#Effect of the #COVID19 pandemic response on intrapartum care, #stillbirth, and #neonatal #mortality #outcomes in #Nepal: a prospective observational study (Lancet Glob Health, abstract)

[Source: Lancet Global Health, full page: (LINK). Abstract, edited.]

Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study

Ashish KC, PhD  *, Rejina Gurung, MSc *, Mary V Kinney, MSc, Avinash K Sunny, MD, Md Moinuddin, PhD, Omkar Basnet, BSc, Prajwal Paudel, MD, Pratiksha Bhattarai, MA, Kalpana Subedi, MD, Mahendra Prasad Shrestha, MPH, Joy E Lawn, FMedSci †, Mats Målqvist, PhD †

Open Access | Published: August 10, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30345-4

 

Summary

Background

The COVID-19 pandemic response is affecting maternal and neonatal health services all over the world. We aimed to assess the number of institutional births, their outcomes (institutional stillbirth and neonatal mortality rate), and quality of intrapartum care before and during the national COVID-19 lockdown in Nepal.

Methods

In this prospective observational study, we collected participant-level data for pregnant women enrolled in the SUSTAIN and REFINE studies between Jan 1 and May 30, 2020, from nine hospitals in Nepal. This period included 12·5 weeks before the national lockdown and 9·5 weeks during the lockdown. Women were eligible for inclusion if they had a gestational age of 22 weeks or more, a fetal heart sound at time of admission, and consented to inclusion. Women who had multiple births and their babies were excluded. We collected information on demographic and obstetric characteristics via extraction from case notes and health worker performance via direct observation by independent clinical researchers. We used regression analyses to assess changes in the number of institutional births, quality of care, and mortality before lockdown versus during lockdown.

Findings

Of 22 907 eligible women, 21 763 women were enrolled and 20 354 gave birth, and health worker performance was recorded for 10 543 births. From the beginning to the end of the study period, the mean weekly number of births decreased from 1261·1 births (SE 66·1) before lockdown to 651·4 births (49·9) during lockdown—a reduction of 52·4%. The institutional stillbirth rate increased from 14 per 1000 total births before lockdown to 21 per 1000 total births during lockdown (p=0·0002), and institutional neonatal mortality increased from 13 per 1000 livebirths to 40 per 1000 livebirths (p=0·0022). In terms of quality of care, intrapartum fetal heart rate monitoring decreased by 13·4% (−15·4 to −11·3; p<0·0001), and breastfeeding within 1 h of birth decreased by 3·5% (−4·6 to −2·6; p=0·0032). The immediate newborn care practice of placing the baby skin-to-skin with their mother increased by 13·2% (12·1 to 14·5; p<0·0001), and health workers’ hand hygiene practices during childbirth increased by 12·9% (11·8 to 13·9) during lockdown (p<0·0001).

Interpretation

Institutional childbirth reduced by more than half during lockdown, with increases in institutional stillbirth rate and neonatal mortality, and decreases in quality of care. Some behaviours improved, notably hand hygiene and keeping the baby skin-to-skin with their mother. An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period.

Funding

Grand Challenges Canada.

Keywords: SARS-CoV-2; COVID-19; Pediatrics; Pregnancy; Gynaecology; Nepal.

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#Placental #SARS‐CoV‐2 in a #Pregnant Woman with #Mild #COVID19 Disease (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Placental SARS‐CoV‐2 in a Pregnant Woman with Mild COVID‐19 Disease

Albert L. Hsu MD,  Minhui Guan,  Eric Johannesen DO,  Amanda J. Stephens MD,  Nabila Khaleel MD,  Nikki Kagan,  Breanna C. Tuhlei,  Xiu‐Feng Wan PhD

First published: 04 August 2020 | DOI:  https://doi.org/10.1002/jmv.26386

Conflicts of interest: the authors have declared that no conflict of interest exists.

Financial support: supported by the Department of Obstetrics and Gynecology, University of Missouri School of Medicine

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26386

 

ABSTRACT

Background

The full impact of COVID‐19 on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality.1 COVID‐19 manifestations appear similar between pregnant and non‐pregnant women.2

Objectives/Study Design

We present a case of placental SARS‐CoV‐2 virus in a woman with mild COVID‐19 disease, then review the literature. RT‐PCR was performed to detect SARS‐CoV‐2. Immunohistochemistry staining was performed with specific monoclonal antibodies to detect SARS‐CoV‐2 antigen or to identify trophoblasts.

