Pregnant Women In Italy Research Articles

Vaccinazioni in gravidanza: occasione da non perdere

Whooping cough is a highly contagious bacterial infection primarily affecting the respiratory system, leading to severe coughing, particularly in infants under one year of age. These infants face significant risks for serious complications, including pneumonia and neurological damage. While adults may show mild symptoms, they can still spread the disease. Vaccination has greatly reduced whooping cough cases, but periodic outbreaks occur due to waning immunity from both infection and vaccination. To protect newborns, it is crucial for pregnant women to receive the acellular diphtheria-tetanus-pertussis (dTPa) vaccine during the third trimester, ideally between weeks 27 and 32, facilitating the transfer of maternal antibodies to the baby. However, recent statistics show that only about 50% of pregnant women in Italy are vaccinated, with notable disparities based on age and education. The dTPa vaccination significantly reduces the risk of severe whooping cough in infants, as the disease can lead to high hospitalization rates and is potentially fatal. Furthermore, the influenza vaccine is recommended during pregnancy to protect both mothers and children from severe illness. This article aims to raise awareness about the importance of vaccination against whooping cough and influenza during pregnancy, emphasizing that successful immunization requires a collective effort from the entire community to protect vulnerable populations, particularly newborns.

Respiratory Syncytial Virus: Willingness towards a Future Vaccine among Pregnant Women in Italy.

This cross-sectional survey was designed to evaluate pregnant women's awareness regarding Respiratory Syncytial Virus (RSV) infection and willingness to receive the vaccine during pregnancy and to vaccinate their newborn against RSV. An anonymous survey was administered from 20 April to 30 June 2023, to pregnant women aged ≥ 18 years attending gynecology wards of randomly selected public hospitals in southern Italy. A minimum sample size of 427 participants was calculated. The survey assessed women's socio-demographic characteristics, health-related information, their source(s) of information, and attitudes regarding RSV. A total of 490 women participated. Those who were married/cohabiting, with a high-school degree compared to those who had a university degree, and those who needed additional information were more concerned that the newborn could acquire the RSV infection. The perceived utility of a future RSV vaccine administered during pregnancy was higher among those who were married/cohabiting, with a university degree, those with very good perceived health status, those who received information from healthcare workers, and those who needed additional information. Only 45.9% were willing to be vaccinated during pregnancy, and this was more likely among those with a university degree, with a very good perceived health status, who had received information from healthcare workers, and who needed more information. Finally, almost two-thirds (61.1%) were willing to vaccinate their newborn, and this was more likely among women with a university degree, with a very good perceived health status, and who needed additional information. An education campaign regarding RSV infection and its vaccine is needed in order to improve women's perception and to support healthcare workers in promoting it when it will be available.

Vaccine hesitancy and knowledge regarding maternal immunization among reproductive age women in central Italy: a cross sectional study.

Vaccination in pregnancy offers protection to the mother and the newborn. In Italy, influenza, pertussis, and COVID-19 vaccinations are recommended in pregnancy, but vaccination coverage is still far from the National Immunization Plan goals. We aimed to assess knowledge and attitude on maternal immunization in two groups of Italian women, in pregnancy and in reproductive age (non pregnant). A cross sectional study on Italian childbearing age women gathering information on their knowledge on maternal immunization and attitudes to receiving influenza and pertussis vaccines in pregnancy was carried out at the University of Rome Tor Vergata, between September 2019 and February 2020. Logistic and multinomial regressions were chosen as statistical tests for our analysis. 1,031 women participated in the survey by answering the questionnaire. Out of these, 553 (53.6%) women were pregnant, and 478 (46.4%) were in the reproductive age. 37% (204/553) of pregnant women and 41% (198/476) of non pregnant women are aware of the existence of an immunization plan for pregnant women in Italy. The group with age between 20 and 30, for both pregnant women and women in the reproductive age, has a better knowledge of vaccination in pregnancy. Working status is a variable associated with more awareness about vaccination during pregnancy only for pregnant women (OR = 2.34, p < 0.00001). Educational status, trimester of pregnancy and knowledge on the topic are associated with vaccine hesitancy in our multivariate analysis for pregnant women. In the reproductive age group women who had a previous pregnancy are more likely to be hesitant towards vaccination in pregnancy, on the other hand the one with a higher knowledge and educational status are more likely to get vaccinated. The study highlights the persistent vaccine hesitancy among Italian women of reproductive age and pregnant women. Despite healthcare providers being identified as a reliable source of information, their recommendations alone are insufficient to overcome vaccine hesitancy. Factors such as employment status, educational level, pregnancy trimester, and knowledge about vaccinations during pregnancy influence vaccine hesitancy. Tailored educational interventions and communication campaigns targeting these areas can help reduce vaccine hesitancy and promote maternal immunization.

