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COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice

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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: closed (25 September 2022) | Viewed by 27764

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Dr. Eva Meler

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Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain Sabino de Arana 1, 08028 Barcelona, Spain
Interests: fetal growth restriction; preeclampsia; adverse perinatal outcomes; COVID-19; placental function assessment

Dr. Anna Goncé

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Guest Editor

Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, IDIBAPS, University of Barcelona, Barcelona, Spain Sabino de Arana 1, 08028 Barcelona, Spain
Interests: fetal infections; vaccination in pregnancy; COVID-19 in pregnancy; twin pregnancies

Special Issue Information

Dear Colleagues,

COVID-19 has rapidly spread all over the world, infecting tens of millions of individuals in one year. The current evidence suggests that most infected pregnant women are asymptomatic or have mild clinical manifestations, even though they are at an increased risk for severe SARS-CoV-2 compared to non-pregnant women, and this is increased in those women with comorbidities. COVID-19 complications have a direct impact on perinatal outcomes, especially in terms of higher iatrogenic prematurity. However, scant evidence exists about the impact of maternal infections on fetal intrauterine life, and about the interaction of SARS-CoV-2 with other concomitant maternal conditions. Finally, no research has been conducted to date on the efficacy and complications of COVID-19 vaccination in pregnancy.

Apart from direct infections, the impact of the pandemic on healthcare infrastructure has directly restructured prenatal care circuits, with little information and heterogeneity. The consequences of decreased prenatal care visits and potentially harmful policies have not been reported.

The aim of this Special Issue is to gather, into one collection, reviews and original contributions illustrating optimal management protocols adapted to different healthcare systems for pregnant women at risk of COVID-19 infection. Thereby, we could help to reduce maternal, fetal and neonatal morbimortality.

Dr. Eva Meler
Dr. Anna Goncé
Guest Editors

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Keywords

SARS-CoV-2 infection
maternal, fetal and neonatal outcomes
management protocol
maternal comorbidities
severe disease
prevention

Published Papers (9 papers)

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Research

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10 pages, 492 KiB

Open AccessArticle

Trends in Caesarean Section Rate According to Robson Group Classification among Pregnant Women with SARS-CoV-2 Infection: A Single-Center Large Cohort Study in Italy

by Angelo Sirico, Luigi Carbone, Luisa Avino, Cira Buonfantino, Maria Chiara De Angelis, Marco Di Cresce, Annamaria Fabozzi, Francesco Paolo Improda, Antonietta Legnante, Carla Riccardi, Romina Santoro, Roberta Vallone, Brunella Zizolfi, Antonio Riccardo Buonomo, Ivan Gentile, Serena Salomè, Francesco Raimondi, Giuseppe Bifulco and Maurizio Guida

J. Clin. Med. 2022, 11(21), 6503; https://doi.org/10.3390/jcm11216503 - 2 Nov 2022

Cited by 5 | Viewed by 1879

Abstract

Background: Since there is no available data on temporal trends of caesarean section (CS) rates in pregnant women with COVID-19 through the pandemic, we aimed to analyze the trends in caesarean section rate in a large cohort of pregnant women with COVID-19, according to the Robson Ten Group Classification System of deliveries. Methods: We prospectively enrolled pregnant women with a diagnosis of COVID-19 who delivered in our center between March 2020 and November 2021. Deliveries were classified, according to the Robson group classification, and according to three time periods: (1) deliveries from March 2020 to December 2020; (2) deliveries from January 2021 to April 2021; (3) deliveries from May 2021 to November 2021. We compared pregnancy characteristics and incidence of caesarean section, according to the Robson category in the total population, and according to the three time periods. Results: We included 457 patients matching the inclusion criteria in our analysis. We found that overall CS rate significantly decreased over time from period 1 to period 3 (152/222, 68.5% vs. 81/134, 60.4% vs. 58/101, 57.4%, χ² = 4.261, p = 0.039). CS rate significantly decreased over time in Robson category 1 (48/80, 60% vs. 27/47,57.4% vs. 8/24, 33.3%, χ² = 4.097, p = 0.043) and Robson category 3 (13/42, 31% vs. 6/33, 18.2% vs. 2/22, 9.1%, χ² = 4.335, p = 0.037). We also found that the incidence of induction of labor significantly increased over time (8/222, 3.6% vs. 12/134, 9% vs. 11/101, 10.9%, χ² = 7.245, p = 0.027). Conclusion: Our data provide an overview of the temporal changes in the management and obstetric outcome of COVID-19 pregnant women through the pandemic, confirming that standards of obstetrical assistance for pregnancies complicated by SARS-CoV-2 infection improved over time. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

