COVID-19 during pregnancy and adverse outcomes: Concerns and recommendations from The Brazilian Teratology Information Service

Vianna, Fernanda S.L.; Fraga, Lucas Rosa; Abeche, Alberto Mantovani; Silva, André Anjos da; Sanseverino, Maria Teresa Vieira; Schüler‐Faccini, Lavínia

doi:10.1590/1678-4685-gmb-2020-0224

Cited by 11 publications

(11 citation statements)

References 45 publications

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“…In late 2020, there was raised awareness towards the possibility of worse outcomes associated to new SARS-CoV-2 variants of concern (VOCs) with reported increased transmissibility, risk of hospitalization and virulence 20 , 43 . The dissemination of VOCs in Brazil was reported since December 2020, mostly the Gamma lineage (PANGO: P.1).…”

Section: Discussionmentioning

confidence: 99%

“…The higher frequency of congenital anomaly in confirmed COVID-19 pregnant women rises concern, however, this might reflect the enhanced surveillance employed to positive COVID-19 cases and not the virus itself. From the 19 cases of congenital anomaly, only 6 were tested for SARS-CoV-2 neonatal infection; all were negative The Brazilian Teratology Information Service has proposed some strategies to investigate, detect and prevent possible embryonic damaging effects of the new coronavirus, including multidisciplinary approach to report the events 43 . Nevertheless, data from this national system has not been published yet; multicenter well-designed studies are crucial for addressing this topic.…”

Section: Discussionmentioning

confidence: 99%

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The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study

Souza

Cecatti

Pacagnella

et al. 2022

Sci Rep

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Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04–3.04]), primary schooling or less (RR 2.16 [1.21–3.87]), being overweight (RR 4.34 [1.04–19.01]) or obese (RR 6.55 [1.57–27.37]), having public prenatal care (RR 2.16 [1.01–4.68]), planned pregnancies (RR 2.09 [1.15–3.78]), onset of infection in postpartum period (RR 6.00 [1.37–26.26]), chronic hypertension (RR 2.15 [1.37–4.10]), pre-existing diabetes (RR 3.20 [1.37–7.46]), asthma (RR 2.22 [1.14–4.34]), and anaemia (RR 3.15 [1.14–8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study

Souza

Cecatti

Pacagnella

et al. 2022

Sci Rep

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“…The placenta is a selective barrier, able to protect the developing fetus against infections, including SARS-CoV-2 virus infection (29). It also acts as an immunity-modulating organ, regulating immune responses of cells present both at the implantation site and systemically (30). However, evidence of fetal vascular malperfusion or thrombosis has been observed in COVID-19, which may be related to an exacerbated maternal systemic in ammatory response and hypercoagulable state (31,32).…”

Section: Discussionmentioning

confidence: 99%

Mechanical Ventilation and Death During Pregnancy Complicated by COVID-19: A Prognostic Analysis from the Brazilian COVID-19 Registry Score

