COVID-19 Mothers Research Articles

Outcomes of Infants Born to Mothers with SARS-CoV-2 Infection in a Tertiary Hospital

Introduction: Pregnant women are a susceptible population to emerging infections. Recent published data have shown evidence of possible transplacental transmission of SARS-CoV-2. However, at present there are not enough data to determine its effect on the fetus. This study aims to determine the outcomes of infants born to mothers with SARS-CoV-2 infection. Methods: A retrospective descriptive institution-based study using data collected from medical records of infants born to confirmed COVID-19 mothers delivered from April to June 2020. Results: Of the 47 neonates, none of them were positive for SARS-CoV-2 RT-PCR. Majority were born full-term, mean gestational age of 37 weeks, weight of 2867 grams, appropriate for gestational age, good APGAR score, and delivered through cesarean section. Symptomatic neonates (27.7%) had tachypnea and vomiting as the most common manifestation, 13.3% had lymphopenia while pneumonia was the predominant radiologic finding. There was a significant association between the presence or absence of symptoms among mothers and neonates (p=0.037). Conclusion: The neonatal outcome in this study was good with 98% survival at 2 weeks of life. There was note of 2.1% morbidity and mortality. Given that the clinical data in newborns are very limited and the possibility of a vertical transmission is still uncertain, it is crucial to closely monitor neonates with increased risk of COVID-19 infection.

187 Mental health clusters during COVID-19 pandemic are associated with multiple dimensions of sleep in a sample of pregnant women

IntroductionSleep and mental health have a bidirectional relationship. During pregnancy, poor sleep health, depression and stress are common and have been associated with poor maternal and fetal outcomes. The COVID-19 pandemic has introduced additional physical and psychological risk factors, due to high mortality rate, and economic and social repercussions. This study examines whether prenatal maternal mental health clusters are associated with multiple dimensions of sleep during pregnancy in the context of the COVID-19 pandemic.MethodsFrom June-December 2020, participants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) Cohort at Columbia University (N=188; at recruitment gestational age: 32.2±8.2 weeks; age: 32±6.75 years; N=74 Hispanic, N=65 White non-Hispanic, N=27 Black/African American, N=22 other). Survey data on maternal depression (PHQ-9), perceived stress (PSS), Covid-related stress, and sleep health (PSQI) were collected. Using hierarchical clustering, we created maternal mental health clusters (MMHC). Regressions analyses were implemented to estimate the associations between multiple dimensions of sleep based on MMHC.Results\\We derived three MMHC: Low-risk (no depression, no Covid-stress, low-moderate perceived stress), Covid-stress (no depression, moderate Covid-stress, low-moderate perceived stress) and high-risk (moderate depression, moderate Covid-stress, moderate to high perceived stress). Maternal age, gestational age, income, and race were not significantly different across clusters. The Covid-stress cluster compared to the low-risk cluster reported worse subjective sleep quality (ß=0.34±0.11, p=0.0025), longer sleep latency (ß=0.44±0.13,p<0.000), more sleep disturbances (ß=0.67±0.18, p=0.004) and an overall higher PSQI score (ß=0.32±0.13,p=0.017). Compared to the low-risk group, the high-risk group reported worse subjective sleep quality (ß=0.96±0.3,p<0.000), longer sleep latency (ß=0.79±0.13,p<0.000), shorter sleep duration (ß=0.67±0.18,p=0.0003), lower sleep efficiency (ß=0.67±0.25,p=0.008), more sleep disturbances (ß=0.59±0.10, p<0.000), higher daytime dysfunction (ß=0.85±0.10, p=0.000) and an overall higher PISQI score (ß=1.15±0.16, p<0.000).ConclusionOur results indicate that the COVID-19 pandemic has affected mental health profiles during pregnancy, with evidence of a high-risk cluster presenting Covid-stress and depressive symptoms and a Covid-stress cluster presenting Covid-stress without depressive symptoms in a multi-ethnic sample of pregnant women. Both were associated with poorer sleep health outcomes compared to the low-risk cluster. These results have important implications for screening and treatment for the sleep health and obstetric communities during these unprecedented times.Support (if any):

