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Effects of COVID-19 on Pregnancy
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Effects of COVID-19 on Pregnancy

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Epidemiology".

Deadline for manuscript submissions: closed (10 March 2024) | Viewed by 21726

Special Issue Editors

Dr. Alessandro Favilli

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Guest Editor
Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
Interests: hysteroscopy; myomas; reproductive health; surgery
Dr. Simone Garzon

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Guest Editor
Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, 21100 Varese, Italy
Interests: infertility; fertility preservation; endometriosis; polycystic ovary syndrome; assisted reproduction technology; gynecologic surgical procedures; endometrial cancer
Special Issues, Collections and Topics in MDPI journals
Dr. Antonio Simone Laganà

E-Mail Website
Guest Editor
1. Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
2. Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
Interests: endometriosis; infertility; minimally invasive surgery; assisted reproduction technology; gynecological endocrinology; reproductive immunology; laparoscopy; hysteroscopy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Starting from March 2020, a global pandemic of coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared by the World Health Organization. This required radical changes in the organization of the healthcare systems and the development of new strategies to counteract the diffusion and adverse outcomes of SARS-CoV-2 infection. Among different subpopulations, pregnant women need careful management because of their relatively immunosuppressed state and restricted respiratory capacity. This should be taken into account carefully, considering that poor reproductive and maternal–fetal outcomes were associated with other viral infections.

Based on this background, this Special Issue aims to present papers focusing on the symptoms and signs of COVID-19 in pregnant women, the effects of SARS-CoV-2 infection on early , mid-, and late-term pregnancies, the maternal–fetal transmission of the virus, the placental characteristics of pregnancies complicated by SARS-CoV-2 infection, the effects of SARS-CoV-2 infection on assisted reproduction technologies (ARTs), the organizational changes in healthcare environments involved in the management of pregnant women and/or women who are seeking pregnancy through ARTs, new therapeutic and vaccination strategies, and the impact of the current pandemic on the mode of providing obstetric care.

Dr. Alessandro Favilli
Dr. Simone Garzon
Dr. Antonio Simone Laganà
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19 and pregnancy
  • COVID-19 and assisted reproduction technologies
  • SARS-CoV-2 infection
  • maternal mortality and morbidity
  • pregnancy complications
  • vertical transmission
  • obstetric care

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Published Papers (8 papers)

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Editorial

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4 pages, 223 KiB  
Editorial
COVID-19 and Pregnancy: Have We Gotten through the Darkest Hour?
by Alessandro Favilli, Antonio Simone Laganà, Vito Chiantera, Stefano Uccella, Sandro Gerli and Simone Garzon
J. Pers. Med. 2022, 12(12), 1987; https://doi.org/10.3390/jpm12121987 - 1 Dec 2022
Cited by 4 | Viewed by 2014
Abstract
On December 2019, a new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) was isolated and identified in Wuhan (China) [...] Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)

