New Advances in COVID-19 and Pregnancy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 4845

Special Issue Editor


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Guest Editor
Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital IVF UNIT, University of Palermo, 90146 Palermo, Italy
Interests: obstetrics and gynecology; endoscopy; cancer; laparoscopy; fertility preservation; medical therapies; genital prolapse; urinary incontinence; endometriosis; oncological gynecology
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Special Issue Information

Dear Colleagues,

Global preparedness frameworks continue to overlook risks to pregnant women and babies during epidemics. Beyond COVID-19, this neglect had tragic consequences for women affected by the Zika and Ebola outbreaks. Intrauterine exposures to maternal COVID-19 could reach 20 million a year globally, according to recent estimates. This, coupled with lessons from previous antenatal viral infections, means the possibility of long term neurological or neurodevelopmental harms from COVID-19 warrant close attention.

Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. Therefore, there is a need to investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women. Worldwide, there are more than 140 million births every year, and pregnant women are potentially at risk for adverse outcomes of novel coronavirus. Although maternal mortality has been reported in some studies, limited information is available about SARS-CoV-2 infection in critically ill pregnant women hospitalized for COVID-19.

The aim of this Special Issue is to present papers summarizing well-established data on the clinical manifestation of COVID-19 in pregnant women, maternal and perinatal outcomes associated with COVID-19, the risk of vertical transmission of the virus, and the effect of SARS-COV-2 infection during pregnancy on fetal and neonatal outcomes. The data provided by the papers included in this Special Issue will allow researchers to determine maternal, fetal, and neonatal risk associated with SARS-COV-2 infection during pregnancy and may help to provide evidenced-based and personalized recommendations for the care of pregnant women with COVID-19. 

Dr. Gaspare Cucinella
Guest Editor

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Keywords

  • COVID-19 and pregnancy
  • SARS-CoV-2 infection
  • maternal mortality and morbidity
  • pregnancy complication
  • management protocol
  • maternal comorbidities
  • severe disease
  • prevention
  • diagnosis
  • treatment
  • management

Published Papers (5 papers)