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9 pages, 253 KiB

Open AccessArticle

Risk Factors Associated with Severe Disease and Intensive Care Unit Admission of Pregnant Patients with COVID-19 Infection—A Retrospective Study

by Ana-Maria Adam, Ingrid-Andrada Vasilache, Demetra Socolov, Mariana Stuparu Cretu, Costinela Valerica Georgescu, Petronela Vicoveanu, Elena Mihalceanu, Anamaria Harabor and Razvan Socolov

J. Clin. Med. 2022, 11(20), 6055; https://doi.org/10.3390/jcm11206055 - 13 Oct 2022

Cited by 4 | Viewed by 1446

Abstract

(1) Background: Pregnant patients with severe forms of coronavirus disease 2019 (COVID-19) can experience adverse pregnancy outcomes. The aim of this study was to retrospectively assess the risk factors associated with admission to the intensive care unit (ICU) of pregnant patients with COVID-19, as well as the pregnancy outcomes of these patients; (2) Methods: Medical records of 31 pregnant patients with COVID-19 admitted to three clinical hospitals from Romania, between October 2020 and November 2021 were examined. The patients were segregated into two groups depending on their clinical evolution: non-ICU admission (n = 19) or ICU admission (n = 12). Clinical and paraclinical findings were evaluated using univariate analysis, and the association of significant risk factors with maternal ICU admission was assessed using a multivariate analysis. Pregnancy outcomes of these patients were also recorded; (3) Results: Pulmonary disease, cough, dyspnea, leukocytosis, thrombocytosis, high serum values of transaminases, serum ferritin, and increased duration of hospital admission were identified as significant risk factors associated with maternal admission to the ICU. No significant differences regarding pregnancy outcomes were noted between the evaluated patients; (4) Conclusions: Specific risk factor identification in pregnant patients with severe forms of COVID-19 could improve the patient’s management. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

11 pages, 915 KiB

Open AccessArticle

COVID-19 Vaccine Acceptance during Pregnancy and Influencing Factors in South Korea

by Heesu Yoon, Bo Yun Choi, Won Joon Seong, Geum Joon Cho, Sunghun Na, Young Mi Jung, Ji Hye Jo, Hyun Sun Ko and Joong Shin Park

J. Clin. Med. 2022, 11(19), 5733; https://doi.org/10.3390/jcm11195733 - 28 Sep 2022

Cited by 7 | Viewed by 1817

Abstract

Pregnant women were excluded from vaccination against Coronavirus 2019 (COVID-19) until September 2021 in South Korea. Although vaccination for pregnant women started in October 2021, vaccine acceptance in pregnant women is yet unknown. This cross-sectional study aimed to investigate COVID-19 vaccine acceptance during pregnancy and influencing factors. An anonymous survey was distributed in obstetrics departments to all pregnant or postpartum women, during the prenatal or postpartum visit. The proportion of self-reported COVID-19 vaccination during pregnancy among 436 women was 26.6%. Pregnancy-related independent factors influencing maternal COVID-19 vaccination were “received vaccine information about from obstetrics and gynecology (OBGYN) doctors” (OR 3.41, 95% CI 2.05–5.65), “cohabitant COVID-19 vaccination” (OR 2.43, 95% CI 1.06–5.59), and “second trimester” (OR 7.35, 95% CI 1.54–35.15). In women who did not want to get vaccinated, the most common reason for COVID-19 vaccination hesitancy was concern that COVID-19 vaccine might affect the fetus (91.7%, 243/266), followed by distrust in COVID-19 vaccine effectiveness (42.6%, 113/266). This study showed that providing information about maternal COVID-19 vaccination, especially by OBGYN doctors, is crucial for increasing vaccination coverage in pregnant women. Providing updated evidence of COVID-19 vaccine efficacy and safety in pregnant women may be also helpful for increasing vaccine acceptance. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