OUTCOMES OF COVID-19 DURING PREGNANCY: A SYSTEMATIC REVIEW

Objective: This paper presents specific pregnancy outcomes of COVID-19 during pregnancy, based on the literature available until August 2020. Methods: A systematic review was conducted in PubMed, Scopus, Google Scholar, Springer, Science Direct, and the EMBASE database of publications regarding coronavirus disease (COVID-19) following the PRISMA checklist. The search terms used include: “pregnancy”; “pregnant”; “neonatal”; “neonate”; “COVID-19”; “coronavirus disease 2019” “pregnancy”, “pregnant”, “neonatal” and “neonate”. All studies exploring the maternal and fetal outcomes among pregnant women with COVID-19 were considered for this review. Results: A total of 11 case reports on 17 pregnant women and 12 retrospective reviews of the medical records of 795 pregnant women meeting the inclusion criteria were included in the review. Of 362 deliveries, 59.3% involved caesarean sections [CS] while 40.6% were vaginal deliveries. Of the 362 deliveries, 22.37% were preterm. Of 51 neonates, 20% were found to have low birth weight and one tested positive for SARS-CoV-2. A total of nine neonatal deaths were reported, which were not associated with the viral infection, and 15 neonates were found to be COVID-19 positive, although no indication of vertical transmission of infection was established. Conclusions: Pregnancy does not increase the risk of COVID-19 and prospective mothers should follow the same recommendations as applicable to the general population, to limit the transmission of COVID-19. Information compiled in this systematic review of COVID-19-related pregnancy outcomes may help in planning the best care in future.

Infant outcomes and maternal COVID-19 status at delivery.

To compare clinical characteristics and outcomes of infants born to COVID-19 to non COVID-19 mothers at delivery in a community hospital in Queens, New York. Case-control study conducted March 15 to June 15, 2020. Cases were infants born to mothers with laboratory-confirmed COVID-19 infection at delivery. The infant of non COVID-19 mother born before and after each case were selected as controls. Of 695 deliveries, 62 (8.9%) infants were born to COVID-19 mothers; 124 controls were selected. Among cases, 18.3% were preterm compared to 8.1% in controls (p=0.04). In preterm cases, birth weight was not significantly different between groups. However, there was a significantly higher proportion of neonatal intensive care unit (NICU) admissions, need for respiratory support, suspected sepsis, hyperbilirubinemia, feeding intolerance and longer length of stay (LOS) in preterm cases. Among term cases, birth weight and adverse outcomes were not significantly different between cases and controls except for more feeding intolerance in cases. All infants born to COVID-19 mothers were COVID-19 negative at 24 and 48h of life. No infants expired during birth hospitalization. Significantly, more infants of COVID-19 mothers were premature compared to controls. Preterm cases were more likely to have adverse outcomes despite having similar birth weight and gestational age. These differences were not seen among full term infants. Health care providers should anticipate the need for NICU care when a COVID-19 mother presents in labor.

Issues and challenges related to breastfeeding during COVID-19 pandemic

The COVID-19 pandemic has drastically affected continuum of care throughout the life. To "bend the curve", regarding argument among all the research community whether positive or symptomatically suspected COVID-19 mother isolation can reduce the risk of transmission to new born. The recommendation is, infant and Mother's should be enabled to remain together and practice kangaroo mother care. Breastfeeding is most essential for an infant growth and development and maternal psychology, evidences till now supporting exclusive breastfeeding is been only been beneficiary and it will be an injustice to obstruct in the wake of this pandemic. The spread of active SARS-CoV-2 virus that can cause infection through breast milk and breastfeeding has not been detected so far.

Human Milk Antibodies Against S1 and S2 Subunits from SARS-CoV-2, HCoV-OC43, and HCoV-229E in Mothers with A Confirmed COVID-19 PCR, Viral SYMPTOMS, and Unexposed Mothers.

