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1.
Sci Total Environ ; 751: 141476, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-32871309

RESUMO

BACKGROUND: More women in reproductive ages are entering occupations where exposure to whole body vibrations (WBV) is common (e.g. in transportation and construction). Previous studies based on self-assessed exposure suggest increased risks of adverse birth outcomes, but it is unclear at what exposure levels and if the current exposure guidelines are appropriate during pregnancy. OBJECTIVES: To investigate whether occupational WBV-exposure increases the risk of preterm birth, low birth weight, and/or small-for-gestational age, in a large, nationwide, prospective, cohort study. DESIGN: The Fetal Air Pollution Exposure cohort (FAIR) was formed by merging data from multiple, national registers, and the present study includes singletons born 1994-2014 to working women in Sweden (n = 1,091,080 births). WBV-exposure was assessed quantitatively using a job-exposure matrix based on measurements, and calculated odds ratios were adjusted for potential confounders such as smoking and BMI, and other occupational exposures like noise, combustion particles, and physically and psychologically strenuous work. Data on absence from work (full-/part time, sick leave, parental leave, etc.) was also used. RESULTS: Exposure to WBV during pregnancy, among women with low absence from work (n = 476,419), was associated with an increased risk of preterm birth, below the occupational exposure limit (1.15 m/s2). Compared to unexposed mothers, the OR was 1.38 (95% CI: 1.05, 1.83) for exposure ≥0.5 m/s2, corresponding to an increase from 47/1000 cases to 65/1000 cases. No increased risk was found for small-for-gestational age. CONCLUSIONS: Exposure to WBV was associated with an increased risk of preterm birth. The results suggest that the current permissible exposure and action levels for WBV-exposure do not adequately protect pregnant women with continuous exposure.


Assuntos
Exposição Ocupacional , Nascimento Prematuro , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Exposição Ocupacional/efeitos adversos , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Suécia/epidemiologia , Vibração/efeitos adversos
2.
Lancet Infect Dis ; 21(1): 97-106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33129424

RESUMO

BACKGROUND: Influenza vaccination during pregnancy prevents influenza among women and their infants but remains underused among pregnant women. We aimed to quantify the risk of antenatal influenza and examine its association with perinatal outcomes. METHODS: We did a prospective cohort study in pregnant women in India, Peru, and Thailand. Before the 2017 and 2018 influenza seasons, we enrolled pregnant women aged 18 years or older with expected delivery dates 8 weeks or more after the season started. We contacted women twice weekly until the end of pregnancy to identify illnesses with symptoms of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing and collected mid-turbinate nasal swabs from symptomatic women for influenza real-time RT-PCR testing. We assessed the association of antenatal influenza with preterm birth, late pregnancy loss (≥13 weeks gestation), small for gestational age (SGA), and birthweight of term singleton infants using Cox proportional hazards models or generalised linear models to adjust for potential confounders. FINDINGS: Between March 13, 2017, and Aug 3, 2018, we enrolled 11 277 women with a median age of 26 years (IQR 23-31) and gestational age of 19 weeks (14-24). 1474 (13%) received influenza vaccines. 310 participants (3%) had influenza (270 [87%] influenza A and 40 [13%] influenza B). Influenza incidences weighted by the population of women of childbearing age in each study country were 88·7 per 10 000 pregnant woman-months (95% CI 68·6 to 114·8) during the 2017 season and 69·6 per 10 000 pregnant woman-months (53·8 to 90·2) during the 2018 season. Antenatal influenza was not associated with preterm birth (adjusted hazard ratio [aHR] 1·4, 95% CI 0·9 to 2·0; p=0·096) or having an SGA infant (adjusted relative risk 1·0, 95% CI 0·8 to 1·3, p=0·97), but was associated with late pregnancy loss (aHR 10·7, 95% CI 4·3 to 27·0; p<0·0001) and reduction in mean birthweight of term, singleton infants (-55·3 g, 95% CI -109·3 to -1·4; p=0·0445). INTERPRETATION: Women had a 0·7-0·9% risk of influenza per month of pregnancy during the influenza season, and antenatal influenza was associated with increased risk for some adverse pregnancy outcomes. These findings support the added value of antenatal influenza vaccination to improve perinatal outcomes. FUNDING: US Centers for Disease Control and Prevention. TRANSLATIONS: For the Thai, Hindi, Marathi and Spanish translations of the abstract see Supplementary Materials section.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Recém-Nascido Pequeno para a Idade Gestacional , Influenza Humana/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Índia , Recém-Nascido , Estudos Longitudinais , Masculino , Peru , Gravidez , Estudos Prospectivos , Tailândia , Adulto Jovem
3.
Eur J Obstet Gynecol Reprod Biol ; 256: 194-204, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246205

