Non-infected Pregnant Women Research Articles

Serotonin, cortisol, and DHEA-S levels in anxious and depressive pregnant women living with HIV

Pregnancy in women living with human immunodeficiency virus (WLWH) represents an important challenge for maternal-fetal health. Besides, they can also present anxiety (Anx) and depression (Dep). Imbalances in serotonin (5-HT), dehydroepiandrosterone sulfate (DHEA-S), and cortisol (CORT) levels can contribute to Anx and Dep manifestations. Currently, there is not enough data about the neuroendocrine and neurochemical changes in pregnant WLWH with affective disorders. This study aimed to characterize 5-HT, DHEA-S, and CORT plasma levels in Mexican pregnant WLWH presenting Anx/Dep. Forty-two adult pregnant women were recruited during the third trimester of gestation at the National Institute of Perinatology in Mexico during 2019–2022. These patients were divided into three groups: (1) pregnant WLWH with Anx/Dep (n = 16), (2) pregnant without HIV but with Anx/Dep (n = 12), and (3) healthy pregnant women without Anx/Dep (n = 14). WLWH presented a marked reduction in 5-HT (41.33 ± 39.37 ng/dL) compared to non-infected pregnant women with Anx/Dep (220.2 ± 151.8 ng/dL) and the healthy group (370.0 ± 145.3 ng/dL). Anx/Dep infected and uninfected pregnant women showed a significant reduction in DHEA-S levels (86.58 ± 30.59 and 76.9 ± 36.7 µg/dL, respectively) compared to healthy subjects (149.7 ± 44.6 µg/dL). Anx and Dep symptoms were inversely correlated with 5-HT and DHEA-S levels. No significant differences were observed in CORT levels among the three groups (p = 0.094). Our results suggest the presence of a disbalance in 5-HT and DHEA-S levels in pregnant WLWH with affective symptoms.

Effects of the COVID-19 pandemic on maternal-fetal outcomes in a nonepidemic designated hospital: a retrospective study and clinical experience summary

ObjectiveTo assess the changes in maternal-fetal outcomes in a nonepidemic designated hospital during the COVID-19 pandemic.MethodsThis retrospective cohort study was conducted between January 1, 2019, and December 31, 2021 on pregnant patients. The fixed-effects regression model was used to determine changes in birth outcomes and pregnancy-related complications between three periods with the pre-epidemic cohort as the control group. Logistic regression was applied to determine the odds ratio (OR) for binary outcomes.ResultsThere were 15,261 births during the pre-epidemic period, and this number decreased by 15% and 23% to 12,980 and 11,736 in the first and second epidemic cohorts, respectively. The mean birth weight during the pre-epidemic period was 3319 which decreased to 3309 and 3272 g in the following periods. Excluding stillbirth and preterm, all other outcomes differed significantly between the three periods. Gestational diabetes mellitus (GDM) (17–19%) and maternal hypertension (9.2–11%) appeared to increase. Compared to the pre-epidemic period, the odds of macrosomia and LGA significantly decreased in the second epidemic cohort (adjusted ORs: 0.76 and 0.8), while the odds of low birth weight (LBW) and small gestation age (SGA) increased (ORs: 1.25 and 1.16). The odds of neonatal asphyxia (OR: 1.4), and hypertension (OR: 1.29) appeared to increase in the second epidemic cohort, while GDM decreased in the first cohort (OR: 0.88) and increased in the second cohort (OR: 1.15). Vaginal delivery underwent a marginal decrease in both the first and second epidemic cohorts (ORs: 0.89 and 0.92).ConclusionThe COVID-19 pandemic may have had a substantial and long-term impact on non-infected pregnant women and newborns. Our research results provided precious research information and clinical experience summary for population health research in the future.

