Perinatal Outcomes In Pregnant Women Research Articles

Assessment of Perinatal Outcomes in Pregnant Women with Borderline Amniotic Fluid Index

Assessment of Perinatal Outcomes in Pregnant Women with Borderline Amniotic Fluid Index

The utility of systemic immune-inflammation index and systemic immune-response index in the prediction of adverse outcomes in pregnant women with coronavirus disease 2019: Analysis of 2649 cases.

To investigate the association of systemic immune-inflammation index (SII) and systemic immune-response index (SIRI) with adverse perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19). The cases were divided into (1) the Mild-moderate COVID-19 group (n= 2437) and (2) the Severe-critical COVID-19 group (n= 212). Clinical characteristics, perinatal outcomes, SII (neutrophilXplatelet/lymphocyte), and SIRI (neutrophilXmonocyte/lymphocyte) were compared between the groups. Afterward, SII and SIRI values were compared between subgroups based on pregnancy complications, neonatal intensive care unit (NICU) admission, and maternal mortality. A receiver operator characteristic analysis was performed for the determination of optimal cutoff values for SII and SIRI in the prediction of COVID-19 severity, pregnancy complications, NICU admission, and maternal mortality. Both SII and SIRI were significantly higher in complicated cases (p< 0.05). Cutoff values in the prediction of severe-critical COVID-19 were 1309.8 for SII, and 2.3 for SIRI. For pregnancy complications, optimal cutoff values were 973.2 and 1.6. Cutoff values of 1045.4 and 1.8 were calculated for the prediction of NICU admission. Finally, cut-off values of 1224.2 and 2.4 were found in the prediction of maternal mortality. SII and SIRI might be used in combination with other clinical findings in the prediction of poor perinatal outcomes.

Increased pulsatility index of uterine artery Doppler between 26 and 28 weeks of gestation and adverse perinatal outcomes

Objective To compare adverse perinatal outcomes in pregnant women with or without normalization of the mean pulsatility index (PI) uterine artery Doppler between 24 and 28 weeks of gestation. Methods Retrospective cohort which pregnant women were divided into three groups: normal uterine artery Doppler between 20–24 and 26–28 weeks (controls), abnormal uterine artery Doppler between 20–24 and normal between 26–28 weeks (anUtA), and abnormal uterine artery Doppler between 20–24 and 26–28 weeks (aaUtA). To compare adverse perinatal results between the groups Chi-square test was used. Binary logistic regression was used to assess the ability of uterine artery Doppler to predict birthweight < 10th and composite perinatal outcomes. Results Birthweight was significantly lower in the aaUtA compared to anUtA (2687 vs 3248 grams, p = 0.0479). A significant negative correlation was observed between the mean PI uterine artery Doppler during the 3rd trimester and birthweight (r = −0.13, R 2 = 0.035, p = .0192). The prevalence of composite perinatal outcomes was significantly higher in aaUtA compared to anUtA (25.9 vs 0%, p = .013). Mean PI uterine artery Doppler during the 3rd trimester was significant predictor for birthweight < 10th (OR: 2.74, CI 95% = 1.03–7.3), but the protodiastolic notch and the association between mean PI uterine artery Doppler and protodiastolic notch were not. Conclusion Maintenance of altered uterine artery Doppler during the 3rd trimester was associated with higher prevalence of composite perinatal outcomes and lower birthweight compared to its late normalization. Although modest, uterine artery Doppler in the 3rd trimester proved to be predictor of birthweight < 10th.

Effects of External Radiation Exposure on Perinatal Outcomes in Pregnant Women After the Fukushima Daiichi Nuclear Power Plant Accident: the Fukushima Health Management Survey.

