Maternal COVID-19 Research Articles

Psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19: A qualitative study.

ObjectiveThere is a paucity of data on the psychosocial issues and coping mechanisms among pregnant and postnatal women with COVID-19 infection. We, therefore, aimed to explore the psychosocial issues and coping mechanisms of pregnant and postnatal women diagnosed with COVID-19 at tertiary-level hospitals.MethodsThis was a qualitative phenomenological study conducted in 2021 with a sample size of 16 women admitted at two referral hospitals serving as COVID-19 admission facilities for pregnant and postnatal women in Lusaka, Zambia. In-depth interviews were conducted via telephone to understand what these women experienced when diagnosed with COVID-19. All the interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted using the six steps approach to develop emerging themes.ResultsTwo major themes emerged: psychosocial issues and coping mechanisms. The primary psychosocial issues were worry and stigma. Women worried about infecting their unborn baby or neonate, being separated from the baby, the general safety of the baby, and the health of other family members. Women also worried about the attitude of health care providers and faced discrimination or stigma because of their infection. Thus, some coping mechanisms were developed that helped them, such as a positive attitude, keeping the disease secret, reliance on family members for support and using positive information from social media.ConclusionThis study provides unique insights into the psychosocial experiences of pregnant and postnatal women diagnosed with COVID-19. Women were particularly concerned about the unborn baby’s well-being and discrimination.This study suggests the need for policy and clinical practice to consider the integration of effective mental health services into the provision of maternal health and COVID-19 services.

Correlations between Maternal Age, Education, and Knowledge on the Compliance of COVID-19 Vaccine Uptake in Children Aged 6 – 11 Years

Background: The coverage rate for giving the COVID-19 vaccine to children in several regions of Indonesia is still in the low category, one of which is in Abeli District, Kendari City. One of the factors that can affect the low administration of vaccines to children is due to mothers' concerns about their children so they are hesitant and reluctant to be given the COVID-19 vaccine. This study aims to analyze the relationship between age, education, and knowledge of mothers with compliance with the COVID-19 vaccine in children aged 6-11 years in Abeli District, Kendari City. Subjects and Method: A cross-sectional study was conducted in Abeli District, Kendari City, from August to October 2022. A total of 90 subjects were selected using a proportionate stratified random sampling technique. The dependent variable is adherence to giving the COVID-19 vaccine to children. The independent variables include age, education, and mother's knowledge. The instrument used is a questionnaire. Data analysis used was the Chi Square test . Results: Adherence to maternal COVID-19 vaccine administration increased with knowledge (OR= 3.57; 95% CI= 1.46 to 8.75; p= 0.007). Meanwhile, age (OR= 0.34; 95% CI= 0.14 to 0.83; p= 0.003) and education (0.31; 95% CI= 0.12 to 0.31; p= 0.020) reduced maternal adherence in administering the COVID-19 vaccine to children. Conclusion: There is a significant relationship between age, education, and mother's knowledge with compliance with the COVID-19 vaccine in children aged 6-11 years in Abeli District, Kendari City. Keywords: maternal age, maternal education, knowledge, COVID-19 vaccine . Correspondence: Lilis Sri Supiatun Mamesah. Midwifery Program Study, Faculty of Medicine, Universitas Airlangga, Indonesia. Jl. Mayjen Prof. Dr. Moestopo No.47, Pacar Kembang, Tambaksari, Surabaya, Jawa Timur 60132. Email: lilis.sri.supiatun-2019@fk.unair.ac.id. Mobile: +6285333622541. Journal of Maternal and Child Health (2022), 07(06): 720-728 https://doi.org/10.26911/thejmch.2022.07.06.10

A cross-sectional evaluation of maternal and perinatal outcomes in pregnancies complicated with COVID-19

