Pregnancy and COVID-19: past, present and future.

Current evidence suggests that severe acute respiratory syndrome coronavirus 2 infection is associated with an increased incidence of adverse severe maternal and perinatal outcomes. However, vertical transmission is rare. The management of pregnant women with coronavirus disease 2019 (COVID-19) is similar to that of non-pregnant women, and effective treatments, including antiviral therapy, dexamethasone, and prophylactic anticoagulation should not be withheld during pregnancy. During the early COVID-19 pandemic period, the management of pregnant women was often delayed until the polymerase chain reaction (PCR) results came out or due to close contact, even among those without symptoms. Out of concern for the spread of infection, cesarean sections were performed instead of vaginal birth, since infection could have led to an increase in maternal and neonatal morbidities. Additionally, if the maternal PCR test was positive, the neonate was quarantined, and despite infectivity decreasing 10 days after symptom onset. It is necessary to ease the strict measures of infection control in the field of obstetrics. The presence or absence of maternal COVID-19 symptoms should be identified to stratify the risk, and vaginal delivery can be attempted in asymptomatic women with low infectivity. With more women being vaccinated safety data about vaccination is rapidly accumulating and no concerns have been detected. Globally, COVID-19 vaccines are recommended even during pregnancy. In order to prepare for future pandemics, it is necessary to apply lessons learned from this pandemic. Policymakers and healthcare leaders must determine efficient and effective strategies for preserving safe maternal care, even during an ongoing global emergency.

Pregnancy outcomes of COVID-19 positive pregnant women at the Cantonal Hospital Zenica, Bosnia and Herzegovina.

Aim To investigate clinical presentation of COVID-19 infection in pregnancy, its course during pregnancy, effects on pregnancy outcomes for both mothers and newborns as well as the potential for vertical transmission. Methods This retrospective observational study included all identifi ed COVID-19-positive pregnant women admitted to the Cantonal Hospital in Zenica at any stage of pregnancy or labour from 30 April 2020 to April 30 2021. Maternity and newborns were followed until discharge from the hospital. Results Twenty-four pregnant women were positive for COVID-19. There were 79.2% asymptomatic cases, 12.5% had mild symptoms, while 8.3% had more severe forms of the disease. The main follow-up morbidities were high BMI 33.3%, anaemia 16.7%, thrombocytopenia 12.5%, hypertensive disorders 4.2% and diabetes 4.2%. The rate of premature births was 33.3%, while 8.3% pregnant women had premature rupture of the amniotic sac. Caesarean section was done for 75% women while 25% delivered vaginally. Previous caesarean section (54.2%) was the most common indication for operative completion of labour. Twentythree (92%) live babies were born, of which 8 (33.3%) were admitted to the neonatal intensive care unit. Two (8%) intrauterine foetal deaths were recorded that occurred before admission to our hospital. Two infants (8.7%) had a positive PCR test for COVID-19. Conclusion COVID-19 viral disease in pregnancy is usually presented as an asymptomatic or mild disease. It is associated with high rates of preterm birth, admission of newborns to the intensive care unit and intrauterine foetal death. Vertical transmission is possible but the newborns were asymptomatic.

Human Immunodeficiency Virus infection associated with crack cocaine use: the impact on perinatal transmission among 890 pregnancies in Brazil / Infecção pelo vírus da imunodeficiência humana em associação ao uso de crack: qual o impacto na transmissão perinatal entre 890 gestantes

Introduction: Human Immunodeficiency Virus infection is a prevalent infection occurring during pregnancy. The implementation of a program to screen and prevent vertical transmission is highly important in Public Healthcare. Pregnant crack users could face difficulties to test and adhere to the Highly Active Antiretroviral Therapy. Objective: The purpose of this research paper was to investigate whether crack cocaine abuse increases Human Immunodeficiency Virus perinatal transmission rates, as well as to evaluate the risk factors associated with such an increase. Methods: Design: A retrospective study. Setting: Department of Obstetrics and Gynecology, General Hospital of Universidade Federal do Paraná. Population: pregnancies of Human Immunodeficiency Virus-positive women who were using crack cocaine (n=64) were compared with that of non-users (n=826) from 2005 to 2013. Prenatal medical records, delivery records, and newborn records were analyzed. Main Outcome Measures: The vertical transmission of Human Immunodeficiency Virus in the group of crack cocaine users was 9.37% (6) versus 2.54% (21) among non-users (p=0.009744). Results: Over the years of the study, there was a decrease in the vertical transmission rate in non-users, while this number remained constant in the group of users. When analyzing the cases of perinatal transmission, it was found that 83.34% (5) had inadequate prenatal care, and 100% (6) had inadequate Human Immunodeficiency Virus treatment, compared to the group in which there was no vertical transmission, where 65.52% (38) had inadequate prenatal care and 70.86% (41) had inadequate treatment. Conclusion: Vertical transmission is higher among crack cocaine users and did not decrease over the years of the study, as occurred among non-users. Trends that explain this increase were non-adherence to adequate prenatal care, Human Immunodeficiency Virus diagnosis during pregnancy, irregular treatment, absence of intrapartum antiretroviral prophylaxis, and vaginal delivery route.

