Illness In Pregnant Women Research Articles

ASSESSMENT OF SEVERITY OF IRON DEFICIENCY AND ASSOCIATED RISK FACTORS AMONG PREGNANT WOMEN

Introduction: Iron deficiency (ID) is a common problem in pregnant women. The primary drivers of anemia in pregnancy are ID, aplastic anemia, a lack of vitamin B12, and vitamin B9. ID is the most widely recognized and can lead to unfavorable pregnancy outcomes. Both ID and iron deficiency anemia (IDA) are normal clinical illnesses in pregnant women. Anemia can cause a compromised immune system during pregnancy, leading to negative outcomes including premature birth and premature rupture of membranes. Objective: The objectives of this research are to determine the severity of ID among pregnant women and to check the associated risk factors for ID. Methodology: It is a cross-sectional study in government hospitals in Lahore. The data was collected through a self-administered questionnaire. Simple random sampling techniques are used, and SPSS is used for data analysis. Results: According to this study, the prevalence of IDA is high. Out of 385 women, 96 are normal, 102 are mild, 129 are moderate, and 58 are anemic. All associated risk factors—level of education, trimester, gravidity, family planning, and animal source food values—were significantly positive. Conclusion: The iron deficiency anemia (IDA) prevalence is high, and risk factors are high among pregnant women: living in rural areas, high gravidity, no family planning, and poor food from animal sources.

Seroprevalence and Risk Factors Associated with Chlamydia abortus Infection in Sheep and Goats in North-Western Italy.

Chlamydia abortus, although poorly recognized as a human pathogen, is a zoonotic microorganism that can cause many different symptoms in humans, including subclinical infection and fatal illnesses in pregnant women. C. abortus is one of the most common causes of ovine and caprine infectious abortion worldwide, known as the causative agent of the enzootic abortion of ewes (EAE) or ovine enzootic abortion (OEA). To estimate C. abortus seroprevalence and the risk factors related to C. abortus in small ruminants, the sera from 3045 animals (both sheep and goat) belonging to 202 herds were tested and a questionnaire investigating flock management was administered. At the herd level, the true seroprevalence was 56.6% (CI95%: 46.9-66.3%), at sheep-farm and goat-farm level, the true seroprevalence was 71.4% (CI95%: 54.6-88.3%) and 44.8% (CI95%: 41.3-57.0%), respectively. The true seroprevalence was significantly higher among the sheep than the goats. The logistic regression model identified four factors associated with Chlamydia seropositivity: flock size (i.e., farms with >50 heads), contact with cattle, introduction of animals, and Coxiella seropositivity. The study evidenced a high seroprevalence of Chlamydia abortus in small ruminant farms in the Piedmont region. Considering its zoonotic potential and the health consequences in humans, communication to farmers on the importance of vaccination, as well as the sensibilization of farm vets, seem to be strategical.

Acceptance of Pregnancy-Induced Disease and Intrapersonal Resistance Resources of Pregnant Women—Preliminary Report

The health problems complicating pregnancy are a source of anxiety and concern about the developing fetus' health and life. The aim of the study was to assess the acceptance of illness and selected intrapersonal resistance resources for women whose pregnancies are complicated by gestational diabetes or pregnancy-induced hypertension and their determinants. The study was conducted from April 2019 to January 2021 in 688 pregnant women who were patients of the pregnancy pathology department and gynecology-obstetrics outpatient clinics in Lublin (Poland), using a diagnostic survey method with the use of the following research tools: Acceptance Illness Scale, Generalized Self-Efficacy Scale, Multidimensional Health Locus of Control Scale, and the standardized interview questionnaire. The study group included 337 women with gestational diabetes and pregnancy-induced hypertension. The control group included 351 women with an uncomplicated course of pregnancy. The level of acceptance of illness in pregnant women with pregnancy-induced diseases is on the border between medium and high acceptance (29.36 ± 7.82). The respondents in the control group had lower levels of self-efficacy (28.47 vs. 29.62) and health locus of control in the internal dimension (24.61 vs. 26.25) (p < 0.05). Respondents with pregnancy-induced diseases are characterized by the internal dimension of locus of health control.

