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1.
Biochim Biophys Acta Mol Basis Dis ; 1869(1): 166582, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36273675

RESUMEN

The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Humanos , Recién Nacido , Adulto , Femenino , Embarazo , COVID-19/complicaciones , SARS-CoV-2 , Mujeres Embarazadas , Estudios Prospectivos
2.
J Infect Chemother ; 29(1): 33-38, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36103949

RESUMEN

BACKGROUND: Information regarding effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant strains on clinical manifestations and outcomes of coronavirus disease 2019 (COVID-19) in pregnant women is limited. METHODS: A retrospective observational study was conducted using the data from the nationwide COVID-19 registry in Japan. We identified pregnant patients with symptomatic COVID-19 hospitalized during the study period. The Delta and Omicron variants of concern (VOC) predominant periods were defined as August 1 to December 31, 2021 and January 1 to May 31, 2022, respectively. Clinical characteristics were compared between the patients in the Delta and Omicron VOC periods. In addition, logistic regression analysis was performed to identify risk factors for developing moderate-to-severe COVID-19. RESULTS: During the study period, 310 symptomatic COVID-19 cases of pregnant women were identified; 111 and 199 patients were hospitalized during the Delta and Omicron VOC periods, respectively. Runny nose and sore throat were more common, and fatigue, dysgeusia, and olfactory dysfunction were less common manifestations observed in the Omicron VOC period. In the multivariable logistic regression analysis, onset during the later stage of pregnancy (OR: 2.08 [1.24-3.71]) and onset during the Delta VOC period (OR: 2.25 [1.08-4.90]) were independently associated with moderate-to-severe COVID-19, whereas two doses of SARS-CoV-2 vaccine were protective against developing moderate-to-severe COVID-19 (OR: 0.34 [0.13-0.84]). CONCLUSIONS: Clinical manifestations of COVID-19 in pregnant women differed between the Delta and Omicron VOC periods. SARS-CoV-2 vaccination was still effective in preventing severe COVID-19 throughout the Delta and Omicron VOC periods.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Humanos , Femenino , Embarazo , Mujeres Embarazadas , COVID-19/epidemiología , Vacunas contra la COVID-19 , SARS-CoV-2 , Complicaciones Infecciosas del Embarazo/epidemiología
3.
Obstet Gynecol Clin North Am ; 49(4): 693-712, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36328675

RESUMEN

Efforts to prevent mother-to-child transmission of human immunodeficiency virus (HIV) have led to dramatic reductions in pediatric HIV worldwide. New advances in HIV treatment and prevention, focused on pregnant and breastfeeding women living with HIV, have improved maternal health while decreasing vertical and horizontal HIV transmission. In this article, we describe how such interventions-including antiretroviral therapy and HIV pre-exposure prophylaxis-can be incorporated into antepartum and postpartum care in global settings.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Complicaciones Infecciosas del Embarazo , Embarazo , Femenino , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Fármacos Anti-VIH/uso terapéutico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/prevención & control , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Periodo Posparto , Lactancia Materna , VIH
4.
BMC Pediatr ; 22(1): 625, 2022 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-36324100

RESUMEN

BACKGROUND: Research of coronavirus disease (COVID-19) effects on newborns is ongoing. But the research of specific variant's effects is none. This study analyzed the effects of the Omicron variant on the perinatal outcomes of full-term newborns during the Omicron wave period.  METHODS: Between December 2021 and April 2022, this study was conducted on all newborns who visited a single center. We investigated due to the Omicron maternal infection maternal pregnancy complications, delivery methods, birth week, Apgar scores, neonatal resuscitation program requirement, whether respiratory support was required until 12 h after childbirth, suspicious infectious status, and mortality depending on maternal Omicron infection. RESULTS: A total of 127 neonates were enrolled, and 12 were excluded based on exclusion criteria. Sixteen neonates were born to mothers with a history of Omicron COVID-19, and 99 were born to non-infectious mothers. All infected mothers became infected in the 3rd trimester. Of the 16 mothers, seven were symptomatic, and four met the isolation criteria, according to Korean guidelines. The birth weight of newborns to mothers with a history of COVID and those without was 2.958 ± 0.272 kg and 3.064 ± 0.461 kg (p = 0.049), respectively. The 5-min Apgar score at childbirth was 9.29 ± 0.756 and 9.78 ± 0.460 for neonates born to symptomatic and asymptomatic mothers (p = 0.019), respectively. When compared with or without maternal self-isolation, neonates requiring respiratory support 12 h after birth demonstrated a significant difference (p = 0.014; OR, 10.275). Additionally, the presence or absence of transient tachypnea of the newborn showed a significant value (p = 0.010; OR 11.929). CONCLUSIONS: Owing to Omicron COVID-19, newborns were born with lower birth weight, low 5-min Apgar scores, and required respiratory support until 12 h after birth.


