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1.
J Perinat Med ; 50(6): 660-667, 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1902691

ABSTRACT

OBJECTIVES: The Covid-19 pandemic affected antenatal care in many parts of the world. It brought about many changes as part of control and containment measures. We examined the effect of the first and second waves of the pandemic in India on stillbirth rates, as indicators of quality of maternity care. METHODS: Observational study at a tertiary referral perinatal centre with approximately 10,000 births annually. The Covid-19 first wave period was taken as January to December 2020 with lockdown March to June 2020, which included complete shut down of clinics and ultrasound services. The second wave was from January to September 2021. All women with singleton pregnancy who had hospital based antenatal care were included. We investigated monthly trends in obstetric load (new antenatal registrations, total obstetric clinic numbers and total births) with stillbirth numbers as the pandemic continued (daily Covid case trend). We compared first and second wave stillbirth rates, overall as well as those that were small for gestational age (<10th centile) at delivery. RESULTS: There were 9,251 births with 32 stillbirths in the first wave (rate 3.46/1,000) and 6,228 births with 14 stillbirths in the second wave (2.25/1,000). This represented a 54% higher rate in the first phase and extended lockdown period (p=0.08). The incidence of stillbirths that were SGA was significantly higher in the first wave: 14 vs. 2, (p=0.03). CONCLUSIONS: Reduced access to planned antenatal care during Covid-19 pandemic lockdown was associated with a significant increase in SGA stillbirths.


Subject(s)
COVID-19 , Maternal Health Services , Stillbirth , COVID-19/epidemiology , Communicable Disease Control , Female , Humans , Pandemics , Pregnancy , Stillbirth/epidemiology
2.
BJOG ; 129(8): 1298-1307, 2022 07.
Article in English | MEDLINE | ID: covidwho-1901540

ABSTRACT

OBJECTIVE: To assess, on a population basis, the medical care for pregnant women in specific geographic regions of six countries before and during the first year of the coronavirus disease 2019 (COVID-19) pandemic in relationship to pregnancy outcomes. DESIGN: Prospective, population-based study. SETTING: Communities in Kenya, Zambia, the Democratic Republic of the Congo, Pakistan, India and Guatemala. POPULATION: Pregnant women enrolled in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry. METHODS: Pregnancy/delivery care services and pregnancy outcomes in the pre-COVID-19 time-period (March 2019-February 2020) were compared with the COVID-19 time-period (March 2020-February 2021). MAIN OUTCOME MEASURES: Stillbirth, neonatal mortality, preterm birth, low birthweight and maternal mortality. RESULTS: Across all sites, a small but statistically significant increase in home births occurred between the pre-COVID-19 and COVID-19 periods (18.9% versus 20.3%, adjusted relative risk [aRR] 1.12, 95% CI 1.05-1.19). A small but significant decrease in the mean number of antenatal care visits (from 4.1 to 4.0, p = <0.0001) was seen during the COVID-19 period. Of outcomes evaluated, overall, a small but significant decrease in low-birthweight infants in the COVID-19 period occurred (15.7% versus 14.6%, aRR 0.94, 95% CI 0.89-0.99), but we did not observe any significant differences in other outcomes. There was no change observed in maternal mortality or antenatal haemorrhage overall or at any of the sites. CONCLUSIONS: Small but significant increases in home births and decreases in the antenatal care services were observed during the initial COVID-19 period; however, there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birthweight, or preterm birth rates during the COVID-19 period compared with the previous year. Further research should help to elucidate the relationship between access to and use of pregnancy-related medical services and birth outcomes over an extended period.


Subject(s)
COVID-19 , Premature Birth , Birth Weight , COVID-19/epidemiology , Child , Child Health , Delivery of Health Care , Developing Countries , Female , Humans , Infant , Infant, Newborn , Pandemics , Pregnancy , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Prospective Studies , Registries , Stillbirth/epidemiology , Women's Health
3.
BJOG ; 129(8): 1361-1374, 2022 07.
Article in English | MEDLINE | ID: covidwho-1901536

ABSTRACT

OBJECTIVE: To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and live-born infants presenting with fetal distress. DESIGN: Retrospective, observational. SETTING: Nationwide. POPULATION: Five stillborn and nine live-born infants from 13 pregnant women infected with SARS-CoV-2 seeking care at seven different maternity units in Sweden. METHODS: Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS-CoV-2 infection with impaired fetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus-related pathology on the villous capillary endothelium, trophoblast and other cells. MAIN OUTCOME MEASURES: Maternal and fetal clinical outcomes and placental pathology in stillborn and live-born infants. RESULTS: Reduced fetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of fetal distress among live-born infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the live-born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live-born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live-born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS-CoV-2 placental infection and congenital transmission. CONCLUSIONS: SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration.


Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Cesarean Section , Female , Fetal Distress , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Placenta/blood supply , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Retrospective Studies , SARS-CoV-2 , Stillbirth/epidemiology
4.
Infect Dis Now ; 52(3): 123-128, 2022 May.
Article in English | MEDLINE | ID: covidwho-1889452

ABSTRACT

OBJECTIVES AND BACKGROUND: Wei et al. have published a meta-analysis (MA), which aimed to evaluate the association between SARS-CoV-2 infection during pregnancy and adverse pregnancy outcomes. Using classical random-effects model, they found that SARS-CoV-2 infection was associated with preeclampsia, preterm birth and stillbirth. Performing MA with low event rates or with few studies may be challenging insofar as MA relies on several within and between-study distributional assumptions. The objective was to assess the robustness of the results provided by Wei et al. METHODS: We performed a sensitivity analysis using frequentist and Bayesian meta-analysis methods. We also estimated fragility indexes. RESULTS: For eclampsia, the confidence intervals of most frequentist models contain 1. All beta-binomial models (Bayesian) lead to credible intervals containing 1. The prediction interval, based on DL method, ranges from 0.75 to 2.38. The fragility index is 2 for the DL method. For preterm, the confidence (credible) intervals exclude 1. The prediction interval is broad, ranging from 0.84 to 20.61. The fragility index ranges from 27 to 10. For stillbirth, the confidence intervals of most frequentist models contain 1. Six Bayesian MA models lead to credible intervals containing 1. The prediction interval ranges from 0.52 to 8.49. The fragility index is 3. CONCLUSION: Given the available data and the results of our broad sensitivity analysis, we can suggest that SARS-CoV-2 infection during pregnancy is associated with preterm, and that it may be associated with preeclampsia. For stillbirth, more data are needed as none of the Bayesian analyses are conclusive.


Subject(s)
COVID-19 , Pre-Eclampsia , Pregnancy Complications, Infectious , Premature Birth , Bayes Theorem , COVID-19/complications , COVID-19/epidemiology , Female , Humans , Infant, Newborn , Pre-Eclampsia/epidemiology , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Premature Birth/epidemiology , SARS-CoV-2 , Stillbirth/epidemiology
5.
J Perinat Med ; 50(6): 653-659, 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1879336

ABSTRACT

OBJECTIVES: Data collected worldwide on stillbirth (SB) rates during the Covid-19 pandemic are contradictory. Variations may be due to methodological differences or population characteristics. The aim of the study is to assess the changes in SB rate, risk factors, causes of death and quality of antenatal care during the pandemic compared to the control periods. METHODS: This prospective study is based on the information collected by the Emilia-Romagna Surveillance system database. We conducted a descriptive analysis of SB rate, risk factors, causes of death and quality of cares, comparing data of the pandemic (March 2020-June 2021) with the 16 months before. RESULTS: During the pandemic, the SB rate was 3.45/1,000 births, a value in line with the rates of previous control periods. Neonatal weight >90th centile was the only risk factor for SB that significantly changed during the pandemic (2.2% vs. 8.0%; p-value: 0.024). No significant differences were found in the distribution of the causes of death groups. Concerning quality of antenatal cares, cases evaluated with suboptimal care (5.2%) did not change significantly compared to the control period (12.0%), as well as the cases with less than recommended obstetric (12.6% vs. 14%) and ultrasound evaluations (0% vs. 2.7%). CONCLUSIONS: During the COVID-19 pandemic, no significant differences in SB rates were found in an area that maintained an adequate level of antenatal care. Thus, eventual associations between SB rate and the COVID-19 infection are explained by an indirect impact of the virus, rather than its direct effect.


