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in category obstetrics and gynecology

215 results found. For more information, click each entry to expand.

1: COVID-19 vaccine response in pregnant and lactating women: a cohort study
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Posted 08 Mar 2021

COVID-19 vaccine response in pregnant and lactating women: a cohort study
11,885 downloads medRxiv obstetrics and gynecology

Kathryn J. Gray, Evan A. Bordt, Caroline Atyeo, Elizabeth Deriso, Babatunde Akinwunmi, Nicola Young, Aranxta Medina Baez, Lydia L Shook, Dana Cvrk, Kaitlyn James, Rose De Guzman, Sara Brigida, Khady Diouf, Ilona Goldfarb, Lisa M. Bebell, Lael M. Yonker, Alessio Fasano, Sayed A Rabi, Michal A Elovitz, Galit Alter, Andrea G. Edlow

Background: Pregnant and lactating women were excluded from initial COVID-19 vaccine trials; thus, data to guide vaccine decision-making are lacking. We sought to evaluate the immunogenicity and reactogenicity of COVID-19 mRNA vaccination in pregnant and lactating women. Methods: 131 reproductive-age vaccine recipients (84 pregnant, 31 lactating, and 16 non-pregnant) were enrolled in a prospective cohort study at two academic medical centers. Titers of SARS-CoV-2 Spike and RBD IgG, IgA and IgM were quantified in participant sera (N=131), umbilical cord sera (N=10), and breastmilk (N=31) at baseline, 2nd vaccine dose, 2-6 weeks post 2nd vaccine, and delivery by Luminex, and confirmed by ELISA. Titers were compared to pregnant women 4-12 weeks from native infection (N=37). Post-vaccination symptoms were assessed. Kruskal-Wallis tests and a mixed effects model, with correction for multiple comparisons, were used to assess differences between groups. Results: Vaccine-induced immune responses were equivalent in pregnant and lactating vs non-pregnant women. All titers were higher than those induced by SARS-CoV-2 infection during pregnancy. Vaccine-generated antibodies were present in all umbilical cord blood and breastmilk samples. SARS-CoV-2 specific IgG, but not IgA, increased in maternal blood and breastmilk with vaccine boost. No differences were noted in reactogenicity across the groups. Conclusions: COVID-19 mRNA vaccines generated robust humoral immunity in pregnant and lactating women, with immunogenicity and reactogenicity similar to that observed in non-pregnant women. Vaccine-induced immune responses were significantly greater than the response to natural infection. Immune transfer to neonates occurred via placental and breastmilk.

2: Addressing anti-syncytin antibody levels, and fertility and breastfeeding concerns, following BNT162B2 COVID-19 mRNA vaccination
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Posted 25 May 2021

Addressing anti-syncytin antibody levels, and fertility and breastfeeding concerns, following BNT162B2 COVID-19 mRNA vaccination
11,613 downloads medRxiv obstetrics and gynecology

Citra Nurfarah Mattar, Winston Koh, Yiqi Seow, Shawn Hoon, Aparna VENKATESH, Pradip Dashraath, Li Min LIM, Judith ONG, Rachel Jiayu Lee, Nuryanti Johana, Julie SL Yeo, David Shao Hong Chong, Lay Kok Tan, Jerry Kok Yen Chan, Mahesh Choolani, Paul Tambyah

Objective: To determine whether antibodies against the SARS-CoV-2 spike protein following BNT162B2 (Pfizer-BioNTech) COVID-19 mRNA vaccination cross-react with human syncytin-1 protein, and if BNT162B2 mRNA enters breast milk. Methods: In this observational cohort study of female front-line workers with no history of COVID-19 infection, we amplified BNT162B2 mRNA in plasma and breast milk and assayed anti-SARS-CoV-2 neutralising antibodies and anti-human syncytin-1 binding antibodies in plasma, at early (1-4 days) and late (4-7 weeks) time points following first-dose vaccination. Results: Fifteen consented participants (mean age 40.4 years, various ethnicities) who received at least one dose of BNT162B2, including five breast-feeding women and two women who were inadvertently vaccinated in early pregnancy, were recruited. BNT162B2 mRNA, detected by amplifying part of the spike-encoding region, was detected in plasma 1-4 days following the first dose (n=13), but not 4-5 weeks later (n=2), nor was the mRNA isolated from aqueous or lipid breast milk fractions collected 0-7 days post-vaccination (n=5). Vaccine recipients demonstrated strong SARS-CoV-2 neutralising activity by at least four weeks after the first dose (n=15), including the two pregnant women. None had placental anti-syncytin-1 binding antibodies at either time-point following vaccination. Conclusions: BNT162B2-vaccinated women did not transmit vaccine mRNA to breast milk, and did not produce a concurrent humoral response to syncytin-1, suggesting that cross-reactivity to syncytin-1 on the developing trophoblast, or other adverse effects in the breast-fed infant from vaccine mRNA ingestion, are unlikely.