Peripartum outcomes and immune responses after SARS-CoV-2 infection in the third trimester of pregnancy

BackgroundSARS-CoV-2 infection in pregnant women during the third trimester resulted in overall adverse pregnancy outcomes compared to non-infected controls and a unique humoral and cellular response at delivery. In this study we aimed to assess the impact of SARS-CoV-2 infection on maternal/neonatal peripartum outcomes andimmunological profiles.MethodIn this study, we recruited 304 SARS-CoV-2 infected pregnant women and 910 SARS-CoV-2 non-infected pregnant women who were admitted for delivery. Peripartum and neonates’ outcomes response to SARS-CoV-2 infection were analyzed. Furthermore, we characterized the antibody and cytokines profile in SARS-CoV-2 infected maternal blood (MB) and cord blood (CB). We also assessed routine laboratory tests and liver function tests in MB before labor. Unpaired T test, Mann-Whitney test and Spearman test were used to analyze the data.ResultsSARS-CoV-2 infected pregnant women were significantly associated with increased risk of adverse pregnancy outcomes, including preterm labor (13.8% vs. 9.5%, p = 0.033) and meconium-stained amniotic fluid (8.9% vs. 5.5%, p = 0.039). The risk of low birth weight (< 2500 g) (10.5% vs. 6.5%, p = 0.021) and Apgar score < 8 at 1-minute (9.2% vs. 5.8%, p = 0.049) significantly increased in newborns from COVID-19 positive mothers than their counterparts. Our results showed that antibodies were increased in adverse-outcome SARS-CoV-2 infected mothers and their neonates, and abnormal proportion of immune cells were detected in SARS-CoV-2 infected mothers. While the immune response showed no difference between adverse-outcome infected pregnant women and normal-outcome infected pregnant women. Thus, SARS-CoV-2 infection during the third trimester of pregnancy induced a unique humoral and cellular response at delivery.ConclusionSARS-CoV-2 infection closer to delivery could incline to adverse pregnancy outcomes. Therefore, the utmost care is required for SARS-CoV-2 infected pregnant women and their newborns.Trial registrationThe study protocol was approved by the Institutional Review Board of the First Hospital of Jilin University with the approval code number 23K170-001, and informed consent was obtained from all enrolled patients prior to sample collection.

Maternal and Neonatal Outcomes of COVID-19 in Pregnancy in Tertiary Care Centers in Saudi Arabia: A Comparative Study

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

Pregnancy Outcomes in Women Infected With COVID-19: A Retrospective Cohort Study

Introduction: Studies of the impact of the novel coronavirus 2019 (COVID-19) on pregnancy outcomes have yielded conflicting results. Objective: This study examined pregnancy outcomes in COVID-19-infected and non-infected pregnant women. Materials and Methods: In this retrospective cohort study, we included all pregnant women with (n=42) and without COVID-19 infection (n=185) admitted to a training and treatment center in Babol City, Iran, from March to November 2020. We abstracted the records of all pregnancies in women with COVID-19 (exposed cohort) and women without COVID-19 (non-exposed cohort). Patient information was taken from their medical records. The chisquare test and Student t-test were used for data analysis. Modified Poisson regression and mixed linear model were used to assess the adjusted risk ratio (aRR) and adjusted mean difference (aMD) between COVID-19 infection and pregnancy outcomes. Results: A total of 227 pregnant women (42 in the exposure group, 185 in the non-exposed group) were included in the study. The mean age of mothers was 28.12±6.27 years, and also 48.5% of them had their first pregnancy. In comparison with non-infected women, women with COVID-19 faced the highest risk of cesarean section (aRR: 2.22, 95% CI, 1.35%-3.65%, P=0.002) and preterm birth (aRR: 1.22, 95% CI, 1.02%-1.48%, P=0.026). Also, pregnant women with COVID-19 had a significantly higher duration of hospital stay (aMD: 2.20, 95% CI, 1.32%-3.08%, P=0.001) compared to pregnant women without COVID-19. There was no significant difference between the two groups in terms of postpartum hemorrhage and premature rupture of membranes. Conclusion: This study suggests that COVID-19 infection is associated with an increased risk of cesarean section, preterm birth, and increased duration of hospital stay but not with other outcomes. However, the current evidence does not support its causal effects, given the methodological limitations and small sample size.