Background and Aim Pregnancy is considered a vulnerable period for women regarding increased risk of respiratory tract infections, altered immunity, and metabolic changes in their bodies. COVID-19 pandemic possesses a significant risk on pregnants, but the data on the disease course is insufficient. Therefore, this study aimed to evaluate the maternal and perinatal outcomes in pregnant women diagnosed with COVID-19. Methods This is a cross-sectional study that evaluated the hospital records of pregnant women admitted to the Obstetrics and Gynecology Department of 19 Mayıs University Hospital between 01/04/2020 to 30/12/2021. Outcome measures were gestational week at birth, basal gestational and labor characteristics, delivery complications, and perinatal and maternal COVID-19 outcomes. Results Analyses of the data of 98 patients revealed that median age of the mothers was 30 years; 26.5% were primigravid, 43.9% were nulliparous, and 29.6% were primiparous. Three had twin pregnancies, 52% of the births were preterm, 88% were cephalic presentation, and 95.9% were cesarean deliveries.The most common delivery complications were acute fetal distress (51%), preterm premature rupture of membranes (50%), and neonatal asphyxia (49%). Gestational characteristics were similar between treatment groups for COVID-19, but patients admitted to intensive care unit and applied mechanical ventilation (11.2%) had significantly more preterm births, and perinatal complications including acute fetal distress (p=0.030), PPROM (p<0.001), neonatal asphyxia (p=0.021), and lower APGAR scores (p=0.002). Conclusion COVID-19 is a significant risk factor for pregnant women. This study showed that COVID-19 and pregnancy may induce adverse effects on each other. The data provided here will contribute to the growing body of epidemiological and clinical evidence on the interactions between COVID-19 and pregnancies.

Racial disparities in acceptability of maternal influenza and COVID-19 vaccination

Racial disparities in acceptability of maternal influenza and COVID-19 vaccination

Newborn and maternal immunity following 2nd trimester mRNA COVID-19 vaccination

The BNT162b2 mRNA COVID-19 Pfizer vaccine administered in the 3rd trimester was found to elicit a strong maternal humoral IgG response which crosses the placenta and approaches maternal titers in the newborn. Our aim was to evaluate maternal and neonatal COVID-19 antibody levels at birth, following earlier vaccine administration during pregnancy.

Fetal Effects of COVID-19 Infection: Targeted Metabolomic profiling of cord blood

The impact of maternal COVID-19 infection on fetal health remains to be determined. Using targeted metabolomic analysis of newborn umbilical cord blood, we aimed to evaluate the biological consequences of maternal infection on the fetus and develop metabolite biomarkers for the identification of newborn intrauterine exposure.

Evaluating the Association Between Maternal Peripartum Care Interruptions and Infant Affect: A Longitudinal Study

The effect of maternal COVID-19 pandemic-related stress during pregnancy on children born during this time is unknown. We aimed to evaluate whether maternal stress related to disruption in birth experiences during the pandemic was associated with infant temperament. Data were drawn from the NYU COVID-19 and Perinatal Experiences (COPE) Study (3/2020-7/2021) that addressed perinatal care disruptions during the height of the pandemic in New York City. Any negative birth experience (e.g., limited support people at delivery, neonate separation, etc.) was defined as a perinatal stressor. To measure infant temperament, mothers completed the Infant Behavior Questionnaire (IBQ) at 6 months of age for their infants. To characterize infant temperament, we used three broad components of the IBQ-Very Short Form: Negative Emotionality (NEG), Positive Affectivity (PAS), and Orienting and Regulatory Capacity (ORC). We examined the associations using ANOVA, t-test, Χ2, & Fisher’s exact test with significance defined as p < 0.05. There were 83 mother-infant pairs with complete COPE and IBQ survey data. Table 1 shows that the groups with and without a stressor had similar demographics. ORC scores were higher in infants of mothers with perinatal stress (adjusted mean ORC scores = 5.4 ± 0.1 v. 5.1 ± 0.1, p = 0.01). There was no significant difference between PAS and NEG scoring between groups. (Table 2) Maternal birth experience stressors during the COVID-19 pandemic were positively associated with infant ORC. Higher ORC scores reflect positive infant regulatory function, including soothability, cuddliness and low-intensity pleasure. Disruptions in perinatal care were not associated with infant temperament measures of PAS or NEG. Thus, there is no clear association between the acute stress of COVID pandemic-related care disruptions and infant temperament. However, these data indicate that maternal care may vary with pandemic experiences, which may be an important avenue for further investigation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Timing of COVID-19 as a Predictor of Adverse Neonatal Outcomes