A contaminação pelo vírus da imunodeficiência humana é uma infecção prevalente ocorrida na gravidez. A implantação de um programa de rastreamento e prevenção da transmissão vertical é um campo tão importante na saúde pública. Neste caso, a gestante, usuária de crack, pode estar com alguma dificuldade de testagem e adesão à administração da terapia antirretroviral altamente ativa. Objetivo: Analisar os casos de gestantes vírus da imunodeficiência humana positivas e usuárias de crack atendidas na maternidade do Hospital de Clínicas da Universidade Federal do Paraná entre 2005 e 2013. Propõe-se avaliar se o uso de crack aumenta a transmissão vertical do vírus da imunodeficiência humana e, caso isso ocorra, quais seriam os possíveis fatores que explicariam esse aumento. Métodos: Trata-se de um estudo retrospectivo e descritivo, com análise de prontuários da obstetrícia (prénatal), do atendimento ao parto, da ficha de avaliação do recém-nascido e do prontuário de evolução do recém-nato. Foi comparada a taxa de transmissão perinatal de vírus da imunodeficiência humana de usuárias (n=64) e não usuárias de crack (n=826) no período de 2005 a 2013. Posteriormente, analisando apenas os casos de uso de crack, foram pareados os grupos com e sem transmissão vertical, avaliando condições sociais, condições do recém-nato, tratamento adequado para o vírus da imunodeficiência humana durante a gestação, entre outras variáveis. Resultados: A transmissão vertical de vírus da imunodeficiência humana foi de 9,37% em usuárias de crack e de 2,54% em não usuárias, com alta significância estatística (p=0,009744). Ao longo dos anos do estudo, houve um decréscimo da taxa de transmissão vertical em não usuárias de crack, enquanto nas usuárias esse número permaneceu constante. Nos casos de transmissão vertical, 83,34% das pacientes tiveram um pré-natal inadequado e em 100% o tratamento para o vírus da imunodeficiência humana na gestação foi inadequado em comparação com o grupo no qual não houve transmissão vertical, em que o pré-natal inadequado foi de 65,52% e o tratamento inadequado foi de 70,86%. O uso de adequada profilaxia antirretroviral intraparto se mostrou um dos principais fatores diretamente associados com a proteção contra a transmissão vertical (p=0,065). Conclusão: A transmissão vertical de vírus da imunodeficiência humana é maior em usuárias de crack e não se mostrou em queda ao longo dos anos do estudo, como ocorreu nas não usuárias. Foram encontradas tendências que explicam esse aumento, por exemplo não adesão ao pré-natal adequado, diagnóstico do vírus da imunodeficiência humana durante a gestação, tratamento irregular, ausência de profilaxia antirretroviral intraparto e via de parto vaginal. Prematuridade e baixo peso ao nascer foram maiores nos recém-natos das usuárias em relação aos índices encontrados na literatura do país. Fica evidenciada a necessidade de atendimento diferenciado para essas gestantes, visto que elas não obedecem às medidas adotadas até o momento para o controle da transmissão vertical.

Susceptibility to COVID-19 in Pregnancy, Labor, and Postpartum Period: Immune System, Vertical Transmission, and Breastfeeding.

The new coronavirus (SARS-Cov-2) was first identified in late 2019 as the new RNA virus in the coronaviridae family responsible for causing COVID-19 in the residents of China's Hubei province. In mid-March 2020 WHO declared the pandemic caused by this virus as a result of thousands of people infected all over the world. Epidemiological evidence obtained from other pandemics, such as influenza and ebola, suggest that pregnant women are more susceptible to serious complications and death from viral infection. Physiological changes in the anatomical structure of the respiratory system as well as in the immune system during the pregnancy-puerperal period seem to contribute to this greater risk. Thus, pregnant women are more susceptible to be infected by the SARS-COV-2 or other viruses and to have serious COVID-19 disease. In fact, COVID-19 can alter immune responses at the maternal-fetal interface, affecting the well-being of both mother and her fetus. There is still no sufficient evidence in the literature to support the occurrence of vertical transmission and through breastfeeding, but the prevalence of prematurity was high among pregnant women infected by SARS-Cov-2. In this review, the changes in the immune system that may increase susceptibility to SARS-Cov-2 are discussed as well as the possible mechanisms involved in the transmission of the virus to the fetus by vertical transmission and during breastfeeding.

