High maternal viral suppression among pregnant women with HIV: a retrospective cohort study

57 Buprenorphine Initiation for Pregnant Patients With Opioid Use Disorder: A Multicenter Observational Study of California Bridge Sites

Safety of influenza vaccines in pregnant women

Coronavirus disease 2019 in pregnant and non-pregnant women: a retrospective study.

BackgroundUrinary tract infections (UTIs) are one of the most common health problems worldwide and mainly affect women. This study aimed to evaluate the prevalence of UTIs in pregnant women and determine the antimicrobial resistance patterns of bacterial pathogens isolated from pregnant and nonpregnant women in Riyadh, Saudi Arabia.MethodsThis retrospective cohort study was conducted at an academic medical center in Riyadh, Saudi Arabia, from January to June 2022. The study included all urine cultures performed for adult women during the study period. We excluded urine culture performed for women on antibiotics prescribed for any infection, children, and men. Using the SPSS (version 27) package, descriptive statistics and chi-square tests were used to analyze the data, and p < 0.05 was considered to indicate statistical significance.ResultsA total of 2,418 urine cultures performed during the study period were included (985 and 1,433 for pregnant and nonpregnant women, respectively). The overall prevalence of UTIs in pregnant women was 5% (95% CI 3.6–6.4); 10 (1%) women were symptomatic, and 40 (4%) women were asymptomatic. Of the entire cohort, 244 (10.1%) women were diagnosed with UTIs based on bacterial cultures. The predominant bacteria in both pregnant and nonpregnant women were Escherichia coli (134, 54.9%), followed by Klebsiella pneumoniae (48, 19.6%).The antibiotic susceptibility criteria for Escherichia coli and Klebsiella pneumoniae were as follows: nitrofurantoin (94% and 18.8%, respectively), amoxicillin-clavulanic acid (82.8% and 70.8%, respectively), ciprofloxacin (65.7% and 83.3%, respectively), trimethoprim-sulfamethoxazole (65.7% and 79.2%, respectively) and cephalothin (47% and 68.8%, respectively).ConclusionCompared to the findings of other similar studies, the prevalence of UTIs was lower in pregnant women. This may be because the patient population was composed of healthy and educated women who received prenatal education and underwent prenatal assessment as per institutional guidelines. Nitrofurantoin and amoxicillin-clavulanic acid are recommended for use as an empirical therapy for UTIs in pregnant and nonpregnant women because bacteria have the least amount of resistance to these drugs.

To describe viral load levels among pregnant women and factors associated with failure to achieve viral suppression (viral load ≤50 copies/ml) during pregnancy. Between 1 October and 15 November 2017, a cross-sectional survey was conducted among 15-49-year-old pregnant women attending antenatal care (ANC) at 1595 nationally representative public facilities. Blood specimens were taken from each pregnant woman and tested for HIV. Viral load testing was done on all HIV-positive specimens. Demographic and clinical data were extracted from medical records or self-reported. Survey logistic regression examined factors associated with failure to achieve viral suppression. Of 10 052 HIV-positive participants with viral load data, 56.2% were virally suppressed. Participants initiating antiretroviral therapy (ART) prior to pregnancy had higher viral suppression (71.0%) by their third trimester compared with participants initiating ART during pregnancy (59.3%). Booking for ANC during the third trimester vs. earlier: [adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI):1.4-2.3], low frequency of ANC visits (AOR for 2 ANC visits vs. ≥4 ANC visits: 2.0, 95% CI:1.7-2.4), delayed initiation of ART (AOR for ART initiated at the second trimester vs. before pregnancy:2.2, 95% CI:1.8-2.7), and younger age (AOR for 15-24 vs. 35-49 years: 1.4, 95% CI:1.2-1.8) were associated with failure to achieve viral suppression during the third trimester. Failure to achieve viral suppression was primarily associated with late ANC booking and late initiation of ART. Efforts to improve early ANC booking and early ART initiation in the general population would help improve viral suppression rates among pregnant women. In addition, the study found, despite initiating ART prior to pregnancy, more than one quarter of participants did not achieve viral suppression in their third trimester. This highlights the need to closely monitor viral load and strengthen counselling and support services for ART adherence.

