Tocilizumab for coronavirus disease 2019 in pregnancy and lactation: a narrative review DOI Creative Commons
Sarah C J Jorgensen, Stephen E. Lapinsky

Clinical Microbiology and Infection, Journal Year: 2021, Volume and Issue: 28(1), P. 51 - 57

Published: Aug. 23, 2021

BackgroundTocilizumab is a monoclonal antibody that interrupts interleukin-6 signalling, reducing downstream effects on inflammation and the innate immune response. It was shown to reduce mortality in patients with severe or critical coronavirus disease 2019 (COVID-19). Pregnant breastfeeding people were largely excluded from clinical trials hence, extent which results can be applied these populations not clear.ObjectivesTo synthesize published data tocilizumab pregnancy lactation, highlight important knowledge gaps, help inform decision-making about tocilizumab's use COVID-19.SourcesPubMed searched for studies evaluating lactation COVID-19 other indications. Literature pharmacokinetics reproductive/fetal safety of antibodies general also sought. The US Food Drug Administration European Medicines Agency guidance industry regulatory approval documents reviewed.ContentPublished include 610 cases (n = 20 COVID-19) together seven mother–infant pairs. Higher rates spontaneous abortion premature birth have been reported compared population, but multiple confounding variables limit interpretation. There little exposure second third trimesters when transplacental transport highest. developing system are unclear. who received often critically ill corticosteroid uncommon. Neonatal follow up limited. Tocilizumab appears compatible breastfeeding.ImplicationsAlthough available do raise serious signals, they significant limitations sufficient delineate complete spectrum potential adverse outcomes may associated during lactation. Diligent documentation will moving forward. A more effective framework ensure equitable inclusion pregnant research clearly needed.

Language: Английский

SARS-CoV-2 infection during pregnancy and risk of preeclampsia: a systematic review and meta-analysis DOI Creative Commons

Agustín Conde‐Agudelo,

Roberto Romero

American Journal of Obstetrics and Gynecology, Journal Year: 2021, Volume and Issue: 226(1), P. 68 - 89.e3

Published: July 21, 2021

To examine the relationship between SARS-CoV-2 infection during pregnancy and risk for preeclampsia.

Language: Английский

Citations

248
Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury DOI Open Access
David A. Schwartz, Elyzabeth Avvad Portari, Pavel Babál

et al.

Archives of Pathology & Laboratory Medicine, Journal Year: 2022, Volume and Issue: 146(6), P. 660 - 676

Published: Feb. 10, 2022

Perinatal death is an increasingly important problem as the coronavirus disease 2019 (COVID-19) pandemic continues, but mechanism of has been unclear.To evaluate role placenta in causing stillbirth and neonatal following maternal infection with COVID-19 confirmed placental positivity for severe acute respiratory syndrome 2 (SARS-CoV-2).Case-based retrospective clinicopathologic analysis by a multinational group 44 perinatal specialists from 12 countries autopsy pathology findings 64 stillborns 4 deaths having placentas testing positive SARS-CoV-2 delivery to mothers COVID-19.Of 3 constituting placentitis, all 68 had increased fibrin deposition villous trophoblast necrosis 66 chronic histiocytic intervillositis. Sixty-three massive perivillous deposition. Severe destructive placentitis averaged 77.7% tissue involvement. Other included multiple intervillous thrombi (37%; 25 68) villitis (32%; 22 68). The majority (19; 63%) 30 autopsies revealed no significant fetal abnormalities except intrauterine hypoxia asphyxia. Among cases, was detected body specimen 16 28 cases tested, most frequently nasopharyngeal swabs. Four autopsied identified internal organs.The composing cause widespread destruction resulting malperfusion insufficiency. In these likely results directly insufficiency hypoxic-ischemic injury. There evidence that involvement fetus deaths.

Language: Английский

Citations

181
Placental histopathology after SARS-CoV-2 infection in pregnancy: a systematic review and meta-analysis DOI Open Access
Raffaella Di Girolamo, Asma Khalil, Sara Alameddine

et al.

American Journal of Obstetrics & Gynecology MFM, Journal Year: 2021, Volume and Issue: 3(6), P. 100468 - 100468

Published: Aug. 21, 2021

Language: Английский

Citations

147
Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis DOI Creative Commons
Emily R. Smith, Erin Oakley, Gargi Wable Grandner

et al.