Asunto(s)
COVID-19 , Enfermedades del Recién Nacido , Complicaciones Infecciosas del Embarazo , Complicaciones del Embarazo , Embarazo , Femenino , Recién Nacido , Humanos , SARS-CoV-2 , Transmisión Vertical de Enfermedad Infecciosa , Resucitación , Peso al Nacer
5.
J Obstet Gynaecol Res ; 48(11): 2721-2729, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36319204

RESUMEN

AIM: To evaluate the utility of the risk score in assessing the current status and prognosis of COVID-19 in pregnancy. METHODS: Seventy-seven cases affected before the Omicron variant epidemic and 50 pregnant cases affected by the Omicron variant were included. The risk score consists of maternal background, current condition, and examination findings. We determined the risk score in the early stages of disease onset. RESULTS: There were no significant differences in the maternal or gestational ages between the groups. The risk score was significantly lower in the After-Group patients (those affected during the Omicron epoch), while 14.3% of the Before-Group patients (those affected during the pre-Delta and Delta epochs), experienced a worsening of disease after the visit to the center, whereas none of the After-Group patients did. The Before Group's frequency of risk score items was higher among the two groups for "fever for ≥48 h," "mild pneumonia image," and "blood tests," whereas "disease onset 14 days after the second vaccination" was increased in After Group. The blood test parameters for platelet count, C-reactive protein, and D-dimer levels were not significantly different between the groups. CONCLUSIONS: The risk score system appeared superior in detecting deteriorating cases. There were no cases of post-illness deterioration in the After-Group, suggesting that cases of the Omicron variant in pregnancy may have had a less severe course compared to that of previous variants. However, there was no significant difference between the groups in terms of a specific blood test evaluation, suggesting the need for a combined evaluation of cases affected during pregnancy.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Embarazo , Femenino , Humanos , SARS-CoV-2 , Factores de Riesgo , Medición de Riesgo
6.
Nutrients ; 14(21)2022 Oct 27.
Artículo en Inglés | MEDLINE | ID: mdl-36364782

RESUMEN

This systematic review and meta-analysis aimed to determine if probiotic supplementation in pregnancy reduced maternal Group B streptococcus (GBS) recto-vaginal colonization in pregnant women at 35-37 weeks of gestation. Electronic databases (i.e., PubMed, MEDLINE, ClinicalTrials.gov, ScienceDirect, and the Cochrane Library) were searched from inception up to February 2022. We included RCTs assessing the effects of probiotic supplementation in pregnancy on GBS recto-vaginal colonization. The primary outcome was GBS-positive recto-vaginal cultures performed at 35-37 weeks of gestation. Secondarily, we evaluated obstetric and short-term neonatal outcomes. A total of 132 publications were identified; 9 full-length articles were reviewed to finally include 5 studies. Probiotic supplementation reduced vaginal GBS colonization: the GBS positive culture rate was estimated at 31.9% (96/301) in the intervention group compared to 38.6% (109/282) in the control group (OR = 0.62, 95% CI 0.40-0.94, I2 4.8%, p = 0.38). The treatment started after 30 weeks of gestation and was more effective in reducing GBS colonization (OR 0.41, 95% CI 0.21-0.78, I2 0%, p = 0.55). Probiotic administration during pregnancy, namely in the third trimester, was associated with a reduced GBS recto-vaginal colonization at 35-37 weeks and a safe perinatal profile. Whether this new strategy could reduce the exposition of pregnant women to significant doses of antibiotics in labor needs to be evaluated in other trials.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Probióticos , Infecciones Estreptocócicas , Recién Nacido , Femenino , Embarazo , Humanos , Mujeres Embarazadas , Infecciones Estreptocócicas/prevención & control , Streptococcus agalactiae , Vagina , Probióticos/uso terapéutico
7.
East Mediterr Health J ; 28(10): 768-775, 2022 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-36382732

