scholarly journals Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort.

2021 ◽  
Author(s):  
Nicola Vousden ◽  
Rema Ramakrishnan ◽  
Kathryn Bunch ◽  
Edward Morris ◽  
Nigel Simpson ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Perinatal Outcomes ◽  
Severe Infection ◽  
Maternal Infection ◽  
Increased Risk ◽  
National Guidance ◽  
National Cohort ◽  
Alpha Variant ◽  
The Uk ◽  
The Impact

Background In the UK, the Alpha variant of SARS-CoV-2 became dominant in late 2020, rapidly succeeded by the Delta variant in May 2021. The aim of this study was to compare the impact of these variants on severity of maternal infection and perinatal outcomes within the time-periods in which they predominated. Methods This national, prospective cohort study collated data on hospitalised pregnant women with symptoms of confirmed SARS-CoV-2 infection and compared the severity of infection and perinatal outcomes across the Wildtype (01/03/20-30/11/20), Alpha (01/12/20-15/05/21) and Delta dominant periods (16/05/21-11/07/21), using multivariable logistic regression. Findings Of 3371 pregnant women, the proportion that experienced moderate to severe infection significantly increased between Wildtype and Alpha periods (24.4% vs. 35.8%; aOR1.75 95%CI 1.48-2.06), and between Alpha and Delta periods (35.8% vs. 45.0%; aOR1.53, 95%CI 1.07-2.17). Compared to the Wildtype period, symptomatic women admitted in the Alpha period were more likely to require respiratory support (27.2% vs. 20.3%, aOR1.39, 95%CI 1.13-1.78), have pneumonia (27.5% vs. 19.1%, aOR1.65, 95%CI 1.38-1.98) and be admitted to intensive care (11.3% vs. 7.7%, aOR1.61, 95%CI 1.24-2.10). Women admitted during the Delta period had further increased risk of pneumonia (36.8% vs. 27.5%, aOR1.64 95%CI 1.14-2.35). No fully vaccinated pregnant women were admitted between 01/02/2021 when vaccination data collection commenced and 11/07/2021. The proportion of women receiving pharmacological therapies for SARS-CoV-2 management was low, even in those critically ill. Interpretation SARS-CoV-2 infection during Alpha and Delta dominant periods was associated with more severe infection and worse pregnancy outcomes compared to the Wildtype infection, which itself increased risk compared to women without SARS-CoV-2 infection.1 Clinicians need to be aware and implement COVID-specific therapies in keeping with national guidance. Urgent action to tackle vaccine misinformation and policy change to prioritise uptake in pregnancy is essential. Funding National Institute for Health Research HS&DR Programme (11/46/12).

scholarly journals Incidence, risk factors and impact of seasonal influenza in pregnancy: A national cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244986
Author(s):  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Marian Knight ◽  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Seasonal Influenza ◽  
Perinatal Outcomes ◽  
Severe Infection ◽  
Risk Groups ◽  
Increased Risk ◽  
In Pregnancy

Background Pregnant women are particularly vulnerable to severe infection from influenza resulting in poor neonatal outcomes. The majority of evidence relates to pandemic 2009 A/H1N1 influenza. The objective of this study was to describe the characteristics and outcomes of pregnant women hospitalised with seasonal influenza. Methods This national, prospective, observational cohort study used the UK Obstetric Surveillance System (UKOSS) to identify all pregnant women admitted to hospital between 01/11/2016 and 31/10/2018 with laboratory confirmed influenza at any gestation and up to two days after giving birth. These were compared to women admitted to give birth that did not have influenza. Baseline characteristics, immunization status, maternal and perinatal outcomes were compared. Results There were 405 women admitted to hospital with laboratory confirmed influenza in pregnancy: 2.7 per 10,000 maternities. Compared to 694 comparison women, women with influenza were less likely to be professionally employed (aOR 0.59, 95%CI 0.39–0.89) or immunised in the relevant season (aOR 0·59, 0·39–0·89) and more likely to have asthma (aOR 2.42, 1.30–4.49) or have had a previous pregnancy complication (aOR 2·47, 1·33–4·61). They were more likely to be admitted to intensive care (aOR 21.3, 2.78–163.1) and to have a cesarean birth (aOR 1·42, 1·02–1.98). Their babies were more likely to be admitted to neonatal intensive care (aOR 1.86, 1·01–3·42). Conclusions Immunization reduces the risk of hospitalisation with influenza in pregnancy which is associated with increased risk of morbidity for both the mother and baby. There is a continued need to increase awareness of safety and effectiveness of immunization in pregnancy and provision within antenatal care settings, especially for high-risk groups.