Clinical and epidemiological characteristics of mothers with COVID-19 and their neonates: vertical transmission. / Características clínicas y epidemiológicas de madres con COVID-19 y sus neonatos: transmisión vertical.

INTRODUCTION: COVID-19 disease can affect women at any stage of pregnancy, and newborns could become infected with SARS-CoV-2 through vertical or horizontal transmission. OBJECTIVE: To determine clinical and epidemiological characteristics of mothers with COVID-19, associated neonatal outcomes, and to evaluate SARS-CoV-2 vertical transmission. METHODS: We conducted an observational, descriptive, cross-sectional study. We included all mothers with positive serology for SARS-CoV-2 and their newborns at the Hospital Regional Docente de Trujillo from April 18 to September 30, 2020. Variables were collected from the medical records, and descriptive statistics were used for the analysis. RESULTS: A total of 647 mothers and 656 neonates were enrolled. Of all live births, 85.3% and 14.7% were term and preterm neonates, respectively. We found 1.7% (11/656) of newborns with positive RT-PCR for SARS-CoV-2; and that 27.3% (3/11) of these neonates required hospitalization. Neonatal mortality was 4/656 (0.6%), and no case was attributed to COVID-19. Of all mothers affected with COVID-19, 95.7% were asymptomatic, and 4.3% presented clinical symptoms attributed to COVID-19, most of which were mild. The most frequent obstetric complications were preeclampsia-eclampsia, prelabour rupture of membranes, and acute fetal distress. All the mothers were discharged. CONCLUSION: We found 1.7% of newborns with positive RT-PCR test for SARS-CoV-2; and that 20.1% of these neonates were hospitalized. The most frequent morbidity was neonatal sepsis and prematurity. The infection was mild among newborns, showing a 0.6% overall mortality, with no cases attributed to COVID-19. We found that only 5% of mothers presented symptoms, most of which were mild to moderate symptoms. There was no record of maternal mortality in this study group. It is not possible to conclude whether vertical transmission or intrapartum-acquired infection is responsible for neonatal COVID-19 infections.

INTRODUCCIÓN: La enfermedad de COVID-19 puede afectar a gestantes en cualquier trimestre del embarazo. Por su parte, los neonatos podrían infectarse con SARS-CoV-2 por transmisión vertical u horizontal. OBJETIVO: Determinar las características clínicas y epidemiológicas de madres con COVID-19, de sus neonatos y la transmisión vertical del SARS-CoV-2. MÉTODOS: Estudio observacional, descriptivo, transversal. Se incluyeron todas las madres con serología positiva para SARS-CoV-2 y sus neonatos nacidos en el Hospital Regional Docente de Trujillo desde el 18 de abril hasta el 30 de septiembre de 2020. La información para las variables se recogió de las historias clínicas. Para el análisis se usó estadística descriptiva. RESULTADOS: Participaron 647 madres y 656 neonatos. El 85,3% de los neonatos nació de término y el 14,7% fue prematuro. El 1,7% (11/656) tuvieron PCR-RT positivos para SARS-CoV-2, y de ellos el 27,3% (3/11) requirió hospitalizados. La mortalidad fue de 4/656 (0,6%), no atribuida a COVID-19. De las madres afectadas con COVID-19, 95,7% fue asintomática, el 4,3% presentó sintomatología clínica atribuida a COVID-19, siendo en su mayoría casos leves. Las complicaciones obstétricas más frecuentes fueron preeclampsia, eclampsia, rotura prematura de las membranas y sufrimiento fetal agudo. Todas las madres fueron dadas de alta. CONCLUSIÓN: De los neonatos estudiados, el 1,7% presentó prueba PCR-RT para SARS-CoV-2 positiva. El 20,1% fue hospitalizado. La morbilidad más frecuente fue sepsis neonatal y prematuridad. La mortalidad fue de 0,6%, ningún caso atribuido a COVID-19. El cuadro clínico de esta patología fue leve en los neonatos. El 95% de las madres con COVID-19 fueron asintomáticas. De las gestantes que presentaron cuadro clínico, tuvieron sintomatología leve a moderada. No se tuvo registro de mortalidad materna en el grupo de estudio. No se puede concluir si se trata de casos de transmisión vertical del SARS-CoV-2 o estamos frente a casos de posible infección neonatal adquirida intraparto.

Pregnancy Outcome, Antibodies, and Placental Pathology in SARS-CoV-2 Infection during Early Pregnancy.

