Post-Viral Fatigue Following SARS-CoV-2 Infection during Pregnancy: A Longitudinal Comparative Study.

Studies reported post-COVID-19 fatigue in the general population, but not among pregnant women. Our objectives were to determine prevalence, duration, and risk factors of post-viral fatigue among pregnant women with SARS-CoV-2. This study involved 588 pregnant women with SARS-CoV-2 during pregnancy or delivery in Brazil. Three groups were investigated: G1 (n = 259, symptomatic infection during pregnancy); G2 (n = 131, positive serology at delivery); G3 (n = 198, negative serology at delivery). We applied questionnaires investigating fatigue at determined timepoints after infection for G1, and after delivery for all groups; fatigue prevalence was then determined. Cox regression was used to estimate hazard ratio (HR) and 95% CI of the risk of remaining with fatigue in G1. Overall fatigue prevalence in G1 at six weeks, three months and six months were 40.6%, 33.6%, and 27.8%, respectively. Cumulative risk of remaining with fatigue increased over time, with HR of 1.69 (95% CI: 0.89-3.20) and 2.43 (95% CI: 1.49-3.95) for women with moderate and severe symptoms, respectively. Multivariate analysis showed cough and myalgia as independent risk factors in G1. Fatigue prevalence was significantly higher in G1 compared to G2 and G3. Post-viral fatigue prevalence is higher in women infected during pregnancy; fatigue's risk and duration increased with the severity of infection.

Expression of angiogenic factors in placenta of stressed rats.

The aim of the present study was to analyse the influence of stress on pregnant rats, particularly in terms of maternal, placental and fetal weight, placental morphology and placental gene expression of the angiogenic factors Vegfa and Pgf and their receptors. The parameters were evaluated on gestation Day 20. Maternal, fetal and placental weights were statistically lower in stressed animals than controls, suggesting abnormalities in gestational physiology. Morphologically the placentas of rats subjected to stress were reduced in size and weight, with few glycogen cells and a significant increase in the number of apoptotic cells. Stress caused an increase in placental gene expression of Vegfa (P<0.05) and a reduction in Pgf, Flt1 and Kdr expression (P<0.05). It has been suggested that increased VEGF is associated with vasodilatation and hypotension, but in this model persistent hypertension was present. This study suggests that the limited hypotensive Vegfa response to stress-induced hypertension could result from reduced expression of Flt1/Kdr disrupting specific VEGF pathways. These findings may elucidate one of the multiple possible factors underlying how stress modulates placental physiology, and could aid the understanding of stress-induced gestational disorders.

Abordagem anestesiologica para a reducao da mortalidade materna nas formas graves de hipertensao na gravidez / Anesthesiologic management for reduction of maternal deaths in severe pregnancy-induced hypertesion

A Classificacao Internacional de Doencas, decima revisao, definiu as mortes maternas decorrentes de anestesia como mortes por causa direta. A gestante com hipertensao arterial grave e um...

Analise de variaveis maternas e perinatais em pacientes com diagnostico histologico renal de hipertensao arterial cronica e hipertensao arterial cronica com pre-eclampsia superajuntada / Analysis of maternal and perinatal factors in patients with renal hystological diagnosis of chronic arterial hypertension and chronic arterial hypertension with superimposed pre eclampsia

A hipertensao arterial cronica (HAC) possui grande prevalencia em todo mundo e uma das complicacoes mais comuns durante a gestacao. Um diagnostico preciso da hipertensao arterial permite um tratamento adequado e assim diminuir a morbiletalidade materna e perinatal. O trabalho analisa os diagnosticos clinicos HAC e HAC com doenca hipertensiva especifica da gestacao superajuntada a luz da histopatologia renal, procurando identificar parametros clinicos e laboratoriais que permitissem diferenciar os dois diagnosticos. Analisamos retrospectivamente 96 pacientes cujo resultado histopatologico da biopsia renal pos-parto foram...

Pre-eclampsia como resposta inflamatoria exacerbada a gestacao / Preeclampsia as an excessive inflammatory response to pregnancy

A pre-eclampsia e uma sindrome com repercussoes maternas e fetais, caracterizada por vasoespasmo, ativacao do sistema de coagulacao e alteracoes nos sistemas humorais relacionados ao controle da volemia e da pressao arterial. O estresse oxidativo e a resposta inflamatoria sistemica podem ser tambem importantes na fisiopatologia da sindrome. Nesse trabalho sao abordados os aspectos fisiopatologicos mais recentemente descritos para a...

Sindrome HELLP: analise critica e consideracoes fisiopatologicas em 34 casos / Hellp sindrome: critical analysis and physiopathologic considerations by 34 cases

A hemolise microangiopatica e a lesao hepatica que ocorre nas gestantes com pre-eclampsia/eclampsia continua ainda sendo motivo de controversias, pricipalmente no que se refere a fatores predisponentes, sintomatologia, evolucao natural e conduta...

Estresse e pre-eclampsia / Stress and preeclampsia

A correlacao entre estresse e pre-eclampsia foi revisada, avaliada e discutida neste artigo.A pre-eclampsia nao tem ainda etiologia completamente definida. Varios fatores de risco para pre-eclampsia foram identificados e varios mecanismos fisiopatologicos foram descritos...

The effect of chronic nitric oxide inhibition on vascular reactivity and blood pressure in pregnant rats

CONTEXT: The exact mechanism involved in changes in blood pressure and peripheral vascular resistance during pregnancy is unknown. OBJECTIVE:To evaluate the importance of endothelium-derivated relaxing factor (EDRF) and its main component, nitric oxide, in blood pressure and vascular reactivity in pregnant rats. DESIGN: Clinical trial in experimentation animals. SETTING: University laboratory of Pharmacology. SAMPLE: Female Wistar rats with normal blood pressure, weight (152 to 227 grams) and age (90 to 116 days). INTERVENTION: The rats were divided in to four groups: pregnant rats treated with L-NAME (13 rats); pregnant control rats (8 rats); virgin rats treated with L-NAME (10 rats); virgin control rats (12 rats). The vascular preparations and caudal blood pressure were obtained at the end of pregnancy, or after the administration of L-NAME in virgin rats. MAIN MEASUREMENTS: The caudal blood pressure and the vascular response to acetylcholine in pre-contracted aortic rings, both with and without endothelium, and the effect of nitric oxide inhibition, Nw-L-nitro-arginine methyl-ester (L-NAME), in pregnant and virgin rats. The L-NAME was administered in the drinking water over a 10-day period. RESULTS: The blood pressure decreased in pregnancy. Aortic rings of pregnant rats were more sensitive to acetylcholine than those of virgin rats. After L-NAME treatment, the blood pressure increased and relaxation was blocked in both groups. The fetal-placental unit weight of the L-NAME group was lower than that of the control group. CONCLUSION: Acetylcholine-induced vasorelaxation sensitivity was greater in pregnant rats and that blood pressure increased after L-NAME administration while the acetylcholine-induced vasorelaxation response was blocked.