Immunological and physiopathological approach of COVID-19 in pregnancy.

Coronavirus disease-2019 (COVID-19) related to Coronavirus-2 (SARS-CoV-2) is a worldwide health concern. Despite the majority of patients will evolve asymptomatic or mild-moderate upper respiratory tract infections, 20% will develop severe disease. Based on current pathogenetic knowledge, a severe COVID-19 form is mainly a hyperinflammatory, immune-mediated disorder, triggered by a viral infection. Due to their particular immunological features, pregnant women are supposed to be particularly susceptible to complicate by intracellular infections as well as immunological disturbances. As an example, immune-thrombosis has been identified as a common immune-mediated and pathogenic phenomenon both in COVID-19, in obstetric diseases and in COVID-19 pregnant women. According to extensive published clinical data, is rationale to expect an interference with the normal development of pregnancy in selected SARS-CoV-2-infected cases, mainly during third trimester.This manuscript provides insights of research to elucidate the potential harmful responses to SARS-CoV-2 and /or other coronavirus infections, as well as bidirectional interactions between COVID-19 and pregnancy to improve their respective management.

Angiogenic Factors and Long-Term Cardiovascular Risk in Women That Developed Preeclampsia During Pregnancy.

Preeclampsia is caused by placental impairment with increased expression of sFlt-1 (soluble fms-like tyrosine kinase 1) and decreased PlGF (placental growth factor); it has been associated with cardiovascular morbidity and mortality later in life, but the underlying mechanism remains unknown. The aim of this study was to determine whether sFlt-1 and PlGF levels during preeclampsia are associated to long-term cardiovascular risk. We prospectively recruited 43 women with previous preeclampsia and 21 controls with uncomplicated pregnancies. Cardiovascular risk assessment ≈12 years later included maternal hemodynamic, cardiac function and structure, biomarker analysis, and carotid-intima thickness evaluation. Women with previous preeclampsia had higher prevalence of hypertensive disorders and dyslipidemia than controls. In addition, they had worse global longitudinal strain, thicker left ventricular septal and posterior walls, more myocardial mass and increased carotid intima-media thickness compared with controls. PlGF during pregnancy correlated positively with high-density lipoprotein (r=0.341; P=0.006), and negatively with global longitudinal strain (r=-0.581; P<0.001), carotid intima-media thickness (r=-0.251; P=0.045), and mean arterial blood pressure (r=-0.252; P=0.045), when adjusted by study group. sFlt correlated negatively with high-density lipoprotein (r=-0.372; P=0.002) and apolipoprotein A-1 (r=-0.257; P=0.040), and positively with carotid intima-media thickness (r=0.269; P=0.032) and left ventricular posterior wall thickness (r=0.368; P=0.003). The antiangiogenic state present in preeclampsia is related to greater prevalence of cardiovascular risk factors ≈12 years after delivery. The knowledge of altered angiogenic factors may help detect women with a higher risk for premature cardiovascular disease, who will require earlier follow-up after delivery.

Amniocentesis and the risk of second trimester fetal loss in twin pregnancies: results from a prospective observational study.

AIM: To compare the rate of pregnancy loss between twin pregnancies undergoing a genetic amniocentesis (AC) and a control group with similar characteristics. METHODS: Prospective observational study on a population of twin pregnancies referred to our prenatal diagnosis unit for screening from 1990 to 2010. Those women referred for an AC were compared with those without indication for the procedure. Primary outcomes were pregnancy loss within the 4 weeks after procedure and pregnancy loss before 24 weeks. Secondary outcome included neonatal morbidity, gestational age at delivery and birth weight. results: Maternal characteristics were similar for both groups, except for maternal age. There was neither difference in the pregnancy loss rate within 4 weeks (2.7 versus 2.6%) nor in the loss rate before 24 weeks of gestation (1.2 versus 1.1%). Gestational age at birth was 36 weeks for both groups. Chorionicity and gestational age at procedure played no role in modifying the risk. CONCLUSION: Based on our results, there is no difference in the pregnancy loss rate in twin gestations, regardless of chorionicity or gestational age at procedure, either within 4 weeks after the procedure or before 24 weeks, in patients who undergo AC when compared with patients who do not.

