BACKGROUND. The effects of the novel coronavirus disease 2019 in pregnancy remain relatively unknown. We present a case of second trimester pregnancy with symptomatic COVID-19 complicated by severe preeclampsia and placental abruption. METHODS.We analyzed the placenta for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through molecular and immunohistochemical assays and by and electron microscopy and measured the maternal antibody response in the blood to this infection.RESULTS. SARS-CoV-2 localized predominantly to syncytiotrophoblast cells at the materno-fetal interface of the placenta. Histological examination of the placenta revealed a dense macrophage infiltrate, but no evidence for the vasculopathy typically associated with preeclampsia.CONCLUSION. This case demonstrates SARS-CoV-2 invasion of the placenta, highlighting the potential for severe morbidity among pregnant women with COVID-19. FUNDING.Beatrice Kleinberg Neuwirth Fund and Fast Grant Emergent Ventures funding from the Mercatus Center at George Mason University. The funding bodies did not have roles in the design of the study or data collection, analysis, and interpretation and played no role in writing the manuscript.

Background. The effects of Covid-19 in pregnancy remain relatively unknown. We present a case of second trimester pregnancy with symptomatic Covid-19 complicated by severe preeclampsia and placental abruption.Methods. We analyzed placenta for the presence of SARS-CoV-2 through molecular and immunohistochemical assays and by and electron microscopy, and we measured the maternal antibody response in blood to this infection.Results. SARS-CoV-2 localized predominantly to syncytiotrophoblast cells at the maternal-fetal interface of the placenta. Histological examination of the placenta revealed a dense macrophage infiltrate, but no evidence for vasculopathy typically associated with preeclampsia.Conclusion. This case demonstrates, for the first time, SARS-CoV-2 invasion of the placenta, highlighting the potential for severe morbidity among pregnant women with Covid-19.

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OBJECTIVE To quantify the association of pregnancy context and health-related quality of life (HRQoL). STUDY DESIGN English- or Spanish-speaking women, aged 16–44, with pregnancies <24 weeks gestation were enrolled in this cross-sectional study between June 2014 and June 2015. Participants completed self-assessments of pregnancy “context,” including: timing, intention, wantedness, desirability, happiness, and planning (measured with the London Measure of Unplanned Pregnancy). HRQoL was measured using the Patient Reported Outcomes Measurement Information System Global Short Form (PROMIS-GSF). Associations between measures of pregnancy context and HRQoL scores in the lowest tertile were examined using multivariable logistic regression to adjust for potential confounding variables. RESULTS We enrolled 161 participants (mean age=27.2±6.6 years). Only 14% self-identified as White, non-Hispanic; 42% Hispanic, 37% Black, non-Hispanic, and 7% multiracial. Most (79%) participants were unmarried, and 75% were parenting. Mean gestational age was 9±4.6 weeks. In unadjusted models, women reporting mixed feelings about wanting to have a baby, an undesired pregnancy, or feeling unhappy about learning of their pregnancy more frequently had low mental and physical HRQoL compared to women reporting wanted, desired, happy pregnancies. Women with an unplanned pregnancy or pregnancy occurring at the wrong time also had lower physical HRQoL than women reporting pregnancies that were planned or happened at the right time. However, after multivariate adjustment, including history of depression, pregnancy contexts were not associated with low mental or physical HRQoL. CONCLUSIONS After adjusting for multiple confounders, pregnancy context is not significantly associated with HRQoL. IMPLICATIONS The focus on pregnancy intention in public health programs may not sufficiently assess multidimensional aspects of pregnancy context and may not align with patient-centered outcomes such as HRQoL.

Background Pregnancy planning and timing may be associated with psychiatric illness, psychological distress and support during pregnancy. Methods We performed secondary analyses of a prospective cohort of 2,654 pregnant women evaluating the impact of depression on preterm birth. We used multivariable logistic regression to test associations between pregnancy planning (“Was this pregnancy planned? Yes/No”) and/or timing (“Do you think this is a good time for you to be pregnant?”) with Composite International Diagnostic Interview generated psychiatric diagnoses and measures of psychological distress and support. Results 37% and 13% of participants reported an unplanned or poorly timed pregnancy, respectively. Unplanned pregnancies were associated with a Major Depressive Episode (MDE) (adjusted odds ratio (aOR) 1.69, 95%CI 1.23–2.32) and the Cohen Perceived Stress Scale’s (CPSS) highest quartile (aOR 1.74, 95%CI 1.40–2.16). Poorly timed pregnancies were associated with a MDE (aOR 3.47, 95%CI 2.46–4.91) and the CPSS’s highest quartile (aOR 5.20, 95%CI 3.93–6.87). Poorly timed pregnancies were also associated with General Anxiety Disorder (GAD; aOR 1.60, 95%CI 1.07–2.40), and the modified Kendler Social Support Inventory’s (MKSSI) lowest quartile (aOR 1.64, 95%CI 1.25–2.16). Psychiatric conditions were strongly associated with planned pregnancies that were subsequently deemed poorly timed (MDE=aOR 5.08, 95%CI 2.52–10.25; GAD=aOR 2.28, 95%CI 1.04–5.03); high CPSS=aOR 6.48, 95%CI 3.59–11.69; and low MKSSI=aOR 3.19, 95%CI 1.81–5.62). Limitations Participant characteristics may limit generalizability of findings. Conclusions Pregnancy timing was a stronger predictor of maternal psychiatric illness, psychological distress and low social support than pregnancy planning in our cohort.

Background The study was conducted to evaluate the impact of out-of-pocket expense on intrauterine device (IUD) utilization among women with private insurance. Study Design We reviewed the records of all women with private insurance who requested an IUD for contraception from an urban academic gynecology practice from May 2007 through April 2008. For each patient, we determined the out-of-pocket expense that would be incurred, and whether she ultimately had an IUD placed. The total charge for placement of a copper or levonorgestrel IUD (including the device) was $815. Results Ninety-five women requested an IUD during the study period. The distribution of out-of-pocket expense was bimodal: less than $50 for 35 (37%) women and greater than $500 for 52 (55%) women. IUD insertion occurred in 24 (25%) women, 19 of whom had an out-of-pocket expense less than $50. In univariate and multivariable analysis, women with insurance coverage that resulted in less than $50 out-of-pocket expense for the IUD were more likely to have an IUD placed than women required to pay $50 or more (adjusted OR=11.4, 95% CI = 3.6, 36.6),. Conclusions Women requesting an IUD for contraception are significantly more likely to have an IUD placed when out-of-pocket expense is less than $50.

PerspectiveThe NEW ENGLA ND JOURNAL of MEDICINE n engl j med nejm.org 1 P ermanent sterilization is the second-most-common contraceptive approach used by women in the United States, undergone by about 345,000 women per year. For many decades, laparoscopic