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COVID-19 and Pregnancy: Prevention and Control Strategies for Coronavirus in Women

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A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Human Vaccines and Public Health".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 13276

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Dr. Gianluca Straface

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Division of Perinatal Medicine, Abano Terme, Italy
Interests: COVID-19 and pregnancy; pregnant women; public health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The novel severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) begin in Wuhan, China in December 2019. As of 17 March 2020, 153 countries had reported cases of infection caused by this virus, with Italy becoming the new epicentre. COVID-19 is a global public health emergency and could cause devastating health issues during pregnancy.

Since the emergence of a novel coronavirus in China at the end of December 2019, COVID-19 has been associated with high morbidity and mortality rates and has left healthcare systems struggling to find the optimal management strategy, especially for vulnerable populations, such as pregnant women.

To date, we have limited data concerning the transmission of COVID-19 during pregnancy. According to the existing data, pregnant women do not seem to be more vulnerable to the virus than other members of the population. However, pregnant women who have other diseases alongside COVID-19 run a higher risk of suffering from the virus than non-pregnant individuals with the same diseases.

Previous studies have indicated that SARS during gestation is linked with a high risk of spontaneous miscarriage, preterm birth and intrauterine growth restriction. To date, studies regarding pregnant women with COVID-19 have indicated few maternal and neonatal complications, but more concrete evidence is required, as these studies involved a small number of women over a short period. Importantly, viral respiratory illnesses, such as influenza, can easily develop during pregnancy, which means pregnant women may be more vulnerable to COVID-19 and require prioritized medical care.

Interim COVID-19 guidelines for the effective counselling and education of pregnant women are currently available from the Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Recommendations which were published following the COVID epidemic in Wuhan are also available from Chinese experts.

It is important to acknowledge the speed and the rapidity of clinical trials and the development of management, treatment and prevention related to COVID-19 disease during pregnancy that has occurred since

December 2019. At the same time, the fact that results from studies concerning COVID-19 infection in pregnant and lactating women are being published so quickly may be a limitation of any review of the literature.

More original studies regarding infected pregnant women are needed to establish totally evidence-based protocols of care for these patients.

Dr. Gianluca Straface
Guest Editor

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Keywords

COVID-19 and pregnancy
pregnant women
public health

Published Papers (5 papers)

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15 pages, 2844 KiB

Open AccessArticle

COVID-19 Vaccination during Pregnancy and Lactation: Attitudes and Uptakes before and after Official Recommendations in Germany

by Carsten Hagenbeck, Janine Zöllkau, Martina Helbig, Tanja Fehm and Nora K. Schaal

Vaccines 2023, 11(3), 627; https://doi.org/10.3390/vaccines11030627 - 10 Mar 2023

Cited by 1 | Viewed by 1388

Abstract

Background: Vaccination against COVID-19 is an effective measure to mitigate the pandemic. Pregnant and breastfeeding women were not included in registration studies, so official recommendations to vaccinate this vulnerable group appeared belated. Therefore, our aims were to evaluate vaccination uptake, reasons for and against vaccination, and the changes in these depending on the official national recommendations in Germany. Methods: An anonymous online cross-sectional survey among pregnant and breastfeeding women was conducted prior to and after the publication of the official vaccination recommendation. Results: Data from the convenience sample of 5411 participants (42.9% pregnant; 57% breastfeeding) were analysed. The recommendation was known to 95% of the participants. The information was obtained mainly autonomously (61.6%) and through the media (56.9%). Vaccination uptake increased in pregnant (2.4% before vs. 58.7% after) and breastfeeding women (13.7% vs. 74.7%). As reasons to get vaccinated, pregnant women indicated more fear of the infection than of the side effects of vaccination (52.0% before vs. 66.2% after), intended protection of the baby and oneself (36.0% vs. 62.9%), and limited information about vaccination (53.5% vs. 24.4%). Conclusion: The official national recommendation is widely known and mostly obtained autonomously, thereby showing a high level of awareness and a rise in vaccination uptake. Nonetheless, targeted education campaigns focusing on scientific evidence should be maintained, whereas the engagement of health professionals should be enhanced. Full article

(This article belongs to the Special Issue COVID-19 and Pregnancy: Prevention and Control Strategies for Coronavirus in Women)