PENDIDIKAN KESEHATAN DALAM UPAYA PENCEGAHAN DAN PENANGGULANGAN ANEMIA IBU HAMIL

Maternal mortality in pregnant women 17.52% occurred during pregnancy. One of the illnesses in pregnant women is anemia which can cause maternal death due to bleeding during delivery. Knowledge of pregnant women about anemia and nutrients rich in iron and folic acid during pregnancy are needed to ensure a good pregnancy and influence hemoglobin levels. The purpose of this community service is to increase the knowledge of pregnant women about anemia so that they can change their behavior in preventing and overcoming anemia. The method used is the lecture method and using flipcharts aimed at pregnant women at the Gerung Utara Polindes, Pohdana Village. The counseling that is carried out is an activity or effort to convey information about anemia to pregnant women, including the definition, causes, risk factors, signs and symptoms, impacts, and handling/prevention of anemia in pregnant women. To monitor the increase in knowledge of pregnant women, used pre and post-test. The results show a significant increase in participants' insight and understanding. There was an increase in the average knowledge of pregnant women about anemia from 5.93 to 7.80. Suggestions for health centers and health observers, especially pregnant women, are to provide more information about the health of pregnant women with various media so that pregnant women get the correct information and indirectly prevent risks to mothers and babies.&#x0D; Keyword; Health education, anemia of pregnant women

A new modified obstetric early warning score for prognostication of severe maternal morbidity

BackgroundMaternal mortality is still a major challenge for health systems, while severe maternal complications are the primary causes of maternal death. Our study aimed to determine whether severe maternal morbidity is effectively predicted by a newly proposed Modified Obstetric Early Warning Score (MOEWS) in the setting of an obstetric intensive care unit (ICU).MethodsA retrospective study of pregnant women admitted in the ICU from August 2019 to August 2020 was conducted. MOEWS was calculated 24 h before and 24 h after admission in the ICU, and the highest score was taken as the final value. For women directly admitted from the emergency department, the worst value before admission was collected. The aggregate performance of MOEWS in predicting critical illness in pregnant women was evaluated and finally compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.ResultsA total of 352 pregnant women were enrolled; 290 women (82.4%) with severe maternal morbidity were identified and two of them died (0.6%). The MOEWSs of women with serious obstetric complications were significantly higher than those of women without serious obstetric complications [8(6, 10) vs. 4(2, 4.25), z = -10.347, P < 0.001]. MOEWSs of 24 h after ICU admission had higher sensitivity, specificity and AUROC than MOEWSs of 24 h before ICU admission. When combining the two MOEWSs, sensitivity of MOEWS was 99.3% (95% CI: 98–100), specificity 75.8% (95% CI: 63–86), positive predictive value (PPV) 95.1% (95% CI: 92–97) and negative predictive value (NPV) 95.9% (95% CI: 86–100). The areas under the receiver operator characteristic (ROC) curves of MOEWS were 0.92 (95% CI: 0.88–0.96) and 0.70 (95% CI: 0.63–0.76) of the APACHE II score.ConclusionThe newly proposed MOEWS has an excellent ability to identify critically ill women early and is more effective than APACHE II. It will be a valuable tool for discriminating severe maternal morbidity and ultimately improve maternal health.

Management and Implications of Severe COVID-19 in Pregnancy in the United Kingdom: Data From the UK OBSTETRIC Surveillance System National Cohort

(Acta Obstet Gynecol Scand. 2022;101:461–470. doi: 10.1111/aogs.14329) With the inauspicious rise to dominance of the Sars-CoV-2 Delta variant (B.1.617.2) in the United Kingdom in May 2021, the proportion of pregnant women experiencing severe disease proliferated significantly [35.8% during the Alpha variant duration vs. 45% in the Delta-dominant duration, adjusted odds ratio (aOR): 1.53]. A high proportion of pregnant women with COVID-19 deliver prematurely, are admitted to intensive care, and have neonates that also require intensive care. Most data thus far have come from single-center cohorts with small sample sizes, and present conflicting conclusions. There is an urgent need to investigate the risks and outcomes of severe COVID-19 illness in pregnant women to update guidelines for clinical management and prevention practices.

Knowledge and attitudes of pregnant women on maternal immunization against COVID-19 in Croatia.