COVID-19 provokes a profound inflammatory response that can lead to significant maternal morbidity. The impact on a developing fetus is not well-described, especially in regards to the timing of maternal infection. We sought to determine whether gestational age at diagnosis of maternal COVID-19 is associated with adverse neonatal outcomes.

Role of maternal COVID-19 vaccination in providing immunological protection to the newborn.

Pregnant and postpartum individuals are known to have an elevated risk of severe COVID-19 compared with their non-pregnant counterparts. Vaccination is the most important intervention to protect these populations from COVID-19-related morbidity and mortality. An added benefit of maternal COVID-19 vaccination is transfer of maternal immunity to newborns and infants, for whom a vaccine is not (yet) approved. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific binding and neutralizing antibodies are present in infant cord blood and breast milk following natural maternal infection and transfer of maternal immunity following COVID-19 vaccination is an area of active research. In this review, we synthesize the available research, discuss knowledge gaps, and outline factors that should be evaluated and reported when studying the transfer of maternal immunity following COVID-19 vaccination. The data reviewed herein suggest that maternal SARS-CoV-2-specific binding antibodies are efficiently transferred via the placenta and breast milk following maternal mRNA COVID-19 vaccination. Moreover, antibodies retain strong neutralizing capacity. Antibody concentrations appear to be at least as high in infant cord blood as in the maternal serum, but lower in breast milk. Breast milk IgA rises rapidly following maternal vaccination, whereas IgG rises later but may persist longer. At least two COVID-19 vaccine doses appear to be required to reach maximal antibody concentrations in cord blood and breast milk. There is no indication that infants consuming breast milk from vaccinated mothers experience serious adverse effects, although follow-up is limited. No clear pattern has emerged regarding changes in milk supply following maternal vaccination. The heterogeneity in important methodological aspects of reviewed studies underscores the need to establish standard best practices related to research on the transfer of maternal COVID-19 vaccine-induced immunity.

Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization - United States, March 2020-September 2021.

Pregnant women are at increased risk for severe COVID-19-related illness, and COVID-19 is associated with an increased risk for adverse pregnancy outcomes and maternal and neonatal complications (1-3). To date, studies assessing whether COVID-19 during pregnancy is associated with increased risk for stillbirth have yielded mixed results (2-4). Since the B.1.617.2 (Delta) variant of SARS-CoV-2 (the virus that causes COVID-19) became the predominant circulating variant,* there have been anecdotal reports of increasing rates of stillbirths in women with COVID-19.† CDC used the Premier Healthcare Database Special COVID-19 Release (PHD-SR), a large hospital-based administrative database,§ to assess whether a maternal COVID-19 diagnosis documented at delivery hospitalization was associated with stillbirth during March 2020-September 2021 as well as before and during the period of Delta variant predominance in the United States (March 2020-June 2021 and July-September 2021, respectively). Among 1,249,634 deliveries during March 2020-September 2021, stillbirths were rare (8,154; 0.65%): 273 (1.26%) occurred among 21,653 deliveries to women with COVID-19 documented at the delivery hospitalization, and 7,881 (0.64%) occurred among 1,227,981 deliveries without COVID-19. The adjusted risk for stillbirth was higher in deliveries with COVID-19 compared with deliveries without COVID-19 during March 2020-September 2021 (adjusted relative risk [aRR]=1.90; 95% CI=1.69-2.15), including during the pre-Delta (aRR=1.47; 95% CI=1.27-1.71) and Delta periods (aRR=4.04; 95% CI=3.28-4.97). COVID-19 documented at delivery was associated with increased risk for stillbirth, with a stronger association during the period of Delta variant predominance. Implementing evidence-based COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to reducing the impact of COVID-19 on stillbirths.

