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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 9656

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Dr. Gaspare Cucinella

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Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital IVF UNIT, University of Palermo, 90146 Palermo, Italy
Interests: obstetrics and gynecology; endoscopy; cancer; laparoscopy; fertility preservation; medical therapies; genital prolapse; urinary incontinence; endometriosis; oncological gynecology
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Dear Colleagues,

Global preparedness frameworks continue to overlook risks to pregnant women and babies during epidemics. Beyond COVID-19, this neglect had tragic consequences for women affected by the Zika and Ebola outbreaks. Intrauterine exposures to maternal COVID-19 could reach 20 million a year globally, according to recent estimates. This, coupled with lessons from previous antenatal viral infections, means the possibility of long term neurological or neurodevelopmental harms from COVID-19 warrant close attention.

Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. Therefore, there is a need to investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women. Worldwide, there are more than 140 million births every year, and pregnant women are potentially at risk for adverse outcomes of novel coronavirus. Although maternal mortality has been reported in some studies, limited information is available about SARS-CoV-2 infection in critically ill pregnant women hospitalized for COVID-19.

The aim of this Special Issue is to present papers summarizing well-established data on the clinical manifestation of COVID-19 in pregnant women, maternal and perinatal outcomes associated with COVID-19, the risk of vertical transmission of the virus, and the effect of SARS-COV-2 infection during pregnancy on fetal and neonatal outcomes. The data provided by the papers included in this Special Issue will allow researchers to determine maternal, fetal, and neonatal risk associated with SARS-COV-2 infection during pregnancy and may help to provide evidenced-based and personalized recommendations for the care of pregnant women with COVID-19.

Dr. Gaspare Cucinella
Guest Editor

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Keywords

COVID-19 and pregnancy
SARS-CoV-2 infection
maternal mortality and morbidity
pregnancy complication
management protocol
maternal comorbidities
severe disease
prevention
diagnosis
treatment
management

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Published Papers (9 papers)

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Research

12 pages, 2354 KiB

Open AccessArticle

Vitamin D Receptor—Interplay in COVID-19-Negative, -Infected, and -Vaccinated Women during Pregnancy

by Constantin Condac, Ludmila Lozneanu, Daniela Roxana Matasariu, Alexandra Ursache, Iuliana Elena Bujor, Maria Elena Niță, Vasile Lucian Boiculese, Mihai Sava, Paula Țăroi and Victoria Bîrluțiu

J. Clin. Med. 2024, 13(20), 6140; https://doi.org/10.3390/jcm13206140 (registering DOI) - 15 Oct 2024

Viewed by 363

Abstract

Background: The trophoblast is a significant source of vitamin D synthesis during pregnancy, with the literature suggesting its role in fetal growth. We aim to underline a possible mechanism that would explain negative fetal outcomes in COVID-19-positive mothers by examining the relationship between altered placental structure and function and throphoblast cells‘ vitamin D receptor levels. Methods: The study included 170 placental samples collected from women who gave birth at term without complications, divided into three groups: COVID-19-positive and unvaccinated, COVID-19-negative and vaccinated, and COVID-19-negative and unvaccinated, with exclusion criteria for any other medical complications. Immunohistochemistry (IHC) was performed to detect vitamin D receptor (VDR) expression, and immediate fetal outcomes (weight and Apgar score) were assessed. Results: We found lower gestational age at birth, lower birth weight, and reduced placental VDR (vitamin D receptor) levels in COVID-19-positive women compared to COVID-19-vaccinated and COVID-19-negative women. Conclusions: The presence of the vitamin D receptor in the placenta is related to fetal and placental growth. Its deficiency may contribute to negative fetal outcomes in COVID-19-positive cases. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

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12 pages, 11776 KiB

Open AccessArticle

Shedding Light on the COVID-19 Pandemic: Placental Expression of Cell Biomarkers in Negative, Vaccinated, and Positive Pregnant Women