The aim of this study was to assess pregnant women's knowledge and attitudes regarding maternal COVID-19 immunization during pregnancy. A cross-sectional study was performed in two teaching hospitals between May and October 2021 in Zagreb, Croatia. During antenatal clinic visit pregnant women were approached and asked to fill out a predesigned questionnaire about their knowledge and attitudes towards COVID-19 vaccination. Collected data was later analyzed. A total of 430 women participated in the study. Only 16% of women expressed their willingness to be vaccinated against COVID-19 if offered, despite that 71% of them believe that COVID-19 might be a serious illness in pregnant women. The most important obstacle in having better acceptance of the vaccines is in the assumption that the vaccines are not safe for pregnant women (73%) or the fetus (75%), or that the vaccines are not effective (41%). The relationship exists between acceptance of vaccination in general and willingness to get other vaccines in pregnancy and readiness to be vaccinated against COVID-19 in pregnancy. Only one out of 55 women who were not adherent to the current vaccination recommendations in Croatia would accept the COVID-19 vaccine during pregnancy if offered. 21 (5%) women stated that vaccination against influenza and pertussis during pregnancy is necessary and 13 (62%) of them would get vaccinated against COVID-19 if offered. This study showed that the crucial reasons for refusing vaccination against COVID-19 among pregnant women in Croatia are the concerns about the vaccines' effectiveness and safety. All healthcare providers should put more effort into education of pregnant women on risks of COVID-19, as well as on the benefits and safety of the vaccines.

Severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Pregnancy in Ontario: A Matched Cohort Analysis.

Pregnancy represents a physiological state associated with increased vulnerability to severe outcomes from infectious diseases, both for the pregnant person and developing infant. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic may have important health consequences for pregnant individuals, who may also be more reluctant than nonpregnant people to accept vaccination. We sought to estimate the degree to which increased severity of SARS-CoV-2 outcomes can be attributed to pregnancy using a population-based SARS-CoV-2 case file from Ontario, Canada. Because of varying propensity to receive vaccination, and changes in dominant circulating viral strains over time, a time-matched cohort study was performed to evaluate the relative risk of severe illness in pregnant women with SARS-CoV-2 compared to other SARS-CoV-2 infected women of childbearing age (10-49 years old). Risk of severe SARS-CoV-2 outcomes was evaluated in pregnant women and time-matched nonpregnant controls using multivariable conditional logistic regression. Compared with the rest of the population, nonpregnant women of childbearing age had an elevated risk of infection (standardized morbidity ratio, 1.28), whereas risk of infection was reduced among pregnant women (standardized morbidity ratio, 0.43). After adjustment for confounding, pregnant women had a markedly elevated risk of hospitalization (adjusted odds ratio, 4.96; 95% confidence interval, 3.86-6.37) and intensive care unit admission (adjusted odds ratio, 6.58; 95% confidence interval, 3.29-13.18). The relative increase in hospitalization risk associated with pregnancy was greater in women without comorbidities than in those with comorbidities (P for heterogeneity, .004). Given the safety of SARS-CoV-2 vaccines in pregnancy, risk-benefit calculus strongly favors SARS-CoV-2 vaccination in pregnant women.

Trans-Placental Transfer and Vertical Transmission of SARS-CoV-2, HIV and HCV: A Comparative Review

Background: Although SARS-CoV-2 infection has spread fast throughout the world, information on the natural history of illness in pregnant women and the risk of mother-to-fetal transmission is limited. HIV and HCV also showed evidence of mother-to-fetal transmission. Aim: Reviewing literature reports and published data regarding possibility of viral transmission to fetus, and to what extend it could occur for SARS-CoV-2, HIV, and HCV. Discussion: According to certain research, there is no viremia detected in maternal or cord blood, and there is no indication of vertical SARS-CoV-2transmission. Infection can be transmitted transplacentally during the last pregnancy weeks. The absence of placental infection is supported by the finding that the SARS-CoV-2 receptor, the Angiotensin 2 Converting Enzyme (ACE2) required for cell integration, is only present at extremely low amounts in the placenta during the first third trimester. Studies indicated that HIV vertical transmission rates during pregnancy, birth, or breastfeeding range from 13% to 48%, but researches indicated that 90% of the babies protected against HIV during pregnancy. HCV-infected pregnant women have a 2% to 8% risk of viral transmission, but the presence of NK cells in the placentas of HCV-positive women contribute for protective effect. Conclusion: The possibility of Trans-placental transmission of SARS-CoV-2, HIV, and HCV is possible with different incidence rates.