COVID-19 vaccination hesitancy and willingness among pregnant women in Italy.

BackgroundPregnant women, especially those with comorbidities, compared to those non-pregnant, have higher risk of developing a severe form of COVID-19. However, COVID-19 vaccine uptake is very low among them.MethodsAn anonymous questionnaire was administered to randomly selected women 18 years of age that were currently pregnant or had just given birth between September 2021 and May 2022 in the geographic area of Naples. Vaccine hesitancy was assessed using the vaccine hesitancy scale (VHS).ResultsA total of 385 women participated. Women who had not been infected by SARS-CoV-2 and who needed information about vaccination against COVID-19 had a higher perceived risk of being infected with SARS-CoV-2. More than half (54.3%) of the women were very afraid of the potential side effects of the COVID-19 vaccination on the fetus. There was higher concern of the side effects of the vaccine on the fetus among those who did not have a graduate degree, those with high-risk pregnancy, those who had not been infected by SARS-CoV-2, those who were more concerned that they could be infected by SARS-CoV-2, those who did not know that this vaccination was recommended for them, and those trusting mass media/internet/social networks for information. Only 21.3% were vaccinated when pregnant, mostly women with a university degree, those who had been infected by SARS-CoV-2 before pregnancy, those who did not need information, and those who acquired information about the vaccination from gynecologists. Almost three-quarters (71.9%) were willing to receive the vaccination and those more likely were those with a university degree, those who have had at least one relative/cohabitant partner/friend who had been infected by SARS-CoV-2, those who were more concerned that they could be infected by SARS-CoV-2, and those who were not extremely concerned of the side effects of the vaccine on the fetus. A total of 86.4% were highly hesitant. Highly hesitant were respondents who did not get a graduate degree, those less concerned that they could be infected by SARS-CoV-2, and those trusting mass media/internet/social networks for information.ConclusionPublic health efforts and education campaigns for pregnant women are needed for changing their perception patterns and for supporting gynecologists in promoting the uptake of this vaccination.

Longitudinal Nutritional Intakes in Italian Pregnant Women in Comparison with National Nutritional Guidelines.

Background: Nutritional quality during pregnancy is crucial for mother and child health and their short/long-term outcomes. The aim of this study is to evaluate the adherence to nutritional recommendations in Italy during the three pregnancy trimesters in Normal Weight (NW) and Over Weight (OW) women. Methods: Data from a multicenter randomized controlled trial included 176 women (NW = 133; OW = 43) with healthy singleton pregnancies enrolled within 13 + 6 weeks of gestation. Dietary intake was assessed every trimester by a Food Frequency Questionnaire. Results: OW and NW had similar gestational weight gain. However, as Institute of Medicine (IOM) recommend lower gestational weight gain (GWG) for OW, they exceeded the suggested range. In both groups, caloric intake during the three trimesters never met recommendations. Protein intake in first and second trimester was higher than recommendations, as was sugars percentage. Dietary fiber intake was lower in OW. Polyunsaturated fatty acids, calcium, iron and folic acid requirements were never satisfied, while sodium intake exceeded recommendations. Conclusions: NW and OW women in Italy do not adhere to nutritional recommendations during pregnancy, with lower caloric intake, protein and sugars excess and inadequacies in micronutrients intake. Pregnant women in Italy should be provided with an adequate counseling and educational intervention as well as supplementation when indicated.