Background: Preexisting immunity to SARS-CoV-2 could be related to cross-reactive antibodies to common human-coronaviruses (HCoVs). This study aimed to evaluate whether human milk antibodies against to S1 and S2 subunits SARS-CoV-2 are cross-reactive to S1 and S2 subunits HCoV-OC43 and HCoV-229E in mothers with a confirmed COVID-19 PCR test, in mothers with previous viral symptoms during COVID-19 pandemic, and in unexposed mothers; Methods: The levels of secretory IgA (SIgA)/IgA, secretory IgM (SIgM)/IgM, and IgG specific to S1 and S2 SARS-CoV-2, and reactive to S1 + S2 HCoV-OC43, and HCoV-229E were measured in milk from 7 mothers with a confirmed COVID-19 PCR test, 20 mothers with viral symptoms, and unexposed mothers (6 Ctl1-2018 and 16 Ctl2-2018) using ELISA; Results: The S2 SARS-CoV-2 IgG levels were higher in the COVID-19 PCR (p = 0.014) and viral symptom (p = 0.040) groups than in the Ctl1-2018 group. We detected a higher number of positive correlations between the antigens and secretory antibodies in the COVID-19 PCR group than in the viral symptom and Ctl-2018 groups. S1 + S2 HCoV-OC43-reactive IgG was higher in the COVID-19 group than in the control group (p = 0.002) but did not differ for the other antibodies; Conclusions: Mothers with a confirmed COVID-19 PCR and mothers with previous viral symptoms had preexisting human milk antibodies against S2 subunit SARS-CoV-2. Human milk IgG were more specific to S2 subunit SARS-CoV-2 than other antibodies, whereas SIgA and SIgM were polyreactive and cross-reactive to S1 or S2 subunit SARS-CoV-2.

Pemberdayaan Masyarakat Desa Plesungan Melalui Penyuluhan Pembuatan Oleh-Oleh Makanan dan Cenderamata Khas Desa

The impact of the covid-19 pandemic on society has occurred in almost all sectors and regions of Indonesia, even the world. One of them is regarding the productivity of the community which has begun to decline due to the reduction in employees. In addition, the limited expertise possessed by rural communities cannot yet be compared with those in remote cities. One of the efforts to overcome this problem is to hold outreach and counselling in the framework of the Community Empowerment Program carried out by the UNISRI KKN-PPM Team in Plesungan Village, Gondangrejo District, Karanganyar Regency, Central Java Province in 2020 by empowering Communities affected by the Covid-19 pandemic and mothers. PKK and in order to prepare Plesungan Village as a tourism village through a program of making souvenirs of food and souvenirs typical of Plesungan Village by utilizing local wisdom such as cassava (pohong), corn, kencur which is processed into typical village food, and the use of used candles, leaves, flowers wild or ornamental dried as a souvenir. This is as motivation and support for the community to be able to compete with other products, so entrepreneurship counseling and packaging are given. The result of this activity is the manufacture of food souvenirs and souvenirs typical of the village in the form of Cassava Bolu, Herbal Kencur, Egg Corn, Aromatherapy Candles, and also resin key chains.

Risk transmission through breastfeeding and antibody in COVID-19 mother

ObjectiveSARS-CoV-2 has spread beyond the world and makes a new challenge in the breastfeeding issue. There is some disagreement among breastfeeding management in confirmed COVID-19 patients China consensus but no evidence shows the transmission via breastfeeding. This paper aims to know the risk of transmission through breastfeeding in COVID-19 patients and antibodies in breast milk. MethodWe conducted a literature review of publicly available information to summarize knowledge about risk transmission through breastfeeding and antibody in mother confirmed COVID-19. ResultA maternal woman was positive for COVID-19 in throat swabs show negative SARS-CoV-2 in breast milk. No evidence suggests the transmission of SARS-CoV-2 from mother to baby via vertical route or breast milk. IgG and IgA were detected in breast milk and potentially against SARS-CoV-2. ConclusionMother with COVID-19 can continuing direct breastfeeding with appropriate hygiene precautions (using a mask and wash hand) and should remain separate (home isolation precautions) from other family members including the infant, except for breastfeeding.

How Do We Manage Breastfeeding During the COVID-19 Pandemic?