Subject(s)
COVID-19 , Stillbirth , COVID-19/epidemiology , Female , Humans , Infant, Newborn , Pandemics , Pregnancy , Prenatal Care , Prospective Studies , Stillbirth/epidemiology
6.
Arch Pathol Lab Med ; 146(6): 660-676, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1876076

ABSTRACT

CONTEXT.­: Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.­: To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). DESIGN.­: Case-based retrospective clinicopathologic analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.­: Of the 3 findings constituting SARS-CoV-2 placentitis, all 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25 of 68) and chronic villitis (32%; 22 of 68). The majority (19; 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.­: The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.


Subject(s)
COVID-19 , Perinatal Death , Placenta , Pregnancy Complications, Infectious , COVID-19/complications , Female , Fibrin , Humans , Hypoxia/pathology , Hypoxia/virology , Infant, Newborn , Infectious Disease Transmission, Vertical , Perinatal Death/etiology , Placenta/pathology , Pregnancy , Pregnancy Complications, Infectious/mortality , Pregnancy Complications, Infectious/pathology , Pregnancy Complications, Infectious/virology , Retrospective Studies , SARS-CoV-2 , Stillbirth
7.
Vaccine ; 40(26): 3605-3613, 2022 06 09.
Article in English | MEDLINE | ID: covidwho-1873313

ABSTRACT

INTRODUCTION: Since the establishment of the Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) case definitions in 2015, there has been an urgent need for field validation of pharmacovigilance feasibility in low- and middle-income countries. In this study, we assess the availability and quality of archival medical records at ten randomly selected high-traffic maternity wards in Kinshasa province, Democratic Republic of Congo (DRC). METHODS: A retrospective cohort of mother-child pairs was established from all recorded births taking place at study sites between July 1, 2019 to February 28, 2020 through digitization of medical records. Adverse birth outcomes and maternal vaccination status, where available and linkable, were defined according to GAIA. Basic demographic information on mothers and newborns was also tabulated; birth outcomes were assessed for both intra-site prevalence and a pooled prevalence. RESULTS: A total of 7,697 mother-newborn pair records were extracted, with 37% of infants screening positive as cases of adverse outcomes. Maternal vaccination information was linkable to 67% of those cases. In total, 51% of stillbirths, 98% of preterm births, 100% of low birthweight infants, 90% of small for gestational age infants, 100% of microcephalic infants, and 0% of neonatal bloodstream infections were classifiable according to GAIA standards following initial screening. Forty percent of case mothers had some indication of tetanus vaccination prior to delivery in their medical records, but only 26% of case mothers met some level of GAIA definition for maternal vaccination during the pregnancy of interest. CONCLUSIONS: Archival birth records from delivery centers can be feasibly utilized to screen for stillbirth and maternal tetanus vaccination, and to accurately classify preterm birth, low birthweight, small for gestational age, and congenital microcephaly. Assessment of other neonatal outcomes were limited by inconsistent postpartum infant follow-up and records keeping.


Subject(s)
Premature Birth , Tetanus , Birth Weight , Democratic Republic of the Congo/epidemiology , Feasibility Studies , Female , Humans , Immunization/adverse effects , Infant , Infant, Newborn , Medical Records , Pregnancy , Premature Birth/epidemiology , Premature Birth/etiology , Retrospective Studies , Stillbirth , Vaccination/adverse effects
8.
Ann Epidemiol ; 72: 74-81, 2022 08.
Article in English | MEDLINE | ID: covidwho-1866846