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11 pages, 631 KiB

Open AccessArticle

Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study

by Adrian I. Espiritu, Sybil Lizanne R. Bravo, Hannah Andrea A. Sombilla, Ourlad Alzeus G. Tantengco, Marie Charmaine C. Sy, Alvin Duke R. Sy, Veeda Michelle M. Anlacan and Roland Dominic G. Jamora

Vaccines 2023, 11(2), 226; https://doi.org/10.3390/vaccines11020226 - 19 Jan 2023

Cited by 2 | Viewed by 1977

Abstract

Objective: Our study determined the association of pregnancy with various clinical outcomes among women with COVID-19 infection. Methods: We conducted a retrospective, cohort, subgroup analysis of the Philippine CORONA Study datasets comparing the clinical/neurological manifestations and outcomes of pregnant and nonpregnant women admitted in 37 Philippine hospitals for COVID-19 infection. Results: We included 2448 women in the analyses (322 pregnant and 2.126 nonpregnant). Logistic regression models showed that crude odds ratio (OR) for mortality (OR 0.26 [95% CI 0.11, 0.66]), respiratory failure [OR 0.37 [95% CI 0.17, 0.80]), need for intensive care (OR 0.39 [95% CI 0.19, 0.80]), and prolonged length of hospital stay (OR 1.73 [95% CI 1.36, 2.19]) among pregnant women were significant. After adjusting for age, disease severity, and new-onset neurological symptoms, only the length of hospital stay remained significant (adjusted OR 1.99 [95% CI 1.56,2.54]). Cox regression models revealed that the unadjusted hazard ratio (HR) for mortality (HR 0.22 [95% CI 0.09, 0.55]) among pregnant women was statistically significant; however, after adjustment, the HR for mortality became nonsignificant. Conclusion: We did not find a significantly increased risk of mortality, respiratory failure, and need for ICU admission in pregnant women compared with nonpregnant women with COVID-19. However, the likelihood of hospital confinement beyond 14 days was twice more likely among pregnant women than nonpregnant women with COVID-19. Full article

(This article belongs to the Special Issue COVID-19 and Pregnancy: Prevention and Control Strategies for Coronavirus in Women)

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14 pages, 993 KiB

Open AccessSystematic Review

Assessing the Impact of COVID-19 Vaccination on Preterm Birth: A Systematic Review with Meta-Analysis

by Mihaela Uta, Marius Craina, Felicia Marc and Ileana Enatescu

Vaccines 2024, 12(1), 102; https://doi.org/10.3390/vaccines12010102 - 19 Jan 2024

Cited by 1 | Viewed by 1818

Abstract

During the coronavirus diseases 2019 (COVID-19) pandemic, the safety and efficacy of vaccination during pregnancy, particularly regarding the risk of preterm birth, have been a subject of concern. This systematic review aims to evaluate the impact of COVID-19 vaccination on preterm birth risk and to inform clinical practice and public health policies. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a database search included PubMed, Embase, and Scopus, conducted up until October 2023. Inclusion criteria focused on studies that examined COVID-19 vaccination during pregnancy and its correlation with preterm birth, defined as a birth before 37 weeks of gestation. Six studies met these criteria, encompassing 35,612 patients. A quality assessment was performed using the Newcastle–Ottawa Scale and the Cochrane Collaboration’s tool, with the risk of bias evaluated via a funnel plot analysis and an Egger’s regression test. The studies demonstrated geographical diversity, mainly from Israel, Romania, and the United States, with a blend of prospective and retrospective designs. The patient cohort’s mean age was 31.2 years, with common comorbidities such as gestational diabetes and obesity affecting 9.85% of the total population. The vaccination types varied across the studies, with BNT162b2 being the most used. The results indicated a low heterogeneity among the included studies, evidenced by a Cochran’s Q statistic of 2.10 and an I² statistic of 13%. The meta-analysis yielded a pooled odds ratio (OR) for a preterm birth risk post-vaccination of approximately 1.03 (95% CI: 0.82–1.30), suggesting no significant increase in preterm birth risk was associated with COVID-19 vaccination. Notable findings included a low preterm birth rate (as low as 0.6% and up to 6.1%) with minimal differences in neonatal outcomes, such as birth weight and APGAR (appearance, pulse, grimace, activity, and respiration) scores between vaccinated and unvaccinated groups. This study concludes that a COVID-19 vaccination during pregnancy does not significantly increase the risk of preterm birth. These findings are crucial for reassuring healthcare providers and pregnant women about the safety of COVID-19 vaccines and supporting their use in public health strategies during the pandemic. Full article

