SARS-CoV-2 in Pregnancy: Fitting Into the Existing Viral Repertoire

The risk of viral infection during pregnancy is well-documented; however, the intervention modalities that in practice enable maternal-fetal protection are restricted by limited understanding. This becomes all the more challenging during pandemics. During many different epidemic and pandemic viral outbreaks, worse outcomes (fetal abnormalities, mortality, preterm labor, etc.) seem to affect pregnant women than what has been evident when compared to non-pregnant women. The condition of pregnancy, which is widely understood as “immunosuppressed,” needs to be re-understood in terms of the way the immune system works during such a state. The immune system gets transformed to accommodate and facilitate fetal growth. The interference of such supportive conversion by viral infection and the risk of co-infection lead to adverse fetal outcomes. Hence, it is crucial to understand the risk and impact of potent viral infections likely to be encountered during pregnancy. In the present article, we review the effects imposed by previously established and recently emerging/re-emerging viral infections on maternal and fetal health. Such understanding is important in devising strategies for better preparedness and knowing the treatment options available to mitigate the relevant adverse outcomes.

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Case 39

Oxford Case Histories in Infectious Diseases and Microbiology ◽

10.1093/med/9780198846482.003.0039 ◽

2020 ◽

pp. 269-276

Author(s):

Katie Jeffery

Keyword(s):

Viral Infection ◽

Viral Infections ◽

Parvovirus B19 ◽

Adverse Outcomes ◽

Varicella Zoster ◽

Parvovirus B19 Infection ◽

Diagnostic Approaches ◽

In Pregnancy

Viral infection in pregnancy can lead to adverse outcomes for both the mother and the foetus. This chapter examines the steps to be taken on exposure to viruses associated with rash illness in pregnancy. Consideration is given to the important points in the history, which viral infections are of concern in pregnancy (varicella-zoster, parvovirus B19, rubella, measles, and Zika), the possible outcomes of infection, diagnostic approaches, and the management of a confirmed case of Parvovirus B19 infection.

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The Impact of Microorganisms in Pregnancy

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2021/v19i530326 ◽

2021 ◽

pp. 22-38

Author(s):

Nastaran Ghandali ◽

Hoda Sabati ◽

Ali Emami ◽

Masumeh Dadashaliha

Keyword(s):

Pregnant Women ◽

Viral Infections ◽

Adverse Outcomes ◽

Physiological Changes ◽

Timely Manner ◽

Increased Risk ◽

Recent Outbreak ◽

Immune Changes ◽

The Impact ◽

In Pregnancy

The pregnancy process involves many physiological changes, including weight gain, hormonal, metabolic and immune changes. One of the effective factors in this process is infection caused by microorganisms. Originally, before the advent of antibiotics, pregnancy was known as a risk factor for severe complications of pneumococcal pneumonia. Among viral infections, the 2009 flu pandemic issued a newer warning that some infections may disproportionately affect pregnant women and cause miscarriage and its complications during pregnancy. Generalization of pregnancy as a condition of suppression of the general immune system or increased risk is misleading and prevents the establishment of adequate guidelines for the treatment of pregnant women during epidemics. Viral infection has also become an important factor in pregnancy conditions. The recent outbreak of Ebola and other viral outbreaks and epidemics shows how pregnant women show worse outcomes (such as preterm delivery and fetal adverse outcomes) than the general population and non-pregnant women. The purpose of this article is studying pathogenesis of microorganisms and the risks which pose to the mother and the fetus. In order to investigate these factors, from 120 article prepared from google scholar and Pub med, Elsevier database. Knowing these factors can increase the ability to treat the infections in a timely manner and prevent their effects on the fetus and the patient.

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Remotely delivered interventions to support women with symptoms of anxiety in pregnancy: a mixed methods systematic review of quantitative and qualitative evidence (Preprint)

10.2196/preprints.28093 ◽

2021 ◽

Author(s):

