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1.
Obstet Gynecol Clin North Am ; 48(1): 53-74, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33573790

RESUMEN

Viral infections are common complications of pregnancy. Although some infections have maternal sequelae, many viral infections can be perinatally transmitted to cause congenital or chronic infection in fetuses or infants. Treatments of such infections are geared toward reducing maternal symptoms and complications and toward preventing maternal-to-child transmission of viruses. The authors review updates in the treatment of herpes simplex virus, cytomegalovirus, hepatitis B and C viruses, human immunodeficiency virus, and COVID-19 during pregnancy.


Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/terapia , Virosis/terapia , Virosis/transmisión , Adulto , Antivirales/uso terapéutico , /transmisión , Infecciones por Citomegalovirus/terapia , Infecciones por Citomegalovirus/transmisión , Femenino , Infecciones por VIH/terapia , Infecciones por VIH/transmisión , Hepatitis B/terapia , Hepatitis B/transmisión , Hepatitis C/terapia , Hepatitis C/transmisión , Herpes Simple/terapia , Herpes Simple/transmisión , Humanos , Lactante , Embarazo , Complicaciones Infecciosas del Embarazo/virología
2.
BMC Pregnancy Childbirth ; 21(1): 108, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546624

RESUMEN

BACKGROUND: As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. METHODS: Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID-19 based either on a positive swab or high clinical suspicion where no swab had been performed. Additional registry cases known to the authors were included. Steps were taken to minimise duplicate patients. Information on coagulopathy based on abnormal coagulation test results or clinical evidence of disseminated intravascular coagulation (DIC), and on arterial or venous thrombosis, were extracted using a standard form. If available, detailed laboratory results and information on maternal outcomes were analysed. RESULTS: One thousand sixty-three women met the inclusion criteria, of which three (0.28, 95% CI 0.0 to 0.6) had arterial and/or venous thrombosis, seven (0.66, 95% CI 0.17 to 1.1) had DIC, and a further three (0.28, 95% CI 0.0 to 0.6) had coagulopathy without meeting the definition of DIC. Five hundred and thirty-seven women (56%) had been reported as having given birth and 426 (40%) as having an ongoing pregnancy. There were 17 (1.6, 95% CI 0.85 to 2.3) maternal deaths in which DIC was reported as a factor in two. CONCLUSIONS: Our data suggests that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Detection of the former may be useful in the identification of women at risk of deterioration.


Asunto(s)
/epidemiología , Coagulación Intravascular Diseminada/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Hematológicas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Tromboembolia/epidemiología , Trombosis de la Vena/epidemiología , /virología , Comorbilidad , Coagulación Intravascular Diseminada/virología , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/virología , Complicaciones Hematológicas del Embarazo/virología , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo , Tromboembolia/virología , Trombosis de la Vena/virología
3.
Cells ; 10(2)2021 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-33578631

RESUMEN

Clinical manifestations of coronavirus disease 2019 (COVID-19) in pregnant women are diverse, and little is known of the impact of the disease on placental physiology. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been detected in the human placenta, and its binding receptor ACE2 is present in a variety of placental cells, including endothelium. Here, we analyze the impact of COVID-19 in placental endothelium, studying by immunofluorescence the expression of von Willebrand factor (vWf), claudin-5, and vascular endothelial (VE) cadherin in the decidua and chorionic villi of placentas from women with mild and severe COVID-19 in comparison to healthy controls. Our results indicate that: (1) vWf expression increases in the endothelium of decidua and chorionic villi of placentas derived from women with COVID-19, being higher in severe cases; (2) Claudin-5 and VE-cadherin expression decrease in the decidua and chorionic villus of placentas from women with severe COVID-19 but not in those with mild disease. Placental histological analysis reveals thrombosis, infarcts, and vascular wall remodeling, confirming the deleterious effect of COVID-19 on placental vessels. Together, these results suggest that placentas from women with COVID-19 have a condition of leaky endothelium and thrombosis, which is sensitive to disease severity.