Exploring Tdap and influenza vaccine uptake and its determinants in pregnancy: a cross-sectional study.

The literature claims that an increased risk of complications from pertussis and influenza exists for pregnant women and infants. Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines seem to decrease this risk so that several countries are committed to increase vaccination uptake, but not all of them know their own vaccination coverage and factors that motivate this population to vaccination. A cross-sectional survey was conducted. We conducted this survey to estimate among pregnant women: 1) the vaccine coverage, 2) the availability of information, 3) the knowledge about maternal Tdap and influenza vaccination, 4) the factors that could have driven unvaccinated pregnant women to have themselves vaccinated. In addition, determinants of Tdap and influenza vaccine uptake and correct knowledge about vaccine-preventable diseases and vaccination in pregnancy were assessed using univariate and multivariate analyses. Of the 250 women included in the present study, only 58 (23.2%, 95% Confidence Interval (CI): 18-28.4%) and 21 (8.1%, 95% CI: 5-11.8%) reported that they had been vaccinated with Tdap and influenza vaccine, respectively, during their current pregnancy. The most common reasons cited for getting themselves vaccinated was having background knowledge of the health problems due to the diseases prevented by Tdap and influenza vaccines, awareness regarding these vaccines being recommended in pregnancy, knowledge of their effectiveness and/or side effects, and having been informed about vaccination by a healthcare professional. Influenza and Tdap vaccine uptake among pregnant women in Italy is low, however, the present study showed that women are available to get vaccinated during pregnancy when adequately informed about the vaccines recommended.

The first SARS-CoV-2 wave among pregnant women in Italy: results from a prospective population-based study.

This study aimed to estimate the incidence of SARS-CoV-2 infection among pregnant women during the first pandemic wave in Italy, and to describe COVID-19 disease characteristics and maternal and perinatal outcomes. National population-based prospective cohort study collecting information on women with SARS-CoV-2 diagnosis, confirmed within 7 days from hospital admission. The national SARS-CoV-2 rate was 6.04 per 1,000 births (95% CI 5.62-6.49) among pregnant women and 7.54 (95% CI 7.47-7.61) among women in reproductive age. 72.1% of the cohort developed mild COVID-19 disease without pneumonia nor need for ventilatory support. Severe disease was significantly associated with women's previous comorbidities (OR 2.55; 95% CI 0.98-6.90), obesity (OR 4.76; 95% CI 1.79-12.66) and citizenship from High Migration Pressure Countries (OR 3.43; 95% CI 1.27-9.25). During the first pandemic wave in Italy, the SARS-CoV-2 rate among pregnant women was lower compared to that detected among women of reproductive age, and risks of severe COVID-19 disease and adverse maternal and perinatal outcomes were rare.

Pregnant women voice their concerns and birth expectations during the COVID-19 pandemic in Italy

BackgroundIn March 2020, COVID-19 was declared to be a pandemic. While data suggests that COVID-19 is not associated with significant adverse health outcomes for pregnant women and newborns, the psychological impact on pregnant women is likely to be high. AimThe aim was to explore the psychological impact of the COVID-19 pandemic on Italian pregnant women, especially regarding concerns and birth expectations. MethodsA cross-sectional online survey of pregnant women in Italy was conducted. Responses were analysed for all women and segregated into two groups depending on previous experience of pregnancy loss. Analysis of open text responses examined expectations and concerns before and after the onset of the pandemic. FindingsTwo hundred pregnant women responded to the first wave of the survey. Most (n=157, 78.5%) had other children and 100 (50.0%) had a previous history of perinatal loss. ‘Joy’ was the most prevalent emotion expressed before COVID-19 (126, 63.0% before vs 34, 17.0% after; p<0.05); fear was the most prevalent after (15, 7.5% before vs 98, 49.0% after; p<0.05). Positive constructs were prevalent before COVID-19, while negative ones were dominant after (p<0.05). Across the country, women were concerned about COVID-19 and a history of psychological disorders was significantly associated with higher concerns (p<0.05). A previous pregnancy loss did not influence women’s concerns. ConclusionsWomen’s expectations and concerns regarding childbirth changed significantly as a result of the COVID-19 pandemic in Italy. Women with a history of psychological disorders need particular attention as they seem to experience higher levels of concern.

Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study.

Objectives Coronavirus (COVID-19) is a new respiratory disease that is spreading widely throughout the world. The aim of this study was to evaluate the psychological impact of COVID-19 pandemic on pregnant women in Italy. Methods We considered 200 pregnancies attending our antenatal clinic. A questionnaire was sent to each woman in the days of maximum spread of COVID-19. Sectional was finalized to acquire in 18 items maternal characteristics and to test the women's perception of infection. Section included the State-trait anxiety inventory (STAI) 40 items validated test for scoring trait anxiety (basal anxiety, STAI-T) and state anxiety (related to the ongoing pandemic, STAI-S). An abnormal value of STAI was considered when≥40. Results The questionnaire was completed by 178 women (89%). Fear that COVID-19 could induce fetal structural anomalies was present in 47%, fetal growth restriction in 65% and preterm birth in 51% of the women. The median value of STAI-T was 37 and in 38.2% of the study group STAI-T score≥40 was evidenced. STAI-S values were significantly higher with an increase of median values of 12 points (p≤0.0001). There was a positive linear correlation between STAI-T and STAI-S (Pearson=0.59; p≤0.0001). A higher educational status was associated with increased prevalence of STAI-S≥ 40(p=0.004). Subgrouping women by the other variables considered did not show any further difference. Conclusions COVID-19 pandemic induces a doubling of the number of women who reached abnormal level of anxiety. These findings validate the role of the remote use of questionnaire for identifying women at higher risk of anxiety disorders allowing the activation of support procedures.

Use and Intentional Avoidance of Prescribed Medications in Pregnancy: A Cross-Sectional, Web-Based Study among 926 Women in Italy.

Nation-wide information about medication use in pregnancy is lacking for Italy, and no study has so far investigated the prescribed medications which pregnant women deliberately avoid. In this study, we map medication use patterns in pregnancy, as well as the extent and type of prescribed medications which are purposely avoided by pregnant women in Italy. This is a sub-study within the “Multinational Medication Use in Pregnancy Study”—a cross-sectional, web-based study conducted in Italy from 7 November 2011 to 7 January 2012. Using an anonymous electronic questionnaire, we collected data from pregnant women and new mothers on medication use and deliberate avoidance during pregnancy and maternal characteristics. The sample included 926 women residing in Italy. The point prevalence of total medication use was 71.2%. Whereas 61.4% and 12.4% of women reported medication use for the treatment of short and longer-term illnesses, respectively, only 8.8% reported medication use for the treatment of both a short and a longer-term illness in pregnancy. We found no substantial differences in estimates across various geographical areas of Italy. Overall, 26.6% of women reported to have deliberately avoided a prescribed medication in pregnancy—most often nimesulide or ketoprofen, but also antibiotics. We conclude that prenatal exposure to medication is common among women in Italy, but estimates are lower than in other Western countries. Intentional avoidance of important medications by pregnant women raises concerns about the safeguarding of maternal–child health.