In the context of the coronavirus disease 2019 (COVID-19) pandemic, the quickly developed COVID-19 vaccine may cause various adverse reactions, especially in special groups, such as pregnant women. However, many pregnant women have concerns regarding vaccination in terms of safety for themselves and their neonates. Therefore, we studied the obstetric outcomes of pregnant women in Zunyi, China. In this retrospective study, we examined differences between pregnant women who were vaccinated and pregnant women who were not vaccinated/vaccinated at the end of pregnancy. In addition, we collected and retrieved the literature related to the COVID-19 vaccine and pregnancy outcomes from PubMed. Among concluded women, 369 were included in the study group and 231 were included in the control group. There were no differences in the baseline characteristics, labor rate, or rates of poor pregnancy outcomes between the 2 groups. Based on the adverse reaction and obstetric outcome data of pregnant women who received the COVID-19 vaccine in China, the vaccine does not raise any safety concerns. This result is the same as that of other countries we summarized. The COVID-19 vaccine has no effect on pregnancy outcomes.

This study aimed to compare pregnant and non-pregnant women infected with SARS-CoV-2 disease (COVID-19) in terms of in-hospital mortality. This historical cohort study was conducted on hospitalized women of reproductive ages (15-49 years) infected with SARS-CoV-2 in Fars province, Iran during 15 March 2019-10 May 2021. Out of the 5,322 patients, 330 were pregnant. The fatality rate of SARS-CoV-2 was 1.2% amongst pregnant women and 3.5% amongst non-pregnant ones. Pregnant and non-pregnant women reported the same history of smoking, opium use, previous COVID-19 infection, vaccination against SARS-CoV-2, and COVID-19 symptoms (p>0.05 for all). However, the pregnant women were younger and had fewer underlying diseases (p<0.001 for both). The results revealed no significant difference between the two groups regarding in-hospital clinical manifestations including the number of days after the onset ofCOVID-19 symptoms, mechanical ventilation, and longinvolvement (cRR; 95% CI=0.99 (0.96-1.02), 1.18 (0.72-2.02), and 0.95 (0.88-1.02), respectively). Nonetheless, Intensive Care Unit (ICU) admission was significantly higher in pregnant women (cRR; 95% CI=2.37(1.85-3.02)). After adjusting for age, history of underlying diseases, and ICU admission, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant women (aRR; 95% CI=0.32 (0.12-0.87)). Based on the current study findings, pregnant women showed lower in-hospital mortality due to COVID-19 compared to non-pregnant ones. Nevertheless, they should follow the same recommendations as non-pregnant women, avoiding exposure to the virus and receiving medical treatment and vaccination. Further studies are recommended to address the follow-up of recovered pregnant women, their babies, and puerperium.