Asunto(s)
/complicaciones , Placenta/irrigación sanguínea , Placenta/patología , Complicaciones Cardiovasculares del Embarazo/etiología , Complicaciones Infecciosas del Embarazo/etiología , Trombosis/etiología , Adulto , Antígenos CD/análisis , /virología , Cadherinas/análisis , Claudina-5/análisis , Endotelio/irrigación sanguínea , Endotelio/patología , Endotelio/virología , Femenino , Humanos , Recién Nacido , Microvasos/patología , Microvasos/virología , Embarazo , Complicaciones Cardiovasculares del Embarazo/patología , Complicaciones Cardiovasculares del Embarazo/virología , Complicaciones Infecciosas del Embarazo/patología , Complicaciones Infecciosas del Embarazo/virología , Trombosis/patología , Trombosis/virología , Adulto Joven , Factor de von Willebrand/análisis
4.
mBio ; 12(1)2021 02 09.
Artículo en Inglés | MEDLINE | ID: mdl-33563823

RESUMEN

Whether mother-to-infant SARS-CoV-2 transmission can occur during breastfeeding and, if so, whether the benefits of breastfeeding outweigh this risk during maternal COVID-19 illness remain important questions. Using RT-qPCR, we did not detect SARS-CoV-2 RNA in any milk sample (n = 37) collected from 18 women following COVID-19 diagnosis. Although we detected evidence of viral RNA on 8 out of 70 breast skin swabs, only one was considered a conclusive positive result. In contrast, 76% of the milk samples collected from women with COVID-19 contained SARS-CoV-2-specific IgA, and 80% had SARS-CoV-2-specific IgG. In addition, 62% of the milk samples were able to neutralize SARS-CoV-2 infectivity in vitro, whereas milk samples collected prior to the COVID-19 pandemic were unable to do so. Taken together, our data do not support mother-to-infant transmission of SARS-CoV-2 via milk. Importantly, milk produced by infected mothers is a beneficial source of anti-SARS-CoV-2 IgA and IgG and neutralizes SARS-CoV-2 activity. These results support recommendations to continue breastfeeding during mild-to-moderate maternal COVID-19 illness.IMPORTANCE Results from prior studies assaying human milk for the presence of SARS-CoV-2, the causative virus of COVID-19, have suggested milk may act as a potential vehicle for mother-to-child transmission. Most previous studies are limited because they followed only a few participants, were cross-sectional, and/or failed to report how milk was collected and/or analyzed. As such, considerable uncertainty remains regarding whether human milk is capable of transmitting SARS-CoV-2 from mother to child. Here, we report that repeated milk samples collected from 18 women following COVID-19 diagnosis did not contain SARS-CoV-2 RNA; however, risk of transmission via breast skin should be further evaluated. Importantly, we found that milk produced by infected mothers is a source of anti-SARS-CoV-2 IgA and IgG and neutralizes SARS-CoV-2 activity. These results support recommendations to continue breastfeeding during mild-to-moderate maternal COVID-19 illness as milk likely provides specific immunologic benefits to infants.


Asunto(s)
Anticuerpos Neutralizantes/metabolismo , Anticuerpos Antivirales/metabolismo , Leche Humana/inmunología , Complicaciones Infecciosas del Embarazo/inmunología , /inmunología , Adulto , Mama/virología , Lactancia Materna , /virología , Femenino , Humanos , Lactante , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Leche Humana/virología , Madres , Embarazo , Complicaciones Infecciosas del Embarazo/virología , ARN Viral/aislamiento & purificación , /aislamiento & purificación
5.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541967

RESUMEN

A 29-year-old pregnant woman presented at 26 weeks of gestation with fever and cough for 4 days. On admission, her nasopharyngeal swab confirmed COVID-19. As her respiratory distress worsened, she was shifted to the intensive care unit (ICU). Since the patient was unable to maintain saturation even on high settings of mechanical ventilation, she underwent venovenous extracorporeal membrane oxygenation (VV-ECMO) and was monitored in surgical ICU by a multidisciplinary team. The obstetrical team was on standby to perform urgent delivery if needed. Her condition improved, and she was weaned off after 5 days on extracorporeal membrane oxygenation. She was observed in the antenatal ward for another week and discharged home with the mother and fetus in good condition. VV-ECMO can be considered as rescue therapy for pregnant women with refractory hypoxaemia of severe respiratory failure due to COVID-19. It can save two lives, the mother and fetus.