ABSTRACT

PURPOSE: Given contradictory evidence about preterm birth (PTB) decreases during COVID-19 lockdowns, we investigate PTB rates during France's strict nationwide lockdown (March 17, 2020 to May 10, 2020). METHODS: This is an interrupted time series analysis using data on maternal delivery hospitalizations in France from January 01, 2016 to July 31, 2020 (3,448,286 singleton births ≥22 weeks' gestational age (GA)). Outcomes were weekly PTB rates (overall and by GA sub-group: <28, 28-31, 32-34, 35-36 weeks), stillbirth and cesarean birth. We estimate odds ratios (OR) using the lockdown period as exposed and other weeks as unexposed, nationally and for districts grouped by COVID-19 incidence. RESULTS: Of 96,076 singleton live births during the lockdown, 4,799 were preterm. PTB rates were 6% (OR: 0.94, 95% CI: 0.90-0.98) lower than expected over this period. This decrease occurred among births 35-36 weeks' GA (OR: 0.92, 95% CI: 0.87-0.98), with no detectable reductions for other GA groups. Cesarean and stillbirth rates were stable. Larger differences were observed in districts with low (OR: 0.92, 95% CI 0.87-0.98) versus moderate/high COVID-19 incidence (OR: 0.97, 95% CI 0.92-1.03). CONCLUSIONS: Late preterm births decreased during France's first lockdown without concurrent change in cesareans and stillbirths. Effects were not more pronounced in moderate/high-COVID-19 districts, contradicting expectations if healthcare disruption were a principal cause.


Subject(s)
COVID-19 , Premature Birth , COVID-19/epidemiology , Communicable Disease Control , Female , Gestational Age , Humans , Incidence , Infant, Newborn , Pregnancy , Premature Birth/epidemiology , Premature Birth/etiology , Stillbirth/epidemiology
9.
PLoS One ; 17(5): e0267176, 2022.
Article in English | MEDLINE | ID: covidwho-1862263

ABSTRACT

BACKGROUND: Pregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the pandemic impact on pregnancy experience, rates of primary childhood immunisations and the differences in birth outcomes in during 2020 to those of previous years. METHODS: Self-reported pregnancy experience: 215 expectant mothers (aged 16+) in Wales completed an online survey about their experiences of pregnancy during the pandemic. The qualitative survey data was analysed using codebook thematic analysis. Population-level birth outcomes in Wales: Stillbirths, prematurity, birth weight and Caesarean section births before (2016-2019) and during (2020) the pandemic were compared using anonymised individual-level, population-scale routine data held in the Secure Anonymised Information Linkage (SAIL) Databank. Uptake of the first three scheduled primary childhood immunisations were compared between 2019 and 2020. FINDINGS: The pandemic had a negative impact on the mental health of 71% of survey respondents, who reported anxiety, stress and loneliness; this was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives. There was no significant difference in annual outcomes including gestation and birth weight, stillbirths, and Caesarean sections for infants born in 2020 compared to 2016-2019. There was an increase in late term births (≥42 weeks gestation) during the first lockdown (OR: 1.28, p = 0.019) and a decrease in moderate to late preterm births (32-36 weeks gestation) during the second lockdown (OR: 0.74, p = 0.001). Fewer babies were born in 2020 (N = 29,031) compared to 2016-2019 (average N = 32,582). All babies received their immunisations in 2020, but there were minor delays in the timings of immunisations. Those due at 8-weeks were 8% less likely to be on time (within 28-days) and at 16-weeks, they were 19% less likely to be on time. INTERPRETATION: Whilst the pandemic had a negative impact on mothers' experiences of pregnancy. Population-level data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic.


Subject(s)
COVID-19 , Premature Birth , Birth Weight , COVID-19/epidemiology , Cesarean Section , Child , Communicable Disease Control , Female , Humans , Infant , Infant, Newborn , Mothers , Pandemics , Pregnancy , Premature Birth/epidemiology , Stillbirth/epidemiology , Wales/epidemiology
10.
J Obstet Gynaecol Res ; 48(7): 1978-1982, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1861445

ABSTRACT

Although various perinatal outcomes in coronavirus disease 2019 (COVID-19) pregnancies have been reported, the fetal and neonatal consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remain unclear. Several reports of miscarriages and stillbirths have been recorded, but vertical transmission by SARS-CoV-2 is considered very rare, and the cause remains unknown. We report a case of a 22-year-old uncomplicated Japanese woman infected with SARS-CoV-2 during the second trimester, resulting in intrauterine fetal death due to placental insufficiency associated with COVID-19 placentitis. This report emphasizes the importance of longitudinal assessment of fetal well-being by fetal heart rate monitoring and early detection of maternal coagulation dysfunction representing SARS-CoV-2 inflammation to manage COVID-19 in pregnancy.