RESUMO

Evidence concerning coronavirus disease-19 (covid-19) in pregnancy is still scarce and scattered. This meta-analysis aims to evaluate maternal and neonatal outcomes in covid-19 pregnancies and identify factors associated with perinatal viral transmission. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched to 3 June 2020. Overall, 16 observational studies and 44 case reports/series were included. Fever was the most frequent maternal symptom, followed by cough and shortness of breath, while about 15 % of infected were asymptomatic. Severe disease was estimated to occur in 11 % of women in case reports/series and in 7 % (95 % CI: 4 %-10 %) in observational studies. Two maternal deaths were reported. The rate of neonatal transmission did not differ between women with and without severe disease (OR: 1.94, 95 % CI: 0.50-7.60). Preterm birth occurred in 29.7 % and 16 % (95 % CI: 11 %-21 %) in data obtained from case series and observational studies, respectively. Stillbirth occurred in 3 cases and 2 neonatal deaths were observed. Vertical transmission was suspected in 4 cases. Fever was the most common neonatal symptom (40 %), followed by shortness of breath (28 %) and vomiting (24 %), while 20 % of neonates were totally asymptomatic. In conclusion, the maternal and neonatal clinical course the infection is typically mild, presenting low mortality rates. The risk of vertical transmission is suggested to be low and may not be affected by the severity of maternal disease. Further large-scale studies are needed to clarify the risk factors associated with viral transmission and severe infection in the neonatal population.


Assuntos
/epidemiologia , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Infecções Assintomáticas , /transmissão , Cesárea/estatística & dados numéricos , Tosse/fisiopatologia , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Índice de Gravidade de Doença , Natimorto/epidemiologia , Vômito/fisiopatologia
4.
Womens Health Issues ; 31(1): 40-48, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32962874

RESUMO

BACKGROUND: Advanced maternal age (AMA) has been linked to both higher risk of adverse birth outcomes and higher levels of comorbidities. It is unclear if adverse outcomes are higher for older healthy women. This study examined the association between AMA and adverse birth outcomes among women with and without preexisting and pregnancy-related health conditions. METHODS: Analysis of data for 14,933 singleton births between 2004 and 2015 from the population-based Maryland Pregnancy Risk Assessment Monitoring System was conducted, comparing women aged 20-34 years and 35 years and older. Multivariable logistic regression estimated the difference in odds of preterm birth (PTB) and low birthweight (LBW) by age group among women with and without health conditions. The analysis of women without health conditions was stratified by parity. RESULTS: Among women without health conditions, AMA was associated with higher odds of PTB regardless of birthweight, LBW regardless of term, LBW term births, and LBW PTBs; stratified analysis showed higher risk of these outcomes among both older primiparas and multiparas. Compared with younger women with hypertensive disorders, older women with similar health conditions had higher odds of PTB regardless of birthweight. Older women with asthma had higher odds of LBW term births. CONCLUSIONS: AMA is associated with adverse birth outcomes among women with and without health conditions compared with younger women with similar health status. Improved screening and management of health conditions during pregnancy is needed for older women, regardless of parity.


