Maternal and Perinatal Outcomes Associated With the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) Variant

Seasely, Angela R.; Blanchard, Christina T.; Arora, Nitin; Battarbee, Ashley N.; Casey, Brian M.; Dionne-Odom, Jodie; Leal, Sixto M.; Moates, Derek; Sinkey, Rachel G.; Szychowski, Jeff M.; Tita, Alan; Subramaniam, Akila

doi:10.1097/aog.0000000000004607

Cited by 55 publications

(48 citation statements)

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“…The mentioned study reported that cases diagnosed after the spread of the Delta variant were more symptomatic and their gestational age at diagnosis was earlier [ 16 ]. Similarly, a single-center retrospective cohort study from another tertiary center from the United States compared the outcomes of pregnant women diagnosed in the pre-Delta variant period with those diagnosed in the Delta period indicating increased rates of critical illness and adverse perinatal outcomes [ 17 ]. A multicenter prospective cohort study from the United States including 1515 pregnant women reported increased COVID-19-related morbidity after the predomination of the Delta variant especially in populations with lower vaccine acceptance [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases

Şahın

Tanaçan

Anuk

et al. 2022

Arch Gynecol Obstet

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Purpose To compare the clinical features and perinatal outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-variant and post-variant periods. Methods This prospective cohort study includes pregnant women with SARS-CoV-2 who were followed-up at Ankara City Hospital between 11, March 2020 and 15, September 2021. Demographic features, clinical characteristics and pregnancy outcomes were compared between the pre-variant ( n = 1416) and post-variant ( n = 519) groups. Results The rates of severe and critical cases significantly increased in the post-variant group (9.7% vs 2%, p < 0.001). The rates of respiratory support (26.8% vs 7.3%, p < 0.001), ICU admission (12.9% vs 1.8%, p < 0.001) and maternal mortality (2.9% vs 0.4%, p < 0.001) were significantly higher in the post-variant group. A significant increase was observed for pregnancy complications in the post-variant group (45.6% vs 18.8%, p = 0.007). The rates of preterm delivery (26.4% vs 4.4%, p < 0.001) and NICU admission (34% vs 18.8%, p < 0.001) were significantly higher in the post-variant group. Positive, weak, statistically significant correlations were observed between the post-variant period, disease severity and maternal mortality ( r = 0.19, r = 0.12 and p < 0.001). Conclusion Post-variant COVID-19 period was associated with a severe course of the disease and increased rates of adverse obstetric outcomes in pregnant patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases

Şahın

Tanaçan

Anuk

et al. 2022

Arch Gynecol Obstet

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“…The mutations in Delta strains reported may differ depending on the resources consulted [77,93,185]. The description of mutations that occurred in the ORF1ab locus is especially unclear for the Delta variant, and often they do not match from one source to another (Table 2).…”

Section: Beta (B1351 Lineage)mentioning

confidence: 99%

The Development of SARS-CoV-2 Variants: The Gene Makes the Disease

Perez-Gomez

2021

JDB

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A novel coronavirus (SARS-CoV-2) emerged towards the end of 2019 that caused a severe respiratory disease in humans called COVID-19. It led to a pandemic with a high rate of morbidity and mortality that is ongoing and threatening humankind. Most of the mutations occurring in SARS-CoV-2 are synonymous or deleterious, but a few of them produce improved viral functions. The first known mutation associated with higher transmissibility, D614G, was detected in early 2020. Since then, the virus has evolved; new mutations have occurred, and many variants have been described. Depending on the genes affected and the location of the mutations, they could provide altered infectivity, transmissibility, or immune escape. To date, mutations that cause variations in the SARS-CoV-2 spike protein have been among the most studied because of the protein’s role in the initial virus–cell contact and because it is the most variable region in the virus genome. Some concerning mutations associated with an impact on viral fitness have been described in the Spike protein, such as D614G, N501Y, E484K, K417N/T, L452R, and P681R, among others. To understand the impact of the infectivity and antigenicity of the virus, the mutation landscape of SARS-CoV-2 has been under constant global scrutiny. The virus variants are defined according to their origin, their genetic profile (some characteristic mutations prevalent in the lineage), and the severity of the disease they produce, which determines the level of concern. If they increase fitness, new variants can outcompete others in the population. The Alpha variant was more transmissible than previous versions and quickly spread globally. The Beta and Gamma variants accumulated mutations that partially escape the immune defenses and affect the effectiveness of vaccines. Nowadays, the Delta variant, identified around March 2021, has spread and displaced the other variants, becoming the most concerning of all lineages that have emerged. The Delta variant has a particular genetic profile, bearing unique mutations, such as T478K in the spike protein and M203R in the nucleocapsid. This review summarizes the current knowledge of the different mutations that have appeared in SARS-CoV-2, mainly on the spike protein. It analyzes their impact on the protein function and, subsequently, on the level of concern of different variants and their importance in the ongoing pandemic.

