EFFECTS OF COVID-19 INFECTION DURING PREGNANCY AND NEONATAL PROGNOSIS: WHAT IS THE EVIDENCE?

AbstractBackgroundLittle is known about how COVID-19 infection affects pregnant women, as well as about the possibility of vertical transmission or that of premature labor. Thus, this study’s objective was to identify existing evidence to directive public policies.MethodSystematic literature review assessing papers published in the most comprehensive databases in the field of health.Results12 papers were eligible. A total of 119 pregnant women aged between 22 and 42 years old and between the 12th and 41st weeks were analyzed; 90 children were born. Most pregnant women acquired the infection in the third trimester of pregnancy, 97.4% were diagnosed before hospitalization based on signs and symptoms. There was no maternal death and no vertical transmission was confirmed.Conclusionspregnant women must be cautious and vigilant because their exposure to the virus, even if at the end of a pregnancy, has important repercussions, especially for the type of labor.

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The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England

BMJ Open ◽

10.1136/bmjopen-2016-015594 ◽

2017 ◽

Vol 7 (11) ◽

pp. e015594 ◽

Cited By ~ 13

Author(s):

James Mahon ◽

Carlos Lifschitz ◽

Thomas Ludwig ◽

Nikhil Thapar ◽

Julie Glanville ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Functional Gastrointestinal Disorders ◽

Signs And Symptoms ◽

Third Party ◽

Gastrointestinal Disorders ◽

Over The Counter ◽

Party Payer ◽

The Third ◽

The Cost

ObjectivesTo estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents.Study designTo estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a ‘de novo’ analysis was performed. For the latter, the potential costs for the third party payer (the National Health Service (NHS) in England) and for parents/carers for the treatment of FGIDs in infants were calculated, by using publicly available data. In constructing the calculation, estimates and assumptions (where necessary) were chosen to provide a lower bound (minimum) of the potential overall cost. In doing so, the interpretation of the calculation is that the true COI can be no lower than that estimated.ResultsOur calculation estimated that the total costs of treating FGIDs in infants in England were at least £72.3 million per year in 2014/2015 of which £49.1 million was NHS expenditure on prescriptions, community care and hospital treatment. Parents incurred £23.2 million in costs through purchase of over the counter remedies.ConclusionsThe total cost presented here is likely to be a significant underestimate as only lower bound estimates were used where applicable, and for example, costs of alternative therapies, inpatient treatments or diagnostic tests, and time off work by parents could not be adequately estimated and were omitted from the calculation. The number and kind of prescribed products and products sold over the counter to treat FGIDs suggest that there are gaps between treatment guidelines, which emphasise parental reassurance and nutritional advice, and their implementation.

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Vertical Transmission of COVID-19 to the Neonate

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2020/8460672 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Sindy C. Moreno ◽

Justin To ◽

Hajoon Chun ◽

Ivan M. Ngai

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pregnant Women ◽

Vertical Transmission ◽

Medical Centre ◽

Test Results ◽

Third Trimester ◽

The Third ◽

Hospital Medical ◽

Pcr Test

Objective. To estimate the incidence rate of vertical transmission of coronavirus disease 2019 (COVID-19) to the neonate during the third trimester. Study Design. We conducted a retrospective observational study of pregnant women diagnosed with COVID-19 during the third trimester, who delivered at Flushing Hospital Medical Centre (FHMC) or Jamaica Hospital Medical Centre (JHMC) between March 20, 2020, and April 30, 2020. The study participants were symptomatic pregnant women diagnosed with COVID-19 via positive SARS-CoV-2 RNA, real-time reverse transcription-polymerase chain reaction (SARS-CoV-2 rRT-PCR) test. Evidence of vertical transmission was assessed in the neonate via a SARS-CoV-2 rRT-PCR test, with nasopharyngeal swab samples collected on the neonates after 24 hours of birth. The exclusion criteria for this study were maternal or neonate records without SARS-CoV-2 rRT-PCR test results, neonates not delivered at FHMC or JHMC, and foetuses with suspected foetal anomalies or incomplete medical records. Results. We identified 19 symptomatic pregnant women diagnosed with COVID-19, including two women with twin pregnancies. Seven patients (36.8%) were delivered via cesarean. 12 patients (63.1%) presented in spontaneous labour, and 8 (38.1%) had preterm delivery. No maternal intensive care unit admission, maternal sepsis, or maternal mortality was observed. Twenty-one neonates were evaluated for COVID-19 after birth. SARS-CoV-2 rRT-PCR test results were negative in 100% of the neonates. Thirteen neonates (61.9%) were admitted to the neonatal intensive care unit. Prematurity was the most common cause of NICU admission 6 (46.1%), with a length of stay of 5.5 ± 6.4 days. No invasive mechanical ventilation, neonatal sepsis, or neonatal mortality was observed. Conclusion. In our cohort, symptomatic COVID-19 during the third trimester of pregnancy was not associated with vertical transmission to the neonate.