Results

A 29 year‐old multigravida presented at 40‐4/7 weeks for labor induction. With myalgias two days prior, she tested positive for SARS‐CoV‐2. We demonstrate maternal vascular malperfusion, with no fetal vascular malperfusion, as well as SARS‐CoV‐2 virus in chorionic villi endothelial cells, and also rarely in trophoblasts.

Conclusions

To our knowledge, this is the first report of placental SARS‐CoV‐2 despite mild COVID‐19 disease (no symptoms of COVID‐19 aside from myalgias); patient had no fever, cough, or shortness of breath, but only myalgias and sick contacts. Despite her mild COVID‐19 disease in pregnancy, we demonstrate placental vasculopathy and presence of SARS‐CoV‐2 virus across the placenta.

Evidence of placental COVID‐19 raises concern for placental vasculopathy (potentially leading to fetal growth restriction and other pregnancy complications) and possible vertical transmission – especially for pregnant women who may be exposed to COVID‐19 in early pregnancy.

This raises important questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID‐19 symptoms, increased antenatal surveillance, and possibly routine COVID‐19 testing throughout pregnancy.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Pregnancy.

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#COVID19 (#SARS-CoV-2) Infection in #Pregnancy: A Systematic Review (Gynecol Obstet Invest., abstract)

[Source: Gynecologic and Obstetric Investigation, full page: (LINK). Abstract, edited.]

COVID-19 (SARS-CoV-2) Infection in Pregnancy: A Systematic Review

Akhtar H.a · Patel C.a · Abuelgasim E.b · Harky A.c,d

Author affiliations: a Department of Medicine, St George’s, University of London, London, United Kingdom; b Faculty of Medicine, Imperial College London, London, United Kingdom; c Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; d Department of Integrative Biology, Faculty of Life Science, University of Liverpool, Liverpool, United Kingdom

Gynecol Obstet Invest | DOI: https://doi.org/10.1159/000509290

 

Abstract

Introduction:

To review published studies related to the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections with pregnancy, foetal, and neonatal outcomes during coronavirus disease 2019 (COVID-19) pandemic in a systematic manner.

Methods:

A comprehensive electronic search was done through PubMed, Scopus, Medline, Cochrane database, and Google Scholar from December 01, 2019, to May 22, 2020, along with the reference list of all included studies. All cohort studies that reported on outcomes of COVID-19 during pregnancy were included. Qualitative assessment of included studies was performed using the Newcastle-Ottawa scale.

Results:

Upon admission, most pregnant women underwent a low-dose radiation CT scan; the reports of which included unilateral/bilateral pneumonia in most patients. A marked lymphopenia was also noted in many patients with COVID-19. 513 titles were screened, and 22 studies were included, which identified 156 pregnant women with COVID-19 and 108 neonatal outcomes. The most common maternal/foetal complications included intrauterine/foetal distress (14%) and premature rupture of membranes (8%). The neonatal clinical manifestations of COVID-19 commonly included shortness of breath (6%), gastrointestinal symptoms (4%), and fever (3%).

Conclusion:

COVID-19 infection in pregnancy leads to increased risk in pregnancy complications such as preterm birth, PPROM, and may possibly lead to maternal death in rare cases. There is no evidence to support vertical transmission of SARS-CoV-2 infection to the unborn child. Due to a paucity of inconsistent data regarding the impact of COVID-19 on the newborn, caution should be undertaken to further investigate and monitor possible infection in the neonates born to COVID-19-infected mothers.

© 2020 S. Karger AG, Basel

Keywords: SARS-CoV-2; COVID-19; Pregnancy; Gynecology.

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Disproportionate #impact of #COVID19 among #pregnant and #postpartum #Black Women in  #Brazil through structural #racism lens (Clin Infect Dis., summary)

[Source: Clinical Infectious Diseases, full page: (LINK). Summary, edited.]

