Immunological aspects of coronavirus disease during pregnancy: an integrative review

SUMMARY OBJECTIVE To review the immunological aspects of the 2019 coronavirus disease (COVID-19) in pregnancy, based on the scientific evidence currently available. METHODS An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed) and LILACS databases, using the descriptors “pregnancy” and “COVID-19”. This search included articles published up until 14th April 2020 published in English, Spanish or Portuguese. After reading the articles available in their entirety, those related specifically to the immunological aspects of the disease in pregnancy were selected. We initially found a total of 62 articles; 52 were accessed in full-text, and 5 were finally selected. RESULTS Pregnant women are more affected by respiratory diseases possibly because of physiological, immune, and anatomical changes. Some studies highlight the important shift to a T-helper lymphocyte type 2 (Th2) immune response in pregnancy, as a potential contributor to the severity in cases of COVID-19. Additionally, the cytokine storm present in severe cases leads to an increased inflammatory state, which may deteriorate the clinical prognosis in this population. Therefore, pregnant women may represent a vulnerable group to COVID-19 infection, primarily due to the immune imbalance in the maternal-fetal interface. CONCLUSION Maternal immune response probably plays an important role in the pathophysiology of this infection, although some details remain unsolved. Although further studies are needed to deeply investigate the immunological aspects of the disease in pregnancy, our findings may provide insights into the possible immune mechanisms involved in the pathophysiology of COVID-19 in pregnancy.

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Pregnant Women Positioning in Spinal Anesthesia for Cesarean Section: Integrative Review

International Archives of Medicine ◽

10.3823/2449 ◽

2017 ◽

Vol 10 ◽

Cited By ~ 1

Author(s):

Sarah Lima Pinto ◽

Geórgia Alcântara Alencar Melo ◽

Lívia Moreira Barros ◽

Nelson Miguel Galindo Neto ◽

Kenya Waleria de Siqueira Coêlho Lisboa ◽

...

Keyword(s):

Cesarean Section ◽

Pregnant Women ◽

Spinal Anesthesia ◽

Scientific Evidence ◽

Patient Positioning ◽

Lateral Position ◽

Integrative Review ◽

Review Of The Literature ◽

Multidisciplinary Practice ◽

Lateral Decubitus

Objective: to analyze the scientific evidence on the positioning of pregnant women in spinal anesthesia for cesarean section. Method: an integrative review of the literature in the Scopus, CINAHL, LILACS and PubMed databases using the descriptors "patient positioning", "spinal anesthesia" and "obstetrics" and their synonyms "patient position" and "spinal anesthetics". Results: the sample of 8 articles showed that the fastest onset of blockade in pregnant women occurs in the lateral horizontal decubitus position and in the sitting position with legs downwards. Lateral decubitus with elevated head presented insufficient blockade. Lateral position was related to greater comfort, and its maintenance for 15 minutes before the supine position, after infiltration with the anesthetic was associated with lower incidence of hypotension. Conclusion: Scientific evidence has shown that positioning influences the effect, potentiation and delay of anesthesia, comfort and the pregnant woman's blood pressure, being relevant to the perioperative and obstetric multidisciplinary practice.

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Associations Among Obesity, Inflammation, and Tryptophan Catabolism in Pregnancy

Biological Research For Nursing ◽

10.1177/1099800417738363 ◽

2017 ◽

Vol 20 (3) ◽

pp. 284-291 ◽

Cited By ~ 6

Author(s):

Maureen Groer ◽

Dietmar Fuchs ◽

Allyson Duffy ◽

Adetola Louis-Jacques ◽

Amy D’Agata ◽

...

Keyword(s):

