Publications

12

Jan, 2021

Zika virus infection in pregnancy: a protocol for the join analysis of the prospective cohort studies of the ZIKAlliance, ZikaPLAN and ZIKAction consortia

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Authors: A E Ades, Elizabeth B Brickley, Neal Alexander, David Brown, Thomas Jaenisch, Demócrito de Barros Miranda-Filho, Moritz Pohl, Kerstin D Rosenberger, Antoni Soriano-Arandes , Claire Thorne et al.

Published in: BMJ Journals

 

Abstract: 

Introduction    Zika virus (ZIKV) infection in pregnancy has been associated with microcephaly and severe neurological damage to the fetus. Our aim is to document the risks of adverse pregnancy and birth outcomes and the prevalence of laboratory markers of congenital infection in deliveries to women experiencing ZIKV infection during pregnancy, using data from European Commission-funded prospective cohort studies in 20 centres in 11 countries across Latin America and the Caribbean.

Methods and analysis    We will carry out a centre-by- centre analysis of the risks of adverse pregnancy and birth outcomes, comparing women with confirmed and suspected ZIKV infection in pregnancy to those with no evidence of infection in pregnancy. We will document the proportion of deliveries in which laboratory markers of congenital infection were present. Finally, we will investigate the associations of trimester of maternal infection in pregnancy, presence or absence of maternal symptoms of acute ZIKV infection and previous flavivirus infections with adverse outcomes and with markers of congenital infection. Centre-specific estimates will be pooled using a two-stage approach.

Ethics and dissemination   Ethical approval was obtained at each centre. Findings will be presented at international conferences and published in peer-reviewed open access journals and discussed with local public health officials and representatives of the national Ministries of Health, Pan American Health Organization and WHO involved with ZIKV prevention and control activities.

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29

Sep, 2020

COVID-19 Online Educational Program

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This online educational program will be presented by Dr Lynne Mofenson, of the Elizabeth Glaser Pediatric AIDS Foundation, on October 13th 2020.

Dr Mofenson’s talk will focus on the effects of COVID-19 in pregnant women and possible mother to child transmission during breastfeeding.

Join us to hear important insights into the clinical characteristics and possible risks associated with COVID-19 during the pregnancy and postnatal period.

Click here for more information.

Click here to register.

17

Apr, 2020

Preterm delivery in pregnant women with critical COVID-19 pneumonia and vertical transmission

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Since December 2019, the novel coronavirus disease (COVID-19) infection has spread quickly from China to different parts of the world including Iran . Since February 18, 2020, over 12,000 confirmed cases of COVID-19 have been reported in Iran, and more than 150,000 cases in numerous other countries worldwide, with an around 3-4% mortality rate as up to March 15. One of the most important ways of viral transmission is the individuals contact in hospitals, inside families, and other crowded places, but still no finding is reported on the optimal treatment modalities or vaccines,

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16

Apr, 2020

Universal screening for SARS-CoV-2 in women admitted for delivery

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In recent weeks, Covid-19 has rapidly spread throughout New York City. The obstetrical population presents a unique challenge during this pandemic, since these patients have multiple interactions with the health care system and eventually most are admitted to the hospital for delivery. We first diagnosed a case of Covid-19 in an obstetrical patient on March 13, 2020, and we previously reported our early experience with Covid-19 in pregnant women, including two initially asymptomatic women in whom symptoms developed and who tested positive for SARS-CoV-2, the virus that causes Covid-19, after delivery.1,2 After these two cases were identified, we implemented universal testing with nasopharyngeal swabs and a quantitative polymerase-chain-reaction test to detect SARS-CoV-2 infection in women who were admitted for delivery.

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15

Apr, 2020

An uncomplicated delivery in a patient with Covid-19 in the United States

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At 39 weeks of gestation, a 34-year-old woman (gravida 7, para 5) presented to the labor and delivery unit with a 3-day history of fever, chills, dry cough, and myalgia. She reported decreased fetal movements during the past day. She worked as a waitress and reported that she had not traveled recently. Her husband had had similar symptoms for the past 24 hours.