O-054 COVID-19 during pregnancy, maternal immune response and neonatal cell-specific immunity

Pathogens are a major threat to maternal health and the progression of pregnancy. The immune response during normally progressing pregnancies, primarily the suppression of inflammation, likely accounts for this high susceptibility of pregnant women to infections. An increased morbidity and mortality related to influenza, COVID-19 and malaria has been reported for pregnant women, compared to non-pregnant women. Especially influenza infections during pregnancy have been well studied, as humans are severely and recurrently affected by seasonal epidemics and random pandemics. Besides severe maternal symptoms such as acute cardiopulmonary events, pneumonia, and acute respiratory distress syndrome, maternal influenza infection also causes foetal complications, such as intrauterine growth restriction, preterm birth or even foetal death. However, vertical transmission of the influenza virus across the placenta and infection of the foetus has not been observed, suggesting that the pregnancy pathologies are maternally derived.In addition to influenza-mediated adverse conditions, the recent COVID-19 pandemic has underscored that infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) can also lead to severe illnesses in pregnant women, accompanied by a higher risk for foetal loss or preterm birth. Fortunately, with the ongoing pandemic, large cohort studies and meta-analyses revealed that vertical transmission and related fetal infection is a rare complication affecting only 1-3% of SARS-CoV-2 infections in pregnancy. These low risk for placental infection is likely due to the inefficient SARS-CoV-2 virus replication in placental tissues. Since understanding SARS-CoV-2-related pathogenicity during pregnancy is highly relevant, we initiated a study early in 2020, to which we have recruited more than 160 pregnant women with COVID-19. Our comprehensive placental analyses unearthed a paucity of SARS-CoV-2 viral expression ex vivo in term placentae under acute infection and in convalescent pregnant women. Furthermore, we could show inefficient SARS-CoV-2 replication in placental tissues in vitro, which provides a rationale for the low ex vivo viral expression. We detected specific SARS-CoV-2 T cell responses in mothers within a few days upon infection, which is undetectable in cord blood. Reports by others have shown that maternal SARS-CoV-2 during pregnancy may cause placental insufficiency, defined by increased perivillous fibrin deposition, histiocytic intervillositis and trophoblast necrosis. These changes can cause extensive placental damage leading to placental malperfusion and insufficiency that is incompatible with intrauterine survival. Considering that multiple SARS-CoV-2 variants of concern which emerged until today may affect pregnant women differently and bear a differential risk for pregnancy complication. This, continuous vigilance is needed in order to provide best protection of the highly vulnerable group of pregnant women and their unborn children.Trial registration number

Analysis of Vitamin D Levels in Vaccinated and Non Vaccinated Pregnant Women with Covid-19

Objective: The purpose of this research is to examine the levels of vitamin D in pregnant women who have been vaccinated and those who have not been vaccinated. Study Design: Comparative/Observational study Place and Duration: CMH Bahawalpur.Jun-2019-Feb 2020 Methods: A total of 106 cases of coronavirus illness in pregnant women were reported. Permission to collect detailed demographic information such as age, gestational age, parity, and body mass index was obtained by written informed permission. Women were mostly between the ages of 18 and 42. Patients were grouped into two distinct categories. Group A included 53 people who had vaccinations, whereas group B included 53 women who had not received vaccinations. Serum 25-hydroxy vitaminD3 [25 (OH) D3] levels were measured in all individuals. The levels of vitamin D insufficiency in the two groups were compared. Vitamin D sufficiency was defined as a blood level of &gt;30ng/ml. The full dataset was analyzed by using SPSS 24.0. Results: In group number of primigravida was 24 (45.2%) and in group II 26 (49.1%) cases were. Frequency of vitamin D deficiency was lower in group I 44 (83.01%) patients as compared to group II in 50 (94.3%) cases. In group I, severe deficiency (&lt;10ng/ml) was found in 10 (18.9%), deficiency (10-20ng/ml) were found in 14 (26.4%) and not-sufficient (20-30ng/ml) were in 20 (37.7%) while in group II severe deficiency (&lt;10ng/ml) was found in 15(28.3%), frequency of deficient patients (10-20ng/ml) was 17 (32.1%) and not-sufficient cases (20-30ng/ml) were 18 (33.9%). In group I deficient vitamin D serum levels was 16.03±2.42 and in group II was 13.14±8.41. Conclusion: According to the findings of this research, vitamin D insufficiency is more common in pregnant women who have not been vaccinated and is more likely to occur in these women, as well as in non-vaccinated patients who do not have low blood levels. Keywords: Vaccination Pregnancy, Vitamin D, COVID-19