Pregnant Women ◽

Depressed Mood ◽

Inverse Correlation ◽

Cross Sectional Study ◽

Cross Sectional ◽

Inflammatory State ◽

Tryptophan Catabolism ◽

Obesity In Pregnancy ◽

Positive Correlations ◽

In Pregnancy

Objective: To evaluate relationships among obesity in pregnancy and plasma levels of tryptophan (TRP) and kynurenine (KYN), inflammatory markers, and depressed mood. Methods: Pregnant women ( N = 374) were enrolled, and data were collected at a mean gestation of 20 weeks in this cross-sectional study. Plasma was analyzed for TRP, KYN, neopterin, and nitrite levels. Women completed demographic and mood scales. Results: There was a statistically significant inverse correlation between body mass index (BMI) and TRP and positive correlations between BMI and KYN and the kynurenine/tryptophan (KYN/TRP) ratio. Neopterin was correlated with KYN/TRP, suggesting that the indoleamine 2,3-dioxygenase-1 (IDO-1) enzyme was activated. The correlations of neopterin and nitrite with BMI were too small to be clinically meaningful but may provide mechanistic insight. There was a correlation between depressed mood and nitrite levels. Depressed mood was also associated with lower TRP levels. When the sample was divided into pregnant women with or without obesity, TRP was significantly lower and the KYN/TRP ratio was significantly higher in the women with obesity. Conclusion: The pro-inflammatory state of obesity in pregnancy may drive activation of IDO-1, resulting in diversion of TRP away from serotonin and melatonin production and toward KYN metabolites. This alteration could contribute to depression, impaired sleep, increased production of excitotoxic neurotransmitters, and reinforcement of a pro-inflammatory state in pregnancy.

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Coronavirus (COVID 19) Infection in Pregnancy

Colombia Medica ◽

10.25100/cm.v51i2.4271 ◽

2020 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Edgar Ivan Ortiz ◽

Enrique Herrera Castañeda ◽

Alejandro De La Torre

Keyword(s):

Decision Making ◽

General Population ◽

Best Practices ◽

Pregnant Women ◽

Scientific Evidence ◽

Recent Infection ◽

The World ◽

Expectant Mothers ◽

In Pregnancy

Coronavirus illness 2019 (COVID-19) is an airways infection caused by the new coronavirus (SARS-CoV-2) which has been quickly disseminated all over the world, affecting to the general population including women in pregnancy time. As being a recent infection, the evidence that supports the best practices for the management of the infection during pregnancy is limited, and most of the questions have not been completely solved yet. This publication offers general guidelines focused on decision-making people, managers, and health’s teams related to pregnant women attention and newborn babies during COVID-19 pandemic. Its purpose is to promote useful interventions to prevent new infections as well as prompt and adequate attention to avoid serious complications or deaths, trying to be adapted to the different contexts in which attention to expectant mothers is provided. Guidelines are set within a well-scientific evidence and available recommendations up to date.

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Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Scientific Evidence and What Is Being Said in the Media—A Systematic Review

Brain Sciences ◽

10.3390/brainsci8080155 ◽

2018 ◽

Vol 8 (8) ◽

pp. 155 ◽

Cited By ~ 5

Author(s):

Anna Kurzeck ◽

Beatrice Kirsch ◽

Elif Weidinger ◽

Frank Padberg ◽

Ulrich Palm

Keyword(s):

Pregnant Women ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Scientific Evidence ◽

Medical Databases ◽

Direct Current Stimulation ◽

Emotional Perception ◽

Treatment Of Depression ◽

The Media ◽

In Pregnancy

Major depression is the most frequent morbidity in pregnancy. The first-line therapies, psychopharmacologic treatment and psychotherapy, are either insufficient or may cause severe or teratogenic adverse events. As a result of its local limitation to the patient’s brain, transcranial direct current stimulation (tDCS) could potentially be an ideal treatment for pregnant women with depression. A literature search was conducted in medical databases, globally published newspapers, search engines, and clinical trial registers to collect all articles on tDCS for the treatment of depression during pregnancy. The aim of this review was to investigate the scientific evidence of tDCS use for depression during pregnancy and to compare these results with the textual and emotional perception in the media as interventions during pregnancy are under particular surveillance. We detected 13 medical articles dealing with tDCS for depression in pregnancy. Overall, the scientific evidence as well as articles in the media for tDCS in pregnancy are sparse, but promising. Further studies are required in this specifically vulnerable population of pregnant women to generate evidence. It is likely that public interest will increase when the results of a pilot study in Canada are published.