This study aimed to investigate the effects of maternal exposure to external radiation on perinatal outcomes among women who experienced the Fukushima Daiichi Nuclear Disaster (FDND) using the Fukushima Health Management Survey (FHMS). Data from the Pregnancy and Birth Survey and Basic Survey in the FHMS were combined to analyze external maternal radiation exposure following the FDND, and the relationship between radiation dose and perinatal outcomes was analyzed using binomial logistic regression analysis. Missing dose data were supplemented using multiple imputation. A total of 6,875 individuals responded to the survey. Congenital anomalies occurred in 2.9% of patients, low birth weight (LBW) in 7.6%, small for gestation age (SGA; <10th percentile) in 8.9%, and preterm birth in 4.1%. The median maternal external radiation dose was 0.5 mSv (maximum, 5.2 mSv). Doses were classified as follows: <1 mSv (reference), 1 to <2 mSv, and ≥2 mSv. For congenital anomalies, the crude odds ratio for 1 to <2 mSv was 0.81 (95% confidence interval [CI], 0.56-1.17) (no participants with congenital anomaly were exposed to ≥2 mSv). At 1 to <2 mSv and ≥2 mSv, the respective adjusted odds ratios were 0.91 (95% CI, 0.71-1.18) and 1.21 (95% CI, 0.53-2.79) for LBW, 1.14 (95% CI, 0.92-1.42) and 0.84 (95% CI, 0.30-2.37) for SGA, and 0.91 (95% CI, 0.65-1.29) and 1.05 (95% CI, 0.22-4.87) for preterm birth. External radiation dose due to the FDND was not associated with congenital anomalies, LBW, SGA, or preterm birth.

Association of Obesity with Adverse Maternal and Perinatal Outcome in Pregnant Women

Introduction: Obesity is a current issue that has an impact on all healthcare services. Several prenatal and postpartum problems have maternal obesity as one of their risk factors. Many studies have shown that women with BMI≥30Kg/m2 experience increased incidence of intrapartum and perinatal complications. Objective: The objective of this study was to1determine the association of obesity with adverse maternal and perinatal outcome in pregnant women. Study design: Prospective cohort study. Setting: Obstetrics and Gynecology, Unit-II, Jinnah Hospital, Lahore. Material and methods: Total 232 pregnant women aged between 20-45 years presenting at ≥37 weeks of gestation. These patients were evaluated for obesity and two groups of patients were assimilated; those with obesity (BMI≥30 Kg/m2) and healthy controls (BMI 18.5-24.9 Kg/m2). Frequency of various fetomaternal outcome measures was noted and compared among these groups. A written informed consent was taken from each patient. Results: The age range from 20 years to 40 years with a mean of 28.40±5.30 years. Majority (n=210, 63.3%) of the patients were aged1between 20-30 years. The mean gestational age was 39.061.59 weeks. There were 157 (47.3%) primiparas and 175 (52.7%) multiparas. 187 (56.3%) patients were booked. Both the study groups1were comparable in terms1of mean age (p=0.613), mean gestational age (p=0.317), mean parity (p=0.168) and age (p=0.820), gestational age (p=0.071), parity (p=0.099) and booking status (p=0.580) groups distribution. The frequency of instrumental vaginal delivery (16.3% vs. 5.4%; p=0.001), cesarean delivery (36.1% vs. 10.2%; p&lt;0.001), post-partum hemorrhage (10.8% vs. 1.8%; p=0.001), poor Apgar score (15.1% vs. 4.8%; p=0.002) &amp; NICU admission (33.7% vs. 9.0; p&lt;0.001) was significantly higher in obese women compared to non-obese controls. Conclusion: Maternal obesity was found to be associated with significantly higher frequency of instrumental vaginal delivery, cesarean delivery, post-partum hemorrhage, fetal macrosomia, poor Apgar score at 5.0 minutes &amp; NICU admission regardless of patient’s age, gestational age, parity and booking status. Keywords: Maternal Obesity, Pregnancy, Maternal Complications, Fetal Complications

Obstetric and perinatal outcomes in women with endometriosis

Key content Endometriosis in pregnancy is associated with an increased risk of spontaneous miscarriage, pre‐eclampsia, postpartum haemorrhage, caesarean section, placenta praevia, fetal growth restriction, prematurity and adverse neonatal outcomes. Women with mild disease are considered as having ‘low‐risk endometriosis’ (LRE) and can expect a normal pregnancy and labour. The ‘high‐risk endometriosis’ (HRE) group may require additional antenatal and intrapartum specialist care. Learning objectives To understand the pathophysiologic basis of adverse obstetric and perinatal outcomes in pregnant women with endometriosis. To understand the obstetric outcomes in relation to the severity and staging of endometriosis. To appreciate the risk of spontaneous haemoperitoneum in pregnancy (SHiP) associated with endometriosis in pregnancy.