Kerry Evans ◽

Stefan Rennick-Egglestone ◽

Serena Cox ◽

Yvonne Kuipers ◽

Helen Spiby

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Quantitative Data ◽

Meta Analysis ◽

Treatment Options ◽

Social Science Citation Index ◽

Cochrane Library ◽

Access To Treatment ◽

On Line ◽

In Pregnancy

BACKGROUND Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low level psychological therapy is recommended as first line treatment options for women with mild to moderate anxiety, with the aim to prevent an escalation of symptoms and provide women with coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support for women in pregnancy and provide a cost-effective, flexible and timely solution. OBJECTIVE To identify and evaluate remotely delivered, digital or on-line interventions to support women with symptoms of anxiety in pregnancy. METHODS A mixed method systematic review following a convergent segregated approach to synthesise the qualitative and quantitative data. The ACM Digital Library, AMED, ASSIA, CRD, CENTRAL, the Cochrane Library, CINAHL, EMBASE, HTA, IEEE Xplore, JBI, Maternity and Infant Care, Medline, PsycINFO and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research including pregnant women which evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women’s views, feedback and opinions were included in the review. RESULTS Three qualitative and 14 were quantitative studies included. Populations included a general antenatal population, and pregnant women with anxiety and depression, fear of childbirth, insomnia and pre-term labour. Interventions included CBT, Problem Solving, Mindfulness and Educational designs. Most interventions were delivered via on-line platforms and 8 included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found for I-CBT and facilitated interventions there was observed beneficial effect in relation to the reduction of anxiety scores (SMD=-0.49; 95% CI=-0.75 to -0.22; SMD=-0.48; 95% CI=-0.75 to -0.22). However, due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesised findings from quantitative and qualitative data found some evidence to suggest that interventions are more effective when women are motivated to maintain regular participation in interventions. Participation may be enhanced by providing regular contact with therapists, targeting interventions for women with anxiety symptoms; providing peer support forums; including components of relaxation and cognitive based skills; and providing sufficient sessions to develop new skills without being too time consuming. CONCLUSIONS There is limited evidence to suggest that pregnant women may benefit from remotely delivered interventions. The synthesised findings highlighted components of interventions which may improve the effectiveness and acceptability of remotely delivered interventions. These include providing women with contact with a therapist, healthcare professional or peer community. Women may be more motivated to complete interventions which are perceived as relevant or tailored to their needs and situations. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.

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COVID-19 OUTCOMES IN PREGNANCY: A REVIEW OF 275 SCREENED STUDIES

10.1101/2021.08.28.21262778 ◽

2021 ◽

Author(s):

Rupalakshmi Vijayan ◽

Hanna Moon ◽

Jasmine Joseph ◽

Madiha Zaidi ◽

Chhaya Kamwal ◽

...

Keyword(s):

Literature Review ◽

Pregnant Women ◽

Direct Evidence ◽

Case Series ◽

Adverse Outcomes ◽

Morbidity And Mortality ◽

World Health ◽

Increased Risk ◽

Immunological Changes ◽

In Pregnancy

In December 2019, a novel strain of severe acute respiratory syndrome (SARS-CoV-2), was declared as a cause of respiratory illness, called coronavirus 2019 (COVID-19), characterized by fever and cough. In diagnostic imaging, the afflicted population showed pathognomonic findings of pneumonia. What started out as an epidemic in China, rapidly spread across geographical locations with a significant daily increase in the number of affected cases. According to the World Health Organization (WHO) reports, the range of worldwide mortality is 3 to 4%. Maternal adaptations and immunological changes predispose pregnant women to a prolonged and severe form of pneumonia, which results in higher rates of maternal, fetal, and neonatal morbidity and mortality. There is limited data about the consequences of COVID-19 in pregnancy, thereby limiting the prevention, counseling, and management of these patients. The objective of this literature review is to explore pregnancy and perinatal outcomes of COVID-19, complications, morbidity, and mortality in this sub-population. We conducted a literature review pertaining to COVID-19 and pregnancy in databases such as: PubMed, Google Scholar, and Science Direct. The studies we chose to focus on were systematic reviews, meta-analysis, case series, and case reports. Twenty four articles were reviewed regarding COVID-19 and pregnancy, complications and their outcomes. Due to immunological changes during pregnancy as evidenced by the flaring of auto-immune diseases; pregnant women may be at an increased risk for infection. Women (19.7%) who had underlying comorbidities such as gestational DM, HTN, hypothyroidism, and autoimmune disease, COPD, or HBV infection were considered high risk. The most common maternal outcomes were premature rupture of membranes (PROM) and pre-eclampsia. Asthma was the most common comorbidity associated with maternal mortality. The most common neonatal complications were fetal distress leading to NICU admissions and preterm birth <37 weeks. The most common laboratory changes were elevated CRP and lymphocytopenia. Most patients underwent C-section due to their underlying comorbidities. Pregnant and lactating women did not shed viral particles through their vaginal mucus and milk, as evidenced by negative nucleic-acid tests of these secretions. Neonatal infections as demonstrated by positive RT-PCR were rare, but direct evidence supporting intrauterine transmission was not confirmed. Direct evidence indicating vertical transmission of COVID-19 is not available, but risk for transmission cannot be ruled out. Pregnant women should be closely monitored due to increased risk of adverse outcomes.