Subject(s)
Blood Coagulation Disorders , COVID-19 , Chorioamnionitis , Pregnancy Complications, Infectious , Adult , COVID-19/complications , Female , Fetal Death/etiology , Heart Rate, Fetal , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Placenta , Pregnancy , Pregnancy Outcome , SARS-CoV-2 , Stillbirth , Young Adult
11.
J Gynecol Obstet Hum Reprod ; 51(5): 102366, 2022 May.
Article in English | MEDLINE | ID: covidwho-1851614

ABSTRACT

OBJECTIVE: To evaluate maternal and neonatal outcomes of pregnant women who were infected by COVID-19 during pregnancy. STUDY DESIGN: A Case control retrospective study was conducted in an Obstetrical Department of a west Parisian area during the first year of COVID-19 pandemic. Maternal and neonatal outcomes were compared between a group of women infected by the SARS-CoV-2 virus during pregnancy (March 2020- February 2021) and a control group of women delivering before pandemic. They were matched according to age and parity. Subgroups of SARS-CoV-2 infection occurring before vs after 37 weeks of gestations and symptomatic vs asymptomatic patients were analyzed. The rate of preterm birth, preeclampsia, placental abruption and stillbirth were compared between the year of pandemic and the year before for all deliveries. RESULTS: Maternal and neonatal outcomes were similar. Among the 86 pregnant women with SARS-CoV-2 infection, five were admitted to Hospital (5.8%). One was transferred in intensive care unit for respiratory distress (1.2%). All patients had favorable outcomes. Patients with symptoms had more associated comorbidities (34.5%, n = 20/58, with symptoms, vs 9,1%, n = 2/22, without symptoms, p = 0.023). No differences in preeclampsia, placenta abruption and stillbirth, but less preterm births (4.9%, n = 160/3383 vs 6.2%, n = 209/3235, p = 0.04) were observed between the year of pandemic and the year before. CONCLUSION: There were few complications associated with COVID-19 infection among pregnant patients and their neonates. A low rate of associated comorbidities, a good access to healthcare services in this area and the small sample size of patients could explain these results.


Subject(s)
COVID-19 , Pre-Eclampsia , Pregnancy Complications, Infectious , Premature Birth , COVID-19/epidemiology , Case-Control Studies , Female , Humans , Infant, Newborn , Pandemics , Placenta , Pre-Eclampsia/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Premature Birth/epidemiology , Retrospective Studies , SARS-CoV-2 , Stillbirth/epidemiology
12.
Eur J Obstet Gynecol Reprod Biol ; 274: 117-127, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1850992

ABSTRACT

Worldwide reports have produced conflicting data on perinatal outcomes during the COVID-19 pandemic. This systematic review and meta-analysis addressed the effect of mitigation measures against COVID-19 on preterm birth, stillbirth, low birth weight, and NICU admission during the first nine months of the pandemic. A search was performed using MEDLINE, Embase and SCOPUS for manuscripts published up until 24th May 2021. Studies that reported perinatal outcomes (preterm birth, stillbirth, low birth weight, NICU admission) during the COVID-19 pandemic with a pre-pandemic control period were included. Risk of bias assessment was performed using ROBINS-I tool. RevMan5 was used to perform meta-analysis with random-effects models. A score of the stringency of mitigation measures was calculated from the Oxford COVID-19 Government Response Tracker. Thirty-eight studies of moderate to serious risk of bias were included, with varied methodology, analysis and regional mitigation measures, using stringency index scores. There was no overall effect on preterm birth at less than 37 weeks (OR 0.96, 95% CI 0.92-1.00). However, there was a reduction in preterm birth at less than 37 weeks (OR 0.89, 95% CI 0.81-0.98) and 34 weeks (OR 0.56, 95% CI 0.37-0.83) for iatrogenic births and in singleton pregnancies. There was also a significant reduction in preterm births at less than 34 weeks in studies with above median stringency index scores (OR 0.71, 95% CI 0.58-0.88). There was no effect on risk of stillbirth (OR 1.04, 95% CI 0.90-1.19) or birth weight. NICU admission rates were significantly reduced in studies with above median stringency index scores (OR 0.87, 95% CI 0.78-0.97). The reduction in preterm births in regions with high mitigation measures against SARS-CoV-2 infection is likely driven by a reduction in iatrogenic births. Variability in study design and cohort characteristics need to be considered for future studies to allow further investigation of population level health measures of perinatal outcomes.