Barriers and facilitators regarding influenza and pertussis maternal vaccination uptake: A multi-center survey of pregnant women in Italy

ObjectiveIn 2017, the Italian Ministry of Health issued the new 2017-19 National Plan of Vaccine Prevention and pregnant women were targeted to be vaccinated against influenza and pertussis. Our study aim was to assess the barriers and facilitators regarding maternal immunization acceptance among pregnant women after the launch of this program. Study designWe conducted a multi-center survey in three Italian cities between March and June 2018. Collected data were analyzed anonymously, and included information about current recommendations of maternal immunization, antenatal care characteristics and reasons for accepting or rejecting vaccination. ResultsA total of 743 pregnant women completed the survey. Half of the study population were aged 25–35 years and 88 % were Italian. Only 18 % pregnant women received advice to be vaccinated. In this group, the vaccine was recommended in most cases by an obstetrician-gynecologist (68 %) and during a routine antenatal visit (74 %). Self-reported influenza and pertussis vaccination coverage was 6.5 % (95 % confidence interval, 4.9 %–8.5 %) and 4.8 % (95 % confidence interval, 3.5 %–6.6 %), respectively. The main vaccination barriers identified were lack of vaccine recommendation by any health-care provider (81 %) and safety concerns (18 %). Respondents mentioned the willingness to protect their offspring (82 %) and themselves (66 %) and having received immunization advice by a maternal care provider (62 %), as the main vaccination facilitators. ConclusionsLack of immunization advice by health-care providers and safety concerns were the main vaccination barriers against influenza and pertussis, among surveyed pregnant women. Vaccine delivery in the antenatal care setting could lead to increase of vaccine acceptance among pregnant women.

Insights and expectations for Tdap vaccination of pregnant women in Italy

Background Pertussis is a widespread vaccine-preventable disease, associated with an increasing trend to hospitalization among newborns. Pertussis in newborns can be fatal, and the most effective way to prevent it is maternal immunization (MI) with a reduced antigen content tetanus, diphtheria, and acellular pertussis vaccine (Tdap). In Italy, the National Immunization Plan (NIP) 2017–2019 introduced de novo Tdap vaccination during each pregnancy at no cost for the recipient. Despite this, vaccination coverage is suboptimal. This survey of pregnant women across Italy was conducted to investigate their knowledge and expectations of Tdap. Methods A cross-sectional survey was conducted. Pregnant women up to 28th gestational weeks were interviewed by Telephone using a questionnaire with 16 questions. Statistics were descriptive. Results The final sample recruited 600 respondents evenly distributed across Italy. The average duration of pregnancy at the time of the interview was 20.8 weeks (standard deviation [SD] 6.0). Most women (60.7%) were between 30 and 40 years of age. About half were aware of the risks of pertussis for newborns (54.5%) and the increased risk of hospitalization (59.8%); 47.2% were aware that Tdap MI was offered free of charge under the NIP. Safety information regarding the mother and newborn was considered the most important information in deciding whether to be vaccinated (47.4%), followed by safety information related only to the newborn (29.5%). About half (52.2%) stated that they would “certainly” accept MI, and 25.3% would like to receive more information. Gynecologists were the preferred healthcare providers (HCPs) for the provision of MI information (34.3%), followed by pediatricians (25.5%). Two-thirds of the respondents would prefer to be informed about MI before getting pregnant (66.0%). Vaccines investigated specifically for use in pregnancy were preferred by respondents. Overall, no relevant differences were observed between women pregnant for the first time and those with more than one pregnancy, nor between geographical regions. Conclusions The results show room for improving the awareness and understanding of the risks of pertussis for infants and the protective role of MI. The pregnant women preferred to receive advice on MI from an HCP, primarily their gynecologist. They were most interested in information on the safety profile of Tdap during pregnancy, on the mother, fetus, and newborn. The potential impact of this study to support clinical practice of Healthcare Providers is highlighted in the Focus on the Patient section.

Factors influencing refusing of flu vaccination among pregnant women in Italy: Healthcare workers' role.