J. Clin. Med. 2024, 13(18), 5546; https://doi.org/10.3390/jcm13185546 - 19 Sep 2024

Viewed by 497

Abstract

Background: We investigated the expression of inflammation, placental development, and function markers, including cluster of differentiation 44 (CD44), osteopontin (OPN), and cyclooxygenase-2 (COX-2), to shed light on the controversy regarding the impact of the COVID-19 epidemic on fetal development and pregnancy outcomes. Methods: We immunohistochemically analyzed placental tissue from 170 patients (65 COVID-positive and unvaccinated women; 35 Pfeizer-vaccinated and COVID-negative women; and 70 COVID-negative and unvaccinated women, without any other associated pathology) for particularities in the expression of these three molecules. Results: CD44 expression was highest in COVID-negative and unvaccinated women, moderate in COVID-positive cases, and lowest in vaccinated and COVID-negative women. OPN expression was highest in COVID-negative and Pfeizer-vaccinated cases, moderate in COVID-negative and unvaccinated cases, and lowest in COVID-positive cases. COX-2 expression was increased in COVID-negative and unvaccinated women, modestly elevated in COVID-positive and unvaccinated cases, and lowest in vaccinated cases. Conclusions: These findings reflected an alteration in the placental structure and consequent function due to altered expression of the three studied molecules. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

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12 pages, 254 KiB

Open AccessArticle

Maternal and Fetal Outcomes of COVID-19 According to the Trimester of Diagnosis: A Cross-Sectional Prospective Study in a Tertiary University Hospital

by Naser Al-Husban, Rahaf Mohammad Di’bas, Sara Salem Karadsheh, Lara Ali Alananzeh, Iman Aolymat, Asma Kilani, Ala’eddien Obeidat, Alhareth Eid Alhusban and Hedaieh Al-Husban

J. Clin. Med. 2024, 13(17), 5262; https://doi.org/10.3390/jcm13175262 - 5 Sep 2024

Viewed by 625

Abstract

Objectives: Pregnant women are considered a high-risk group because they may be particularly susceptible to COVID-19. Our study tried to relate fetomaternal outcomes and trimester-specific infection. Methods: A prospective study on 224 pregnant women with confirmed antenatal infections at a tertiary hospital. Data from the antenatal clinic records, admission files, labor ward and neonatal notes, lab results, respiratory consultations, and ICU admission were analyzed using Jamovi 2.2.5, with p < 0.05 indicating significance. Results: A total of 224 patients were included—10, 32, and 182 patients were diagnosed in the first, second, and third trimesters, respectively. Neonatal NICU admissions were significantly higher among those with infections in the third trimester compared to those in the first trimester (p = 0.008). Significant differences in Apgar scores at 1 and 5 min emerged between the second and third trimesters (p = 0.014 and p = 0.037, respectively). However, no significant differences were observed in Apgar scores between the first and second trimesters (p = 0.341, p = 0.108) or the first and third trimesters (p = 0.545, p = 0.755). Complications of pregnancy, including maternal mortality and various conditions (respiratory, obstetrical, sepsis, DIC), neonatal outcomes, ICU admission, and cesarean section indications, showed no significant differences related to the trimester of infection (p-values: 0.989, 0.892). Study limitations include sample size impacting generalization, higher COVID-19 cases in the third trimester than other trimesters, and potential historical data availability and accuracy issues. Conclusions: In the third trimester, COVID-19 caused more neonatal ICU admissions than the first trimester, with lower Apgar scores at 1 and 5 min compared to the second trimester, indicating an increasing susceptibility and vulnerability to COVID-19 infection with an increasing pregnancy age. Other fetal and maternal outcomes showed no significant differences in infection timing. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

12 pages, 473 KiB

Open AccessArticle

Personality Traits and Depression in Infertile Couples during the COVID-19

by Sofia Burgio, Concetta Polizzi, Marianna Alesi, Antonio Perino, Gaspare Cucinella, Yulia Kotlik, Alessandra Lopez, Alessandra Vassiliadis and Giuseppe Gullo