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Transmission of SARS-CoV-2 infection mother to the newborn

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203970 ◽

2020 ◽

Vol 7 (10) ◽

pp. 2086

Author(s):

Bonifacio Caballero ◽

Daniel Caballero

Keyword(s):

Virus Infection ◽

Pregnant Women ◽

Vertical Transmission ◽

Intrauterine Infection ◽

Late Pregnancy ◽

Hubei Province ◽

Capital City ◽

Third Trimester ◽

The Third ◽

The World

The emergence of the new corona virus infection that occurred in Wuhan, the capital city of China's Hubei province in December 2019 initially labeled 2019-nCoV and later named SARS-CoV-2, has spread in several countries around the world and subsequently raised concerns about the possibility of vertical transmission from the mother to the fetus, producing its disease named COVID-19. Around 12 articles about pregnant women infected with COVID-19 and their newborns have been published between February 10 and April 4, 2020. So far, there are few reports on newborns. There is currently evidence of vertical transmission from pregnant women with COVID-19 infection during the third trimester. The results of this report suggest that currently there is evidence of intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia and die in late pregnancy. However, most of these newborns have been asymptomatic or mildly symptomatic, but as the outbreak and information are changing rapidly, it is recommended to continue to check for updates.

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Placental Pathology of the Third Trimester Pregnant Women from COVID-19

10.21203/rs.3.rs-104837/v1 ◽

2020 ◽

Author(s):

Likun Gao ◽

Jiacai Ren ◽

Li Xu ◽

Xiaokang Ke ◽

Lin Xiong ◽

...

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Plasma Cells ◽

Inflammatory Cells ◽

Spike Protein ◽

Third Trimester ◽

The Third ◽

Negative Results ◽

Virus Rna ◽

Novel Coronavirus

Abstract Aims: To explore the clinical characteristics and placental pathological changes of pregnant women with 2019 novel coronavirus (CoV) disease (COVID-19) in the third trimester, and to assess the possibility of vertical transmission.Methods and results: The placenta tissues were evaluated by using immunohistochemistry for inflammatory cells and Hofbauer cells, and using severe acute respiratory syndrome (SARS) CoV-2 RNA Fluorescence In-Situ Hybridization (FISH) and SARS-CoV-2 spike protein immunoﬂuorescence (IF) double staining. All Eight placentas from the third trimester pregnancy women were studied. all patients were cured, no clinical or serological evidence pointed to vertical transmission of SARS-CoV-2. Features of maternal vascular malperfusion (MVM) such as increased syncytial knots were present in all 8 cases (8/8), and increased focal perivillous fibrin depositions were presented in 7 cases (7/8). No significate inflammatory cell reaction was noted in the placenta. The number of macrophages and inflammatory cells such as T cells, B cells and plasma cells in the placental villous was not significantly increased in all cases. Moreover, all of eight cases demonstrated negative results by FISH using a SARS-CoV-2 virus RNA probe and by IF using a monoclonal antibody against SARS-CoV-2 spike protein. Conclusions: We found no evidence of vertical transmission and adverse maternal-fetal outcomes in the placentas of third trimester COVID-19 pregnancy women, which provided further information for the clinical management of those women in the third trimester. However, further studies are still needed for patients with infections in different stage of gestation, especially in first and second trimester.