BackgroundPregnant women are at increased risk of influenza complications. Influenza vaccine provides them a substantial protection.ObjectiveThe aim of this study was to investigate determinants associated with non‐adherence to influenza vaccine recommendations in pregnant women in Italy.MethodsA cross‐sectional study has been carried out among pregnant women attending their follow‐up visit in some mother and child services in a Region of Italy from October 2016 to January 2017. The study protocol was approved by the local research Ethics. A self‐administered close‐ended questionnaire has been administered to the pregnant women. Differences in background, socio‐demographic characteristics, knowledge and attitudes towards flu vaccine were tested in vaccinated and unvaccinated women. Multivariate analysis was performed to control for confounding factors.ResultsThree hundred and sixty‐six women answered the survey (97% response rate) and 96.1% (348) declared of being unvaccinated against influenza during the 2016‐2017 influenza season. Frequent reasons for refusing vaccination were drugs objection and concerns about vaccines’ effects. According to the refusal attitude, influenza knowledge was low in the group. Moreover, analysis showed that low adherence to vaccination is associated to lacking promotion of vaccination to pregnant women carried out by healthcare workers (P < 0.005).ConclusionsHealthcare workers have a key role in assisting women during the gestational period, so their active involvement in vaccination promotion is essential. It is necessary to improve health care workers’ knowledge about vaccine relevance in protecting pregnancy and their communication skills to properly inform pregnant women.

Vaccination knowledge and acceptability among pregnant women in Italy

ABSTRACTThe aims of this survey were to ascertain pregnant women's level of knowledge and acceptability on the vaccinations and to identify their associations with several characteristics. A cross-sectional study was performed from December 2017 through March 2018 in the geographic area of Naples, Italy. The study used two stages cluster sampling method for selection and recruitment of participants. Data were collected through face-to-face interviews with pregnant women present at the Obstetrics outpatient clinic of the selected hospitals. A total of 358 respondents agreed to be interviewed out of the 405 pregnant women selected. One-fourth knew at least one of the vaccinations recommended during pregnancy and only 2.8% correctly identified all of these. Women who had received information about the vaccinations during pregnancy from general practitioners or gynecologists or other sources and those with at least one child were more likely to know at least one of the recommended vaccinations, whereas women with middle school education were less knowledgeable. None of the women had received tetanus, diphtheria, and acellular pertussis vaccine and only 1.4% the seasonal influenza vaccination. Only 27.9% reported a positive willingness to receive all the recommended vaccinations during pregnancy. Pregnant women would be willing to get all recommended vaccinations if they had at least one child and if they needed additional information, whereas the willingness was significantly lower among women who had reported high school as the highest level of education, who were in the second trimester of pregnancy, and who felt that the recommended vaccines administered during pregnancy were less dangerous for them and for the unborn child. This study suggests important focus points to be taking into account for informing and for implementing education activities on the benefits regarding vaccinations in order to increase the level of knowledge and the uptake in pregnant women.

Drug prescribing during pregnancy in a central region of Italy, 2008-2012

BackgroundDrug consumption during pregnancy is a matter of concern, especially regarding drugs known or suspected to be teratogens. Little is known about drug use in pregnant women in Italy. The present study is aimed at examining the prevalence, and to detect potential inappropriateness of drug prescribing among pregnant women in Latium, a region of central Italy.MethodsThis retrospective study was conducted on a cohort of women aged 18-45 years who delivered between 2008 and 2012 in public hospitals. Women were enrolled through the Regional Birth Register. After linking the regional Health Information Systems and the Regional Drug Claims Register, women’s clinical data and prescribed medications were analyzed. Italian Medicine Agency (AIFA) and US Food and Drug Administration (FDA) evidence were used to investigate inappropriate prescribing and teratogenic risk.ResultsExcluding vitamins and minerals, 80.6% (n = 153,079) of the women were prescribed at least one drug during pregnancy, with an average of 4.6 medications per pregnancy. Drugs for blood and hematopoietic organs were the most commonly prescribed (53.0%,), followed by anti-infectives for systemic use (50.7%). Among the inappropriate prescriptions, progestogen supplementation was given in 20.1% of pregnancies; teratogen drugs were prescribed in 0.8%, mostly angiotensin co-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) (0.3%).ConclusionsIn Latium, drugs are widely used in pregnancy. Prescriptions of inappropriate drugs are observed in more than a fifth of pregnancies, and teratogens are still used, despite their known risk. Continuous updates of information provided to practitioners and an increased availability of information to women might reduce inappropriate prescribing.

