Maternal and neonatal outcomes in pregnant women with COVID-19: a systemic review

Background & aim: Novel coronavirusease 2019 (Covid-19) started in China and caused unexplained pneumonia. The risk of adverse pregnancy outcomes increase in respiratory viral infection during pregnancy. This systematic review was performed to investigate the maternal and neonatal outcomes in pregnant women infected with Covid-19. Methods: In this systematic review, the international databases (PubMed, Cochrane Library, Web of Science, Scopus, Embase, PsycINFO, Google scholar) as well as national databases (SID and Magiran) were searched to find out the articles published from 1 September 2020 to 30 April 2021 regarding maternal and neonatal outcomes in pregnant women infected with Covid-19. Keywords were selected based on Mesh (“Pregnancy”, “Gravidity”, “Delivery”, “Infant”, “Newborn”, “Neonate”, “Outcome”, “Complication”, “Abortion”, “Obstetric Labor, Premature”, “Cesarean Section”, “Fetal Death”, “Infant, Premature”, “Coronavirus Infection”, “COVIDK19”). The full texts of articles were reviewed by two independent reviewers and the relevant data was extracted. Results: 20 studies including 78 pregnant women entered in this review. All women were at third trimester of pregnancy except 2 cases who were less than 28 weeks. The most prevalent clinical symptoms were fever, cough and sore throat. The most common maternal outcomes were intrauterine distress, rupture of membranes and preterm delivery. Most infants delivered by cesarean section. The most common neonatal complications were prematurity, small for gestational age, fetal distress, low birth weight and bacterial pneumonia. Conclusion: In this systematic review, we found some evidence to suggest that COVID-19 pneumonia causes negative maternal and neonatal outcomes in pregnant women infected with Covid-19.

Gestational diabetes mellitus and COVID-19: results from the COVID-19–Related Obstetric and Neonatal Outcome Study (CRONOS)

Effects of mobile health management model on the prevention of gestational diabetes mellitus in pregnant women at risk of gestational diabetes: A randomized controlled trial.

Objective: To analyze the association between different treatment timings and adverse neonatal outcomes (premature birth, death, congenital syphilis) in syphilis-infected pregnant women. Methods: The National Management Information System for Prevention of HIV, Syphilis and HBV Mother-to-Child Transmission was used to collect information on the detection and treatment of syphilis-infected pregnant women and their newborns in Guangdong Province from October 2011 to December 2021. According to the gestational weeks of syphilis-infected pregnant women receiving penicillin treatment for the first time, they were divided into four groups: treatment in the first trimester, treatment in the second trimester, treatment in the third trimester, and no treatment during pregnancy. Multivariate logistic regression was used to analyze the association between different treatment timings and adverse neonatal outcomes in syphilis-infected pregnant women. Results: A total of 22 483 syphilis-infected pregnant women were included. The number of pregnant women who started treatment in the first trimester, second trimester, and third trimester and did not receive treatment during pregnancy were 4 549 (20.23%), 8 719 (38.78%), 2 235 (9.94%) and 6 980 (31.05%), respectively. Compared with pregnant women who started treatment in the first trimester, pregnant women who did not receive anti-syphilis treatment during pregnancy had increased risks of neonatal preterm birth (OR=1.42, 95%CI: 1.24-1.62), death (OR=4.27, 95%CI: 1.64-14.69) and congenital syphilis (OR=12.26, 95%CI: 6.35-27.45). At the same time, the risk of congenital syphilis in the newborns of pregnant women who started anti-syphilis treatment in the second trimester (OR=2.68, 95%CI: 1.34-6.16) and third trimester (OR=6.27, 95%CI: 2.99-14.80) also increased. Conclusion: Early initiation of anti-syphilis treatment during pregnancy in patients with syphilis can improve neonatal outcomes.