Assuntos
Nascimento Prematuro , Adulto , Idoso , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Maryland/epidemiologia , Idade Materna , Paridade , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto Jovem
5.
Womens Health Issues ; 31(1): 49-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32972809

RESUMO

INTRODUCTION: Although previous studies have found a relationship between having a preterm birth and maternal depression, methodologic issues may have limited the generalizability of results. Thus, the purpose of this study was to evaluate the relationship between having a preterm birth and postpartum depressive symptoms using a large, population-based sample of U.S. women. METHODS: This secondary data analysis used 2012-2014 U.S. Pregnancy Risk Assessment Monitoring System data (N = 89,366). Data on the exposure, preterm birth, were obtained from birth certificates. Infants born at 32 to less than 37 weeks' gestation were considered moderate to late preterm, infants born at 28 to less than 32 full weeks' gestation were considered very preterm, and infant born at less than 28 full weeks' gestation were considered extremely preterm. To assess the outcome, two Pregnancy Risk Assessment Monitoring System questions measuring postpartum depressive symptoms were used. Logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence interval (CIs). RESULTS: After adjustment for confounders, the relationship between having a preterm birth and maternal hopelessness was statistically significant for those who had very preterm and extremely preterm births (moderate to late preterm OR, 1.19; 95% CI, 1.00-1.42; very preterm OR, 1.28; 95% CI, 1.04-1.58; extremely preterm OR, 1.81; 95% CI, 1.31-2.49). In addition, after adjustment, findings indicated no association between preterm birth and maternal loss of interest (extremely preterm OR, 0.85 95% CI, 0.60-1.19; very preterm OR, 1.04; 95% CI, 0.86-1.26; preterm OR, 0.95; 95% CI, 0.82-1.10). CONCLUSIONS: Given the statistically significant increased association between having a preterm birth and postpartum depressive symptoms, health professionals may consider implementing comprehensive screening for depression and other mental illnesses among women who give birth prematurely. Findings may also inform future interventions to emphasize the importance of postpartum care among women who have experienced preterm birth.


Assuntos
Nascimento Prematuro , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Saúde Mental , Período Pós-Parto , Gravidez , Nascimento Prematuro/epidemiologia , Medição de Risco
6.
Environ Pollut ; 269: 115741, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33279267

RESUMO

Recent studies suggests that air pollution, from among others road traffic, can influence growth and development of the human foetus during pregnancy. The effects of air pollution from heavy industry on birth outcomes have been investigated scarcely. Our aim was to investigate the associations of air pollution from heavy industry on birth outcomes. A cross-sectional study was conducted among 4488 singleton live births (2012-2017) in the vicinity of a large industrial area in the Netherlands. Information from the birth registration was linked with a dispersion model to characterize annual individual-level exposure of pregnant mothers to air pollutants from industry in the area. Associations between particulate matter (PM10), nitrogen oxides (NOX), sulphur dioxide (SO2), and volatile organic compounds (VOC) with low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) were investigated by logistic regression analysis and with gestational age, birth weight, birth length, and head circumference by linear regression analysis. Exposures to NOX, SO2, and VOC (per interquartile range of 1.16, 0.42, and 0.97 µg/m3 respectively) during pregnancy were associated with LBW (OR 1.20, 95%CI 1.06-1.35, OR 1.20, 95%CI 1.00-1.43, and OR 1.21, 95%CI 1.08-1.35 respectively). NOX and VOC were also associated with PTB (OR 1.14, 95%CI 1.01-1.29 and OR 1.17, 95%CI 1.04-1.31 respectively). Associations between exposure to air pollution and birth weight, birth length, and head circumference were statistically significant. Higher exposure to PM10, NOX, SO2 and VOC (per interquartile range of 0.41, 1.16, 0.42, and 0.97 µg/m3 respectively) was associated with reduced birth weight of 21 g to 30 g. The 90th percentile industry-related PM10 exposure corresponded with an average birth weight decrease of 74 g.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Nascimento Prematuro , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Exposição Materna , Países Baixos , Material Particulado , Gravidez , Nascimento Prematuro/epidemiologia
7.
Arch Dis Child Fetal Neonatal Ed ; 106(1): 93-95, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32788391