RESUMEN

Background: The detection of hepatitis B surface antigen positivity in pregnant women before delivery is crucial to preventing mother-to-child transmission of hepatitis B virus. Aims: This study aimed to evaluate the status and rate of testing for hepatitis B surface antigen, rate of hepatitis B surface antigen positivity, hepatitis B surface antigen positivity distribution rate by age, and changes in hepatitis B surface antigen positivity rate in pregnant women over the study period. Methods: We conducted a multicentre, cross-sectional, descriptive study covering the period January 2005 to June 2019 for 2 145 668 pregnant women from 27 provinces in all 7 regions of Turkey, collected using Microsoft Excel before statistical analysis. Results: We found that 1 012 593 (47.1%) pregnant women were tested for hepatitis B surface antigen over the 15-year period, out of which 11 471 (1.1%) were hepatitis B surface antigen-positive. Overall, 97% of the hepatitis B surface antigen positive women were born before 1998, the year that national HBV vaccination was launched in Turkey. The rate of hepatitis B surface antigen positivity in that group was 1.1%, compared with 0.3% among women born after 1998. Conclusion: There was a downward trend in the hepatitis B surface antigen positivity rate among pregnant women in the younger age groups, especially among those born after universal hepatitis B vaccination was inaugurated, and low rate of HBsAg testing during pregnancy.


Asunto(s)
Hepatitis B , Complicaciones Infecciosas del Embarazo , Femenino , Embarazo , Humanos , Antígenos de Superficie de la Hepatitis B , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Hepatitis B/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Mujeres Embarazadas , Estudios Transversales , Turquia/epidemiología , Virus de la Hepatitis B , Vacunación , Vacunas contra Hepatitis B
8.
Turk J Med Sci ; 52(3): 554-564, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-36326345

RESUMEN

BACKGROUND: Convalescent plasma (CP) might be an additional treatment modality in COVID-19. The aim of this study was to compare CP-related clinical characteristics and perinatal outcomes in pregnant women with mild or moderate-severe COVID-19. METHODS: This prospective cohort study included 36 pregnant women (12 mild and 24 moderate-severe), who underwent CP therapy. The CP obtained from recently recovered donors was transfused to patients together with maximum supportive care and antiviral agents. The groups were then compared in respect of clinical characteristics, laboratory parameters, obstetric complications, and neonatal outcomes. RESULTS: Significant differences were determined between the groups in respect of systemic corticosteroids in COVID-19 treatment (41.7%, 87.5%, p = 0.004), oxygen (O2) support (0%, 91.7%, p < 0.001), chest imaging (41.7%, 58.3%, p = 0.02), intensive care unit admission (0%, 20.8%, p = 0.03) and length of hospitalization (5.5 versus 9.5 days, p < 0.001). The O2 saturation levels before and after administration of CP were significantly lower in the moderate-severe COVID-19 group (p < 0.05). The O2 therapy time before and after administration of CP and total O2 therapy time were significantly lower in the mild COVID-19 group (p < 0.05). Platelet, plateletcrit and lymphocyte counts were significantly higher in both the mild and moderate-severe COVID-19 groups after treatment compared to the pretreatment values (p < 0.05). DISCUSSION: Although data on the results of CP treatment in pregnant women are somewhat limited, it has been suggested that early CP treatment may be associated with improvements in laboratory and ventilatory parameters in pregnant women with mild and moderate-severe COVID-19. Nevertheless, there is a need for further, randomized controlled studies on this subject with the inclusion of greater numbers of patients.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Femenino , Humanos , Recién Nacido , Embarazo , COVID-19/terapia , Inmunización Pasiva/métodos , Pandemias , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/terapia , Estudios Prospectivos , SARS-CoV-2
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(11): 1266-1268, 2022 Nov 15.
Artículo en Chino | MEDLINE | ID: mdl-36398554

RESUMEN

A 7-day-old male neonate was admitted due to testing positive for SARS-CoV-2. The neonate was born through cesarian section at 40 weeks and 2 days of gestation. His mother was diagnosed with coronavirus disease 2019 (COVID-19) caused by Omicron variant infection 1 day before delivery. The neonate was separated from his mother after birth and was taken care of by his father. Three days after the neonate was born, his father was also diagnosed with COVID-19. The neonate was diagnosed with COVID-19 on day 7 of life. The neonate presented with hyperpyrexia, dyspnea, hypoxia, and feeding difficulties, and the chest CT showed the coexistence of consolidation and ground glass-like changes mainly located below the posterior pleura. He was given symptomatic support treatment such as low flow oxygen therapy and posture management after admission. He was cured and discharged after 10 days of hospitalization. This is the first reported case of neonatal severe COVID-19 caused by Omicron variant infection in China. It is necessary to take appropriate protective measures for the neonate to prevent infection when the mother or caregiver of the neonate is a suspected or confirmed cases of COVID-19.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Recién Nacido , Embarazo , Femenino , Humanos , Masculino , SARS-CoV-2 , Hospitalización , Madres
10.
Zhonghua Er Ke Za Zhi ; 60(11): 1163-1167, 2022 Nov 02.
Artículo en Chino | MEDLINE | ID: mdl-36319151

