scholarly journals SARS-CoV-2 and the Immune Response in Pregnancy with Delta Variant Considerations

2021 ◽  
Vol 13 (4) ◽  
pp. 993-1008
Author(s):  
Patrida Rangchaikul ◽  
Vishwanath Venketaraman
Keyword(s):  
T Cells ◽  
Pregnant Women ◽  
Severe Disease ◽  
Pregnant Patient ◽  
Host Cells ◽  
Phagocytic Index ◽  
Neutrophil Granulocytes ◽  
Maternal Circulation ◽  
Case Volume ◽  
In Pregnancy

As of September 2021, there has been a total of 123,633 confirmed cases of pregnant women with SARS-CoV-2 infection in the US according to the CDC, with maternal death being 2.85 times more likely, pre-eclampsia 1.33 times more likely, preterm birth 1.47 times more likely, still birth 2.84 times more likely, and NICU admission 4.89 times more likely when compared to pregnant women without COVID-19 infection. In our literature review, we have identified eight key changes in the immunological functioning of the pregnant body that may predispose the pregnant patient to both a greater susceptibility to SARS-CoV-2, as well as a more severe disease course. Factors that may impede immune clearance of SARS-CoV-2 include decreased levels of natural killer (NK) cells, Th1 CD4+ T cells, plasmacytoid dendritic cells (pDC), a decreased phagocytic index of neutrophil granulocytes and monocytes, as well as the immunomodulatory properties of progesterone, which is elevated in pregnancy. Factors that may exacerbate SARS-CoV-2 morbidity through hyperinflammatory states include increases in the complement system, which are linked to greater lung injury, as well as increases in TLR-1 and TLR-7, which are known to bind to the virus, leading to increased proinflammatory cytokines such as IL-6 and TNF-α, which are already elevated in normal pregnant physiology. Other considerations include an increase in angiotensin converting enzyme 2 (ACE2) in the maternal circulation, leading to increased viral binding on the host cell, as well as increased IL-6 and decreased regulatory T cells in pre-eclampsia. We also focus on how the Delta variant has had a concerning impact on SARS-CoV-2 cases in pregnancy, with an increased case volume and proportion of ICU admissions among the infected expecting mothers. We propose that the effects of the Delta variant are due to a combination of (1) the Delta variant itself being more transmissible, contagious, and efficient at infecting host cells, (2) initial evidence pointing to the Delta variant causing a significantly greater viral load that accumulates more rapidly in the respiratory system, (3) the pregnancy state being more susceptible to SARS-CoV-2 infection, as discussed in-depth, and (4) the lower rates of vaccination in pregnant women compared to the general population. In the face of continually evolving strains and the relatively low awareness of COVID-19 vaccination for pregnant women, it is imperative that we continue to push for global vaccine equity.

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

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.

scholarly journals The status of probiotics supplementation during pregnancy

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.

scholarly journals The use of thrombolytic therapy in pregnancy

2013 ◽  
Vol 6 (3) ◽  
pp. 105-111 ◽  
Author(s):  
Eric J Gartman
Keyword(s):  
Pregnant Women ◽  
Clinical Trial Data ◽  
Mechanical Valve ◽  
Pregnant Patient ◽  
Primary Treatment ◽  
Published Data ◽  
Thrombolytic Agents ◽  
Hemodynamic Compromise ◽  
Increased Risk ◽  
In Pregnancy

The relative hypercoagulable state of pregnancy leads to an increased risk of thrombotic complications, of which some may be life-threatening or medically devastating. In the non-pregnant patient, the current guidelines suggest thrombolysis as the primary treatment in acute ischemic stroke, myocardial infarction when percutaneous intervention is unavailable, certain cases of mechanical valve thrombosis, and pulmonary embolism with hemodynamic compromise or shock. Given that clinical trial data regarding thrombolytic use in pregnant women are absent due to exclusion, the goal of this review is to summarize the available published data regarding the use of thrombolytic agents and subsequent outcomes and complications in pregnant women. Overall, the use of thrombolytic agents in pregnancy is associated with a relatively low reported complication rate, especially given the severe medical conditions for which they are indicated. The data would suggest that thrombolysis should be considered for appropriate indications similar to that of non-pregnant patients. However, caution should be exercised when drawing conclusions regarding maternal and fetal safety, given the lack of controlled clinical trials including pregnant women and the nature of the weak evidence level of the cumulative data presented in this review.