Symposium 2-5 - Clinical characteristics of pregnant women with COVID‑19 in Japan from a nationwide questionnaire survey

BackgroundWe examined the clinical characteristics and outcomes of pregnant women with COVID‑19 on a national scale in Japan.MethodsA nationwide questionnaire-based survey for all maternity services in Japan by the Japan Association of Obstetricians and Gynaecologists was conducted in July 2020 and July 2021, respectively. Information regarding maternal characteristics and epidemiological, clinical, treatment, and perinatal outcomes of pregnant women with COVID-19 during the first wave and second to fourth wave were collected.ResultsResponses from 1,418 and 1,288 institutions were assessed (65% and 60% of all delivery institutions in Japan.) Seventy-two and 1,474 pregnant women with COVID-19 were reported in the first wave and second to fourth wave, respectively. The most common route of infection was familial. Of the all patients, 80% were symptomatic, 7% had severe respiratory symptoms and one died (a tourist). The third trimester of pregnancy was the most common timing of diagnosis and severe cases were frequently reported in late pregnancy compared with in early pregnancy. Most pregnant women with COVID-19 had a cesarean section if delivery was necessary. In severe cases, preterm delivery due to infection was also common. There were no SARS-CoV-2 transmissions to newborns.ConclusionsThe importance of infection prevention should be emphasized, especially in women in late pregnancy, their families, and any cohabitants. The pregnant women in late pregnancy with COVID-19 need careful observation and follow-up.

Maternal and perinatal outcomes of pregnancy associated with COVID-19: Systematic review and meta-analysis.

INTRODUCTIONThis study explored maternal and infant outcomes in the periods of pregnancy, birth and the postpartum, in women with COVID-19.METHODSAfter PROSPERO registration (CRD42020191106), scanning for the studies was carried out over the period 5–15 May 2020 in the PubMed, Science Direct, EBSCO and Web of Science databases with the search string: [‘COVID-19’ AND (‘pregnancy’ OR ‘pregnant’ OR ‘maternal outcomes’ OR ‘infant outcomes’ OR ‘fetal outcomes’ OR ‘birth’)]. Studies reporting maternal and perinatal outcomes of pregnant women with COVID-19 were included. Data were extracted independently by two researchers and combined with meta-analysis and pooled analysis.RESULTSThe 54 studies included in this analysis contained data on 517 pregnant women diagnosed with COVID-19 and 385 infants. Of the pregnant women, 18% had gone into preterm labor and 77% had given birth by caesarean. Of the newborns, 19% had low birth weight, 14% had fetal distress, and 24% were admitted into the neonatal intensive care unit. Nine maternal and eight baby mortalities were reported in the studies.CONCLUSIONSThe study revealed that COVID-19 in pregnant women appeared to be negative maternal and infant outcomes, with mortalities as well.

Maternal and perinatal outcomes in pregnant women with confirmed COVID-19 infection, Santa Teresa Hospital, Comayagua, Honduras. Case series

RESUMENObjetivos: Describir el resultado materno y perinatal de las gestantes con infección confirmada por COVID-19 en una institución hospitalaria en Comayagua, Honduras.Materiales y métodos: Estudio descriptivo tipo serie de casos. Se incluyeron gestantes sintomáticas que consultaron o fueron remitidas desde el 1 de marzo de 2020 hasta el 31 de marzo del 2021 a una institución pública de referencia, con diagnóstico confirmado por PCR de infección por COVID-19. Se midieron variables sociodemográficas, obstétricas, severidad de la infección, estancia hospitalaria, complicaciones maternas y perinatales. Se estimó la frecuencia de infección por COVID-19 y los resultados maternos y perinatales de estas gestaciones; se realizó análisis descriptivo.Resultados: En el periodo descrito consultaron 2.258 gestantes, de estas se incluyeron 23, quienes cumplieron con los criterios de selección, para una frecuencia de infección por COVID-19 del 1,01 %. La población de estudio se caracterizó por estar constituida por mujeres jóvenes y en unión libre. Trece pacientes recibieron manejo ambulatorio por cuadro clínico leve, diez requirieron hospitalización. Las embarazadas manejadas ambulatoriamente finalizaron la gestación vía cesárea (76,9 %) por estado fetal insaisfactorio, con edad gestacional mayor o igual a 37 semanas, y tres casos fueron pretérmino (36 semanas). De las gestantes hospitalizadas, una desarrolló aborto espontáneo, y nueve finalizaron la gestación por una indicación obstétrica. Se presentó un parto prematuro y se documentó una muerte materna (4 %) y neonatal.Conclusiones: El 1 % de las gestantes adquirieron la infección por COVID-19 en el Hospital Santa Teresa de Comayagua en el perido de estudio. Se requieren más estudios que analicen el impacto materno perinatal de la infección por COVID-19 en la región centroamericana.

