancy Childbirth ; 21(1): 587, 2021 Aug 26.
Article in English | MEDLINE | ID: covidwho-1371956

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused ongoing challenges in health services worldwide. Despite the growing body of literature on COVID-19, reports on perinatal care in COVID-19 cases are limited. CASE PRESENTATION: We describe a case of severe acute respiratory distress syndrome (ARDS) in a 36-year-old G5/P2 pregnant woman with morbid obesity, confirmed severe acute respiratory syndrome coronavirus 2 infection, and fulminant respiratory failure. At 28+ 1 gestational weeks, the patient delivered an uninfected newborn. Using ImmunoCAP ISAC® technology, we found no immunoglobulin (Ig) M antibodies, suggesting that no mother-to-child viral transmission occurred during pregnancy or delivery. The maternal respiratory state improved rapidly after delivery; both maternal and neonatal outcomes were encouraging given the early gestational age and fulminant course of respiratory failure in our patient. CONCLUSIONS: The management of ARDS in pregnant women with COVID-19 is complex and requires an individualized, multidisciplinary approach, while considering maternal and fetal outcomes.


Subject(s)
COVID-19 , Cesarean Section/methods , Pneumonia, Viral , Pregnancy Complications, Infectious , Premature Birth , Respiratory Distress Syndrome , SARS-CoV-2/isolation & purification , Adult , COVID-19/complications , COVID-19/diagnosis , Female , Fetal Monitoring/methods , Gestational Age , Humans , Obesity, Morbid/diagnosis , Obesity, Morbid/physiopathology , Patient Care Team/organization & administration , Perinatal Care/methods , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/etiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Premature Birth/etiology , Premature Birth/therapy , Respiration, Artificial/methods , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy , Treatment Outcome
5.
Placenta ; 112: 97-104, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1333705

ABSTRACT

INTRODUCTION: Pregnant women with covid-19 are more likely to experience preterm birth. The virus seems to be associated with a wide range of placental lesions, none of them specific. METHOD: We collected cases of Covid-19 maternal infection during pregnancy associated with poor pregnancy outcomes, for which we received the placenta. We studied clinical data and described pathological findings of placenta and post-mortem examination of fetuses. We performed an immunohistochemical study and RT-PCR of SARS-Cov-2 on placenta samples. RESULTS: We report 5 cases of poor fetal outcome, 3 fetal deaths and 2 extreme premature neonates, one with growth restriction, without clinical and biological sign of SARS-Cov-2 infection. All placenta presented massive perivillous fibrin deposition and large intervillous thrombi associated with strong SARS-Cov-2 expression in trophoblast and SARS-CoV-2 PCR positivity in amniotic fluid or on placenta samples. Chronic histiocytic intervillositis was present in 4/5 cases. Placental ultrasound was abnormal and the sFLT1-PIGF ratio was increased in one case. Timing between mothers' infection and the poor fetal outcome was ≤10 days in 4 cases. The massive placental damage are directly induced by the virus whose receptors are expressed on trophoblast, leading to trophoblast necrosis and massive inflammation in villous chamber, in a similar way it occurs in diffuse alveolar damage in adults infected by SARS-Cov-2. DISCUSSION: SARS-Cov-2 can be associated to a rare set of placental lesions which can lead to fetal demise, preterm birth, or growth restriction. Stronger surveillance of mothers infected by SARS-Cov-2 is required.


Subject(s)
COVID-19/complications , Placenta Diseases/etiology , Premature Birth/etiology , Stillbirth , Adult , COVID-19/diagnosis , COVID-19/pathology , Female , Fetal Death/etiology , France , Humans , Infant, Newborn , Male , Perinatal Death/etiology , Placenta/pathology , Placenta/virology , Placenta Diseases/diagnosis , Placenta Diseases/pathology , Placenta Diseases/virology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/pathology , Pregnancy Outcome , Premature Birth/pathology , Premature Birth/virology , SARS-CoV-2/physiology , Trophoblasts/pathology , Trophoblasts/virology
6.
Anesth Analg ; 133(2): 462-473, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1311270

