Early pregnancy anxiety during the COVID-19 pandemic: preliminary findings from the UCSF ASPIRE study.

BACKGROUND: Antenatal anxiety has been linked to adverse obstetric outcomes, including miscarriage and preterm birth. However, most studies investigating anxiety during pregnancy, particularly during the COVID-19 pandemic, have focused on symptoms during the second and third trimester. This study aims to describe the prevalence of anxiety symptoms early in pregnancy and identify predictors of early pregnancy anxiety during the COVID-19 pandemic. METHODS: We assessed baseline moderate-to-severe anxiety symptoms after enrollment in the UCSF ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic) Prospective Cohort from May 2020 through February 2021. Pregnant persons < 10 weeks' gestation completed questions regarding sociodemographic characteristics, obstetric/medical history, and pandemic-related experiences. Univariate and multivariate hierarchical logistic regression analyses determined predictors of moderate or severe anxiety symptoms (Generalized Anxiety Disorder-7 questionnaire score ≥ 10). All analyses performed with Statistical Analysis Software (SAS®) version 9.4. RESULTS: A total of 4,303 persons completed the questionnaire. The mean age of this nationwide sample was 33 years of age and 25.7% of participants received care through a fertility clinic. Over twelve percent of pregnant persons reported moderate-to-severe anxiety symptoms. In univariate analysis, less than a college education (p < 0.0001), a pre-existing history of anxiety (p < 0.0001), and a history of prior miscarriage (p = 0.0143) were strong predictors of moderate-to-severe anxiety symptoms. Conversely, having received care at a fertility center was protective (26.6% vs. 25.7%, p = 0.0009). COVID-19 related stressors including job loss, reduced work hours during the pandemic, inability to pay rent, very or extreme worry about COVID-19, and perceived stress were strongly predictive of anxiety in pregnancy (p < 0.0001). In the hierarchical logistic regression model, pre-existing history of anxiety remained associated with anxiety during pregnancy, while the significance of the effect of education was attenuated. CONCLUSION(S): Pre-existing history of anxiety and socioeconomic factors likely exacerbated the impact of pandemic-related stressors on early pregnancy anxiety symptoms during the COVID-19 pandemic. Despite on-going limitations for in-person prenatal care administration, continued emotional health support should remain an important focus for providers, particularly when caring for less privileged pregnant persons or those with a pre-existing history of anxiety.

Effect of SARS-CoV-2 Infection on Pregnancy Outcomes in an Inner-City Black Patient Population.

While data have shown that Black populations are disproportionately affected by COVID-19, few studies have evaluated birth outcomes in these understudied populations. This study hypothesized that SARS-CoV-2 infection would confer worse maternal and neonatal outcomes in a predominantly Black and underserved population in Brooklyn, New York City. In particular, SARS-CoV-2 is associated with higher rates of preterm birth, cesarean delivery, postpartum hemorrhage, lower APGAR scores, and neonatal resuscitation. Demographic factors and comorbidities were compared between the SARS-CoV-2 positive and negative groups. A retrospective cohort study was conducted in hospitalized patients who gave birth at Kings County Hospital from April 10 through June 10, 2020. Demographic and clinical data were obtained from the electronic medical record. Patients were categorized based on SARS-CoV-2 infection status and peripartum outcomes were analyzed. We used the Fisher exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. P < 0.05 was considered significant. There were no differences in obstetric or neonatal outcomes between the SARS-CoV-2 positive and negative cohorts. Most SARS-CoV-2 positive patients were asymptomatic on admission. The rates of maternal comorbidities were similar in the SARS-CoV-2 positive and negative groups. In this predominantly Black population in Brooklyn, SARS-CoV-2 infection did not confer increased risk of adverse obstetric or neonatal outcomes, despite the prevalence of comorbidities. The impact of SARS-CoV-2 infection on pregnancy outcomes is complex and may differ on a community level. Determining how COVID-19 is associated with perinatal outcomes in this minoritized patient population will augment our understanding of health disparities in order to improve care.

Home Testing May Not Improve Postvasectomy Semen Analysis Compliance.

