Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study.

Introduction: SARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators. Methods: A sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array. Results: In the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester. Discussion and conclusion: From an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women.

Considerações sobre a Psicologia Perinatal em um ambulatório público de pré-natal especializado em gestantes expostas à COVID-19 / Considerations on Perinatal Psychology in a public prenatal clinic specialized in pregnant women exposed to COVID-19 / Consideraciones sobre Psicología Perinatal en un consultorio prenatal público especializado en gestantes expuestas a la COVID-19

INTRODUÇÃO: A COVID-19 surgiu com o imperativo urgente de construção de novos saberes e conhecimento científico. OBJETIVO: Diante dessa necessidade, este trabalho visa relatar a experiência da psicologia perinatal, em um ambulatório público de pré-natal especializado em gestantes expostas à Covid-19 durante a gravidez; e discutir como essa experiência pode contribuir para a construção de intervenções em saúde mental voltadas para esse público durante a pandemia. MÉTODO: Trata-se de um relato de experiência. RESULTADOS: Pôde-se observar a presença de demandas circunscritas à própria perinatalidade e construção da parentalidade; relativas à pandemia, falta de informação precisa, adoecimento e sequelas físicas e emocionais provocadas pelo coronavírus. CONCLUSÃO: Esses achados permitem à psicologia, em especial ao campo da psicologia perinatal, adequar suas intervenções psicoterapêuticas e psicoeducativas às questões emergentes da pandemia. As estratégias precisam possibilitar a integração do cuidado, a ampliação do suporte social, emocional e instrumental para esse público, de modo a possibilitar maior sensação de segurança frente à este problema de saúde púbica. Ressalta-se a necessidade de estudos que validem intervenções de saúde mental para gestantes durante a pandemia.

INTRODUCTION: COVID-19 emerged with the urgent imperative to build new knowledge and scientific knowledge. OBJECTIVE: Given this need, this paper aims to report the experience of perinatal psychology in a public prenatal clinic specializing in pregnant women exposed to Covid-19 during pregnancy; and discuss how this experience can contribute to the construction of mental health interventions aimed at this public during the pandemic. METHODS: This is an experience report. RESULTS: We could observe the presence of demands circumscribed to the perinatality itself and the construction of parenthood; related to the pandemic, lack of accurate information, illness and physical and emotional sequelae caused by the coronavirus. CONCLUSION: These findings allow psychology, especially the field of perinatal psychology, to adapt its psychotherapeutic and psychoeducational interventions to the issues emerging from the pandemic. The strategies must enable the integration of care, the expansion of social, emotional and instrumental support to this public, in order to provide a greater sense of security in the face of this public health problem. We emphasize the need for studies that validate mental health interventions for pregnant women during the pandemic.

INTRODUCCIÓN: El COVID-19 surgió con el imperativo urgente de construir nuevos conocimientos y saberes científicos. OBJETIVO: Dada esta necesidad, este trabajo tiene como objetivo: informar la experiencia de la psicología perinatal, en una clínica prenatal pública especializada en mujeres embarazadas expuestas a Covid-19 durante el embarazo; y discutir cómo esta experiencia puede contribuir a la construcción de intervenciones de salud mental dirigidas a este público durante la pandemia. MÉTODO: Se trata de un relato de experiencia. RESULTADOS: Fue posible observar la presencia de demandas limitadas a la propia perinatalidad y a la construcción de la paternidad; relacionados con la pandemia, falta de información veraz, enfermedades y secuelas físicas y emocionales provocadas por el coronavirus. CONCLUSIÓN: Estos hallazgos permiten a la psicología, especialmente en el campo de la psicología perinatal, adaptar sus intervenciones psicoterapéuticas y psicoeducativas a las cuestiones emergentes de la pandemia. Las estrategias deben permitir la integración de la atención, la ampliación del apoyo social, emocional e instrumental para este público, con el fin de proporcionar una más grande sensación de seguridad frente a la pandemia. Se destaca la necesidad de estudios que validen las intervenciones de salud mental para mujeres embarazadas durante la pandemia.

Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study.

BACKGROUND: A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2-exposed children. OBJECTIVE: The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. METHODS: The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children's growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2-exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. RESULTS: Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. CONCLUSIONS: Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2-exposed mothers and children and support the development of evidence-based public health policies. TRIAL REGISTRATION: Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26477.