Reis

Aguiar

Sales

et al. 2021

Preprint

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Background: Assessing predictors of critical outcomes in COVID-19 may advise timely treatments and better prepare facilities to overcome extra adversities during pregnancy. However, many clinical parameters of existent scores are deeply modified by physiologic adaptations. Our aim was to assess the feasibility of a prognosis score developed for general hospitalized adults with COVID-19 in Brazil to predict clinical adverse outcomes in pregnant women upon hospital admission.Methods: This is a multicenter retrospective substudy of the Brazilian COVID-19 Registry, a multicenter cohort analysis in Brazilian hospitals, which provided an accurate score to predict in-hospital death. The present analysis assessed the performance of this model, ABC2-SPH, based on data of 3978 patients, to assess poor clinical outcomes in data from 85 pregnant women admitted due to COVID-19 from March 1, 2020, to May 5, 2021, in 19 Brazilian hospitals. The primary outcomes were death and the composite mechanical ventilation or death, and secondary were pregnancy outcomes and severe/critical Covid-19. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC).Results: Thirty-one (36.5%) pregnant women had critical or severe COVID-19. Most of them had no previous comorbidities (64.7%). The median gestational age was 31.0 (26.0, 36.2) weeks; 38 (44.7%) women gave birth during hospitalization by Covid-19, most of them by C-section (76.3%). The need for mechanical ventilation or death occurred in 14 (17.3%) pregnant women. Severe and critical COVID-19 in pregnant women was associated with diabetes, inflammatory markers, and abnormal vital signals observed at admission. The model was not able to identify adverse clinical outcomes. The AUROC of predicting severe/critical Covid-19 illness was 0.595 (95% CI: 0.424-0.754); AUROC of the inpatient death discrimination was 0.683 (95% CI: 0.293-0.945), as the AUROC of mechanical ventilation or death discrimination was 0.591 (95% CI: 0.434-0.75).Conclusions: The model ABC2-SPH developed in Brazilian general patients was not able to identify adverse clinical outcomes in pregnant women with COVID-19. We warn against the use of general inpatients COVID-19 prognosis in pregnant women. A more useful model for clinical prognosis is necessary concerning the specificities of pregnancy affected by COVID-19.

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“…Desde o surgimento do atual surto da doença causada pelo novo coronavírus (SARS-CoV-2), responsável pela doença da COVID-19, existiu uma enorme apreensão diante de uma patologia que se espalhou celeremente em várias regiões do planeta, com diferentes impactos (FREITAS et al, 2020), infectando e causando o óbitos de milhares de pessoas, atualmente já ocorrem pesquisas com diferentes abordagens voltadas diretamente ao grupo das gestantes, visando identificar o impacto do COVID-19 tanto para a mãe quanto para o bebê (VIANNA et al, 2021). Logo, o presente trabalho tem como finalidade realizar uma revisão integrativa acerca das principais complicações da COVID-19 em gestantes.…”

Section: Principais Referênciasunclassified

“…Estudos acerca da COVID-19 em gestantes estão sendo realizados para compreender quais impactos inerentes das doenças sobre essas pacientes, em virtude que, nem todos os questionamentos são totalmente compreendidos. As gestantes em geral têm maior taxa de mortalidade e complicações associadas a infecções virais, já que mulheres grávidas são consideradas mais propensas a desenvolver a forma grave da doença quando comparado a mulheres não grávidas, com maior taxa de entradas nas unidades de terapias intensivas (UTI), necessidade de oxigênio suplementar e ventilação mecânica (VIANNA et al, 2021, SHERER et al, 2020, YAN et al, 2020 Um estudo publicado pelo The United States Centers of Disease Control (CDC) avaliou aproximadamente 400.000 mulheres sintomáticas para COVID-19 com idades variando de 15 e 44 anos, e observou que em unidades de terapia intensiva, ocorreu a necessidade de intubação ou oxigenação extracorpórea maior em gestantes do que em mulheres não grávidas (ZAMBRANO et al, 2020). A trombose venosa profunda relacionada ao ciclo gravídico-puerpal também já foi relatada como uma consequência da Covid-19 em gestantes e também como a maior causa de morte materna (MENDONÇA et al, 2021).…”

Section: Fundamentação Teóricaunclassified

Anais Do Ii Congresso Nacional De Residências Em Saúde (Online) - Resumos Expandidosanais Do Ii Congresso Nacional De Residências Em Saúde (Online) - Resumos Expandidos

2022

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COVID-19 during pregnancy and adverse outcomes: Concerns and recommendations from The Brazilian Teratology Information Service

Cited by 11 publications

References 45 publications

The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study

The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study

Mechanical Ventilation and Death During Pregnancy Complicated by COVID-19: A Prognostic Analysis from the Brazilian COVID-19 Registry Score

Anais Do Ii Congresso Nacional De Residências Em Saúde (Online) - Resumos Expandidosanais Do Ii Congresso Nacional De Residências Em Saúde (Online) - Resumos Expandidos

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