ABSTRACT

BACKGROUND: Early reports associating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with adverse pregnancy outcomes were biased by including only women with severe disease without controls. The Society for Obstetric Anesthesia and Perinatology (SOAP) coronavirus disease 2019 (COVID-19) registry was created to compare peripartum outcomes and anesthetic utilization in women with and without SARS-CoV-2 infection delivering at institutions with widespread testing. METHODS: Deliveries from 14 US medical centers, from March 19 to May 31, 2020, were included. Peripartum infection was defined as a positive SARS-CoV-2 polymerase chain reaction test within 14 days of delivery. Consecutive SARS-CoV-2-infected patients with randomly selected control patients were sampled (1:2 ratio) with controls delivering during the same day without a positive test. Outcomes were obstetric (eg, delivery mode, hypertensive disorders of pregnancy, and delivery <37 weeks), an adverse neonatal outcome composite measure (primary), and anesthetic utilization (eg, neuraxial labor analgesia and anesthesia). Outcomes were analyzed using generalized estimating equations to account for clustering within centers. Sensitivity analyses compared symptomatic and asymptomatic patients to controls. RESULTS: One thousand four hundred fifty four peripartum women were included: 490 with SARS-CoV-2 infection (176 [35.9%] symptomatic) and 964 were controls. SARS-CoV-2 patients were slightly younger, more likely nonnulliparous, nonwhite, and Hispanic than controls. They were more likely to have diabetes, obesity, or cardiac disease and less likely to have autoimmune disease. After adjustment for confounders, individuals experiencing SARS-CoV-2 infection exhibited an increased risk for delivery <37 weeks of gestation compared to controls, 73 (14.8%) vs 98 (10.2%) (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.03-2.09). Effect estimates for other obstetric outcomes and the neonatal composite outcome measure were not meaningfully different between SARS-CoV-2 patients versus controls. In sensitivity analyses, compared to controls, symptomatic SARS-CoV-2 patients exhibited increases in cesarean delivery (aOR, 1.57; 95% CI, 1.09-2.27), postpartum length of stay (aOR, 1.89; 95% CI, 1.18-2.60), and delivery <37 weeks of gestation (aOR, 2.08; 95% CI, 1.29-3.36). These adverse outcomes were not found in asymptomatic women versus controls. SARS-CoV-2 patients (asymptomatic and symptomatic) were less likely to receive neuraxial labor analgesia (aOR, 0.52; 95% CI, 0.35-0.75) and more likely to receive general anesthesia for cesarean delivery (aOR, 3.69; 95% CI, 1.40-9.74) due to maternal respiratory failure. CONCLUSIONS: In this large, multicenter US cohort study of women with and without peripartum SARS-CoV-2 infection, differences in obstetric and neonatal outcomes seem to be mostly driven by symptomatic patients. Lower utilization of neuraxial analgesia in laboring patients with asymptomatic or symptomatic infection compared to patients without infection requires further investigation.


Subject(s)
COVID-19/complications , Delivery, Obstetric , Pregnancy Complications, Infectious , Premature Birth/etiology , Adult , Analgesia, Obstetrical , Anesthesia, General , Anesthesia, Obstetrical , COVID-19/diagnosis , Case-Control Studies , Cesarean Section , Delivery, Obstetric/adverse effects , Female , Gestational Age , Humans , Infant, Premature , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Registries , Risk Assessment , Risk Factors , United States , Young Adult
7.
Aust N Z J Obstet Gynaecol ; 62(1): 62-70, 2022 02.
Article in English | MEDLINE | ID: covidwho-1307662

ABSTRACT

BACKGROUND: Reports from around the world suggest that rates of preterm birth decreased during COVID-19 lockdown measures. AIMS: To compare the prevalence of preterm birth and stillbirth rates during COVID-19 restriction measures with infants born at the same maternity centre during the same weeks in 2013-2019. MATERIALS AND METHODS: Deidentified data were extracted from the Mater Mothers' healthcare records database. This is a supra-regional tertiary perinatal centre. Logistic regressions were used to examine singleton live preterm birth rates during the beginning of COVID-19 restrictions (16 March-17 April; 'early'; 6955 births) and during the strictest part of COVID-19 restrictions (30 March-1 May; 'late'; 6953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Singleton stillbirth rates were also examined between 16 March-1 May. RESULTS: Planned moderate/late preterm births declined by more than half during early COVID-19 restrictions compared with the previous seven years (29 vs an average of 64 per 1000 births; adjusted odds ratio 0.39, 95% CI 0.22-0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two-week non-significant spike in spontaneous preterm births from late April to early May, 2020. CONCLUSIONS: Together with evidence from other nations, the pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth.