The COVID-19 pandemic is causing global disturbances and creating many questions in every aspect of life. Since it influences health in multiple ways, including sexual and reproductive health, publishing in all of these areas has increased lately. One aspect that requires basing on scientific evidence is breastfeeding. There are some controversies in the literature on the breastfeeding management in confirmed COVID-19 mothers. Breast milk is excellent for the infant's nutritional needs and growth, because it includes all of the nutrients an infant requires. It promotes the immature immune system of the infant and reinforces defense mechanisms against infectious and other agents during the breastfeeding period. While limited clinical research is available, we can build on what we know about breastfeeding and previous similar outbreaks to plan and manage this crisis. The aim of this chapter is to provide pediatricians with further guidance on breastfeeding and associated safety measures during the COVID-19 crisis, particularly in instances where a mother has or may have COVID-19. This will also be a benefit to future epidemics and pandemics.

Care of Mother and Neonate during COVID-19 Pandemic for a Healthy Future

COVID-19 caused by coronavirus 2 (SARS-CoV-2) was first time reported in December 2019. The disease has been showing rapid progression to a global pandemic causing profound adverse impact on medical, social, and economic status of the world. Pregnant women and new-borns belong to vulnerable population, who need to be protected. However, currently the impact of this novel virus on the foetus and neonate remains unknown. This article outlines the precautions and steps to be taken by nurses, an important member of the Health Care Team (HCT) before, and during delivery, during and after resuscitation of a neonate born to a COVID-19 mother. More evidence and research work are needed to know the risk of vertical and horizontal transmission of SARS-CoV-2 and its impact on maternal, fetal and neonatal outcomes.

Pregnancy and COVID-19: what anesthesiologists should know.

Anesthetic management of parturients with COVID-19 is a big challenge to anesthesiologists. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with SARS and MERS might provide insights into COVID-19's effects during pregnancy. Evidence from previous reports from SARS and MERS, and from COVID-19 cases were reviewed. Concepts from guidelines from the government and academic societies were collected as well. The evidence was described and summarized. Principles to minimize the risk of infection as well as optimize patients' safety during obstetric anesthesia were found to include careful evaluation, tight protection, and multi-discipline-based strategy. Though vertical transmission of COVID-19 still needs more definitive evidence, strict isolation is necessary for the newborn of COVID-19 mothers. Psychological support for the parturients is also an important issue during COVID-19 pandemic.

Revisiting Strategies for Maternal Health Care in the Face of COVID-19 Pandemic

Novel coronavirus (SARS-CoV-2) is a new strain of coronavirus causing COVID-19, first identified in Wuhan City, China towards the end of 2019. At present, there is no evidence that pregnant women are more likely to be severely ill, need ICU care, or die from the illness in comparison to non-pregnant adults. Evidences suggest that vertical transmission, might be possible. We searched and retrieved the published literature from PubMed and Google Scholar using various keywords. We further searched the official webpages of various organizations for the updated information. Pregnant individuals in particular are encouraged to take all available precautions to optimize health and avoid exposure to COVID-19. Adequate Testing should be prioritized in pregnant women admitted with suspected COVID-19. When a pregnancy is complicated by critical illness, the pregnant patient should ideally be cared for at a Level III or IV hospital. In the face of COVID-19, antenatal fetal surveillance and ultrasonography should continue as medically indicated when possible and elective ultrasound examinations should not be performed. Maternal immunizations continue to be an essential component of prenatal care and Obgyns should screen all pregnant individuals for mental health issues. Although the most commonly reported sign in COVID-19 is fever, nevertheless, other causes of intrapartum fever should not be overlooked. Cesarean delivery should be based on obstetric indications and not COVID-19 status alone. Infants born to patients with known COVID-19 should be considered infants with suspected COVID-19. The suspected or confirmed COVID-19 mother and infant can be allowed to remain together with enhanced precautions and suspected or confirmed maternal COVID-19 is not a contraindication to breastfeeding. If both the mother and the infant are healthy, it may be prudent to expedite discharge, so as to limit the risk of inadvertent exposure and infection. The Ob-gyns should commit to providing necessary care, although modifications to health care delivery approaches may be necessary.

Safe Perinatal Management of Neonates Born to SARS-CoV-2 Positive Mothers at the Epicenter of the Italian Epidemic.