Subject(s)
COVID-19 , Premature Birth , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Iatrogenic Disease/epidemiology , Infant, Newborn , Pandemics/prevention & control , Pregnancy , Premature Birth/epidemiology , Premature Birth/prevention & control , SARS-CoV-2 , Stillbirth/epidemiology
13.
BJOG ; 129(2): 282-290, 2022 01.
Article in English | MEDLINE | ID: covidwho-1831885

ABSTRACT

OBJECTIVE: To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval. DESIGN: Nationwide cohort study. SETTING: Sweden. POPULATION: From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval. MAIN OUTCOME MEASURES: Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. RESULTS: During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02). CONCLUSIONS: Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. TWEETABLE ABSTRACT: Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.


Subject(s)
COVID-19 Testing , COVID-19 , Intensive Care Units, Neonatal/statistics & numerical data , Pregnancy Complications, Infectious , Pregnancy Outcome/epidemiology , SARS-CoV-2/isolation & purification , Apgar Score , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Premature Birth/epidemiology , Prenatal Care/methods , Prenatal Care/standards , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Stillbirth/epidemiology , Sweden/epidemiology
14.
Nat Commun ; 13(1): 2414, 2022 05 10.
Article in English | MEDLINE | ID: covidwho-1830053

ABSTRACT

Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 vaccinated pregnant people, I2 = 73·9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0·85; 95% CI 0·73-0·99, 66,067 vaccinated vs. 424,624 unvaccinated, I2 = 93·9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission (p > 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth.


Subject(s)
COVID-19 , Premature Birth , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Placenta , Pregnancy , Premature Birth/epidemiology , RNA, Messenger , SARS-CoV-2 , Stillbirth/epidemiology , Vaccination
15.
Postgrad Med ; 134(5): 524-532, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1819649

ABSTRACT

OBJECTIVE: The maternal-child health services remain an important indicator to look at how different countries have handled the pandemic. This study aims to investigate the effect of the COVID-19 pandemic on maternal and child healthcare use and evaluate data on stillbirths and infant mortality. METHODS: In this descriptive, cross-sectional study, a retrospective analysis was performed on 293 stillbirths and 324 infant deaths, which occurred in Samsun Province of Turkey between 1 March 2018 and 1 March 2021. The study period was examined in three groups as pre-pandemic period 1 (1 March 2018-28 February 2019), pre-pandemic period 2 (1 March 2019-29 February 2020) and pandemic period (1 March 2020-28 February2021). RESULTS: The study found that the share of difficulties in delivering health-care services to the families (may be due to reasons such as difficulty in accessing health services for those living in rural areas, disruption of the referral chain) in stillbirths and infant deaths has decreased during the COVID-19 pandemic compared to previous years (p = 0.037 in stillbirths, p = 0.002 in infant deaths). The mean number of follow-up visits during pregnancy has partially reduced during the pandemic (p > 0.05). Other variables of the health-care services have remained similar to years before the pandemic (p > 0.05). The rate of families without health insurance (p = 0.001 in stillbirths, p = 0.001 in infant deaths) and unemployed persons contributing to family budget (p = 0.012 in stillbirths, p = 0.016 in infant deaths) has significantly decreased during the pandemic. CONCLUSIONS: In our study, it was determined that the variables of stillbirth and infant mortality during the COVID-19 pandemic period, and maternal and child health services in primary care and hospitals continued to provide services in a similar way to the pre-pandemic period. Compared to pre-pandemic periods during the COVID-19 pandemic, it was found that while the number of stillbirths was similar, there was a significant decrease in infant mortality.