Potential role of latent toxoplasmosis in inducing thyroid disorders with relevance to autoimmune thyroid disease and interleukin-33 level during pregnancy

Background and Aim: Latent toxoplasmosis is the most frequently occurring parasitic infection worldwide, which causes hormonal and behavioral changes that seriously affect pregnant women. It has also been linked to several autoimmune diseases, including autoimmune thyroid disease (AITD). This study aimed to investigate the association between Toxoplasma gondii seropositivity and thyroid dysfunction, considering the impact of latent toxoplasmosis on the prevalence of maternal AITD and interleukin-33 (IL-33) levels in infected and non-infected pregnant women. Materials and Methods: We conducted a cross-sectional study on 400 pregnant women aged 15–50 in the 8th–36th gestational week. Toxoplasma status was confirmed by detecting anti-Toxoplasma immunoglobulin (Ig)G antibodies. Recent and past chronic toxoplasmosis status was differentiated using the Toxoplasma IgG avidity test. Free triiodothyronine (FT3), free thyroxine, and thyroid-stimulating hormone (TSH) levels were determined to evaluate thyroid disorders. Antibodies against thyroid peroxidase, thyroglobulin, and TSH receptor were assessed to distinguish patients with autoimmune thyroid disorders from those with other thyroid diseases. We divided the subjects into four groups (Toxo+ and abnormal hormone level, Toxo– and normal hormone level, Toxo+ and normal hormone level, and Toxo– and abnormal hormone level) and evaluated their IL-33 levels to investigate its role during the infection. All the tests were performed using the enzyme-linked immunosorbent assay. Results: The results showed that (205/400, 51.2%) samples were seropositive for anti-Toxoplasma IgG antibodies. Of these, (25/205, 12.2%) and (180/195, 87.8%) had recent and past chronic infections, respectively. High infection rates were reported among rural dwellers (150/400, 37.5%) and those in their 3rd trimester (110/400, 27.5%). Of the 205 seropositive patients, (131/205, 63.9%) had thyroid disorders, among which (69/205, 33.7%) and (119/205, 58.0%) had abnormal FT3 and TSH hormone levels, respectively. In contrast, out of 195 Toxoplasma seronegative samples, (99/195, 50.8%) had thyroid disorders; (48/195, 24.6%) and (90/195, 46.2%) had abnormal FT3 and TSH hormone levels, respectively. Groups with abnormal FT3 and TSH levels had significantly higher seropositive anti-toxoplasma IgG antibodies (p = 0.01). Women with seropositive anti-Toxoplasma IgG antibodies had a high hypothyroidism rate (115/205, 56.1%) compared with those with seronegative anti-Toxoplasma IgG antibodies (86/195, 44.1%). We found an association between toxoplasmosis and thyroid status (p &lt; 0.05). Out of 400 samples, 85 (85/400, 21.25%) had AITD. Further, (58/205, 28.3%) of women with seropositive anti-toxoplasma IgG antibodies had AITD compared to (27/195, 13.85%) in the seronegative ones. We found a significant association between toxoplasmosis and AITD (p &lt; 0.05). The IL-33 level was highest in the Toxo+ and abnormal hormone level group (210.86 ± 44.39 pg/mL) and lowest in the Toxo-and normal hormone level group (22.27 ± 8.41 pg/mL). Conclusion: Our results suggest that latent toxoplasmosis was significantly associated with thyroid hormone secretion, which might stimulate the immune system, leading to the development of AITD among pregnant women. Furthermore, the T. gondii seroprevalence was positively correlated with pregnant patients who were rural dwellers and in their 3rd trimester. Keywords: autoimmune thyroiditis disease, interleukin-33, pregnancy, thyroid hormones, toxoplasmosis.