INTRODUCTION: Vasectomy is the most effective form of permanent male contraception. Although vasectomy techniques and outcomes have steadily improved, postvasectomy semen analysis compliance remains a significant challenge. The aim of this study was to assess if home testing improved postvasectomy semen analysis compliance. METHODS: Data were collected prospectively but retrospectively reviewed between 2007 and 2019 from a single surgeon's high volume practice. Subjects were divided into 2 groups based on postvasectomy semen analysis method (home vs office) and further subdivided by compliance status. Patients were considered compliant if they provided at least 1 semen sample postvasectomy. Statistical analysis was completed to determine factors predictive of compliance. RESULTS: A total of 364 patients were included. Median age for the home group vs the office group was similar (42 years [IQR 39-46] vs 41 years [IQR 38-46]). Median number of children for both groups was 2 (IQR 2-3). In all, 109 men (30.0%) opted for at-home testing. No significant difference in compliance was found (59.6% of home test vs 58.8% of laboratory patients, p=0.89). No statistically significant difference in patient demographics (age, partner age, number of children, smoking and alcohol) was observed, and there were no demographic factors predicting compliance with regression modeling. CONCLUSIONS: At-home semen analysis kits did not significantly improve compliance. Clinicians should be aware that this may be a reasonable alternative for those who are unable to obtain a postvasectomy semen analysis in-office. Contact of the female partner instead may improve postvasectomy semen analysis compliance as the female partner has a stake in ensuring postvasectomy semen analysis azoospermia.

Identification of cell-specific targets of sumoylation during mouse spermatogenesis.

Recent findings suggest diverse and potentially multiple roles of small ubiquitin-like modifier (SUMO) in testicular function and spermatogenesis. However, SUMO targets remain uncharacterized in the testis due to the complex multicellular nature of testicular tissue, the inability to maintain and manipulate spermatogenesis in vitro, and the technical challenges involved in identifying low-abundance endogenous SUMO targets. In this study, we performed cell-specific identification of sumoylated proteins using concentrated cell lysates prepared with de-sumoylation inhibitors from freshly purified spermatocytes and spermatids. One-hundred and twenty proteins were uniquely identified in the spermatocyte and/or spermatid fractions. The identified proteins are involved in the regulation of transcription, stress response, microRNA biogenesis, regulation of major enzymatic pathways, nuclear-cytoplasmic transport, cell-cycle control, acrosome biogenesis, and other processes. Several proteins with important roles during spermatogenesis were chosen for further characterization by co-immunoprecipitation, co-localization, and in vitro sumoylation studies. GPS-SUMO Software was used to identify consensus and non-consensus sumoylation sites within the amino acid sequences of the proteins. The analyses confirmed the cell-specific sumoylation and/or SUMO interaction of several novel, previously uncharacterized SUMO targets such as CDK1, RNAP II, CDC5, MILI, DDX4, TDP-43, and STK31. Furthermore, several proteins that were previously identified as SUMO targets in somatic cells (KAP1 and MDC1) were identified as SUMO targets in germ cells. Many of these proteins have a unique role in spermatogenesis and during meiotic progression. This research opens a novel avenue for further studies of SUMO at the level of individual targets.

CDK14 expression is down-regulated by cigarette smoke in vivo and in vitro.

In this study, DNA arrays have been employed to monitor gene expression patterns in testis of mice exposed to tobacco smoke for 24 weeks and compared to control animals. The results of the analysis revealed significant changes in expression of several genes that may have a role in spermatogenesis. Cdk14 was chosen for further characterization because of a suggested role in the testis and in regulation of Wnt signaling. RT-PCR analysis confirmed down regulation of Cdk14 in mice exposed to cigarette smoke (CS). Cdk14 is expressed in all testicular cells; spermatogonia- and Sertoli-derived cell lines treated with cigarette smoke extract (CSE) in vitro showed down-regulation of CDK14 mRNA and protein levels as well as down-regulation of ß-catenin levels. CS-induced down-regulation of CDK14 mRNA and protein levels was also observed in several lung epithelium-derived cell lines including primary normal human bronchial epithelial cells (NHBE), suggesting that the effect is not restricted to the testis. Similar to testicular cells, CS-induced down-regulation of CDK14 in lung cells correlated with decreased levels of ß-catenin, a finding suggesting impaired Wnt signaling. In the lungs, CDK14 was localized to the alveolar and bronchial epithelium.