Ramadan Fasting and Maternal and Fetal Outcomes in Pregnant Women with Diabetes Mellitus: Literature Review.

There is an emerging Muslim and diabetic population in the United States and other Western countries and majority of pregnant women and patients with diabetes mellitus choose to fast during Ramadan. Fasting during Ramadan in pregnant women with diabetes may represent a ‘perfect storm’ of metabolic disturbances including hyperglycemia, hypoglycemia and ketosis. Recent continuous and flash glucose monitoring data suggests increased glycemic variability (fasting hypo- and post-Iftar hyperglycemia) in non-pregnant patients with diabetes during Ramadan. Only five small-scale studies, predominantly focused on women with gestational diabetes mellitus in Muslim-majority nations have explored maternal glycemic outcomes during Ramadan which is associated with lower mean blood glucose levels and higher frequency of fasting hypoglycemia. Data is limited however on important clinical outcomes such as symptomatic and serious hypoglycemia requiring hospitalization. Results have been conflicting regarding maternal Ramadan fasting and association with fetal outcomes in women without diabetes. Only one recently published study reported on perinatal outcomes in pregnant women with gestational diabetes which found no effect of Ramadan exposure on mean birthweight or macrosomia frequency but lower neonatal hypoglycemia prevalence, however a significant limitation was lack of documentation of maternal fasting status. At this stage, due to paucity of data, the current medical recommendation is against Ramadan fasting for pregnant Muslim women with diabetes. Large-scale population-based studies are warranted regarding maternal and fetal outcomes in pregnant fasting women with diabetes and such studies should characterize maternal fasting status and have meaningful and consistent clinical outcomes. High-quality data derived from these studies can assist clinicians in providing more evidence-based advice to safely navigate both mother and fetus through a potentially challenging pregnancy.

Clinical outcomes in pregnant women with coronavirus disease 2019 in a perinatal medical centre in Japan: a retrospective study of the first 1 year of the pandemic

In this retrospective study, we analysed clinical and demographic data from the medical records of 31 pregnant women with coronavirus disease 2019 (COVID-19) who were treated at our hospital between April 2020 and April 2021. The most common symptom was a fever; ∼10% of patients were asymptomatic. One patient with rapidly worsening pneumonia needed a Caesarean Section at 30 weeks and was admitted for intensive care. Twelve patients received perinatal care in our hospital (10 live births, one stillbirth, and one artificial abortion). Six patients delivered vaginally; the others delivered via caesarean section. Two patients had complications, including severe hypertensive disorders and preeclampsia. All patients recovered from COVID-19. Severe acute respiratory syndrome coronavirus 2 was not detected in the placenta, umbilical cord, cord blood, amniotic fluid, vaginal fluid, or breast milk in any patient. There were no neonatal adverse outcomes. The possibility of transmitting the coronavirus to pregnancy-related samples was low. IMPACT STATEMENT What is already known on the subject? COVID-19 has been affecting different countries in diverse ways, and the incidence, mortality, and morbidity rates of patients with COVID-19 vary widely by country or region and race. These differences in results may reflect racial differences and differences in national health care systems. Moreover, the information about the perinatal outcomes of pregnant women with COVID-19 and their newborns from Japan is limited. What do the results of this study add to what is known? We described the perinatal outcomes of 31 Japanese pregnant women with COVID-19 who were managed safely in a perinatal medical centre in Tokyo Japan, during the first 1 year of the pandemic. What are the implications of these findings for clinical practice and/or further research? Severe pneumonia and perinatal complications may occur, although no maternal and neonatal deaths were observed for COVID-19-positive pregnant women in our facility. Therefore, it is important to prevent this infection during pregnancy with the provision of effective medical care.