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

PurposeTo assess the effects of levothyroxine (LT4) therapy on pregnancy and neonatal outcomes in pregnant women with subclinical hypothyroidism (SCH) who had different thyroid peroxidase antibody (TPOAb) status.MethodsThe data of pregnant women from the Chengdu Hospital of Integrated Traditional Chinese and Western Medicine between January 2017 and August 2019 were collected. SCH was defined as 11.88 < free thyroxine (FT4) < 20.06pmol/L in conjunction with thyroid-stimulating hormone (TSH) >4.00 mU/L. Some clinical characteristics have been collected, including body mass index (BMI) before pregnancy, number of pregnancies, number of miscarriages (spontaneous abortion), parity, family history of diabetes, history of smoking, history of drinking, TSH, FT4, and TPOAb levels. The prevalence of pregnancy and neonatal outcomes in the LT4 and non-LT4 groups, and in the LT4 and euthyroid control groups were compared, respectively. Univariate and multivariate logistic regression analyses were used to assess the effects of LT4 therapy on pregnancy and neonatal outcomes in SCH pregnant women with TPOAb.ResultsA total of 985 subjects were enrolled and divided into LT4 group with 478 patients, non-LT4 group with 156 patients and euthyroid control group with 351 patients. The prevalence of amniotic fluid abnormalities and premature delivery in the LT4 group was lower than that in the non-LT4 group in participants with TPOAb-positive (TPOAb+). After adjusting age, BMI prior to pregnancy, number of pregnancies, number of miscarriages, parity, TSH and FT4 level, the SCH pregnant women with TPOAb+ in the LT4 group had a lower risk of amniotic fluid abnormalities and premature delivery than that in the non-LT4 group.ConclusionLT4 therapy could reduce the risk of premature delivery and amniotic fluid abnormalities in the SCH pregnant women with TPOAb+. However, more randomized trials are required to confirm this association before the unequivocal advocacy of LT4 therapy in pregnant women with SCH.

Effects of insulin combined with metformin on serum cystatin C (Cys C), homocysteine (Hcy) and maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus (GDM) were investigated. In total, 80 cases of pregnant women diagnosed with GDM in the Department of Obstetrics and Gynecology of Liaocheng Third People's Hospital from July 2015 to July 2017 were selected and divided into a study group (42 cases) and a control group (38 cases). The study group was treated with insulin combined with metformin, and the control group was treated with insulin. Fasting blood glucose (FBG) and postprandial blood glucose after 2 h (2hPG) of the two groups were compared before and after treatment. Levels of serum Cys C, Hcy, urinary protein (UmAlb), postpartum maternal outcomes and adverse reactions during pregnancy were compared in the two groups before and after treatment. After treatment, the level of FBG and 2hPG in the control group was higher than that in the treatment group (P<0.05). After treatment, the level of serum Cys C and Hcy in both groups were lower than that before the treatment, and the level in the study group was lower than that in the control group (P<0.05). The total incidence of neonatal adverse outcomes and the number of adverse pregnancies in GDM patients in the study group were significantly lower than those in the control group (P<0.05). There were no significant differences in adverse reactions during pregnancy between the two groups (P>0.05). In conclusion, insulin combined with metformin is more effective than insulin alone in reducing serum Cys C and Hcy levels, with significant effect on the improvement of maternal and neonatal outcomes.

Purposes. To evaluate the effects of thyroid peroxidase antibodies (TPOAb) on maternal and neonatal adverse outcomes in pregnant women. Methods. 208 pregnant women at 24–28 weeks were divided into two groups, TPOAb-positive and TPOAb-negative groups. Thyroid function and TPOAb were determined in all subjects until 12 months postpartum. Levothyroxine was supplemented to maintain euthyroid with periodical checking of thyroid functions. The prevalence of postpartum thyroiditis (PPT), placenta previa, placental abruption, premature rupture of membrane, postpartum haemorrhage, polyhydramnios, oligohydramnios, preterm birth, low birth weight, congenital hypothyroidism, and neonatal diseases were observed in two groups. Results. Of all women, 11.54% had a PPT. The prevalence of PPT was significantly higher in TPOAb-positive than TPOAb-negative group (42.31% versus 7.14%, P < 0.001), with 45.46% and 53.85% of PPT happening at 6 weeks postpartum in TPOAb-positive and TPOAb-negative groups. The incidence of polyhydramnios was significantly higher in TPOAb-positive than TPOAb-negative group (15.38% versus 2.74%, P = 0.02). Conclusion. Pregnant women with TPOAb-positive had increased risk of PPT, predominantly happening at 6 weeks postpartum. TPOAb was associated with increased incidence of polyhydramnios and the underlying mechanisms required further investigation. Earlier screening of thyroid function during pregnancy and postpartum was warranted in our region.