Research

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13 pages, 1125 KiB  
Article
Immune Response and Transplacental Antibody Transfer in Pregnant Women after COVID-19 Vaccination
by Chiara Lubrano, Alessandro Mancon, Gaia Maria Anelli, Gloria Gagliardi, Roberta Corneo, Micol Bianchi, Chiara Coco, Giulia Dal Molin, Michele Vignali, Irene Schirripa, Nicoletta Di Simone, Giulia Pavone, Antonio Pellegrino, Maria Rita Gismondo, Valeria Maria Savasi and Irene Cetin
J. Pers. Med. 2023, 13(4), 689; https://doi.org/10.3390/jpm13040689 - 20 Apr 2023
Cited by 1 | Viewed by 2235
Abstract
COVID-19 infection is associated with increased risk of pregnancy complications, making vaccination during pregnancy critical for mother-neonate dyads. Few data, often with an unrepresentative sample size, are available on SARS-CoV-2 vaccine-induced humoral and cell-mediated response. Here, we evaluated anti-S antibody and interferon-gamma (IFN-γ) [...] Read more.
COVID-19 infection is associated with increased risk of pregnancy complications, making vaccination during pregnancy critical for mother-neonate dyads. Few data, often with an unrepresentative sample size, are available on SARS-CoV-2 vaccine-induced humoral and cell-mediated response. Here, we evaluated anti-S antibody and interferon-gamma (IFN-γ) production elicited by SARS-CoV-2 immunization in maternal and neonatal plasma. Pregnant women (n = 230) were prospectively enrolled and classified as unvaccinated (n = 103) and vaccinated (n = 127); after serological screening for previous infections, assays were performed on 126 dyads, 15 mothers and 17 newborns. Positive anti-S antibodies were found in most of the vaccinated subjects, regardless of timespan between immunization and delivery (range: 7–391 days). A total of 89 of 92 vaccinated women showed a broad response to COVID-19 immunization and highly effective placental transfer, as attested by anti-S positive rates (maternal = 96.7%, cord = 96.6%). Most of our subjects had indeterminate results in an IGRA assay, preventing a conclusive evaluation of IFN-γ production. Indeed, pregnancy-related hormonal changes may influence T-cell response with an impact on IFN-γ production. Positive pregnancy and perinatal outcomes reinforce the evidence that the anti-SARS-CoV-2 immunization is effective and well-tolerated in pregnant women and also protective for the fetus/neonate, even though it was not possible to define the related IFN-γ production and role. Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)
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11 pages, 1327 KiB  
Article
Impact of COVID-19 Pandemic on Women’s Health and Obstetric Outcomes after Assisted Reproduction: A Survey from an Italian Fertility Center
by Michela Cirillo, Valentina Basile, Letizia Mazzoli, Maria Elisabetta Coccia and Cinzia Fatini
J. Pers. Med. 2023, 13(3), 563; https://doi.org/10.3390/jpm13030563 - 21 Mar 2023
Cited by 2 | Viewed by 2171
Abstract
Background: the restrictive measures that were adopted during three waves of the COVID-19 pandemic had an impact on both the emotional state and lifestyle of the general population. We evaluated the impact of COVID-19 pandemic on lifestyles and emotional states of women planning [...] Read more.
Background: the restrictive measures that were adopted during three waves of the COVID-19 pandemic had an impact on both the emotional state and lifestyle of the general population. We evaluated the impact of COVID-19 pandemic on lifestyles and emotional states of women planning assisted reproductive technology (ART), and whether these changes affected ART outcomes. Methods: quantitative research, using a web-based survey, was performed on 289 Caucasian women. Results: In preconception, we observed higher percentage of women with positive obstetric outcomes who reduced body weight (52.4% vs. 27.2%, p = 0.09). Over 60% of women with positive outcomes practiced physical activity vs. 47% of women with negative outcomes (p = 0.03), as well as having better quality of sleep (45% vs. 35%), and a more solid relationships with their partners (65.1% vs. 51.7%, p = 0.03). Women who increased their intake of whole grains, fruits, vegetables, and legumes (p < 0.05), according to the Mediterranean diet, showed positive outcomes. We observed that participants who experienced “very much” or “extreme” anxiety, sadness, and fear (p < 0.05) during pandemic were clearly more numerous in the group with negative pregnancy outcomes. Conclusions: healthy lifestyle together with a positive emotional state in preconception can positively influence the obstetric outcomes after ART. Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)
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8 pages, 228 KiB  
Article
Impact of the First and Second Lockdown for COVID-19 Pandemic on Preterm Birth, Low Birth Weight, Stillbirth, Mode of Labor, and of Delivery in Lombardy, Italy
by Giovanna Esposito, Marta Rossi, Alessandro Favilli, Matteo Franchi, Giovanni Corrao, Fabio Parazzini and Carlo La Vecchia
J. Pers. Med. 2023, 13(3), 499; https://doi.org/10.3390/jpm13030499 - 10 Mar 2023
Cited by 7 | Viewed by 2667
Abstract
We investigated the effect of lockdown measures implemented in Lombardy on selected obstetric and perinatal outcomes. Births that occurred during the two lockdowns imposed (i.e., the first from 16 March to 2 June 2020 and the second from 3 November 2020 to 5 [...] Read more.
We investigated the effect of lockdown measures implemented in Lombardy on selected obstetric and perinatal outcomes. Births that occurred during the two lockdowns imposed (i.e., the first from 16 March to 2 June 2020 and the second from 3 November 2020 to 5 April 2021) and the comparison periods (i.e., the first from 16 March to 2 June 2018 and the second from 3 November 2018 to 5 April 2019) were identified using regional healthcare databases. The distribution of births according to the selected outcomes was computed and the Chi-square test was used for testing differences in the periods compared. During the two lockdowns, we observed a lower proportion of low birth weight, from 6.8% in the comparison period to 6.1% in the first lockdown (p = 0.019), and from 6.5% to 6.1% in the second one (p = 0.109). The proportion of preterm births decreased from 6.8% to 6.3% in the first lockdown (p = 0.097), and from 6.2% to 6.0% in the second one (p = 0.172). No differences in stillbirth rate emerged for both lockdowns. Induction of labor was more frequent during both lockdowns, from 28.6% to 32.7% in the first (p < 0.0001), and from 29.9% to 33.2% in the second one (p < 0.0001). Cesarean section was less frequent during the second lockdown. Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)
13 pages, 963 KiB  
Article
A Prospective Analysis of Vitamin D Levels in Pregnant Women Diagnosed with Gestational Hypertension after SARS-CoV-2 Infection