COVID-19 vaccines in pregnancy.

COVID-19 caused by SARS-CoV-2 coronavirus has been associated with severe illness in pregnant women. Furthermore, COVID-19 during pregnancy is associated with adverse fetal outcomes including preterm labor. Pregnant women were largely excluded from initial clinical trials investigating the safety and efficacy of COVID-19 vaccines; however, they have since been included as part of the routine roll-out of these vaccines. This narrative review synthesizes the evidence on the safety, immunogenicity, and effectiveness predominantly of the mRNA COVID-19 vaccines which have been most widely used in pregnant women.

Coronavirus disease 2019 vaccination and infertility treatment outcomes

ObjectiveTo assess the influence of coronavirus disease 2019 (COVID-19) messenger ribonucleic acid vaccine on ovarian response and in vitro fertilization (IVF) treatment outcomes.DesignA retrospective cohort study.SettingA tertiary university-affiliated medical center and a private medical center.Patient(s)The study included a total of 400 patients, 200 vaccinated women and 200 age-matched unvaccinated women, who underwent IVF in January–April 2021.Intervention(s)None.Main Outcome Measure(s)The mean number of oocytes retrieved and clinical pregnancy rates in vaccinated vs. unvaccinated patients.Result(s)A total of 200 patients underwent oocyte retrieval 14–68 days after receiving COVID-19 vaccination. No difference was found in the mean number of oocytes retrieved per cycle (10.63 vs. 10.72) between vaccinated and unvaccinated patients. Among 128 vaccinated and 133 unvaccinated patients who underwent fresh embryos transfers, no difference was demonstrated in the clinical pregnancy rates (32.8% vs. 33.1%), with 42 and 44 clinical pregnancies, respectively. The fertilization rates and mean number of cryopreserved embryos were similar between the 2 groups in freeze-all cycles (55.43% vs. 54.29% and 3.59 vs. 3.28, respectively). Among vaccinated and unvaccinated patients who underwent fresh embryo transfers, no difference was noted in the fertilization rate (64.81% vs. 61.98%) and transferred embryos’ quality. Regression models applied demonstrated no effect of the vaccine on oocyte yields and pregnancy rates.Conclusion(s)The COVID-19 messenger ribonucleic acid vaccine did not affect the ovarian response or pregnancy rates in IVF treatment. Women should be vaccinated for COVID-19 before attempting to conceive via IVF treatments, given the higher risk of severe illness in pregnant women.

An Immunomodulatory Transcriptional Signature Associated With Persistent Listeria Infection in Hepatocytes

Listeria monocytogenes causes severe foodborne illness in pregnant women and immunocompromised individuals. After the intestinal phase of infection, the liver plays a central role in the clearance of this pathogen through its important functions in immunity. However, recent evidence suggests that during long-term infection of hepatocytes, a subpopulation of Listeria may escape eradication by entering a persistence phase in intracellular vacuoles. Here, we examine whether this long-term infection alters hepatocyte defense pathways, which may be instrumental for bacterial persistence. We first optimized cell models of persistent infection in human hepatocyte cell lines HepG2 and Huh7 and primary mouse hepatocytes (PMH). In these cells, Listeria efficiently entered the persistence phase after three days of infection, while inducing a potent interferon response, of type I in PMH and type III in HepG2, while Huh7 remained unresponsive. RNA-sequencing analysis identified a common signature of long-term Listeria infection characterized by the overexpression of a set of genes involved in antiviral immunity and the under-expression of many acute phase protein (APP) genes, particularly involved in the complement and coagulation systems. Infection also altered the expression of cholesterol metabolism-associated genes in HepG2 and Huh7 cells. The decrease in APP transcripts was correlated with lower protein abundance in the secretome of infected cells, as shown by proteomics, and also occurred in the presence of APP inducers (IL-6 or IL-1β). Collectively, these results reveal that long-term infection with Listeria profoundly deregulates the innate immune functions of hepatocytes, which could generate an environment favorable to the establishment of persistent infection.