3: Stopping the misinformation: BNT16b2 COVID-19 vaccine has no negative effect on women's fertility
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Posted 01 Jun 2021

Stopping the misinformation: BNT16b2 COVID-19 vaccine has no negative effect on women's fertility
8,123 downloads medRxiv obstetrics and gynecology

Myriam Safrai, Amihai Rottenstreich, Shmuel Herzberg, Tal Imbar, Benjamin Reubinoff, Assaf Ben-Meir

Objective: To investigate the possible impact of Pfizer-BioNTech's mRNA BNT162b2 COVID-19 vaccine on women's fertility. Methods: A retrospective single-center study examining women's IVF treatment parameters and pregnancies before and after their vaccination between February and May 2021. Each woman served as a self-control before and after vaccination. Additionally, in order to neutralize the effect of the sperm on fertilization, only Intracytoplasmic Sperm Injection (ICSI) patients who were currently being treated with an ICSI cycle and had an earlier ICSI cycle available were included in the study. The study outcomes compared between the PRE and POST vaccination groups and consisted of: the IVF cycle outcomes, including the number of oocytes retrieved; the number of matured oocytes; the fertilization rate; and the number and quality of embryos at day 3. Clinical pregnancy was based on the first hCG value reported if the data were available for both cycles. Results: A final total of 47 women were eligible for inclusion with a mean interval of 362 +/- 368 days between the two ovum pick ups. The characteristics of their ICSI cycles before and after the vaccination were similar for all the parameters. Additionally, the number and percentage of clinical pregnancies did not significantly differ between the PRE and POST vaccination groups (n=15). Conclusion: This study is the first to evaluate the impact of the BNT162b2 vaccine on women's fertility. From our findings, the vaccine appears to have no impact on women's fertility. This study is the first step in abolishing the misinformation derived from unreliable sources and reassuring patients in order to improve compliance and promote COVID-19 eradication.

4: BNT162b2 mRNA Covid-19 vaccine does not impair sperm parameters
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Posted 03 May 2021

BNT162b2 mRNA Covid-19 vaccine does not impair sperm parameters
7,540 downloads medRxiv obstetrics and gynecology

Myriam Safrai, Benjamin Reubinoff, Assaf Ben-Meir

Mass vaccination using newly approved vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has begun globally. However, their effect on fertility have not yet been investigated. Previous studies demonstrate that SARS-CoV-2 infection may impair sperm parameters. In this study, we are the first to assess the effect of the BNT162b2 mRNA Covid-19 vaccine on sperm parameters. Our results demonstrate that the vaccine does not impair sperm parameters. Thus, we recommend that couples desiring to conceive should vaccinate, as vaccination does not affect sperm whereas SARS-CoV-2 infection does impair sperm.

5: Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort.
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Posted 25 Jul 2021

Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort.
6,856 downloads medRxiv obstetrics and gynecology

Nicola Vousden, Rema Ramakrishnan, Kathryn Bunch, Edward Morris, Nigel Simpson, Christopher Gale, Patrick O'Brien, Maria Quigley, Peter Brocklehurst, Jennifer J Kurinczuk, Marian Knight

Background In the UK, the Alpha variant of SARS-CoV-2 became dominant in late 2020, rapidly succeeded by the Delta variant in May 2021. The aim of this study was to compare the impact of these variants on severity of maternal infection and perinatal outcomes within the time-periods in which they predominated. Methods This national, prospective cohort study collated data on hospitalised pregnant women with symptoms of confirmed SARS-CoV-2 infection and compared the severity of infection and perinatal outcomes across the Wildtype (01/03/20-30/11/20), Alpha (01/12/20-15/05/21) and Delta dominant periods (16/05/21-11/07/21), using multivariable logistic regression. Findings Of 3371 pregnant women, the proportion that experienced moderate to severe infection significantly increased between Wildtype and Alpha periods (24.4% vs. 35.8%; aOR1.75 95%CI 1.48-2.06), and between Alpha and Delta periods (35.8% vs. 45.0%; aOR1.53, 95%CI 1.07-2.17). Compared to the Wildtype period, symptomatic women admitted in the Alpha period were more likely to require respiratory support (27.2% vs. 20.3%, aOR1.39, 95%CI 1.13-1.78), have pneumonia (27.5% vs. 19.1%, aOR1.65, 95%CI 1.38-1.98) and be admitted to intensive care (11.3% vs. 7.7%, aOR1.61, 95%CI 1.24-2.10). Women admitted during the Delta period had further increased risk of pneumonia (36.8% vs. 27.5%, aOR1.64 95%CI 1.14-2.35). No fully vaccinated pregnant women were admitted between 01/02/2021 when vaccination data collection commenced and 11/07/2021. The proportion of women receiving pharmacological therapies for SARS-CoV-2 management was low, even in those critically ill. Interpretation SARS-CoV-2 infection during Alpha and Delta dominant periods was associated with more severe infection and worse pregnancy outcomes compared to the Wildtype infection, which itself increased risk compared to women without SARS-CoV-2 infection.1 Clinicians need to be aware and implement COVID-specific therapies in keeping with national guidance. Urgent action to tackle vaccine misinformation and policy change to prioritise uptake in pregnancy is essential. Funding National Institute for Health Research HS&DR Programme (11/46/12).