by George Dahma, Marius Craina, Catalin Dumitru, Radu Neamtu, Zoran Laurentiu Popa, Adrian Gluhovschi, Cosmin Citu, Felix Bratosin, Vlad Bloanca, Satish Alambaram, Anthony Willie, Shiva Charana Kodimala, Rodica Anamaria Negrean and Elena Bernad
J. Pers. Med. 2023, 13(2), 317; https://doi.org/10.3390/jpm13020317 - 12 Feb 2023
Cited by 3 | Viewed by 2235
Abstract
The great majority of existing studies suggests that the prognosis and outcomes of SARS-CoV-2 infections are improved with adequate vitamin D levels, with or without supplementation. Simultaneously, whether vitamin D supplementation during pregnancy lessens the chance of developing gestational hypertension is controversial. The [...] Read more.
The great majority of existing studies suggests that the prognosis and outcomes of SARS-CoV-2 infections are improved with adequate vitamin D levels, with or without supplementation. Simultaneously, whether vitamin D supplementation during pregnancy lessens the chance of developing gestational hypertension is controversial. The objective of the present research was to evaluate whether vitamin D levels during pregnancy differ substantially among pregnant women who develop gestational hypertension following SARS-CoV-2 infection. The current research was designed as a prospective cohort following the pregnant women admitted to our clinic with COVID-19 until 36 weeks of gestation. Total vitamin D (25(OH)D) levels were measured in the three study groups in which pregnant women with COVID-19 during pregnancy and a diagnosis of hypertension after 20 weeks of gestation were considered the group of cases (GH-CoV). The second group (CoV) included those with COVID-19 and no hypertension, while the third group (GH) included those with hypertension and no COVID-19. It was observed that 64.4% of SARS-CoV-2 infections in the group of cases occurred during the first trimester, compared to 29.2% in the first trimester among the controls who did not develop GH. Normal vitamin D levels were measured at admission in a significantly higher proportion of pregnant women without GH (68.8% in the CoV group vs. 47.9% in the GH-CoV group and 45.8% in the GH group). At 36 weeks of gestation, the median values of 25(OH)D in the CoV group was 34.4 (26.9–39.7) ng/mL compared to 27.9 (16.2–32.4) ng/mL in the GH-CoV group and 29.5 ng/mL (18.4–33.2) in the GH group, while the blood pressure measurements remained over 140 mmHg among the groups who developed GH. There was a statistically significant negative association between serum 25(OH)D levels and systolic blood pressure (rho = −0.295; p-value = 0.031); however, the risk of developing GH was not significantly higher among pregnant women with COVID-19 if the vitamin D levels were insufficient (OR = 1.19; p-value = 0.092) or deficient (OR = 1.26; p-value = 0.057). Although insufficient or deficient vitamin D among pregnant women with COVID-19 was not an independent risk factor for the development of GH, it is likely that an association between first-trimester SARS-CoV-2 infection and low vitamin D plays a key role in developing gestational hypertension. Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)
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16 pages, 2271 KiB  
Article
Exploring Clinical and Biological Features of Premature Births among Pregnant Women with SARS-CoV-2 Infection during the Pregnancy Period
by Ingrid Hrubaru, Andrei Motoc, Felix Bratosin, Ovidiu Rosca, Roxana Folescu, Marius Liviu Moise, Octavian Neagoe, Ioana Mihaela Citu, Bogdan Feciche, Florin Gorun, Dragos Erdelean, Adrian Ratiu and Cosmin Citu
J. Pers. Med. 2022, 12(11), 1871; https://doi.org/10.3390/jpm12111871 - 8 Nov 2022
Cited by 8 | Viewed by 2388
Abstract
Studies observed that women infected with SARS-CoV-2 during pregnancy had a higher risk of preterm birth. Although it is likely that COVID-19 during the late trimester of pregnancy can trigger premature birth, prematurity remains a concern, and it is vital to study additional [...] Read more.
Studies observed that women infected with SARS-CoV-2 during pregnancy had a higher risk of preterm birth. Although it is likely that COVID-19 during the late trimester of pregnancy can trigger premature birth, prematurity remains a concern, and it is vital to study additional clinical and biological patient factors that are highly associated with this negative pregnancy outcome and allow for better management based on the existing predictors. In order to achieve this goal, the current study retrospectively recruited 428 pregnant patients that were separated into three study groups using a 1:2:4 matching ratio and a nearest-neighbor matching method. Sixty-one pregnant patients had a history of COVID-19 during pregnancy and gave birth prematurely; 124 pregnant patient controls had COVID-19 and gave birth full-term, while the second control group of 243 pregnant patients had a premature birth but no history of COVID-19. It was observed that a symptomatic SARS-CoV-2 infection during the third trimester was significantly more likely to be associated with premature birth. Even though the rate of ICU admission was higher in these cases, the mortality rate did not change significantly in the COVID-19 groups. However, SARS-CoV-2 infection alone did not show statistical significance in determining a premature birth (β = 1.09, CI = 0.94–1.15, p-value = 0.067). Maternal anemia was the strongest predictor for prematurity in association with SARS-CoV-2 infection (β = 3.65, CI = 1.46–5.39, p-value < 0.001), followed by elevated CRP (β = 2.11, CI = 1.20–3.06, p-value < 0.001), and respectively IL-6 (β = 1.92, CI = 1.20–2.47, p-value = 0.001. SARS-CoV-2 infection is associated with an increased risk of preterm birth, as shown by our data. If SARS-CoV-2 infection arises during the third trimester, it is recommended that these patients be hospitalized for surveillance of clinical evolution and biological parameters, such as anemia and high inflammatory markers, which have a multiplicative influence on the pregnancy result. Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)
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8 pages, 267 KiB  
Article
Clinical Manifestation and Obstetric Outcomes in Pregnant Women with SARS-CoV-2 Infection at Delivery: A Retrospective Cohort Analysis
by Gordana Grgić, Anis Cerovac, Igor Hudić, Antonio Simone Laganà, Alessandro Favilli, Simone Garzon, Vito Chiantera, Chrysoula Margioula-Siarkou, Azra Hadžimehmedović and Amer Mandžić
J. Pers. Med. 2022, 12(9), 1480; https://doi.org/10.3390/jpm12091480 - 9 Sep 2022
Cited by 15 | Viewed by 2346
Abstract
This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. [...] Read more.
This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women. Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)