scholarly journals A review on safety Endodontic Management in Pregnancy

2020 ◽  
Vol 11 (4) ◽  
pp. 5192-5197
Author(s):  
Chanchal Rathi ◽  
Manoj Chandak ◽  
Madhulika Chandak ◽  
Pavan Bajaj ◽  
Pooja Chandak
Keyword(s):  
Pregnant Women ◽  
Dental Treatment ◽  
Dental Health ◽  
Pregnant Patient ◽  
Hormonal Changes ◽  
Dental Procedure ◽  
Dental Health Care ◽  
Drug Of Choice ◽  
Anaesthetic Agents ◽  
In Pregnancy

The dental practitioner provides dental treatment to pregnant women to maintain their oral health. This is known as Intrauterine Dentistry. Dental treatment neither is cancelled nor be obstructed after confirming the pregnancy. Precautions should be taken while performing a dental procedure. During pregnancy number of physiologic and hormonal changes are taking place. Due to this, the oral cavity is more prone to infection. Also, increased consumption of carbohydrates leads to more acid formation. Also, vomiting and saliva are reduced. Also, pregnant women are always at high risk for caries than non-pregnant women. So proper dental health care of a pregnant patient is utmost necessary. Endodontic treatment comprises the use of radiographs, local anaesthetic agents, intracanal irrigants, intra-canal medicaments, and drugs. While performing an endodontic procedure, a radiograph should be taken with minimal exposure and only when it is required. Also, local anaesthesia has been chosen depending upon its effects on the baby and pregnant women. Antibiotics like amoxicillin and cephalosporin are considered to be safe in pregnancy. Also, it is stated that the second trimester is the safest period for performing any dental treatment. Analgesics are also used when a patient is in pain condition. Whenever analgesia is required paracetamol is always used safely in pregnancy. It is the drug of choice for pain relief. Only plain paracetamol is indicated. So this review discusses endodontic consideration and possible risk while performing a dental treatment.

Maternal infection in pregnancy

2020 ◽  
pp. 2671-2677
Author(s):  
Rosie Burton
Keyword(s):  
Hiv Infection ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Severe Malaria ◽  
Perinatal Death ◽  
Severe Disease ◽  
Neonatal Morbidity ◽  
Reproductive Age ◽  
Sub Saharan ◽  
In Pregnancy

This chapter will consider infection with human immunodeficiency virus (HIV), tuberculosis, and malaria in pregnancy. The global roll-out of antiretroviral therapy has significantly improved survival for people living with HIV and reduced mother-to-child transmission, but HIV infection remains a leading cause of maternal mortality, infant death, and early childhood death. Most women with HIV infection are in sub-Saharan Africa, where the highest prevalence is among young women of reproductive age. Meanwhile, tuberculosis is a major cause of maternal mortality. Active tuberculosis also adversely affects pregnancy outcomes, with an increased risk of preterm delivery, growth restriction, and perinatal death. Malaria is a major cause of maternal and neonatal morbidity and mortality. Pregnant women are more susceptible to malaria, have more severe disease, and may deteriorate rapidly. In severe malaria, mortality is 15–20% in non-pregnant women, compared to 50% in pregnancy. Primigravidae are at highest risk of severe malaria and death.

scholarly journals Preserved recognition of Omicron Spike following COVID-19 mRNA vaccination in pregnancy