There are reports that pregnant women infected with SARS-CoV-2 not only have increased morbidity but also increased complications and evidence of maternal and fetal vascular malperfusion on placental pathology. This was a retrospective study of pregnant women diagnosed with SARS-CoV-2 infection after March 2020. The results of reverse transcription polymerase chain reaction testing and IgM and IgG antibody testing of the amniotic fluid, cord blood, placenta, and maternal blood were confirmed at delivery. Placentas were evaluated histopathologically. The study included seven pregnant women diagnosed with SARS-CoV-2 infection during pregnancy at a mean gestational age of 14.5 weeks. Out of the seven women, five were infected during the first trimester. The mean gestational age at delivery was 38.4 weeks. The reverse transcription polymerase chain reaction results for maternal plasma, cord blood, placenta, and amniotic fluid were negative and IgG antibodies were detected in maternal plasma and cord blood. On placental pathology, maternal vascular malperfusion was found in only one case, fetal vascular malperfusion in four cases, and inflammatory changes were found in two cases. Pregnancy outcomes for women diagnosed with SARS-CoV-2 infection during early pregnancy are positive and it is likely that maternal antibodies are passed to the fetus, which results in a period of immunity.

Risk factors for vertical transmission of Chagas disease: A systematic review and meta-analysis.

BACKGROUND: Vertical transmission of Trypanosoma cruzi infection from mother to infant accounts for a growing proportion of new Chagas disease cases. However, no systematic reviews of risk factors for T. cruzi vertical transmission have been performed. METHODS: We performed a systematic review of the literature in PubMed, LILACS, and Embase databases, following PRISMA guidelines. Studies were not excluded based on language, country of origin, or publication date. RESULTS: Our literature review yielded 27 relevant studies examining a wide variety of risk factors, including maternal age, parasitic load, immunologic factors and vector exposure. Several studies suggested that mothers with higher parasitic loads may have a greater risk of vertical transmission. A meta-analysis of 2 studies found a significantly higher parasitic load among transmitting than non-transmitting mothers with T. cruzi infection. A second meta-analysis of 10 studies demonstrated that maternal age was not significantly associated with vertical transmission risk. CONCLUSIONS: The literature suggests that high maternal parasitic load may be a risk factor for congenital Chagas disease among infants of T. cruzi seropositive mothers. Given the considerable heterogeneity and risk of bias among current literature, additional studies are warranted to assess potential risk factors for vertical transmission of T. cruzi infection.

Pregnant women infected by the Zika virus: Ultrasound findings and growth patterns of fetuses with and without microcephaly.

OBJECTIVE: To compare ultrasound growth measurements of fetuses with and without microcephaly in suspected Zika virus infection. METHODS: A retrospective cohort study included pregnant women with suspected Zika virus infection to evaluate 110 fetuses with and without microcephaly. The women had been admitted to the fetal medicine unit between October 2015 and August 2016. Cases of fetal microcephaly resulting from other causes were excluded. Variables evaluated were the ultrasound measurements taken at fetal biometry. The relation between each fetal biometry measurement and gestational age was analyzed using fractional polynomials in random-effects regression models. To evaluate fetal growth, curves of the mean fetal biometric parameters were constructed as a function of gestational age. RESULTS: Mean biparietal diameter and mean head circumference increased in both groups as a function of gestational age. In the group with fetal microcephaly, mean head circumference was significantly larger in the 13th and 14th weeks of pregnancy, becoming smaller compared with the group without microcephaly from the 20th week onwards, with the difference increasing with gestational age. CONCLUSION: Fetal head circumference continues to increase until birth, even after a diagnosis of microcephaly, with a reduction only in the pace of growth. Growth decelerates as the pregnancy approaches term.

Safe Perinatal Management of Neonates Born to SARS-CoV-2 Positive Mothers at the Epicenter of the Italian Epidemic.

Introduction: 2019-novel Coronavirus Disease (COVID-19) pandemic has recently struck Northern Italy. Limited data are available about COVID-19 during pregnancy and infancy, mostly from China. Herein, our experience on a safe perinatal management of neonates born to COVID-19 mothers is reported. Method: Since late February through May 15, 2020, 375 pregnant women delivered at our City Hospital in Piacenza, at the epicenter of the Italian epidemic. Of these, 144 were tested via a SARS-CoV-2 quantitative rRT-PCR nasopharyngeal swab prior to delivery, firstly on the basis of epidemiological and clinical criteria, then adopting a universal screening approach. All newborns from SARS-CoV-2 positive mothers were tested via nasopharyngeal swab at birth, on day 3 and/or day 7. In case of positive result, they were re-tested on day 14. Results: Fifteen women tested positive for SARS-CoV-2 infection. All newborns except one were born at term. All of them were non-infected at birth, irrespective of mode of delivery; 13 out 15 remained negative; the two positive neonates became negative by day 14 of life. All of them have always remained asymptomatic. All newborns except two were allowed to have immediate bonding, permanent rooming-in, and direct breastfeeding. Conclusions: Our study supports the claim that COVID-19 in pregnancy is not associated with worse clinical outcomes compared to non-COVID-19 pregnant women and/or with higher rates of preterm birth and intrauterine growth restriction. Intrauterine vertical transmission of SARS-CoV-2 seems to be unlikely. Breastfeeding appears to be safe and protective for the neonate, once appropriate preventive measures are adopted.