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Regulatory T Cells in Pregnancy Adverse Outcomes: A Systematic Review and Meta-Analysis

Frontiers in Immunology ◽

10.3389/fimmu.2021.737862 ◽

2021 ◽

Vol 12 ◽

Author(s):

Samantha Green ◽

Marina Politis ◽

Kathrine S. Rallis ◽

Alba Saenz de Villaverde Cortabarria ◽

Athina Efthymiou ◽

...

Keyword(s):

Systematic Review ◽

T Cells ◽

Regulatory T Cells ◽

Pregnant Women ◽

Peripheral Blood ◽

Meta Analysis ◽

Adverse Outcomes ◽

Case Control Studies ◽

Inconsistency Index ◽

In Pregnancy

BackgroundSeveral studies report the role of Regulatory T-cells (Tregs) in the pathophysiology of pregnancy adverse outcomes.ObjectiveThe aim of this systematic review and meta-analysis was to determine whether there is an association between regulatory T cell levels and pregnancy adverse outcomes (PAOs), including pre-eclampsia and preterm birth (PTB).MethodLiterature searches were conducted in PubMed/MEDLINE, Embase, and Cochrane CENTRAL databases. Inclusion criteria were original articles (clinical trials, case-control studies and cohort studies) comparing Tregs, sampled from the decidua or maternal blood, in healthy pregnant women versus women with pre-eclampsia or PTB. The outcome was standardised mean difference (SMD) in Treg numbers. The tau-squared (Tau²), inconsistency index (I²), and chi-squared (χ²) test quantified heterogeneity among different studies. Analyses were performed in RevMan software V.5.4.0 for Mac using a random-effects model with outcome data reported with 95% confidence intervals (CI). This study was prospectively registered with PROSPERO (CRD42020205469). PRISMA guidelines were followed.ResultsFrom 4,085 unique studies identified, 36 were included in qualitative synthesis, and 34 were included in quantitative synthesis (meta-analysis). In total, there were 1,783 participants in these studies: healthy controls=964, pre-eclampsia=759, PTB=60. Thirty-two studies compared Tregs in healthy pregnant women and women with pre-eclampsia, and 30 of these sampled Tregs from peripheral blood showing significantly higher Treg numbers in healthy pregnancies (SMD; 1.46; 95% CI, 1.03–1.88; I²=92%). Four studies sampled Tregs from the maternal decidua showing higher Tregs in healthy pregnancies (SMD, 0.76; 95% CI, -0.13–1.65; I²=84%). No difference was found in the number of Tregs between early versus late pre-eclampsia (SMD,-1.17; 95% CI, -2.79–0.44; I²=94%). For PTB, two studies compared Tregs sampled from the peripheral blood with a tendency for higher Tregs in healthy pregnancies but this did not reach significance (SMD, 2.18; 95% CI, -1.34–5.70; I²=96%). Subcohort analysis using Treg analysis (flow cytometry vs. qPCR vs. immunofluorescence tissue staining) showed similar associations.ConclusionLower Tregs in pregnancy, sampled from the maternal peripheral blood, are associated with pre-eclampsia. There is a need for further studies to confirm a relationship between low Tregs and PTB. As the precise mechanisms by which Tregs may mediate pre-eclampsia and PTB remain unclear, further fundamental research is necessary to elucidate the underlying processes and highlight the causative link.Systematic Review RegistrationPROSPERO, identifier CRD42020205469.

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The Trans-zoonotic Virome interface: Measures to balance, control and treat epidemics

10.29328/journal.abse.1001009 ◽

2020 ◽

Vol 4 (1) ◽

pp. 020-027

Author(s):

Nikhra Vinod

Keyword(s):