6: Characterizing menstrual bleeding changes occurring after SARS-CoV-2 vaccination
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Posted 12 Oct 2021

Characterizing menstrual bleeding changes occurring after SARS-CoV-2 vaccination
6,296 downloads medRxiv obstetrics and gynecology

Katharine MN Lee, Eleanor J Junkins, Urooba A Fatima, Maria L Cox, Kathryn B.H. Clancy

Many people began sharing that they experienced unexpected menstrual bleeding after SARS-CoV-2 inoculation. This emerging phenomenon was undeniable yet understudied. We investigated menstrual bleeding patterns among currently and formerly menstruating people, with a research design based off our expectations that these bleeding changes related to changes in clotting or inflammation, affecting normal menstrual repair. In this sample, 42% of people with regular menstrual cycles bled more heavily than usual, while 44% reported no change, after being vaccinated. Among people who typically do not menstruate, 71% of people on long-acting reversible contraceptives, 39% of people on gender-affirming hormones, and 66% of post-menopausal people reported breakthrough bleeding. We found increased/breakthrough bleeding was significantly associated with age, other vaccine side effects (fever, fatigue), history of pregnancy or birth, and ethnicity. Changes to menstrual bleeding are not uncommon nor dangerous, yet attention to these experiences is necessary to build trust in medicine.

7: Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV-2 in women with COVID-19: A systematic review
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Posted 15 Apr 2020

Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV-2 in women with COVID-19: A systematic review
5,386 downloads medRxiv obstetrics and gynecology

Rahul Gajbhiye, Dr. Deepak N Modi, Smita D Mahale

Abstract Objective: The aim of this systematic review was to examine published and preprint reports for maternal and fetal outcomes in pregnant women with COVID-19 and also assess the incidence of maternal-fetal transmission of SARS CO-V-2 infection. Design : Systematic review Data sources:We searched PUMBED. Medline, Embase, MedRxiv and bioRxiv databases upto 31st March 2020 utilizing combinations of word variants for " coronavirus " or " COVID-19 " or " severe acute respiratory syndrome " or " SARS-COV-2 " and " pregnancy " . We also included data from preprint articles. Study selection : Original case reports and case series on pregnant women with a confirmed diagnosis of SARS-CoV-2 infection. Data extraction : We included 23 studies [China (20), USA (01), Republic of Korea (01) and Honduras, Central America (01) reporting the information on 172 pregnant women and 162 neonates. The primary outcome measures were maternal health characteristics and adverse pregnancy outcomes, neonatal outcomes and SARS-CoV-2 infection in neonates was extracted. Treatments given to pregnant women with COVID-19 were also recorded. Results: Out of 172 women affected by COVID-19 in pregnancy, 160 women had delivered 162 newborns (2 set of twins, 12 ongoing pregnancies). In pregnant women with COVID-19, the most common symptoms were fever (54%), cough (35%), myalgia (17%), dyspnea (12%) and diarrhea (4%). Pneumonia was diagnosed by CT scan imaging in 100 % of COVID-19 pregnant women. Pregnancy complications included delivery by cesarean section (89%), preterm labor (21%), fetal distress (9%) and premature rupture of membranes (8%). The most common co-morbidities associated with pregnant women with COVID-19 were diabetes (11%), hypertensive disorders (9%), placental disorders (5%), co-infections (6%), scarred uterus (5%), hypothyroidism (5%) and anemia (4%). Amongst the neonates of COVID-19 mothers, preterm birth (23%), respiratory distress syndrome (14%), pneumonia (14%) low birth weight (11%), small for gestational age (3%) were reported. There was one still birth and one neonatal death reported. Vertical transmission rate of SARS-CoV-2 is estimated to be 11%. Conclusion In pregnant women with COVID-19, diabetes and hypertensive disorders are common co-morbidities and there is a risk of preterm delivery. Amongst the neonates born to mothers with COVID-19, respiratory distress syndrome and pneumonia are common occurrence. There is an evidence of vertical transmission of SARS-CoV-2 infection in women with COVID-19.

8: Ovarian follicular function is not altered by SARS-Cov-2 infection or BNT162b2 mRNA Covid-19 vaccination.
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Posted 13 Apr 2021

Ovarian follicular function is not altered by SARS-Cov-2 infection or BNT162b2 mRNA Covid-19 vaccination.
4,058 downloads medRxiv obstetrics and gynecology

Yaakov Bentov, Ofer Beharier, Arbel Moav-Zafrir, Maor Kabessa, Miri Godin, Caryn Greenfield, Mali Ketzinel-Gilad, Efrat Esh Broder, Hananel Holzer, Dana Wolf, Esther Oiknine-Djian, Iyad Barghouti, Debra Goldman-Wohl, Simcha Yagel, Asnat Walfisch, Anat Hershko Klement