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15 pages, 1356 KiB

Open AccessArticle

Maternal–Neonatal Outcomes of Obstetric Deliveries Performed in Negative Pressure Isolation Rooms during the COVID-19 Omicron Variant Pandemic in Taiwan: A Retrospective Cohort Study of a Single Institution

by Yi-Chiao Liao, Ping-Chung Wu, Li-Chun Chiu, Ho-Yen Chueh, Yu-Ning Chen, Yen-Chang Lee, Wen-Fang Li, Chi-Yuan Chiang, Chin-Chieh Hsu, Hsiu-Huei Peng, An-Shine Chao, Shuenn-Dyh Chang, Po-Jen Cheng, Meng-Chen Hsieh and Yao-Lung Chang

J. Clin. Med. 2022, 11(18), 5441; https://doi.org/10.3390/jcm11185441 - 16 Sep 2022

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Abstract

Objective: To investigate the maternal–neonatal outcomes of obstetric deliveries performed in negative pressure isolated delivery rooms (NPIDRs) during the coronavirus disease 2019 (COVID-19) omicron variant pandemic period in a single tertiary center in northern Taiwan. Methods: Confirmed positive and suspected-positive COVID-19 cases delivered in NPIDRs and COVID-19-negative mothers delivered in conventional delivery rooms (CDRs) in the period of 1 May 2022 to 31 May 2022 during the COVID-19 omicron variant pandemic stage were reviewed. The maternal–neonatal outcomes between the two groups of mothers were analyzed. All deliveries were performed following the obstetric and neonatologic protocols conforming to the epidemic prevention regulations promulgated by the Taiwan Centers for Disease Control (T-CDC). Multiple gestations, deliveries at gestational age below 34 weeks, and major fetal anomalies were excluded from this study. Results: A total of 213 obstetric deliveries were included. Forty-five deliveries were performed in NPIDRs due to a positive COVID-19 polymerase chain reaction (PCR) test (n = 41) or suspected COVID-19 positive status (n = 4). One hundred and sixty-eight deliveries with negative COVID-19 PCR tests were performed in CDRs. There was no statistical difference in maternal characteristics between the two groups of pregnant women. All COVID-19-confirmed cases either presented with mild upper-airway symptoms (78%) or were asymptomatic (22%); none of these cases developed severe acute respiratory syndrome. The total rate of cesarean section was not statistically different between obstetric deliveries in NPIDRs and in CDRs (38.1% vs. 40.0%, p = 0.82, respectively). Regardless of delivery modes, poorer short-term perinatal outcomes were observed in obstetric deliveries in NPIDRs: there were significant higher rates of neonatal respiratory distress (37.8% vs. 10.7%, p < 0.001, respectively), meconium-stained amniotic fluid (22.2% vs. 4.2%, p < 0.001, respectively) and newborn intensive care unit admission (55.6% vs. 8.3%, p < 0.001, respectively) in obstetric deliveries performed in NPIDRs than in CDRs. Maternal surgical outcomes were not significantly different between the two groups of patients. There was no vertical transmission or nosocomial infection observed in COVID-19 confirmed cases in this study period. Conclusions: Our study demonstrates that obstetric deliveries for positive and suspected COVID-19 omicron-variant cases performed in NPIDRs are associated with poorer short-term perinatal outcomes. Reasonable use of personal protective equipment in NPIDRs could effectively prevent nosocomial infection during obstetric deliveries for pregnant women infected with the COVID-19 omicron variant. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

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13 pages, 280 KiB

Open AccessArticle

Evaluation of an Augmented Cognitive Behavioural Group Therapy for Perinatal Generalized Anxiety Disorder (GAD) during the COVID-19 Pandemic

by Sheryl M. Green, Briar Inness, Melissa Furtado, Randi E. McCabe and Benicio N. Frey