RESUMEN

Objective: To summarize the management and short-term outcomes of neonates delivered by mothers infected with SARS-CoV-2 Omicron variant. Methods: A retrospective study was performed on 158 neonates born to mothers infected with SARS-CoV-2 Omicron variant admitted to the isolation ward of Children's Hospital of Fudan University from March 15th, 2022 to May 30th, 2022. The postnatal infection control measures for these neonates, and their clinical characteristics and short-term outcomes were analyzed. They were divided into maternal symptomatic group and maternal asymptomatic group according to whether their mothers had SARS-CoV-2 symptoms. The clinical outcomes were compared between the 2 groups using Rank sum test and Chi-square test. Results: All neonates were under strict infection control measures at birth and after birth. Of the 158 neonates, 75 (47.5%) were male. The gestational age was (38+3±1+3) weeks and the birth weight was (3 201±463)g. Of the neonates included, ten were preterm (6.3%) and the minimum gestational age was 30+1 weeks. Six neonates (3.8%) had respiratory difficulty and 4 of them were premature and required mechanical ventilation. All 158 neonates were tested negative for SARS-COV-2 nucleic acid by daily nasal swabs for the first 7 days. A total of 156 mothers (2 cases of twin pregnancy) infected with SARS-CoV-2 Omicron variant, the time from confirmed SARS-CoV-2 infection to delivery was 7 (3, 12) days. Among them, 88 cases (56.4%) showed clinical symptoms, but none needed intensive care treatment. The peripheral white blood cell count of the neonates in maternal symptomatic group was significantly higher than that in maternal symptomatic group (23.0 (18.7, 28.0) × 109 vs. 19.6 (15.4, 36.6) × 109/L, Z=2.44, P<0.05). Conclusions: Neonates of mothers infected with SARS-CoV-2 Omicron variant during third trimester have benign short-term outcomes, without intrauterine infection through vertical transmission. Strict infection control measures at birth and after birth can effectively protect these neonates from SARS-CoV-2 infection.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Madres , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Retrospectivos , SARS-CoV-2
11.
PLoS One ; 17(11): e0277271, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36342923

RESUMEN

BACKGROUND: Prevention of mother-to-child transmission (PMTCT) has reduced HIV incidence among new-borns. However, PMTCT remains concerning in sub-Saharan Africa due to bottlenecks including viral load (VL) monitoring during pregnancy. We assessed VL coverage and materno-foetal outcomes of pregnancy among HIV-infected women within the Cameroonian context. METHODS: A hospital-based study was conducted among HIV-infected mothers and their babies in three facilities of the Littoral region of Cameroon from January 2019 to May 2021. Maternal VL-coverage was monitored during pregnancy (VL>1000 copies/ml or unknown were classified as MTCT high-risk group); HIV early infant diagnosis (EID) was evaluated by PCR at six-weeks after birth, and EID results were analysed according to maternal VL; p<0.05 was considered statistically significant. RESULTS: Of 135 HIV-infected pregnant women enrolled (median [IQR] age 39 [27-37] years), VL-coverage during antenatal care (ANC) was 50.4% (68/135), with a lower VL-coverage in 2019 (37.5% vs. 61.9%, p = 0.0069). Married women vs. single (61.8% vs. 42.5%, p = 0.0275) and those on treatment before vs. during pregnancy (56.7% vs. 5.8%, p = 0.0043) had a higher VL-coverage, respectively. Among those with known VL, 10.3% (7/68) had high (VL>1000 copies/mL), 22.1% (15/68) had low (50-1000 copies/mL), and 67.6% (46/68) had undetectable (<50 copies/mL) VL, suggesting an overall viral suppression (<1000copies/mL) of 89.7% (61/68). Vaginal delivery was 80.75% (109/135) regardless of VL, including 81.1% (59/74) women in the high-risk group. EID coverage was 88.1% (119/135) and the rate of HIV-1 MTCT was 1.68% (2/119). Both HIV-positive infants were from the high-risk group, had prolonged labour, had vaginal delivery and were breastfed. CONCLUSION: In these Cameroonian settings, VL-coverage remains suboptimal (below 90%) among ANC attendees, and women at high-risk of MTCT mainly have vaginal delivery. Viral suppression rate remains below the target (below 90%) for accelerating the elimination of MTCT. HIV-MTCT persists, and might be driven essentially by poor VL monitoring. Thus, achieving an optimal PMTCT performance requires a thorough compliance to virologic assessment during ANC.