RESUMO

To explore the impact of COVID-19 lockdown on premature birth rates in Denmark, a nationwide register-based prevalence proportion study was conducted on all 31 180 live singleton infants born in Denmark between 12 March and 14 April during 2015-2020.The distribution of gestational ages (GAs) was significantly different (p=0.004) during the lockdown period compared with the previous 5 years and was driven by a significantly lower rate of extremely premature children during the lockdown compared with the corresponding mean rate for the same dates in the previous years (OR 0.09, 95% CI 0.01 to 0.40, p<0.001). No significant difference between the lockdown and previous years was found for other GA categories.The reasons for this decrease are unclear. However, the lockdown has provided a unique opportunity to examine possible factors related to prematurity. Identification of possible causal mechanisms might stimulate changes in clinical practice.


Assuntos
/epidemiologia , Pandemias , Nascimento Prematuro/epidemiologia , Isolamento Social , Dinamarca/epidemiologia , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Prevalência
9.
Obstet Gynecol ; 137(1): 49-55, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33116054

RESUMO

OBJECTIVE: To investigate the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in parturient women, their partners, and their newborns and the association of such antibodies with obstetric and neonatal outcomes. METHODS: From April 4 to July 3, 2020, in a single university hospital in Denmark, all parturient women and their partners were invited to participate in the study, along with their newborns. Participating women and partners had a pharyngeal swab and a blood sample taken at admission; immediately after delivery, a blood sample was drawn from the umbilical cord. The swabs were analyzed for SARS-CoV-2 RNA by polymerase chain reaction, and the blood samples were analyzed for SARS-CoV-2 antibodies. Full medical history and obstetric and neonatal information were available. RESULTS: A total of 1,313 parturient women (72.5.% of all women admitted for delivery at the hospital in the study period), 1,188 partners, and 1,206 newborns participated in the study. The adjusted serologic prevalence was 2.6% in women and 3.5% in partners. Seventeen newborns had SARS-CoV-2 immunoglobulin G (IgG) antibodies, and none had immunoglobulin M antibodies. No associations between SARS-CoV-2 antibodies and obstetric or neonatal complications were found (eg, preterm birth, preeclampsia, cesarean delivery, Apgar score, low birth weight, umbilical arterial pH, need for continuous positive airway pressure, or neonatal admission), but statistical power to detect such differences was low. Full serologic data from 1,051 families showed an absolute risk of maternal infection of 39% if the partner had antibodies. CONCLUSION: We found no association between SARS-CoV-2 infection and obstetric or neonatal complications. Sixty-seven percent of newborns delivered by mothers with antibodies had SARS-CoV-2 IgG antibodies. A limitation of our study is that we lacked statistical power to detect small but potentially meaningful differences between those with and without evidence of infection.


Assuntos
Anticorpos Antivirais/sangue , /epidemiologia , Recém-Nascido/sangue , Parceiros Sexuais , Adulto , Dinamarca/epidemiologia , Feminino , Hospitalização , Hospitais Universitários , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Masculino , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Análise de Regressão , Fatores de Risco , /imunologia
11.
Adv Chronic Kidney Dis ; 27(5): 397-403, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33308505