J. Clin. Med. 2022, 11(1), 209; https://doi.org/10.3390/jcm11010209 - 31 Dec 2021

Cited by 7 | Viewed by 2185

Abstract

The perinatal period is considered a window of vulnerability given the increased risk of psychiatric difficulties during this time, such as mood and anxiety disorders (ADs). Pre-pandemic rates of ADs in perinatal women were one in five but have since increased with the onset of the COVID-19 pandemic (COVID). In addition, recent research suggests that the focus of worry has shifted during the pandemic, with perinatal women reporting significantly more COVID-specific worries. The objective of this study was to augment our current evidence-based Cognitive Behavioural Group Therapy (CBGT) for perinatal anxiety protocol by targeting intolerance of uncertainty and tailoring existing strategies to address COVID-related worry and impact. Pregnant (n = 19) and postpartum (n = 49) women were recruited from regular clinic patient flow from a university-affiliated teaching hospital between September 2020 and March 2021. Improvements in generalized anxiety symptoms, worry, intolerance of uncertainty, and mood were observed at post-treatment, maintained at 3-months, and the intervention received high ratings of treatment satisfaction. This is the first study to examine an augmented CBGT for perinatal women with GAD during the pandemic and supports the inclusion of strategies that target intolerance of uncertainty as well as specific pandemic and perinatal worry content for effective outcomes. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

11 pages, 1503 KiB

Open AccessArticle

Assessing SARS-CoV-2 Vertical Transmission and Neonatal Complications

by Cosmin Citu, Radu Neamtu, Virgiliu-Bogdan Sorop, Delia Ioana Horhat, Florin Gorun, Emanuela Tudorache, Oana Maria Gorun, Aris Boarta, Ioana Tuta-Sas and Ioana Mihaela Citu

J. Clin. Med. 2021, 10(22), 5253; https://doi.org/10.3390/jcm10225253 - 11 Nov 2021

Cited by 16 | Viewed by 2778

Abstract

We designed and implemented a prospective study to analyze the maternal and neonatal outcomes associated with COVID-19 and determine the likelihood of viral transmission to the fetus and newborn by collecting samples from amniotic fluid, placenta, umbilical cord blood, and breast milk. The study followed a prospective observational design, starting in July 2020 and lasting for one year. A total of 889 pregnant women were routinely tested for SARS-CoV-2 infection in an outpatient setting at our clinic, using nasal swabs for PCR testing. A total of 76 women were diagnosed with COVID-19. The positive patients who accepted study enrollment were systematically analyzed by collecting weekly nasal, urine, fecal, and serum samples, including amniotic fluid, placenta, umbilical cord, and breast milk at hospital admission and postpartum. Mothers with COVID-19 were at a significantly higher risk of developing gestational hypertension and giving birth prematurely by c-section than the general pregnant population. Moreover, their mortality rates were substantially higher. Their newborns did not have negative outcomes, except for prematurity, and an insignificant number of newborns were infected with SARS-CoV-2 (5.4%). No amniotic fluid samples were positive for SARS-CoV-2, and only 1.01% of PCR tests from breast milk were confirmed positive. Based on these results, we support the idea that SARS-CoV-2 positive pregnant women do not expose their infants to an additional risk of infection via breastfeeding, close contact, or in-utero. Consequently, we do not support maternal–newborn separation at delivery since they do not seem to be at an increased risk of SARS-CoV-2 infection. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

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9 pages, 259 KiB

Open AccessArticle

Application of Telehealth in Prenatal Care during the COVID-19 Pandemic—A Cross-Sectional Survey of Polish Women

by Dominik Jakubowski, Dorota Sys, Anna Kajdy, Roksana Lewandowska, Ewa Kwiatkowska, Aneta Cymbaluk-Płoska, Michał Rabijewski, Andrzej Torbé and Sebastian Kwiatkowski

J. Clin. Med. 2021, 10(12), 2570; https://doi.org/10.3390/jcm10122570 - 10 Jun 2021

Cited by 13 | Viewed by 3359

Abstract

To reduce the risk of infection of SARS-CoV-2 during commuting to the clinic or due to contact with medical staff, the American College of Obstetricians and Gynecologists has recommended arranging some appointments in the form of “telehealth”. The aim of the study was to assess the access to medical care in pregnancy during the SARS-CoV-2 pandemic and the role of telehealth in the implementation of prenatal care standards. This is a cross-sectional study. The study group included 618 women who were pregnant and/or gave birth in Poland during the COVID-19 pandemic. The majority of the participants experienced difficulties accessing medical care because of the pandemic. The correlation between this experience and the use of the hybrid healthcare model was established. The affiliation to public or private healthcare was irrelevant. There was no relationship between healthcare (private/public or in-person/hybrid) and implementation of the prenatal care standards. To ensure safe access to prenatal care for pregnant women, recommendations for a hybrid pregnancy management model should be created with detailed information regarding which appointments patients must be present for in-person and which can be conducted remotely. To reduce the risks associated with movement and interpersonal contact, all visits during which tests and screenings take place should be conducted in-person; other appointments can be arranged in the form of telehealth. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