Subject(s)
COVID-19 , Premature Birth , Australia/epidemiology , Communicable Disease Control , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Pregnancy , Premature Birth/epidemiology , Premature Birth/etiology , SARS-CoV-2
8.
Cells ; 10(7)2021 07 08.
Article in English | MEDLINE | ID: covidwho-1302161

ABSTRACT

COVID-19 is associated with increased incidence of preterm birth (PTB). We assessed pathways by which SARS-CoV-2 could access the placenta. Placentae, from PTB with or without chorioamnionitis (ChA), or from term pregnancies (n = 12/13/group) were collected. Peripheral blood was collected from healthy pregnant women (n = 6). Second trimester placental explants (16-20 weeks, n = 5/group) were treated with lipopolysaccharide (LPS, to mimic bacterial infection) and ACE2, CCL2, IL-6/8 and TNFα mRNA was assessed. ChA-placentae exhibited increased ACE2 and CCL2 mRNA expression (p < 0.05). LPS increased cytokine and ACE2 mRNA in placental explants. Placental ACE2 protein localized to syncytiotrophoblast, fetal endothelium, extravillous trophoblast and in immune cells-subsets (M1/M2 macrophage and neutrophils) within the villous stroma. Significantly increased numbers of M1 macrophage and neutrophils were present in the ChA-placenta (p < 0.001). Subsets of peripheral immune cells from pregnant women express the ACE2 mRNA and protein. A greater fraction of granulocytes was positive for ACE2 protein expression compared to lymphocytes or monocytes. These data suggest that in pregnancies complicated by ChA, ACE2 positive immune cells in the maternal circulation have the potential to traffic SARS-CoV-2 virus to the placenta and increase the risk of vertical transmission to the placenta/fetus.


Subject(s)
Angiotensin-Converting Enzyme 2/genetics , Gene Expression , Placenta/metabolism , Pregnancy Complications, Infectious/genetics , Premature Birth/etiology , Adult , COVID-19/genetics , COVID-19/transmission , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Lymphocytes/metabolism , Monocytes/metabolism , Placenta/cytology , Pregnancy , Premature Birth/genetics , SARS-CoV-2/isolation & purification
9.
Am J Perinatol ; 38(7): 747-752, 2021 06.
Article in English | MEDLINE | ID: covidwho-1182901

ABSTRACT

OBJECTIVE: A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester. STUDY DESIGN: We present a patient with monochorionic-diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation. The pregnancy is further complicated by stage II twin-twin transfusion syndrome. She undergoes laser ablation, which is complicated by development of a subchorionic hematoma. The patient then develops Escherichia coli bacteremia, resulting in septic shock and preterm labor followed by previable delivery at 21 weeks of gestation. Amniotic fluid and placenta were negative for SARS-CoV-2 by real-time polymerase chain reaction. CONCLUSION: This case of SARS-CoV-2 argues against transplacental transmission after a second-trimester infection but brings attention to the possible downstream complications that may arise following early infection. KEY POINTS: · Vertical transmission of SARS-CoV-2 is not evident after a second-trimester infection.. · Antepartum coronavirus disease 2019 may cause vascular placental changes and placental insufficiency.. · SARS-CoV-2 is associated with a maternal hypercoagulable state with adverse perinatal outcomes..