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a rapidly spreading pandemic. Owing to changes in the immune system and respiratory physiology, pregnant women are vulnerable to severe viral pneumonia. We review the clinical course, pregnancy outcomes, and management of women with COVID-19 in pregnancy with a focus on those with kidney involvement. Current evidence does not show an increased risk of acquiring SARS-CoV-2 during pregnancy and the maternal course appears to be similar to nonpregnant patients. However, severe maternal disease can lead to complex management challenges and has shown to be associated with higher incidence of preterm and caesarean births. The risk of congenital infection with SARS-CoV-2 is not known. All neonates must be considered as high-risk contacts and should be screened at birth and isolated. Pregnant women should follow all measures to prevent SARS-CoV-2 exposure and this fear should not compromise antenatal care. Use of telemedicine, videoconferencing, and noninvasive fetal and maternal home monitoring devices should be encouraged. High-risk pregnant patients with comorbidities and COVID-19 require hospitalization and close monitoring. Pregnant women with COVID-19 and kidney disease are a high-risk group and should be managed by a multidisciplinary team approach including a nephrologist and neonatologist.


Assuntos
Lesão Renal Aguda/terapia , Transplante de Rim , Complicações Infecciosas na Gravidez/terapia , Complicações na Gravidez/terapia , Insuficiência Renal Crônica/terapia , Lesão Renal Aguda/etiologia , /prevenção & controle , Cesárea/estatística & dados numéricos , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa , Necrose do Córtex Renal/complicações , Necrose do Córtex Renal/diagnóstico , Equipe de Assistência ao Paciente , Pré-Eclâmpsia/diagnóstico , Gravidez , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/métodos , Pielonefrite/complicações , Pielonefrite/diagnóstico , Insuficiência Renal Crônica/complicações , Telemedicina/métodos , Microangiopatias Trombóticas/complicações , Microangiopatias Trombóticas/diagnóstico
12.
Front Public Health ; 8: 558144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330308

RESUMO

Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19. Methods: Searches were conducted in PubMed®, Scopus®, Web of Science®, and MedRxiv® up to 26th June 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality. Results: We identified 161 original studies reporting 3,985 cases of pregnant women with COVID-19 (1,007 discharged while pregnant). The 2,059 published cases with pregnancy outcomes resulted in 42 abortions, 21 stillbirths, and 2,015 live births. Preterm birth occurred in 23% of cases. Around 6% of pregnant women required admission to an intensive care unit and 28 died. There were 10 neonatal deaths. From the 163 cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus, 10 were positive. Sixty-one newborns were positive for SARS-CoV-2. Four breast milk samples from 92 cases showed evidence of SARS-CoV-2. Conclusion: Emerging evidence suggests that vertical transmission is possible, however, there is still a limited number of reported cases with intrapartum samples. Information, counseling and adequate monitoring are essential to prevent and manage adverse effects of SARS-CoV-2 infection during pregnancy.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Resultado da Gravidez , Gestantes , Aborto Espontâneo/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia
13.
Fertil Steril ; 114(6): 1242-1249, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33280730

RESUMO

OBJECTIVE: To investigate, with pre-COVID-19 data, whether parental exposure to severe systemic infections near the time of conception is associated with pregnancy outcomes. DESIGN: Retrospective cohort study. SETTING: Population-based study covering births within the United States from 2009 to 2016. PARTICIPANTS: The IBM MarketScan Research database covers reimbursed health care claims data on inpatient and outpatient encounters that are privately insured through employment-sponsored health insurance. Our analytic sample included pregnancies to paired fathers and mothers. INTERVENTIONS(S): Parental preconception exposure (0-6 months before conception) to severe systemic infection (e.g., sepsis, hypotension, respiratory failure, critical care evaluation). MAIN OUTCOME MEASURE(S): Preterm birth (i.e., live birth before 37 weeks) and pregnancy loss. RESULT(S): A total of 999,866 pregnancies were recorded with 214,057 pregnancy losses (21.4%) and 51,759 preterm births (5.2%). Mothers receiving intensive care in the preconception period had increased risk of pregnancy loss, as did fathers. Mothers with preconception sepsis had higher risk of preterm birth and pregnancy loss, and paternal sepsis exposure was associated with an increased risk of pregnancy loss. Similar results were noted for hypotension. In addition, a dose response was observed for both mothers and fathers between preconception time in intensive care and the risk of preterm birth and pregnancy loss. CONCLUSION(S): In a pre-COVID-19 cohort, parental preconception severe systemic infection was associated with increased odds of preterm birth and pregnancy loss when conception was soon after the illness.