The aim of the study was to evaluate the effects of thyroperoxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) on maternal and neonatal adverse outcomes in pregnant women. A total of 296 singleton pregnant women were classified into four groups according to the thyroid auto-antibody in the first trimester. Finally, there were 97 women in TPOAb positive group (TPOAb+/TgAb-), 35 in TgAb positive group (TPOAb-/TgAb+), 85 in TPOAb and TgAb positive group (TPOAb+/TgAb+), and 79 in TPOAb and TgAb negative group (TPOAb-/TgAb-). Thyroid function, TPOAb, and TgAb were checked during pregnancy and followed up at 6 weeks, 3 months, 6 months, 9 months, and 12 months postpartum. Levothyroxine sodium tablets could be taken to maintain euthyroid antepartum. Thyroid function of women with postpartum thyroiditis (PPT) were followed up at 2 and 3 years postpartum. We observed the incidence of PPT, premature rupture of membranes (PROM), placental abruption, placenta previa, polyhydramnios, oligohydramnios, postpartum hemorrhage, preterm birth, and low birth Weight in the four groups. 19.93% of the women had PPT. The incidence of PPT in TPOAb+/TgAb-, TPOAb-/TgAb+, TPOAb+/TgAb+groups was significantly higher than that in TPOAb-/TgAb- group, respectively (16.49 vs. 6.33%, 22.86 vs. 6.33%, 35.29 vs. 6.33%, p <0.05). The incidence of PPT in TPOAb+/TgAb+group was significantly higher than that in TPOAb+/TgAb- group (35.29 vs. 16.49%, p <0.01). PPT occurred as early as 6 weeks postpartum, but mainly at 3 and 6 months postpartum in the four groups (62.50%, 75.00%, 70.00%, 80.00%). All PPT in TPOAb-/TgAb- group occurred within 6 months postpartum, while it was found at 9 months or 12 months postpartum in other three groups. There was no classical form of PPT in TPOAb-/TgAb- group, while in the other three groups, all three types (classical form, isolated thyrotoxicosis, isolated hypothyroidism) existed. At 2 years postpartum of the women with PPT, the rate of euthyroidism in TPOAb+/TgAb+group was significantly lower than that in TPOAb-/TgAb- group (p <0.05). At 3 years postpartum of the women with PPT, the rate of euthyroidism in TPOAb+/TgAb-, TPOAb-/TgAb+, and TPOAb+/TgAb+groups were significantly lower than that in TPOAb-/TgAb- group (p <0.05). The values of TPOAb and TgAb postpartum were significantly higher than those during pregnancy (p <0.05). The incidence of PROM in TPOAb+/TgAb- group was significantly higher than that in TPOAb-/TgAb- group (32.99 vs. 17.72%, p <0.05). The binary logistic regression for PPT showed that the OR value of TPOAb was 2.263 (95% CI 1.142-4.483, p=0.019). The OR value of TgAb was 3.112 (95% CI 1.700-5.697, p=0.000). In conclusion, pregnant women with positive thyroid auto-antibodies had an increased risk of PPT and a reduced rate of euthyroidism at 2 and 3 years postpartum. TPOAb is associated with the incidence of PROM. Both of TPOAb and TgAb were independent risk factors for PPT. TgAb deserves more attention when studying autoimmune thyroid disease (AITD) combined with pregnancy.

Background: The coronavirus disease 2019 (COVID-19) infection has been linked to increased risks of severe maternal outcomes globally, including intensive care unit admissions and mechanical ventilation. Studies and reports suggest that pregnant women with COVID-19 face higher risks of complications. However, there is limited data directly comparing maternal and neonatal outcomes in pregnant women with and without COVID-19. Objectives: We aimed to compare both maternal and neonatal outcomes in pregnant women with and without COVID-19 infection. Materials and Methods: This is a multicenter retrospective cohort study conducted at two Ministry of National Guard Health Affairs Hospitals in Saudi Arabia, including all pregnant women, who delivered and received follow-up care at either site between March 2020 and October 2021. COVID-19 infection was confirmed by laboratory tests in the infected patients. Descriptive statistics were conducted for the cohort baseline description, and multivariable logistic regression was conducted to assess the associated risks for maternal, and neonatal outcomes. Results: The study included 639 pregnant women with confirmed COVID-19 infection and 644 pregnant women with no COVID-19 infection. There was no statistically significant difference in the risk of stillbirth [adjusted odds ratio (aOR) = 2.88; 95% confidence interval (95% CI) = 0.89, 11.74] or miscarriage (aOR = 0.53, 95% CI = 0.24, 1.09) between COVID-19 infected and noninfected pregnant women. On the other hand, COVID-19 infection was associated with an increased risk of low birth weight (aOR = 1.53, 95% CI = 1.06, 2.20), Apgar score-1 min &lt;7 (aOR = 2.30, 95% CI 1.62, 3.29), and Apgar score-5 min &lt;7 (aOR 2.84, 95% CI 1.92, 4.27). Conclusion: This study concludes that infants born to pregnant women with COVID-19 infection were more likely to have neonatal complications compared with those born to noninfected women. Future prospective studies could include the long-term effects of maternal and neonatal COVID-19 infection.