Immunity and coagulation and fibrinolytic processes may reduce the risk of severe illness in pregnant women with coronavirus disease 2019

BackgroundThere are specific physiological features regarding the immunity and coagulation among pregnant women, which may play important roles in the development of coronavirus disease 2019.ObjectiveThis study aimed to determine the key factors associated with the deterioration of patients with coronavirus disease 2019 and the differentiating clinical characteristics of pregnant women with coronavirus disease 2019 to interfere with the progression of coronavirus disease 2019.Study DesignA retrospective study of 539 Chinese Han adult patients with coronavirus disease 2019 was conducted, of which 36 cases were pregnant women. In addition, 36 pregnant women without coronavirus disease 2019 were recruited as the control. The characteristics of severe and critical illnesses, which were differentiated from mild and moderate illnesses in patients with coronavirus disease 2019, were analyzed using a machine learning algorithm. In addition, major differences between pregnant women with coronavirus disease 2019 and age-matched nonpregnant women with severe or critical coronavirus disease 2019, paired with pregnant women without coronavirus disease 2019, were explored to identify specific physiological features of pregnant women with coronavirus disease 2019.ResultsFor the total patient population, the lymphocyte, CD3+, CD4+, CD8+, CD19+, and CD16+CD56+ cell counts were significantly lower, and white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio were higher in those with severe or critical illness than those with mild or moderate illness (P<.001). The plasma levels of interleukin-6, interleukin-10, and interleukin-6–to–interleukin-10 ratio were significantly increased in patients with critical illness compared with patients with mild, moderate, and severe illnesses (P<.001). The above immunologic coclusters achieved an area under the receiver operating characteristic curve of 0.801 (95% confidence interval, 0.764–0.838), and its combined model with the coagulation and fibrinolysis indices (prothrombin time, D-dimer) achieved an area under the receiver operating characteristic curve of 0.815 (95% confidence interval, 0.779–0.851) using the random forest regression model to predict severe or critical illness. For pregnant women with coronavirus disease 2019, none had preexisting diseases. Compared with nonpregnant women with mild or moderate coronavirus disease 2019, pregnant women with coronavirus disease 2019 displayed increased white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, and levels of D-dimer and fibrinogen, along with decreased lymphocyte and interleukin-4 levels (P<.05). Although they presented similar changes of immunologic markers of lymphocyte; white blood cell count; neutrophil-to-lymphocyte ratio; CD3+, CD4+, CD8+, and CD16+CD56+ cell counts; and interleukin-6–to–interleukin-10 ratio, compared with nonpregnant women with severe or critical coronavirus disease 2019, none of the pregnant women with coronavirus disease 2019 deteriorated into severe or critical illness. There was no significant difference in white blood cell count, lymphocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, immunologic markers, or coagulation and fibrinolysis markers between pregnant women with coronavirus disease 2019 and pregnant women without coronavirus disease 2019. As for the discrepancy of pathophysiological features between pregnant women with coronavirus disease 2019 and nonpregnant women with severe or critical coronavirus disease 2019, the immunologic markers achieved an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.773–0.977), and its combined model with coagulation and fibrinolysis indices achieved an area under the receiver operating characteristic curve of 0.931 (95% confidence interval, 0.850–1.000).ConclusionImmune dysregulation was identified as a crucial feature of patients with coronavirus disease 2019, which developed severe or critical illness, and pregnant women with coronavirus disease 2019 presented with similar immune responses but rarer incidences of severe or critical illness. Immune dysregulation is related to the risks of deterioration into severe or critical illness. The specific coagulation and fibrinolysis systems of pregnancy may reduce the risk of pregnant women with coronavirus disease 2019 without preexisting disease from developing severe illness.