Malaria during pregnancy is associated with adverse events for the fetus and newborn, but the association of malaria during pregnancy with the head circumference of the newborn is unclear. To investigate the association of malaria during pregnancy with fetal head growth. Two cohort studies were conducted at the general maternity hospital of Cruzeiro do Sul (Acre, Brazil) in the Amazonian region. One cohort study prospectively enrolled noninfected and malaria-infected pregnant women who were followed up until delivery, between January 2013 and April 2015. The other cohort study was assembled retrospectively using clinical and malaria data from all deliveries that occurred between January 2012 and December 2013. Data analyses were conducted from January to August 2017 and revised in November 2018. Clinical data from pregnant women and anthropometric measures of their newborns were evaluated. A total of 600 pregnant women were enrolled through volunteer sampling (prospective cohort study), and 4697 pregnant women were selected by population-based sampling (retrospective cohort study). After application of exclusion criteria, data from 251 (prospective cohort study) and 232 (retrospective cohort study) malaria-infected and 158 (prospective cohort study) and 3650 (retrospective cohort study) noninfected women were evaluated. Malaria during pregnancy. The primary end point was the incidence of altered head circumference in newborns delivered from malaria-infected mothers compared with that from noninfected mothers. Secondary end points included measures of placental pathology relative to newborn head circumference. In total, 4291 maternal-child pairs were analyzed. Among 409 newborns in the prospective cohort study, the mothers of 251 newborns had malaria during pregnancy, infected with Plasmodium vivax, Plasmodium falciparum, or both. Among 3882 newborns in the retrospective cohort study, 232 were born from mothers that had malaria during pregnancy. The prevalence of newborns with a small head (19 [30.7%] in the prospective cohort study and 30 [36.6%] in the retrospective cohort study) and the prevalence of microcephaly among newborns (5 [8.1%] in the prospective cohort study and 6 [7.3%] in the retrospective cohort study) were higher among newborns from women infected with P falciparum during pregnancy. Multivariate logistic regression analyses revealed that P falciparum infection during pregnancy represented a significant risk factor for the occurrence of small head circumference in newborns (prospective cohort study: odds ratio, 3.15; 95% CI, 1.52-6.53; P = .002; retrospective cohort study: odds ratio, 1.91; 95% CI, 1.21-3.04; P = .006). Placental pathologic findings corroborated this association, with more syncytial nuclear aggregates and inflammatory infiltrates occurring in placentas of newborns born with decreased head circumference. This study indicates that falciparum malaria during pregnancy is associated with decreased head circumference in newborns, which is in turn associated with evidence of placental malaria.

Background/ObjectivesPregnant women were included in the COVID-19 vaccination strategy adopted in Spain in May 2021. We evaluated the obstetric and neonatal symptoms and complications presented by these first pregnant women infected with SARS-CoV-2, vaccinated and unvaccinated.MethodsA retrospective observational cohort study of 156 pregnant women with a positive diagnosis of SARS-CoV-2 (infection rate of 4.2%, 156/3719 births), treated at two public hospitals in the Valencian Community (Spain) over two years (2020–2022). Of those pregnant women infected, 28.8% (45) had received at least one dose of the COVID-19 vaccine before infection. The data were obtained from the digital medical record, the Nominal Vaccination Registry (RNV), and symptom data from the Epidemiological Surveillance Application (AVE) of the CV, supervised by the epidemiology units. We analyzed the symptoms of the disease and the main obstetric and neonatal variables depending on whether or not they were vaccinated with mRNA vaccines.ResultsMost pregnant women were diagnosed in the third trimester of pregnancy (p = 0.003) and reported symptoms associated with the infection (73%), but vaccinated women reported all the symptoms described to a lesser extent, with headache (R1.38, 95%IC 1.15 to 1.66) and vomiting (R 1.38, 95%IC 1.15 to 1.66) statistically significant. All cases of pneumonia occurred in unvaccinated pregnant women who required ventilatory assistance and referral to the Intensive Care Unit. Pregnant women vaccinated against SARS-CoV-2 infection had lower rates of gestational pathology, milder symptoms, and fewer postpartum complications than unvaccinated women, although the small sample size did not allow for a significant difference to be seen. Neonatal outcomes were similar in both groups.ConclusionsCOVID-19 vaccination in pregnant women with at least one dose is associated with reduced symptoms, less headache and vomiting, and fewer maternal complications, including pneumonia, which did not occur in the vaccinated cohort. Furthermore, the Apgar score at one and five minutes is higher than 7 in children of immunized mothers.Public health strategies should promote access to vaccines during pregnancy as an urgent priority, to minimize the risk of complications from COVID-19.