Importance: This is the first study to examine the impact of SARS-Cov-2 infection and COVID-19 vaccination on ovarian function. Objective: To characterize anti-COVID-19 antibodies in follicular fluid and compare ovarian follicle function in women following confirmed SARS-CoV-2 infection, COVID-19 vaccination, and non-infected, unvaccinated controls. Design: This is a cohort study conducted between February 1 and March 10, 2021. Setting: A single university hospital-based IVF clinic. Participants: Consecutive sample of female patients undergoing oocyte retrieval. Interventions: Consenting patients were recruited and assigned to one of three study groups: recovering from confirmed COVID 19 (n=9); vaccinated (n=9); and uninfected, non-vaccinated controls (n=14). Serum and follicular fluid samples were taken and analyzed for anti-COVID IgG as well as estrogen, progesterone and HSPG2 concentration, as well as the number and maturity of aspirated oocytes and previous estrogen and progesterone measurements. Main outcome measures: Follicular function, including steroidogenesis, follicular response to the LH/hCG trigger, and oocyte quality biomarkers. Results: Both natural and vaccine elicited anti-COVID IgG antibodies were detected in the follicular fluid in levels proportional to the IgG serum concentration. No differences were detected in any of the surrogate ovarian follicle quality reporting parameters. Conclusions and relevance: Both SARS-COV-2 infection and vaccination with the BNT162b2 mRNA vaccine mediate IgG immunity that crosses into the follicular fluid. No detrimental effect on follicular function was detected.

9: Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS)
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Posted 12 May 2020

Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS)
4,047 downloads medRxiv obstetrics and gynecology

Marian Knight, Kathryn Bunch, Nicola Vousden, Edward Morris, Nigel Simpson, Christopher Gale, Patrick O'Brien, Maria Quigley, Peter Brocklehurst, Jennifer J Kurinczuk

Objective: To describe a national cohort of pregnant women hospitalised with SARS-CoV-2 infection in the UK, identify factors associated with infection and describe outcomes, including transmission of infection, for mother and infant. Design: Prospective national population-based cohort study using the UK Obstetric Surveillance System (UKOSS). Setting: All 194 obstetric units in the UK Participants: 427 pregnant women admitted to hospital with confirmed Sars-CoV-2 infection between 01/03/2020 and 14/04/2020. 694 comparison women who gave birth between 01/11/2017 and 31/10/2018. Main outcome measures: Incidence of maternal hospitalisation, infant infection. Rates of maternal death, level 3 critical care unit admission, preterm birth, stillbirth, early neonatal death, perinatal death; odds ratios for infected versus comparison women. Results: Estimated incidence of hospitalisation with confirmed SARS-CoV-2 in pregnancy 4.9 per 1000 maternities (95%CI 4.5-5.4). The median gestation at symptom onset was 34 weeks (IQR 29-38). Black or other minority ethnicity (aOR 4.49, 95%CI 3.37-6.00), older maternal age (aOR 1.35, 95%CI 1.01-1.81 comparing women aged 35+ with those aged 30-34), overweight and obesity (aORs 1.91, 95%CI 1.37-2.68 and 2.20, 95%CI 1.56-3.10 respectively compared to women with a BMI<25kg/m2) and pre-existing comorbidities (aOR 1.52, 95%CI 1.12-2.06) were associated with admission with SARS-CoV-2 during pregnancy. 247 women (58%) gave birth or had a pregnancy loss; 180 (73%) gave birth at term. 40 (9%) hospitalised women required respiratory support. Twelve infants (5%) tested positive for SARS-CoV-2 RNA, six of these infants within the first 12 hours after birth. Conclusions: The majority of pregnant women hospitalised with SARS-CoV-2 were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes and transmission of SARS-CoV-2 to infants was uncommon. The strong association between admission with infection and black or minority ethnicity requires urgent investigation and explanation. Study Registration: ISRCTN 40092247

10: Estrogen and COVID-19 symptoms: associations in women from the COVID Symptom Study
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Posted 01 Aug 2020

Estrogen and COVID-19 symptoms: associations in women from the COVID Symptom Study
2,943 downloads medRxiv obstetrics and gynecology

Ricardo Costeira, Karla A Lee, Benjamin Murray, Colette Christiansen, Juan Castillo-Fernandez, Mary Ni Lochlainn, Joan Capdevila Pujol, Iain Buchan, Louise C. Kenny, Jonathan Wolf, Janice Rymer, Sebastien Ourselin, Claire Steves, Timothy Spector, Louise Newson, Jordana Bell