Introduction: Placenta previa is one of the main causes of antepartum hemorrhage and is an important cause of maternal and perinatal morbidity &amp; mortality worldwide. Objective: To find the frequency of adverse maternal and neonatal outcomes in pregnant women, with placenta previa, presenting in a tertiary care hospital. Methodology: This cross-sectional descriptive, case was done at Obstetrics &amp; Gynecology Department, Central Park Medical College, Lahore from 1st January 2019 to 31st December 2019. A total 171 patients were included with ultrasound evidence of placenta previa and/or placenta accreta. Demographic characteristics and other required information recorded in proforma. Maternal outcomes in terms of primary PPH and neonatal outcomes in terms of NICU admission were noted. Results: The patients mean age was 29.71±2.94 years &amp; mean Duration of pregnancy was 36.44±1.36 weeks. There were 43(25.1%) women with no C-section, 105(61.4%) had 1-2 C-sections and 23(13.5%) had 3 or more C-sections. There were 146(85.4%) women with history of painless vaginal bleeding. In this study there were 58(33.9%) women had PPH and 25(14.6%) women with placenta Accreta. Peripartum Hysterectomy was done in 24 (14%) patients. There were 66(38.6%) babies admitted in NICU. There was no significant association between PPH and age groups as the p-value was not significant (P-values=0.19). Conclusion: The frequency of adverse maternal &amp; neonatal outcomes in pregnant women, with placenta previa was very high in this study so it is concluded that the presence of placenta previa increases adverse maternal &amp; neonatal outcomes when delivered

Objective: To analyze the effect of continuous positive airway pressure (CPAP) on maternal and neonatal outcomes in pregnant women with obstructive sleep apnea syndrome (OSAS), especially on the incidence of hypertensive disorder in pregnancy (HDP) in women with moderate to severe OSAS. Methods: A total of 180 pregnant women with OSAS who were diagnosed through sleep monitoring during pregnancy due to high-risk factors of OSAS and registered in Peking University People's Hospital from January 2021 to May 2024 were selected as the study subjects. Clinical data were collected from medical records for retrospective analysis. According to whether they received standardized treatment with CPAP, they were divided into the CPAP treatment group (42 cases) and the control group (138 cases). The CPAP treatment group consisted of 9 pregnant women with moderate to severe OSAS, while the control group consisted of 34 pregnant women with moderate to severe OSAS. The maternal and neonatal outcomes, the incidence of HDP, placental weight after delivery and placental weight/neonatal birth weight ratio were compared between the two groups. Results: (1) The average gestational age of pregnant women in the CPAP treatment group was higher than that in the control group [(38.7±1.0) vs (38.0±1.4) weeks], the proportion of infants small for gestational age (SGA) in the CPAP treatment group was lower [0 (0/42) vs 12.3% (17/138)], and the birth weight of infants in the CPAP treatment group was bigger [(3 396±475) vs (3 082±710) g); the differences between the two groups were statistically significant (all P<0.05). There were no significant differences between the CPAP treatment group and the control group in terms of delivery mode, rates of postpartum hemorrhage and preterm birth, umbilical artery blood gas analysis pH<7.1, lactate≥6.0 mmol/L, base excess<-12.0 mmol/L and the incidence of gestational diabetes mellitus and HDP (all P>0.05). (2) The placental weight of the CPAP treatment group was significantly lower than that of the control group [(554.0±70.6) vs (615.7±119.1) g], the placental weight/newborn birth weight ratio of the CPAP treatment group was significantly lower than that of the control group (median: 0.17 vs 0.19), and the differences were statistically significant (all P<0.05). (3) The incidence of HDP in pregnant women with moderate to severe OSAS in the CPAP treatment group was lower than that in the control group [1/9 vs 61.8% (21/34)], and the difference was statistically significant (P<0.05). Conclusions: CPAP treatment could prolong the gestational age in pregnant women with OSAS, reduce the incidence of SGA, increase the birth weight of infants, and reduce the incidence of HDP in pregnant women with moderate to severe OSAS, and is worth promoting in clinical practice. The improvement of neonatal outcomes by CPAP treatment is closely related to the placenta, which is worthy of further exploration.