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15

Apr, 2020

COVID‐19 in pregnancy with comorbidities: more liberal testing strategy is needed

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Abstract Despite a global pandemic, reports on pregnant women with Coronavirus disease 2019 (COVID‐19) are few so far, testing strategies vary substantially and management guidelines are not uniform.

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15

Apr, 2020

Lung ultrasound and computed tomographic findings in pregnant woman with COVID‐19

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Abstract Imaging modalities play a crucial role in the management of suspected COVID‐19‐infected patients. Before reverse transcription polymerase chain reaction (RT‐PCR) test results are positive, 60–93% of patients have positive chest computed tomographic (CT) findings consistent with COVID‐19 infection. We report a case of positive lung ultrasound findings consistent with COVID‐19 in a woman with an initial negative RT‐PCR result. The lung ultrasound‐imaging findings were present between the negative and subsequent positive RT‐PCR tests and correlated with CT findings. The point‐of‐care lung‐ultrasound examination was easy to perform and, as such, could play an important role in the triage of women with suspected COVID‐19. The neonatal swabs, cord blood, and placental swab RT‐PCR tests were negative for SARS‐CoV‐2, a finding consistent with the published literature suggesting no vertical transmission of SARS‐CoV‐2 in pregnant women.

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10

Apr, 2020

Clinical and CT imaging features of the COVID-19 pneumonia: focus on pregnant women and children

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J Infect, March 2020

Background The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported.

Methods Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared.

Findings Compared with the non-pregnant adults group (n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed (n = 16) and clinically-diagnosed (n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults (P = 0·007, P < 0·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults (P = 0·001, P < 0·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twentythree patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6–9 days after initial CT scans.

Interpretation Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT.

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6

Apr, 2020

Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission

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Abstract This study is to investigate the clinical characteristics of late pregnancy with asymptomatic 2019 novel coronavirus disease (COVID‐19) infection, evaluate the outcome of maternal and fetal prognosis, and identify the evidence of intrauterine vertical transmission. A 22‐years‐old pregnant woman with asymptomatic COVID‐19 infection who was admitted to our hospital on 11 February 2020 was enrolled in this study. Clinical data including laboratory test results and chest computed tomography (CT) scanning were collected and reviewed. Diagnosis of late pregnancy with asymptomatic COVID‐19 infection was made. Lumbar anesthesia for cesarean section was performed and a female baby was delivered uneventfully, with the Apgar score of 9 to 10 points. Three times of COVID‐19 nucleic acid test for the baby was negative after delivery. The puerpera returned to normal after the operation and two times of throat swab COVID‐19 nucleic acid test were all negative after antiviral therapy. We reported an asymptomatic COVID‐19 pregnant woman with detailed clinical information and our result indicated that for late pregnant women with asymptomatic COVID‐19 infection, there might be no intrauterine infection caused by vertical transmission.

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15

Mar, 2020

Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study

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Background The ongoing epidemics of coronavirus disease 2019 (COVID-19) have caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia.

Methods We conducted a case-control study to compare clinical characteristics, maternal and neonatal outcomes of pregnant women with and without COVID-19 pneumonia.

Results During January 24 to February 29, 2020, there were sixteen pregnant women with confirmed COVID-19 pneumonia and eighteen suspected cases who were admitted to labor in the third trimester. Two had vaginal delivery and the rest took cesarean section. Few patients presented respiratory symptoms (fever and cough) on admission, but most had typical chest CT images of COVID-19 pneumonia. Compared to the controls, COVID-19 pneumonia patients had lower counts of white blood cells (WBC), neutrophils, C-reactive protein (CRP), and alanine aminotransferase (ALT) on admission. Increased levels of WBC, neutrophils, eosinophils, and CRP were found in postpartum blood tests of pneumonia patients. There were three (18.8%) and two (10.5%) of the mothers with confirmed or suspected COVID-19 pneumonia had preterm delivery due to maternal complications, which were significantly higher than the control group. None experienced respiratory failure during hospital stay. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.

Conclusion Severe maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had vaginal delivery or caesarean section. Mild respiratory symptoms of pregnant women with COVID-19 pneumonia highlight the need of effective screening on admission.

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