What are the novel findings of this work? Preterm delivery occurred in a higher proportion of women with SARS-CoV-2 infection in the PAN-COVID and AAP-SONPM registries compared to contemporaneous and historical national data from uninfected women in the UK and USA. The majority of preterm deliveries occurred between 32 + 0 and 36 + 6 weeks' gestation. SARS-CoV-2 infection in pregnancy did not appear to be associated with a clinically significant effect on fetal growth, adverse neonatal outcome or the rate of stillbirth. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. What are the clinical implications of this work? Pregnant women should be counseled that SARS-CoV-2 infection increases the risk of preterm delivery but not stillbirth, early neonatal death or a small baby. Healthcare providers should recommend SARS-CoV-2 vaccination in pregnant women and women planning pregnancy, alongside enhanced social distancing.

Pregnancy creates a condition of cardiac volume overload which leads to physiological eccentric hypertrophy of the heart that is reversed in the postpartum period. Pathological cardiac changes in non-pregnant animals are associated with extracellular matrix remodeling. Based on preliminary microarray findings in the hearts of non-pregnant, pregnant, and postpartum mice, we hypothesized that changes in the expression of extracellular matrix protein genes would accompany functional changes in the heart that occur with reproductive status. Adult left ventricle parameters were evaluated by echocardiography in C57BL/6 mice at diestrous (virgin), and at pregnancy days (eds) 10, 12, and 18/19, and at postpartum days (ppds) 1.5 and 7. Twenty-one left ventricle mRNAs were evaluated including genes for tissue inhibitor of metalloproteinases (Timps), several matrix metallopeptidases (Mmps), collagens (Cols), proteoglycans, and enzymes involved in matrix remodeling at similar days except ed10. Compared to virgin mice, left ventricle internal diameter during diastole and end diastolic volumes significantly increased at ed12, ed18/19, ppd1.5, and ppd7. Left ventricle internal diameter during systole was increased at ed18/19 and ppd1.5, and end systolic volume was increased at ed18/19 compared to virgin mice. Timp1 mRNA levels were higher in late pregnancy and the early postpartum period, and Timp2-4 mRNAs levels were lower at one or both postpartum days compared to specific earlier time points. Mmp3 mRNA levels were higher during late pregnancy and postpartum than earlier in pregnancy. Mmp13 mRNA level was lower at ppd1.5 than late pregnancy, and Mmp15 mRNA level was lowest at ppd7 compared to all other time points. Col1a1 and Col3a1 increased with pregnancy and stayed elevated through ppd7. Col8a1 mRNA was increased on both postpartum days compared to late pregnancy. Our results indicate that late pregnancy and the first week of the postpartum period are an active time for altered expression of extracellular matrix protein genes. Impact statement This study provides the first comprehensive analysis of extracellular matrix protein (ECM) gene expression combined with echocardiographic analyses of heart functional parameters in the murine heart during pregnancy and the early postpartum period. Our findings show regulation of all Timp, selected Mmps, and Col1a1, Col3a1, and Col8a1 mRNA levels with reproductive status, with the greatest number of significant changes occurring in the early postpartum period. Left ventricle cardiac diastolic parameters were the first to change during pregnancy and remained elevated postpartum, whereas systolic parameters were increased in late pregnancy and began to recover during the first week postpartum. These novel findings indicate that although some ECM genes are elevated during late pregnancy, that the postpartum period is a time of robust altered ECM gene expression. These studies provide a basis for examining ECM proteins and their activities in the normal pregnant and postpartum heart and in models of postpartum cardiomyopathy.

Brucellosis is one of the most common zoonotic infections in the world. Human infections are the result of direct exposure to infected animals or ingestion of unprocessed dairy products. While Brucella sp. infection has largely been eliminated from commercial cattle and swine with aggressive vaccination, there is a significant prevalence of Brucella sp. infection in the expanding population of feral swine in the US. We report the surgical treatment of a ruptured mycotic aneurysm of the abdominal aorta due to Brucella suis in a woman living in a rural community with a large population of feral swine. Vascular surgeons should be aware that brucellosis can result in arterial infection and should be considered in the differential diagnosis in patients with a history of exposure to feral swine or the ingestion of unprocessed dairy products.

Original Clinical Science-General Background. Uterus transplantation is a temporary transplant allowing women with absolute uterine factor infertility to experience pregnancy and childbirth. The degree of immunosuppression (IS) required to prevent rejection while minimizing toxicity to the recipient and fetus remains an area of investigation. Methods. In this article, we describe immunosuppressive therapy, rejection episodes, infections, and adverse events in 14 uterus transplant recipients. Induction consisted of antithymocyte globulin and methylprednisolone. Ten recipients (71%) received no steroids postoperatively, and 4 (29%) had steroids tapered off at 42 d. All received oral tacrolimus, either immediate release (n = 2, 14%) or extended release (n = 12, 86%). Mycophenolate was used in 4 cases (29%), de novo azathioprine in 9 (64%), and de novo everolimus in 1 (7%).Results. Sixteen clinically silent, treatment-responsive rejection episodes occurred in 10 recipients. Five recipients (36%) experienced acute kidney injury. In 3 recipients, IS was discontinued due to renal dysfunction. Eleven infection episodes were noted in 7 recipients. No babies had congenital abnormalities. Conclusions. Our experience demonstrates that safe IS regimens can be used for uterus transplant recipients before and during pregnancy.