Asunto(s)
Infecciones por VIH , Seropositividad para VIH , VIH-1 , Complicaciones Infecciosas del Embarazo , Lactante , Femenino , Embarazo , Humanos , Adulto , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Carga Viral , Camerún/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Instituciones de Salud
12.
Georgian Med News ; (328-329): 100-107, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36318851

RESUMEN

Currently, in relation to the effect of this pandemic on pregnancy, there are more questions than certainties about the real impact of COVID-19 on pregnant women. Studies are updated and often contradict each other. There is no evidence to suggest that pregnant women with COVID-19 have higher morbidity than affected non-pregnant women. We aimed to know whether maternal morbidities were more frequent in pregnant woman with COVID-19 compared to non-infected pregnant women. A retrospective case control study was conducted during a period of 6 months. Medical records were reviewed. A 120 files of COVID-19 infected women from Mosul city, and 95 files of non-infected pregnant women were reviewed and analyzed. We found that Infection with COVID-19 had a significant effect on pregnancy outcome, infected women were more likely to have higher incidence rates of adverse perinatal outcomes in both mothers and the newborns. Also, higher odds of complications associated with severe disease form Findings of our study came in line with previous studies in other countries, however, more medical care and support should be provided to pregnant women infected with COVID-19, particularly severe cases. Further studies with larger sample size are still needed for good understanding of the effect of virus on pregnancy outcomes.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Recién Nacido , Femenino , Embarazo , Humanos , Tercer Trimestre del Embarazo , Estudios de Casos y Controles , Estudios Retrospectivos , Resultado del Embarazo
13.
JAMA Netw Open ; 5(11): e2240993, 2022 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-36350652

RESUMEN

Importance: Pregnant persons are at an increased risk of severe COVID-19 from SARS-CoV-2 infection, and COVID-19 vaccination is currently recommended during pregnancy. Objective: To ascertain the association of vaccine type, time from vaccination, gestational age at delivery, and pregnancy complications with placental transfer of antibodies to SARS-CoV-2. Design, Setting, and Participants: This cohort study was conducted in Pennsylvania Hospital in Philadelphia, Pennsylvania, and included births at the study site between August 9, 2020, and April 25, 2021. Maternal and cord blood serum samples were available for antibody level measurements for maternal-neonatal dyads. Exposures: SARS-CoV-2 infection vs COVID-19 vaccination. Main Outcomes and Measures: IgG antibodies to the receptor-binding domain of the SARS-CoV-2 spike protein were measured by quantitative enzyme-linked immunosorbent assay. Antibody concentrations and transplacental transfer ratios were measured after SARS-CoV-2 infection or receipt of COVID-19 vaccines. Results: A total of 585 maternal-newborn dyads (median [IQR] maternal age, 31 [26-35] years; median [IQR] gestational age, 39 [38-40] weeks) with maternal IgG antibodies to SARS-CoV-2 detected at the time of delivery were included. IgG was detected in cord blood from 557 of 585 newborns (95.2%). Among 169 vaccinated persons without SARS-CoV-2 infection, the interval from first dose of vaccine to delivery ranged from 12 to 122 days. The geometric mean IgG level among 169 vaccine recipients was significantly higher than that measured in 408 persons after infection (33.88 [95% CI, 27.64-41.53] arbitrary U/mL vs 2.80 [95% CI, 2.50-3.13] arbitrary U/mL). Geometric mean IgG levels were higher after vaccination with the mRNA-1273 (Moderna) vaccine compared with the BNT162b2 (Pfizer/BioNTech) vaccine (53.74 [95% CI, 40.49-71.33] arbitrary U/mL vs 25.45 [95% CI, 19.17-33.79] arbitrary U/mL; P < .001). Placental transfer ratios were lower after vaccination compared with after infection (0.80 [95% CI, 0.68-0.93] vs 1.06 [95% CI, 0.98-1.14]; P < .001) but were similar between the mRNA vaccines (mRNA-1273: 0.70 [95% CI, 0.55-0.90]; BNT162b2: 0.85 [95% CI, 0.69-1.06]; P = .25). Time from infection or vaccination to delivery was associated with transfer ratio in models that included gestational age at delivery and maternal hypertensive disorders, diabetes, and obesity. Placental antibody transfer was detectable as early as 26 weeks' gestation. Transfer ratio that was higher than 1.0 was present for 48 of 51 (94.1%) births at 36 weeks' gestation or later by 8 weeks after vaccination. Conclusions and Relevance: This study found that maternal and cord blood IgG antibody levels were higher after COVID-19 vaccination compared with after SARS-CoV-2 infection, with slightly lower placental transfer ratios after vaccination than after infection. The findings suggest that time from infection or vaccination to delivery was the most important factor in transfer efficiency.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Vacuna BNT162 , Estudios de Cohortes , COVID-19/prevención & control , Vacunas contra la COVID-19 , Inmunoglobulina G , Philadelphia , Placenta , Complicaciones Infecciosas del Embarazo/prevención & control , SARS-CoV-2 , Vacunación
15.
Obstet Gynecol ; 140(3): 447-449, 2022 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-36356238