Assuntos
/epidemiologia , Estado Terminal/epidemiologia , Pais , Resultado da Gravidez , Sepse/epidemiologia , Aborto Espontâneo/epidemiologia , Adulto , Estudos de Coortes , Cuidados Críticos , Pai , Feminino , Fertilização , Humanos , Masculino , Mães , Cuidado Pré-Concepcional , Gravidez , Nascimento Prematuro/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
14.
PLoS One ; 15(12): e0242489, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33296383

RESUMO

OBJECTIVES: To explore associations between exposures to medicines prescribed for asthma and their discontinuation in pregnancy and preterm birth [<37 or <32 weeks], SGA [<10th and <3rd centiles], and breastfeeding at 6-8 weeks. METHODS: Design. A population-based cohort study. Setting. The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes. Population. 107,573, 105,331, and 38,725 infants born 2000-2010 with information on premature birth, SGA and breastfeeding respectively, after exclusions. Exposures. maternal prescriptions for asthma medicines or their discontinuation in pregnancy. Methods. Odds ratios for adverse pregnancy outcomes were calculated for the exposed versus the unexposed population, adjusted for smoking, parity, age and socio-economic status. RESULTS: Prescriptions for asthma, whether continued or discontinued during pregnancy, were associated with birth at<32 weeks' gestation, SGA <10th centile, and no breastfeeding (aOR 1.33 [1.10-1.61], 1.10 [1.03-1.18], 0.93 [0.87-1.01]). Discontinuation of asthma medicines in pregnancy was associated with birth at<37 weeks' and <32 weeks' gestation (aOR 1.22 [1.06-1.41], 1.53 [1.11-2.10]). All medicines examined, except ICS and SABA prescribed alone, were associated with SGA <10th centile. CONCLUSIONS: Prescription of asthma medicines before or during pregnancy was associated with higher prevalence of adverse perinatal outcomes, particularly if prescriptions were discontinued during pregnancy. Women discontinuing medicines during pregnancy could be identified from prescription records. The impact of targeting close monitoring and breastfeeding support warrants exploration.


Assuntos
Asma/tratamento farmacológico , Aleitamento Materno , Medicamentos sob Prescrição/uso terapêutico , Suspensão de Tratamento , Estudos de Coortes , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Nascimento Prematuro/epidemiologia , Resultado do Tratamento
15.
Arch Iran Med ; 23(12): 856-863, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33356344

RESUMO

BACKGROUND: Due to the physiological changes in the body during pregnancy, the increased susceptibility to viral infections during this period and also the high prevalence of coronavirus disease 2019 (COVID-19) in the Guilan province, Iran, this study aimed to evaluate risk factors, clinical symptoms, laboratory findings and imaging of pregnant mothers with COVID-19. METHODS: In this descriptive study, 70 pregnant women aged 17-41 years with COVID-19 who were hospitalized from early March to late April 2020 were enrolled. Sampling was performed by census and from all hospitals in Guilan. The research instruments included a researcher-made questionnaire, including demographic characteristics, clinical symptoms, medical examinations, and paraclinical results. Data were analyzed with SPSS version 16. Frequency and percent were used to describe qualitative variables; for quantitative variables, if they were normally distributed, mean and standard deviation were used, and if they were non-normal, median and interquartile range (IQR) were used. RESULTS: The most severe symptoms recorded in mothers at the time of hospitalization were fever (47%), shortness of breath (16%) and cough (15%), respectively. One of 68 (1%) was in the severe stage of the disease and two mothers (2%) were in critical condition and admitted to the intensive care unit and finally died. Fifty-five of 66 women (83%) had lymphopenia, 22 of 42 (52%) tested positive on PCR, and 30 of 33 (90%) had an increase in lactate dehydrogenase (LDH) levels.Results showed that 15 of 32 patients who gave birth had preterm delivery (46%). CONCLUSION: The most common manifestations of the disease in pregnant women were fever, cough and shortness of breath, and in some cases muscle pain. The most common laboratory finding in infected mothers was lymphopenia. Complications of pregnancy and childbirth in women included an increase in cesarean delivery.