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Placental pathology of the third trimester pregnant women from COVID-19

Diagnostic Pathology ◽

10.1186/s13000-021-01067-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Likun Gao ◽

Jiacai Ren ◽

Li Xu ◽

Xiaokang Ke ◽

Lin Xiong ◽

...

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Plasma Cells ◽

Inflammatory Cells ◽

Spike Protein ◽

Third Trimester ◽

The Third ◽

Negative Results ◽

Virus Rna ◽

Novel Coronavirus

Abstract Aims To explore the clinical characteristics and placental pathological changes of pregnant women with 2019 novel coronavirus (CoV) disease (COVID-19) in the third trimester, and to assess the possibility of vertical transmission. Methods and results The placenta tissues were evaluated by using immunohistochemistry for inflammatory cells and Hofbauer cells, and using severe acute respiratory syndrome (SARS) CoV-2 RNA Fluorescence In-Situ Hybridization (FISH) and SARS-CoV-2 spike protein immunofluorescence (IF) double staining. All eight placentas from the third trimester pregnancy women were studied. All patients were cured, no clinical or serological evidence pointed to vertical transmission of SARS-CoV-2. Features of maternal vascular malperfusion (MVM) such as increased syncytial knots were present in all 8 cases (8/8), and increased focal perivillous fibrin depositions were presented in 7 cases (7/8). No significate chronic histiocytic intervillositis was noted in the placenta. The number of macrophages and inflammatory cells such as T cells, B cells and plasma cells in the placental villous was not significantly increased in all cases. Moreover, all of eight cases demonstrated negative results by FISH using a SARS-CoV-2 virus RNA probe and by IF using a monoclonal antibody against SARS-CoV-2 spike protein. Conclusions We found no evidence of vertical transmission and adverse maternal-fetal outcomes in the placentas of third trimester COVID-19 pregnancy women, which provided further information for the clinical management of those women in the third trimester. However, further studies are still needed for patients with infections in different stage of gestation, especially in first and second trimester.

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Features of the course and treatment of glaucoma during pregnancy

Clinical Medicine (Russian Journal) ◽

10.30629/0023-2149-2020-98-3-178-184 ◽

2020 ◽

Vol 98 (3) ◽

pp. 178-184

Author(s):

T. V. Chernyakova ◽

A. Yu. Brezhnev ◽

I. R. Gazizova ◽

A. V. Kuroyedov ◽

A. V. Seleznev

Keyword(s):

Pregnant Women ◽

Laser Treatment ◽

Progressive Disease ◽

Clinical Course ◽

The Other ◽

Third Trimester ◽

The Third ◽

Chronic Progressive Disease ◽

Hypotensive Therapy ◽

Eye Pressure

In the review we have integrated all up-to-date knowledge concerning clinical course and treatment of glaucoma among pregnant women to help specialists choose a proper policy of treatment for such a complicated group of patients. Glaucoma is a chronic progressive disease. It rarely occurs among childbearing aged women. Nevertheless the probability to manage pregnant patients having glaucoma has been recently increasing. The situation is complicated by the fact that there are no recommendations on how to treat glaucoma among pregnant women. As we know, eye pressure is progressively going down from the first to the third trimester, so we often have to correct hypotensive therapy. Besides, it is necessary to take into account the effect of applied medicines on mother health and evaluate possible teratogenic complications for a fetus. The only medicine against glaucoma which belongs to category B according to FDA classification is brimonidine. Medicines of the other groups should be prescribed with care. Laser treatment or surgery may also be a relevant decision when monitoring patients who are planning pregnancy or just bearing a child. Such treatment should be also accompanied by medicines.

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A systematic review and meta-analysis of prevalence of insomnia in the third trimester of pregnancy

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03755-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nader Salari ◽

Niloofar Darvishi ◽

Behnam Khaledi-Paveh ◽

Aliakbar Vaisi-Raygani ◽

Rostam Jalali ◽

...