Asunto(s)
/terapia , Oxigenación por Membrana Extracorpórea/métodos , Complicaciones Infecciosas del Embarazo/terapia , /terapia , Adulto , Femenino , Humanos , Unidades de Cuidados Intensivos , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Segundo Trimestre del Embarazo , Respiración Artificial , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
6.
Ugeskr Laeger ; 183(5)2021 02 01.
Artículo en Danés | MEDLINE | ID: mdl-33570033

RESUMEN

This case report describes a young woman, pregnant in week 33, who was admitted to hospital with severe COVID-19 pneumonia. As her condition worsened over the next few days with increasing respiratory distress and oxygen needs, it was decided to perform a subacute caesarean delivery. The patient improved rapidly over the next days following the delivery, and the neonate, who tested negative for COVID-19, was vigorous after two days of nasal continuous positive airway pressure. This case emphasises that delivery by cesarean section should be considered as a treatment option in pregnant women with severe COVID-19 infection.


Asunto(s)
/complicaciones , Cesárea , Complicaciones Infecciosas del Embarazo/virología , Nacimiento Prematuro , Femenino , Humanos , Recién Nacido , Embarazo
7.
Medicine (Baltimore) ; 100(4): e22670, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530154

RESUMEN

ABSTRACT: This study aimed to evaluate the relationships between different types of antiretroviral therapy (ART) and preterm birth.Preterm birth was studied among all singleton pregnancies and compared between human immunodeficiency virus (HIV)-infected and uninfected women.We performed a matched case-control study from the pregnancy outcome registry of Cayenne Hospital. HIV-infected and uninfected women who delivered in the maternity ward of Cayenne Hospital from January 1, 2013 to December 31, 2015 were studied. We conducted an initial analysis to determine the risk factors for preterm birth among HIV-infected pregnant women. We also evaluated associations between exposure to antiretroviral therapy (ART) and preterm birth.There were 8682 deliveries; of these, 117 involved HIV-infected women, representing a prevalence of 1.34%. There were 470 controls. The sociodemographic characteristics were comparable. HIV-infected women were more likely to experience preterm birth (adjusted odds ratio [AOR] = 3.9, 95% confidence interval [CI] 1.5-9.9). Overall, 95.73% of the women received antiretroviral therapy before becoming pregnant, and they were in good clinical condition. The median CD4 count at the beginning of pregnancy was 500 cells/mm3 (357-722). Additionally, 53% of HIV-infected women had an undetectable viral load count (<20 copies/mL). Their median haemoglobin level was 120 g/L (100-120). There were 2 human immunodeficiency virus-infected babies. A higher rate of preterm birth was associated with protease inhibitor-based ART than a reverse transcriptase inhibitor-based ART regimen. The sample size being small this result would be considered with caution.The preterm birth rate among HIV-infected pregnant women was twice that of the general population; this trend was not explained by sociodemographic characteristics. Preterm birth was independently associated with combination ART, especially with ritonavir-boosted protease inhibitor therapy during pregnancy.


