Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes.

Importance: There are limited high-quality, population-level data about the effect of SARS-CoV-2 infection on pregnancy using contemporaneous comparator cohorts. Objectives: To describe maternal and perinatal outcomes associated with SARS-CoV-2 infection in pregnancy and to assess variables associated with severe disease in the pregnant population. Design, Setting, and Participants: CANCOVID-Preg is an observational surveillance program for SARS-CoV-2-affected pregnancies in Canada. This analysis presents exploratory, population-level data from 6 Canadian provinces for the period of March 1, 2020, to October 31, 2021. A total of 6012 pregnant persons with a positive SARS-CoV-2 polymerase chain reaction test result at any time in pregnancy (primarily due to symptomatic presentation) were included and compared with 2 contemporaneous groups including age-matched female individuals with SARS-CoV-2 and unaffected pregnant persons from the pandemic time period. Exposure: SARS-CoV-2 infection during pregnancy. Incident infections in pregnancy were reported to CANCOVID-Preg by participating provinces/territories. Main Outcomes and Measures: Maternal and perinatal outcomes associated with SARS-CoV-2 infection as well as risk factors for severe disease (ie, disease requiring hospitalization, admission to an intensive care unit/critical care unit, and/or oxygen therapy). Results: Among 6012 pregnant individuals with SARS-CoV-2 in Canada (median age, 31 [IQR, 28-35] years), the greatest proportion of cases were diagnosed at 28 to 37 weeks' gestation (35.7%). Non-White individuals were disproportionately represented. Being pregnant was associated with a significantly increased risk of SARS-CoV-2-related hospitalization compared with SARS-CoV-2 cases among all women aged 20 to 49 years in the general population of Canada (7.75% vs 2.93%; relative risk, 2.65 [95% CI, 2.41-2.88]) as well as an increased risk of intensive care unit/critical care unit admission (2.01% vs 0.37%; relative risk, 5.46 [95% CI, 4.50-6.53]). Increasing age, preexisting hypertension, and greater gestational age at diagnosis were significantly associated with worse maternal outcomes. The risk of preterm birth was significantly elevated among SARS-CoV-2-affected pregnancies (11.05% vs 6.76%; relative risk, 1.63 [95% CI, 1.52-1.76]), even in cases of milder disease not requiring hospitalization, compared with unaffected pregnancies during the same time period. Conclusions and Relevance: In this exploratory surveillance study conducted in Canada from March 2020 to October 2021, SARS-CoV-2 infection during pregnancy was significantly associated with increased risk of adverse maternal outcomes and preterm birth.

Prioritizing Maternal Sepsis: National Adoption of an Obstetric Early Warning System to Prevent Morbidity and Mortality.

Sepsis is one of the leading causes of maternal morbidity and mortality. Analyses have determined that delays in early recognition and prompt initiation of appropriate management are key contributing factors in maternal sepsis deaths. Recent cases of sepsis-related maternal morbidity and mortality across Canada have highlighted the urgent need for a national standardized approach to the detection and treatment of maternal sepsis. The SOGC has established a national multidisciplinary maternal sepsis task force to address this priority. The adoption of a national modified obstetric early warning system (MEOWS) is recommended as a key first step. This early warning scoring (EWS) system will facilitate early detection of maternal clinical deterioration and mandate timely escalation of care appropriate for the severity of illness. There is currently limited use of EWSs in Canada. Introducing a national EWS and a standardized maternal sepsis management guideline provides a tremendous opportunity to improve maternal care. A standardized approach will facilitate future evidence-based evaluation and refinement of the tool, and enable the reduction of preventable maternal morbidity and mortality from sepsis, as well as all causes duplicated.

No 378 - Placentophagie.

La consommation du placenta humain a récemment été mise en évidence. Toutefois, aucune donnée probante ne fait état des bienfaits qui seraient liés à cette pratique. De plus, elle peut nuire à la santé. Par conséquent, la SOGC ne recommande pas la pratique de la placentophagie.

No. 378-Placentophagy.