Keyword(s):

Pregnant Women ◽

Sleep Disorders ◽

Sleep Disturbances ◽

Meta Analysis ◽

Physical And Mental Health ◽

Third Trimester ◽

Cross Sectional ◽

The Third ◽

Physical Problems ◽

Meta Regression Analysis

Abstract Background Sleep disorders, which are among the foremost important medical care issues, are prevalent in pregnancy. The present study is a meta-analysis of the prevalence of insomnia in the third trimester of pregnancy. This study aims to systematically review the overall prevalence of insomnia in the third trimester of pregnancy through conducting a meta-analysis. Method The literature used in this meta-analysis for the topic discussed above were obtained through searching several databases, including SID, MagIran, IranDoc, Scopus, Embase, Web of Science (WoS), PubMed Science Direct and Google Scholar databases without time limitation until December 2020. Articles developed based on cross-sectional studies were included in the study. The heterogeneity of studies was investigated using the I2 index. Also, the possible effects of heterogeneity in the studied studies are investigated using meta-regression analysis. Result In 10 articles and 8798 participants aged between11–40, the overall prevalence of insomnia in the third trimester of pregnancy based on meta-analysis was 42.4% (95% CI: 32.9–52.5%). It was reported that as the sample size increases, the prevalence of insomnia in the third trimester of pregnancy increases. Conversely, as the year of research increases, the prevalence of insomnia in the third trimester of pregnancy decreases. Both of these differences were statistically significant (P < 0.05). Conclusion Insomnia was highly prevalent in the last trimester of pregnancy. Sleep disorders are neglected among pregnant women, and they are considered natural. While sleep disturbances can cause mental and physical problems in pregnant women, they can consequently cause problems for the fetus. As a result, maintaining the physical and mental health of pregnant mothers is very important. It is thus recommended that in addition to having regular visits during pregnancy, pregnant women should also be continuously monitored for sleep-related disorders.

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The sFlt-1 to PlGF Ratio in Pregnant Women with Rheumatoid Arthritis: Impact of Disease Activity and Sulfasalazine Use

Rheumatology ◽

10.1093/rheumatology/keab372 ◽

2021 ◽

Author(s):

Rugina I Neuman ◽

Hieronymus T W Smeele ◽

A H Jan Danser ◽

Radboud J E M Dolhain ◽

Willy Visser

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Disease Activity ◽

Pregnant Women ◽

Gestational Age ◽

Third Trimester ◽

Low Disease Activity ◽

The Third ◽

Observational Prospective Cohort Study ◽

Plgf Ratio

Abstract Objectives An elevated sFlt-1/PlGF-ratio has been validated as a significant predictor of preeclampsia, but has not been established in women with rheumatoid arthritis (RA). We explored whether the sFlt-1/PlGF-ratio could be altered due to disease activity in RA, and could be applied in this population to predict preeclampsia. Since sulfasalazine has been suggested to improve the angiogenic imbalance in preeclampsia, we also aimed to examine whether sulfasalazine could affect sFlt-1 or PlGF levels. Methods Making use of a nationwide, observational, prospective cohort study on pregnant women with RA, sFlt-1 and PlGF were measured in the third trimester. A total of 221 women, aged 21–42 years, were included, with a median gestational age of 30 + 3 weeks. Results No differences in sFlt-1 or PlGF were observed between women with high, intermediate or low disease activity (p= 0.07 and p= 0.41), whereas sFlt-1 and PlGF did not correlate with DAS28-CRP score (r=-0.01 and r=-0.05, respectively). Four (2%) women with a sFlt-1/PlGF-ratio ≤38 developed preeclampsia in comparison to three (43%) women with a ratio > 38, corresponding to a negative predictive value of 98.1%. Sulfasalazine users (n = 57) did not show altered levels of sFlt-1 or PlGF in comparison to non-sulfasalazine users (n = 164, p= 0.91 and p= 0.11). Conclusion Our study shows that in pregnant women with RA, the sFlt-1/PlGF-ratio is not altered due to disease activity and a cut-off ≤38 can be used to exclude preeclampsia. Additionally, sulfasalazine use did not affect sFlt-1 or PlGF levels in this population.