Response to the concern that the baseline change in CTG traces does not reflect the impact of maternal COVID-19

Article Response to the concern that the baseline change in CTG traces does not reflect the impact of maternal COVID-19 was published on February 1, 2022 in the journal Journal of Perinatal Medicine (volume 50, issue 2).

Could Maternal COVID-19 Disease be a Risk Factor for Neurodevelopmental Disorders in the Child?

Could Maternal COVID-19 Disease be a Risk Factor for Neurodevelopmental Disorders in the Child?

Maternal COVID-19 Vaccination and Its Potential Impact on Fetal and Neonatal Development.

Vaccines have been developed at “warp speed” to combat the COVID-19 pandemic caused by the SARS-CoV-2 coronavirus. Although they are considered the best approach for preventing mortality, when assessing the safety of these vaccines, pregnant women have not been included in clinical trials. Thus, vaccine safety for this demographic, as well as for the developing fetus and neonate, remains to be determined. A global effort has been underway to encourage pregnant women to get vaccinated despite the uncertain risk posed to them and their offspring. Given this, post-hoc data collection, potentially for years, will be required to determine the outcomes of COVID-19 and vaccination on the next generation. Most COVID-19 vaccine reactions include injection site erythema, pain, swelling, fatigue, headache, fever and lymphadenopathy, which may be sufficient to affect fetal/neonatal development. In this review, we have explored components of the first-generation viral vector and mRNA COVID-19 vaccines that are believed to contribute to adverse reactions and which may negatively impact fetal and neonatal development. We have followed this with a discussion of the potential for using an ovine model to explore the long-term outcomes of COVID-19 vaccination during the prenatal and neonatal periods.

Maternal COVID-19 leaves a lasting immunological impression on the fetus.

Whether COVID-19 during pregnancy affects the health of children is unclear. Data now show that SARS-CoV-2 infection of mothers can prime the fetal immune response indirectly even when the virus does not infect the fetus.

Use of learning media to support resident doctor skills in obstetrics and gynecology during the COVID-19 pandemic: A narrative review

COVID-19 is a pandemic that has spread in various countries. The health care system in hospitals is burdened with widespread infections and health problems. In addition, educational aspects, especially obstetrics and gynecology education, have problems in clinical practice. This study reviews the role of the learning media in supporting the competence of resident doctors in specialist education for obstetrics and gynecology. Narrative review is done by reviewing some literature that explores the use of media in supporting medical education competencies. The search was performed using MeSH keywords in the PubMed, Google Scholar and ScienceDirect databases. The literature used is research conducted in the last 5 years. The collected data is then arranged in a narrative manner. The challenges experienced in medical resident education, especially the focus on obstetrics and gynecology during the COVID-19 pandemic, have become a consideration for the need for innovative media so that learning can run as usual. All aspects need to ensure quality education for resident doctors because they will continue to provide health services in the future.&#x0D; Keywords: Maternal health, COVID-19, Media, Obstetrics and gynecology

Postmortem Documentation of SARS-CoV-2 in Utero and Postpartum Transmission, through Amniotic Fluid, Placental, and Pulmonary Tissue RT-PCR

