SARS-CoV-2 IgG "heritage" in newborn: A credit of maternal natural infection.

Description of transplacental passage of specific SARS-CoV-2 IgG from mothers who contracted natural infection to their newborns. Retrospective cohort analysis including pregnant women diagnosed with SARS-CoV-2 and their newborns both tested for SARS-CoV-2 specific IgG and IgM with antibody titration at delivery. Nasopharyngeal swab were taken from both mothers and neonates, and tested for SARS-CoV-2 using polymerase chain reaction (PCR). IgM and IgG were analyzed in maternal and neonatal serum of 143 mother-infant dyads. 86% of women with a positive SARS-CoV-2 PCR >14 days before delivery developed specific IgG and 84% of their infants showed transplacental passage of IgG. Pregnant women infected with SARS-CoV-2 achieve antibody seroconversion following the kinetics described in the general population, and transplacental transfer of IgG specific antibodies occurs. No conclusion can be drawn on passive immunity efficacy or duration.

Fluid status changes during the transition in infants of diabetic mothers.

In animal and human neonates, expansion of the extracellular fluid volume is associated with "wet" lung and poor respiratory outcomes. To define fluid status changes during the transition from fetal to neonatal life in infants of diabetic mothers (IDM), we conducted a single-centre (Policlinico Abano Terme, Abano Terme, Italy) study of 66 IDM and a 1:2 matched control group from January 1 to September 30, 2020. Fluid status changes were assessed by computing Δ Hct from umbilical cord blood at birth and capillary heel Hct at 48 h, accounting for body weight decrease. IDM presented with significantly lower cord blood Hct levels in comparison to controls (47.33 ± 4.52 vs 50.03 ± 3.51%, p < 0.001), mainly if delivered by elective cesarean Sect. (45.01 ± 3.77 vs 48.43 ± 3.50%, p = 0.001). Hct levels at 48 h were comparable (55.18 ± 5.42 vs 54.62 ± 7.41%, p = 0.703), concurrently with similar body weight decrease (- 217.21 ± 113.34 vs - 217.51 ± 67.28 g, p = 0.614). This supports significantly higher ∆ Hct in IDM (5.13 ± 5.24 vs 7.29 ± 6.48, p < 0.01) and extra circulating fluid loss of 2-3%.Conclusion: Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung. What is Known: • In neonates, evidence suggests that expansion of the extracellular fluid volume prior to the postnatal diuresis is associated with poor respiratory outcomes. What is New: • Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung.

Pilot study of home phototherapy for neonatal jaundice monitored in maternity ward during the enforced Italy-wide COVID-19 national lockdown.

In Italy, where neonatal jaundice treatment is required, it is largely carried out in hospitals. However, it is possible to safely administer home phototherapy (HPT). We report our pilot center's experience of HPT and its potential benefits during the COVID-19-enforced national lockdown. This is an observational study performed at the Policlinic Abano Terme, a suburban hospital that covers a large catchment area near the Euganean Hills in Northeast Italy with around 1000 deliveries per year. HPT was started after regular nursery discharge, and the mothers brought the neonates back to the hospital maternity ward each day to check infants' bilirubin levels, weight, and general state of health, until it was deemed safe to stop. The efficacy of HPT in bilirubin reduction, hospital readmission rates, and parental satisfaction were evaluated. Thirty infants received HPT. In 4 of these infants, HPT was associated with total serum bilirubin (TSB) between 75 and 95th percentile (high-intermediate-risk zone) and in 26 infants HPT was associated with TSB > 95th percentile (high-risk zone) of the Bhutani nomogram. Among these 30 infants, 27 (90%) completed the HPT with a progressive decrease of TSB levels with 4 neonates requiring a second course and 3 infants requiring a third course of 24-h HPT. Three (10%) neonates failed HPT and were readmitted after one 24-h phototherapy course. No abnormalities of breastfeeding, body weight (defined as > 10% decrease), temperature, nor COVID infections were detected following HPT consultation in the neonatal ward. Home treatment efficacy with varying degrees of parental satisfaction occurred in all but 3 cases that involved difficulties with the equipment and inconsistent lamp manipulation practices. CONCLUSION: Our pilot study suggests that HPT for neonatal jaundice can be carried out effectively and with parental satisfaction as supported by daily back bilirubin monitoring in the maternity ward during the enforced COVID-19 national lockdown in Italy. WHAT IS KNOWN: • No high-quality evidence is currently available to support or refute the practice of phototherapy in patients' own homes. WHAT IS NEW: • Phototherapy can be delivered at home in a select group of infants and could be an ideal option if parents are able to return with their infants to the hospital maternity ward for daily follow-up. • It can be as effective as inpatient phototherapy and potentially helps in delivering family-centered care.