Asunto(s)
Fármacos Anti-VIH/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Nacimiento Prematuro/inducido químicamente , Adulto , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Femenino , Guyana Francesa/epidemiología , VIH , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Oportunidad Relativa , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/virología , Sistema de Registros , Factores de Riesgo , Ritonavir/efectos adversos
8.
Diagn Pathol ; 16(1): 8, 2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33441152

RESUMEN

AIMS: To explore the clinical characteristics and placental pathological changes of pregnant women with 2019 novel coronavirus (CoV) disease (COVID-19) in the third trimester, and to assess the possibility of vertical transmission. METHODS AND RESULTS: The placenta tissues were evaluated by using immunohistochemistry for inflammatory cells and Hofbauer cells, and using severe acute respiratory syndrome (SARS) CoV-2 RNA Fluorescence In-Situ Hybridization (FISH) and SARS-CoV-2 spike protein immunofluorescence (IF) double staining. All eight placentas from the third trimester pregnancy women were studied. All patients were cured, no clinical or serological evidence pointed to vertical transmission of SARS-CoV-2. Features of maternal vascular malperfusion (MVM) such as increased syncytial knots were present in all 8 cases (8/8), and increased focal perivillous fibrin depositions were presented in 7 cases (7/8). No significate chronic histiocytic intervillositis was noted in the placenta. The number of macrophages and inflammatory cells such as T cells, B cells and plasma cells in the placental villous was not significantly increased in all cases. Moreover, all of eight cases demonstrated negative results by FISH using a SARS-CoV-2 virus RNA probe and by IF using a monoclonal antibody against SARS-CoV-2 spike protein. CONCLUSIONS: We found no evidence of vertical transmission and adverse maternal-fetal outcomes in the placentas of third trimester COVID-19 pregnancy women, which provided further information for the clinical management of those women in the third trimester. However, further studies are still needed for patients with infections in different stage of gestation, especially in first and second trimester.


Asunto(s)
/virología , Placenta/virología , Complicaciones Infecciosas del Embarazo/virología , /patogenicidad , Adulto , Femenino , Humanos , Embarazo , Tercer Trimestre del Embarazo/inmunología , Mujeres Embarazadas , Glicoproteína de la Espiga del Coronavirus/metabolismo
9.
Int J Med Sci ; 18(3): 763-767, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33437211

RESUMEN

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is an emerging disease. There has been a rapid increase in cases and deaths since it was identified in Wuhan, China, in early December 2019, with over 4,000,000 cases of COVID-19 including at least 250,000 deaths worldwide as of May 2020. However, limited data about the clinical characteristics of pregnant women with COVID-19 have been reported. Given the maternal physiologic and immune function changes during pregnancy, pregnant women may be at a higher risk of being infected with SARS-CoV-2 and developing more complicated clinical events. Information on severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) may provide insights into the effects of COVID-19's during pregnancy. Even though SARS and MERS have been associated with miscarriage, intrauterine death, fetal growth restriction and high case fatality rates, the clinical course of COVID-19 pneumonia in pregnant women has been reported to be similar to that in non-pregnant women. In addition, pregnant women do not appear to be at a higher risk of catching COVID-19 or suffering from more severe disease than other adults of similar age. Moreover, there is currently no evidence that the virus can be transmitted to the fetus during pregnancy or during childbirth. Babies and young children are also known to only experience mild forms of COVID-19. The aims of this systematic review were to summarize the possible symptoms, treatments, and pregnancy outcomes of women infected with COVID-19 during pregnancy.


Asunto(s)
/epidemiología , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , /inmunología , Adulto , /terapia , Femenino , Humanos , Recién Nacido , Exposición Materna , Coronavirus del Síndrome Respiratorio de Oriente Medio/inmunología , Embarazo , Complicaciones Infecciosas del Embarazo/inmunología , Complicaciones Infecciosas del Embarazo/terapia , Complicaciones Infecciosas del Embarazo/virología , Virus del SRAS/inmunología , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/inmunología , Síndrome Respiratorio Agudo Grave/virología , Índice de Severidad de la Enfermedad
10.
BMC Infect Dis ; 21(1): 61, 2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33435863

RESUMEN

BACKGROUND: To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. METHODS: A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. RESULTS: A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2-43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42-141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value< 0.0001). CONCLUSION: Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.