The physiopathology of SARS-CoV-2 infection, during pregnancy and in early childhood, is poorly understood. Unfavorable maternal outcomes, the risk of vertical/postpartum transmission, and severe, multisystem involvement in infants and children highlight the importance of developing a cohesive treatment and nuanced prophylaxis strategy. In this study, we evaluate autopsy reports, pathological findings, and SARS-CoV-2 genome expression in three distinct clinical scenarios: maternal death due to severe COVID-19 with in utero fetal demise (27 weeks); mother with moderate COVID-19 and in utero fetal demise (29 weeks); and 2-month-old infant death with confirmed COVID-19 caregivers. We report the presence of the SARS-CoV-2 genome in amniotic fluid and placental tissue in the context of in utero transmission of SARS-CoV-2, but also in postmortem infant pulmonary tissue samples in a case of late postpartum SARS-CoV-2 transmission with asymptomatic, rapidly progressive disease, resulting in infant death. Key pathological findings offer a descriptive portrayal of maternal, in utero, and infantile COVID-19 pathogenesis. Further investigations are necessary to fully comprehend the clinical implications of SARS-CoV-2 infection during pregnancy, a prerequisite for adequate therapeutic management and harm reduction.

Increased incidence of Persistent Pulmonary Hypertension of the Newborn following third trimester maternal COVID-19 infection

Abstract Background Novel coronavirus (COVID-19) has been a world concern since December 2019. The knowledge about vertical transmission and fetal morbidity and mortality from maternal COVID-19 infection is limited. We detected an increase in the number of cases of term and near-term neonates with persistent pulmonary hypertension (PPHN) during the COVID-19 pandemic in 2020. Methods and results We collected data on all newborns with PPHN born between 2018 and 2020. We excluded premature infants (&amp;lt;34+0 weeks) and infants with other significant pathology or genetic syndromes. Compared to 5 cases of PPHN of 22930 live births in 2018, and 6 cases of PPHN of 22270 live births in 2019 (2-year average 0.02%, 95% CI 0.013%-0.043%), there were 16 PPHN cases from 22323 live births in 2020 (0.07%, 95% CI 0.044%-0.12%), a 3 fold increase (p&amp;lt;0.01). We report 5 cases of term and near-term neonates born to mothers who had highly suspected (2) and PCR proven (3) COVID-19 infection during the third trimester of pregnancy, who presented with PPHN during COVID-19 pandemic in 2020. All had otherwise unexplained pulmonary hypertension, right ventricular hypertrophy (RVH) and dilatation. Two patients needed endotracheal intubation, one was supported by nasal continuous positive airway pressure (CPAP) without intubation, two needed O2 support by nasal cannula only ant two newborns (one of them was intubated) needed Nitric oxide (NO) as pulmonary vasodilator therapy. No patient required Extracorporeal membrane oxygenation (ECMO) or died, and no prolonged residual cardiovascular or pulmonary morbidity was recorded during a median follow up of 4.8 months (range 4–6 months). Conclusions The increase in the incidence of PPHN during the COVID-19 pandemic, and the cases presented, suggest an intrauterine effect of maternal COVID-19 infection on the fetal pulmonary circulation. It is possible that the maternal infection affected the fetal pulmonary vascular resistance, or altered the normal decline in the resistance after birth. The right ventricular hypertrophy and dilatation with reduced function may be secondary to this hypothetical increased afterload or a direct effect of the infection. Further studies are warranted to elucidate the pathogenesis and clinical implications of this phenomenon. Funding Acknowledgement Type of funding sources: None.

Impact of COVID-19 Infection on Neonatal Birth Outcomes.