Consumption of human placenta has recently been highlighted; however, there is no evidence of benefit from its consumption. In addition, there is potential for harm. Therefore the SOGC does not recommend the practice of placentophagy.

Cervical Cancer Screening in Immunocompromised Women.

In the context of changing recommendations for cervical cancer screening, differing recommendations in each province, and a lack of guidance for cervical screening of immunocompromised women, this article provides specific recommendations for cervical cancer screening of immunocompromised women in Canada.

No. 275-Antibiotic Prophylaxis in Gynaecologic Procedures.

OBJECTIVE: To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic procedures. OUTCOMES: Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in gynaecologic procedures. EVIDENCE: Medline and The Cochrane Library were searched for articles published between January 1978 and January 2011 on the topic of antibiotic prophylaxis in gynaecologic procedures. Results were restricted to systematic reviews, randomized control trials/ controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated in the guideline to June 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES: The quality of evidence obtained was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). BENEFITS, HARMS, AND COSTS: Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit.

No. 247-Antibiotic Prophylaxis in Obstetric Procedures.

OBJECTIVE: To review the evidence and provide recommendations on antibiotic prophylaxis for obstetrical procedures. OUTCOMES: Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in obstetrical procedures. EVIDENCE: Published literature was retrieved through searches of Medline and The Cochrane Library on the topic of antibiotic prophylaxis in obstetrical procedures. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and articles published from January 1978 to June2009 were incorporated in the guideline. Current guidelines published by the American College of Obstetrics and Gynecology were also incorporated. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES: The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS: Implementation of this guideline should reduce the cost and harm resulting from the administration of antibiotics when they are not required and the harm resulting from failure to administer antibiotics when they would be beneficial. SUMMARY STATEMENTS: RECOMMENDATIONS.

N° 342-L'hépatite B et la grossesse.

OBJECTIF: Examiner l'épidémiologie, l'histoire naturelle, l'évaluation et le traitement de l'infection au virus de l'hépatite B (VHB) durant la grossesse. Cela aidera les fournisseurs de soins obstétricaux à conseiller leurs patientes quant aux risques périnataux et aux options de prise en charge offertes aux femmes enceintes atteintes de l'hépatite B. ISSUES: Les éléments évalués comprennent les seuils de traitement antiviral contre le VHB pour la prévention de la transmission périnatale et pour les interventions effractives durant la grossesse pour les femmes atteintes de l'hépatite B. RéSULTATS: Nous avons recherché dans MEDLINE, Embase et CINAHL des articles en anglais sur les sujets liés à l'infection par le VHB, à la grossesse et à la transmission périnatale publiés de 1966 à mars 2016. Nous n'avons tenu compte que des résultats qui proviennent de revues systématiques, d'essais contrôlés aléatoires ou d'essais cliniques contrôlés et d'études d'observation. Nous avons également étudié d'autres articles (non publiés) trouvés sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes connexes, dans des collections de directives cliniques et dans des registres d'essais cliniques, et obtenus auprès d'associations nationales et internationales de médecins spécialistes. MéTHODES DE VALIDATION: La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). Les recommandations pour la pratique sont classées selon la méthode décrite dans ce rapport. MISE à JOUR DE DIRECTIVES CLINIQUES: La directive clinique sera évaluée cinq ans après sa publication afin de déterminer si une mise à jour est nécessaire. Cependant, si de nouvelles données probantes importantes sont publiées avant la fin du cycle de cinq ans, le processus peut être accéléré pour mettre à jour rapidement certaines recommandations. PARRAIN: La présente directive clinique a été élaborée à l'aide de ressources financées par la Société des obstétriciens et gynécologues du Canada. RECOMMANDATIONS.

No. 342-Hepatitis B and Pregnancy.