Disproportionate impact of COVID-19 among pregnant and postpartum Black Women in  Brazil through structural racism lens

Debora de Souza Santos, RN, PhD, Nursing School, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil; Mariane de Oliveira Menezes, CM, MSc, Department of  Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista  (UNESP), Botucatu, Brazil; Carla Betina Andreucci, MD, PhD, Department of Medicine,  Universidade Federal de São Carlos (UFSCAR), São Carlos, Brazil; Marcos Nakamura- Pereira, MD, PhD, Fernandes Figueira National Institute of Women, Adolescent and Child  Health, Fundação Osvaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Roxana Knobel, MD,  PhD, Department of Gynecology and Obstetrics, Universidade Federal de Santa Catarina  (UFSC), Florianópolis, Brazil; Leila Katz, MD, PhD, Postgraduation Program, Instituto de  Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil; Heloisa de Oliveira  Salgado, MSc, PhD, Departament of Social Medicine, Ribeirão Preto Medical School,  Universidade de São Paulo (USP), Ribeirão Preto, Brazil; Melania Maria Ramos de  Amorim, MD, PhD, Postgraduation Program, Instituto de Medicina Integral; Prof.  Fernando Figueira (IMIP), Recife, Brazil; Maira LS Takemoto, CNM, PhD, Department of  Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, Brazil

Downloaded from https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/ciaa1066/5877027 by guest on 28 July 2020

Accepted Manuscript

Corresponding author: Maíra L S Takemoto, maira.libertad@unesp.br – Rua Carlos Guadanini, 2564, Botucatu-SP, Brazil – Postal code 18610-120, +55 21 971724103

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Dear Editor, Tai and collaborators raised important questions about the potential  biomedical factors and social determinants that play a role in the observed racial  disparities on COVID-19 outcomes in the US[1]. Evidence of such disproportionate impact  is also arising on historically oppressed ethnic groups in Brazil, current  worldwide pandemic epicenter [2]. Our group is closely monitoring an overwhelming number of SARS-CoV-2-related maternal deaths in the country[3]. Racial disparities  among childbearing women within the healthcare system have been widely described,  and already pose difficult challenges to improve maternal outcomes in the country[4,5].  Thus, it was expected that Black Brazilian pregnant and postpartum women would face  additional challenges during the pandemic. We searched the Brazilian Acute Respiratory  Distress Syndrome Surveillance System looking for COVID-19 cases among pregnant or  postpartum women with complete data on ethnicity until July 14, 2020 (n=1,860), then  selecting records of White and Black women (n=669, Table 1).

(…)

Keywords: SARS-CoV-2; COVID-19; Pregnancy; Society; Poverty; Racism; Brazil.

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#Clinical Characteristics of #Pregnant Women with #Coronavirus Disease 2019 in #Wuhan, #China (Open Forum Infect Dis., abstract)

[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]

Clinical Characteristics of Pregnant Women with Coronavirus Disease 2019 in Wuhan, China

Biheng Cheng, M.D, Tao Jiang, M.D, Lu Zhang, M.D, Ruheng Hu, M.D, Jinhua Tian, M.D, Yan Jiang, M.D, Bo Huang, M.D, Jun Li, M.D, Min Wei, M.D, Jing Yang, M.D., Ph.D, Shengxiang Ren, M.D., Ph.D, Gaohua Wang, M.D. Ph.D

Open Forum Infectious Diseases, ofaa294, https://doi.org/10.1093/ofid/ofaa294

Published: 11 July 2020

 

Abstract

Background

Coronavirus disease 2019 (COVID-19) has become a pandemic. Despite of the growing number of patients with COVID-19 infection, data on the clinical characteristics of pregnant patients is still limited.

Methods

We retrospectively included childbearing-age women patients with laboratory-confirmed COVID-19 at Renmin Hospital of Wuhan University from January 15 to February 23, 2020. Demographic, clinical, radiological, laboratory, and treatment data were reviewed. Clinical characteristics of pregnant and non-pregnant patients were compared.