Assuntos
/epidemiologia , Hospitalização/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
J Perinat Med ; 48(9): 883-891, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33151180

RESUMO

The outbreak of the SARS-CoV-2 elicited a surge in publications. Obstetric reports were with few exceptions characterized by small sample sizes with potentially limited generalizability. In this review, evidence suggests increased susceptibility to COVID-19 in pregnancy; common pregnancy comorbidities may help explain worse outcomes. While the risk of death is low, pregnancy may be associated with increased need for ventilation. Prematurity rates seem to be increased but may be accounted for in part by higher cesarean rates, to a large degree accounted for by elective decision to shorten the course of the labor. Though fetal/neonatal complication rates may be higher in the presence of COVID-19 infection, survival rates seem unaffected and vertical transmission is rare. As the outbreak continues in the USA with resurgence in many other western countries that achieved initial success in suppressing the virus, much remains to be learned. For example, the question related to the degree to pregnancy modifying symptomatology remains open. Currently, routine polymerase chain reaction testing remains limited by supply shortages possibly delaying diagnosis until later in the course of the disorder and thus altering the symptom complex at presentation. To add to the knowledge base, we initiated a regional COVID-19 in pregnancy collaborative observational study with a coordinating center, standardized data collection and a shared database. This was facilitated by a longstanding tradition of collaboration among regional obstetric services. Over an anticipated two-year study duration, we expect to study 400 documented and suspected COVID-19 pregnancies with time and site of services controls for cohort effect and high power to detect several adverse maternal/infant outcomes. We include a complete listing of variables in our database, which, along with our experience in setting up our regional collaborative, we hope and believe will be of use in other settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Colaboração Intersetorial , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Suscetibilidade a Doenças , Feminino , Humanos , Metanálise como Assunto , Michigan/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Sistema de Registros , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Revisões Sistemáticas como Assunto , Resultado do Tratamento
17.
MMWR Morb Mortal Wkly Rep ; 69(44): 1635-1640, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33151917

RESUMO

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness and might be at risk for preterm birth (1-3). The full impact of infection with SARS-CoV-2, the virus that causes COVID-19, in pregnancy is unknown. Public health jurisdictions report information, including pregnancy status, on confirmed and probable COVID-19 cases to CDC through the National Notifiable Diseases Surveillance System.* Through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), 16 jurisdictions collected supplementary information on pregnancy and infant outcomes among 5,252 women with laboratory-confirmed SARS-CoV-2 infection reported during March 29-October 14, 2020. Among 3,912 live births with known gestational age, 12.9% were preterm (<37 weeks), higher than the reported 10.2% among the general U.S. population in 2019 (4). Among 610 infants (21.3%) with reported SARS-CoV-2 test results, perinatal infection was infrequent (2.6%) and occurred primarily among infants whose mother had SARS-CoV-2 infection identified within 1 week of delivery. Because the majority of pregnant women with COVID-19 reported thus far experienced infection in the third trimester, ongoing surveillance is needed to assess effects of infections in early pregnancy, as well the longer-term outcomes of exposed infants. These findings can inform neonatal testing recommendations, clinical practice, and public health action and can be used by health care providers to counsel pregnant women on the risks of SARS-CoV-2 infection, including preterm births. Pregnant women and their household members should follow recommended infection prevention measures, including wearing a mask, social distancing, and frequent handwashing when going out or interacting with others or if there is a person within the household who has had exposure to COVID-19.†.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Resultado da Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Laboratórios , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Medição de Risco , Estados Unidos/epidemiologia , Adulto Jovem
19.
BMJ Open ; 10(11): e042813, 2020 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-33243817