Asunto(s)
Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Pobreza , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , Atención Primaria de Salud , Servicios de Salud Rural , Adolescente , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/virología , Humanos , Incidencia , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Prevalencia , Pruebas Serológicas , Sudáfrica/epidemiología , Adulto Joven
11.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33408101

RESUMEN

Highly active antiretroviral therapy (HAART) has dramatically lowered rates of mother-to-child HIV transmission among patients with access to treatment. Barriers to complete viral suppression increase rates of transmission, even with only low levels of viral replication. Here, we present the case of a pregnant patient who developed a detectable viral load in pregnancy, thought to be related to calcium supplement consumption or emesis while using a dolutegravir-based HAART regimen. Ultimately, with adjustments, the patient again reached an undetectable viral load and had an uncomplicated perinatal and neonatal outcome. We discuss new data on the use of dolutegravir in pregnancy and precautions for maintaining viral suppression while on antiretroviral therapy in pregnancy.


Asunto(s)
Fármacos Anti-VIH/farmacología , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Medicamentos sin Prescripción/farmacología , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Carbonato de Calcio/farmacología , Interacciones Farmacológicas , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/transmisión , Infecciones por VIH/virología , VIH-1/aislamiento & purificación , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Carga Viral/efectos de los fármacos , Vitaminas/farmacología , Vómitos/inducido químicamente
12.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431449

RESUMEN

Congenital parvovirus B19 infection is a rare but serious condition that can result in hydrops fetalis and fetal death. Due to the virus' cytotoxic effect on fetal red blood cell precursors, postnatal infection can cause a neonatal viremia and secondary pure red cell aplasia. Here, we describe a case of congenital parvovirus infection in a preterm infant complicated by hydrops fetalis and chronic anaemia that responded to postnatal treatment with intravenous immunoglobulin administered on day of life 44. After treatment, the anaemia resolved as the neonate exhibited interval increases in haemoglobin, haematocrit and reticulocyte count with no subsequent need for red blood cell transfusions.


Asunto(s)
Anemia/terapia , Inmunoglobulinas Intravenosas/administración & dosificación , Infecciones por Parvoviridae/tratamiento farmacológico , Parvovirus B19 Humano/aislamiento & purificación , Complicaciones Infecciosas del Embarazo/diagnóstico , Adulto , Anemia/sangre , Anemia/virología , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Cordocentesis , Ecocardiografía , Transfusión de Eritrocitos , Femenino , Sangre Fetal/virología , Rotura Prematura de Membranas Fetales/virología , Feto/diagnóstico por imagen , Feto/virología , Humanos , Hidropesía Fetal/sangre , Hidropesía Fetal/diagnóstico , Hidropesía Fetal/terapia , Hidropesía Fetal/virología , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Recién Nacido , Recien Nacido Prematuro , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Infecciones por Parvoviridae/complicaciones , Infecciones por Parvoviridae/congénito , Infecciones por Parvoviridae/transmisión , Parvovirus B19 Humano/inmunología , Polihidramnios/diagnóstico , Polihidramnios/virología , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Resultado del Tratamiento , Ultrasonografía Prenatal
13.
Paediatr Perinat Epidemiol ; 35(1): 24-33, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33496995