An Exploration of Barriers and Enablers of Retention in a Program to Reduce Vertical Transmission of HIV at Health Centers in Zimbabwe.

BACKGROUND: Poor retention in the prevention of women in prevention of vertical transmission programs remains a formidable common setback in elimination of HIV/AIDS. It creates new problems such as poor health outcomes and increased incidence of vertical transmission of HIV. There is a dearth of qualitative information to explain poor retention of women in prevention of mother-to-child transmission (PMTCT) programs in Zimbabwe. The purpose of the study was to explore the enablers and barriers of retention of women in PMTCT programs. METHODS: This was a basic qualitative study conducted at four health centers in Zimbabwe. Four audiotaped focus group discussions were conducted with 34 pregnant or breastfeeding women coming for PMTCT services at the health centers. Descriptive statistics was used for sample demographics. Transcripts were analyzed through latent content analysis based on the Graneheim and Lundman method. RESULTS: Maternal determination, a four-tier support system, and an inspiring health package were enablers to retention in the PMTCT program while uninspired individual engagement, paternalism, and undesirable PMTCT-related events were barriers to retention of women in the PMTCT program. CONCLUSIONS: Reinforcing hope for the women and their children, active management of side effects of antiretroviral medicine, consistent peer support, enhancing confidentiality among community cadres, and commitment from community or religious leaders may improve retention of women in PMTCT programs; for women with HIV during pregnancy, delivery and post-natal care.

The effect of rupture of membranes and labour on the risk of hepatitis B vertical transmission: Prospective multicentre observational study.

OBJECTIVE: To evaluate the effect of rupture of membranes and labour on the risk of hepatitis B virus (HBV) vertical transmission. STUDY DESIGN: A prospective multicentre observational study was carried out in Hong Kong between 2014-2016. Pregnant HBV carriers were recruited. The duration of rupture of membranes, labour and mode of delivery were collected prospectively. HBV DNA was examined at 28-30 weeks of gestation. All newborns received standard HBV vaccination and immunoglobulin. Hepatitis B surface antigen of infants was tested at 9-12 months of age. RESULTS: 641 pregnancies were recruited and analyzed. No statistically significant difference was found in gravida, parity, gestational age at delivery, mode of delivery, duration of rupture of membranes, duration of labour, preterm delivery, preterm rupture of membranes or birth weight (p > 0.05). Subgroup analysis in viral load > 7log10IU/ml and 8log10IU/ml also did not find a significant association between duration of rupture of membranes and labour with immunoprophylaxis failure. CONCLUSIONS: Duration of rupture of membranes and labour would not affect the risk of HBV vertical transmission in infants following standard HBV vaccination and hepatitis B immunoglobulin administration.

Transmissão vertical tardia do vírus da imunodeficiência humana via aleitamento materno: análise de casos de infecção pediátrica com história materna soronegativa durante a gestação / Late postnatal mother-to-child transmission of the human immunodeficiency virus through breastfeeding: analysis of infant cases of previously seronegative mothers infected during lactation

Na faixa etária de 0 a 5 anos, considera-se a transmissão vertical o indicador da infecção pelo vírus da imunodeficiência humana (HIV). A principal via de exposição pós-natal ocorre pelo aleitamento materno. Quando a infecção aguda materna se dá no período puerperal, há maior risco de infecção infantil, devido à elevada carga viral materna. Objetivo: Avaliar as formas de infecção pediátrica pelo HIV no serviço de Infectologia Pediátrica do Complexo do Hospital de Clínicas da Universidade Federal do Paraná (UFPR), com ênfase na transmissão vertical tardia via aleitamento materno. Métodos: Estudo transversal e analítico, com coleta de dados retrospectiva, avaliando pacientes de 0 a 16 anos infectados pelo vírus HIV, acompanhados de 2010 a 2015. Realizada análise da categoria de exposição por protocolo geral, seguida de protocolo específico para casos sugestivos de transmissão vertical tardia via aleitamento materno, objetivando compreender as características maternas e pediátricas. Resultados: Dos 122 pacientes incluídos, 95,0% foram infectados via transmissão vertical. Desses, 11 (9,5%) casos foram de infecção tardia ­ possível ou confirmada ­ via aleitamento materno. Ao diagnóstico da criança, 72,7% apresentaram sintomas decorrentes da infecção pelo HIV. Em 45,4% desses casos, mães e filhos foram diagnosticados concomitantemente e 72,7% das mães apresentaram categoria de exposição sexual. Conclusão: A transmissão vertical confirmou-se como a principal forma de contaminação pelo vírus HIV, com importante prevalência da infecção tardia pelo aleitamento materno. Essa observação, a gravidade dos sintomas pediátricos, o momento do diagnóstico e categoria de exposição maternos destacam a importância da busca de medidas profiláticas e avanços científicos que objetivem a redução da transmissão do HIV via leite materno