Subject(s)
COVID-19 , Escherichia coli Infections , Fetofetal Transfusion , Placenta , Pregnancy Complications, Infectious , Pregnancy Trimester, Second , Shock, Septic , Adult , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , Escherichia coli Infections/complications , Escherichia coli Infections/diagnosis , Female , Fetofetal Transfusion/diagnosis , Fetofetal Transfusion/etiology , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Placenta/diagnostic imaging , Placenta/physiopathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Pregnancy, Twin , Premature Birth/etiology , Premature Birth/virology , SARS-CoV-2 , Shock, Septic/diagnosis , Shock, Septic/etiology , Twins, Monozygotic , Ultrasonography, Prenatal/methods
12.
Sci Rep ; 10(1): 18126, 2020 10 22.
Article in English | MEDLINE | ID: covidwho-889217

ABSTRACT

This systematic review and meta-analysis aimed to evaluate the impact of COVID-19 on pregnant women. We searched for qualified studies in PubMed, Embase, and Web of Science. The clinical characteristics of pregnant women with COVID-19 and their infants were reported as means and proportions with 95% confidence interval. Eleven studies involving with 9032 pregnant women with COVID-19 and 338 infants were included in the meta-analysis. Pregnant women with COVID-19 have relatively mild symptoms. However, abnormal proportions of laboratory parameters were similar or even increased, compared to general population. Around 30% of pregnant women with COVID-19 experienced preterm delivery, whereas the mean birth weight was 2855.9 g. Fetal death and detection of SARS-CoV-2 were observed in about 2%, whereas neonatal death was found to be 0.4%. In conclusion, the current review will serve as an ideal basis for future considerations in the treatment and management of COVID-19 in pregnant women.


Subject(s)
Coronavirus Infections/pathology , Perinatal Death/etiology , Pneumonia, Viral/pathology , Premature Birth/etiology , Betacoronavirus/isolation & purification , Birth Weight , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Female , Fetal Death/etiology , Humans , Infant, Newborn , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Pregnancy , SARS-CoV-2
13.
BMC Med ; 18(1): 330, 2020 10 19.
Article in English | MEDLINE | ID: covidwho-873988

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. However, little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes. METHOD: We conducted a retrospective cohort study based on the Maternal and Child Health Information System (MCHIMS) of Wuhan, China. All pregnant women with singleton live birth recorded by the system between January 13 and March 18, 2020, were included. The adverse birth outcomes were preterm birth, low birth weight, neonatal asphyxia, premature rupture of membrane (PROM), and cesarean section delivery. Multivariate logistic regression was used to evaluate the associations between maternal COVID-19 diagnosis and adverse birth outcomes. RESULTS: Out of 11,078 pregnant women, 65 were confirmed with coronavirus disease 2019 (COVID-19). No deaths occurred from these confirmed cases or their newborns. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth (OR 3.34, 95% CI 1.60-7.00) and cesarean section (OR 3.63, 95% CI 1.95-6.76). There was no statistical difference in low birth weight, neonatal asphyxia, and PROM between the mothers with and without COVID-19. Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal CT results. Only one had diarrhea and three had a fever. CONCLUSIONS: This population-based cohort study suggests that COVID-19 during the later pregnancy is associated with an increased risk of adverse birth outcomes, including iatrogenic preterm birth and cesarean section delivery. Our data provide little evidence for maternal-fetal vertical transmission of SARS-CoV-2. It is important to monitor the long-term health effects of SARS-CoV-2 infection on pregnant women and their children.


Subject(s)
Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Pregnancy Complications, Infectious , Adult , Betacoronavirus , COVID-19 , Cesarean Section , China , Cohort Studies , Female , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Newborn, Diseases/etiology , Logistic Models , Male , Pandemics , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Outcome , Premature Birth/epidemiology , Premature Birth/etiology , Retrospective Studies , SARS-CoV-2
15.
Rev Esp Quimioter ; 33(5): 313-326, 2020 Oct.
Article in Spanish | MEDLINE | ID: covidwho-680717