RESUMEN

BACKGROUND: While studies from large cities affected by coronavirus disease 2019 (COVID-19) have reported on the prevalence of SARS-CoV-2 in the context of universal testing during admission for delivery, the patient demographic, social and clinical factors associated with SARS-CoV-2 infection in pregnant women are not fully understood. OBJECTIVE: To evaluate the epidemiological factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in women admitted for labour and delivery, in the context of universal screening at four Boston-area hospitals. METHODS: In this prospective cohort study, we reviewed the health records of all women admitted for labour and delivery at four hospitals from the largest health system in Massachusetts between 19 April 2020 and 27 June 2020. We calculated the risk of SARS-CoV-2 infection, including asymptomatic infection. We calculated associations between SARS-CoV-2 infection and demographic and clinical characteristics. RESULTS: A total of 93 patients (3.2%, 95% confidence interval 2.5, 3.8) tested positive for SARS-CoV-2 infection on admission for labour and delivery out of 2945 patients included in the analysis; 80 (86.0%) of the patients who tested positive were asymptomatic at the time of testing. Factors associated with SARS-CoV-2 infection included the following: younger age, obesity, African American or Hispanic race/ethnicity, residence in heavily affected communities (as measured in cases reported per capita), presence of a household member with known SARS-CoV-2 infection, non-health care essential worker occupation and MassHealth or Medicaid insurance compared to commercial insurance. 93.8% of patients testing positive for SARS-CoV-2 on admission had one or more identifiable factors associated with disease acquisition. CONCLUSIONS: In this large sample of deliveries during the height of the surge in infections during the spring of 2020, SARS-CoV-2 infection was largely concentrated in patients with distinct demographic characteristics, those largely from disadvantaged communities. Racial disparities seen in pregnancy persist with respect to SARS-CoV-2 infection.


Asunto(s)
/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Adulto , /diagnóstico , Femenino , Hospitalización , Humanos , Massachusetts , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Prevalencia , Estudios Prospectivos , Factores Socioeconómicos , Adulto Joven
14.
J Gynecol Obstet Hum Reprod ; 50(3): 102064, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33453449

RESUMEN

BACKGROUND: Data about obstetric complications of maternal infection by SARS-CoV-2 remain sparse. CASE: A 40-year-old pregnant woman, gravida 3 para 1 with no previous obstetric complications, presented a late miscarriage at 16 weeks of gestation on day 9 of COVID-19 disease. The results of her nasopharyngeal swab for SARS-CoV-2, tested the same day, were negative, but the placenta was infected by SARS-CoV-2 and serology was positive 11 days later. No other obstetric or infectious cause was found to explain this outcome. CONCLUSION: This case strongly suggests that SARS-CoV-2 may lead to a late miscarriage.


Asunto(s)
Aborto Espontáneo/virología , Complicaciones Infecciosas del Embarazo/virología , Adulto , /métodos , Femenino , Feto/virología , Edad Gestacional , Humanos , Placenta/virología , Embarazo , Reacción en Cadena en Tiempo Real de la Polimerasa , /inmunología , /aislamiento & purificación
15.
BMJ Open ; 11(1): e041247, 2021 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514576

RESUMEN

INTRODUCTION: Previous novel COVID-19 pandemics, SARS and middle east respiratory syndrome observed an association of infection in pregnancy with preterm delivery, stillbirth and increased maternal mortality. COVID-19, caused by SARS-CoV-2 infection, is the largest pandemic in living memory.Rapid accrual of robust case data on women in pregnancy and their babies affected by suspected COVID-19 or confirmed SARS-CoV-2 infection will inform clinical management and preventative strategies in the current pandemic and future outbreaks. METHODS AND ANALYSIS: The pregnancy and neonatal outcomes in COVID-19 (PAN-COVID) registry are an observational study collecting focused data on outcomes of pregnant mothers who have had suspected COVID-19 in pregnancy or confirmed SARS-CoV-2 infection and their neonates via a web-portal. Among the women recruited to the PAN-COVID registry, the study will evaluate the incidence of: (1) miscarriage and pregnancy loss, (2) fetal growth restriction and stillbirth, (3) preterm delivery, (4) vertical transmission (suspected or confirmed) and early onset neonatal SARS-CoV-2 infection.Data will be centre based and collected on individual women and their babies. Verbal consent will be obtained, to reduce face-to-face contact in the pandemic while allowing identifiable data collection for linkage. Statistical analysis of the data will be carried out on a pseudonymised data set by the study statistician. Regular reports will be distributed to collaborators on the study research questions. ETHICS AND DISSEMINATION: This study has received research ethics approval in the UK. For international centres, evidence of appropriate local approval will be required to participate, prior to entry of data to the database. The reports will be published regularly. The outputs of the study will be regularly disseminated to participants and collaborators on the study website (https://pan-covid.org) and social media channels as well as dissemination to scientific meetings and journals. STUDY REGISTRATION NUMBER: ISRCTN68026880.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Resultado del Embarazo/epidemiología , Aborto Espontáneo/epidemiología , Aborto Espontáneo/virología , /terapia , Femenino , Salud Global , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Mortalidad Materna , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/virología , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/virología , Sistema de Registros , Proyectos de Investigación , Reino Unido
16.
Int J Risk Saf Med ; 32(1): 3-17, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33386817