Vertical transmission is considered an indication of human immunodeficiency virus (HIV) infection in children aged below five years. The main postnatal category of exposure is through breastfeeding. When maternal infection occurs in early postnatal period, the risk of infant infection is even higher, due to a high maternal viral rate in this period. Objective: To evaluate HIV infection in infants assisted by the Pediatric Infectology Service of Hospital de Clínicas da Universidade Federal do Paraná, emphasizing the cases where vertical transmission occurred postnatally through breastfeeding. Methods: Transversal, analytical and descriptive study, with quantitative and qualitative approach, analyzing all HIV-infected patients aged 0 to 16 years, assisted between 2010 and 2015. The analysis of category of exposure was carried out by a general protocol, followed by a specific protocol for cases where transmission was suspected to have occurred due to late postnatal transmission through breastfeeding, aiming at understanding pediatric and maternal characteristics. Results: Records from 122 patients were analyzed, with 95.0% of mother-to-child-transmission cases. Between these cases, 11 (9.5%) were considered possible or confirmed late postnatal transmission through breastfeeding, having the presence of breastfeeding as a requirement. By the time of diagnosis, 72.7% presented symptoms of HIV infection. In 45.4% of these cases, mother and children were diagnosed at the same time, and 72.7% of mothers were infected sexually. Conclusion: Mother­to­childtransmission was the main responsible for infant infection and there was a significant prevalence of late postnatal transmission through breastfeeding in our sample. Moreover, the severity of infant symptoms, the moment of diagnosis and mother's category of exposure highlight a gap on HIV prevention, and the importance of finding prophylactic measures and scientific improvement in order to reduce HIV transmission through breastfeeding

The prevalence and risk factors of group B streptococcus colonization in Iranian pregnant women.

BACKGROUND: Group B Streptococcus (GBS) is a leading cause of serious neonatal infections. Although great progress has been made in preventing prenatal GBS, its colonization rate in different regions of Iran remains unknown. AIM: To determine GBS colonization prevalence and its risk factors among Iranian pregnant women. METHODS: This prospective cross-sectional study was performed on 186 pregnant women, who attended Boo-Ali hospital which is affiliated with Islamic Azad University in Tehran, Iran, from March 2014 to June 2015. The demographic, obstetric and gynecological data were gathered. A recto-vaginal culture was taken from each patient, with a sterile swab, in lithotomy position without using speculum, and vaginal pH was measured. Patients with positive GBS received IV antibiotic therapy during labor (penicillin G 3 gram at first dose then 1.5 gram Q/4h until delivery). Data were analyzed by statistical software SPSS version 21. Statistical tests for differences were performed by Chi-square test. Potential confounding was assessed by logistic regression. Level of significance was set at p<0.05. RESULTS: Twenty-two (11.8%) patients had positive recto-vaginal colonization. No significant differences between colonized and GBS-negative women with regard to age, obstetrics history and socio-economic factor were noticed. In contrast, smoking, history of previous infection with HPV, presence of vulvitis and a vaginal pH>4.5 were associated with GBS colonization (p≤0.05). CONCLUSIONS: With a relatively low prevalence and few significantly correlated factors, it is hardly possible to define a high risk group of pregnant women for GBS colonization. Therefore, thorough measures should be taken in order to prevent infection complications in mothers and neonates in the Iranian population.

Vertically transmitted HPV-dependent squamous cell carcinoma of the external auditory canal : Case report of a child.

BACKGROUND: There is much evidence that high-risk human papillomavirus (HPV) plays a causative role in a subset of head and neck squamous cell cancer (HNSCC) in adults. HPV-positive tumors behave differently even in their response to treatment and are therefore a distinct subset. Both HPV-positive and HPV-negative tumors of the head and neck region are usually in the domain of adults and cases in children are rare; thus when a 2­year-old child was diagnosed with this cancer in the external auditory canal, an in-depth assessment of the tumor was considered necessary. CASE REPORT: A 2­year-old girl was born to a HPV-positive mother who was diagnosed with cervical cancer during pregnancy. The child was delivered by caesarean section and the mother died of her cancer 7 months after delivery. After the diagnosis of locally invasive HPV-positive squamous cell cancer of the external auditory canal, the child was treated surgically, and with chemotherapy and radiotherapy. Full remission was obtained lasting up to 325 weeks since treatment was started, resulting in over 6 years of disease-free survival. CONCLUSION: This is the first case of advanced, HPV-related HNSCC in a 2­year-old child, in whom the tumor was located in the external auditory canal and who made a dramatic recovery after treatment with nonradical surgery, chemotherapy and radiotherapy. The child has currently been disease free for 6 years. This case supports the observation that HPV-related HNSCC tumors appear to respond favorably to treatment despite the patient's young age and the clinically advanced stage of the tumor.