RESUMEN

This is a descriptive study of pregnant patients who received nirmatrelvir-ritonavir therapy from April 16, 2022, through May 18, 2022. Patients were eligible to receive nirmatrelvir-ritonavir if they were diagnosed with mild-to-moderate coronavirus disease 2019 (COVID-19) with symptom onset within 5 days, did not require oxygen therapy or hospital admission, and had no contraindications to nirmatrelvir-ritonavir. During the study time frame, 11 patients were identified as candidates for nirmatrelvir-ritonavir treatment. All patients agreed to nirmatrelvir-ritonavir treatment after a telehealth consultation; seven patients completed the treatment. All patients who received nirmatrelvir-ritonavir experienced symptom resolution without the need for additional care. All but one patient tolerated nirmatrelvir-ritonavir without immediate adverse effects, and no adverse fetal or neonatal effects were observed.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Femenino , Recién Nacido , Embarazo , Humanos , Ritonavir/uso terapéutico , Ritonavir/efectos adversos , COVID-19/tratamiento farmacológico , Lopinavir/uso terapéutico , SARS-CoV-2 , Resultado del Embarazo , Antivirales/uso terapéutico , Combinación de Medicamentos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico
16.
BMJ Open ; 12(11): e063482, 2022 11 08.
Artículo en Inglés | MEDLINE | ID: mdl-36351715

RESUMEN

OBJECTIVES: Eliminating mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is central to WHO's target of reducing hepatitis B infection in children to <0.1% by 2030. While Nigeria accounts for 8.3% of the global burden, interventional studies on prevention of MTCT of HBV are hardly available. This study aimed to assess the impact of prevention of MTCT interventions on vertical transmission of HBV among pregnant women in Nigeria. DESIGN: A prospective cohort study. SETTING: A University Teaching Hospitals Complex in Nigeria between 2015 and 2021. PARTICIPANTS: 10 866 pregnant women and their pre-existing children. INTERVENTIONS: Eligible pregnant women were screened for HBsAg using chromatographic immunoassay (Micropoint, USA). HbsAg-positive women had HBV serological assay done and their pre-existing children were screened. Women with HBV DNA ≥2 00 000 IU/mL and those positive for hepatitis B e-antigen (HBeAg) had 300 mg/day of Tenofovir Disoproxil Fumarate (TDF) in the third trimester. The newborns had hepatitis B vaccines and HB immunoglobulin (HBIG) administered, followed by testing for HBsAg at 9 months postnatally. PRIMARY OUTCOME MEASURES: Prevalence of chronic hepatitis B infection in pregnancy, and the incidence of MTCT of HBV. RESULTS: Overall, 395 women had chronic HBV infection, giving a prevalence of 3.64%. Their mean age was 31.51±5.71 years, with a median parity of 1.2. Thirteen women (5.2%) were positive for HBeAg, seven (3.1%) of the 225 pre-existing hepatitis B-exposed children were HbsAg positive and 17 women had prenatal TDF. Overall, 376 women completed the study, with mean birth weight of 3.21±1.86 kg and perinatal mortality rate of 29.2/1000 births. Hepatitis Bvaccine-HBIG combination was administered to 260 newborns, while the others had hepatitis B vaccine alone. All the children tested negative to the HbsAg at 9 months. CONCLUSION: Eliminating MTCT of HBV infection through validated protocols in low and middle income countries with the highest burden of chronic HBV infections is feasible. National scale-up of such protocols is recommended.


