IMPORTANCE Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). OBJECTIVES To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. EXPOSURES SARS-CoV-2 infection during pregnancy. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described.

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Background The definition for anemia in pregnancy is outdated, derived from Scandinavian studies in the 1970’s to 1980’s. To identity women at risk of blood transfusion, a common cause of Severe Maternal Morbidity, a standard definition of anemia in pregnancy in a modern, healthy United States cohort is needed. Objective To define anemia in pregnancy in a United States population including a large county vs. private hospital population using uncomplicated patients. Materials and methods Inclusion criteria were healthy women with the first prenatal visit before 20 weeks. Exclusion criteria included preterm birth, preeclampsia, hypertension, diabetes, short interval pregnancy (<18 months), multiple gestation, abruption, and fetal demise. All women had iron fortification (Ferrous sulfate 325 mg daily) recommended. The presentation to care and pre-delivery hematocrits were obtained, and the percentiles determined. A total of 2000 patients were included, 1000 from the public county hospital and 1000 from the private hospital. Each cohort had 250 patients in each 2011, 2013, 2015, and 2018. The cohorts were compared for differences in the fifth percentile for each antepartum epoch. Student’s t-test and chi-squared statistical tests were used for analysis, p-value of ≤0.05 was considered significant. Results In the public and private populations, 777 and 785 women presented in the first trimester while 223 and 215 presented in the second. The women at the private hospital were more likely to be older, Caucasian race, nulliparous, and present earlier to care. The fifth percentile was compared between the women in the private and public hospitals and were clinically indistinguishable. When combining the cohorts, the fifth percentile for hemoglobin/hematocrit was 11 g/dL/32.8% in the first trimester, 10.3 g/dL/30.6% in the second trimester, and 10.0 g/dL/30.2% pre-delivery. Conclusions Fifth percentile determinations were made from a combined cohort of normal, uncomplicated pregnancies to define anemia in pregnancy. Comparison of two different cohorts confirms that the same definition for anemia is appropriate regardless of demographics or patient mix.

Objective This study aimed to evaluate the association of ARCHITECT chemiluminescent immunoassay (CIA) signal strength (signal-to-cutoff [S/CO] ratio), with maternal syphilis stage, rapid plasma reagin (RPR) reactivity, and congenital syphilis. Study Design A prospective observational study of reverse syphilis screening was conducted. Pregnant women were screened with CIA. Reactive CIA was reflexed to RPR; particle agglutination test (Treponema pallidum particle agglutination [TPPA]) was performed for CIA+/RPR− results. Clinical staging with history and physical was performed, and disease stage was determined. Prior treatment was confirmed. We compared S/CO ratio and neonatal outcomes among the following groups: Group 1: CIA+/RPR+/TPPA+ or CIA+/RPR−/TPPA+ with active syphilis; Group 2: CIA+/RPR−/TPPA+ or CIA+/serofast RPR/TPPA+, previously treated; Group 3: CIA+/RPR−/TPPA+, no history of treatment or active disease; Group 4: CIA+/RPR−/TPPA−, false-positive CIA. Results A total of 144 women delivered with reactive CIA: 38 (26%) in Group 1, 69 (48%) in Group 2, 20 (14%) in Group 3, and 17 (12%) in Group 4. Mean (±standard deviation) S/CO ratio was 18.3 ± 5.4, 12.1 ± 5.3, 9.1 ± 4.6, and 1.9 ± 0.8, respectively (p < 0.001). Neonates with overt congenital syphilis occurred exclusively in Group 1. Conclusion Women with active syphilis based on treatment history, clinical staging, and laboratory indices have higher CIA S/CO ratio and are more likely to deliver neonates with overt evidence of congenital syphilis.

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We appreciate the interest in our recent report on the realworld effectiveness of Chlamydia trachomatis expedited partner therapy (EPT) in pregnancy. 1 As has been well described, there are potential barriers at all levels of implementation of EPT, including concerns about partner adverse events, physician liability and malpractice, payment for medications, intimate partner violence, and the fact that most community pharmacists were unaware of EPT per a recent assessment. 2 Golden et al 3 also acknowledged that EPT was less effective in reducing persistent or recurrent chlamydia compared with gonorrhea in their 2005 randomized trial of men and nonpregnant women.Indeed, although we agree that EPT is 1 of many strategies needed to address the rising rates of sexually transmitted infections in the United States, 4 we felt that an evaluation of our EPT program-which included a direct method for treating partners with azithromycin tablets instead of a prescription-was necessary in real-world practice. We reported our outcomes and acknowledged both the limitations of our observational study and the strengths of our standardized practices in a high-risk, urban population. Without this assessment, we would have no baseline for comparison with future efforts. We suspect that the practice of providing EPT for chlamydial infection in a real-world prenatal setting is more likely to resemble our own, rather than that of a clinical trial, and we hope that the general obstetrician-gynecologists find our report informative and motivating. As we described, additional solutions, including but not limited to EPT, are needed to make progress in reducing the surge in sexually transmitted infections in the United States.

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INTRODUCTION:The COVID-19 pandemic has impacted mental health. We evaluated the impact on pregnant women and compared the Edinburgh Postpartum Depression Scale (EPDS) and a Maternal Postpartum Quality of Life Questionnaire (mPQOL) before and during the pandemic to evaluate the effect of the pandemic on maternal mental health and quality of life.METHODS:After institutional review board approval, EPDS screening exams and mPQOL surveys were collected postpartum on all pregnant women during six 12-week epochs prior to and during the pandemic (Epoch 1: December 16, 2019, to March 8, 2020; Epoch 2: March 9, 2020, to May 31, 2020; Epoch 3: June 1, 2020, to August 23, 2020; Epoch 4: August 24, 2020, to November 15, 2020; Epoch 5: November 16, 2020, to January 31, 2021; Epoch 6: February 1, 2021, to May 2, 2021). Scores were compared among the epochs. A score of 13 or higher indicated screening positive for depression. The mPQOL survey was evaluated by sub-categories: Psychological/Baby, Socioeconomic, Relational/Partner, Relationships/Family, and Health/Functioning. Satisfaction was ranked on a scale from 1 to 6 (1=very dissatisfied, 6=very satisfied). EPDS scores and mPQOL scores were compared among the epochs to determine contributors that impacted quality of life during the pandemic.RESULTS:Out of 2,011 women, an EPDS score of 13 or higher increased from 3% to 9% from Epoch 1 to Epoch 2 and peaked at 11% in Epoch 5 (P=0.007). mPQOL Socioeconomic and Relational/Partner sub-category scores decreased significantly from 5.8 to 5.5 (P=0.014) and 5.5 to 5.4 (P=0.041), respectively, from Epoch 2 to Epoch 3.CONCLUSION:There was a significant increase in positive EPDS screens in pregnant women during the COVID-19 pandemic. Sub-scores obtained from the mPQOL survey suggest that increasing socioeconomic concerns and relational partner issues may have driven these trends.