Review

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11 pages, 275 KiB

Open AccessReview

ISIDOG Consensus Guidelines on COVID-19 Vaccination for Women before, during and after Pregnancy

by Gilbert G. G. Donders, Svitrigaile Grinceviciene, Kai Haldre, Risa Lonnee-Hoffmann, Francesca Donders, Aristotelis Tsiakalos, Albert Adriaanse, José Martinez de Oliveira, Kevin Ault, Werner Mendling and on the behalf of the COVID-19 ISIDOG Guideline Group

J. Clin. Med. 2021, 10(13), 2902; https://doi.org/10.3390/jcm10132902 - 29 Jun 2021

Cited by 21 | Viewed by 7534

Abstract

Introduction. Sars-CoV-2 infection poses particular problems in pregnancy, as the infection more frequently causes severe complications than in unaffected pregnant women or nonpregnant women with SARS-CoV-2 infection. Now that vaccination is available and rapidly being implemented worldwide, the question arises whether pregnant women should be vaccinated, and if so, whether they should receive priority. Methods. Available scientific data and available guidelines about vaccination against SARS-CoV-2 were collected by the Guideline Committee of the International Society of Infectious Diseases in Obstetrics and Gynecology (ISIDOG) and were analyzed, discussed and summarized as guidelines for healthcare workers caring for pregnant women. Concluding statements were graded according to the Oxford evidence-based medicine grading system. Results. There is evidence to consider pregnancy as a risk factor for serious complications of COVID-19 infection, even in the absence of additional risk factors, such as hypertension, diabetes and obesity which increase these risks even more in pregnancy. Currently available data slightly favor mRNA-based vaccines above vector-based vaccines during pregnancy and breastfeeding, until more safety data become available. Conclusion. ISIDOG advises policy makers and societies to prioritize pregnant women to receive vaccination against SARS-CoV-2 and favor the mRNA vaccines until further safety information becomes available. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

Other

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28 pages, 1068 KiB

Open AccessSystematic Review

Cardiovascular Complications of COVID-19 among Pregnant Women and Their Fetuses: A Systematic Review

by Shirin Yaghoobpoor, Mobina Fathi, Kimia Vakili, Zohreh Tutunchian, Mina Dehghani, Ashkan Bahrami, Ramtin Hajibeygi, Samira Eslami, Tina Yaghoobpour and Mohammadreza Hajiesmaeili

J. Clin. Med. 2022, 11(20), 6194; https://doi.org/10.3390/jcm11206194 - 20 Oct 2022

Cited by 6 | Viewed by 3390

Abstract

Background: COVID-19 is a viral infectious disease leading to a spectrum of clinical complications, especially cardiovascular. Evidence shows that this infection can potentially accompany a worse outcome in pregnant women. Cardiovascular complications in mothers and their fetuses are reported by previous studies. Objective: In this systematic review, we aim to investigate the cardiovascular complications of COVID-19 during pregnancy in the mothers and fetus, according to the published literature. Method: We systematically searched the online databases of PubMed, Scopus, Web of Science, and Google Scholar, using relevant keywords up to April 2022. We included all observational studies reporting cardiovascular complications among COVID-19-affected pregnant women and their fetuses. Results: We included 74 studies containing 47582 pregnant COVID-19 cases. Pre-eclampsia, hypertensive disorders, cardiomyopathy, heart failure, myocardial infarction, thrombosis formation, alterations in maternal–fetal Doppler patterns, and maternal and fetal arrhythmia were reported as cardiovascular complications. The highest incidences of pre-eclampsia/eclampsia among COVID-19 pregnant cases, reported by studies, were 69% and 62%, and the lowest were 0.5% and 3%. The highest and lowest incidences of fetal bradycardia were 20% and 3%, and regarding fetal tachycardia, 5.4% and 1%, respectively. Conclusion: SARS-CoV-2 infection during pregnancy can potentially be associated with cardiovascular complications in the mother, particularly pre-eclampsia and heart failure. Moreover, SARS-CoV-2 infection during pregnancy can potentially cause cardiovascular complications in the fetus, particularly arrhythmia. Full article

(This article belongs to the Special Issue COVID-19 in Pregnancy: A Clinical Management Protocol and Considerations for Practice)

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