scholarly journals Incidence, risk factors and impact of seasonal influenza in pregnancy: A national cohort study

2020 ◽  
Author(s):  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Marian Knight ◽  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Seasonal Influenza ◽  
Perinatal Outcomes ◽  
Severe Infection ◽  
Risk Groups ◽  
Increased Risk ◽  
In Pregnancy

Background Pregnant women are particularly vulnerable to severe infection from influenza resulting in poor neonatal outcomes. The majority of evidence relates to pandemic 2009 A/H1N1 influenza. The objective of this study was to describe the characteristics and outcomes of pregnant women hospitalised with seasonal influenza. Methods This national, prospective, observational cohort study used the UK Obstetric Surveillance System (UKOSS) to identify all pregnant women admitted to hospital between 01/11/2016 and 31/10/2018 with laboratory confirmed influenza together with a comparison group of pregnant women. Baseline characteristics, immunisation status, maternal and perinatal outcomes were compared. Results There were 405 women admitted to hospital with laboratory confirmed influenza in pregnancy: 2.7 per 10,000 maternities. Compared to 694 comparison women, women with influenza were less likely to be professionally employed (aOR 0.59, 95%CI 0.39-0.89) or immunised in the relevant season (aOR 0.59, 0.39-0.89) and more likely to have asthma (aOR 2.42, 1.30-4.49) or have had a previous pregnancy complication (aOR 2.47, 1.33-4.61). They were more likely to be admitted to intensive care (aOR 21.3, 2.78-163.1) and to have a caesarean birth (aOR 1.42, 1.02-1.98). Their babies were more likely to be admitted to neonatal intensive care (aOR 1.86, 1.01-3.42). Conclusions Immunisation reduces the risk of hospitalisation with influenza in pregnancy which is associated with increased risk of morbidity for both the mother and baby. There is a continued need to increase awareness of safety and effectiveness of immunisation in pregnancy and provision within antenatal care settings, especially for high risk groups.

scholarly journals Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

2020 ◽  
Author(s):  
Fu-Rong Li ◽  
Xian-Bo Wu
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Cox Proportional Hazards ◽  
Uk Biobank ◽  
Cvd Risk ◽  
Increased Risk ◽  
National Cohort ◽  
The Uk ◽  
Stage 1 ◽  
The Impact

ABSTRACTImportanceThe 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension (HTN) guideline lowered the threshold for HTN from 140/90 mmHg to 130/80 mmHg for systolic/diastolic blood pressure (SBP/DBP), resulting in a newly defined stage 1 HTN with an SBP/DBP reading of 130–139/80–89 mmHg. Few studies have assessed the impact of the redefined HTN on cardiovascular outcomes among UK population.ObjectiveTo examine the effects of the revised ACC/AHA stage 1 HTN blood pressure parameters on the prevalence of HTN and related cardiovascular disease (CVD) risk in a large UK population.DesignAdult men and women from a national cohort study in the UK.SettingThe UK Biobank Study.ParticipantsA total of 470,625 adults (mean age 56 years) with available data on blood pressure (BP) and without history of CVDs at baseline.Main outcome measuresPrevalence of HTN and incident composite CVD outcomes.MethodsProspective CVD events were analysed for survival in relation to BP measures using Cox proportional hazards regression models, adjusting for potential confounders. The associations are described by hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsBy adopting the 2017 ACC/AHA HTN guideline, an additional 24.7% of the participants were classified as having ACC/AHA stage 1 HTN, which resulted in a prevalence of HTN of 75.1% at baseline. During a mean follow-up period of 8.1 years, ACC/AHA stage 1 HTN (130–139/80–89 mmHg) was associated with a significantly increased risk of CVD (HR 1.20; 95% CI 1.10–1.30) compared to the risk associated with a normal BP (<120/80 mmHg). The excess risk of CVD associated with ACC/AHA stage 1 HTN was mainly driven by myocardial infarction (HR 1.19; 95% CI 1.05-1.36) and haemorrhagic stroke (HR 1.40; 95% CI 1.08-1.81), rather than ischaemic stroke (HR 1.02; 95% CI 0.87-1.19) and CVD death (HR 1.07; 95% CI 0.90-1.26).ConclusionsThe adoption of the 2017 ACC/AHA guideline would lead to a dramatic increase in the prevalence of HTN in the UK Biobank cohort study. Evidence from the present national cohort study may support lowering the threshold for HTN from 140/90 mmHg to 130/80 mmHg in the UK.