RESUMEN

Coronavirus disease 2019 (COVID-19) is a viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) presenting with pulmonary and extra-pulmonary manifestations. The first case was reported in Wuhan, China in December 2019 and it has rapidly progressed to the form of a pandemic. The presentation is mild in about 80 percent of the cases but the disease can also progress to a severe form of respiratory illness leading to acute respiratory distress syndrome (ARDS) and sometimes multi-organ failure, especially in people with other co-morbidities. Pregnant women also appear to be at a greater risk of acquiring a severe infection due to physiological changes during pregnancy. Many drugs with in vitro activity against the virus or an immunomodulatory effect have been considered for repurposing or have been tried as off-label drugs. The safety data regarding the use of newly approved or off-label or investigational drugs in pregnant women is limited and this poses a great challenge for clinicians. Therefore, it is important to know the utility and safety of the medications to avoid untoward adverse effects on pregnant women and fetuses. In this review, we aim to provide an overview of the approved, off-label, unlicensed, new and some promising pharmacological options for their use in the treatment of COVID-19 and the safety profile in pregnancy in an Indian scenario.


Asunto(s)
Antivirales/uso terapéutico , Feto/efectos de los fármacos , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/virología , Antiinfecciosos/efectos adversos , Antiinfecciosos/uso terapéutico , Antivirales/efectos adversos , Drogas en Investigación , Femenino , Humanos , Hidroxicloroquina/efectos adversos , Hidroxicloroquina/uso terapéutico , India/epidemiología , Uso Fuera de lo Indicado , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Mujeres Embarazadas , Esteroides/efectos adversos , Esteroides/uso terapéutico
18.
Int J Antimicrob Agents ; 57(2): 106260, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33309765

RESUMEN

OBJECTIVES: Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. However, the hazard to newborns in pregnancy remains controversial. The aim of this study was to investigate the vertical transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from mother to child and developmental toxicity in the fetus. METHODS: All clinical information was recorded on 22 neonates born to mothers with confirmed COVID-19 pneumonia in Tongji Hospital. RESULTS: The average birth weight of the 22 newborns (16 males and 6 females) was 2980 g, and the mean gestational week was 37W+3. The birth weight of three babies was <2500 g, and the gestational week of all three low-birth-weight neonates was less than 36W. Three newborns had minor lesions of infection in the lungs as shown by computed tomography (CT) scans. Furthermore, three newborns had elevated SARS-CoV-2-related immunoglobin M (IgM) antibodies, and 11 newborns (52.4%) had positive immunoglobin G (IgG) antibodies. Notably, both cystatin C and ß2-microglobulin were increased in all newborns. Five of the 21 tested newborns had leukocytosis, and 11 had increased neutrophil levels. In addition, the aspartate aminotransferase of 18 newborns and the γ-glutamyl transpeptidase of 19 newborns were increased. Total bilirubin was elevated in all newborns and serum albumin was reduced in 20 of 22 newborns. CONCLUSIONS: This study was the first to discover that COVID-19 infection in the third trimester of pregnancy could cause fetal kidney developmental injury, as indicated by increased cystatin C and ß2-microglobulin in all neonates. Furthermore, there is the possibility of maternal-fetal transmission of SARS-CoV-2.