A/H1N1 pandemic influenza vaccination: A retrospective evaluation of adverse maternal, fetal and neonatal outcomes in a cohort of pregnant women in Italy

Although concerns about safety of influenza vaccination during pregnancy have been raised in the past, vaccination of pregnant women was recommended in many countries during the 2009 A/H1N1 pandemic influenza. A retrospective cohort study was conducted to evaluate the risk of adverse maternal, fetal and neonatal outcomes among pregnant women vaccinated with a MF59-adjuvanted A/H1N1 pandemic influenza vaccine.The study was carried out in four Italian regions (Piemonte, Friuli-Venezia-Giulia, Lazio, and Puglia) among 102,077 pregnant women potentially exposed during the second or third trimester of gestation to the vaccination campaign implemented in 2009/2010. Based on data retrieved from the regional administrative databases, the statistical analysis was performed using the Cox proportional-hazards model, adjusting for the propensity score to account for the potential confounding effect due to the socio-demographic characteristics and the clinical and reproductive history of women.A total of 100,332 pregnant women were eligible for the analysis. Of these, 2003 (2.0%) received the A/H1N1 pandemic influenza vaccination during the second or third trimester of gestation. We did not observe any statistically significant association between the A/H1N1 pandemic influenza vaccination and different maternal outcomes (hospital admissions for influenza, pneumonia, hypertension, eclampsia, diabetes, thyroid disease, and anaemia), fetal outcomes (fetal death after the 22nd gestational week) and neonatal outcomes (pre-term birth, low birth weight, low 5-min Apgar score, and congenital malformations). Pre-existing health-risk conditions (hospital admissions and drug prescriptions for specific diseases before the onset of pregnancy) were observed more frequently among vaccinated women, thus suggesting that concomitant chronic conditions increased vaccination uptake. The results of this study add some evidence on the safety of A/H1N1 pandemic influenza vaccination during pregnancy but, because of the reduced statistical power, meta-analyses and large multi-centres studies are needed in order to obtain more conclusive results, especially for rare outcomes.

Neutralizing and IgG antibodies against simian virus 40 in healthy pregnant women in Italy.

ObjectivePolyomavirus simian virus 40 (SV40) sequences have been detected in various human specimens and SV40 antibodies have been found in human sera from both healthy individuals and cancer patients. This study analyzed serum samples from healthy pregnant women as well as cord blood samples to determine the prevalence of SV40 antibodies in pregnancy.MethodsSerum samples were collected at the time of delivery from two groups of pregnant women as well as cord bloods from one group. The women were born between 1967 and 1993. Samples were assayed by two different serological methods, one group by neutralization of viral infectivity and the other by indirect ELISA employing specific SV40 mimotopes as antigens. Viral DNA assays by real-time polymerase chain reaction were carried out on blood samples.ResultsNeutralization and ELISA tests indicated that the pregnant women were SV40 antibody-positive with overall prevalences of 10.6% (13/123) and 12.7% (14/110), respectively. SV40 neutralizing antibodies were detected in a low number of cord blood samples. Antibody titers were generally low. No viral DNA was detected in either maternal or cord bloods.ConclusionsSV40-specific serum antibodies were detected in pregnant women at the time of delivery and in cord bloods. There was no evidence of transplacental transmission of SV40. These data indicate that SV40 is circulating at a low prevalence in the northern Italian population long after the use of contaminated vaccines.