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Research

10 pages, 243 KiB  
Article
The Importance of Vaccination, Variants and Time Point of SARS-CoV-2 Infection in Pregnancy for Stillbirth and Preterm Birth Risk: An Analysis of the CRONOS Register Study
by Antonella Iannaccone, Alexandra Gellhaus, Beatrix Reisch, Mark Dzietko, Boerge Schmidt, Laven Mavarani, Katrina Kraft, Kristin Andresen, Rainer Kimmig, Ulrich Pecks and Ekkehard Schleußner
J. Clin. Med. 2024, 13(6), 1522; https://doi.org/10.3390/jcm13061522 - 07 Mar 2024
Viewed by 967
Abstract
Background: The risk of preterm birth (PTB) and stillbirth increases after a SARS-CoV-2 infection during gestation. We aimed to estimate the risk depending on gestational age at infection (early <28 + 0 and late ≥28 weeks of gestation, WoG), virus variants, severity of [...] Read more.
Background: The risk of preterm birth (PTB) and stillbirth increases after a SARS-CoV-2 infection during gestation. We aimed to estimate the risk depending on gestational age at infection (early <28 + 0 and late ≥28 weeks of gestation, WoG), virus variants, severity of infection, and vaccination. Methods: PTB was divided into early PTB (<32 + 0) and late PTB (32 + 0–36 + 6 WoG). The prospective register COVID-19 Related Obstetrics and Neonatal Outcome Study (CRONOS) included 8032 pregnant women with a confirmed SARS-CoV-2 infection from 3 April 2020 to 31 December 2022, in Germany and Austria. Results: Stillbirth and early preterm births rates were higher during the Alpha (1.56% and 3.13%) and Delta (1.56% and 3.44%) waves than during the Omicron wave (0.53% and 1.39%). Early SARS-CoV-2 infection increased the risk for stillbirth (aRR 5.76, 95% CI 3.07–10.83) and early PTB before 32 + 0 (aRR, 6.07, 95% CI 3.65–10.09). Hospital admission increased the risks further, especially in the case of ICU admission. Vaccination against SARS-CoV-2 significantly reduced the risk of stillbirth (aRR 0.32, 95% CI 0.16–0.83). Conclusions: This multicentric prospective study shows an increased risk of stillbirth and preterm birth after infection early in pregnancy and therefore the importance of obstetrical surveillance thereafter. Vaccination offers effective protection. Full article
(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)
12 pages, 259 KiB  
Article
Obstetric and Gynecological Admissions and Hospitalizations in an Italian Tertiary-Care Hospital during COVID-19 Pandemic: A Retrospective Analysis According to Restrictive Measures
by Gaetano Riemma, Pasquale De Franciscis, Marina Tesorone, Egle Coppa, Antonio Schiattarella, Valentina Billone, Alessandra Lopez, Gaspare Cucinella, Giuseppe Gullo and Raffaela Maria Carotenuto
J. Clin. Med. 2023, 12(22), 7097; https://doi.org/10.3390/jcm12227097 - 15 Nov 2023
Viewed by 549
Abstract
Background: The national lockdown and the different restrictions applied in 2020 during the COVID-19 pandemic brought several changes to hospitalization procedures. The aim of this study was to evaluate the patterns in access to emergency services and hospitalization in a tertiary-care obstetric and [...] Read more.
Background: The national lockdown and the different restrictions applied in 2020 during the COVID-19 pandemic brought several changes to hospitalization procedures. The aim of this study was to evaluate the patterns in access to emergency services and hospitalization in a tertiary-care obstetric and gynecological emergency department (OG-ED) throughout the restrictions applied during 2020. Methods: A single-center retrospective comparative study on data from January to December 2020 was carried out on the following timeframes: January to February 2020 (before COVID-19 pandemic), March to June 2020 (nationwide lockdown period), July to September 2020 (removal of restrictive measures), October to December 2020 (regional lockdown) and compared to the same periods of 2019. All obstetric and gynecological patients with complete medical data admitted to the OG-ED were included. Results: Overall, 4233 accesses for 2019 and 3652 for 2020 were reported, with a decreasing trend of −13.7%. Between March and June 2020 (nationwide lockdown) and 2019, the overall number of patients attending the OG-ED decreased compared to July–September and October–December differences (Δ −23.5% vs. −3.1% and −5.9%; p = 0.001 respectively) for 2020–2019, but this reduction was not statistically significant when compared to January–February (Δ −23.5% vs. −18.5%; p = 0.356). No significant differences for obstetric patients (Δ −1.8% vs. −1.0% vs. −2.3% and +1.9% respectively; p = 0.883) were noted. Hospitalizations showed a stable trend with an increase between October–December 2019 and 2020 (Δ +4.6%; p = 0.001 vs. January–February (+2.4%) and March–June (+2.6%) 2019–2020), mainly related to regional lockdowns. Conclusions: In contrast to available national studies, in our institution, the overall rate of OG-ED admissions was slightly reduced with a similar trend of decrease even before COVID-19, with an increase in admissions for serious issues, despite expectations that the suspension of elective admissions and outpatient services would have led to an increase in non-urgent hospitalizations during the COVID-19 lockdown period. Full article
(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)
9 pages, 262 KiB  
Article
Comparison of Maternal and Neonatal Outcomes between SARS-CoV-2 Variants: A Retrospective, Monocentric Study
by Giosuè Giordano Incognito, Rosario Emanuele Carlo Distefano, Giorgia Campo, Ferdinando Antonio Gulino, Chiara Gulisano, Chiara Gullotta, Giuseppe Gullo, Gaspare Cucinella, Attilio Tuscano, Maria Teresa Bruno and Marco Palumbo
J. Clin. Med. 2023, 12(19), 6329; https://doi.org/10.3390/jcm12196329 - 01 Oct 2023
Cited by 4 | Viewed by 815
Abstract
The impact of SARS-CoV-2 variants on maternal and neonatal outcomes during pregnancy is still poorly understood, and the emergence of different variants has further complicated our understanding of the virus’s effects. This retrospective, monocentric study aimed to fill this knowledge gap by analyzing [...] Read more.
