Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.
Objective: To assess the added value of maternal serum levels of IL-6 in women with preterm-prelabor rupture of membranes (PPROM) as a non-invasive test for the prediction of histological chorioamnionitis (HCA). Methods: This was a prospective cohort study of pregnant women between 20 + 0 and 36 + 6 weeks of gestation with a confirmed diagnosis of PPROM. Logistic regression models were created for the prediction of HCA and compared by assessing the improvement in their Naegelkerke R2 as a measure of goodness of fit. Predictive performance of all models was assessed by receiver operating characteristics curve (ROC) analysis and compared by the DeLong method. Results: From 47 women with PPROM, 31 (66%) developed HCA. Maternal serum IL-6 ≥19.5 pg/dL was the best cut-off point for the prediction of HCA (OR = 15; 95% CI: 3.6–61; p < 0.01). A model comprising maternal characteristics and IL-6 ≥19.5 pg/dL showed an area under the curve of 0.85 (95% CI: 0.74–0.95), significantly improving the previous models of IL-6 ≥19.5 pg/dL (R2: 23.3 vs. 34.1%; p = 0.01) or maternal characteristics (R2: 8.4 vs. 34.1%; p < 0.01). Conclusions: A model comprising maternal serum levels of IL-6 plus maternal characteristics proves to be a good non-invasive predictor of HCA.
What are the novel findings of this work?Valacyclovir (VCV) reduces the risk of maternal-fetal transmission of cytomegalovirus (CMV), with a trend towards reduction in the rate of transmission even in the second trimester of pregnancy. Its efficacy seems to be greater in cases with positive maternal viremia at treatment initiation.
What are the clinical implications of this work?There are no longer significant barriers to widespread screening for CMV during pregnancy. Screening for CMV should be performed early and repeated in order to date more accurately maternal seroconversion and initiate VCV treatment as soon as possible. Continuation of VCV treatment after negative amniocentesis and treatment of second-trimester seroconversion are discussed.
Introduction: Cytomegalovirus (CMV), is a major cause of childhood disabilities and consensus recommendations emphasize the importance of hygienic measures to reduce perinatal infection.
Objective: To evaluate the level of awareness about CMV among health professionals and pregnant women.
Methods: We submitted a 20-item online survey regarding CMV perinatal infection to all obstetricians and midwives in Catalonia (Spain) and a 7-item lay-version of the questionnaire to 700 pregnant women. Levels of knowledge were compared among groups.
Results: Of the 1449 health professionals approached, 338 surveys were answered. 72% of professionals considered CMV a relevant problem. 47% of obstetricians and 28% of midwives (p=<0.001) routinely informed pregnant women, and less than half knew the risk of fetal transmission.
We observed significant differences in knowledge between obstetricians and midwives concerning the risks of recurrent infections, risk of transmission, and risk of severe infection (60.7% vs 45.6%, p=0.006 and 50.6% vs 22.5% p=<0.001); and regarding maternal and neonatal symptoms, and newborn sequelae (23% vs. 8.8% p=<0.001).
Of the 700 women approached, we obtained a response rate of 72%. Only 23% had previously heard about CMV; 22% identified transmission routes, and 15% preventive measures. Compared to women without risk factors for CMV infection women at greater risk had heard more about CMV [mothers of children <3 years: 36% vs. 20% p< 0.001; occupational exposure: 43% vs. 20% p=<0.001] and had received more information (mothers of children <3 years: 18% vs. 9.5% p=<0.001; occupational exposure: 23% vs. 9.3% p=0.001).
Conclusions: Health care professionals have limited knowledge about CMV and may fail to enforce preventive measures. While pregnant women have limited awareness about CMV infection, they recognize the need for information. Health campaigns should be promoted to enhance awareness about this perinatal infection.
Spanish-speaking countries where such information is urgently needed.Therefore, we propose a translated algorithm for Spanish-speaking coun tries (appendix). We also suggest that the new breastfeeding recommendations and the option to use dexamethasone as an alternative to betamethasone are adopted in Latin America. This information can be valuable for clinical practice as SARS-CoV-2 is spreading rapidly not only in Latin America but worldwide.We declare no competing interests.
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