2022 ◽  
Author(s):  
Yannic C Bartsch ◽  
Caroline Atyeo ◽  
Jaewon Kang ◽  
Kathryn J Gray ◽  
Andrea G. Edlow ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Disease Severity ◽  
Receptor Binding ◽  
Neutralizing Antibodies ◽  
Severe Disease ◽  
Fc Receptor ◽  
Binding Domain ◽  
Vaccine Uptake ◽  
Receptor Binding Domain ◽  
In Pregnancy

Summary Background SARS-CoV-2 infection is associated with enhanced disease severity in pregnant women. Despite the potential of COVID-19 vaccines to reduce severe disease, vaccine uptake remained relatively low among pregnant women. Just as coordinated messaging from the CDC and leading obstetrics organizations began to increase vaccine confidence in this vulnerable group, the evolution of SARS-CoV-2 variants of concerns (VOC) including the Omicron VOC raised new concerns about vaccine efficacy, given their ability to escape vaccine-induced neutralizing antibodies. Early data point to a milder disease course following omicron VOC infection in vaccinated individuals. Thus, these data suggest that alternate vaccine induced immunity, beyond neutralization, may continue to attenuate omicron disease, such as antibody-Fc-mediated activity. However, whether vaccine induced antibodies raised in pregnancy continue to bind and leverage Fc-receptors remains unclear. Methods VOC including Omicron receptor binding domain (RBD) or full Spike specific antibody isotype binding titers and FcγR binding were analyzed in pregnant women after the full dose regimen of either Pfizer/BioNtech BNT62b2 (n=10) or Moderna mRNA-1273 (n=10) vaccination using a multiplexing Luminex assay. Findings Comparable, albeit reduced, isotype recognition was observed to the Omicron Spike and receptor binding domain (RBD) following both vaccines. Yet, despite the near complete loss of Fc-receptor binding to the Omicron RBD, Fc-receptor binding was largely preserved to the Omicron Spike. Interpretation Reduced binding titer to the Omicron RBD aligns with observed loss of neutralizing activity. Despite the loss of neutralization, preserved Omicron Spike recognition and Fc-receptor binding potentially continues to attenuate disease severity in pregnant women. Funding NIH and the Bill and Melinda Gates Foundation

A Cause of Recurrent Urinary Retention in Pregnancy; Retroverted Uterus: Case Report

2021 ◽  
Author(s):  
Mehmet Sevim ◽  
Barış Şengül ◽  
Okan Alkış ◽  
Bekir Aras ◽  
Şahin Kabay
Keyword(s):  
Pregnant Women ◽  
Urinary Retention ◽  
Preterm Labor ◽  
Acute Urinary Retention ◽  
Rare Condition ◽  
Pregnant Patient ◽  
Older Men ◽  
Retroverted Uterus ◽  
Urological Emergencies ◽  
In Pregnancy

Acute urinary retention is one of the most common situations encountered in urological emergencies. It is more frequently seen in older men. Acute urinary retention in pregnant women is a rare condition but it may cause abortus, preterm labor and rarely uterine ischemia. It is very difficult to reveal the causes of acute urinary retention in pregnant women. One of them is acute urinary retention due to retroverted uterus which is observed in 11% of pregnant women. In this case, we discussed a young pregnant patient who presented to our outpatient clinic with complaints of recurrent urinary retention due to retroverted uterus.

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

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.

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

1965 ◽  
Vol 48 (1) ◽  
pp. 14-22 ◽  
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.

LEUCOCYTE METABOLISM IN PREGNANCY

1960 ◽  
Vol XXXV (IV) ◽  
pp. 575-584 ◽  
Author(s):  
C. Borel ◽  
J. Frei ◽  
A. Vannotti
Keyword(s):  
Alkaline Phosphatase ◽  
Oxygen Consumption ◽  
Pregnant Women ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Lactate Production ◽  
Glucose Consumption ◽  
In Pregnancy

ABSTRACT Enzymatic studies, on leucocytes of pregnant women, show an increase of the alkaline phosphatase activity and a decrease of the glucose consumption and lactate production, as well as of proteolysis. The oxygen consumption, with succinate as substrate, does not vary.

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