Background: Men and older women have been shown to be at higher risk of adverse COVID-19 outcomes. Animal model studies of SARS-CoV and MERS suggest that the age and sex difference in COVID-19 symptom severity may be due to a protective effect of the female sex hormone estrogen. Females have shown an ability to mount a stronger immune response to a variety of viral infections because of more robust humoral and cellular immune responses. Objectives: We sought to determine whether COVID-19 positivity increases in women entering menopause. We also aimed to identify whether premenopausal women taking exogenous hormones in the form of the combined oral contraceptive pill (COCP) and post-menopausal women taking hormone replacement therapy (HRT) have lower predicted rates of COVID-19, using our published symptom-based model. Design: The COVID Symptom Study developed by Kings College London and Zoe Global Limited was launched in the UK on 24th March 2020. It captured self-reported information related to COVID-19 symptoms. Data used for this study included records collected between 7th May - 15th June 2020. Main outcome measures: We investigated links between COVID-19 rates and 1) menopausal status, 2) COCP use and 3) HRT use, using symptom-based predicted COVID-19, tested COVID-19, and disease severity based on requirement for hospital attendance or respiratory support. Participants: Female users of the COVID Symptom Tracker Application in the UK, including 152,637 women for menopause status, 295,689 for COCP use, and 151,193 for HRT use. Analyses were adjusted for age, smoking and BMI. Results: Post-menopausal women aged 40-60 years had a higher rate of predicted COVID (P=0.003) and a corresponding range of symptoms, with consistent, but not significant trends observed for tested COVID-19 and disease severity. Women aged 18-45 years taking COCP had a significantly lower predicted COVID-19 (P=8.03E-05), with a reduction in hospital attendance (P=0.023). Post-menopausal women using HRT or hormonal therapies did not exhibit consistent associations, including increased rates of predicted COVID-19 (P=2.22E-05) for HRT users alone. Conclusions: Our findings support a protective effect of estrogen on COVID-19, based on positive association between predicted COVID-19 and menopausal status, and a negative association with COCP use. HRT use was positively associated with COVID-19 symptoms; however, the results should be considered with caution due to lack of data on HRT type, route of administration, duration of treatment, and potential comorbidities. Trial registration: The App Ethics has been approved by KCL ethics Committee REMAS ID 18210, review reference LRS-19/20-18210

11: Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy
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Posted 18 May 2021

Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy
2,853 downloads medRxiv obstetrics and gynecology

Regan N Theiler, Myra Wick, Amy Weaver, Ramila Mehta, Abinash Virk, Melanie D Swift

Background: SARS-CoV-2 infection during pregnancy is associated with significant maternal morbidity and increased rates of preterm birth. For this reason, COVID-19 vaccine administration in pregnancy has been endorsed by multiple professional societies including ACOG and SMFM despite exclusion of pregnant women from initial clinical trials of vaccine safety and efficacy. However, to date little data exists regarding outcomes after COVID-19 vaccination of pregnant patients. Study Design: A comprehensive vaccine registry was combined with a delivery database for an integrated healthcare system to create a delivery cohort including vaccinated patients. Maternal sociodemographic data were examined univariately for factors associated with COVID-19 vaccination. Pregnancy and birth outcomes were analyzed, including a composite measure of maternal and neonatal pregnancy complications, the Adverse Outcome Index. Results: Of 2002 patients in the delivery cohort, 140 (7.0%) received a COVID-19 vaccination during pregnancy and 212 (10.6%) experienced a COVID-19 infection during pregnancy. The median gestational age at first vaccination was 32 weeks (range 13 6/7-40 4/7), and patients vaccinated during pregnancy were less likely than unvaccinated patients to experience COVID-19 infection prior to delivery (1.4% (2/140) vs. 11.3% (210/1862)) P<0.001No maternal COVID-19 infections occurred after vaccination during pregnancy. Factors significantly associated with increased likelihood of vaccination included older age, higher level of maternal education, lower pre-pregnancy BMI, and use of infertility treatment for the current pregnancy. Tobacco or other substance use, Hispanic ethnicity, and higher gravidity were associated with a lower likelihood of vaccination. No significant difference in the composite adverse outcome (5.0% (7/140) vs. 4.9% (91/1862) P=0.95) or other maternal or neonatal complications, including thromboembolic events and preterm birth, was observed in vaccinated mothers compared to unvaccinated patients. Conclusions: Vaccinated pregnant women in this birth cohort were less likely to experience COVID-19 infection compared to unvaccinated pregnant patients, and COVID-19 vaccination during pregnancy was not associated with increased pregnancy or delivery complications. Significant sociodemographic disparities in vaccine uptake and/or access were observed among pregnant patients, and future efforts should focus on outreach to low-uptake populations.

12: Coronavirus and birth in Italy: results of a national population-based cohort study
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Posted 12 Jun 2020

Coronavirus and birth in Italy: results of a national population-based cohort study
2,385 downloads medRxiv obstetrics and gynecology

Alice Maraschini, Edoardo Corsi, Michele Antonio Salvatore, Serena Donati

Introduction The study was implemented to provide guidance to decision makers and clinicians by describing hospital care offered to women who gave birth with confirmed COVID 19 infection. Materials and methods National population based prospective cohort study involving all women with confirmed COVID 19 who gave birth between February 25 and April 22, 2020 in any Italian hospital. Results The incidence rate of confirmed SARS-CoV-2 infection in women who gave birth was 2.1 per 1000 maternities at a national level and 6.9/1000 in the Lombardy Region. Overall one third of the women developed a pneumonia and 49.7% assumed at least one drug. Caesarean section rate was 32.9%, no mothers nor newborns died. Six percent of the infants tested positive for SARS CoV 2 at birth. Conclusions Clinical features and outcomes of COVID 19 in women who gave birth are similar to those described for the general population, most women developing mild to moderate illness.