Review question/objective Objectives: 1. To synthesise the best available evidence on the effectiveness of influenza vaccination during pregnancy, for pregnant women, her foetus and the child up to six months of age. 2. To synthesise the best available evidence on the types and frequency of adverse events for pregnant women, her foetus and the child up to six months of age, associated with influenza vaccination during pregnancy. Review questions: 1. What are the beneficial effects of influenza vaccination during pregnancy for pregnant women, her foetus and child up to six months of age? 2. What are the adverse effects of influenza vaccination during pregnancy for pregnant women, her foetus and child up to six months of age? Inclusion criteria Types of participants This study will focus on pregnant women with or without risk factors for complications from influenza infection, their unborn child that is being carried at the time of the vaccination, and children up to the age of 6 months. Types of intervention(s) Inactivated influenza vaccination, irrespective of antigenic configuration or adjuvant, administered via any route, any dose, to pregnant women of any trimester. Studies investigating the monovalent H1N1 vaccine will be assessed separately, as well as in combination with the standard trivalent vaccine. Comparator: Pregnant women not vaccinated against influenza. Types of outcomes •Number and severity of influenza and influenza-like episodes and hospitalisation from influenza for pregnant women and their infant less than six months. •Adverse effects for pregnant women, including but not limited to local reaction, fever, anaphylaxis, Guillain Barre Syndrome and maternal death. •Effects on the foetus, including but not limited to spontaneous abortion, stillbirth, premature birth, birth weight, foetal growth and congenital malformation. •Adverse effects of maternal immunisation on the infant up to six months of age. The case definition of influenza will be accepted as a collection of respiratory and systemic symptoms as defined by the author, and/or laboratory confirmed influenza using viral isolation and/or serology. Severity for the mother and infants will be assessed by hospitalisation and/or death, and/or severe disease such as pneumonia.

Reliable data are lacking on pregnancy outcomes during Ebola virus disease (EVD) epidemics. We aimed to characterize symptoms and outcomes among pregnant women admitted to Ebola treatment units (ETUs) with suspected and confirmed EVD to better inform obstetric management. We analyzed a retrospective cohort of reproductive-aged women presenting to 5 West African ETUs from September 2014 to September 2015. We compared clinical symptoms, risk of EVD diagnosis, and mortality between pregnant and nonpregnant women. Of 729 reproductive-aged women admitted to study ETUs, 44 (6%) reported pregnancy. Thirteen of 44 pregnant women (30%) tested EVD positive; 6 of 13 (46%) died. Pregnant women were less likely than nonpregnant women to report anorexia, asthenia, diarrhea, fever, myalgias/arthralgias, nausea, or vomiting (P < .05) at admission. Pregnant women with suspected EVD had the same risk, however, of laboratory-confirmed EVD (30% vs 24%, P = .38). While pregnant women with confirmed EVD had similar Ebola viral loads on presentation to nonpregnant women, as measured by initial cycle threshold (26.4 vs 23.2, P = .16), they were less likely to have myalgias/arthralgias (P< .001) and vomiting (P = .02). Both all-cause mortality (14% vs 19%, P = .39) and EVD-specific mortality (46% vs 54%, P = .60) were not significantly different between pregnant and nonpregnant women. Two neonates born live in the ETU died within 8 days. We find no evidence to support a difference in the risk of death between pregnant women with suspected or confirmed EVD compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies.

Adolescents living with HIV face barriers that impede adherence and retention. Differentiated service delivery (DSD) models aim to improve retention and viral suppression (VS), but there is limited programmatic evidence from South Africa on DSD outcomes. This study aimed to measure 12 month retention and VS proportions in adolescents enrolled in DSD and clinic-based care, and measure the association between 12 month retention, VS and covariates. A retrospective cohort study was conducted in the Mopani District, Limpopo province, using TIER.Net data. The study included adolescents aged 10-19 years enrolled in DSD between 01 September 2019 and 30 September 2022, and those eligible for DSD with viral load < 50 copies/mL. The study measured 12-month retention and VS proportions. Multivariable logistic regression measured association among 12-month retention, VS and exposure variables. A total of 646 adolescents in DSD and 1282 in clinic-based care were included. Twelve-month retention was 92.7% (599/646) in DSD and 89.0% (1141/1282) in clinic-based care. There was no association between 12-month retention and being enrolled in DSD versus clinic-based care. Twelve-month VS (< 50 copies/mL) was 63.5% (251/395) in DSD, compared to clinic-based care 51.0% (494/969). In multivariable regression, being on DSD was associated with higher VS at < 50 copies/mL (Adjusted Odds Ratio [AOR] 1.6; 95% confidence interval: 1.2-2.1; p < 0.001) than clinic-based care. Differentiated service delivery improved VS in adolescents in a rural setting and should be prioritised to improve outcomes. Differentiated service delivery improves adolescent VS in a rural setting.