Results

111 childbearing-age women with COVID-19 were included, including severe or critical disease in 16 patients (14.4%). Compared with non-pregnant patients (n = 80), pregnant patients (n = 31) were less likely to have dyspnea (16.1% vs 37.5%), asthenia (3.2% vs 33.8%), and symptoms number ≥ 3 (22.6% vs 45.0%), had significantly higher neutrophil count (5.2 vs 2.5 × 109/L), higher percentage of CD3+ cells (76.7% vs 73.7%) and CD8+ cells (32.3% vs 28.4%), and had dramatically lower percentage of lymphocyte (18.2% vs 31.8%), lower CD4+/CD8+ ratio (1.2 vs 1.4), lower level of IgG (9.8 vs 11.9 g/L). Of note, pregnant patients had significantly lower percentage of severe disease (3.2% vs. 18.8%) and substantially higher level of inflammation markers including neutrophil-to-lymphocyte ratio (4.4 vs 1.9) and systematic inflammatory index (812.8 vs 354.7) than non-pregnant patients. Seventeen livebirths were recorded and all of them showed negative results of postnatal COVID-19 detection together with a normal Apgar score.

Conclusion

Pregnant patients with COVID-19 had less level of severity together with enhanced inflammatory response and cell immunity when compared with non-pregnant patients.

COVID-2019, Pregnant Women, Clinical Characteristics, Severity

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: SARS-CoV-2; COVID-19; Pregnancy; Hubei; China.

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Change in the #Incidence of #Stillbirth and #Preterm #Delivery During the #COVID19 Pandemic (JAMA, summary)

[Source: JAMA, full page: (LINK). Summary, edited.]

Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic

Asma Khalil, MD1; Peter von Dadelszen, PhD2; Tim Draycott, MD3;  Austin Ugwumadu, PhD1; Pat O’Brien, MBBCh, MRCOG, MFFP4; Laura Magee, PhD2

Author Affiliations: 1 Fetal Medicine Unit, St George’s University of London, London, United Kingdom; 2 School of Life Course Sciences, King’s College London, London, United Kingdom; 3 Department of Women’s Health, North Bristol NHS Trust, Westbury on Trym, United Kingdom; 4 Department of Women’s Health, University College London Hospitals, London, United Kingdom

JAMA. Published online July 10, 2020. doi:10.1001/jama.2020.12746

___

High rates of preterm birth and cesarean delivery have been reported in women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.1 However, studies have inadequate power to assess uncommon outcomes like stillbirth (fetal death ≥24 weeks’ gestation). The UK Obstetric Surveillance System reported 3 stillbirths among 247 completed pregnancies in women with confirmed coronavirus disease 2019 (COVID-19) vs the national rate (12.1 per 1000 births vs 4-5 per 1000 births).2 We assessed the change in stillbirth and preterm delivery rates during the pandemic.

(…)

Keywords: SARS-CoV-2; COVID-19; Pregnancy.

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Retrospective #Description of #Pregnant Women Infected with #SARS-CV-2, #France (Emerg Infect Dis., abstract)

[Source: Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 9—September 2020 | Research

Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France

Alexandre J. Vivanti  , Jérémie Mattern, Christelle Vauloup-Fellous, Jacques Jani, Luc Rigonnot, Larissa El Hachem, Agnès Le Gouez, Céline Desconclois, Imane Ben M’Barek, Jeanne Sibiude, Alexandra Benachi, Olivier Picone, and Anne-Gaël Cordier

Author affiliations: Antoine Béclère Hospital, Paris Saclay University, Clamart, France (A.J. Vivanti, J. Mattern, A. Le Gouez, C. Desconclois, A. Benachi); Paul Brousse Hospital, Paris Saclay University, Villejuif, France (C. Vauloup-Fellous); University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (J. Jani); Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France (L. Rigonnot, L. El Hachem); Bicêtre Hospital, Paris Saclay University, Le Kremlin-Bicêtre, France (I. Ben M’Barek, A.-G. Cordier); Louis Mourier Hospital, Paris University, Colombes, France (J. Sibiude, O. Picone)

 

Abstract

Little data are available on the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a retrospective study of 100 pregnant women with SARS-CoV-2 infection in 4 obstetric units in the Paris metropolitan area of France during March 12–April 13, 2020. Among patients, 52 (52%) were hospitalized, 10 (10%) in intensive care units (ICUs). Women with higher body mass indexes (BMIs; median 30.7 kg/m2) were more likely to be hospitalized in ICUs than other women (median BMI 26.2 kg/m2). Women hospitalized in ICUs had lower lymphocyte count at diagnosis (median 0.77 × 109 cells/L) than women not hospitalized in ICUs (median lymphocyte count 1.15 × 109 cells/L). All women requiring oxygen >5 L/min were intubated. Clinical and laboratory evaluation of SARS-CoV-2−positive pregnant women at the time of diagnosis can identify patients at risk for ICU hospitalization.