13: Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies
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Posted 06 May 2020

Effects of Coronavirus Disease 2019 (COVID-19) on Maternal, Perinatal and Neonatal Outcomes: a Systematic Review of 266 Pregnancies
2,319 downloads medRxiv obstetrics and gynecology

Juan Juan, Maria M Gil, Zhihui Rong, Yuanzhen Zhang, Huixia Yang, Liona Chiu Yee Poon

Objective: To perform a systematic review of available published literature on pregnancies affected by COVID-19 to evaluate the effects of COVID-19 on maternal, perinatal and neonatal outcomes. Methods: We performed a systematic review to evaluate the effects of COVID-19 on pregnancy, perinatal and neonatal outcomes. We conducted a comprehensive literature search using PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure Database and Wan Fang Data until April 20, 2020 (studies were identified through PubMed alert after April 20, 2020). For the research strategy, combinations of the following keywords and MeSH terms were used: SARS-CoV-2, COVID-19, coronavirus disease 2019, pregnancy, gestation, maternal, mothers, vertical transmission, maternal-fetal transmission, intrauterine transmission, neonates, infant, delivery. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient was pregnant on admission, availability of clinical characteristics, including maternal, perinatal or neonatal outcomes. Exclusion criteria were unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, and unreported maternal or perinatal outcomes. No language restrictions were applied. Results: We identified several case-reports and case-series but only 19 studies, including a total of 266 pregnant women with COVID-19, met eligibility criteria and were finally included in the review. In the combined data from seven case-series, the maternal age ranged from 20 to 41 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath and fatigue. The rate of severe pneumonia was relatively low, with the majority of the cases requiring intensive care unit admission. Almost all cases from the case-series had positive computer tomography chest findings. There were six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, which were negative for SARS-CoV-2. Only a few cases had spontaneous miscarriage or abortion. 177 cases had delivered, of which the majority by Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at 1 and 5 minutes ranged from 7 to 10 and 8 to 10, respectively. A few neonates had birthweight less than 2500 grams and over one-third of cases were transferred to neonatal intensive care unit. There was one case each of neonatal asphyxia and neonatal death. There were 113 neonates that had nucleic-acid testing in throat swab, which was negative for SARS-CoV-2. From the case-reports, two maternal deaths among pregnant women with COVID-19 were reported. Conclusions: The clinical characteristics of pregnant women with COVID-19 are similar to those of nonpregnant adults with COVID-19. Currently, there is no evidence that pregnant women with COVID-19 are more prone to develop severe pneumonia, in comparison to nonpregnant patients. The subject of vertical transmission of SARS-CoV-2 remains controversial and more data is needed to investigate this possibility. Most importantly, in order to collect meaningful pregnancy and perinatal outcome data, we urge researchers and investigators to reference previously published cases in their publications and to record such reporting when the data of a case is being entered into a registry or several registries.

14: COVID-19 and first trimester spontaneous abortion: a case-control study of 225 pregnant patients
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Posted 20 Jun 2020

COVID-19 and first trimester spontaneous abortion: a case-control study of 225 pregnant patients
2,215 downloads medRxiv obstetrics and gynecology

Stefano Cosma, Andrea Carosso, Jessica Cusato, Fulvio Borella, Marco Carosso, Marialuisa Bovetti, Claudia Filippini, Antonio D'Avolio, Valeria Ghisetti, Giovanni Di Perri, Chiara Benedetto

Background Evidence for the impact of COVID-19 during the second and the third trimester of pregnancy is limited to a relatively small series, while data on the first trimester are scant. With this study we evaluated COVID-19 infection as a risk factor for spontaneous abortion in first trimester of pregnancy. Methods Between February 22 and May 21, 2020, we conducted a case-control study at S. Anna hospital, Torino, among first trimester pregnant women, paired for last menstruation. The cumulative incidence of COVID-19 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by detection of SARS-CoV-2 from nasopharingeal swab and SARS-CoV-2 IgG/IgM antibodies in blood sample. Patient demographics, COVID-19-related symptoms, and the main risk factors for abortion were collected. Findings Twenty-three (10.2%) of the 225 women tested positive for COVID-19 infection. There was no difference in the cumulative incidence of COVID-19 between the cases (11/100, 11%) and the controls (12/125, 9.6%) (p=0.73). Logistic regression analysis confirmed that COVID-19 was not an independent predictor of abortion (1.28 confidence interval 0.53-3.08). Interpretation COVID-19 infection during the first trimester of pregnancy does not appear to predispose to abortion; its cumulative incidence did not differ from that of women with ongoing pregnancy.

15: Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019
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Posted 27 Mar 2020

Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019
2,098 downloads medRxiv obstetrics and gynecology

Rui Nie, Shao-shuai Wang, Qiong Yang, Cui-fang Fan, Yu-ling Liu, Wen-cong He, Mei Jiang, Cheng-cheng Liu, Wan-jiang Zeng, Jian-li Wu, Kutluk Oktay, Ling Feng, Lei Jin