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AB0747 MATERNAL AND FETAL OUTCOMES IN PREGNANT WOMEN WITH JUVENILE IDIOPATHIC ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3647 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1402.1-1402

Author(s):

R. Pinheiro Torres ◽

M. H. Fernandes Lourenco ◽

A. Neto ◽

F. Pimentel Dos Santos ◽

I. Silva ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Literature Review ◽

Pregnant Women ◽

Systematic Literature Review ◽

English Language ◽

Placenta Previa ◽

Bibliographic Databases ◽

Fetal Outcomes ◽

Term Birth ◽

Increased Risk

Background:Juvenile idiopathic arthritis (JIA), one of the most common chronic diseases in children, can be classified in seven different categories according to its onset presentation. Concerns about pregnancy outcomes play a secondary role in disease approach. However, recent data showed an increased risk of pre-term birth in women with JIA instead the small patient samples analysed.Objectives:In this review, our aim is to describe the current available knowledge on JIA adverse, maternal and fetal, outcomes.Methods:A systematic literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases. The search was limited to articles in English language, presenting a comparator group (healthy individuals or patients without known auto-immune rheumatic diseases) and at least one clinical outcome of interest. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility.Results:Ten observational studies out of 1560 references, fulfilled the inclusion criteria, of which, 9 were retrospective and 1 prospective. A total of 6.214 women with JIA (with 6.811 pregnancies) and 18.659.513 healthy controls (with 21.339.194 pregnancies) were included in this review.Concerning maternal outcomes, delivery by caesarian section (CS) was more frequent among JIA women (in 4 out of 6 studies). Pre-eclampsia was referred in 3 out of 6 studies and a higher risk of vaginal bleeding and placenta previa in one additional study. No study found an increased risk for gestational diabetes or hypertension in pregnant women with JIA.Regarding fetal outcomes, 8 studies revealed significantly increased of pre-term birth (only in first births in one study) but one study didn’t show any increased risk. Two studies showed a higher risk of small gestational age (SGA) and in another 2, increased risk for low birth weight (LBW). No evidence of increased risk of major congenital malformations.Conclusion:This systematic review suggests an increased risk for pre-eclampsia, preterm birth, delivery by CS, SGA and LBW, among pregnant women with JIA. Conclusions should be carefully interpreted, giving the heterogeneity of studied populations regarding demography, disease type, disease activity, and prescribed medication.Disclosure of Interests:None declared

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Health anxiety and related factors among pregnant women during the COVID-19 pandemic: a cross-sectional study from Iran

BMC Psychiatry ◽

10.1186/s12888-021-03092-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Najmieh Saadati ◽

Poorandokht Afshari ◽

Hatam Boostani ◽

Maryam Beheshtinasab ◽

Parvin Abedi ◽

...

Keyword(s):

Pregnant Women ◽

Health Care Providers ◽

Health Anxiety ◽

Cross Sectional Study ◽

Care Providers ◽

Sectional Study ◽

Third Trimester ◽

Related Factors ◽

Cross Sectional ◽

The Third

Abstract Background The COVID-19 pandemic has affected many countries around the world and Iran was no exception. The aim of this study was to evaluate health anxiety of Iranian pregnant women during the COVID-19 pandemic. Methods In this cross-sectional study, 300 pregnant women in different trimesters (n = 100 in each trimester) were recruited. A demographic questionnaire and the Health Anxiety Questionnaire were used to collect data. Scores of < 27, 27–34 and more than 35 were defined as low, moderate and high health anxiety, respectively. Due to nationwide restrictions, data were collected through social media groups. Chi-square tests, ANOVA and multiple linear regression were used to analyze the data. Results Mean (SD) total anxiety scores were 22.3 ± 9.5, 24.6 ± 9.3 and 25.4 ± 10.6 in the first, second and third trimesters of pregnancy, respectively. 9, 13 and 21% of women had severe anxiety in the first, second and third trimesters of pregnancy, respectively. Women in the third trimester had significantly higher health anxiety scores than those in the first trimester (p = 0.045). Conclusion At the time of the COVID-19 pandemic, women in the second and third trimesters of pregnancy were more worried about consequences of disease, but total health anxiety scores were significantly higher among women in the third trimester of pregnancy. Health care providers should pay more attention to the mental health of pregnant women in times of crises such as the COVID-19 pandemic.

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