The impact of SARS-CoV-2 variants on maternal and neonatal outcomes during pregnancy is still poorly understood, and the emergence of different variants has further complicated our understanding of the virus’s effects. This retrospective, monocentric study aimed to fill this knowledge gap by analyzing the outcomes of pregnant women with acute SARS-CoV-2 infection caused by the Alpha, Delta, and Omicron variants. The study, conducted between December 2020 and March 2022 at San Marco Hospital, included 313 pregnant women with confirmed SARS-CoV-2 infection. The results showed that the Delta variant was associated with a significantly higher incidence of adverse outcomes, such as premature births, maternal intensive care unit admission, intrauterine growth restriction, and small for gestational age infants. Additionally, the Delta variant was linked to lower Apgar scores, higher maternal and fetal mortality rates, and increased levels of various biomarkers indicating more severe illness. Finally, the Delta variant also presented a greater possibility of vertical transmission. These findings underscore the complexity of understanding the impact of SARS-CoV-2 on pregnancy outcomes, especially considering the distinctive characteristics of different variants. By better understanding the specific impacts of each variant, appropriate preventive measures and management strategies can be implemented to optimize maternal and neonatal outcomes. Full article
(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)
16 pages, 1766 KiB  
Article
The Emotional Landscape of Pregnancy and Postpartum during the COVID-19 Pandemic in Italy: A Mixed-Method Analysis Using Artificial Intelligence
by Claudia Ravaldi, Laura Mosconi, Roberto Bonaiuti and Alfredo Vannacci
J. Clin. Med. 2023, 12(19), 6140; https://doi.org/10.3390/jcm12196140 - 23 Sep 2023
Viewed by 960
Abstract
The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country that had high mortality and implemented a strict lockdown during the pandemic. This study explores the emotions and challenges of pregnant and postpartum women during the pandemic, using AI-based mixed methods. [...] Read more.
The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country that had high mortality and implemented a strict lockdown during the pandemic. This study explores the emotions and challenges of pregnant and postpartum women during the pandemic, using AI-based mixed methods. The study analyzed 1774 women from the national survey COVID-ASSESS: 1136 pregnant and 638 postpartum women. The survey had qualitative questions on emotions and feelings related to birth, communication with healthcare professionals, media, and peers and family. We used natural language processing and machine learning to classify emotions, identify themes, and extract citations from the data. Fear and anxiety replaced joy as dominant emotions during the pandemic: trust and joy decreased by 49.3% and 36.4%, respectively, while sadness and fear increased by 52.3% and 49.3%, respectively. The pandemic also induced loneliness, isolation, frustration, and anger. Women faced challenges related to birth, communication with HCPs, media, and peers and family. They also used coping strategies such as self-care, news limitation, and trying to cultivate gratitude and hope. This study provides a comprehensive exploration of the perinatal emotional landscape of Italian women during the pandemic. The findings underscore the significant psychological impact of the pandemic and also highlight women’s resilience and coping strategies. Full article
(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)
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10 pages, 289 KiB  
Article
Risk Factors for Severe–Critical COVID-19 in Pregnant Women
by María Guadalupe Berumen-Lechuga, Alfredo Leaños-Miranda, Carlos José Molina-Pérez, Luis Rey García-Cortes and Silvia Palomo-Piñón
J. Clin. Med. 2023, 12(18), 5812; https://doi.org/10.3390/jcm12185812 - 07 Sep 2023
Viewed by 1225
Abstract
Risk factors associated with severe–critical COVID-19 (coronavirus disease 2019) are based on findings in the general population. Pregnant women are at increased risk of severe–critical infection, and few reports are based on these women. A multicentric case–control study was conducted at the Mexican [...] Read more.
Risk factors associated with severe–critical COVID-19 (coronavirus disease 2019) are based on findings in the general population. Pregnant women are at increased risk of severe–critical infection, and few reports are based on these women. A multicentric case–control study was conducted at the Mexican Institute of Social Security, State of Mexico, during the COVID-19 pandemic. We included pregnant women who were consecutively admitted to respiratory care units and were followed until 30 days after the resolution of pregnancy. A total of 758 pregnant women with a positive RT-PCR test for SARS-CoV-2 were enrolled from June 2020 to July 2021. We defined groups using the World Health Organization Severity Classification; cases were pregnant women with severe–critical COVID-19 (n = 123), and controls were subjects with non-severe COVID-19 (n = 635). Data was gathered from clinical files. A multivariate logistic regression analysis was used to adjust odds ratios and their 95% confidence intervals of factors associated with severe–critical COVID-19. Risk factors associated with severe–critical COVID-19 in pregnancy were non-vaccination (OR 10.18), blood type other than O (OR 6.29), maternal age > 35 years (OR 5.76), history of chronic hypertension (OR 5.12), gestational age at infection ≥ 31 weeks (OR 3.28), and multiparity (OR 2.80). Full article
(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)
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