Subject(s)
COVID-19 , Stillbirth , COVID-19/epidemiology , Cross-Sectional Studies , Female , Humans , Infant , Infant Death , Infant Mortality , Pandemics , Pregnancy , Retrospective Studies , Stillbirth/epidemiology
16.
Biomed Res Int ; 2022: 4284146, 2022.
Article in English | MEDLINE | ID: covidwho-1807688

ABSTRACT

Background: It is of vital importance to determine the safety of drugs. Pregnant women, as a special group, need to evaluate the effects of drugs on pregnant women as well as the fetus. The use of drugs during pregnancy may be subject to fetal toxicity, thus affecting the development of the fetus or even leading to stillbirth. The U.S. Food and Drug Administration (FDA) issued a toxicity rating for drugs used during pregnancy in 1979. These toxicity ratings are denoted by the letters A, B, C, D, and X. However, the query of drug pregnancy category has yet to be well established as electronic service. Results: Here, we presented PregTox, a publicly accessible resource for pregnancy category information of 1114 drugs. The PregTox database also included chemical structures, important physico-chemical properties, protein targets, and relevant signaling pathways. An advantage of the database is multiple search options which allow systematic analyses. In a case study, we demonstrated that a set of chemical descriptors could effectively discriminate high-risk drugs from others (area under ROC curve reached 0.81). Conclusions: PregTox can serve as a unique drug safety data source for drug development and pharmacological research.


Subject(s)
Drug-Related Side Effects and Adverse Reactions , Female , Fetus , Humans , Pharmaceutical Preparations , Pregnancy , Prenatal Care , Stillbirth
18.
Vaccine ; 40(24): 3389-3394, 2022 05 26.
Article in English | MEDLINE | ID: covidwho-1783826

ABSTRACT

BACKGROUND: Pregnant persons are at increased risk of severe illness from COVID-19 infection, including intensive care unit admission, mechanical ventilation, and death compared with non-pregnant persons of reproductive age. Limited data are available on the safety of COVID-19 vaccines administered during and around the time of pregnancy. OBJECTIVE: To evaluate and summarize reports to the Vaccine Adverse Event Reporting System (VAERS), a national spontaneous reporting system, in pregnant persons who received a COVID-19 vaccine to assess for potential vaccine safety problems. METHODS: We searched VAERS for US reports of adverse events (AEs) in pregnant persons who received a COVID-19 vaccine from 12/14/2020-10/31/2021. Clinicians reviewed reports and available medical records. Crude reporting rates for selected AEs were calculated, and disproportional reporting was assessed using data mining methods. RESULTS: VAERS received 3,462 reports of AEs in pregnant persons who received a COVID-19 vaccine; 1,831 (52.9%) after BNT162b2, 1,350 (38.9%) after mRNA-1273, and 275 (7.9%) after Ad26.COV2.S. Eight maternal deaths and 12 neonatal deaths were reported. Six-hundred twenty-one (17.9%) reports were serious. Pregnancy-specific outcomes included: 878 spontaneous abortions (<20 weeks), 101 episodes of vaginal bleeding, 76 preterm deliveries (<37 weeks), 62 stillbirths (≥20 weeks), and 33 outcomes with birth defects. Crude reporting rates for preterm deliveries and stillbirths, as well as maternal and neonatal mortality rates were below background rates from published sources. No disproportional reporting for any AE was observed. CONCLUSIONS: Review of reports to VAERS following COVID-19 vaccines in pregnant persons did not identify any concerning patterns of maternal or infant-fetal outcomes.


Subject(s)
COVID-19 , Vaccines , Ad26COVS1 , Adverse Drug Reaction Reporting Systems , BNT162 Vaccine , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Female , Humans , Infant , Infant, Newborn , Pregnancy , Stillbirth/epidemiology , United States/epidemiology
19.
BMC Pregnancy Childbirth ; 21(1): 761, 2021 Nov 10.
Article in English | MEDLINE | ID: covidwho-1770504