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Epidemiology of cytomegalovirus infection in pregnant women living in the Greater Romagna Area, Italy

Microbiologia Medica ◽

10.4081/mm.2015.5083 ◽

2015 ◽

Vol 30 (2) ◽

Author(s):

Patrizia Billi ◽

Mara Della Strada ◽

Simona Semprini ◽

Vittorio Sambri

Keyword(s):

Immune Response ◽

Pregnant Women ◽

Cytomegalovirus Infection ◽

Cmv Infection ◽

Serological Tests ◽

Best Management ◽

Igm Antibodies ◽

North East ◽

In Pregnancy ◽

Romagna Area

Background. Aim of this study was to assess the incidence of Cytomegalovirus (CMV) infection in pregnant women living in Romagna area, in North East Italy to implement the best management of this infection. Materials and Methods. In 2012, 23,727 serological tests for CMV IgG and IgM antibodies were performed in the Microbiology Unit, the Hub Laboratory of the Greater Romagna Area: 6931 were pregnant women. Results and Conclusions. 179 subjects were positive for CMV IgM antibodies: 82 were not pregnant; 97 were IgM positive during pregnancy or in the course of a pre-conception evaluation. The detected incidence of the CMV infection in pregnancy (calculated at 1.40%) actually validates the literature data. This study’s findings clearly underline the usefulness of testing the CMV specific immune response in the pre-conception period or as early as possible during pregnancy.

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Immune Response to COVID-19 During Pregnancy

Frontiers in Immunology ◽

10.3389/fimmu.2021.675476 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ge Chen ◽

Qiuyue Liao ◽

Jihui Ai ◽

Bin Yang ◽

Hualin Bai ◽

...

Keyword(s):

Immune Response ◽

Pregnant Women ◽

Nk Cell ◽

Clinical Symptoms ◽

Cell Activity ◽

Innate Immune ◽

Pregnant Female ◽

Reactive Protein ◽

The Impact ◽

In Pregnancy

Pregnant women are generally more susceptible to viral infection. Although the impact of SARS-CoV-2 on pregnant women remains to be determined, evidence indicates that risks of adverse clinical outcomes are similar in pregnancy to the general population. Here we analyzed clinical symptoms and outcomes of 20 pregnant and 299 reproductive-aged non-pregnant female COVID-19 patients who were hospitalized during the same period. Laboratory measurements were compared among mild cases and healthy pregnant women. Our study found that pregnant patients showed enhanced innate immune response evident by higher neutrophils and C-reactive protein. Cytokines, chemokines, and growth factors (CCGFs) profiles from 11 pregnant and 4 non-pregnant COVID-19 patients and 10 healthy pregnant female patients, and lymphocyte subsets analysis of 7 pregnant patients and 19 non-pregnant patients, indicate suppressed cytokine storm and potential enhanced CD8+ T cell and NK cell activity in pregnant patients with COVID-19, which may be essential in contributing to the unique anti-SARS-CoV-2 response in pregnancy.

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Complications, clinical manifestations of congenital syphilis, and aspects related to its prevention: an integrative review

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2019-0318 ◽

2021 ◽

Vol 74 (4) ◽

Author(s):

Ana Fátima Braga Rocha ◽

Maria Alix Leite Araújo ◽

Valéria Lima de Barros ◽

Camila Félix Américo ◽

Geraldo Bezerra da Silva Júnior

Keyword(s):

Pregnant Women ◽

Congenital Syphilis ◽

Scientific Evidence ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Integrative Review ◽

Clinical Complications ◽

Low Weight ◽

Prevention Methods ◽

Laboratory Changes

ABSTRACT Objectives: to identify the scientific evidence about the clinical complications and manifestations of congenital syphilis and aspects related to its prevention. Methods: integrative review after a search in the databases LILACS and MEDLINE, carried out in March 2018, using the descriptors “syphilis, congenital”, “complications”, and “signs and symptoms”, leading to the selection of 27 researches. Results: the publications found were published from 1966 to 2017, and most of them were from Latin America and Africa. Negative outcomes, laboratory changes, and the clinical manifestations in congenital syphilis, whether early or delayed, were, respectively: low weight at birth, anemia, hepatosplenomegaly, and dental alterations. The lack of treatment of the pregnant women in the prenatal was the most common occasion in which the opportunity to prevent the complications of congenital syphilis was lost. Conclusions: the scientific evidences analyzed showed serious complications of congenital syphilis that could be avoided if early opportunities of diagnosing and treating the pregnant women are not lost during the prenatal.

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Screening for Toxoplasmosis in Pregnancy: What is the Evidence of Reducing a Health Problem?