(This article belongs to the Special Issue COVID-19 and Pregnancy: Prevention and Control Strategies for Coronavirus in Women)

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21 pages, 484 KiB

Open AccessSystematic Review

Determinants of COVID-19 Vaccination Decision-Making Behaviors among Pregnant Women in Sub-Saharan Africa: A Scoping Review

by Sylvia Ayieko, Kimberly Baker, Sarah E. Messiah, Brianna Lewis and Christine Markham

Vaccines 2023, 11(7), 1233; https://doi.org/10.3390/vaccines11071233 - 12 Jul 2023

Cited by 3 | Viewed by 1371

Abstract

Despite the availability of the coronavirus disease 2019 (COVID-19) vaccination, uptake among pregnant women in Sub-Saharan Africa has been low. This scoping review aimed to identify and characterize determinants influencing COVID-19 vaccination decision-making behaviors among pregnant women in Sub-Saharan Africa. We searched five online databases for articles on COVID-19 vaccination among pregnant women in Sub-Saharan Africa. We identified studies published in English between March 2020 and April 2023 that assessed vaccine-specific issues, psychosocial constructs, and contextual factors associated with COVID-19 vaccination decision-making behaviors. Of the fourteen studies identified, over half (57.1%) were cross-sectional; three used qualitative research methods; and three involved multi-country participants. Most studies assessed COVID-19 vaccination acceptability and willingness. Overall, 85.7% of the publications examined knowledge, attitudes, or both as critical factors associated with COVID-19 vaccination. The prevalence of COVID-19 vaccine uptake during pregnancy was low in Sub-Saharan Africa (14.4–28%). While most current studies assess COVID-19 vaccination knowledge, research on maternal vaccination in Sub-Saharan Africa would benefit from the inclusion of theory-informed and driven studies that measure additional psychosocial factors and contextual constructs. Future studies should also employ study designs that can determine causal pathways of vaccination determinants and vaccination uptake. Full article

(This article belongs to the Special Issue COVID-19 and Pregnancy: Prevention and Control Strategies for Coronavirus in Women)

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7 pages, 213 KiB

Open AccessCase Report

Placental Transfer Immunity to the Newborns in a Twin Pregnant Women Vaccinated with Heterologous CoronaVac-ChAdOx1

by Saipin Pongsatha, Kriangkrai Chawansuntati, Supachai Sakkhachornphop and Theera Tongsong

Vaccines 2023, 11(1), 116; https://doi.org/10.3390/vaccines11010116 - 03 Jan 2023

Viewed by 6199

Abstract

Pregnant women who receive the COVID-19 vaccine develop anti-SARS-CoV-2 antibodies, which can be transferred to the fetus. However, the effectiveness of placental transfer has not been evaluated in twin pregnancy, especially in cases vaccinated with heterologous CoronaVac (Sinovac)—ChAdOx1 (Oxford-AstraZeneca) regimen, which was commonly used in many countries. Case: A 34-year-old Thai woman with a twin pregnancy attended our antenatal care clinic at 21 + 2 weeks of gestation and requested COVID-19 vaccination. Her medical history and physical examination were unremarkable. She had not received COVID-19 vaccination before. Ultrasound screening for fetal anomaly revealed a dichorion diamnion twin pregnancy. Both twins showed no structural anomaly. She received the CoronaVac vaccine at 21 + 2 weeks of gestation without serious side effects and the ChAdOx1 vaccine at 24 + 2 weeks of gestation. Cesarean delivery was performed at 36 + 5 weeks of gestation, giving birth to the two healthy babies. The levels of anti-spike protein IgG levels (BAU/mL) in maternal blood just before delivery and umbilical cord blood of the two newborns were 313.349, 678.219, and 874.853, respectively. The levels of % inhibition (wild-type and delta) in the two newborns were also higher than those in the mother. In conclusion, heterologous CoronaVac-ChAdOx1-S vaccination in a twin pregnancy could effectively provide protective immunity to both twin newborns. The antibody levels in both were approximately two times higher than those in the mothers. This case report may serve as a reference in counseling couples with a twin pregnancy, while the studies on placental transfer of vaccine-derived antibodies in twin pregnancy are currently not available, especially in countries experiencing a vaccine shortage or unavailability of mRNA vaccines. Full article

(This article belongs to the Special Issue COVID-19 and Pregnancy: Prevention and Control Strategies for Coronavirus in Women)

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