Chagas Disease Screening in Maternal Donors of Publicly Banked Umbilical Cord Blood, United States.

To assess patterns of Chagas disease, we reviewed results of screening umbilical cord blood from a US public cord blood bank during 2007-2014. Nineteen maternal donors tested positive for Trypanosoma cruzi parasites (0.04%). Because perinatal transmission of Chagas disease is associated with substantial illness, targeted prenatal programs should screen for this disease.

Viral Suppression and Resistance in a Cohort of Perinatally-HIV Infected (PHIV+) Pregnant Women.

Our objective was to describe viral suppression and antiretroviral (ARV) resistance mutations in an ongoing cohort of perinatally-infected HIV+ (PHIV+) pregnant women. Descriptive analysis was performed using SPSS 18.0. From 2011 to 2014, we followed 22 PHIV+ pregnant women. Median age at prenatal entry was 19 years (Interquartile range (IQR) 17.6-21.0); 86% had an AIDS diagnosis; 81% had disclosed their HIV status to partner 11. The median age at HIV diagnosis was 8.3 y (IQR 4.0-13.6), the median age at sexual debut was 16 years (IQR 14-18). At the time of prenatal care initiation, four (18%) were on their first antiretroviral treatment (ART), eight (36%) in their second regimen and nine (41%) in their third regimen or beyond, and one had no data. Seventeen of 22 (77%) had HIV-viral load (VL) > 50 copies/mL at prenatal care entry, 16 had a genotyping exam performed. Seventeen of 22 PHIV+ had VL results near delivery: 7/17 (41%) had VL < 50 copies/mL. Among those who had genotyping at prenatal entry, 11/16 (69%) had mutations associated with ARV resistance. The most frequent major mutations were K103N, M184V, T215, M41L, D67N at reverse transcriptase gene and M46, I54V and V82A at protease gene. No vertical transmissions occurred. Management of pregnancy among PHIV+ is challenging. Individualized ART are needed to achieve viral suppression in a highly ART-exposed subpopulation.

Avaliação dos fatores associados à transmissão vertical de HIV-1 / Evaluation of factors associated with vertical HIV-1 transmission

Resumo Objetivo Comparar a prevalência e os fatores associados à transmissão vertical de HIV-1 entre grávidas tratadas de 1998-2004 e de 2005-2011 em um serviço de referência de cuidado de pacientes com HIV no sul do Brasil. Métodos Estudo descritivo e analítico que usou as bases de dados de laboratórios da Rede Nacional de Laboratórios de CD4 e Carga Viral de DST/Aids do Ministério da Saúde. As grávidas com HIV-1 foram selecionadas em uma pesquisa ativa de informações clínicas e dados obstétricos e neonatais em seus prontuários médicos entre 1998-2011. Resultados Foram analisadas 102 grávidas entre 1998 e 2004 e 251 entre 2005-2011, no total 353 crianças nascidas de grávidas com HIV-1. Observou-se que a transmissão vertical foi de 11,8% entre 1998 e 2004 e de 3,2% entre 2005-2011 (p < 0,001). O maior uso de medicamentos antirretrovirais (p = 0,02), a redução na carga viral (p < 0,001) e o tempo de ruptura de membranas menor do que quatro horas (p < 0,001) foram associados à redução nos fatores de transmissão vertical quando os dois períodos são comparados. Conclusão Observou-se uma redução na taxa de transmissão vertical nos últimos anos. De acordo com as variáveis estudadas, sugere-se que os fatores de risco de transmissão vertical de HIV-1 foram ausência de terapia antirretroviral, alta carga viral das grávidas e tempo de ruptura maior do que quatro horas.

Abstract Objective To compare the prevalence and factors associated with vertical transmission of human immunodeficiency virus 1 (HIV-1) among pregnant women treated in the periods of 1998-2004 and 2005-2011 in a reference service for the care of HIV-infected patients in southern Brazil. Methods This was a descriptive and analytical study that used the databases of laboratories from the CD4 and STDs/AIDS Viral Load National Laboratory Network of the Brazilian Ministry of Health. HIV-1-infected pregnant women were selected after an active search for clinical information and obstetric and neonatal data from their medical records between the years of 1998 and 2011. Results 102 pregnant women were analyzed between 1998 and 2004 and 251 in the period between 2005 and 2011, totaling 353 children born to pregnant women with HIV-1. It was observed that the vertical transmission rate was 11.8% between 1998 and 2004 and 3.2% between 2005 and 2011 (p < 0.001). The increased use of antiretroviral drugs (p = 0.02), the decrease in viral load (p < 0.001), and time of membrane rupture lower than 4 h (p < 0.001) were associated with the decrease of vertical transmission factors when comparing the two periods. Conclusion It was observed a decrease in the rate of vertical transmission in recent years. According to the studied variables, is suggested that the risk factors for vertical transmission of HIV-1 were absence of antiretroviral therapy, high viral load in the pregnant women, and membrane rupture time >4 h.

