Determinants of congenital syphilis in Fortaleza, Brazil: A retrospective case-control study.

Congenital syphilis (CS) is a significant public health problem in Brazil. Despite efforts to increase syphilis testing and treatment among pregnant women, rates of CS in the country remain high. We conducted a retrospective case-control study to identify potential associations between the mothers' sociodemographic characteristics, clinical factors related to the current and previous pregnancies, and the occurrence of CS among newborns in Fortaleza, a populous city with one of the highest incidences of CS in Brazil. Data from newborns diagnosed with CS between 2017 and 2020 were extracted from SINAN, the national database for notifiable diseases. Data from women who had delivered an infant with CS were extracted from SINASC, the national database for registration of live births, and linked with their infant's data. CS cases and non-CS controls were matched by year of birth at a ratio of 1:3 respectively. Potential associations were estimated using a multivariate regression model accounting for sociodemographic, obstetric, and antenatal care-related factors. Epidemiological data from 8,744 live births were included in the analysis, including 2,186 cases and 6,588 controls. The final multivariate regression model identified increased odds of delivering an infant with CS among pregnant women and girls aged below 20 years (OR 1.29), single women (OR 1.48), women who had less than 8 years of formal education (OR 2.42), women who delivered in a public hospital (OR 6.92), women who had more than 4 previous pregnancies (OR 1.60), and women who had one or more prior fetal loss (OR 1.19). The odds of delivering an infant with CS also increased as the number of antenatal visits decreased. Women who did not attend any antenatal visits had 3.94 times the odds of delivering an infant with CS compared to women who attended 7 or more visits. Our study found that increased odds of delivering an infant with CS were highly associated with factors related to socioeconomic vulnerability. These determinants not only affect the access to essential antenatal care services, but also the continuity and quality of such preventive measures. Future policies aimed at reducing the incidence of CS should not only target those pregnant women and adolescents with identifiable risk factors for testing, but also assure high quality care, treatment and follow-up for this group.

Maternal vaccination: a review of current evidence and recommendations.

Maternal vaccination is an effective means of protecting pregnant women, their fetuses, and infants from vaccine-preventable infections. Despite the availability of sufficient safety data to support the use of vaccines during pregnancy, maternal immunization remains an underutilized method of disease prevention, often because of concerns from both healthcare providers and pregnant women about vaccine safety. Such concerns have been reflected in the low uptake of the COVID-19 vaccine among pregnant women seen in many parts of the world. Here, we present an update of the current recommendations for the use of vaccines during pregnancy, including the evidence supporting the use of novel vaccine platforms. We also provide an overview of the data supporting the use of COVID-19 vaccines in pregnancy and an update of the status of vaccines that are currently under development for use in pregnant women.

Global research priorities for COVID-19 in maternal, reproductive and child health: Results of an international survey.

BACKGROUND: The World Health Organization's "Coordinated Global Research Roadmap: 2019 Novel Coronavirus" outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported case significant knowledge gaps remain, highlighting the need for a coordinated approach. To address this need, the Maternal, Newborn and Child Health Working Group (MNCH WG) of the COVID-19 Clinical Research Coalition conducted an international survey to identify global research priorities for COVID-19 in maternal, reproductive and child health. METHOD: This project was undertaken using a modified Delphi method. An electronic questionnaire was disseminated to clinicians and researchers in three different languages (English, French and Spanish) via MNCH WG affiliated networks. Respondents were asked to select the five most urgent research priorities among a list of 17 identified by the MNCH WG. Analysis of questionnaire data was undertaken to identify key similarities and differences among respondents according to questionnaire language, location and specialty. Following elimination of the seven lowest ranking priorities, the questionnaire was recirculated to the original pool of respondents. Thematic analysis of final questionnaire data was undertaken by the MNCH WG from which four priority research themes emerged. RESULTS: Questionnaire 1 was completed by 225 respondents from 29 countries. Questionnaire 2 was returned by 49 respondents. The four priority research themes which emerged from the analysis were 1) access to healthcare during the COVID-19 pandemic, 2) the direct and 3) indirect effects of COVID-19 on pregnant and breastfeeding women and children and 4) the transmission of COVID-19 and protection from infection. CONCLUSION: The results of these questionnaires indicated a high level of concordance among continents and specialties regarding priority research themes. This prioritized list of research uncertainties, developed to specifically highlight the most urgent clinical needs as perceived by healthcare professionals and researchers, could help funding organizations and researchers to answer the most pressing questions for clinicians and public health professionals during the pandemic. It is hoped that these identified priority research themes can help focus the discussion regarding the allocation of limited resources to enhance COVID-19 research in MNCH globally.

SARS-CoV-2 Infection in Pregnant Women and Their Newborns.

There remain a number of uncertainties globally about the risks posed to women who are infected with SARS-CoV-2 during pregnancy. Furthermore, our understanding of the spread of COVID-19 in Sub-Saharan Africa is limited, owing to low testing rates in many parts of the continent. PeriCOVID Africa, in conjunction with the WHO/HRP Alliance, plans to address these knowledge gaps by harnessing research infrastructures in place in five sub-Saharan African countries in order to screen more than 50,000 pregnant women and their infants for SARS-CoV-2, while monitoring pregnancy and neonatal outcomes. We anticipate that the results of this study will provide much needed information about the risks that SARS-CoV-2 poses to pregnant women and their babies, as well as establishing potential routes of mother-to-child transmission.