Review

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11 pages, 1646 KiB  
Review
SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic
by Valentina Tosto, Arun Meyyazhagan, Malek Alqasem, Valentina Tsibizova and Gian Carlo Di Renzo
J. Pers. Med. 2023, 13(4), 699; https://doi.org/10.3390/jpm13040699 - 21 Apr 2023
Cited by 8 | Viewed by 4286
Abstract
As the COVID-19 pandemic continues into its third year, there is accumulating evidence on the consequences of maternal infection. Emerging data indicate increased obstetrics risks, including maternal complications, preterm births, impaired intrauterine fetal growth, hypertensive disorders, stillbirth, gestational diabetes, and a risk of [...] Read more.
As the COVID-19 pandemic continues into its third year, there is accumulating evidence on the consequences of maternal infection. Emerging data indicate increased obstetrics risks, including maternal complications, preterm births, impaired intrauterine fetal growth, hypertensive disorders, stillbirth, gestational diabetes, and a risk of developmental defects in neonates. Overall, controversial concerns still exist regarding the potential for vertical transmission. Histopathological examination of the placenta can represent a useful instrument for investigation and can contribute significant information regarding the possible immunohistopathological mechanisms involved in developing unfavorable perinatal outcomes. Based on current evidence, SARS-CoV-2 infection can affect placental tissue by inducing several specific changes. The level of placental involvement is considered one of the determining factors for unfavorable outcomes during pregnancy due to inflammation and vascular injuries contributing to complex cascade immunological and biological events; however, available evidence does not indicate a strong and absolute correlation between maternal infection, placental lesions, and obstetric outcomes. As existing studies are still limited, we further explore the placenta at three different levels, using histology, immunohistochemistry, and molecular genetics to understand the epidemiological and virological changes observed in the ongoing pandemic. Full article
(This article belongs to the Special Issue Effects of COVID-19 on Pregnancy)
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