A Randomized Controlled Trial of Intact Cord Milking versus Immediate Cord Clamping in Term Infants Born by Elective Cesarean Section.

OBJECTIVE: We evaluated whether intact umbilical cord milking (UCM) is more effective than immediate cord clamping (ICC) in enhancing placental transfusion after elective cesarean delivery. STUDY DESIGN: In a randomized trial, volume of placental transfusion was assessed by Δ hematocrit (Hct) between neonatal cord blood and capillary heel blood at 48 hours of age, corrected for the change in body weight. RESULTS: There were no significant differences in cord blood mean Hct values at birth (UCM, 44.5 ± 4.8 vs. ICC, 44.9 ± 4.2%, p = 0.74). Conversely, at 48 hours of age, the UCM group had significantly higher capillary heel Hct values (UCM, 53.7 ± 5.9 vs. ICC, 49.8 ± 4.6%, p < 0.001), supporting a higher placental transfusion volume (Δ Hct, UCM 9.2 ± 5.2 vs. ICC 4.8 ± 4.7, p < 0.001), despite comparable neonatal body weight decrease (UCM, -7.3 vs. ICC, -6.8%, p = 0.77). CONCLUSION: Higher Δ Hct between cord blood at birth and capillary heel blood at 48 hours of age, corrected for the change in body weight, suggests that intact UCM is an efficacious and safe procedure to enhance placental transfusion among neonates born via elective cesarean delivery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT03668782.

Association of maternal food insecurity before and during pregnancy with fetal structural anomalies: A multicenter case-control study protocol.

BACKGROUND: Food insecurity, an issue also affecting developed countries, is associated with different negative outcomes. Particularly in pregnant women, a vulnerable population group, it has a double burden, as it affects both the woman and her child. Food insecurity has been associated with low birth weight and shorter gestational age, but there is less evidence on the association with fetal structural anomalies. AIM: To fill this gap, a study will be conducted to examine if pregnant women in a condition of food insecurity have a higher risk for fetal structural anomalies. METHODS: A case-control study will be conducted in three centers. Cases will be pregnant women (>18 years old) diagnosed with a fetal structural anomaly during the prenatal ultrasound examination of the II-III trimester, while controls will be pregnant women (>18 years old) with a negative result for fetal structural anomaly at the II-III trimester prenatal ultrasound examination. The exposure of interest will be food insecurity during the last 12 months, measured using the validated Household Food Insecurity Access Scale. A dedicated questionnaire will be given to women after they sign the informed consent form. SUMMARY: Finding a positive association between food insecurity in pregnant women and fetal structural anomalies could be the first step towards screening for it among pregnant women and designing policies that could mitigate this condition. Lowering food insecurity could prevent a certain number of fetal structural anomalies, leading to fewer negative pregnancy outcomes and health problems during childhood and adulthood.

Gestational weight gain and eating-related disorders.

This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from January to November 2018. In the second day postpartum, 463 healthy at term puerperae, 122 (26.35%) with inadequate gestational weight gain (GWG), 210 (45.46%) with adequate GWG, and 131 (28.29%) with excessive GWG, were studied by EAT-26, through distinguishing three factors: 'Dieting', 'Bulimia and food preoccupation', and 'Oral control'. EAT-26 Global score increased from inadequate, to adequate, and excessive GWG puerperae, resulting significantly higher in excessive GWG group (p = .0029, Anova's). In addition, among EAT-26 subscales 'Dieting' scores significantly increased from inadequate, to adequate, and to excessive GWG category women, resulting significantly higher in excessive GWG group (p = .006, Anova's). It was found that excessive GWG is a warning indicator of unhealthy eating and 'Dieting' disorders. This relationship highlights the potential for interventions directed towards psychosocial support to have salutary effects upon GWG.Excessive gestational weight gain across an uncomplicated pregnancy is a warning indicator of unhealthy eating and dieting disorders.IMPACT STATEMENTWhat is already known on this subject? Pregnancy represents a time of rapid trimester-specific changes in body weight and size.What do the results of this study add? Excessive gestational weight gain is a warning indicator of unhealthy eating and dieting disorders.What are the implications of these findings for clinical practice and/or further research? This relationship highlights the potential for interventions directed towards psychosocial support to have salutary effects upon gestational weight gain.

Determinants and effects of fluid status changes in caesarean delivered neonates.