There is limited data on newborns born to mothers with COVID-19 infection. This multicenter cohort study aimed to investigate the clinical characteristics and outcomes of neonates born to mothers with and without COVID-19 infection to fill a gap in the literature review. The medical records of all neonates in Isfahan, Iran, between October 2020 and March 2021, were retrospectively reviewed. Among the 600 neonates in this study, 255 (42.5%) were in the infected group and 345 (57.5%) were assigned to the control group as they were born to non-infected mothers. In the infected group, sepsis, fever and pneumothorax were detected in 3 (1.2%), 3 (1.2%) and 4 (1.6%) neonates, respectively, compared with no case in the control group. In the infected group, neonatal respiratory distress (NRDS) (32, 12.5%) was significantly higher than the control group (27, 10.6%). Asphyxia in the infected group was 22(6.4%), compared with 19 (5.5%), in the control group. Preterm labor (PTL) (55, 21.65%), premature rupture of membranes (PROMs) (24, 9.4%) and intra-uterine growth retardation (IUGR) (15, 5.9%) were significantly higher in women with COVID-19 (45, 13.0%, 4, 1.2% and 7, 2.0%, respectively). Low birth weight (LBW) accounted for 42 (16.5%) neonates in the infected group and 25 (7.2%) in the control group (p < 0.05). Of the 255 neonates born to infected mothers, 38 (14.9%) were admitted to the Neonatal Intensive Care Unit (NICU), compared with 31 out of 345 (9.0%) in the control group (p < 0.05). RT-PCR test results were positive in two newborns (0.8%), one of whom died of necrotizing enterocolitis. As a result of maternal COVID-19 infections, neonates experienced higher rates of sepsis, fever, pneumothorax, asphyxia and NRDS in addition to PTL, PROMs, IUGR, and LBW.

Maternal Psychological Distress and Children's Internalizing/Externalizing Problems during the COVID-19 Pandemic: The Moderating Role Played by Hypermentalization.

In order to explore the psychological impact of the COVID-19 outbreak on the caregiver–child relationship, we investigated the interplay among COVID-19 exposure and children’s internalizing/externalizing problems during the Italian lockdown, hypothesizing a mediation effect played by maternal distress. Additionally, we included maternal reflective functioning (i.e., hypermentalization) as a moderator factor among this interplay. A total of 305 Italian mothers of children aged 6–13 years (M = 10.3; SD = 2.4) filled in an online survey. Findings revealed an indirect effect of maternal COVID-19 exposure on children’s anxious/depressed (k2 = 0.46) and attention problems (k2 = 0.32) via maternal distress. Hypermentalization moderated the impact of maternal COVID-19 exposure on children’s anxious/depressed problems (β = −1.08, p = 0.04). Hypermentalization moderated both the relation between maternal distress and children’s aggressive behaviors (β = 12.226; p < 0.001) and between maternal distress and children’s attention problems (β = 5.617, p < 0.001). We found pivotal significant effects of maternal hypermentalization on children’s anxious/depressed and attention problems, indicating that the higher the mother’s hypermentalization was, the higher the children’s problems were. Our results broaden what we knew on the role of maternal reflective and emotional functioning on children’s emotional/behavioral adjustment during stressful situations.

Maternal COVID-19 and neonatal hearing loss: a multicentric survey.

PurposeGestational SARS-Cov-2 infection can impact maternal and neonatal health. The virus has also been reported of causing sensorineural hearing loss. The objective of this study was to determine the possible effect of maternal SARS-COV-2 infection on neonatal hearing as identified during universal hearing screening.MethodsRetrospective cohort study in two tertiary referral centers including all neonates born from November 2020 through April 1st, 2021 and undergoing the universal hearing screening program. Maternal Covid-19 infection was recorded (timing and severity) and the results of hearing screening of their neonates compared to the incidence of neonatal hearing loss results of the national universal screening program during the same period.ResultsA total of 984 neonates were included (508 males and 476 females). Sixty-three neonates were excluded due to comorbidities which could cause hearing loss. The incidence of failed responses in the community at large was 2.3%. Twenty-seven failed both steps of screening (2.9%; p < 0.2). There were 34 Covid-19 positive mothers (17 in the first trimester, 8 in the second and 9 in the third). Twenty-nine neonates failed the first screening (p < 0.00001) but on further testing only one neonate failed (2.9%).ConclusionIn this study, neonates born to Covid-19 positive mothers do not seem to have an increased risk of hearing loss. However longer follow-up of these neonates is mandatory to detect any possible delayed effects of the virus.