Asunto(s)
/transmisión , Enfermedades Renales/virología , Complicaciones Infecciosas del Embarazo/virología , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , /inmunología , Femenino , Humanos , Inmunoglobulina M/sangre , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Enfermedades Renales/embriología , Masculino , Neutrófilos , Embarazo , Complicaciones Infecciosas del Embarazo/etiología , Tercer Trimestre del Embarazo , Estudios Retrospectivos , gamma-Glutamiltransferasa/sangre
19.
Ultrasound Obstet Gynecol ; 57(2): 224-231, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33320401

RESUMEN

OBJECTIVE: There are limited, unmatched data reporting low complication rates in pregnant women with coronavirus disease 2019 (COVID-19). The aim of this study was to compare COVID-19-related outcomes between pregnant and non-pregnant women after adjusting for potential risk factors for severe outcomes. METHODS: Data were obtained from the COVID-19 National Data Registry of Mexico, which is an ongoing prospective cohort of people of any age with clinically suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and admitted to 475 monitoring hospitals. This study included pregnant and non-pregnant women of reproductive age (15-45 years) with COVID-19 confirmed by reverse transcription polymerase chain reaction. To adjust for underlying risk factors, propensity score matching was conducted for chronic obstructive pulmonary disease, asthma, smoking, hypertension, cardiovascular disease, obesity, diabetes, chronic renal disease, immunosuppression, age, language, nationality and level of health insurance. The primary outcome was death. Secondary outcomes were pneumonia, intubation and intensive care unit (ICU) admission. RESULTS: The cohort comprised 5183 pregnant and 175 905 non-pregnant women with COVID-19. The crude (unmatched) rates of death, pneumonia, intubation and ICU admission in pregnant compared with non-pregnant women were 1.5% vs 1.5%, 9.9% vs 6.5%, 8.1% vs 9.9% and 13.0% vs 6.9%, respectively. After propensity score matching (5183 pregnant and 5183 non-pregnant matched women), pregnant women had a higher odds of death (odds ratio (OR), 1.84; 95% CI, 1.26-2.69), pneumonia (OR, 1.86; 95% CI, 1.60-2.16) and ICU admission (OR, 1.86; 95% CI, 1.41-2.45) than non-pregnant women, but similar odds of intubation (OR, 0.93; 95% CI, 0.70-1.25). CONCLUSION: After adjusting for background demographic and medical factors, pregnancy is a risk factor for death, pneumonia and ICU admission in SARS-CoV-2-infected women of reproductive age. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.


Asunto(s)
/mortalidad , Neumonía/etiología , Complicaciones Infecciosas del Embarazo/mortalidad , Complicaciones Infecciosas del Embarazo/virología , Adolescente , Adulto , /virología , Estudios de Casos y Controles , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , México/epidemiología , Persona de Mediana Edad , Mortalidad , Pandemias , Neumonía/virología , Embarazo , Puntaje de Propensión , Estudios Prospectivos , Factores de Riesgo , /aislamiento & purificación , Adulto Joven
20.
Physiol Rev ; 101(1): 303-318, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32969772

RESUMEN

There are many unknowns for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe SARS-CoV-2 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation. These may have positive or negative effects on COVID-19 disease progression. The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management. Besides the direct impacts of the disease, a plethora of indirect consequences of the pandemic adversely affect maternal health, including reduced access to reproductive health services, increased mental health strain, and increased socioeconomic deprivation. In this review, we explore the current knowledge of COVID-19 in pregnancy and highlight areas for further research to minimize its impact for women and their children.


Asunto(s)
/complicaciones , Complicaciones Infecciosas del Embarazo/patología , Complicaciones Infecciosas del Embarazo/virología , Femenino , Humanos , Embarazo , Resultado del Embarazo , Factores de Riesgo
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