Journal of Medical Screening ◽

10.1177/096914139600300406 ◽

1996 ◽

Vol 3 (4) ◽

pp. 188-194 ◽

Cited By ~ 28

Author(s):

Anne Eskild ◽

Andy Oxman ◽

Per Magnus ◽

Arild Bjorndal ◽

Leiv S Bakketeig

Keyword(s):

Pregnant Women ◽

Negative Impact ◽

Transmission Rate ◽

Scientific Evidence ◽

Empirical Studies ◽

Congenital Toxoplasmosis ◽

Congenital Infection ◽

Screening Tests ◽

The Impact ◽

In Pregnancy

Objectives— Toxoplasma gondii is a parasite which may give rise to congenital infection. Screening pregnant women for antibodies against toxoplasmosis is being debated in many countries. The preventive impact of toxoplasmosis screening of pregnant women depends on the magnitude of disease caused by congenital toxoplasmosis (incidence x transmission rate to fetus x diseased proportion of infected children), on the one hand, and the preventable proportion of disease (sensitivity of the screening test x efficacy of the treatment x compliance), on the other. In this study the preventive impact of screening pregnant women for toxoplasmosis antibodies is assessed by letting the value for these variables change within reasonable limits. Methods— To obtain information on these variables, relevant publications were reviewed in the Medline database from 1983 to February 1996 and the Cochrane Pregnancy and Childbirth Database. References in review articles on congenital toxoplasmosis were also studied. Results— The literature review showed that no population based prospective studies of the natural history of toxoplasmosis infection during pregnancy, nor any randomised controlled trials of the efficacy of antiparasitic treatment, had been carried out. In the empirical studies which have been performed the values of most variables show considerable differences. According to these values, the estimates in this study of the impact of toxoplasmosis screening in pregnancy may range from 0 to 40 children in whom disease is preventable per 100 000 pregnant women susceptible to toxoplasmosis infection. Conclusion— Sufficient scientific evidence is not yet available to propose screening for toxoplasmosis in pregnant women, and efforts should be made to provide such knowledge. Also, the magnitude of the negative impact of screening, such as induced abortion of healthy fetuses, anxiety in women with false positive screening tests, and side effects of treatment, has not been sufficiently examined.

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TO REVIEW THE TIMING OF INTERVENTION WHICH WILL PROVIDE THE BEST OUTCOME IN HYPOTHYROIDISM IN PREGNANCY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i4.209 ◽

2019 ◽

Vol 3 (4) ◽

Author(s):

Dr. Archana Mohana ◽

Dr. Sujata Badoniya

Keyword(s):

Pregnant Women ◽

Thyroid Disease ◽

Fetal Outcome ◽

Thyroxine Therapy ◽

In Pregnancy

The Aim of this study is to Review the timing of intervention which will provide the Best Outcome in Hypothyroidism in Pregnancy. Hypothyroid pregnant women are appropriately managed with regular antenatal checkup and thyroxine therapy during pregnancy, a good maternal and fetal outcome can be achieved and congenital cretinism and other neuro developmental sequele in the offspring can be averted. Keywords: Intervention, Hyperthyroidism, Pregnancy & Thyroid disease.

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A COMPARATIVE STUDY OF IODINE METABOLISM IN PREGNANCY, SPORADIC GOITRE AND THYROTOXICOSIS

Acta Endocrinologica ◽

10.1530/acta.0.0480014 ◽

1965 ◽

Vol 48 (1) ◽

pp. 14-22 ◽

Cited By ~ 3

Author(s):

S. A. Aboul-Khair ◽

J. Crooks

Keyword(s):

Comparative Study ◽

Pregnant Women ◽

Iodine Deficiency ◽

Physiological Responses ◽

Iodine Uptake ◽

Thyroid Activity ◽

Deficiency State ◽

Iodine Metabolism ◽

Inorganic Iodine ◽

In Pregnancy

ABSTRACT Studies of iodine metabolism have been carried out in 15 pregnant women, 33 cases with sporadic goitre and 11 with thyrotoxicosis. A low plasma inorganic iodine was common to the three groups. In pregnancy and sporadic goitre the thyroid clearance of iodine was elevated and the absolute iodine uptake normal. A high thyroid clearance of iodine in thyrotoxicosis was associated with a high absolute iodine uptake. The results suggest that both pregnancy and sporadic goitre are physiological responses to an iodine deficiency state while the iodine deficiency state of thyrotoxicosis is secondary to increased thyroid activity.

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