Introduction: 2019-novel Coronavirus Disease (COVID-19) pandemic has recently struck Northern Italy. Limited data are available about COVID-19 during pregnancy and infancy, mostly from China. Herein, our experience on a safe perinatal management of neonates born to COVID-19 mothers is reported.Method: Since late February through May 15, 2020, 375 pregnant women delivered at our City Hospital in Piacenza, at the epicenter of the Italian epidemic. Of these, 144 were tested via a SARS-CoV-2 quantitative rRT-PCR nasopharyngeal swab prior to delivery, firstly on the basis of epidemiological and clinical criteria, then adopting a universal screening approach. All newborns from SARS-CoV-2 positive mothers were tested via nasopharyngeal swab at birth, on day 3 and/or day 7. In case of positive result, they were re-tested on day 14.Results: Fifteen women tested positive for SARS-CoV-2 infection. All newborns except one were born at term. All of them were non-infected at birth, irrespective of mode of delivery; 13 out 15 remained negative; the two positive neonates became negative by day 14 of life. All of them have always remained asymptomatic. All newborns except two were allowed to have immediate bonding, permanent rooming-in, and direct breastfeeding.Conclusions: Our study supports the claim that COVID-19 in pregnancy is not associated with worse clinical outcomes compared to non-COVID-19 pregnant women and/or with higher rates of preterm birth and intrauterine growth restriction. Intrauterine vertical transmission of SARS-CoV-2 seems to be unlikely. Breastfeeding appears to be safe and protective for the neonate, once appropriate preventive measures are adopted.

Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID-19.

This review examined how applicable national and regional clinical practice guidelines and recommendations for managing neonates born to mothers with COVID-19 mothers were to the evolving pandemic. A systematic search and review identified 20 guidelines and recommendations that had been published by May 25, 2020. We analysed documents from 17 countries: Australia, Brazil, Canada, China, France, India, Italy, Japan, Saudi Arabia, Singapore, South Africa, South Korea, Spain, Sweden, Switzerland, the UK and the United States. The documents were based on expert consensus with limited evidence and were of variable, low methodological rigour. Most did not provide recommendations for delivery methods or managing symptomatic infants. None provided recommendations for post-discharge assimilation of potentially infected infants into the community. The majority encouraged keeping mothers and infants together, subject to infection control measures, but one-third recommended separation. Although breastfeeding or using breastmilk was widely encouraged, two countries specifically prohibited this. The guidelines and recommendations for managing infants affected by COVID-19 were of low, variable quality and may be unsustainable. It is important that transmission risks are not increased when new information is incorporated into clinical recommendations. Practice guidelines should emphasise the extent of uncertainty and clearly define gaps in the evidence.

Managing Preterm Infants Born to COVID-19 Mothers: Evidence from a Retrospective Cohort Study in Wuhan, China

Background: COVID-19 has spread rapidly over the world. Little is known about the outcomes of infections in pregnant women. The management and characteristics of preterm infants born to COVID-19 mothers need to be clarified. Methods: In this retrospective, single-center cohort study, we describe the clinical courses of 6 preterm infants born to COVID-19 mothers, the management protocol, and related outcomes. Results: Six preterm infants were admitted to Tongji Hospital between January 23 and March 19, 2020. Gestational age ranged from 28+5 to 36+3 weeks. One late preterm infant was delivered early due to maternal dyspnea from COVID-19. Five infants were delivered by Caesarean section. None had perinatal asphyxia. Two infants required respiratory support due to respiratory distress syndrome and apnea of prematurity. All infants did not develop severe complications of prematurity and are negative for severe acute respiratory syndrome (SARS)-CoV-2 nucleic acid testing. Conclusion: With an expedited and adequate delivery protocol, less invasive treatment principle, and active infection precautious, we found a limited impact of COVID-19 mothers on preterm delivery and neonatal short-term outcomes. The risk of vertical transmission of SARS-CoV-2 is low in preterm infants born to COVID-19 mothers if appropriate management is implemented.

Newborns of COVID-19 mothers: short-term outcomes of colocating and breastfeeding from the pandemic's epicenter.

Newborns of COVID-19 mothers: short-term outcomes of colocating and breastfeeding from the pandemic's epicenter.

Multicentre Spanish study found no incidences of viral transmission in infants born to mothers with COVID-19.