EPH166 The Effect of COVID-19 on Maternal and Neonatal Outcomes in a Large Tertiary Health System in Saudi Arabia

There is a scarcity of data comparing the rates of maternal and neonatal outcomes in pregnant women with and without COVID-19 infection. Our aim was to assess the effect of COVID-19 on maternal outcomes (stillbirths and miscarriage) and neonatal outcomes (low birth weight <2500 gm Apgar-1 minute score < 7, and Apgar-5 minute score < 7). This is a multicenter retrospective cohort study that included pregnant women who were followed and delivered at three National Guard health System hospitals between March 2020 and October 2021. A laboratory test confirmed the diagnosis of COVID-19 during pregnancy. Multivariable Logistic regression was conducted to assess the risks of maternal and neonatal outcomes. The study included 644 pregnant women with a confirmed COVID-19 infection and 654 pregnant women with no COVID-19 infection. There was no statistically significant difference in the risk of stillbirth (adjusted odds ratio, aOR1.93, 95% CI 0.55, 8.12) or miscarriage (aOR 0.52, 95% CI 0.23, 1.10) between COVID-19 infected pregnant women and non-infected pregnant women. COVID-19 infection, on the other hand, was associated with increased odds of low birth weight (aOR 1.5, 95%CI 1.06, 2.14), Apgar score-1 minute <7 (aOR 2.14, 95%CI 1.53, 3.03), and Apgar score-5 Minutes <7 (aOR 2.8, 95%CI 1.91, 4.17). Infants born to pregnant women with COVID-19 infection were more likely to have low birth weight and low Apgar scores than those born to uninfected mothers.

Evaluation of Vitamin D Serum Levels in Pregnant Women with COVID-19 Compared with the Control Group in Pregnant Women: A Case-Control Study.

The findings of studies on serum 25-hydroxy-vitamin D [25(OH) D] levels in pregnant women with or without coronavirus disease 2019 (COVID-19) were found to be controversial and inadequate. The present study was thus carried out at to fill the gap felt in this regard. In this case-control study, 63 pregnant women with singleton pregnancy who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and 62 pregnant women who were matched for gestational age and not infected by COVID-19 were examined. Based on clinical symptoms, the patients with COVID-19 were divided into three groups: mild, moderate, and severe. ELISA method was adopted to measure [25(OH) D] level. The [25(OH) D] means of 23.4 ± 9.2ng/ml and 31.2 ± 0.15ng/ml were noted in the case and control groups, respectively (p < 0.001). The [25(OH) D] level of lower than 30ng/ml was observed in 43.5% of the control group (n = 27) and 71.4% of the case group (n = 45; p = 0.002). Multivariate linear regression analysis to match age, gestational age, [25(OH) D] supplement use, and number of pregnancies showed that [25(OH) D] mean in the case group is 8.2 units lower, compared to the control group (p < 0.001). The [25(OH) D] level in pregnant women with COVID-19 is lower, compared to non-infected pregnant women. However, there is no significant relationship between [25(OH) D] level and disease severity. A sufficient level of [25(OH) D] may protect pregnant women against COVID-19.

GLOBAL SYSTEMATIC REVIEW AND META-ANALYSIS OF FOETAL AND MATERNAL OUTCOMES IN PREGNANT WOMEN INFECTED WITH COVID-19

This study aimed to systematically review the effects of COVID-19 infection on pregnant women and their neonatal outcomes in eight countries: UK, USA, China, France, India, Russia, Italy, and Iran. Data from various registries worldwide were analyzed, focusing on preterm births, maternal and neonatal mortality rates, and mode of delivery. The results showed that all countries experienced a significant increase in preterm birth rates among COVID-19-infected pregnant women compared to non-infected pregnant women. No significant difference was observed in maternal mortality rates across the countries, but India had the highest neonatal mortality rate. The rate of vertical transmission from infected mothers in the third trimester to their infants was estimated at 3.2%. In conclusion, COVID-19 has the most significant impact on the increase of preterm birth rates, with India experiencing the highest neonatal mortality rate compared to the other country.

Risk factors for and pregnancy outcomes after SARS-CoV-2 in pregnancy according to disease severity: A nationwide cohort study with validation of the SARS-CoV-2 diagnosis.