Vacunación antigripal en gestantes. Cobertura vacunal y conocimientos y prácticas de los obstetras / Influenza vaccination in pregnant women. Coverage, practices and knowledge among obstetricians

Fundamento y objetivo: El embarazo es un factor de riesgo independiente para presentar una forma clínica grave de gripe. Múltiples organismos nacionales e internacionales incluyen en sus recomendaciones oficiales la administración de vacunación antigripal a gestantes. El objetivo de este trabajo fue estimar las coberturas de vacunación antigripal en una muestra amplia de mujeres atendidas por parto en un hospital de tercer nivel y conocer los conocimientos y prácticas de los obstetras en relación con la indicación de la vacuna. Métodos: Estudio descriptivo transversal mediante 2 encuestas: una administrada a las puérperas atendidas por parto entre diciembre de 2007 y febrero de 2008, y otra dirigida a los obstetras que trabajaban en este hospital o en centros de atención primaria del área de referencia. Resultados: La cobertura vacunal en las puérperas del estudio fue de un 4,1%. El 80,5% de las mujeres no presentaba comorbilidad asociada. La cobertura vacunal en el grupo con comorbilidad fue del 3,3%. El profesional que recomendó más frecuentemente la vacuna fue la comadrona (28,9%) y la enfermera (18,4%). Entre los obstetras, sólo el 20% conocía la indicación de la vacunación antigripal en gestantes durante el primer trimestre, y el 65,1%, en el segundo o tercer trimestre. Sólo el 7% manifestó prescribir la vacuna en el primer trimestre y un 20,9%, en el segundo o tercer trimestre. Conclusiones: La cobertura vacunal en las gestantes de nuestro estudio es muy baja. Los obstetras encuestados presentaron un bajo nivel de conocimiento de las recomendaciones vigentes, en especial la de la inmunización durante el primer trimestre del embarazo, y muy pocos la prescriben (AU)

Background and objectives: Women who are pregnant during influenza season have an increased risk of infection and severe clinical disease. Several national and international organizations currently recommend vaccination for pregnant women. We intended to estimate the influenza vaccination rate in a population of postpartum women attended in a tertiary hospital in Barcelona. Moreover, we assessed the knowledge and practice of obstetricians about influenza vaccination during pregnancy. Methods: Two cross-sectional surveys were performed. Postpartum women who delivered from December 2007 to February 2008 were included. The sample of obstetricians was constituted by those who were working in hospital or primary care reference areas. Results: Influenza vaccination rate was 4.1%. Healthy women represented 80.5% of our population. The vaccination rate in the group with comorbidities was 3.3%. The providers who recommended the vaccine more frequently were the midwife in 28.9% and the nurse in 18.4%. Among the obstetricians, 20.9% responded that the influenza vaccine was recommended in the first trimester of pregnancy and 65.1% said that it was recommended in the second or third trimester. In relation to practice, only 7% offered the vaccine in the first trimester and 20,9% in the second or third trimester. Conclusions: The influenza vaccination rate in pregnant women in our study is very low. Obstetricians showed a low level of knowledge about the current influenza vaccination recommendations, mainly in the case of first trimester of pregnancy and only few offered the vaccine in their practice (AU)

[Influenza vaccination in pregnant women. Coverage, practices and knowledge among obstetricians]. / Vacunación antigripal en gestantes. Cobertura vacunal y conocimientos y prácticas de los obstetras.

BACKGROUND AND OBJECTIVES: Women who are pregnant during influenza season have an increased risk of infection and severe clinical disease. Several national and international organizations currently recommend vaccination for pregnant women. We intended to estimate the influenza vaccination rate in a population of postpartum women attended in a tertiary hospital in Barcelona. Moreover, we assessed the knowledge and practice of obstetricians about influenza vaccination during pregnancy. METHODS: Two cross-sectional surveys were performed. Postpartum women who delivered from December 2007 to February 2008 were included. The sample of obstetricians was constituted by those who were working in hospital or primary care reference areas. RESULTS: Influenza vaccination rate was 4.1%. Healthy women represented 80.5% of our population. The vaccination rate in the group with comorbidities was 3.3%. The providers who recommended the vaccine more frequently were the midwife in 28.9% and the nurse in 18.4%. Among the obstetricians, 20.9% responded that the influenza vaccine was recommended in the first trimester of pregnancy and 65.1% said that it was recommended in the second or third trimester. In relation to practice, only 7% offered the vaccine in the first trimester and 20,9% in the second or third trimester. CONCLUSIONS: The influenza vaccination rate in pregnant women in our study is very low. Obstetricians showed a low level of knowledge about the current influenza vaccination recommendations, mainly in the case of first trimester of pregnancy and only few offered the vaccine in their practice.

[Rubella susceptibility of immigrant pregnant women in Catalonia]. / Susceptibilidad a la rubéola en gestantes inmigrantes con residencia en Cataluña.