Chinese Herbal Medicines Have Potentially Beneficial Effects on the Perinatal Outcomes of Pregnant Women

Introduction: Tocolytic treatment is beneficial to pregnant women with a risk of premature labor or miscarriage. However, previous reports have shown that progestogen might not be effective and ritodrine may increase the risk of maternal vascular-related diseases. Chinese herbal products (CHP) are used as alternative therapies for pregnant women. The goal was to evaluate the efficacy of combined tocolytic therapy and CHP therapy in pregnancy outcomes for pregnant women in Taiwan. Materials and Methods: We conducted a retrospective cohort study based on the National Health Insurance Research Database. A total of 47,153 pregnant women treated with tocolytics aged 18–50 years from 2001 to 2015 were selected from two million random samples. According to the medical use of tocolytics and CHP, we divided the users into two groups: western medicine (WM) only (n = 40,961) and WM/CHP (n = 6,192) groups. A propensity score (PS)-matched cohort (6,192 pairs) was established based on baseline confounders. All participants were followed up to perinatal outcomes. Conditional logistic regression analysis was used to examine the effects of CHP use on the odds of miscarriage and preterm birth. Results: The adjusted odds ratio (OR) for premature birth in the WM/CHP group (n = 411, 6.64%) was significantly lower than in the WM group (n = 471, 7,61%) (0,86, 95% confidence interval [CI], 0.74–0.99). Further subgroup analysis based on the usage of formulae that activate blood and remove stasis or purgative formulae, the adjusted OR of preterm birth of those using these formulae was significantly lower in the WM/CHP group (n = 215, 6.32%) than that in the WM group (n = 265, 7.77%) (OR: 0.79, 95% CI: 0.65–0.96). Conclusion: We found that the combination of CHP and tocolytics can be beneficial to pregnant women in the prevention of premature birth. Further research is required to investigate causal relationships.

Doppler ultrasound findings in symptomatic pregnant women diagnosed with COVID-19

The primary aim of this study was to investigate the potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on maternal and foetal Doppler findings. Doppler ultrasound findings were compared in 40 pregnant women diagnosed with COVID-19 disease who required hospitalisation (group 1) and 30 healthy pregnant women (group 2). Maternal characteristics and birth histories were recorded. Body mass index, gestational week at birth, type of delivery, oligihydroamnios, pre-term birth (<37 weeks), low birth weight (<10 percentile), perinatal death and f1st and 5th minute Apgar scores were recorded. Birth weights and foetal biophysical profile (BPP) scores in group 1 were significantly lower than those in group 2. There was a statistically significant between-group difference in the umbilical artery pulsatility index (PI), umbilical artery resistive index (RI), middle cerebral artery (MCA) PI, MCA RI, mean uterine artery (UtA) PI, mean UtA RI and cerebroplacental ratio (CPR), the parameters used to evaluate foetal-maternal blood flow. In the pregnant group diagnosed with COVID-19 and hospitalised, all foetal-maternal Doppler indicators of foetal-maternal blood flow were impaired, and birth weights and BPP scores in these patients were statistically significantly lower than those in the healthy controls. Impact statement What is already known on this subject? Foetal and maternal vascular malperfusion characterised by decidual arteriopathy have been reported in pathologies of placentas from pregnant women with SARS-CoV-2 infection. What the results of this study add? It was determined that COVID-19 disrupted foetal and maternal blood flow. What the implications are of these findings for clinical practice and/or further research? Foetal biometric measurements and foetal Doppler may be useful in the follow-up of perinatal outcomes in pregnant women with COVID-19

COVID-19 mRNA vaccine in pregnancy: Results of the Swiss COVI-PREG registry, an observational prospective cohort study.

SummaryBackgroundPregnant individuals with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, prematurity, and stillbirth. In March 2021, vaccination for at risk pregnant women was recommended in Switzerland, expanding this to all pregnant women in May 2021. Our aim was to assess the safety of mRNA COVID-19 vaccines in pregnancy.MethodsThis multicentre prospective cohort study describes early adverse events and perinatal outcomes in pregnant women who received at least one dose of mRNA vaccine between March 1st and December 27th, 2021 in Switzerland, using the COVI-PREG registry. Early adverse events were collected at least one month following vaccine administration. Pregnancy and neonatal outcomes were extracted from medical records using the maternity discharge letters providing follow-up information up to 5 days after birth.FindingsOf 1012 vaccinated women, 894 (88·3%) received both injections during pregnancy, with BNT162b2 (n = 271) or mRNA-1273 (n = 623) vaccines. Local events (mainly local pain) were reported in 81·3% and 80·5% after the first and second doses. Rates of systemic reactions (mainly fatigue and headache) were similar after the first dose and most frequent after the second dose of mRNA-1273. Of the 1012 women, four (0·4%; 95%CI [0·1-1·0]) severe early adverse events occurred: pulmonary embolism, preterm premature rupture of membranes, isolated fever with hospitalisation, and herpes zoster. Of 107 patients vaccinated before 14 weeks, one (0·9%; 95%CI [0·0-5·1]) early spontaneous abortions was reported (8 weeks). Of 228 vaccinated before 20 weeks one (0·4%; 95%CI [0·0-2·4]) late spontaneous abortion was reported (16 weeks). Of 513 women exposed before 37 weeks, 33 (6·4%; 95%CI [4·5-8·9]) delivered preterm. Among 530 patients exposed in pregnancy, no stillbirth was reported and 25 (4·7%; 95%CI [3·0-6·8]) neonates were admitted to intensive care unit.InterpretationFrequent local and systemic effects were described after exposure to mRNA COVID-19 vaccines during pregnancy but severe events were rare. Women vaccinated during pregnancy did not experience higher adverse pregnancy or neonatal outcomes when compared to historical data on background risks in the obstetric population.FundingThis research was funded by a grant from the Swiss Federal Office of Public Health and the CHUV Foundation.