We identified risk factors and outcomes associated with SARS-CoV-2 infection in pregnancy in a universally tested population according to disease severity and validated information on SARS-CoV-2 during pregnancy in national health registers in Denmark. Cohort study using data from national registers and medical records including all pregnancies between March 1, 2020 and February 28, 2021. We compared women with a validated positive SARS-CoV-2 test during pregnancy with non-infected pregnant women. Risk factors and pregnancy outcomes were assessed by Poisson and Cox regression models and stratified according to disease severity defined by hospital admission status and admission reason (COVID-19 symptoms or other). Using medical record data on actual period of pregnancy, we calculated predictive values of the SARS-CoV-2 diagnosis in pregnancy in the registers. SARS-CoV-2 infection was detected in 1819 (1.6%) of 111 185 pregnancies. Asthma was associated with infection (relative risk [RR] 1.63, 95% confidence interval [CI] 1.28-2.07). Risk factors for severe COVID-19 disease requiring hospital admission were high body mass index (median ratio 1.06, 95% CI 1.04-1.09), asthma (RR 7.47, 95% CI 3.51-15.90) and gestational age at the time of infection (gestational age 28-36 vs < 22: RR 3.53, 95% CI 1.75-7.10). SARS-CoV-2-infected women more frequently had hypertensive disorders in pregnancy (adjusted hazard ratio [aHR] 1.31, 95% CI 1.04-1.64), early pregnancy loss (aHR 1.37, 95% CI 1.00-1.88), preterm delivery before gestational age 28 (aHR 2.31, 95% CI 1.01-5.26), iatrogenically preterm delivery before gestational age 37 (aHR 1.49, 95% CI 1.01-2.19) and small-for-gestational age children (aHR 1.28, 95% CI 1.05-1.54). The associations were stronger among women admitted to hospital for any reason. The validity of the SARS-CoV-2 diagnosis in relation to pregnancy in the registers compared with medical records showed a negative predictive value of 99.9 (95% CI 99.9-100.0) and a positive predictive value of 82.1 (95% CI 80.4-83.7). Women infected with SARS-CoV-2 during pregnancy were at increased risk of hypertensive disorders in pregnancy, early pregnancy loss, preterm delivery and having children small for gestational age. The validity of Danish national registers was acceptable for identification of SARS-CoV-2 infection during pregnancy.

Maternal and Neonatal Outcomes of COVID-19 Infection in Pregnancy.

Limited data is available on the full spectrum of maternal COVID-19 infection in terms of pregnancy outcomes. The present study aimed to compare the maternal and neonatal outcomes of COVID-19 in infected and non-infected pregnant women. A dual-site retrospective cohort study was conducted in two tertiary hospitals in Isfahan, Iran. The sample included 104 infected and 210 non-infected hospitalized pregnant women. Odds ratios (OR) were estimated using multivariate logistic regression. There were significant differences between COVID-19-infected and non-infected pregnant women regarding preterm labor (PTL) (odds ratio [OR]: 11.34, 95% confidence interval [CI]: 1.19-48.54, P=0.035); hospitalization days (OR: 7.21, 95% CI: 4.05-12.85, P≤0.001); cesarean section (CS) (OR: 4.76, 95% CI: 1.78-12.45, P=0.002); neonatal admission to neonatal intensive care unit (NICU) (OR: 1.28, 95% CI: 1.12-1.67, P=0.004); and neonatal respiratory distress (OR: 2.37, 95% CI: 1.02- 5.47, P=0.044). No significant association was found between COVID-19 infection and abortion (OR: 0.06, 95% CI: 0.01-1.45, P=0.084); stillbirth (OR: 1.84, 95% CI: 0.05-39.68, P=0.743); Apgar score (1 minute) (OR: 0.91, 95% CI: 0.74-1.13, P=0.382); Apgar score (5 minutes) (OR: 0.97, 95% CI: 0.81-1.18, P=0.765); and low birth weight (LBW) (OR: 4.76, 95% CI: 1.78-12.45, P=0.002). PTL, CS, neonatal admission in NICU, neonatal respiratory distress, and hospitalization days were significantly higher in pregnant women with COVID-19 compared to those without infection.

