Financial Disclosure Rachel G. Sinkey reports money was paid to her institution from GestVision and ProLab. Alan T. Tita reports money was paid to his institution from the NIH, CDC, and Pfizer for COVID-19 and RSV vaccine in pregnancy studies. Ashley N. Battarbee reports money was paid to her institution from the NIH and CDC for COVID-19 in pregnancy studies. Akila Subramaniam reports money was paid to her institution from the NIH. Jeff M. Szychowski reports money was paid to his institution from the NIH. Jodie Dionne-Odom currently receives grant funding from NIH/NICHD for an unrelated study on infection in pregnancy. Sixto M. Leal Jr. reports money was paid to his institution from the NIH, CDC, ADPH, CNINE, GenMark, mFluiDx, IMMY, SpeeDx, Abnova, Amplyx, IHMA, and JMI. Nitin Arora reports money was paid to his institution from the Congenital and Perinatal Infections Consortium,

Two years into the coronavirus disease 2019 (COVID-19) pandemic, we have now seen three main variant waves. We performed a retrospective cohort study of all pregnant patients with COVID-19 at our institution from March 22, 2020, to February 26, 2022, to evaluate disease severity and perinatal outcomes among the variants. Patients were

ImportanceExisting reports of pregnant patients with COVID-19 disease who require extracorporeal membrane oxygenation (ECMO) are limited, with variable outcomes noted for the maternal-fetal dyad.ObjectiveTo examine maternal and perinatal outcomes associated with ECMO used for COVID-19 with respiratory failure during pregnancy.Design, Setting, and ParticipantsThis retrospective multicenter cohort study examined pregnant and postpartum patients who required ECMO for COVID-19 respiratory failure at 25 hospitals across the US. Eligible patients included individuals who received care at one of the study sites, were diagnosed with SARS-CoV-2 infection during pregnancy or up to 6 weeks post partum by positive nucleic acid or antigen test, and for whom ECMO was initiated for respiratory failure from March 1, 2020, to October 1, 2022.ExposuresECMO in the setting of COVID-19 respiratory failure.Main outcome and measuresThe primary outcome was maternal mortality. Secondary outcomes included serious maternal morbidity, obstetrical outcomes, and neonatal outcomes. Outcomes were compared by timing of infection during pregnancy or post partum, timing of ECMO initiation during pregnancy or post partum, and periods of circulation of SARS-CoV-2 variants.ResultsFrom March 1, 2020, to October 1, 2022, 100 pregnant or postpartum individuals were started on ECMO (29 [29.0%] Hispanic, 25 [25.0%] non-Hispanic Black, 34 [34.0%] non-Hispanic White; mean [SD] age: 31.1 [5.5] years), including 47 (47.0%) during pregnancy, 21 (21.0%) within 24 hours post partum, and 32 (32.0%) between 24 hours and 6 weeks post partum; 79 (79.0%) had obesity, 61 (61.0%) had public or no insurance, and 67 (67.0%) did not have an immunocompromising condition. The median (IQR) ECMO run was 20 (9-49) days. There were 16 maternal deaths (16.0%; 95% CI, 8.2%-23.8%) in the study cohort, and 76 patients (76.0%; 95% CI, 58.9%-93.1%) had 1 or more serious maternal morbidity events. The largest serious maternal morbidity was venous thromboembolism and occurred in 39 patients (39.0%), which was similar across ECMO timing (40.4% pregnant [19 of 47] vs 38.1% [8 of 21] immediately postpartum vs 37.5% postpartum [12 of 32]; P > .99).Conclusions and RelevanceIn this multicenter US cohort study of pregnant and postpartum patients who required ECMO for COVID-19–associated respiratory failure, most survived but experienced a high frequency of serious maternal morbidity.

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OBJECTIVE: Somatic abnormalities involving chromosome 21, 18, and 13 are found in cancers and are detectable in circulating cfDNA. Previous publications have suggested increased risks of maternal neoplasm when multiple aneuploidies are detected on non-SNPbased NIPTs with normal fetal karyotypes. SNP-based NIPT distinguishes maternal/fetal cfDNA, allowing for CNV origin identification. This study reviewed maternal/fetal outcome SNP-based NIPT data to determine if multiple maternal copy number variants (CNVs) can predict increased risk of maternal neoplasms. STUDY DESIGN: Fetal/maternal outcomes were retrospectively collected for SNP-based NIPT cases accessioned from 7/1/2017 to 3/ 30/2021. Cases reported as unspecified atypical findings with data suggesting multiple maternal CNVs were included. RESULTS: Of 2,004,428 cases with results, 38 (0.002%) had unspecified atypical results with internal data consistent with maternal CNVs. Fetal/maternal health outcomes were obtained in 26/38 (68.4%) cases. A malignancy was diagnosed before, during, or after delivery in 14/26 cases. Positive predictive values (PPVs) for maternal neoplasm ranged from 39% (15/38 all cases) to 58% (15/26 known outcomes). One case of leiomyoma (1/26, 3.8%), and one case of lymphadenopathy (1/26, 3.8%) were observed. Fetal triploidy without reported maternal health issues was seen in 2 cases (2/26; 7.7%). 8/26 (30.8%) cases had no reported fetal/maternal health issues, including one with a family history of a BRCA mutation with patient mutation status unknown. (Table 1) CONCLUSION: SNP-based NIPT can incidentally identify maternal neoplasm presence/recurrence. When maternal CNVs are identified on SNP-based NIPT, our data suggests an increased risk of maternal neoplasm with PPVs ranging from 39-59%. Neoplasms in this cohort could be underdiagnosed due to limited follow-up time post NIPT (2-48 months). Reporting this incidental finding allows for better informed maternal clinical management, with possible earlier neoplasm detection.

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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.