Asunto(s)
Hepatitis B Crónica , Hepatitis B , Complicaciones Infecciosas del Embarazo , Lactante , Femenino , Recién Nacido , Embarazo , Humanos , Adulto , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Antígenos e de la Hepatitis B , Antígenos de Superficie de la Hepatitis B , Estudios Prospectivos , Estudios de Seguimiento , Nigeria/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , ADN Viral , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Virus de la Hepatitis B , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis B Crónica/epidemiología , Hepatitis B Crónica/prevención & control , Tenofovir/uso terapéutico , Inmunoglobulinas/uso terapéutico
17.
Nat Commun ; 13(1): 6961, 2022 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-36379951

RESUMEN

The Centers for Disease Control (CDC) recommend a third dose of COVID-19 vaccine for pregnant women, although data regarding effectiveness during pregnancy are lacking. This national, population-based, historical cohort study of pregnant women in Israel, delivering between August 1, 2021 and March 22, 2022, aims to analyze and compare the third and second doses' vaccine effectiveness in preventing COVID-19-related hospitalizations during pregnancy during two COVID-19 waves (Delta variant in the summer of 2021 and Omicron, BA.1, variant in the winter of 2022). Time-dependent Cox proportional-hazards regression models estimate the hazard ratios (HR) and 95% confidence intervals (CI) for COVID-related outcomes according to vaccine dose, and vaccine effectiveness as 1-HR. Study includes 82,659 and 33,303 pregnant women from the Delta and Omicron waves, respectively. Compared with the second dose, the third dose effectively prevents overall hospitalizations with SARS-CoV-2 infections, with estimated effectiveness of 92% (95% CI 83-96%) during Delta, and enhances protection against significant disease during Omicron, with effectiveness of 92% (95% CI 26-99%), and 48% (95% CI 37-57%) effectiveness against hospitalization overall. A third dose of the BNT162b2 mRNA COVID-19 vaccine during pregnancy, given at least 5 months after the second vaccine dose, enhances protection against adverse COVID-19-related outcomes.


Asunto(s)
COVID-19 , Vacunas contra la Influenza , Gripe Humana , Complicaciones Infecciosas del Embarazo , Femenino , Humanos , Embarazo , Vacunas contra la COVID-19 , Gripe Humana/prevención & control , Vacuna BNT162 , ARN Mensajero , COVID-19/epidemiología , COVID-19/prevención & control , Israel/epidemiología , Estudios de Cohortes , SARS-CoV-2 , Vacunación , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control
18.
Malar J ; 21(1): 336, 2022 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-36380370

RESUMEN

BACKGROUND: Eotaxin-1 concentrations in plasma have been inversely associated with malaria exposure, malaria infection and pregnancy, but the effect of these conditions on the levels of the related chemokines eotaxin-2 and eotaxin-3 remains unknown. METHODS: Eotaxin-2 and -3 concentrations were measured in 310 peripheral or placental plasma samples from pregnant and non-pregnant individuals from Papua New Guinea (malaria-endemic country) and Spain (malaria-naïve individuals) with previous data on eotaxin-1 concentrations. Correlations between eotaxin concentrations were examined with the Spearman's test. Differences in eotaxin concentrations among groups were evaluated with the Kruskal-Wallis or Mann Whitney tests. The pairwise Wilcoxon test was performed to compare eotaxin-2 concentration between peripheral and placental matched plasmas. Univariable and multivariable linear regression models were estimated to assess the association between eotaxins and Plasmodium infection or gestational age. RESULTS: Eotaxin-2 concentrations in plasma showed a weak positive correlation with eotaxin-3 (rho = 0.35, p < 0.05) concentrations. Eotaxin-2 concentrations in the malaria-exposed non-pregnant group were significantly lower than the in the malaria-naive non-pregnant and the malaria-exposed pregnant groups. Eotaxin-3 plasma concentrations were lower in malaria-exposed than in non-exposed groups (p < 0.05), but no differences were found associated to pregnancy. Eotaxin-2 and eotaxin-3 plasma concentrations were negatively correlated with anti-Plasmodium IgG levels: PfDBL5ε-IgG (rhoEo2 = - 0.35, p = 0.005; rhoEo3 =- 0.37, p = 0.011), and eotaxin-3 was negatively correlated with PfDBL3x-IgG levels (rhoEo3 =- 0.36; p = 0.011). Negative correlations of eotaxin-2 and 3 in plasma were also observed with atypical memory B cells (rhoEo2 = - 0.37, p < 0.001; rhoEo3= - 0.28, p = 0.006), a B cell subset expanded in malaria-exposed individuals. In addition, a borderline negative association was observed between eotaxin-3 concentrations and Plasmodium infection (adjusted effect estimate, ß = - 0.279, 95% CI - 0.605; 0.047, p = 0.091). Moreover, eotaxin-2 placental concentrations were significantly increased compared to peripheral concentrations in the malaria-exposed pregnant group whereas the contrary was observed in the non-exposed pregnant group (p < 0.005). CONCLUSION: Although a clear epidemiological negative association is observed between eotaxins concentrations and malaria exposure and/or infection, pregnancy may alter this association for eotaxin-2. Further research is required to understand the role of these chemokines in this disease and in combination with pregnancy.