BACKGROUNDThere is little information about the coronavirus disease 2019 (Covid-19) during pregnancy. This study aimed to determine the clinical features and the maternal and neonatal outcomes of pregnant women with Covid-19. METHODSIn this retrospective analysis from five hospitals, we included pregnant women with Covid-19 from January 1 to February 20, 2020. The primary composite endpoints were admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Secondary endpoints included the clinical severity of Covid-19, neonatal mortality, admission to neonatal intensive care unit (NICU), and the incidence of acute respiratory distress syndrome (ARDS) of pregnant women and newborns. RESULTSThirty-three pregnant women with Covid-19 and 28 newborns were identified. One (3%) pregnant woman needed the use of mechanical ventilation. No pregnant women admitted to the ICU. There were no moralities among pregnant women or newborns. The percentages of pregnant women with mild, moderate, and severe symptoms were 13 (39.4%),19(57.6%), and 1(3%). One (3.6%) newborn developed ARDS and was admitted to the NICU. The rate of perinatal transmission of SARS-CoV-2 was 3.6%. CONCLUSIONSThis report suggests that pregnant women are not at increased risk for severe illness or mortality with Covid-19 compared with the general population. The SARS-CoV-2 infection during pregnancy might not be associated with as adverse obstetrical and neonatal outcomes that are seen with the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy. (Funded by the National Key Research and Development Program.)

16: Pregnancy and breastfeeding during COVID-19 pandemic: A systematic review of published pregnancy cases
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Posted 29 Apr 2020

Pregnancy and breastfeeding during COVID-19 pandemic: A systematic review of published pregnancy cases
1,955 downloads medRxiv obstetrics and gynecology

Carina Rodrigues, Ines Baia, Rosa Domingues, Henrique Barros

Background: The COVID-19 pandemic is an emerging concern regarding the potential adverse effects during pregnancy. This study reviews knowledge on the impact of COVID-19 on pregnancy and describes the outcome of published cases of pregnant women diagnosed with COVID-19. Methods: Searches were conducted in PubMed up to 8 April 2020, using PRISMA standards, to identify original published studies describing pregnant women at any gestational age diagnosed COVID-19. There were no date or language restrictions on the search. All identified studies were included irrespective of assumptions on study quality. Results: We identified 30 original studies reporting 212 cases of pregnant women with COVID-19 (30 discharged while pregnant), 200 from China and 12 from other countries. The 182 published deliveries resulted in one stillbirth and 185 live births. Four women with severe COVID-19 required admission to an intensive care unit but no cases of maternal death were reported. There was one neonatal death. Preterm births occurred in 28.7% of cases, but it is unclear whether this was iatrogenic. All cases with amniotic fluid, placenta, and/or cord blood analyzed for the SARS-CoV-2 virus were negative. Four newborns were positive for SARS-CoV-2 and three newborns had high levels of IgM antibodies. Breast milk samples from 13 mothers and described in seven studies showed no evidence of SARS-CoV-2. Conclusion: The evidence related to the effect of COVID-19 on pregnant women is still limited. Pregnant women and newborns should be considered particularly vulnerable populations regarding COVID-19 prevention and management strategies.

17: SARS-CoV-2 in first trimester pregnancy - does it affect the fetus?
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Posted 09 Jun 2020

SARS-CoV-2 in first trimester pregnancy - does it affect the fetus?
1,869 downloads medRxiv obstetrics and gynecology

Nina la Cour Freiesleben, Pia Egerup, Kathrine Vauvert Rommelmayer Hviid, Elin Rosenbek Severinsen, Astrid Marie Kolte, David Westergaard, Line Fich Olsen, Lisbeth Praetorius, Anne Zedeler, Ann-Marie Hellerung Christiansen, Josefine Reinhardt Nielsen, Didi Bang, Sine Berntsen, Joaquim Olle-Lopez, Andreas Ingham, Judith Bello-Rodriuez, Ditte Marie Storm, Jeppe Ethelberg-Findsen, Eva R. Hoffmann, Charlotte Wilken-Jensen, Finn Stener Jorgensen, Henrik Westh, Henrik Lovendahl Jorgensen, Henriette Svarre Nielsen

Background Several viral infections are known to be harmful to the fetus in the first trimester of pregnancy and can cause increased nuchal translucency thickness and pregnancy loss. Currently, no evidence exists regarding possible effects of SARS-CoV-2 in first trimester pregnancies. Methods Cohort 1 included pregnant women with a double test taken between Feb. 17 and Apr. 23, 2020, during the SARS-CoV-2 epidemic peak in Denmark. The double test was taken as part of the first trimester risk assessment. Cohort 2 included women with a first trimester pregnancy loss before double test. Serum from the double test or from a blood sample, in case of pregnancy loss, was analyzed for SARS-CoV-2 antibodies. The results were correlated to the nuchal translucency thickness and the number of pregnancy losses. Results In total, 1,019 pregnant women with double test and 36 women with pregnancy loss participated in the study. Thirty (2.9%) women had SARS-CoV-2 antibodies in the serum from the double test. All women with pregnancy loss prior to the double test were negative for SARS-CoV-2 antibodies. There were no significant differences in nuchal translucency thickness for women testing positive (n=14) versus negative (p=0.20) or grey zone (n=16) versus negative (p=0.28). In total, 54 women experienced a pregnancy loss of whom two had grey zone or positive SARS-CoV-2 antibodies. Conclusion Maternal SARS-CoV-2 infection did not seem harmful in first trimester pregnancies. Infection had no effect on the nuchal translucency thickness and women with SARS-CoV-2 antibodies were not overrepresented among women with pregnancy loss.