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“…Similar reports have also surfaced: The University of Alabama at Birmingham hospital observed an increase in ICU admission from 8% to 29% between the non-Delta and Delta cohorts, as well as an increase in the rates of cesarean delivery preterm birth and NICU admission. All patients admitted to the hospital were unvaccinated [ 2 ].…”

Section: Delta (B16172) and Other Variant Considerationsmentioning

confidence: 99%

“…Ever since the lockdown of Wuhan on 23 February 2020 and the announcement of the global pandemic in March of 2020, the novel coronavirus has claimed over 5 million lives with over 245 million cases [ 1 ], and has greatly impacted every individual around the world in all facets of life, not just physically, but also in terms of economic and social effects that may reverberate through generations to come. This enveloped single-stranded RNA virus from the Coronaviridae family, named the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [ 2 ], has been greatly researched and reported over the past year, with more and more focus on its impact on each subset of the population. One particular cohort that is in need of further discussion, and which is unfortunately often excluded from trials, is the pregnant population.…”

Section: Introductionmentioning

confidence: 99%

“…One particular cohort that is in need of further discussion, and which is unfortunately often excluded from trials, is the pregnant population. Now more than ever, due to the more deleterious effects of the Delta variant on this cohort, as well as the lower rates of vaccination [ 2 ], we need greater in-depth discussions on how exactly various changes in the pregnant body may impact the fight against SARS-CoV-2 infection, what the implications are for managing COVID-19 pregnancies, as well as the importance of promoting vaccine awareness to pregnant patients moving forward.…”

Section: Introductionmentioning

confidence: 99%

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SARS-CoV-2 and the Immune Response in Pregnancy with Delta Variant Considerations

Rangchaikul

Venketaraman

2021

Infectious Disease Reports

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As of September 2021, there has been a total of 123,633 confirmed cases of pregnant women with SARS-CoV-2 infection in the US according to the CDC, with maternal death being 2.85 times more likely, pre-eclampsia 1.33 times more likely, preterm birth 1.47 times more likely, still birth 2.84 times more likely, and NICU admission 4.89 times more likely when compared to pregnant women without COVID-19 infection. In our literature review, we have identified eight key changes in the immunological functioning of the pregnant body that may predispose the pregnant patient to both a greater susceptibility to SARS-CoV-2, as well as a more severe disease course. Factors that may impede immune clearance of SARS-CoV-2 include decreased levels of natural killer (NK) cells, Th1 CD4+ T cells, plasmacytoid dendritic cells (pDC), a decreased phagocytic index of neutrophil granulocytes and monocytes, as well as the immunomodulatory properties of progesterone, which is elevated in pregnancy. Factors that may exacerbate SARS-CoV-2 morbidity through hyperinflammatory states include increases in the complement system, which are linked to greater lung injury, as well as increases in TLR-1 and TLR-7, which are known to bind to the virus, leading to increased proinflammatory cytokines such as IL-6 and TNF-α, which are already elevated in normal pregnant physiology. Other considerations include an increase in angiotensin converting enzyme 2 (ACE2) in the maternal circulation, leading to increased viral binding on the host cell, as well as increased IL-6 and decreased regulatory T cells in pre-eclampsia. We also focus on how the Delta variant has had a concerning impact on SARS-CoV-2 cases in pregnancy, with an increased case volume and proportion of ICU admissions among the infected expecting mothers. We propose that the effects of the Delta variant are due to a combination of (1) the Delta variant itself being more transmissible, contagious, and efficient at infecting host cells, (2) initial evidence pointing to the Delta variant causing a significantly greater viral load that accumulates more rapidly in the respiratory system, (3) the pregnancy state being more susceptible to SARS-CoV-2 infection, as discussed in-depth, and (4) the lower rates of vaccination in pregnant women compared to the general population. In the face of continually evolving strains and the relatively low awareness of COVID-19 vaccination for pregnant women, it is imperative that we continue to push for global vaccine equity.

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Maternal and Perinatal Outcomes Associated With the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) Variant

Cited by 55 publications

References 1 publication

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases

The Development of SARS-CoV-2 Variants: The Gene Makes the Disease

SARS-CoV-2 and the Immune Response in Pregnancy with Delta Variant Considerations

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