OBJECTIVE: To review the epidemiology, natural history, evaluation, and treatment of hepatitis B virus (HBV) infection during pregnancy. This will aid obstetric care providers in counseling their patients regarding perinatal risks and management options available to pregnant women with hepatitis B. OUTCOMES: Outcomes evaluated include thresholds for HBV anti-viral treatment for prevention of perinatal transmission and for invasive procedures during pregnancy for women with hepatitis B infection. EVIDENCE: Medline, EMBASE, and CINAHL were searched for articles in English on subjects related to HBV infection, pregnancy, and perinatal transmission from 1966 to March 2016. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Other (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical speciality societies. VALIDATION METHODS: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Recommendations for practice are ranked according to the method described in this Report. GUIDELINE UPDATE: The guideline will be reviewed 5 years after publication to decide if an update is required. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. SPONSORS: This guideline was developed with resources funded by the Society of Obstetricians and Gynaecologists of Canada.

No. 233-Antibiotic Therapy in Preterm Premature Rupture of the Membranes.

OBJECTIVE: To review the evidence and provide recommendations on the use of antibiotics in preterm premature rupture of the membranes (PPROM). OUTCOMES: Outcomes evaluated include the effect of antibiotic treatment on maternal infection, chorioamnionitis, and neonatal morbidity and mortality. EVIDENCE: Published literature was retrieved through searches of Medline, EMBASE, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary and key words (PPROM, infection, and antibiotics). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and new material incorporated in the guideline to July 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES: The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: Guideline implementation should assist the practitioner in developing an approach to the use of antibiotics in women with PPROM. Patients will benefit from appropriate management of this condition. VALIDATION: This guideline has been reviewed and approved by the Infectious Diseases Committee and the Maternal Fetal Medicine Committee of the SOGC, and approved by the Executive and Council of the SOGC. SPONSOR: The Society of Obstetricians and Gynaecologists of Canada.

Vulvovaginite : Dépistage et prise en charge de la trichomonase, de la candidose vulvovaginale et de la vaginose bactérienne.

OBJECTIF: Analyser les données probantes et formuler des recommandations quant au dépistage et à la prise en charge de la candidose vulvovaginale, de la trichomonase et de la vaginose bactérienne. ISSUES: Parmi les issues évaluées, on trouve l'efficacité de l'antibiothérapie, les taux de guérison en ce qui concerne les infections simples et compliquées, et les implications de ces pathologies pendant la grossesse. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans MEDLINE, EMBASE, CINAHL et The Cochrane Library en juin 2013 au moyen d'un vocabulaire contrôlé (p. ex. « vaginitis ¼, « trichomoniasis ¼, « vaginal candidiasis ¼) et de mots clés (p. ex. « bacterial vaginosis ¼, « yeast ¼, « candidiasis ¼, « trichomonas vaginalis ¼, « trichomoniasis ¼, « vaginitis ¼, « treatment ¼) appropriés. Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n'a été appliquée en matière de date, mais les résultats ont été limités aux documents rédigés en anglais ou en français. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en mai 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques et auprès de sociétés de spécialité médicale nationales et internationales. VALEURS: La qualité des résultats est évaluée au moyen des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.

Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.