RESUMO

INTRODUCTION: The effects of SARS-CoV-2 in pregnancy are not fully delineated. We will describe the incidence of COVID-19 in pregnancy at population level in Scotland, in a prospective cohort study using linked data. We will determine associations between COVID-19 and adverse pregnancy, neonatal and maternal outcomes and the proportion of confirmed cases of SARS-CoV-2 infection in neonates associated with maternal COVID-19. METHODS AND ANALYSIS: Prospective cohort study using national linked data sets. We will include all women in Scotland, UK, who were pregnant on or became pregnant after, 1 March 2020 (the date of the first confirmed case of SARS-CoV-2 infection in Scotland) and all births in Scotland from 1 March 2020 onwards. Individual-level data will be extracted from data sets containing details of all livebirths, stillbirth, terminations of pregnancy and miscarriages and ectopic pregnancies treated in hospital or attending general practice. Records will be linked within the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) platform, which includes primary care records, virology and serology results and details of COVID-19 Community Hubs and Assessment Centre contacts and deaths. We will perform analyses using definitions for confirmed, probable and possible COVID-19 and report serology results (where available). Outcomes will include congenital anomaly, miscarriage, stillbirth, termination of pregnancy, preterm birth, neonatal infection, severe maternal disease and maternal deaths. We will perform descriptive analyses and appropriate modelling, adjusting for demographic and pregnancy characteristics and the presence of comorbidities. The cohort will provide a platform for future studies of the effectiveness and safety of therapeutic interventions and immunisations for COVID-19 and their effects on childhood and developmental outcomes. ETHICS AND DISSEMINATION: COVID-19 in Pregnancy in Scotland is a substudy of EAVE II(, which has approval from the National Research Ethics Service Committee. Findings will be reported to Scottish Government, Public Health Scotland and published in peer-reviewed journals.


Assuntos
/epidemiologia , Vigilância da População , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Feminino , Humanos , Incidência , Recém-Nascido , Pandemias , Gravidez , Estudos Prospectivos , Escócia/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-33233450

RESUMO

Introduction: Housing insecurity is increasingly commonplace among disadvantaged women and children. We measured the individual- and population-level impact of severe housing insecurity during pregnancy on adverse birth and infant outcomes. Methods: We analyzed data from 3428 mother-infant dyads enrolled in the Fragile Families and Child Wellbeing Study, a prospective cohort study representing births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness during pregnancy. Outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. We estimated exposure-outcome associations with risk ratios adjusted for pre-pregnancy maternal sociodemographic and heath factors and calculated a population attributable fraction (PAF) of outcomes attributable to severe housing insecurity. Results: We found statistically significant associations between severe housing insecurity during pregnancy and low birth weight and/or preterm birth (risk ratio (RR] 1.73, 95% confidence interval (CI) 1.28, 2.32), NICU or stepdown stay (RR 1.64, CI 1.17, 2.31), and extended hospitalization (RR 1.66, CI 1.28, 2.16). Associations between housing insecurity and infant fair or poor health (RR 2.62, CI 0.91, 7.48) and poor temperament (RR 1.52, CI 0.98, 2.34) were not statistically significant. PAF estimates ranged from 0.9-2.7%, suggesting that up to three percent of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women in US cities. Conclusions: Results suggest that housing insecurity during pregnancy shapes neonatal and infant health in disadvantaged urban families.


Assuntos
Pessoas em Situação de Rua/psicologia , Habitação , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Grupo com Ancestrais do Continente Africano , Feminino , Hispano-Americanos , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Complicações na Gravidez/etnologia , Nascimento Prematuro/etnologia , Estudos Prospectivos , Estados Unidos/epidemiologia , Adulto Jovem
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