scholarly journals Influence of Maternal Infection and Pregnancy Complications on Cord Blood Telomere Length

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Keith T. S. Tung ◽  
Catherine M. W. Hung ◽  
Ko Ling Chan ◽  
Rosa S. Wong ◽  
Hing Wai Tsang ◽  
...  
Keyword(s):  
Cord Blood ◽  
Pregnant Women ◽  
Telomere Length ◽  
Pregnancy Complications ◽  
Maternal Infection ◽  
Intrauterine Environment ◽  
Important Indicator ◽  
Functional Changes ◽  
Increased Risk ◽  
The Impact

Background. Exposure to suboptimal intrauterine environment might induce structural and functional changes that can affect neonatal health. Telomere length as an important indicator of cellular health has been associated with increased risk for disease development. Objectives. This study was aimed to examine the independent and combined effects of maternal, obstetric, and foetal factors on cord blood telomere length (TL). Methods. Pregnant women at the gestational age of 20th to 24th week who attended the antenatal clinic of a major local hospital in Hong Kong were recruited. Participants were asked to complete a questionnaire on demographics, health-related quality of life, and history of risk behaviors. Medical history including pregnancy complications and neonatal outcomes was obtained from electronic medical records of both mother and neonate. Umbilical cord blood was collected at delivery for TL determination. Results. A total of 753 pregnant women (average age: 32.18 ± 4.51 years) were recruited. The prevalence of maternal infection, anaemia, and hypertension during pregnancy was 30.8%, 30.0%, and 6.0%, respectively. The adjusted regression model displayed that maternal infection was negatively associated with cord blood TL ( β = − 0.18 , p = 0.026 ). This association became even stronger in the presence of antenatal anaemia, hypertension, delivery complications, or neonatal jaundice ( β = − 0.25 to −0.45). Conclusions. This study consolidates evidence on the impact of adverse intrauterine environment at the cellular level. Maternal infection was significantly associated with shorter cord blood TL in a unique manner such that its presence may critically determine the susceptibility of telomere to other factors.

scholarly journals Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 853
Author(s):  
Sara Cruz Melguizo ◽  
María Luisa de la Cruz Conty ◽  
Paola Carmona Payán ◽  
Alejandra Abascal-Saiz ◽  
Pilar Pintando Recarte ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Perinatal Outcomes ◽  
Preterm Births ◽  
Hypertensive Disorder ◽  
Obstetric Emergency ◽  
Increased Risk ◽  
Emergency Group ◽  
Adverse Perinatal Outcomes ◽  
Maternal Disease ◽  
The Relationship

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

scholarly journals Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique

2021 ◽  
Vol 10 (8) ◽  
pp. 1564
Author(s):  
Clara Pons-Duran ◽  
Aina Casellas ◽  
Azucena Bardají ◽  
Anifa Valá ◽  
Esperança Sevene ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Maternal Morbidity ◽  
Low Birthweight ◽  
Negative Binomial ◽  
Perinatal Outcomes ◽  
Sub Saharan Africa ◽  
P Value ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact

Sub-Saharan Africa concentrates the burden of HIV and the highest adolescent fertility rates. However, there is limited information about the impact of the interaction between adolescence and HIV infection on maternal health in the region. Data collected prospectively from three clinical trials conducted between 2003 and 2014 were analysed to evaluate the association between age, HIV infection, and their interaction, with the risk of maternal morbidity and adverse pregnancy and perinatal outcomes in women from southern Mozambique. Logistic regression and negative binomial models were used. A total of 2352 women were included in the analyses; 31% were adolescents (≤19 years) and 29% HIV-infected women. The effect of age on maternal morbidity and pregnancy and perinatal adverse outcomes was not modified by HIV status. Adolescence was associated with an increased incidence of hospital admissions (IRR 0.55, 95%CI 0.37–0.80 for women 20–24 years; IRR 0.60, 95%CI 0.42–0.85 for women >25 years compared to adolescents; p-value < 0.01) and outpatient visits (IRR 0.86, 95%CI 0.71–1.04; IRR 0.76, 95%CI 0.63–0.92; p-value = 0.02), and an increased likelihood of having a small-for-gestational age newborn (OR 0.50, 95%CI 0.38–0.65; OR 0.43, 95%CI 0.34–0.56; p-value < 0.001), a low birthweight (OR 0.40, 95%CI 0.27–0.59; OR 0.37, 95%CI 0.26–0.53; p-value <0.001) and a premature birth (OR 0.42, 95%CI 0.24–0.72; OR 0.51, 95%CI 0.32–0.82; p-value < 0.01). Adolescence was associated with an increased risk of poor morbidity, pregnancy and perinatal outcomes, irrespective of HIV infection. In addition to provision of a specific maternity care package for this vulnerable group interventions are imperative to prevent adolescent pregnancy.

scholarly journals Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shigeki Koshida ◽  
Shinsuke Tokoro ◽  
Daisuke Katsura ◽  
Shunichiro Tsuji ◽  
Takashi Murakami ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternal Behavior ◽  
Multivariable Analysis ◽  
Perinatal Outcomes ◽  
Fetal Movement ◽  
Post Intervention ◽  
Fetal Movements ◽  
Adverse Perinatal Outcomes ◽  
The Impact ◽  
Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

scholarly journals Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

2021 ◽  
Vol 12 ◽  
pp. 204209862098569
Author(s):  
Phyo K. Myint ◽  
Ben Carter ◽  
Fenella Barlow-Pay ◽  
Roxanna Short ◽  
Alice G. Einarsson ◽  
...  
Keyword(s):  
Medical Attention ◽  
Close Monitoring ◽  
Plain Language ◽  
Discharge Data ◽  
Specific Patient ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

scholarly journals The development of a digital intervention to increase influenza vaccination amongst pregnant women

2021 ◽  
Vol 7 ◽  
pp. 205520762110121
Author(s):  
Joanne E Parsons ◽  
Katie V Newby ◽  
David P French ◽  
Elizabeth Bailey ◽  
Nadia Inglis
Keyword(s):  
Pregnant Women ◽  
Qualitative Methodology ◽  
Intervention Mapping ◽  
Vaccine Uptake ◽  
Flu Vaccination ◽  
Increased Risk ◽  
Diverse Area ◽  
Seasonal Flu ◽  
Flu Vaccine ◽  
The Uk

Objective Pregnant women and unborn babies are at increased risk of complications from influenza, including pneumonia, yet in the UK, uptake of flu vaccination amongst this population remains <50%. Pregnant women hold beliefs about risks of flu and efficacy of vaccination that consistently predict them to decline vaccination. This study aimed to develop a theory and evidence-based intervention addressing these beliefs to promote flu vaccine uptake. Methods The intervention was developed by behavioural scientists, pregnant women, midwives, clinicians and Public Health professionals, informed by Intervention Mapping. Six predefined steps were performed in line with Intervention Mapping. Results The intervention is an animation addressing beliefs about risks of flu and efficacy of vaccination. Preliminary testing using qualitative methodology indicates the information within the animation is appropriate, and the animation is acceptable to pregnant women. Conclusions This is the first known intervention for pregnant women, aiming to increase flu vaccination through addressing risk and efficacy appraisals. It has been implemented within seasonal flu vaccination campaigns during 2018/19 and 2019/20 within one geographically and ethnically diverse area of the UK.

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