Immune Response ◽

Viral Load ◽

Immune System ◽

Viral Infection ◽

Antiviral Therapy ◽

Viral Infections ◽

Habitat Destruction ◽

Interferon Response ◽

Viral Diseases ◽

Intracellular Parasites

The global virome: The viruses have a global distribution, phylogenetic diversity and host specificity. They are obligate intracellular parasites with single- or double-stranded DNA or RNA genomes, and afflict bacteria, plants, animals and human population. The viral infection begins when surface proteins bind to receptor proteins on the host cell surface, followed by internalisation, replication and lysis. Further, trans-species interactions of viruses with bacteria, small eukaryotes and host are associated with various zoonotic viral diseases and disease progression. Virome interface and transmission: The cross-species transmission from their natural reservoir, usually mammalian or avian, hosts to infect human-being is a rare probability, but occurs leading to the zoonotic human viral infection. The factors like increased human settlements and encroachments, expanded travel and trade networks, altered wildlife and livestock practices, modernised and mass-farming practices, compromised ecosystems and habitat destruction, and global climate change have impact on the interactions between virome and its hosts and other species and act as drivers of trans-species viral spill-over and human transmission. Zoonotic viral diseases and epidemics: The zoonotic viruses have caused various deadly pandemics in human history. They can be further characterized as either newly emerging or re-emerging infectious diseases, caused by pathogens that historically have infected the same host species, but continue to appear in new locations or in drug-resistant forms, or reappear after apparent control or elimination. The prevalence of zoonoses underlines importance of the animal–human–ecosystem interface in disease transmission. The present COVID-19 infection has certain distinct features which suppress the host immune response and promote the disease potential. Treatment for epidemics like covid-19: It appears that certain nutraceuticals may provide relief in clinical symptoms to patients infected with encapsulated RNA viruses such as influenza and coronavirus. These nutraceuticals appear to reduce the inflammation in the lungs and help to boost type 1 interferon response to these viral infections. The human intestinal microbiota acting in tandem with the host’s defence and immune system, is vital for homeostasis and preservation of health. The integrity and balanced activity of the gut microbes is responsible for the protection from disease states including viral infections. Certain probiotics may help in improving the sensitivity and effectivity of immune system against viral infections. Currently, antiviral therapy is available only for a limited number of zoonotic viral infections. Because viruses are intracellular parasites, antiviral drugs are not able to deactivate or destroy the virus but can reduce the viral load by inhibiting replication and facilitating the host’s innate immune mechanisms to neutralize the virus. Conclusion: Lessons from recent viral epidemics - Considering that certain nutraceuticals have demonstrated antiviral effects in both clinical and animal studies, further studies are required to establish their therapeutic efficacy. The components of nutraceuticals such as luteolin, apigenin, quercetin and chlorogenic acid may be useful for developing a combo-therapy. The use of probiotics to enhance immunity and immune response against viral infections is a novel possibility. The available antiviral therapy is inefficient in deactivating or destroying the infecting viruses, may help in reducing the viral load by inhibiting replication. The novel efficient antiviral agents are being explored.

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Hypothyroidism and Pregnancy outcome

Asian Journal of Pharmacy Nursing and Medical Sciences ◽

10.24203/ajpnms.v9i3.6671 ◽

2021 ◽

Vol 9 (3) ◽

Author(s):

Emad Alsharu ◽

Bassam Nussair ◽

Jameel Marabha ◽

Ala Hindawi

Keyword(s):

Pregnant Women ◽

Pregnancy Outcome ◽

Preterm Labor ◽

Labor Pain ◽

Control Group ◽

Group I ◽

Antenatal Clinics ◽

Group Ii ◽

Hypothyroid Patients ◽

In Pregnancy

OBJECTIVE: To evaluate maternal and perinatal outcomes among ladies treated for hypothyroidism in pregnancy at antenatal clinics of King Hussein Medical Centre. METHODS: This study was conducted at antenatal clinics of King Hussein medical center during the period from April 2018 to April 2020. We studied 200 pregnant women with hypothyroidism as a study group (group I) who were compared to 200 euthyroid pregnant women as a control group (group II). RESULTS: The incidence of obstetric complications in group I vs group II found to be as the followings: Pre-eclampsia 12%(24) vs 9%(18), miscarriage 10%(20) vs 4%(8), while preterm labor was 20%(40) vs 22%(44), the antepartum hemorrhage 5%(10) vs 4%(8), Post-partum hemorrhage 7%(14) vs 5%(10) respectively. There were no significant statistical differences in these outcomes in both groups and preterm labor pain was the most frequent pregnancy complication encountered (20% vs, 22 %) CONCLUSION: Proper treatment of hypothyroid patients before pregnancy and throughout pregnancy would probably eliminate the potential risk of developing maternal and fetal complications, treated hypothyroid patients hold no significant differences in pregnancy-related complications once compared to euthyroid women. Keywords: Hypothyroidism, Pregnancy, Outcome

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Is the Host Viral Response and the Immunogenicity of Vaccines Altered in Pregnancy?