OBJECTIVE: To review the evidence and provide recommendations on screening for and management of vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis. OUTCOMES: OUTCOMES evaluated include the efficacy of antibiotic treatment, cure rates for simple and complicated infections, and the implications of these conditions in pregnancy. EVIDENCE: Published literature was retrieved through searches of MEDLINE, EMBASE, CINAHL, and The Cochrane Library in June 2013 using appropriate controlled vocabulary (e.g., vaginitis, trichomoniasis, vaginal candidiasis) and key words (bacterial vaginosis, yeast, candidiasis, trichomonas vaginalis, trichomoniasis, vaginitis, treatment). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. Searches were updated on a regular basis and incorporated in the guideline to May 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies. VALUES: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. Vulvovaginal candidiasis affects 75% of women at least once. Topical and oral antifungal azole medications are equally effective. (I) 2. Recurrent vulvovaginal candidiasis is defined as 4 or more episodes per year. (II-2) 3. Trichomonas vaginalis is a common non-viral sexually transmitted infection that is best detected by antigen testing using vaginal swabs collected and evaluated by immunoassay or nucleic acid amplification test. (II-2) 4. Cure rates are equal at up to 88% for trichomoniasis treated with oral metronidazole 2 g once or 500 mg twice daily for 7 days. Partner treatment, even without screening, enhances cure rates. (I-A) 5. Current evidence of the efficacy of alternative therapies for bacterial vaginosis (probiotics, vitamin C) is limited. (I) Recommendations 1. Following initial therapy, treatment success of recurrent vulvovaginal candidiasis is enhanced by maintenance of weekly oral fluconazole for up to 6 months. (II-2A) 2. Symptomatic vulvovaginal candidiasis treated with topical azoles may require longer courses of therapy to be resolved. (1-A) 3. Test of cure following treatment of trichomoniasis with oral metronidazole is not recommended. (I-D) 4. Higher-dose therapy may be needed for treatment-resistant cases of trichomoniasis. (I-A) 5. In pregnancy, treatment of symptomatic Trichomonas vaginalis with oral metronidazole is warranted for the prevention of preterm birth. (I-A) 6. Bacterial vaginosis should be diagnosed using either clinical (Amsel's) or laboratory (Gram stain with objective scoring system) criteria. (II-2A) 7. Symptomatic bacterial vaginosis should be treated with oral metronidazole 500 mg twice daily for 7 days. Alternatives include vaginal metronidazole gel and oral or vaginal clindamycin cream. (I-A) 8. Longer courses of therapy for bacterial vaginosis are recommended for women with documented multiple recurrences. (I-A).

Objectif : Analyser les données probantes et formuler des recommandations quant au dépistage et à la prise en charge de la candidose vulvovaginale, de la trichomonase et de la vaginose bactérienne. Issues : Parmi les issues évaluées, on trouve l'efficacité de l'antibiothérapie, les taux de guérison en ce qui concerne les infections simples et compliquées, et les implications de ces pathologies pendant la grossesse. Résultats : La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans MEDLINE, EMBASE, CINAHL et The Cochrane Library en juin 2013 au moyen d'un vocabulaire contrôlé (p. ex. «â€¯vaginitis ¼, «â€¯trichomoniasis ¼, «â€¯vaginal candidiasis ¼) et de mots clés (p. ex. «â€¯bacterial vaginosis ¼, «â€¯yeast ¼, «â€¯candidiasis ¼, «â€¯trichomonas vaginalis ¼, «â€¯trichomoniasis ¼, «â€¯vaginitis ¼, «â€¯treatment ¼) appropriés. Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n'a été appliquée en matière de date, mais les résultats ont été limités aux documents rédigés en anglais ou en français. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en mai 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats est évaluée au moyen des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau). Déclarations sommaires 1. La candidose vulvovaginale affecte 75 % des femmes à au moins une reprise. Les azoles antifongiques topiques et oraux comptent une efficacité équivalente. (I) 2. Pour être qualifiée de récurrente, la candidose vulvovaginale doit donner lieu à quatre épisodes ou plus par année. (II-2) 3. Trichomonas vaginalis est un organisme à l'origine d'une infection transmissible sexuellement non virale courante. Le dépistage des antigènes (écouvillonnages vaginaux analysés au moyen d'un immunoessai ou d'un test d'amplification des acides nucléiques) constitue la meilleure façon d'en détecter la présence. (II-2) 4. La prise en charge de la trichomonase au moyen de métronidazole oral, que ce soit à raison de 2 g en une dose unique ou de 500 mg deux fois par jour pendant 7 jours, permet l'obtention de taux de guérison équivalents pouvant atteindre 88 %. Le traitement du partenaire, même sans dépistage préalable, améliore les taux de guérison. (I-A) 5. Les données probantes dont nous disposons à l'heure actuelle quant à l'efficacité des traitements de médecine parallèle contre la vaginose bactérienne (probiotiques, vitamine C) sont limitées. (I) Recommandations 1. À la suite du traitement initial, la réussite de la prise en charge de la candidose vulvovaginale récurrente est favorisée par la mise en œuvre d'un traitement d'entretien hebdomadaire au fluconazole oral pendant une période pouvant atteindre six mois. (II-2A) 2. La résolution de la candidose vulvovaginale symptomatique prise en charge au moyen d'azoles topiques pourrait nécessiter un traitement d'une durée prolongée. (1-A) 3. À la suite de la prise en charge de la trichomonase au moyen de métronidazole oral, la tenue d'un test de guérison n'est pas recommandée. (I-D) 4. Le recours à des doses accrues pourrait être requis dans les cas de trichomonase qui présentent une résistance au traitement. (I-A) 5. En présence d'une infection à Trichomonas vaginalis symptomatique pendant la grossesse, la prévention de l'accouchement préterme justifie la mise en œuvre d'un traitement au métronidazole oral. (I-A) 6. La vaginose bactérienne devrait être diagnostiquée au moyen de critères cliniques (Amsel) ou de laboratoire (coloration de Gram et système objectif de notation). (II-2A) 7. La vaginose bactérienne symptomatique devrait être prise en charge au moyen de métronidazole oral, à raison de 500 mg deux fois par jour pendant sept jours. Parmi les solutions de rechange, on trouve le gel vaginal de métronidazole et la clindamycine (comprimés oraux ou crème vaginale). (I-A) 8. Chez les femmes qui présentent de multiples récurrences documentées, la prolongation du traitement contre la vaginose bactérienne est recommandée. (I-A).