Prescription of systemic antibiotics during pregnancy in primary care in Friuli Venezia Giulia, Northeastern Italy

Objective: To investigate the prescriptions of systemic antibiotics in a population of pregnant women in Italy, to identify socio-demographic factors associated with increased risk of being prescribed potentially unsafe medications, to compare prescriptions before and during pregnancy and to identify the prescribing General Practitioners (GPs).Methods: A retrospective study based on administrative anonymous databases included all women resident of the Friuli Venezia Giulia Region who delivered babies in 2011 (n = 9196). The antibiotic prescription risk was calculated by trimester and overall, and compared with that in the year before. Multivariate logistic regression analyses assessed the role of socio-demographic factors on the risk of being prescribed medications that should not be used as first-line.Results: 6688 women (72.7%) were prescribed medicines (27 363 prescriptions) during their pregnancies. Antibiotics were prescribed to 2279 women (24.8%), less commonly during pregnancy than before. Prescriptions were more frequent in the second and third trimesters. 1736 women were prescribed antibiotics other than first-line medicines (of which, seven tetracyclines and 58 quinolones, which are frankly not recommended). Those women were more frequently younger and less educated. The GPs responsible for those prescriptions were identified.Conclusions: In order to improve the prescription of antibiotics in pregnancy, an audit with the GPs is warranted to understand their motivations, discuss clinical cases and build consensus guidelines on which antibiotics should be preferred for use in pregnancy.

Streptococcus agalactiae neonatal infection in Apulia, Southern Italy: The first 24 months of surveillance

Background: Streptococcus agalactiae (GBS) is an important cause of morbidity and mortality in newborn infants. In Italy there are no precise data on the incidence, morbidity and mortality of neonatal GBS infections. Design and population: The National Institute of Health (Rome, Italy) carried on an active surveillance study (2007/2010) to value the early or late neonatal GBS infection and the prevalent serotypes among pregnant women in Italy. Material and methods: Pediatricians, neonatolologists, a gynecologist and a microbiologist of 9 Italian hospitals were involved. Results: During 24 months of surveillance in Bari (Apulia) 500 pregnant women were screened at 35–37 weeks of gestation for GBS colonization; 114 (23%) showed a vaginal/rectal colonization: 65 (57%) were colonized in both sites, 22 (19%) in rectal and 27 (24%) in vaginal sites. Only 81 children were monitored for GBS presence: 9 (11%) resulted positive (4 in auricular site, 3 in more sites [1 auricular and blood site, 1 auricular, and 1 umbilical and pharynx site], 1 in umbilical and 1 in blood site). Sixty-two maternal GBS isolates were serotyped: 27 serotype III, 12 serotype Ia, 9 serotype V, 7 serotype IV, 5 serotype II, 1 serotype Ib, and 1 unserotypable. Conclusions: This work reports GBS colonization rate (23%) and the prevalent capsular serotypes among pregnant women in Bari. In light of actual enrolment of other 8 italian hospital, the results of the present surveillance project will be improved and completed at a national level in the next future.

Trends in HIV Prevalence Among Pregnant Women in Italy, 1994 to 2002

The aim of the study was to analyze the trends in HIV prevalence among childbearing women through unlinked anonymous testing of newborns. Dried-blood specimens, residual to routine metabolic screening of newborns, were collected in Italy during the last quarter of each year, from 1994 to 2002. These samples were tested anonymously for HIV antibodies. Of 844,311 specimens tested, 703 (0.83/1000; 95% confidence interval, 0.76-0.88) resulted as HIV antibody-reactive. Prevalence was 1.05 per 1000 in 1994 and decreased significantly over the following 3 years, reaching 0.60 per 1000 in 1997. Thereafter, a seroprevalence increase was recorded with a figure of 1.01 per 1000 in 1999. A decrease was again observed in 2001 and in 2002, when the seroprevalence rate was significantly lower than that recorded in 1994. During the entire study period, higher prevalence rates were observed in northern Italian regions, where the highest AIDS incidence rates are recorded, and in metropolitan compared with nonmetropolitan areas. The estimated number of children born each year to an HIV-positive mother ranged from 313 to 546. The number of children born to an HIV-positive mother calls for continued efforts to prevent vertical transmission of the infection.