Antibodies ◽

10.3390/antib9030038 ◽

2020 ◽

Vol 9 (3) ◽

pp. 38

Author(s):

Zainab Saeed ◽

Orene Greer ◽

Nishel Mohan Shah

Keyword(s):

Pregnant Women ◽

Viral Infections ◽

Vaccine Development ◽

Chronic Illnesses ◽

Maternal Immune System ◽

Clinical Protection ◽

Maternal Immune Response ◽

Respiratory Viral Infections ◽

Pandemic Vaccine ◽

In Pregnancy

The intricacy of the maternal immune system arises from its ability to prevent a maternal immune response against a semi-allogenic fetus, while protecting the mother against harmful pathogens. However, these immunological adaptations may also make pregnant women vulnerable to developing adverse complications from respiratory viral infections. While the influenza and SARS pandemics support this theory, there is less certainty regarding the clinical impact of SARS-CoV-2 in pregnancy. In the current COVID-19 pandemic, vaccine development is key to public preventative strategies. Whilst most viral vaccines are able to induce a seroprotective antibody response, in some high-risk individuals this may not correlate with clinical protection. Some studies have shown that factors such as age, gender, and chronic illnesses can reduce their effectiveness and in this review, we discuss how pregnancy may affect the efficacy and immunogenicity of vaccines. We present literature to support the hypothesis that pregnant women are more susceptible to respiratory viral infections and may not respond to vaccines as effectively. In particular, we focus on the clinical implications of important respiratory viral infections such as influenza during pregnancy, and the pregnancy induced alterations in important leukocytes such as TFH, cTFH and B cells, which play an important role in generating long-lasting and high-affinity antibodies. Finally, we review how this may affect the efficacy of vaccines against influenza in pregnancy and highlight areas that require further research.

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Association of Thyroid Dysfunction and Pregnancy Outcomes

10.53350/pjmhs2115123367 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3367-3369

Author(s):

Nagina Bibi ◽

Iram Inam ◽

Ghiasul Hassan

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Thyroid Dysfunction ◽

Adverse Outcomes ◽

Common Finding ◽

P Value ◽

Binary Logistic Regression Analysis ◽

Thyroid Disorder ◽

Singleton Pregnancy ◽

In Pregnancy

Background: Hypothyroidism in pregnancy results in serious consequences for both mother and fetus. Pregnant women are prone to thyroid dysfunction due to physiological changes taking place in body. This study is undertaken to see the effect of thyroid dysfunction on pregnancy outcomes. Methodology: A prospective observational study was done. Study was conducted in a private gynecological and obstetric unit. A sample size of 200 women in selected institute with singleton pregnancy was recruited. Pregnant women with chronic disabilities and previously known thyroid disorders were excluded. Data was analyzed using SPSS version 23.0 and binary logistic regression analysis was done. Ethical rules were followed throughout the study and consent taken from all participants. Results: Out of 200, 23 participants were positive for thyroid disorder. Thyroid dysfunctions are responsible for causing multiple complications in pregnancy for mother and fetus. Findings suggest a signification association of thyroid dysfunction and feto-maternal consequences (p-value <0.005). Conclusion: Subclinical hypothyroidism is a common finding during pregnancy. It is compulsory to detect and treat thyroid dysfunction early in pregnancy so that adverse outcomes could be avoided. There is a need for timely screening of thyroid profile in suspected pregnancies. keywords: TSH, FT3, FT4, Pregnancy, Outcomes.

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The status of probiotics supplementation during pregnancy

Medical Journal of Indonesia ◽

10.13181/mji.v24i2.1223 ◽

2015 ◽

Vol 24 (2) ◽

pp. 120-30

Author(s):

Noroyono Wibowo ◽

Johanes C. Mose ◽

Made K. Karkata ◽

Bangun T. Purwaka ◽

Herman Kristanto ◽

...

Keyword(s):

T Cells ◽

Pregnant Women ◽

Mechanism Of Action ◽

Atopic Eczema ◽

Clinical Setting ◽

Preterm Labor ◽

Medical Field ◽

The Status ◽

Long Time ◽

In Pregnancy

Probiotics have been known for their use in medical field for quite a long time. Strong evidences are now available for the use of probiotics in clinical setting. One of the current issues on this topic is the use of probiotics in pregnancy. Recent studies showed that probiotics may be safe and beneficial for prenatal supplementation. In this review, we highlighted several proven use of probiotics supplementation in pregnant women. A few selected strains of probiotics showed promising outcome to prevent preterm labor and preeclampsia, and to reduce atopic eczema but not asthma and wheezing, in offspring of women who had prenatal probiotics supplementation. The mechanism of action responsible for this effect is closely related to the regulation of T cells, although the exact pathways are not defined yet.

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