Background: Human leukocyte antigen G (HLA-G), a non-classic class I antigen, has been well documented in that its concentrations in maternal peripheral blood are significantly lower in pregnant women with preeclampsia (PE) than those pregnant women without PE. However, the clinical significance of measuring serum HLA-G as a test for predicting PE development has not been studied. Methods: First, we determined cutoff values for serum HLA-G levels for PE in a retrospective case-control study with 100 PE patients and 300 non-PE pregnant women. Then, we performed a prospective unselected cohort study with 3,439 pregnant women. In the prospective study, pregnant women whose serum HLA-G levels were lower than the cutoff values and who had other PE risk factors were included in a PE rule-in group. In contrast, pregnant women whose serum HLA-G levels were greater than the cutoff values and who had no other PE risk factors were included in a PE rule-out group. The participants were followed up until end of study. Finding: The cutoff values of serum HLA-G levels for PE were established in the retrospective study. In the subsequent prospective study, we demonstrated that serum HLA-G levels lower than 80 U/mL at 10−13 gestational weeks (GW) in the PE rule-in group showed a positive predictive value for PE development with 83.78% sensitivity and 87.93% specificity while serum HLA-G levels higher than 80 U/mL at 10−13 GW in the PE rule-out group had a negative predictive value with 88.57% sensitivity and 97.14% specificity. Interpretation: Serum HLA-G levels lower than 80 U/mL in the first trimester of pregnancy can be used to predict the absence or presence of PE development in the third trimester of pregnancy. Funding Statement: Allowance to SMY for new technique development from provincial and municipal government department of Sichuan, Chengdu, P. R. China. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The hospital review board (Second Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China) approved the study protocol. All participants provided their written informed consent.

Intensive care unit admissions for pregnant and nonpregnant women with coronavirus disease 2019

Objective: To evaluate the effect of excess weight gain on the development of uteroplacental blood flow disorders in pregnant women with chronic arterial hypertension. Design and method: A retrospective study was conducted to observe 257 pregnant women with chronic hypertension (CAH) and 200 pregnant women without hypertension and other conditions leading to increased blood pressure (control group). The study was conducted on the basis of perinatal centers in Astana (Kazakhstan) for 2018-2019. The average weight gain during pregnancy and its possible impact on the development of UPC disorders were studied. Results: The main goal of managing pregnant women with arterial hypertension is to prevent the development of complications in the mother and fetus. One of the reasons for an unfavorable prognosis for the fetus is a violation of the uteroplacental circulation (UPC). When comparing pregnant women with CAH and the control group, a violation of UPC was detected in 28.1% and 1.0% of cases, respectively (p &lt;0.001). The average age of pregnant women with CAH was 32.9±5.7 years, in the control group 31.6±5.6 (p=0.059). The average weight gain was found to prevail in the CAH group of pregnant women with CAH (16.86±3.68 kg) compared to the control group (12.91±2.36 kg, p=0.004). Using binary logistic regression, we analyzed the effect of excess weight gain on the development of UPC impairment. In the control group, excessive weight gain was observed in 21 (10.5%) pregnant women, only 2 (1.0%) in the group with normal weight gain (n=179) subsequently developed UPC. Of the 257 pregnant CAH women, 125 (48.7%) had excessive weight gain and 71 (27.6%) developed UPC abnormalities. However, 131 (50.9%) had normal weight gain and only 1 (0.4%) pregnant women with normal weight gain later developed a UPC disorder. Conclusions: To prevent disturbances of uteroplacental blood flow in pregnant women with chronic arterial hypertension, weight gain is important and therefore strict control of weight gain during pregnancy is necessary, compared with the control group.