Malaria congénita por Plasmodium falciparum

La malaria congénita (MC) es la infección por Plasmodium spp adquirida in útero o durante el parto y sus manifestaciones clínicas son inespecíficas. Puede causar enfermedad grave en la embarazada y en el recién nacido.Objetivo: describir dos casos de MC causados por Plasmodium falciparum, diagnóstico diferencial de sepsis en recién nacidos de gestantes que hayan visitado o residan en áreas endémicas para malaria.Casos Clínicos: Neonatos de sexo femenino, nacidos en área no endémica para malaria, diagnosticados con sepsis neonatal y tratados con antibióticos sin respuesta clínica. Después de la primera semana de vida la gota gruesa identificó trofozoítos de Plasmodium falciparum y los neonatos recibieron tratamiento con quinina intravenosa con mejoría. Las madres de las recién nacidas tuvieron malaria en el embarazo, una de ellas recibió tratamiento y estaba asintomática y otra tenía malaria complicada al momento del parto.Conclusiones: La MC puede causar enfermedad neonatal grave con manifestaciones clínicas inespecíficas y similares a la sepsis, el tratamiento oportuno disminuye el riesgo de malaria complicada. Es un diagnóstico diferencial en recién nacidos de mujeres con malaria durante el embarazo o gestantes que visiten o residan en áreas endémicas.

COVID-19 and pregnancy: A review of clinical characteristics, obstetric outcomes and vertical transmission.

BackgroundSince its emergence in December 2019, COVID‐19 has spread to over 210 countries, with an estimated mortality rate of 3–4%. Little is understood about its effects during pregnancy.AimsTo describe the current understanding of COVID‐19 illness in pregnant women, to describe obstetric outcomes and to identify gaps in the existing knowledge.MethodsMedline Ovid, EMBASE, World Health Organization COVID‐19 research database and Cochrane COVID‐19 in pregnancy spreadsheet were accessed on 18/4, 18/5 and 23/5 2020. Articles were screened via Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The following were excluded: reviews, opinion pieces, guidelines, articles pertaining solely to other viruses, single case reports.ResultsSixty articles were included in this review. Some pregnant participants may have been included in multiple publications, as admission dates overlap for reports from the same hospital. However, a total of 1287 confirmed SARS‐CoV‐2 positive pregnant cases are reported. Where universal testing was undertaken, asymptomatic infection occurred in 43.5–92% of cases. In the cohort studies, severe and critical COVID‐19 illness rates approximated those of the non‐pregnant population. Eight maternal deaths, six neonatal deaths, seven stillbirths and five miscarriages were reported. Nineteen neonates were SARS‐CoV‐2 positive, confirmed by reverse transcription polymerase chain reaction of nasopharyngeal swabs. [Correction added on 2 September 2020, after first online publication: the number of neonates indicated in the preceding sentence has been corrected from ‘Thirteen’ to ‘Nineteen’.]ConclusionsWhere universal screening was conducted, SARS‐CoV‐2 infection in pregnancy was often asymptomatic. Severe and critical disease rates approximate those in the general population. Vertical transmission is possible; however, it is unclear whether SARS‐CoV‐2 positive neonates were infected in utero, intrapartum or postpartum. Future work should assess risks of congenital syndromes and adverse perinatal outcomes where infection occurs in early and mid‐pregnancy.

Care of the COVID-19 exposed complex newborn infant

As we confront COVID-19, the global public health emergency of our times, new knowledge is emerging that, combined with information from prior epidemics, can provide insights on how to manage this threat in specific patient populations. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), both caused by coronaviruses, caused serious respiratory illness in pregnant women that resulted in adverse perinatal outcomes. Thus far, COVID-19 appears to follow a mild course in the vast majority of pregnant women. A significant proportion of pregnant women appear to be asymptomatic carriers of SARS-CoV-2. However, there is limited information on how COVID-19 impacts the fetus and whether vertical transmission occurs. While these knowledge gaps are addressed, it is important to recognize the highly efficient transmission characteristics of SARS-C0V-2 and its potential for causing serious disease in vulnerable individuals, including health care workers. This review provides perspectives from a single center in New York City, the epicenter of the pandemic within the United States. It offers an overview of the preparations required for deliveries of newborns of mothers with COVID-19 and the management of neonates with particular emphasis on those born with complex issues.