BACKGROUND AND OBJECTIVE: Considering recent outbreaks of rubella in immigrant population in Madrid (Spain), we investigated the proportion of rubella susceptibility in immigrant women in Catalonia, Spain. PATIENTS AND METHOD: Seroprevalence study in pregnant women of the immigrant community. Information of demographic possible risk factors associated to rubella susceptibility was collected. RESULTS: Five hundred and ninety four women were included. The global prevalence of susceptibility was 11.7% (95% confidence interval [CI], 9.2-14.5%). African women showed the highest susceptibility (17%; 95% CI, 10.5-25.2%). Age younger than 25 years was a risk factor statistically associated with rubella susceptibility (adjusted odds ratio=3.02; 95% CI, 1.09-8.35). CONCLUSIONS: Rubella susceptibility in pregnant women from low income countries is 10 times higher than that of Catalonian native women.

Susceptibilidad a la rubéola en gestantes inmigrantes con residencia en Cataluña / Rubella susceptibility of immigrant pregnant women in Catalonia

Fundamento y objetivo: tras los recientes brotes de rubéola descritos en población inmigrante de Madrid, se ha querido conocer la proporción de mujeres inmigrantes susceptibles a esta enfermedad en Cataluña. Pacientes y método: se ha llevado a cabo un estudio de seroprevalencia en mujeres gestantes provenientes de países de renta baja. Se recogió información demográfica y sobre posibles factores predictivos de susceptibilidad. Resultados: se incluyó en el estudio a 594 mujeres. La proporción global de susceptibilidad a la rubéola fue del 11,7% (intervalo de confianza [IC] del 95%, 9,2–14,5%). La mayor prevalencia de susceptibles se observó en las mujeres de origen africano (17%; IC del 95%, 10,5–25,2%). La edad inferior a 25 años fue un factor de riesgo asociado a la susceptibilidad a la rubéola (odds ratio ajustada=3,02; IC del 95%, 1,09–8,35). Conclusiones: el porcentaje de susceptibilidad a la rubéola entre las gestantes provenientes de países de renta baja supera en 10 veces la susceptibilidad de las mujeres en edad fértil autóctonas de Cataluña (AU)

Background and objective: Considering recent outbreaks of rubella in immigrant population in Madrid (Spain), we investigated the proportion of rubella susceptibility in immigrant women in Catalonia, Spain. Patients and method: Seroprevalence study in pregnant women of the immigrant community. Information of demographic possible risk factors associated to rubella susceptibility was collected. Results: Five hundred and ninety four women were included. The global prevalence of susceptibility was 11.7% (95% confidence interval [CI], 9.2–14.5%). African women showed the highest susceptibility (17%; 95% CI, 10.5–25.2%). Age younger than 25 years was a risk factor statistically associated with rubella susceptibility (adjusted odds ratio=3.02; 95% CI, 1.09–8.35). Conclusions: Rubella susceptibility in pregnant women from low income countries is 10 times higher than that of Catalonian native women (AU)

Recurrent Kikuchi-Fujimoto disease during pregnancy: report of case evolving into systemic lupus erythematosus and review of published work.

Kikuchi-Fujimoto disease (KFD) is a distinctive, benign type of necrotizing lymphadenitis. KFD is a rare entity, especially during pregnancy. Although first described in Japan, subsequently it has been reported in the West. We communicate herein a case of KFD in African women with bouts during pregnancy. Diagnosis was difficult because peripheral enlarged lymph nodes were absent and an extended differential diagnosis and adequate work-up was necessary. The patient suffered a miscarriage coinciding with a KFD bout. Further pregnancies were uneventful. Follow up showed that KFD evolved into a systemic lupus erythematosus-like syndrome.

Are anti-beta-glycoprotein-I antibodies markers for recurrent pregnancy loss in lupus anticoagulant/anticardiolipin seronegative women?

PROBLEM: Anti-beta(2)-Glicoprotein-1 antibodies (anti-beta(2)GPI-ab) have been related to recurrent miscarriage (RM) with conflicting results. The aim was to evaluate the role of anti-beta(2)-GPI-ab as unique biological marker in RM related to antiphospholipid (aPL). METHOD OF STUDY: A cohort study that included 59 cases, divided in two groups, was designed: group 1 comprised 43 pregnant women with 'obstetric' antiphospholipid syndrome (APS) and group 2 included 16 cases with similar complaints but only having repeatedly anti-beta(2)-GPI-ab. Previous thrombosis and/or inherited thrombophilia were excluded. Lupus anticoagulant, anticardiolipin antibodies (aCA), anti-beta(2)-GPI-ab, and other autoantibodies were analyzed. Miscarriages, premature births, pre-eclampsia, live births, placental and systemic thromboses were studied. RESULTS: No differences in previous obstetric complications were detected (P = 1.00-0.164). After the treatment, differences in number of obstetric complications were not seen (P = 1.00). Live births were similar in two groups (88.4% and 93.7%; P = 1.00). Placental thrombosis was equal in both groups, 93.3% versus 80% (P = 1.00). CONCLUSION: These results suggest that anti-beta(2)-GPI-ab may be considered a biological marker for obstetric APS.