J. Clin. Med. 2024, 13(16), 4827; https://doi.org/10.3390/jcm13164827 - 15 Aug 2024

Viewed by 645

Abstract

Background/Objectives: The study presented in this paper seeks to examine how personality traits and depressive symptoms, influenced by the fear of COVID-19, interact in infertile couples, who are on the verge of commencing treatments with assisted reproductive technology (ART). The purpose of this observational study was to explore the relationship between personality traits in infertile couples and the occurrence of depressive symptoms, taking into account the mediating effect of COVID-19 fear. Methods: The study sample consisted of 108 women and 71 men (N = 179), all of whom had received an infertility diagnosis and expressed a desire to begin ART treatment at a Sicilian ART center; they were subsequently recruited. The Personality Inventory (PI), Beck Depression Inventory (BDI) and Fear of COVID (FCV-19S) were used for data collection. Results: The FCV-19S demonstrates a significant positive correlation with both neuroticism (r = 0.25, p = 0.001) and agreeableness (r = 0.19, p = 0.012). In addition, there is a significant correlation between FCV-19S (r = 0.67, p < 0.001) and depression symptoms. The mediation analysis reveals that neuroticism is a predictor of fear of COVID-19 (β = 1.77, p = 0.001) and depression (β = 0.22, p = 0.002). Additionally, the fear of COVID-19 significantly influences (β = 0.12, p < 0.001) depression. Conclusions: This study found that neuroticism and agreeableness are positively linked to the fear of COVID-19, and women displayed notable mild mood disorders. Neuroticism predicted both depression and fear of COVID-19, while fear of COVID-19 predicted depressive symptoms. However, the total efficacy of the mediation model was not significant, thereby suggesting that the variables do not fully explain this model. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

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10 pages, 243 KiB

Open AccessArticle

The Importance of Vaccination, Variants and Time Point of SARS-CoV-2 Infection in Pregnancy for Stillbirth and Preterm Birth Risk: An Analysis of the CRONOS Register Study

by Antonella Iannaccone, Alexandra Gellhaus, Beatrix Reisch, Mark Dzietko, Boerge Schmidt, Laven Mavarani, Katrina Kraft, Kristin Andresen, Rainer Kimmig, Ulrich Pecks and Ekkehard Schleußner

J. Clin. Med. 2024, 13(6), 1522; https://doi.org/10.3390/jcm13061522 - 7 Mar 2024

Cited by 4 | Viewed by 1658

Abstract

Background: The risk of preterm birth (PTB) and stillbirth increases after a SARS-CoV-2 infection during gestation. We aimed to estimate the risk depending on gestational age at infection (early <28 + 0 and late ≥28 weeks of gestation, WoG), virus variants, severity of infection, and vaccination. Methods: PTB was divided into early PTB (<32 + 0) and late PTB (32 + 0–36 + 6 WoG). The prospective register COVID-19 Related Obstetrics and Neonatal Outcome Study (CRONOS) included 8032 pregnant women with a confirmed SARS-CoV-2 infection from 3 April 2020 to 31 December 2022, in Germany and Austria. Results: Stillbirth and early preterm births rates were higher during the Alpha (1.56% and 3.13%) and Delta (1.56% and 3.44%) waves than during the Omicron wave (0.53% and 1.39%). Early SARS-CoV-2 infection increased the risk for stillbirth (aRR 5.76, 95% CI 3.07–10.83) and early PTB before 32 + 0 (aRR, 6.07, 95% CI 3.65–10.09). Hospital admission increased the risks further, especially in the case of ICU admission. Vaccination against SARS-CoV-2 significantly reduced the risk of stillbirth (aRR 0.32, 95% CI 0.16–0.83). Conclusions: This multicentric prospective study shows an increased risk of stillbirth and preterm birth after infection early in pregnancy and therefore the importance of obstetrical surveillance thereafter. Vaccination offers effective protection. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