ABSTRACT

OBJECTIVE: The appearance of new infectious diseases, such as COVID-19, poses a challenge in monitoring pregnancy and preventing obstetric and neonatal complications. A scoping review has the objective to review the information available in pregnant women infected with the MERS-CoV, SARSCoV, SARS-CoV-2 coronaviruses to assess the similarities in terms of and differences in the clinical characteristics of the mothers and neonatal outcomes. METHODS: We carried out a bibliographic search (scoping review) according to the PRISMA guidelines between March and April 2020 in the MEDLINE, SciELO, and CUIDEN databases and the Elsevier COVID-19 Information Center. RESULTS: We analyzed 20 articles with a total of 102 cases. 9 of MERS-CoV, 14 of SARS-CoV and 79 of SARS-CoV-2. Fever (75.5%) and pneumonia (73.5%) were the most frequent symptoms in infected pregnant women. The most frequent obstetric complications were the threat of premature delivery (23.5%) and caesarean section (74.5%). No vertical transmission was documented in any of the infants. CONCLUSIONS: All three coronaviruses produce pneumonia with very similar symptoms, being milder in the case of SARSCoV2. Despite documented obstetric complications, neonatal outcomes are mostly favorable. Increased knowledge is needed to improve and prevent obstetric and neonatal complications from these infections in pregnant women.


Subject(s)
Betacoronavirus , Middle East Respiratory Syndrome Coronavirus , Pregnancy Complications, Infectious , SARS Virus , Severe Acute Respiratory Syndrome/complications , Adult , COVID-19 , Cesarean Section , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Female , Fever/etiology , Humans , Infant, Newborn , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Premature Birth/etiology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/epidemiology , Symptom Assessment/statistics & numerical data
16.
Am J Perinatol ; 37(8): 866-868, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-116830

ABSTRACT

Novel coronavirus disease 2019 (COVID-19) infection occurring during pregnancy is associated with an increased risk of preterm delivery. This case report describes successful treatment of preterm labor during acute COVID-19 infection. Standard treatment for preterm labor may allow patients with acute COVID-19 infection to recover without the need for preterm delivery. KEY POINTS: · Acute COVID-19 infection is associated with a high rate of preterm delivery.. · Standard treatment for preterm labor such as intravenous magnesium sulfate, antepartum steroid therapy and antibiotic prophylaxis for group B streptococcus infection were effective in this patient.. · In the absence of maternal or fetal compromise, acute COVID-19 infection is not an indication for early elective delivery..


Subject(s)
Coronavirus Infections , Glucocorticoids/administration & dosage , Magnesium Sulfate/administration & dosage , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Premature Birth , Antibiotic Prophylaxis/methods , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Female , Humans , Infant, Newborn , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Premature Birth/etiology , Premature Birth/prevention & control , SARS-CoV-2 , Streptococcal Infections/prevention & control , Tocolytic Agents/administration & dosage
17.
J Reprod Immunol ; 139: 103122, 2020 06.
Article in English | MEDLINE | ID: covidwho-27137

ABSTRACT

The 2019 novel coronavirus disease (COVID-19) was first detected in December 2019 and became epidemic in Wuhan, Hubei Province, China. COVID-19 has been rapidly spreading out in China and all over the world. The virus causing COVID-19, SARS-CoV-2 has been known to be genetically similar to severe acute respiratory syndrome coronavirus (SARS-CoV) but distinct from it. Clinical manifestation of COVID-19 can be characterized by mild upper respiratory tract infection, lower respiratory tract infection involving non-life threatening pneumonia, and life-threatening pneumonia with acute respiratory distress syndrome. It affects all age groups, including newborns, to the elders. Particularly, pregnant women may be more susceptible to COVID-19 since pregnant women, in general, are vulnerable to respiratory infection. In pregnant women with COVID-19, there is no evidence for vertical transmission of the virus, but an increased prevalence of preterm deliveries has been noticed. The COVID-19 may alter immune responses at the maternal-fetal interface, and affect the well-being of mothers and infants. In this review, we focused on the reason why pregnant women are more susceptible to COVID-19 and the potential maternal and fetal complications from an immunological viewpoint.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/complications , Coronavirus Infections/immunology , Disease Susceptibility/immunology , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Pregnancy Complications, Infectious/immunology , COVID-19 , China , Coronavirus Infections/pathology , Female , Humans , Pandemics , Pneumonia, Viral/pathology , Pregnancy , Pregnancy Complications, Infectious/virology , Premature Birth/etiology , SARS-CoV-2
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