Clinical Characteristics of Pregnant Women with Sars-Cov2 Infection in the 3rd Trimester of Pregnancy

Objectives: The aim of our study is to present the cclinical characteristics of pregnant women with SARS-COV2 infection in the 3rd trimester of pregnancy. Methods: We retrospectively reviewed the medical records of all pregnant women from March to December 2020 in Infanta Leonor University Hospital, in Madrid. Infected women during the 3rd trimester of pregnancy or at delivery time with SARS-CoV2 diagnosis composed infected group, and non-infected women with SARS-CoV2 composed non-infected group. The infection status was determined via RT-PCR of nasopharyngeal swab specimen. Women in our study were not vaccinated because in the first and second waves of the epidemic the indication for vaccination in pregnant women was not clear. Results: 1262 non-infected pregnant women and 86 SARS-CoV2 positive pregnant women were admitted to our clinic during the study period. Within the group of infected pregnant women, they were 49 cases (56.98 %) symptomatic and 37 cases (43.02 %) asymptomatic. In the group of symptomatic infected women, the majority were mild cases (80.23 %). In the group of uninfected pregnant women, the main complication was gestational diabetes 14 (1.09 %) We did not find any complications during pregnancy in case group. Cesarean section was performed in 16.67 % of the infected pregnant women and in 21.71 % of the control group. Mean neonatal birth weight was 3.240 g in case group and 3.210 g in non-infected group. Neonatal admission to NICU was 9.52 % in cases while in the control group was 1.19 % being the most frequent reason for admission due to respiratory distress syndrome. Conclusion: SARS-CoV2 infection in pregnant women in the third trimester does not worsen the prognosis of pregnancy in our study, although metaanalyses suggest heightened risk of COVID-19 severity and adverse pregnancy and perinatal outcomes among women with certain demographic and health profiles.

Examining the immune signatures of SARS-CoV-2 infection in pregnancy and the impact on neurodevelopment: Protocol of the SIGNATURE longitudinal study.

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women.

Post-vaccination SARS-CoV-2 seroprevalence in children aged 3-11 years and the positivity in unvaccinated children: A retrospective, single-center study.

To analyze the positivity and levels of SARS-CoV-2 antibodies in vaccinated children to evaluate the humoral immune response of vaccination on pediatric population. Analysis on the causes of antibody positivity in unvaccinated children. A retrospective study was conducted on children who were admitted to the Children's Hospital Affiliated to Capital Institute of Pediatrics. The clinical data of serological testing of SARS-CoV-2 immunoglobulin M (IgM) and IgG antibodies were collected from SARS-CoV-2 vaccinated or unvaccinated children with no evidence of prior novel coronavirus infection. Chemiluminescence immunoassay was utilized for the in vitro determination of SARS-CoV-2 antibodies. A total of 3,321 healthy children aged 6-11 years received two doses of inactivated SARS-CoV-2 vaccine. At 1 month after the second dose, the positive rate (96.5%) and levels [8.039 (interquartile range (IQR), 6.067-9.098)] of SARS-CoV-2 IgG antibodies reached the peak and remained at a high level for 2-3 months, after which the positive rate and level of vaccine-induced IgG antibody gradually decreased. Compared with 1 month after the second dose of vaccine, the positive rate of IgG antibody decreased to 70.4% at 7 months, and the antibody level decreased by 69.0%. A total of 945 children aged 3-5 years received one or two doses of inactivated vaccine. The positive rate and levels of SARS-CoV-2 IgG antibody in participants remained high for 3 months after vaccination. There was no gender-based difference in positive rate of IgG antibody in children aged 3-11 years old (P>0.05). Among the 5,309 unvaccinated children aged 0 day to 11 years, 105 (2.0%) were positive for SARS-CoV-2 IgG antibody, which was associated with passive infusion. The maternal humoral response to COVID-19 vaccination in noninfected pregnant women was transferred through the placenta to the fetus, and some children obtained SARS-CoV-2-positive antibodies through blood transfusion. Inactivated SARS-CoV-2 vaccines could induce robust humoral immune response that gradually declined within several months after the second dose. Therefore, it helps to determine whether children receive a booster dose and elicit a long-term memory immune response. Positive SARS-CoV-2 antibodies in unvaccinated children were associated with passive IgG antibody infusion.