AIM: Evidence suggests that caesarean section is associated with a reduced placental transfusion and poor iron-related haematological indices, both in cord and peripheral blood, compared with vaginal delivery. We assessed determinants and effects of fluid status changes on placental transfusion in neonates delivered by elective (ElCD) and emergency (EmCD) caesarean section. METHODS: Placental transfusion was estimated by ∆ haematocrit (Hct) increase from birth to 48 hours of life, accounting for contemporaneous ∆ body weight decrease, in 143 women/infant pairs, 62 who underwent ElCD and 81 EmCD, respectively. RESULTS: Cord blood Hct levels at birth of ElCS neonates were significantly lower than those of EmCD neonates (44.58 + 4.87vs 49.93 + 4.29, P = .01). At 48 hours of life, capillary heel Hct levels of ElCD and of EmCD neonates were comparable. ElCD had a higher ∆ body weight decrease (ElCD -7.25 ± 1.74% vs EmCD -6.31 ± 2.34% [P: .011]) and ∆ Hct increase ([ElCD + 5.93 ± 4.92 vs EmCD + 3.59 ± 5.29, [P: .011]). In a linear regression model analysis, gestational age in ElCD neonates had a significant effect on the differences in arterial cord blood Hct, body weight at birth and body weight decrease at 48 hours after birth. CONCLUSION: Early-term surgical delivery is a determinant of transient dilutional anaemia in ElCD neonates, lacking neuroendocrine response of labour and delivery.

Pain and stress after vaginal delivery: characteristics at hospital discharge and associations with parity.

The objective of this study was to characterise pre-discharge maternal pain and stress severity after vaginal delivery and associations with parity. This is a descriptive analysis with 148 women in the early post-partum period (84 primiparae and 64 secondiparae) after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Psychological Stress Measure (PSM). Vaginal delivery in primiparae women was associated with MGPQ, significantly higher pain scores. Sensorial, affective and mixed pain descriptive categories were also significantly higher. Pain location involved lower abdomen, vagina and perianal area. In addition, their PSM showed a significantly higher 'Sense of effort and confusion' subscale scores. In conclusion, this study provides important information on the quality of care implications of hospital-to-home discharge practices in puerperae after vaginal delivery, a critical time characterised by qualitatively and quantitatively high pain and stress in primiparae.Impact statementWhat is already known on this subject? Pain and fatigue are the most common problems reported by women in the early postpartum period.What the results of this study add? Primiparae who delivered vaginally presented at the time of hospital-to-home discharge significantly higher pain and stress, as compared to secondiparae. Pain involved lower abdomen, vagina and perianal area, whereas the stress was quantitatively higher in the 'sense of effort and confusion'.What the implications are of these findings for clinical practice and/or further research? Awareness of problematic pain and stress associations with parity may offer the opportunity to better support puerperae to develop maternal orientation and adjust to motherhood.

A temperature gradient may support mother-infant thermal identification and communication in the breast crawl from birth to breastfeeding.

AIM: The human female's nipple-areolar complex (NAC) is the point of arrival of a natural progression from birth to breastfeeding, linked to functional, chemical and biophysical cues that promote the breast crawl soon after birth. We investigated the thermal gradient generated by the lips of the neonate and warmth of the NAC, which may drive the infant directly to the nipple. METHODS: We prospectively studied 41 full-term singleton infants and their mothers at the Policlinico Abano Terme, Italy, between January 1, 2015, and February 28, 2015. NAC and breast quadrant temperatures were assessed 6 ± 2 hours prepartum and one and two days postpartum, together with the neonates' lip temperature. RESULTS: The temperature of the neonates' lips was significantly lower than the forehead temperature on days one and two postpartum (delta = -1.24°C, p < 0.001 and delta = -1.02°C, p < 0.001, respectively). Thus, the thermal gradient between the NAC and the neonates' lips was -1.66 ± 1.07°C on day one (p < 0.001) and -1.68 ± 0.63°C (p < 0.001) on day two postpartum. CONCLUSION: These findings demonstrate, for the first time, that a temperature gradient may support mother-infant thermal identification and communication in the breast crawl and in the natural progression of the continuum from birth to breastfeeding.

Body image and breastfeeding practices in obese mothers.

PURPOSE: This study analyzed body image perceptions and breastfeeding practices in obese mothers. METHODS: Prospective, case-control study on 25 obese (BMI >30 kg/m(2)) and 25 normal-weight puerperae, matched for parity and delivery route. The participants completed the Body Uneasiness Test, a two-part, self-report questionnaire, investigating body image perception before they were discharged from hospital and participated in telephone interviews concerning breastfeeding practices. RESULTS: Obese women demonstrated body image dissatisfaction related to their obesity. On average, they reported significantly higher scores on Global Severity Index (p < 0.0001) and on all of the BUT-A subscales: Weight Phobia (p < 0.02), Body Image Concerns (p < 0.0001), Avoidance (p < 0.0001), Compulsive Self-Monitoring (p < 0.01), and Depersonalization (p = 0.002) than did normal-weight puerperae. Moreover, they also had higher BUT-B scores and the Positive Symptom Total was significantly higher (p < 0.002). Finally, while breastfeeding practices at discharge were similar in the two groups, the obese mothers were more likely to maintain full breastfeeding at 6 months (p < 0.04). CONCLUSIONS: Obese mothers have negative body image perceptions but they maintain full breastfeeding longer.