Evaluation of factors associated with vertical HIV-1 transmission.

OBJECTIVE: To compare the prevalence and factors associated with vertical transmission of human immunodeficiency virus 1 (HIV-1) among pregnant women treated in the periods of 1998-2004 and 2005-2011 in a reference service for the care of HIV-infected patients in southern Brazil. METHODS: This was a descriptive and analytical study that used the databases of laboratories from the CD4 and STDs/AIDS Viral Load National Laboratory Network of the Brazilian Ministry of Health. HIV-1-infected pregnant women were selected after an active search for clinical information and obstetric and neonatal data from their medical records between the years of 1998 and 2011. RESULTS: 102 pregnant women were analyzed between 1998 and 2004 and 251 in the period between 2005 and 2011, totaling 353 children born to pregnant women with HIV-1. It was observed that the vertical transmission rate was 11.8% between 1998 and 2004 and 3.2% between 2005 and 2011 (p<0.001). The increased use of antiretroviral drugs (p=0.02), the decrease in viral load (p<0.001), and time of membrane rupture lower than 4h (p<0.001) were associated with the decrease of vertical transmission factors when comparing the two periods. CONCLUSION: It was observed a decrease in the rate of vertical transmission in recent years. According to the studied variables, is suggested that the risk factors for vertical transmission of HIV-1 were absence of antiretroviral therapy, high viral load in the pregnant women, and membrane rupture time >4h.

Survey of perinatal hepatitis B virus transmission after Korean National Prevention Program in a tertiary hospital.

BACKGROUND/AIMS: The Ministry of Health and Welfare and the Korea Centers for Disease Control and Prevention in South Korea have been organizing hepatitis B virus (HBV) vertical infection prevention projects since July 2002. In this single-institute study, the results of surveys conducted in target mothers who delivered babies in a tertiary hospital were investigated and analyzed. METHODS: Of the 9,281 mothers and their 9,824 neonates born between July 2002 and December 2012, 308 hepatitis B surface antigen (HBsAg)-positive mothers and their 319 neonates were selected for this study, and their records were analyzed retrospectively. RESULTS: A total of 308 mothers were HBsAg-positive, with an HBV prevalence of 3.32% (308/9,281). There were 319 neonates born to these HBsAg-positive mothers, and 252 were confirmed to as either HBsAg-positive or -negative. Four were confirmed as HBsAg-positive, with a 1.59% (4/252) HBV vertical infection rate. All the mothers of neonates who had an HBV vertical infection were hepatitis B e antigen (HBeAg)-positive. Among the HBsAg-positive neonates, three were HBeAg-positive and had an HBV DNA titer of 1.0 × 10(8) copies/mL. CONCLUSIONS: The HBV prevalence of mothers was 3.32% (308/9,281), and their vertical infection rate was 1.59% (4/252). Thus, the South Korean HBV vertical infection prevention projects are effective, and, accordingly, HBV prevalence in South Korea is expected to decrease continuously.

Survey of perinatal hepatitis B virus transmission after Korean National Prevention Program in a tertiary hospital

BACKGROUND/AIMS: The Ministry of Health and Welfare and the Korea Centers for Disease Control and Prevention in South Korea have been organizing hepatitis B virus (HBV) vertical infection prevention projects since July 2002. In this single-institute study, the results of surveys conducted in target mothers who delivered babies in a tertiary hospital were investigated and analyzed. METHODS: Of the 9,281 mothers and their 9,824 neonates born between July 2002 and December 2012, 308 hepatitis B surface antigen (HBsAg)-positive mothers and their 319 neonates were selected for this study, and their records were analyzed retrospectively. RESULTS: A total of 308 mothers were HBsAg-positive, with an HBV prevalence of 3.32% (308/9,281). There were 319 neonates born to these HBsAg-positive mothers, and 252 were confirmed to as either HBsAg-positive or -negative. Four were confirmed as HBsAg-positive, with a 1.59% (4/252) HBV vertical infection rate. All the mothers of neonates who had an HBV vertical infection were hepatitis B e antigen (HBeAg)-positive. Among the HBsAg-positive neonates, three were HBeAg-positive and had an HBV DNA titer of 1.0 x 10(8) copies/mL. CONCLUSIONS: The HBV prevalence of mothers was 3.32% (308/9,281), and their vertical infection rate was 1.59% (4/252). Thus, the South Korean HBV vertical infection prevention projects are effective, and, accordingly, HBV prevalence in South Korea is expected to decrease continuously.