Keywords: SARS-CoV-2; COVID-19; Pregnancy.

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The “scar” of a pandemic: cumulative #incidence of #COVID19 during the first trimester of #pregnancy (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

The “scar” of a pandemic: cumulative incidence of COVID‐19 during the first trimester of pregnancy

Stefano Cosma M.D., Ph.D.,  Fulvio Borella M.D.,  Andrea Carosso M.D.,  Andrea Sciarrone M.D.,  Jessica Cusato Bsc, MSc, Ph.D.,  Silvia Corcione M.D., Ph.D.,  Giulio Mengozzi M.D. Ph.D.,  Mario Preti M.D.,  Dionyssios Katsaros M.D., Ph.D.,  Giovanni Di Perri M.D., Ph.D., Chiara Benedetto M.D., Ph.D.

First published: 07 July 2020 | DOI:  https://doi.org/10.1002/jmv.26267

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26267

 

Abstract

Congenitally‐ or perinatally‐acquired viral infections can be harmful to the fetus but data are limited about prevalence and outcomes of COVID‐19 disease during the first trimester of pregnancy. We report epidemiologic data from a study investigating a cohort of women who became pregnant just before or during the COVID‐19 pandemic.

We recruited 138 consecutive pregnant women attending for first trimester screening (11‐13 weeks of gestation) at Sant’Anna Hospital, Turin, Piedmont, Italy, during the plateau and the falling phase of the COVID‐19 epidemic curve. Patients were tested for SARS‐CoV‐2 IgM/IgG antibody levels and SARS‐CoV‐2 detection in sera and nasopharyngeal swab samples.

COVID‐19 cumulative incidence during the first trimester was of 10.1% with high prevalence of asymptomatic patients (42.8%). Similar to the course of the disease in non pregnant adults, 80‐90% of infections were not severe.

The prevalence of reported symptoms was four‐fold higher in SARS‐CoV‐2 positive patients (57%) than in those negative (13%) (p<0.001), suggesting that direct self‐testing should open doors to confirmatory testing for COVID‐19.

Our findings support the need for COVID‐19 screening in early pregnancy in epidemic areas to plan materno‐fetal health surveillance programs.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Pregnancy; Italy.

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#Clinical manifestation and #neonatal #outcomes of #pregnant patients with #COVID19 pneumonia in #Wuhan, #China (Open Forum Infect Dis., abstract)

[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]

Clinical manifestation and neonatal outcomes of pregnant patients with COVID-19 pneumonia in Wuhan, China

Shuang Xu, Fei Shao, Banghe Bao, Xuedi Ma, Zhouming Xu, Jiwen You, Peng Zhao, Yuwei Liu, Michael Ng, Hao Cui, Changxiao Yu, Qing Zhang, Dandan Li, Ziren Tang, Peng Sun

Open Forum Infectious Diseases, ofaa283, https://doi.org/10.1093/ofid/ofaa283

Published: 05 July 2020

 

Abstract

Background

Clinical manifestation and neonatal outcomes of pregnant women with Corona Virus Disease 2019(COVID-19) were unclear in Wuhan, China.

Methods

We retrospectively analyzed clinical characteristics of pregnant and non-pregnant women with COVID-19 aged from 20 to 40, admitted between January 15 and March 15, 2020 at Union Hospital, Wuhan, and symptoms of pregnant women with COVID-19 and compared the clinical characteristics and symptoms to historic data previously reported for H1N1.

Results

Among 64 patients, 34 (53.13%) were pregnant, with higher proportion of exposure history (29.41% vs 6.67%) and more pulmonary infiltration on CT test (50% vs 10%) comparing to non-pregnant women. Of pregnant patients, 27 (79.41%) completed pregnancy, 5 (14.71%) had natural delivery, 18 (52.94%) had cesarean section, and 4 (11.76%) had abortion, and 5 (14.71%) were asymptomatic. All 23 newborns had negative RT-PCR results and an average 1-minute Apgar Score was 8-9 points. Pregnant and non-pregnant patients show differences on symptoms like fever, expectoration, and fatigue, and on laboratory tests like: neutrophils, fibrinogen, D-dimer, and erythrocyte sedimentation rate. Pregnant patients with COVID-19 tend to have more mild symptoms than those with H1N1.