'Two-step' head-to-body delivery activates foetal gluconeogenesis.

AIM: The 'two-step' head-to-body delivery method, which involves waiting for the next contraction to deliver the shoulders, causes a decrease in umbilical artery pH. The aim of this study was to assess whether foetal acidemia activates gluconeogenesis. METHODS: We tested umbilical artery cord blood glucose concentration and pH after 341 spontaneous and 25 vacuum extractor 'two-step' vaginal deliveries (VD) and after 85 elective and 49 emergency caesarean sections (CS). RESULTS: Cord blood glucose concentration was significantly higher (95.5 ± 21.4 mg/dL vs 75.6 ± 16.4, p < 0.001), and pH values significantly lower (7.31 ± 0.09 vs 7.33 ± 0.06, p = 0.003) in 'two-step' VD neonates than in CS delivered neonates. In addition, cord blood glucose concentration was significantly higher (101.4 ± 30.6 mg/dL, p = 0.004), and pH values were significantly lower (7.26 ± 0.10, p < 0.001) in VD by vacuum extractor than in all other groups. The cord blood glucose concentration is significantly and negatively correlated with pH in the study population (r = -0.094, p = 0.036) and strongly significantly and negatively correlated in VD by vacuum extractor (r = -0.594, p = 0.007). CONCLUSION: Cord blood glucose concentrations are significantly higher and pH values significantly lower in 'two-step' VD neonates, indicating activated foetal gluconeogenesis.

Trajectory of serum bilirubin in offspring of women with gestational diabetes mellitus.

AIMS: To investigate the trajectory of bilirubin from birth to the first 48 h of life in neonates of women with gestational diabetes. METHODS: In a cohort of 69 neonates of women with gestational diabetes, delivered at Policlinic Abano, Abano Terme, Italy, from October 2021 to May 2022, we conducted a case-control study (1:2 ratio) on total serum bilirubin (TSB) trajectory over the first 48 h after birth. An ancillary analysis was conducted on arterial cord blood gas analysis at birth and on concurrent hemoglobin, hematocrit, lactate, glycemia, and bilirubin levels. RESULTS: The neonates of women with gestational diabetes showed a significantly higher mean percent variation of TSB from birth to the first 48 h of life (p = 0.01), a finding supported by a higher, although not significant, TSB levels at 48 h of life in comparison to controls (8.05 ± 4.8 vs 8.05 ± 4 mg%, p = 0.082), and by a significantly lower cord TSB levels (2.3 ± 0.9 vs 2.6 ± 0.9 mg%, p = 0.010). CONCLUSIONS: The findings suggest that future primary studies on hyperbilirubinemia risk in neonates of women with gestational diabetes should consider the trajectory of TSB beyond the first 48 h, adjusting for a more complete set of pre-pregnancy and gestational prognostic risk factors.

Case report: vertical transmission of Plesiomonas shigelloides. Is it time to strengthen information on safety concerns for raw seafood dietary exposure in pregnancy?

The consumption of raw seafood, generally considered to be a healthy food, has greatly increased worldwide. Pathogens of fish can cause foodborne illnesses in humans, especially following the consumption of raw seafood from contaminated water.Foodborne illness in pregnant women is seldom the cause of neonatal infection, but, as in the reported cases, it has been associated with a high degree of morbidity and mortality.We present the case of a newborn with septicemia and meningitis caused by Plesiomonas shigelloides acquired via the transplacental route. There was a maternal history of ingestion of raw seafood 1 week prior to delivery. A few similar cases are described in the existing literature, which reports 7 neonatal deaths.Therefore, the primary objective of this paper is to highlight the fact that the popularity of raw seafood such as sushi, sashimi, and oysters, requires an improvement in dietary advice regarding unsafe choices in pregnancy in order to avoid preventable foodborne diseases, sometimes fatal for the newborn.

Syphilis Infection during pregnancy: fetal risks and clinical management.

Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

Herpes simplex virus infection in pregnancy.

Infection with herpes simplex is one of the most common sexually transmitted infections. Because the infection is common in women of reproductive age it can be contracted and transmitted to the fetus during pregnancy and the newborn. Herpes simplex virus is an important cause of neonatal infection, which can lead to death or long-term disabilities. Rarely in the uterus, it occurs frequently during the transmission delivery. The greatest risk of transmission to the fetus and the newborn occurs in case of an initial maternal infection contracted in the second half of pregnancy. The risk of transmission of maternal-fetal-neonatal herpes simplex can be decreased by performing a treatment with antiviral drugs or resorting to a caesarean section in some specific cases. The purpose of this paper is to provide recommendations on management of herpes simplex infections in pregnancy and strategies to prevent transmission from mother to fetus.