Most downloaded biology preprints, all time
in category obstetrics and gynecology
290 results found. For more information, click each entry to expand.
16,155 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.
14,889 downloads medRxiv obstetrics and gynecology
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. TeaserIncreased bleeding can occur post SARS-CoV-2 vaccines; this study characterizes patterns to enable future hypothesis testing.
13,574 downloads medRxiv obstetrics and gynecology
Kathryn J. Gray, Evan A. Bordt, Caroline G. Atyeo, Elizabeth Deriso, Babatunde Akinwunmi, Nicola Young, Aranxta Medina Baez, Lydia 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.
10,422 downloads medRxiv obstetrics and gynecology
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).
9,935 downloads medRxiv obstetrics and gynecology
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.
8,788 downloads medRxiv obstetrics and gynecology
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.
8,299 downloads medRxiv obstetrics and gynecology
Background The functional status of mothers after childbirth has implications for maternal, child, and family health. There is a lack of adequate reliable and valid instruments in Ethiopia for assessing women postpartum functional status. Objective This study was intended to reveal the psychometric properties of the Barkin Index of Maternal Functioning (BIMF) for assessing Ethiopian mothers functional status. Method Structured interviews were used to obtain BIMF data from 202 women who had a child less than 1 year of age. Descriptive statistics were calculated for the BIMF items; internal consistency was assessed with interitem correlations and coefficient alphas; construct validity was examined through exploratory factor analyses (EFAs) after face and content validities had been confirmed; and test retest reliability was assessed with intraclass correlation coefficients (ICCs). Results Narrow standard deviations and significant skewness and kurtosis characterized most of the individual BIMF items. Most interitem correlations were < |.15| and 13 of the 20 BIMF items did not load satisfactorily on any factor in exploratory factor analyses. Two factors emerged from the remaining items, one with three items and the other with four. Coefficient alphas were .54 for the first of these factors, .48 for the second, and .58 for all 20 items. The ICCs for test retest reliability were < .40. Conclusions BIMF data from the sample of Ethiopian women in this study exhibited unusually low levels of variability and high levels of skewness and kurtosis. Furthermore, in the context of this study, the BIMF could not be regarded as reliable either in terms of internal (interitem) consistency or temporal (testretest) consistency. Researchers using the BIMF in Ethiopian contexts are advised to examine the nature of their data carefully, identify the factor structure of their samples data, and consider ways in which the index might be improved, or replaced. Keywords: Barkin Index of Maternal Functioning, BIMF, maternal functioning, Ethiopia
5,947 downloads medRxiv obstetrics and gynecology
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.
4,716 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.
4,361 downloads medRxiv obstetrics and gynecology
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
3,590 downloads medRxiv obstetrics and gynecology
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.
3,329 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
2,610 downloads medRxiv obstetrics and gynecology
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.
2,498 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.
2,465 downloads medRxiv obstetrics and gynecology
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.
2,426 downloads medRxiv obstetrics and gynecology
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.
2,295 downloads medRxiv obstetrics and gynecology
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.)
2,213 downloads medRxiv obstetrics and gynecology
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.
2,166 downloads medRxiv obstetrics and gynecology
COVID-19 vaccination in pregnancy generates functional anti-Spike IgG antibodies that are known to cross the placenta. However, the durability of vaccine-induced maternal anti-S IgG in infant circulation, and how it compares to durability of antibody from maternal natural infection, is unknown. We quantified anti-S IgG in 92 2-month and 6-month-old infants whose mothers were vaccinated in pregnancy, and in 12 6-month-old infants after maternal natural infection with SARS-CoV-2. In the vaccinated group, 94% (58/62) of infants had detectable anti-S IgG at 2 months, and 60% (18/30) had detectable antibody at 6 months. In contrast, 8% (1/12) of infants born to women infected with SARS-CoV-2 in pregnancy had detectable anti-S IgG at the 6-month timepoint. Vaccination resulted in significantly higher maternal and cord titers at delivery and significantly greater antibody persistence in infants at 6 months, compared to natural infection.
2,131 downloads medRxiv obstetrics and gynecology
Objective: Pregnancy is a risk factor for severe Covid-19. Looking for safe vaccines that evoke protective maternal and fetal antibody response is important. Methods: We searched from registries (ClinicalTrials.gov, the WHO Clinical Trial Registry, and the EU Clinical Trial Registry) and databases (MEDLINE, ScienceDirect, Cochrane Library, Proquest, and Springer) up until June 20, 2021. Articles were selected based on inclusion and exclusion criteria after duplicates were removed. Infection rate, maternal antibody response, placental antibody transfer, and adverse events were described. This systematic review was performed with quality assessment and semi-quantitative synthesis according to PRISMA guidelines. Results: Twelve observational studies with a total of 40.509 pregnant women included. The mRNA based vaccines (Pfizer-BioNTech and Moderna) can prevent future SARS-CoV-2 infections (p=0.0004). Both vaccines did not affect pregnancy, delivery, and neonatal outcomes. The most commonly encountered adverse reactions are injection-site pain, fatigue, and headache but only transient. Antibody responses were rapid after the prime dose of vaccines. After booster, antibody responses were higher and associated with better placental antibody transfer. Longer intervals between first vaccination dose and delivery were also associated with higher antibody fetal IgG and better antibody transfer ratio. Conclusions: The Pfizer-BioNTech and Moderna vaccines are efficacious for preventing future SARS-CoV-2 infections. These vaccines can be considered as a safe option for pregnancy and their fetus. Two doses of vaccines were recommended for more robust maternal and fetal antibody responses. Longer latency was associated with higher fetal antibody responses.
- 27 Nov 2020: The website and API now include results pulled from medRxiv as well as bioRxiv.
- 18 Dec 2019: We're pleased to announce PanLingua, a new tool that enables you to search for machine-translated bioRxiv preprints using more than 100 different languages.
- 21 May 2019: PLOS Biology has published a community page about Rxivist.org and its design.
- 10 May 2019: The paper analyzing the Rxivist dataset has been published at eLife.
- 1 Mar 2019: We now have summary statistics about bioRxiv downloads and submissions.
- 8 Feb 2019: Data from Altmetric is now available on the Rxivist details page for every preprint. Look for the "donut" under the download metrics.
- 30 Jan 2019: preLights has featured the Rxivist preprint and written about our findings.
- 22 Jan 2019: Nature just published an article about Rxivist and our data.
- 13 Jan 2019: The Rxivist preprint is live!