Listeriosis Knowledge and Attitude among Pregnant Women Attending a Tertiary Health Institution, South Western Nigeria

Background: Listeriosis affects immunosuppressed individual’s especially pregnant women. Maternal infections are usually mild for the woman, but may have devastating effects on the unborn child, including miscarriage, stillbirth, preterm labour and serious neonatal illness. WHO recommends that pregnant women should be educated to avoid foods with high risk of contamination. This study seeks to evaluate knowledge and practices predisposing to listeria infections during pregnancy. Methodology: This is a cross-sectional study on pregnant women, attending the antenatal clinic of Lagos University Teaching Hospital (LUTH) using semi structured questionnaires. The knowledge score of participants was collated and analyzed using SPSS version 26. Results: The mean age of the participants was 32.07 ± 5.6 years. Forty-three (30.7%) women have had previous miscarriages with the mean no of miscarriage of 1.54. Out of 147 participants, only 20 (13.6%) admitted having heard of listeriosis while 127 (86.4%) had never heard of listeriosis and none of the participants has ever been tested for listeriosis. The Overall knowledge score was poor, and this was irrespective of age and duration of pregnancy. However, women with graduate and/or postgraduate degrees were more likely to have heard of Listeriosis (X2 = 10.88, P = 0.028). Conclusion: Our study shows a low level of knowledge about this food-borne illness, which can lead to severe illnesses in pregnant women and their unborn child. It is necessarily to educate pregnant women on the risk of listeriosis. This would be a key factor in creating and implementing accurate measures of prevention and control.

Vaccine Coverage of Newly Introduced Vaccines and Factors Influencing among Children Less Than 23 Months in Laikipia North Subcounty

The epidemiology of vaccine preventable diseases has been modified by use and implementation of various vaccination programs in many countries. However, because of observed suboptimal vaccination rates, debate has emerged on the benefits of such vaccines worldwide. Maternal and childhood vaccinations have been evaluated and found extremely effective at preventing illness in pregnant women and new-borns despite low uptake of such vaccines in many areas. The objective of this study was to determine the Vaccination Coverage and factors that influence uptake of newly introduced vaccines among children aged less than 23 months in Laikipia North Sub-County. The study used multistage sampled parents and guardians of children below 23 months of age but residents of Laikipia North Sub-County within Laikipia County. Trained interviewers visited sampled households and administered a standardized pretested questionnaire. Mothers and guardians were interviewed and asked to show the interviewers Mother-Child Post Natal Booklets for the study enrolled children. Key informant questionnaires were also administered to Health facility staff. Data entry and analysis were performed using SPSS and Microsoft Excel. Chi-Square for Proportion and Student T-test were used to assess factors influencing uptake of vaccines in the sub-county. The study found that slightly above half (59%) of the care givers indicated that their child had been vaccinated. Majority (61%) of the care givers had their children given rotavirus vaccine while an equal number (61%) had their children given Pneumococcal vaccine. 52% of the care givers indicated that their children were given IPV (Inactivated Polio Vaccine). 53% of the children who were given rotavirus vaccine received the required 2 doses. Among social-cultural factors, the need for permission from mother-in-law (p = 0.003), belief that vaccination makes girls infertile (p = 0.046) and belief that vaccination at a very young age can harm the child (p = 0.021). Migration with animals or nomadic lifestyle (p = 0.033) and the need for permission from my husband to have Child Immunized (p = 0.038) were significantly related to uptake of vaccination among the care givers. Occupation of the care giver (p = 0.044), the breadwinner in the family (p = 0.025) and the means of transport used to go to the facility (p = 0.007) and average household income (p = 0.033) were also significantly related to uptake of vaccination. None of the health system factors under investigation was found to significantly relate to uptake of vaccination. The study finding indicates that low uptake of vaccination was due to social cultural and social economic factors and recommends that Health education campaigns on the need of vaccination should target all members of the population. It further recommends that poverty eradication measures should be stepped up in the study area.