Asunto(s)
Malaria Falciparum , Malaria , Complicaciones Infecciosas del Embarazo , Complicaciones Parasitarias del Embarazo , Femenino , Embarazo , Humanos , Quimiocina CCL11 , Quimiocina CCL26 , Quimiocina CCL24 , Placenta , Malaria/complicaciones , Inmunoglobulina G , Malaria Falciparum/complicaciones , Plasmodium falciparum
19.
BMC Public Health ; 22(1): 2069, 2022 11 12.
Artículo en Inglés | MEDLINE | ID: mdl-36371150

RESUMEN

BACKGROUND: Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them. METHODS: This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories. RESULTS: In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61-11.84) and Indigenous (OR 1.32, 95% CI 1.03-1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39-3.13). CONCLUSIONS: We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.


Asunto(s)
Microcefalia , Complicaciones Infecciosas del Embarazo , Infección por el Virus Zika , Virus Zika , Embarazo , Niño , Femenino , Humanos , Estudios Transversales , Complicaciones Infecciosas del Embarazo/epidemiología , Microcefalia/epidemiología , Brasil/epidemiología
20.
PLoS One ; 17(11): e0276766, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36383608

RESUMEN

BACKGROUND: Pregnancies complicated by Coronavirus Disease 2019 (COVID-19) are at an increased risk of severe morbidity due to physiologic changes in immunologic, cardiovascular, and respiratory function. There is little is known about how severity of COVID-19 changes protein and metabolite expression in pregnancy. OBJECTIVE: This study aims to investigate the pathophysiology behind various clinical trajectories in pregnant patients diagnosed with COVID-19 using multi-omics profiling. STUDY DESIGN: This is a prospective cohort study of 30 pregnant patients at a single tertiary care center. Participants were categorized by severity of COVID-19 disease (control, asymptomatic, mild/moderate, or severe). Maternal serum samples underwent LC-MS-based multiomics analysis for profiling of proteins, lipids, electrolytes, and metabolites. Linear regression models were used to assess how disease severity related to analyte levels. Reactome pathway enrichment analysis was conducted on differential analytes. RESULTS: Of 30 participants, 25 had confirmed diagnosis of COVID-19 (6 asymptomatic (one post-infection), 13 mild/moderate (all post-infection), 6 severe), and 5 participants were controls. Severe COVID-19 was associated with distinct profiles demonstrating significant proteomic and lipidomic signatures which were enriched for annotations related to complement and antibody activity. (FDR < 0.05). Downregulated analytes were not significantly enriched but consisted of annotation terms related to lipoprotein activity (FDR > 0.2). Post-infection mild/moderate COVID-19 did not have significantly altered serum protein, metabolite, or lipid metabolite levels compared to controls. CONCLUSIONS: Pregnancies with severe COVID-19 demonstrate greater inflammation and complement activation and dysregulation of serum lipids. This altered multiomic expression provides insight into the pathophysiology of severe COVID-19 in pregnancy and may serve as potential indicators for adverse pregnancy outcomes.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Embarazo , Femenino , Humanos , SARS-CoV-2 , Estudios Prospectivos , Proteómica , Resultado del Embarazo , Activación de Complemento , Lípidos
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