Aim: This study aimed to investigate the utility of inflammatory indices in predicting adverse maternal and neonatal outcomes in pregnant women with recurrent urinary tract infections. Material and Methods: This retrospective study was conducted on pregnant women treated for symptomatic urinary tract infection (UTI) between 2017 and 2021. Pregnant women with two or more episodes of symptomatic UTI were included in the study group. Pregnant women with one UTI were included in the control group. The study group consisted of 91 (46.9%) patients and the control group consisted of 103 (53.1%) patients. The groups were compared in terms of clinical characteristics, adverse outcomes, and inflammatory indices. Results: It was found that more adverse maternal and neonatal outcomes occurred in the study group compared to the control group (p=0.021, and p&amp;lt;0.001, respectively). The cut-off values for platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) to predict adverse maternal outcomes were found 185.00 (p=0.015, area under the curve (AUC)=0.604, 95% confidence interval (CI)=0.558-0.782,), 4.34 (p=0.051, AUC=0.584, 95% CI=0.514-0.746), and 1210.48 (p=0.008, AUC=0.614, 95% CI=0.547-0.771), respectively. The cut-off values for PLR, NLR, and SII for predicting negative neonatal outcomes were found 192.98 (p=0.001, AUC=0.692, 95% CI=0.572-0.812), 4.67 (p=0.166, AUC=0.583, 95% CI=0.475-0.740), and 1339.47 (p=0.006, AUC=0.666, 95% CI=0.526-0.777), respectively. Conclusion: Although the success of discrimination is weak, PLR and SII may be useful to predict adverse maternal and neonatal outcomes in pregnant women with recurrent UTI.

Background: Integrated care models have been increasingly recognized for their role in improving maternal and neonatal outcomes in pregnant women with endocrine disorders such as gestational diabetes mellitus and hypothyroidism. These conditions pose significant risks, including hypertensive disorders, preterm birth, and neonatal complications. While various management strategies exist, the effectiveness of integrated, multidisciplinary care approaches remains inadequately synthesized in the literature. This systematic review addresses this gap by evaluating the impact of integrated care models on maternal and neonatal health outcomes. Objective: This systematic review aims to assess the effectiveness of integrated care models in improving maternal and neonatal outcomes in pregnancies complicated by endocrine disorders compared to standard care. Methods: A systematic review was conducted following PRISMA guidelines. Electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, were searched for studies published between 2019 and 2024. Inclusion criteria encompassed randomized controlled trials, cohort studies, and observational studies evaluating integrated care interventions in pregnant women with endocrine disorders. Studies focusing on gestational diabetes, hypothyroidism, and maternal obesity were included. Data extraction followed a standardized form, and the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale were used for quality assessment. Results: Eight studies met the inclusion criteria, comprising 2,530 participants. Integrated care models demonstrated improved maternal outcomes, including reduced hypertensive disorders (p&lt;0.05), lower preterm birth rates (p&lt;0.01), and better glycemic control in gestational diabetes (p&lt;0.05). Neonatal outcomes, such as lower rates of neonatal hypoglycemia and reduced neonatal intensive care unit admissions, were also observed (p&lt;0.001). Studies on opioid-dependent pregnancies highlighted shorter neonatal hospital stays with integrated care (p&lt;0.001). Conclusion: The findings suggest that integrated care models significantly enhance maternal and neonatal outcomes in pregnancies complicated by endocrine disorders. These results support the integration of multidisciplinary approaches in clinical guidelines. However, variability in study designs necessitates further large-scale trials to validate these findings and assess long-term cost-effectiveness.

Maternal and neonatal outcomes in pregnant women with multiple sclerosis disease: A systematic review and meta-analysis