18: THE EMOTIONAL IMPACT OF THE ASRM GUIDELINES ON FERTILITY PATIENTS DURING THE COVID-19 PANDEMIC
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Posted 01 Apr 2020

THE EMOTIONAL IMPACT OF THE ASRM GUIDELINES ON FERTILITY PATIENTS DURING THE COVID-19 PANDEMIC
1,866 downloads medRxiv obstetrics and gynecology

Jenna Turocy, Alex Robles, Daniel Hercz, Mary D’Alton, Eric J. Forman, Zev Williams

ObjectiveTo survey fertility patients agreement with ASRM recommendations during the COVID-19 pandemic and the emotional impact on them. DesignAn online survey was sent to current fertility patients SettingNew York City academic fertility practice at the epicenter of the COVID-19 pandemic Patient(s)Fertility patients seen within the last year Intervention(s)None Main Outcome Measures(s)Patient agreement with the ASRM recommendations during the COVID-19 pandemic and the emotional impact rated on a Likert scale. Result(s)A total of 518 patients completed the survey for a response rate of 17%. Fifty percent of respondents had a cycle canceled due to the COVID-19 pandemic. Of those who had a cycle cancelled, 85% of respondents found it to be moderately to extremely upsetting with 22% rating it to be equivalent to the loss of a child. There was no difference on the emotional impact based on the type of cycle cancelled. Fifty-five percent of patients agreed that diagnostic procedures such as hysterosalpingograms should be cancelled while 36% of patients agreed all fertility cycles should be cancelled. Patients were slightly more likely to agree with the ASRM guidelines if they have an upcoming cycle cancelled (p = 0.041). Of all respondents 82% would have preferred to have the option to start a treatment cycle in consultation with their doctor. Conclusion(s)Given the severity of the COVID-19 pandemic, the physical, financial and emotional impact of this unprecedented threat cannot be underestimated in our fertility patients.

19: Persistence of SARS-CoV-2 in the first trimester placenta leading to vertical transmission and fetal demise from an asymptomatic mother
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Posted 21 Aug 2020

Persistence of SARS-CoV-2 in the first trimester placenta leading to vertical transmission and fetal demise from an asymptomatic mother
1,837 downloads medRxiv obstetrics and gynecology

Prajakta Shende, Pradip Gaikwad, Manisha Gandhewar, Pawankumar Ukey, Anshul Bhide, Vainav Patel, Sharad Bhagat, Vikrant Bhor, Smita D Mahale, Rahul Gajbhiye, Dr. Deepak N Modi

Coronaviruses infect the respiratory tract and are known to survive in these tissues during the clinical course of infection. However, how long can SARS-CoV-2 survive in the tissues is hitherto unknown. Herein, we report a case where the virus is detected in the first trimester placental cytotrophoblast and syncytiotrophoblasts five weeks after the asymptomatic mother cleared the virus from the respiratory tract. This first trimester placental infection was vertically transmitted as the virus was detected in the amniotic fluid and fetal membranes. This congenitally acquired SARS-CoV-2 infection was associated with hydrops and fetal demise. This is the first study providing concrete evidences towards persistent tissue infection of SARS-CoV-2, its congenital transmission in early pregnancy leading to intrauterine fetal death.

20: Lived experiences of pregnant and new mothers during COVID-19 pandemic: A narrative analysis of YouTube birth stories.
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Posted 04 Jan 2021

Lived experiences of pregnant and new mothers during COVID-19 pandemic: A narrative analysis of YouTube birth stories.
1,801 downloads medRxiv obstetrics and gynecology

Kobi V. Ajayi, Idethia S. Harvey, Sonya Panjwani, Inyang Uwak, Whitney Garney, Robin L. Page

IntroductionThe COVID-19 pandemic has brought on unprecedented changes, not only to our daily lives but also to our healthcare system. The pandemic has particularly impacted pregnant women that must give birth with tight restrictions and significant uncertainties. Birth stories have frequently been used as a way for women to describe their experiences with the birthing process. In this uncertain time, birth stories can provide valuable insight into how pregnancy and birth stressors during a pandemic can impact the patients overall experience. This study sought to describe and understand pregnant and new mothers lived experiences during the COVID-19 pandemic. MethodsResearchers extracted relevant YouTube birth stories using predetermined search terms and inclusion criteria. The mothers birth stories were narrated in their second or third trimester or those who had recently given birth during the study period. Birth stories were analyzed using an inductive and deductive approach to capture different aspects of the birthing experience. ResultsOverall, eighty-three birth stories were analyzed. Within these birth stories, four broad themes and twelve subthemes emerged. Key themes included a sense of loss, hospital experiences, experiences with healthcare providers, and unique experiences during birth and postpartum. The birth stories revealed negative and positive birth experiences. Particularly, mothers were frustrated with constantly changing policies within the healthcare setting that negatively affected their birthing experience. On the other hand, support from healthcare professionals, having their partners in the delivery room, and having a positive mindset was instrumental in having a positive birth experience. ConclusionResults from this study provided a detailed description of womens lived experience with giving birth during the COVID-19 pandemic. Healthcare providers need to provide clear communication and compassionate patient-centered care to relieve womens anxiety about uncertain and unpredictable policy as the pandemic continues to evolve.

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