scholarly journals COVID-19 and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253974
Author(s):  
Agustín Ciapponi ◽  
Ariel Bardach ◽  
Daniel Comandé ◽  
Mabel Berrueta ◽  
Fernando J. Argento ◽  
...  

Background We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783). Methods We searched literature databases and COVID-19 research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR’s results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables. Results We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had "critically low" overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 clinical findings during pregnancy were fever (28–100%), mild respiratory symptoms (20–79%), raised C-reactive protein (28–96%), lymphopenia (34–80%), and pneumonia signs in diagnostic imaging (7–99%). The most frequent maternal outcomes were C-section (23–96%) and preterm delivery (14–64%). Most of their babies were asymptomatic (16–93%) or presented fever (0–50%), low birth weight (5–43%) or preterm delivery (2–69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 versus non-COVID-19 pregnant women was 1.88 (95% Confidence Interval [CI] 1.36–2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05–4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks. Conclusion This comprehensive overview supports that pregnant women with COVID-19 may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.

2021 ◽  
Author(s):  
Agustin Ciapponi ◽  
Ariel Bardach ◽  
Daniel Comande ◽  
Mabel Berrueta ◽  
Fernando J Argento ◽  
...  

Background We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783). Methods We searched literature databases and COVID-19 research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR's results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables. Results We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had "critically low" overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 clinical findings during pregnancy were fever (28-100%), mild respiratory symptoms (20-79%), raised C-reactive protein (28-96%), lymphopenia (34-80%), and pneumonia signs in diagnostic imaging (7-99%). The most frequent maternal outcomes were C-section (23-96%) and preterm delivery (14-64%). Most of their babies were asymptomatic (16-93%) or presented fever (0-50%), low birth weight (5-43%) or preterm delivery (2-69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 versus non-COVID-19 pregnant women was 1.88 (95% Confidence Interval [CI] 1.36-2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05-4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks. Conclusion This comprehensive overview supports that pregnant women with COVID-19 may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.


Author(s):  
Kavitha Garikapati ◽  
K. B. Gayathri ◽  
K. Naga Lalitha

Background: Obesity is a state of excess adipose tissue mass. Body mass index (BMI) is a crucial predictor of nutritional status of pregnant women. High BMI may lead to various adverse maternal and perinatal outcomes. This study is designed to see the effect of maternal BMI on pregnancy outcome and perinatal outcome according to Asian standards.Methods: This is an institutional retrospective, descriptive study of 100 pregnant women conducted in the department of obstetrics and gynaecology of a rural tertiary centre Dr. PSIMS and RF, Chinaoutpalli, Gannavaram, Vijayawada, AP, India from June 2017 to July 2019.Results: It was observed that as BMI increased risk of complications increased like hypertension disorders in pregnancy, gestational diabetes mellitus, preterm labour. Also risk of macrosomia, operative delivery, Neonatal intensive care unit (NICU) admissions increased.Conclusions: As maternal BMI is a good predictor has strong correlation with pregnancy complications and outcomes, measures should be taken to motivate for pre pregnancy counselling regarding weight management and close surveillance in antenatal period to diagnose at the earliest any complications.


PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244986
Author(s):  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Marian Knight ◽  

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.


Author(s):  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Marian Knight ◽  

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.


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 ◽  
...  

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).


2021 ◽  
Vol 10 (8) ◽  
pp. 1564
Author(s):  
Clara Pons-Duran ◽  
Aina Casellas ◽  
Azucena Bardají ◽  
Anifa Valá ◽  
Esperança Sevene ◽  
...  

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.


2020 ◽  
Vol 30 (5) ◽  
pp. 686-691
Author(s):  
Christina J. Ge ◽  
Amanda C. Mahle ◽  
Irina Burd ◽  
Eric B. Jelin ◽  
Priya Sekar ◽  
...  

AbstractObjective:To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD.Study design:A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery.Results:Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06–2.10).Conclusions:Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.


Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.