Adverse perinatal outcomes associated with HAART and monotherapy.

Assess adverse perinatal outcomes in pregnant women living with HIV (WLHIV) receiving HAART or zidovudine (ZDV) monotherapy, compared with antiretroviral therapy (ART)-naive WLHIV and HIV-negative women. Systematic review and meta-analysis. We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, and EMBASE for studies published between 1 January 1980 and 20 April 2020. We included studies reporting on the association of pregnant WLHIV receiving HAART or ZDV monotherapy with 11 perinatal outcomes: preterm birth (PTB), very PTB, spontaneous PTB (sPTB), low birth weight (LBW), very LBW, term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses were conducted. Sixty-one cohort studies assessing 409 781 pregnant women were included. WLHIV receiving ZDV monotherapy were associated with a decreased risk of PTB [relative risk 0.70, 95% confidence interval (CI) 0.62-0.79] and LBW (0.77, 0.67-0.88), and comparable risk of SGA, compared with ART-naive WLHIV. WLHIV receiving ZDV monotherapy had a comparable risk of PTB and LBW, and an increased risk of SGA (1.16, 1.04-1.30) compared with HIV-negative women. In contrast, WLHIV receiving HAART were associated with a comparable risk of PTB and LBW, and increased risk of SGA (1.38, 1.09-1.75), compared with ART-naive WLHIV. WLHIV receiving HAART were associated with an increased risk of PTB (1.55, 1.38-1.74), sPTB (2.09, 1.48-2.96), LBW (1.79, 1.51-2.13), term LBW (1.88, 1.23-2.85), SGA (1.80,1.34-2.40), and VSGA (1.22, 1.10-1.34) compared with HIV-negative women. Pregnant WLHIV receiving HAART have an increased risk of a wide range of perinatal outcomes compared with HIV-negative women.

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.

Clinical Manifestations and Maternal and Perinatal Outcomes in Pregnancy Following Laboratory-Confirmed SARS-CoV-2 Infection in South Korea

Purpose: To determine the clinical manifestations and maternal and perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19).Methods: We conducted a retrospective observational study of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to National Health Insurance Service (NHIS) Ilsan Hospital between August 2020 and October 2021. The maternal and perinatal outcomes were investigated.Results: Among 184 pregnant women infected with SARS-CoV-2, 79 women delivered. Of the women who delivered, with 36 women giving birth during the quarantine period. At delivery, 45 women were positive for SARS-CoV-2 by polymerase chain reaction (PCR), whereas 34 women were negative. The most common clinical manifestations were cough (65.2%), fever (38.0%), and myalgia (33.2%). Regarding perinatal outcomes, none of the babies had an Apgar score &lt;7 at 5 minutes, and none were intubated following the delivery. The preterm birth rate and small-for-gestational-age (SGA) rate were 15.2% and 16.5%, respectively. All babies who was delivered at NHIS Ilsan Hospital were negative for SARS-CoV-2 infection by PCR, which was evaluated using amniotic fluid, cord blood, neonatal nasopharyngeal and oropharyngeal swabs in the 1st and 2nd days following delivery, although 45 women were positive for SARS-CoV-2 infection by PCR at the time of delivery.Conclusion: Most pregnant women with COVID-19 in South Korea were unlikely to manifest symptoms or present with a severe disease progression. The observed preterm birth rate and SGA rate were higher in women with COVID-19 than in those without COVID-19. However, there was no evidence of vertical transmission, and all babies were negative for SARS-CoV-2 infection during pregnancy.

Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort

This study aimed to assess the impact of the Bolsa Familia Program on perinatal outcomes of pregnant women. A cohort study was conducted with pregnant women supported by prenatal services at 17 Family Health Units in Bahia, Brazil. A previously tested structured questionnaire, which has sociodemographic, economic, prenatal care, lifestyle, and nutritional variables, has been used to collect data. The outcomes included premature birth and low birth weight. A hierarchical conceptual model was constructed, and logistic regression analysis was performed. From a total of 1173 pregnant women, the identified average age was 25.44 years and 34.10% had pre-gestational overweight. The non-beneficiary pregnant women presented a 1.54 (95% CI = 0.46–5.09) times higher chance of giving birth to children with low weight and a 1.03 (95% CI = 95% CI = 0.53–2.00) times chance of premature birth when compared to the beneficiary group. In the multilevel model, some variables were statistically significant, such as age between 18 and 24 years (p = 0.003), age greater than or equal to 35 years (p = 0.025), family income (p = 0.008), employment status (p = 0.010), and maternal height (p = 0.009). The Bolsa Familia Program, as an integrated strategy of social inclusion and economic development, is suggested to exert a protective effect on the health of mother-concept binomial.

Effect of Levothyroxine on Pregnancy Outcomes in Pregnant Women With Hypothyroxinemia: An Interventional Study

ContextAdverse maternal outcomes and perinatal complications are associated with maternal hypothyroidism. However, the utility of levothyroxine (L-T4) in the treatment of pregnant women with hypothyroxinemia is unclear.ObjectiveThis study aimed to evaluate the effects of L-T4 on maternal and perinatal outcomes in pregnant women with hypothyroxinemia.MethodsThe nonrandomized interventional study was conducted at Shanghai First Maternity and Infant Hospital, Punan Hospital of Shanghai, and Beicai Community Health Center of Shanghai. The pregnant women with hypothyroxinemia from the first trimester were enrolled and divided into treatment and control groups. 463 taking L-T4 and 501 not administering L-T4 were analyzed in the study. All participants were screened for TPOAB/TGAB antibody status.Main OutcomeThe primary outcome of the study was the hypertensive disorder of pregnancy (HDP), measured as the proportion of HDP. In addition to this primary outcome, some secondary outcomes will be measured: miscarriage, gestational diabetes mellitus, premature rupture of membranes, placental abruption, intrahepatic cholestasis of pregnancy, fetal distress, macrosomia, and neonates admitted to the neonatal intensive care unit (NICU). The effects of L-T4 on the incidence of adverse pregnancy outcomes and perinatal complications were compared.ResultsMultivariate logistic regression analysis showed that L-T4 treatment (adjusted odds ratio = 1.78 [95% CI = 1.00-3.16], p = 0.04) significantly reduced the incidence of miscarriage. Otherwise, lower neonates admitted to the NICU were strongly associated with the L-T4 group (adjusted odds ratio = 1.36 [95% CI = 1.01 – 1.83], p = 0.04). There were no significant differences in the incidence rates of other adverse maternal outcomes and perinatal complications between pregnant women with hypothyroxinemia receiving and those not receiving L-T4 treatment.ConclusionThe incidence of HDP was not significantly reduced using L-T4 in pregnant women with hypothyroxinemia. The results of this study also showed that L-T4 treatment significantly reduced the miscarriages rate and the proportion of newborns admitted to the NICU.

Clinical characteristics and perinatal outcomes of pregnant women with Coronavirus-19 disease

Objective: The aim of this study was to evaluate the maternal and perinatal outcomes of COVID-19 infection during pregnancy. Methods: We performed a retrospective review of medical records of 37 pregnant women with the diagnosis of COVID-19. The clinical characteristics, laboratory results, perinatal and neonatal outcomes were analyzed. Results: The majority of cases with COVID-19 were evaluated as mild (97.3%). None of the women needed intensive care unit or invasive mechanical ventilation and mortality were not observed. The most common symptoms were fever (62.2%) and cough (40.5%). Of all the pregnancies, 5.4% ended with abortion, 2.7% with stillbirth, and 10% of the infants were hospitalized in the neonatal intensive care unit. Neonatal mortality was not observed. Conclusion: In our study, none of the pregnant women with SARS-CoV-2 infection had severe illness. Vertical transmission of SARS-CoV-2 which was possible in several studies is not observed in our patient population.