AimOur aim was to describe the clinical features of mothers infected with COVID‐19 and examine any potential vertical mother to newborn transmission. We also assessed how effective the discharge recommendations were in preventing transmission during the first month of life.MethodsThis multicentre descriptive study involved 16 Spanish hospitals. We reviewed the medical records of 42 pregnant women diagnosed with COVID‐19 from March 13, 2020, to March 29, 2020, when they were in their third trimester of pregnancy. They and their newborn infants were monitored until the infant was 1 month old.ResultsOver half (52.4%) of the women had a vaginal delivery. The initial clinical symptoms were coughing (66.6%) and fever (59.5%), and one mother died due to thrombo‐embolic events. We admitted 37 newborn infants to the neonatal unit (88%), and 28 were then admitted to intermediate care for organisational virus‐related reasons. No infants died, and no vertical transmission was detected during hospitalisation or follow‐up. Only six were exclusively breastfed at discharge.ConclusionThere was no evidence of COVID‐19 transmission in any of the infants born to COVID‐19 mothers, and the post‐discharge advice seemed effective. The measures to avoid transmission appeared to reduce exclusive breastfeeding at discharge.

Conversion and optimization of telehealth in obstetric care during the COVID-19 pandemic

When New York City became the international epicenter of the COVID-19 pandemic, telehealth at Columbia University Irving Medical Center was expanded in the inpatient and outpatient settings. The goals of telehealth during the pandemic were to maintain patient access to care while reducing the risk for COVID-19 exposure for patients and staff. Recommendations are made on how telehealth can be implemented and utilized to accomplish these goals. In the outpatient setting, virtual prenatal care visits and consultations can replace most in-person visits. When visitor restrictions are in effect telehealth can be used to engage support persons in the delivery room. Telehealth innovations can be leveraged to greatly improve care for COVID-19 mothers and their infants during the COVID-19 pandemic and beyond.

Breastfeeding during the COVID-19 pandemic: Suggestions on behalf of woman study group of AMD

SARS-Cov2 infection has recently spread to Italy with important consequences on pregnancy management, mother and child health and mother–child contact. Breastfeeding improves the health of mother and child and reduces risk of neonatal infection with other pathogens that are likely to cause serious illness.To date no evidence confirmed COVID-19 vertical transmission from infected pregnant mother to their fetus. However it is well known that an infected mother can transmit the COVID-19 virus through respiratory droplets during breastfeeding or intimate contact.Thus, the mothers with known or suspected COVID-19 should adhere to standard and contact precautions during breastfeeding.Woman Study Group of AMD, after reviewing current knowledge about COVID-19 vertical transmission and the compatibility of breastfeeding in COVID-19 mother, the available recommendations from Health Care Organizations and main experts opinions, issued the following suggestions on breastfeeding during the COVID-19 pandemic, addressed both to mothers with and without diabetes.It should be considered that following suggestions may change in the future when more evidence is acquired regarding SARS-Cov2 infection.

Breastfeeding and coronavirus disease-2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies.

The recent COVID‐19 pandemic has spread to Italy with heavy consequences on public health and economics. Besides the possible consequences of COVID‐19 infection on a pregnant woman and the fetus, a major concern is related to the potential effect on neonatal outcome, the appropriate management of the mother–newborn dyad, and finally the compatibility of maternal COVID‐19 infection with breastfeeding. The Italian Society on Neonatology (SIN) after reviewing the limited scientific knowledge on the compatibility of breastfeeding in the COVID‐19 mother and the available statements from Health Care Organizations has issued the following indications that have been endorsed by the Union of European Neonatal & Perinatal Societies (UENPS). If a mother previously identified as COVID‐19 positive or under investigation for COVID‐19 is asymptomatic or paucisymptomatic at delivery, rooming‐in is feasible, and direct breastfeeding is advisable, under strict measures of infection control. On the contrary, when a mother with COVID‐19 is too sick to care for the newborn, the neonate will be managed separately and fed fresh expressed breast milk, with no need to pasteurize it, as human milk is not believed to be a vehicle of COVID‐19. We recognize that this guidance might be subject to change in the future when further knowledge will be acquired about the COVID‐19 pandemic, the perinatal transmission of SARS‐CoV‐2, and clinical characteristics of cases of neonatal COVID‐19.