Hepatitis B in pregnancy: a concise review of neonatal vertical transmission and antiviral prophylaxis.

Hepatitis B is a chronic viral infection of the liver leading to complications including cirrhosis and hepatocellular carcinoma. The leading cause of acquisition is vertical transmission from an infected mother to the newborn. Despite newborn immunoprophylaxis, vertical transmission may still occur in 1-14%. The aim of this article is to provide a concise review of the mechanisms and risk factors involved in vertical transmission, as well as prophylactic strategies using immunoprophylaxis and antiviral medications. Mechanisms of vertical transmission include intrauterine and perinatal transfer of virus. High HBV viral load and presence of HBeAg increases risk of transmission. Combination vaccine and hepatitis B immunoglobulin given at birth reduces risk of transmission, as does HBIG given to mothers in the third trimester. Three antivirals have been studied in pregnancy: lamivudine, telbivudine, and tenovofir. All have shown significant reduction in viral loads and vertical transmission and have favorable safety profiles. In conclusion, HBV vertical transmission is preventable through use of immunoprophylaxis and antiviral medications. Recommendation for antiviral use in third trimester in mothers whose HBV VL is greater than 1 x 106 copies/mL.

Reliability and validation of an electronic penicillin allergy risk-assessment tool in a pregnant population.

BACKGROUND: Penicillin allergy adversely impacts patient care, yet most cases do not have true allergies. Clinicians require efficient, reliable clinical tools to identify low risk patients who can be safely de-labeled. Our center implemented the FIRSTLINE electronic point-of-care decision support tool to help non-allergist practitioners risk stratify patients with penicillin allergy. We sought to explore the reliability and validity of this tool in relation to allergist assessment and actual patient outcomes. We additionally compared it with two other published stratification tools, JAMA and PENFAST, to assess ability to accurately identify low risk patients appropriate for direct oral challenge. METHODS: In this single-center, retrospective, observational study, 181 pregnant females with self-reported penicillin allergy between July 2019 to June 2021 at BC Women's Hospital, Vancouver, Canada were used to assess the reliability and validity of all three tools. Physician-guided history of penicillin use and symptoms were used for scoring. Results and recommendations were compared to actual patient outcomes after clinician decision for direct oral challenge or intradermal tests. We compared the performance of JAMA, PENFAST and FIRSTLINE. RESULTS: 181 patients were assessed. 176/181 (97.2%) patients were deemed not allergic. Each risk stratification tool labelled majority of patients as low risk with 88.4% of patients PENFAST 0-2, 60.2% of patients JAMA low risk, 86.7% of patients FIRSTLINE very low risk. CONCLUSION: We demonstrate that our point-of-care electronic algorithm is reliable in identifying low risk pregnant patients, as compared to an allergist assessment. To our knowledge, this is the first study to provide direct comparison between multiple decision support tools using the same population, minimizing participant bias. Providing clinical algorithms to risk stratify patients, can enable healthcare professionals to safely identify individuals who may be candidates for direct penicillin oral challenges versus needing referral to specialists. This increases the generalizability and efficiency of penicillin allergy de-labeling.