Do SARS-CoV-2-Infected Pregnant Women Have Adverse Pregnancy Outcomes as Compared to Non-Infected Pregnant Women?

PurposeTo determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies.Patients and MethodsA retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups.ResultsOur hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46–3.34; p<0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72–30.77; p<0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65–203.5; p<0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99–27.23; p<0.001].ConclusionSignificant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.

Adherence to the United States Department of Agriculture Dietary Recommendations Pre- and During the Coronavirus Disease-19 Pandemic Among Pregnant Women in Arab Countries.

During pregnancy, woman’s diet is one of the most preeminent factors affecting mother and child’s health. Prior to the coronavirus disease-19 (COVID-19) pandemic, inadequate maternal diet and low adherence to dietary guidelines was reported among pregnant women in the Arab countries. Nowadays, COVID-19 infection during pregnancy is widely discussed among literature. However, there is limited data on the health impacts of the COVID-19 pandemic on non-infected pregnant women. This substantially larger group also suffered significant lifestyle changes during the lockdown period. The aim of the study is to characterize dietary patterns, intake and adherence to the United States Department of Agriculture (USDA) pregnancy guidelines before and during the COVID-19 pandemic in Arab pregnant women. Using a specially designed questionnaire and using the snowball sampling method, the survey was carried out among a convenient sample of 1,939 pregnant women from five Arab countries. Our study found an increment in the consumption of cereals, fruits, vegetables, dairy products, meats, and nuts that occurred during the pandemic compared to the preceding period. Despite this noticeable increase during the pandemic, the Arab pregnant women in this study had significantly lower adherence to the USDA pregnancy guidelines. The daily consumption of almost all food groups was lower than the USDA’s daily recommendations, except for fruits intake, which was higher than the daily standard. Demonstrated poor adherence to prenatal USDA dietary guidelines by Arab pregnant women can lead to numerous deficiencies and health risks among their offspring. In conclusion, our study showed that before and during the COVID-19 pandemic, poor adherence to dietary recommendations occurred in a considerable number of Arab pregnant women. The findings emphasize the need for nutritional education and intervention during prenatal visits.

Clinical and Obstetric Aspects of Pregnant Women with COVID-19: A Systematic Review.

To analyze the clinical and obstetric aspects of pregnant women with COVID-19. A systematic literature review in the MEDLINE/PubMed, LILACS, SCIELO, and CNKI databases was performed from March to May 2020, with the descriptors: Pregnancy; 2019-nCov; Coronavirus; SARS-Cov-2, Covid-19. Of those chosen were original titles, without language and period restriction and that addressed pregnant women with a clinical and/or laboratory diagnosis of COVID-19. Revisions, editorials, and duplicate titles were excluded. The Newcastle-Ottawa (NOS) and Murad et al. scales were used to assess the quality of the studies. We included 34 articles with 412 pregnant women infected with severe acute respiratory syndrome (SARS-Cov-2), with an average age of 27.5 years of age and 36.0 gestational weeks. The most common symptom was fever (205 [49.7%]), and 89 (21.6%) pregnant women progressed to severe viral pneumonia. Laboratory tests showed an increase in C-reactive protein (154 [37.8%]), and radiological tests showed pneumonia with peripheral ground-glass pattern (172 [51.4%]). Emergency cesarean delivery was indicated for most pregnant women, and the most common gestational complication was premature rupture of ovarian membranes (14 [3.4%;]). We detected 2 (0.5%) neonatal deaths, 2 (0.5%) stillbirths, and 1 (0.2%) maternal death. Pregnant women with COVID-19 presented a clinical picture similar to that of non-infected pregnant women, with few obstetric or neonatal repercussions. There was a greater indication of cesarean deliveries before the disease aggravated, and there was no evidence of vertical transmission of the infection.

SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study.

IntroductionAssessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) during pregnancy is essential to guide clinical care. Previous studies on SARS‐CoV‐2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS‐CoV‐2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS‐CoV‐2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission.Material and methodsThis was a prospective population‐based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS‐CoV‐2 test during pregnancy to non‐infected pregnant women. Cases of SARS‐CoV‐2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID‐19) symptoms.ResultsAmong 82 682 pregnancies, 418 women had SARS‐CoV‐2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID‐19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41–3.41) and being foreign born (OR 2.12, 95% CI 1.70–2.64). Risk factors for hospital admission due to COVID‐19 included obesity (OR 2.74, 95% CI 1.00–7.51), smoking (OR 4.69, 95% CI 1.58–13.90), infection after gestational age (GA) 22 weeks (GA 22–27 weeks: OR 3.77, 95% CI 1.16–12.29; GA 28–36 weeks: OR 4.76, 95% CI 1.60–14.12), and having asthma (OR 4.53, 95% CI 1.39–14.79). We found no difference in any obstetrical or neonatal outcomes.ConclusionsOnly 1 in 20 women with SARS‐CoV‐2 infection during pregnancy required admission to hospital due to COVID‐19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS‐CoV‐2 infection in pregnancy were rare.

Pregnancy complicated with hepatitis B virus infection and preterm birth: a retrospective cohort study

BackgroundWe aimed to investigate whether maternal chronic hepatitis B virus (HBV) infection affects preterm birth (PTB) in pregnant women.MethodsWe retrospectively analyzed HBV-infected and non-infected pregnant women attending antenatal care at Fujian Maternity and Child Health Hospital, Fuzhou, China between January 1, 2016 to December 31, 2018. Participants were divided into HBV infection (n = 1302) and control (n = 12,813) groups. We compared baseline data, pregnancy and perinatal complications, and preterm delivery outcomes between groups. Performed multiple logistics regression analysis to adjust for confounding factors. Finally, we compared early PTB outcome between different HBV DNA level groups.ResultsThe incidence of preterm birth (gestation less than 37 weeks) was similar between the groups, early preterm birth (gestation less than 34 weeks) were significantly more among the HBV infection group than among the controls (1.6% VS. 0.8%; P = 0.003). After adjusting for confounding factors through logistics regression, HBV infection was found to be an independent early PTB risk factor gestation (adjusted odds ratio 1.770; 95% confidence interval [1.046–2.997]). The incidence of early PTB in < 500 group, 500 ~ 2.0 × 10e5 group and > 2.0 × 10e5 group was not statistically significant (P = 0.417).ConclusionHBV infection is an independent risk factor for early PTB, and the risk did not seem to be influenced by the levels of HBV DNA. Comprehensive programs focusing on pregnant women with HBV infection would reduce the incidence of adverse outcomes.

The Israeli study of Pfizer BNT162b2 vaccine in pregnancy: considering maternal and neonatal benefits.

Pregnant patients with COVID-19 are more likely to require intensive care and die compared with noninfected pregnant women. While the consequences of COVID-19 disease in pregnancy prompted many health care organizations to support vaccination in pregnancy, vaccine effects for mother and infant remained unclear. In this issue of the JCI, Beharier and Mayo et al. explored maternal and neonatal responses to the Pfizer BNT162b2 SARS-CoV-2 mRNA vaccine. The authors examined blood samples from women and cord blood of neonates following childbirth. Samples were stratified into three groups: vaccine recipients, unvaccinated participants with past positive SARS-CoV-2 test, and unvaccinated participants without prior infection. Vaccinated mothers and mothers with previous infection generated and transferred protective IgG antibodies across the placenta. This study provides evidence to support the safety and efficacy of COVID-19 vaccination in pregnancy with protection to the neonate against infection, outlining clear vaccine benefits for both maternal and child health.