Infections and Pregnancy: Effects on Maternal and Child Health

Frontiers in Cellular and Infection Microbiology, Journal Year: 2022, Volume and Issue: 12

Published: June 8, 2022

Pregnancy causes physiological and immunological adaptations that allow the mother fetus to communicate with precision in order promote a healthy pregnancy. At same time, these may make pregnant women more susceptible infections, resulting variety of pregnancy complications; those pathogens also be vertically transmitted fetus, adverse outcomes. Even though placenta has developed robust microbial defense restrict vertical transmission, certain have evolved mechanisms avoid placental barrier cause congenital diseases. Recent mechanistic studies begun uncover striking role maternal microbiota In this review, we discuss how overcome A better understanding control fetal infection should provide new insights into future translational research.

Language: Английский

---

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Nature Human Behaviour, Journal Year: 2023, Volume and Issue: 7(4), P. 529 - 544

Published: Feb. 27, 2023

Abstract Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported many countries following early COVID-19 pandemic response measures (‘lockdowns’). It unclear whether this variation reflects real differences lockdown impacts, or perhaps stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data 52 million births 26 countries, 18 which had representative population-based data, with overall 6% 12% 2.5 10.5 per 1,000 births. We show small reductions first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value <0.0001), second (0.96, 0.92–0.99, 0.03) third (0.97, 0.94–1.00, 0.09) months lockdown, but not fourth month (0.99, 0.96–1.01, 0.34), although there some between-country after month. For high-income study, did observe an association between stillbirths (1.00, 0.88–1.14, 0.98), 0.88–1.12, 0.89) (1.01, 0.87–1.18, 0.86) have imprecise estimates due being a relatively rare event. did, however, find evidence increased risk (1.14, 1.02–1.29, 0.02) and, Brazil, found for (1.09, 1.03–1.15, 0.002), (1.10, 1.03–1.17, 0.003) (1.12, 1.05–1.19, <0.001) lockdown. With estimated 14.8 annually worldwide, modest observed during lockdowns translate into large numbers averted globally warrant further research causal pathways.

Language: Английский

---

Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms

Nature Communications, Journal Year: 2022, Volume and Issue: 13(1)

Published: June 28, 2022

The availability of three COVID-19 vaccines in the United States provides an unprecedented opportunity to examine how vaccine platforms and timing vaccination pregnancy impact maternal neonatal immunity. Here, we characterize antibody profile after Ad26.COV2.S, mRNA-1273 or BNT162b2 158 pregnant individuals evaluate transplacental transfer by profiling umbilical cord blood 175 maternal-neonatal dyads. These analyses reveal lower vaccine-induced functions Fc receptor-binding Ad26.COV2.S compared mRNA subtle advantages titer function with versus BN162b2. have higher titers against SARS-CoV-2 variants concern. First third trimester results enhanced antibody-dependent NK-cell activation, cellular neutrophil phagocytosis, complement deposition relative second trimester. Higher ratios following first may reflect placental compensation for waning titers. provide novel insight into platform on humoral immune response transfer.

Language: Английский

---

Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study

PLoS Medicine, Journal Year: 2022, Volume and Issue: 19(1), P. e1003884 - e1003884

Published: Jan. 10, 2022

Background The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. This national study aimed to compare obstetric intervention pregnancy outcome rates in England during the corresponding pre-pandemic calendar periods, assess whether differences these varied according ethnic socioeconomic background. Methods findings We conducted a of singleton births English National Health Service hospitals. compared period (23 March 2020 22 February 2021) with 1 year earlier. Hospital Episode Statistics database provided administrative hospital data about maternal characteristics, inventions (induction labour, elective or emergency cesarean section, instrumental birth), outcomes (stillbirth, preterm birth, small for gestational age [SGA; birthweight < 10th centile], prolonged length stay (≥3 days), 42-day readmission). Multi-level logistic regression models were used between periods test interactions All adjusted characteristics including age, history, comorbidities, status at birth. included 948,020 (maternal characteristics: median 30 years, 41.6% primiparous, 8.3% diabetes, 2.4% preeclampsia, 1.6% pre-existing diabetes hypertension); 451,727 occurred defined period. Maternal similar periods. Compared period, stillbirth remained (0.36% versus 0.37% pre-pandemic, p = 0.16). Preterm birth SGA slightly lower (6.0% 6.1% births, odds ratio [aOR] 0.96, 95% CI 0.94–0.97; 5.6% 5.8% aOR 0.95, 0.93–0.96; both 0.001). Slightly higher observed (40.4% 39.1% induction 1.04, 1.03–1.05; 13.9% 12.9% 1.13, 1.11–1.14; 18.4% 17.0% 1.07, 1.06–1.08; all Lower (16.7% 20.2%, 0.77, 0.76–0.78, 0.001) readmission (3.0% 3.3%, 0.88, 0.86–0.90, There was some evidence that unassisted vaginal mother’s background but not her A key limitation is multiple comparisons made, increasing chance false-positive results. Conclusions In this study, we found very decreases increases labour section pandemic, different pattern results women from minority backgrounds. These changes may be linked women’s behaviour, environmental exposure, practice, reduced staffing levels.

Language: Английский

---

Investigation and Care of a Small‐for‐Gestational‐Age Fetus and a Growth Restricted Fetus (Green‐top Guideline No. 31)

BJOG An International Journal of Obstetrics & Gynaecology, Journal Year: 2024, Volume and Issue: 131(9)

Published: May 13, 2024

Key recommendations All women should be assessed at booking (by 14 weeks) for risk factors fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings the midtrimester anomaly scan incorporated into assessment and updated throughout pregnancy. GPP] Reduce smoking in pregnancy by identifying smoke with assistance of carbon monoxide (CO) testing ensuring in‐house treatment from a trained tobacco dependence advisor is offered all pregnant smoke, opt‐out referral process. Women pre‐eclampsia and/or placental dysfunction take aspirin 150 mg once daily night 12 +0 –36 weeks reduce their chance small‐for‐gestational‐age (SGA) FGR. A] Uterine artery Dopplers carried out between 18 23 +6 high disorders B]. In woman normal uterine Doppler biometry scan, serial ultrasound scans can commence 32 weeks. abnormal (mean pulsatility index > 95th centile) 24 –28 based on individual history. B] are low FGR have measurement symphysis fundal height (SFH) each antenatal appointment after (no more frequently than every 2 weeks). The first 28 C] moderate category late onset so commencing For majority women, interval four until birth appropriate. Maternity providers ensure that they clearly reference charts plot SFH, estimated weight (EFW) measurements calculate centiles. method used same as development chart EFW Hadlock three parameter model used. guidance promotes use standard planes acquisition calliper placement when performing scanning assessment. Quality control images undertaken. Ultrasound fetuses identified SGA C]. Umbilical primary tool point diagnosis during follow‐up minimum 3rd 10th centile, other features must present recommended prior 39 weeks, either maternal (maternal medical conditions or concerns regarding movements) compromise (a assessment, velocity concern cardiotocography [CTG]) abdominal circumference less centile where has been excluded, initiation induction labour considered discussion her partner/family/support network. Birth occur Pregnancies early (prior monitored managed input tertiary level units highest neonatal care. Care multidisciplinary neonatology obstetricians medicine expertise, particularly extremely preterm (before Fetal repeated Assessment wellbeing include multiple modalities but computerised CTG ductus venous. pregnancies FGR, initiated 37 completed A]. Decisions assessments indication.

Language: Английский

---