12 pages, 259 KiB

Open AccessArticle

Obstetric and Gynecological Admissions and Hospitalizations in an Italian Tertiary-Care Hospital during COVID-19 Pandemic: A Retrospective Analysis According to Restrictive Measures

by Gaetano Riemma, Pasquale De Franciscis, Marina Tesorone, Egle Coppa, Antonio Schiattarella, Valentina Billone, Alessandra Lopez, Gaspare Cucinella, Giuseppe Gullo and Raffaela Maria Carotenuto

J. Clin. Med. 2023, 12(22), 7097; https://doi.org/10.3390/jcm12227097 - 15 Nov 2023

Cited by 1 | Viewed by 870

Abstract

Background: The national lockdown and the different restrictions applied in 2020 during the COVID-19 pandemic brought several changes to hospitalization procedures. The aim of this study was to evaluate the patterns in access to emergency services and hospitalization in a tertiary-care obstetric and gynecological emergency department (OG-ED) throughout the restrictions applied during 2020. Methods: A single-center retrospective comparative study on data from January to December 2020 was carried out on the following timeframes: January to February 2020 (before COVID-19 pandemic), March to June 2020 (nationwide lockdown period), July to September 2020 (removal of restrictive measures), October to December 2020 (regional lockdown) and compared to the same periods of 2019. All obstetric and gynecological patients with complete medical data admitted to the OG-ED were included. Results: Overall, 4233 accesses for 2019 and 3652 for 2020 were reported, with a decreasing trend of −13.7%. Between March and June 2020 (nationwide lockdown) and 2019, the overall number of patients attending the OG-ED decreased compared to July–September and October–December differences (Δ −23.5% vs. −3.1% and −5.9%; p = 0.001 respectively) for 2020–2019, but this reduction was not statistically significant when compared to January–February (Δ −23.5% vs. −18.5%; p = 0.356). No significant differences for obstetric patients (Δ −1.8% vs. −1.0% vs. −2.3% and +1.9% respectively; p = 0.883) were noted. Hospitalizations showed a stable trend with an increase between October–December 2019 and 2020 (Δ +4.6%; p = 0.001 vs. January–February (+2.4%) and March–June (+2.6%) 2019–2020), mainly related to regional lockdowns. Conclusions: In contrast to available national studies, in our institution, the overall rate of OG-ED admissions was slightly reduced with a similar trend of decrease even before COVID-19, with an increase in admissions for serious issues, despite expectations that the suspension of elective admissions and outpatient services would have led to an increase in non-urgent hospitalizations during the COVID-19 lockdown period. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

9 pages, 262 KiB

Open AccessArticle

Comparison of Maternal and Neonatal Outcomes between SARS-CoV-2 Variants: A Retrospective, Monocentric Study

by Giosuè Giordano Incognito, Rosario Emanuele Carlo Distefano, Giorgia Campo, Ferdinando Antonio Gulino, Chiara Gulisano, Chiara Gullotta, Giuseppe Gullo, Gaspare Cucinella, Attilio Tuscano, Maria Teresa Bruno and Marco Palumbo

J. Clin. Med. 2023, 12(19), 6329; https://doi.org/10.3390/jcm12196329 - 1 Oct 2023

Cited by 7 | Viewed by 1214

Abstract

The impact of SARS-CoV-2 variants on maternal and neonatal outcomes during pregnancy is still poorly understood, and the emergence of different variants has further complicated our understanding of the virus’s effects. This retrospective, monocentric study aimed to fill this knowledge gap by analyzing the outcomes of pregnant women with acute SARS-CoV-2 infection caused by the Alpha, Delta, and Omicron variants. The study, conducted between December 2020 and March 2022 at San Marco Hospital, included 313 pregnant women with confirmed SARS-CoV-2 infection. The results showed that the Delta variant was associated with a significantly higher incidence of adverse outcomes, such as premature births, maternal intensive care unit admission, intrauterine growth restriction, and small for gestational age infants. Additionally, the Delta variant was linked to lower Apgar scores, higher maternal and fetal mortality rates, and increased levels of various biomarkers indicating more severe illness. Finally, the Delta variant also presented a greater possibility of vertical transmission. These findings underscore the complexity of understanding the impact of SARS-CoV-2 on pregnancy outcomes, especially considering the distinctive characteristics of different variants. By better understanding the specific impacts of each variant, appropriate preventive measures and management strategies can be implemented to optimize maternal and neonatal outcomes. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