ABSTRACT

BACKGROUND: The ongoing spread coronavirus disease worldwide has caused major disruptions and led to lockdowns. Everyday lifestyle changes and antenatal care inaccessibility during the coronavirus disease 2019 (COVID-19) pandemic have variable results that affect pregnancy outcomes. This study aimed to assess the alterations in stillbirth, neonatal-perinatal mortality, preterm birth, and birth weight during the COVID-19 national lockdown. METHODS: We used the data from the Jordan stillbirths and neonatal death surveillance system to compare pregnancy outcomes (gestational age, birth weight, small for gestational age, stillbirth, neonatal death, and perinatal death) between two studied periods (11 months before the pandemic (May 2019 to March 2020) vs. 9 months during the pandemic (April 2020 to March 1st 2020). Separate multinomial logistic and binary logistic regression models were used to compare the studied outcomes between the two studied periods after adjusting for the effects of mother's age, income, education, occupation, nationality, health sector, and multiplicity. RESULTS: There were 31106 registered babies during the study period; among them, 15311 (49.2%) and 15795 (50.8%) births occurred before and during the COVID-19 lockdown, respectively. We found no significant differences in preterm birth and stillbirth rates, neonatal mortality, or perinatal mortality before and during the COVID-19 lockdown. Our findings report a significantly lower incidence of extreme low birth weight (ELBW) infants (<1kg) during the COVID-19 lockdown period than that before the lockdown (adjusted OR 0.39, 95% CI 0.3-0.5: P value <0.001) CONCLUSIONS: During the COVID-19 lockdown period, the number of infants born with extreme low birth weight (ELBW) decreased significantly. More research is needed to determine the impact of cumulative socio-environmental and maternal behavioral changes that occurred during the pandemic on the factors that contribute to ELBW infants.


Subject(s)
COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Adult , Female , Humans , Infant , Infant Mortality , Infant, Newborn , Infant, Small for Gestational Age , Infectious Disease Transmission, Vertical/statistics & numerical data , Jordan , Perinatal Mortality , Pregnancy , Premature Birth/epidemiology , Stillbirth/epidemiology
20.
Ultrasound Obstet Gynecol ; 59(6): 813-822, 2022 06.
Article in English | MEDLINE | ID: covidwho-1763301

ABSTRACT

OBJECTIVES: To describe the placental pathology, fetal autopsy findings and clinical characteristics of pregnancies that resulted in stillbirth owing to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) placentitis, and to identify potential risk factors. METHODS: This was a prospective multicenter study of non-vaccinated pregnant women affected by coronavirus disease 2019 (COVID-19) in Greece from April 2020 to August 2021. A total of 165 placentas were examined histologically and six cases of stillbirth associated with SARS-CoV-2 placentitis were retrieved. Complete fetal autopsy was performed in three of these cases. Gross, histopathological, immunohistochemical, molecular and electron microscopy examinations were carried out in the stillbirth placentas and fetal organs. The histological findings of cases with SARS-CoV-2 placentitis were compared with those in 159 cases with maternal COVID-19 which resulted in a live birth. Regression analysis was used to identify predisposing risk factors for SARS-CoV-2 placentitis. RESULTS: The placentas of all six stillborn cases showed severe and extensive histological changes typical of SARS-CoV-2 placentitis, characterized by a combination of marked intervillositis with a mixed inflammatory infiltrate and massive perivillous fibrinoid deposition with trophoblast damage, associated with intensely positive immunostaining for SARS-CoV-2 spike protein, the presence of virions on electron microscopy and positive reverse-transcription polymerase chain reaction test of placental tissues. The histological lesions obliterated over 75% of the maternal intervillous space, accounting for intrauterine fetal death. Similar histological lesions affecting less than 25% of the placenta were observed in seven liveborn neonates, while the remaining 152 placentas of COVID-19-affected pregnancies with a live birth did not show these findings. Complete fetal autopsy showed evidence of an asphyctic mode of death without evidence of viral transmission to the fetus. The mothers had mild clinical symptoms or were asymptomatic, and the interval between maternal COVID-19 diagnosis and fetal death ranged from 3 to 15 days. Statistically significant predisposing factors for SARS-CoV-2 placentitis included thrombophilia and prenatally diagnosed fetal growth restriction (FGR). Multiple sclerosis was seen in one case. CONCLUSIONS: SARS-CoV-2 placentitis occurred uncommonly in COVID-19-affected pregnancies of non-vaccinated mothers and, when extensive, caused fetal demise, with no evidence of transplacental fetal infection. Thrombophilia and prenatally detected FGR emerged as independent predisposing factors for the potentially lethal SARS-CoV-2 placentitis. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.


Subject(s)
COVID-19 , Chorioamnionitis , Pregnancy Complications, Infectious , Thrombophilia , COVID-19 Testing , Female , Fetal Death/etiology , Fetus/pathology , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Placenta/pathology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Prospective Studies , Risk Factors , SARS-CoV-2 , Spike Glycoprotein, Coronavirus , Stillbirth/epidemiology , Thrombophilia/complications , Thrombophilia/pathology
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