Retrospective Cohort Study on the Impact of the COVID-19 Pandemic on Pregnancy Outcomes for Women Living With HIV in British Columbia.

BACKGROUND: For pregnant women living with HIV (WLWH), engagement in care is crucial to maternal health and reducing the risk of perinatal transmission. To date, there have been no studies in Canada examining the impact of the COVID-19 pandemic on pregnant WLWH. METHODS: This was a retrospective cohort study assessing the impact of the pandemic on perinatal outcomes for pregnant WLWH using data from the Perinatal HIV Surveillance Program in British Columbia, Canada. We compared maternal characteristics, pregnancy outcomes, and clinical indicators related to engagement with care between a prepandemic (January 2017-March 2020) and pandemic cohort (March 2020-December 2022). We investigated preterm birth rates with explanatory variables using logistic regression analysis. RESULTS: The prepandemic cohort (n = 87) had a significantly (P < 0.05) lower gestational age at the first antenatal encounter (9.0 vs 11.8) and lower rates of preterm births compared with the pandemic cohort (n = 56; 15% vs 37%). Adjusted odds of preterm birth increased with the presence of substance use in pregnancy (aOR = 10.45, 95% confidence interval: 2.19 to 49.94) in WLWH. There were 2 cases of perinatal transmission of HIV in the pandemic cohort, whereas the prepandemic cohort had none. CONCLUSIONS: The pandemic had pronounced effects on pregnant WLWH and their infants in British Columbia including higher rates of preterm birth and higher gestational age at the first antenatal encounter. The nonstatistically significant increase in perinatal transmission rates is of high clinical importance.

Penicillin de-labelling in vancouver, British Columbia, Canada: comparison of approaches, outcomes and future directions.

BACKGROUND: Inaccurate penicillin allergy labels lead to inappropriate antibiotic prescriptions and harmful patient consequences. System-wide efforts are needed to remove incorrect penicillin allergy labels, but more health services research is required on how to best deliver these services. METHODS: Data was extracted from five hospitals in Vancouver, British Columbia, Canada from October 2018-May 2022. The primary outcomes of this study were to outline de-labelling protocol designs, identify the roles of various healthcare professionals in de-labelling protocols and identify rates of de-labelling penicillin allergies and associated adverse events at various institutions. Our secondary outcome was to describe de-labelling rates for special populations, including pediatric, obstetric and immunocompromised subpopulations. To achieve these outcomes, participating institutions provided their de-labelling protocol designs and data on program participants. Protocols were then compared to find common themes and differences. Furthermore, adverse events were reviewed and percentages of patients de-labelled at each institution and in total were calculated. RESULTS: Protocols demonstrated a high level of variability, including different methods of participant identification, risk-stratification and roles of providers. All protocols used oral and direct oral challenges, heavily involved pharmacists and had physician oversight. Despite the differences, of the 711 patients enrolled in all programs, 697 (98.0%) were de-labelled. There were 9 adverse events (1.3%) with oral challenges with mainly minor symptoms. CONCLUSIONS: Our data demonstrates that de-labelling programs effectively and safely remove penicillin allergy labels, including pediatric, obstetric and immunocompromised patients. Consistent with current literature, most patients with a penicillin allergy label are not allergic. De-labelling programs could benefit from increasing clinician engagement by increasing accessibility of resources to providers, including guidance for de-labelling of special populations.