2021 ◽  
Vol 29 (1) ◽  
pp. 36
Author(s):  
Fita Maulina ◽  
M Adya F F Dilmy ◽  
Ali Sungkar

Objectives: To report maternal and perinatal outcomes of hyperthyroidsm in pregnancy.Case Report: There were 3622 cases of delivering pregnant women during the period of the study. From this number, the prevalence of pregnant women with hyperthyroid was 0.2 %. We reported 9 cases of hyperthyroid in pregnancy. The number of pregnancy complication and outcome on pregnant women with hyperthyroidism were preterm labor (44%) and preeclampsia (22%), both were found in group of mother who did taking antihyperthyroid therapy. In those who did not take antihyperthyroid therapy 11% had spontaneous abortion and 11% had preterm delivery. Fetal complications were intrauterine growth restriction (11%) and intrauterine fetal death (23%), both of these complication were on the group who did not take antihyperthyroid. On the contrary, 44% babies were born with normal birthweight in group who took antihyperthyroid.Conclusion: There were differences noted between the group that took adequate treatment and the group that did not take antihyperthyroid. The incidence of intrauterine growth restriction and intrauterine fetal death were high in group that did not took antihyperthyroid therapy but the incidence of preterm delivery as the maternal complication was high in group that did take the antihyperthyroid therapy.  


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Elena Prokopenko ◽  
Aleksei Zulkarnaev ◽  
Irina Nikol`skaya ◽  
Andrey Vatazin ◽  
Daria Penzeva

Abstract Background and Aims Pregnancy in patients with chronic glomerulonephritis (CGN) is associated with higher risk of complications and unfavorable outcomes compared to the general population. The aim of the study was to determine the incidence of pregnancy complications and outcomes in patients with preexisting CGN. Method 126 pregnancies in 119 women with CGN and CKD 1-4 stages: 1 st. – 86 patients, 2 st. – 17, 3 st. – 20, 4 st. – 3 and 20 pregnancies in 20 age-matching healthy women were included. Patients with secondary CGN, multiple pregnancy, pregnancy after IVF were excluded. A kidney biopsy was performed in 18 of 119 (15.1%) women: 15 – before conception and 3 – after delivery. IgA-nephropathy was detected in 11 of 18 (61.1%) patients, MCD/FSGS – in 4 (22.2%), MPGN – in 3 (16.7%). The incidence of unfavorable pregnancy outcome, preeclampsia (PE), preterm delivery, cesarean section (CS), low birth weight (LBW &lt; 2500 g), small for gestational age (SGA) newborn (birth weight &lt; 10th percentile), mean term of delivery, mean birth weight, frequency of treatment in neonatal intensive care unit (NICU) and achieving of end-stage kidney disease in mothers after delivery were evaluated. Results CKD was first diagnosed during pregnancy in 34.1% women with CGN. The incidence of adverse pregnancy outcomes, preterm delivery, LBW, SGA, and treatment in the NICU did not differ between groups, while the frequency of PE and CS were higher, and mean gestational age at delivery, birth weight were lower in the CGN group compared to the healthy control (Table). Severe PE was observed in 6 of 32 (18.7%) patients with PE and CGN. The incidence of PE increased in advanced stages of CKD, but the differences were not significant: 19.8% - in CKD1, 35.3% - CKD2, 35% - CKD3, 66.7% - CKD4, p=0.112. The frequency of PE depended on the presence of baseline nephrotic-range proteinuria (NPU) and chronic arterial hypertension (AH): PE was observed in women w/o NPU and w/o AH in 8.3% cases, w/o NPU and with AH – in 39%, with NPU and w/o AH – in 44,4%, with NPU and with AH – in 43.8%, p=0.00048. Preterm delivery, CS and LBW were more common in women with chronic renal failure, and their frequency increased with increasing severity of CKD: CKD1 – 3.5%, 21.2%, 3.5% resp.; CKD2 – 6.7%, 53.3%, 20%; CKD3 – 40%, 70%, 40%; CKD4 – 100%, 100%, 100% (p&lt;0.0001, for all characteristics). We found differences in gestational age at delivery depending on the stages of CKD: in CKD1 it was 38.9 ± 1.3 wks, CKD2 – 38.2 ± 2.1 wks, CKD3 – 36.3 ± 3.5 wks, CKD4 – 32.4 wks (one child), p=0.00013. The proportion of newborns requiring intensive care was higher in mothers with CKD3 (30%) and CKD4 (100%) compared with CKD1 (0%) and CKD2 (13.3%), p&lt;0.0001. Five of 126 (4%) patients in CGN group achieved stage 5 CKD with average postpartum follow-up period of 92.6 ± 20.5 months; 4 women had CKD3 during pregnancy, one – CKD1. Now 2 patients are treated with regular hemodialysis, 3 - live with kidney transplant. Conclusion Chronic glomerulonephritis has a negative effect on pregnancy course, increasing the incidence of PE and CS and contributing to reduce gestational age and birth weight. Incidence of preterm delivery, CS, LBW and proportion of newborns treated in NICU were highest in patients with CKD 3-4.


Sign in / Sign up

Export Citation Format

Share Document