16 pages, 1766 KiB

Open AccessArticle

The Emotional Landscape of Pregnancy and Postpartum during the COVID-19 Pandemic in Italy: A Mixed-Method Analysis Using Artificial Intelligence

by Claudia Ravaldi, Laura Mosconi, Roberto Bonaiuti and Alfredo Vannacci

J. Clin. Med. 2023, 12(19), 6140; https://doi.org/10.3390/jcm12196140 - 23 Sep 2023

Cited by 1 | Viewed by 1446

Abstract

The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country that had high mortality and implemented a strict lockdown during the pandemic. This study explores the emotions and challenges of pregnant and postpartum women during the pandemic, using AI-based mixed methods. The study analyzed 1774 women from the national survey COVID-ASSESS: 1136 pregnant and 638 postpartum women. The survey had qualitative questions on emotions and feelings related to birth, communication with healthcare professionals, media, and peers and family. We used natural language processing and machine learning to classify emotions, identify themes, and extract citations from the data. Fear and anxiety replaced joy as dominant emotions during the pandemic: trust and joy decreased by 49.3% and 36.4%, respectively, while sadness and fear increased by 52.3% and 49.3%, respectively. The pandemic also induced loneliness, isolation, frustration, and anger. Women faced challenges related to birth, communication with HCPs, media, and peers and family. They also used coping strategies such as self-care, news limitation, and trying to cultivate gratitude and hope. This study provides a comprehensive exploration of the perinatal emotional landscape of Italian women during the pandemic. The findings underscore the significant psychological impact of the pandemic and also highlight women’s resilience and coping strategies. Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

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10 pages, 289 KiB

Open AccessArticle

Risk Factors for Severe–Critical COVID-19 in Pregnant Women

by María Guadalupe Berumen-Lechuga, Alfredo Leaños-Miranda, Carlos José Molina-Pérez, Luis Rey García-Cortes and Silvia Palomo-Piñón

J. Clin. Med. 2023, 12(18), 5812; https://doi.org/10.3390/jcm12185812 - 7 Sep 2023

Cited by 1 | Viewed by 1728

Abstract

Risk factors associated with severe–critical COVID-19 (coronavirus disease 2019) are based on findings in the general population. Pregnant women are at increased risk of severe–critical infection, and few reports are based on these women. A multicentric case–control study was conducted at the Mexican Institute of Social Security, State of Mexico, during the COVID-19 pandemic. We included pregnant women who were consecutively admitted to respiratory care units and were followed until 30 days after the resolution of pregnancy. A total of 758 pregnant women with a positive RT-PCR test for SARS-CoV-2 were enrolled from June 2020 to July 2021. We defined groups using the World Health Organization Severity Classification; cases were pregnant women with severe–critical COVID-19 (n = 123), and controls were subjects with non-severe COVID-19 (n = 635). Data was gathered from clinical files. A multivariate logistic regression analysis was used to adjust odds ratios and their 95% confidence intervals of factors associated with severe–critical COVID-19. Risk factors associated with severe–critical COVID-19 in pregnancy were non-vaccination (OR 10.18), blood type other than O (OR 6.29), maternal age > 35 years (OR 5.76), history of chronic hypertension (OR 5.12), gestational age at infection ≥ 31 weeks (OR 3.28), and multiparity (OR 2.80). Full article

(This article belongs to the Special Issue New Advances in COVID-19 and Pregnancy)

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