Association of Food Deserts and COVID-19 Severity in Pregnancy as Reflected by Need for Hospitalization.

BACKGROUND: Socioeconomic disparities play an important role in disease epidemiology and outcomes in pregnancy. OBJECTIVE: The objective was to evaluate whether pregnant women with COVID-19 living in a food desert, are at increased risk of more severe disease reflected by symptoms at presentation and need for hospitalization. METHODS: In this retrospective observational study, the electronic medical records of all pregnant patients with documented SARS-CoV-2 infection were reviewed. Food deserts were defined by the USDA and the patient's residence was mapped on the Food Access Research Atlas to determine whether each patient lived within a food desert. Comparisons between those with documented symptomatic COVID-19 required hospitalization to those with documented COVID-19 without need for hospitalization were made using univariate analysis and multivariable logistic regression analysis. RESULTS: The cohort consisted of 129 pregnant patients with COVID-19, with 59.7% (n = 77) asymptomatic and 33.3% (n = 43) requiring admission due to disease severity. The majority were Hispanic (70.5%), and obese (median BMI 31.91 kg/m2), with 33.3% living in a food desert. Patients with disease severity necessitating admission were significantly more likely to reside in a food desert (46.5% vs. 27.9%, P 0.037, OR 2.246, 95% CI 1.048-4.814). No other significant differences were identified on univariate. Multivariable binary logistic regression modeling confirmed food desert residence to be the only independent predictor of more severe COVID-19. CONCLUSION FOR PRACTICE: There is a strong association between living in a food desert and the development of symptomatic COVID-19 requiring hospitalization in pregnancy.

MRSA screening: incidence and maternal postpartum outcomes in an obstetric population at a tertiary care center.

PURPOSE: To assess the incidence of MRSA positive patients in pregnancy, as well as the postpartum outcomes in MRSA positive patients. METHODS: This is a retrospective cohort study of women who underwent universal MRSA universal at a tertiary medical center. A MRSA swab was routinely collected as part of the patient's prenatal care at 35-37 weeks gestation or on admission to labor and delivery. Demographic information and decolonization antibiotics were collected by electronic medical record review, using ICD-9 codes. Outcome data were collected, including mode of delivery, hospital length of stay, endometritis, wound cellulitis, and wound infection. p < 0.05 was considered significant. A univariate logistic regression and a multivariable binary logistic regression model were used to analyze the strength of association between outcomes and MRSA status. Statistical analysis was performed with SAS, version 9.4. RESULTS: The incidence of MRSA during the 4 year study period was 1.9% (82 MRSA positive out of 4369 total patients). 90.2% (74/82) of MRSA positive patients received decolonization antibiotics. No difference was noted in mode of delivery. Logistic regression failed to identify any significant differences in other relevant outcomes for MRSA positive women including endometritis 1.1 (0.1-17.5) [positive 0, versus negative 0.6% (n = 24)], wound cellulitis 5.9 (0.4-82.1) positive 0, versus negative 0.1% (Gorwitz et al. in J Infect Dis 197:1226-1234, 2008) and wound infection 3.3 (0.6-16.9) [positive 1.2%, versus negative 0.5% ( in Am J Infect Control 32:470-85, 2004)] when compared to MRSA negative women. CONCLUSION: When universal MRSA screening was performed at an academic tertiary care center, the overall incidence of MRSA was low. MRSA positive and subsequently decolinzed patients did not have any identified increase in postpartum infectious morbidity, as compared to MRSA negative patients.

Bombay blood type and use of red cell apheresis during pregnancy.

BACKGROUND: Bombay blood type is among the rarest in the world and is associated with anti-H antibodies. These antibodies cause severe hemolysis when exposed to any blood product except Bombay and have been reported to cause hemolytic disease of the newborn. CASE: A primigravid woman with Bombay blood type received erythropoietin and underwent autologous blood donation using red cell apheresis. Maternal anti-H immunoglobulin G antibodies were identified and serial evaluation of the middle cerebral artery peak systolic velocity was used to monitor for fetal anemia. Hemolytic disease of the newborn did not develop. CONCLUSION: Red cell apheresis is a valuable procedure that results in two units of red blood cells per donation and was well tolerated during pregnancy.

Adjustment of maternal serum alpha-fetoprotein levels in women with pregestational diabetes.

OBJECTIVE: Decreased second trimester levels of maternal serum alpha-fetoprotein (MSAFP) have been reported in women with pregestational diabetes leading some laboratories to use a correction factor. The aim of this study is to determine if MSAFP levels in pregnant women with diabetes managed on oral antidiabetic agents is lower than non-diabetic controls and require adjustment similar to those on insulin. STUDY DESIGN: We performed a nested case/control study of an existing dataset using women with pregestational diabetes who had routine MSAFP values available. RESULTS: Before adjusting the MSAFP value for weight, both the diabetic patients who used insulin (n = 68) and those who used oral antidiabetic agents (n = 37) showed a non-significant trend toward a lower multiples of the median (MoM) as compared with controls (n = 244). After converting the raw MSAFP values to race-adjusted MoM and adjusting for weight, the median MSAFP MoM for women taking insulin (1.01) versus those on oral antidiabetic agents (1.00) were essentially the same. Furthermore, both of the diabetic groups were virtually identical to non-diabetic controls. CONCLUSIONS: In our study, women with pregestational diabetes managed on either insulin or oral antidiabetic agents had weight-adjusted MSAFP MoM levels equivalent to those in control pregnancies and did not require a correction factor.

Antiretroviral-induced hepatotoxicity presenting as nonreassuring fetal testing.

BACKGROUND: Combination antiretroviral therapy is recommended for pregnant women with human immunodeficiency virus (HIV) to decrease perinatal transmission. Treatment can cause mitochondrial dysfunction, leading to liver damage and acidosis. Early diagnosis is essential to improve outcome. CASE: A multiparous woman with HIV-1 taking combination antiretroviral therapy presented with pneumonia at 28 weeks of gestation. Once treated, she improved clinically. However, nonreassuring fetal testing prompted further assessment, revealing maternal metabolic acidosis and transaminitis. Drug-induced hepatotoxicity was diagnosed, and combination antiretroviral therapy was discontinued. Fetal testing and maternal lab abnormalities subsequently improved. CONCLUSION: Usual manifestations of hepatotoxicity and acidosis secondary to combination antiretroviral therapy include nausea, vomiting, and jaundice. In this case, nonreassuring fetal testing led to the diagnosis of hepatic dysfunction. Abnormal fetal testing can result from drug-related toxicity and warrants prompt assessment.