Conclusion

Clinical characteristics of pregnant patients with COVID-19 are less serious than non-pregnant. No evidence indicated that pregnant women may have fetal infection through vertical transmission of COVID-19. Pregnant patients with H1N1 had more serious condition than those with COVID-19.

COVID-19, H1N1, neonatal, pregnancy, vertical transmission

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: SARS-CoV-2; COVID-19; Hubei; China; Pregnancy.

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Characteristics of Women of Reproductive Age with Laboratory-Confirmed #SARS-CoV-2 Infection by #Pregnancy Status — #USA, January 22–June 7, 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020

Weekly / June 26, 2020 / 69(25);769–775

Sascha Ellington, PhD1; Penelope Strid, MPH1; Van T. Tong, MPH1; Kate Woodworth, MD1; Romeo R. Galang, MD1; Laura D. Zambrano, PhD1; John Nahabedian, MS1; Kayla Anderson, PhD1; Suzanne M. Gilboa, PhD1

Corresponding author: Sascha Ellington, for the CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team, eocevent397@cdc.gov.

1 CDC COVID-19 Emergency Response.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769–775. DOI: http://dx.doi.org/10.15585/mmwr.mm6925a1

 

Summary

  • What is already known about this topic?
    • Limited information is available about SARS-CoV-2 infection in U.S. pregnant women.
  • What is added by this report?
    • Hispanic and non-Hispanic black pregnant women appear to be disproportionately affected by SARS-CoV-2 infection during pregnancy. Among reproductive-age women with SARS-CoV-2 infection, pregnancy was associated with hospitalization and increased risk for intensive care unit admission, and receipt of mechanical ventilation, but not with death.
  • What are the implications for public health practice?
    • Pregnant women might be at increased risk for severe COVID-19 illness. To reduce severe COVID-19–associated illness, pregnant women should be aware of their potential risk for severe COVID-19 illness. Prevention of COVID-19 should be emphasized for pregnant women and potential barriers to adherence to these measures need to be addressed.

 

Abstract

As of June 16, 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 2,104,346 cases and 116,140 deaths in the United States.* During pregnancy, women experience immunologic and physiologic changes that could increase their risk for more severe illness from respiratory infections (1,2). To date, data to assess the prevalence and severity of COVID-19 among pregnant U.S. women and determine whether signs and symptoms differ among pregnant and nonpregnant women are limited. During January 22–June 7, as part of COVID-19 surveillance, CDC received reports of 326,335 women of reproductive age (15–44 years) who had positive test results for SARS-CoV-2, the virus that causes COVID-19. Data on pregnancy status were available for 91,412 (28.0%) women with laboratory-confirmed infections; among these, 8,207 (9.0%) were pregnant. Symptomatic pregnant and nonpregnant women with COVID-19 reported similar frequencies of cough (>50%) and shortness of breath (30%), but pregnant women less frequently reported headache, muscle aches, fever, chills, and diarrhea. Chronic lung disease, diabetes mellitus, and cardiovascular disease were more commonly reported among pregnant women than among nonpregnant women. Among women with COVID-19, approximately one third (31.5%) of pregnant women were reported to have been hospitalized compared with 5.8% of nonpregnant women. After adjusting for age, presence of underlying medical conditions, and race/ethnicity, pregnant women were significantly more likely to be admitted to the intensive care unit (ICU) (aRR = 1.5, 95% confidence interval [CI] = 1.2–1.8) and receive mechanical ventilation (aRR = 1.7, 95% CI = 1.2–2.4). Sixteen (0.2%) COVID-19–related deaths were reported among pregnant women aged 15–44 years, and 208 (0.2%) such deaths were reported among nonpregnant women (aRR = 0.9, 95% CI = 0.5–1.5). These findings suggest that among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women, but their risk for death is similar. To reduce occurrence of severe illness from COVID-19, pregnant women should be counseled about the potential risk for severe illness from COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families.

(…)

Keywords: SARS-CoV-2; COVID-19; Pregnancy; USA.

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