BMJ Global Health, Journal Year: 2023, Volume and Issue: 8(1), P. e009495 - e009495

Published: Jan. 1, 2023

Despite a growing body of research on the risks SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in quality and design published studies.

Language: Английский

Citations

131
COVID-19 Vaccination in Pregnancy, Paediatrics, Immunocompromised Patients, and Persons with History of Allergy or Prior SARS-CoV-2 Infection: Overview of Current Recommendations and Pre- and Post-Marketing Evidence for Vaccine Efficacy and Safety DOI Creative Commons
Nicoletta Luxi,

Alexia Giovanazzi,

Annalisa Capuano

et al.

Drug Safety, Journal Year: 2021, Volume and Issue: 44(12), P. 1247 - 1269

Published: Nov. 5, 2021

Language: Английский

Citations

124
Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: A nationwide cohort study DOI Creative Commons
Ipek Gurol‐Urganci, Lara Waite, Kirstin Webster

et al.

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

Citations

76
SARS-CoV-2 placentitis, stillbirth, and maternal COVID-19 vaccination: clinical–pathologic correlations DOI Creative Commons
David A. Schwartz, Sarah B. Mulkey, Drucilla J. Roberts

et al.

American Journal of Obstetrics and Gynecology, Journal Year: 2022, Volume and Issue: 228(3), P. 261 - 269

Published: Oct. 12, 2022

Stillbirth is a recognized complication of COVID-19 in pregnant women that has recently been demonstrated to be caused by SARS-CoV-2 infection the placenta. Multiple global studies have found placental pathology present cases stillbirth consists combination concurrent destructive findings include increased fibrin deposition typically reaches level massive perivillous deposition, chronic histiocytic intervillositis, and trophoblast necrosis. These 3 pathologic lesions, collectively termed placentitis, can cause severe diffuse parenchymal destruction affect >75% placenta, effectively rendering it incapable performing its function oxygenating fetus leading neonatal death via malperfusion insufficiency. Placental occur absence demonstrable fetal infection. Development placentitis complex process may both an infectious immunologic basis. An important observation all reported causing death, mothers were unvaccinated. likely result episode viremia at some time during pregnancy. This article discusses clinical aspects relationship between maternal vaccination, perinatal death.

Language: Английский

Citations

76
Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors DOI Creative Commons
Levente Zsichla, Viktor Müller

Viruses, Journal Year: 2023, Volume and Issue: 15(1), P. 175 - 175

Published: Jan. 7, 2023

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease death. Understanding the risk factors is relevant both in setting at epidemiological level. Here, we provide an overview host, viral environmental that have been shown or (in some cases) hypothesized be associated with outcomes. considered detail include age frailty, genetic polymorphisms, biological sex (and pregnancy), co- superinfections, non-communicable comorbidities, immunological history, microbiota, lifestyle patient; variation infecting dose; socioeconomic factors; air pollution. For each category, compile (sometimes conflicting) evidence for association factor outcomes (including strength effect) outline possible action mechanisms. We also discuss complex interactions between various factors.

Language: Английский

Citations

71
Maternal vaccination: a review of current evidence and recommendations DOI Creative Commons
Melanie Etti, Anna Calvert, Eva Galiza

et al.

American Journal of Obstetrics and Gynecology, Journal Year: 2021, Volume and Issue: 226(4), P. 459 - 474

Published: Nov. 11, 2021

Maternal vaccination is an effective means of protecting pregnant women, their fetuses, and infants from vaccine-preventable infections. Despite the availability sufficient safety data to support use vaccines during pregnancy, maternal immunization remains underutilized method disease prevention, often because concerns both healthcare providers women about vaccine safety. Such have been reflected in low uptake COVID-19 among seen many parts world. Here, we present update current recommendations for including evidence supporting novel platforms. We also provide overview pregnancy status that are currently under development women.

Language: Английский

Citations

98
Covid-19 and pregnancy: vaccine hesitancy and how to overcome it DOI Open Access

Gareth Iacobucci

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n2862 - n2862

Published: Nov. 22, 2021

Some 80 000 pregnant women in England had received two doses of the covid-19 vaccine up to 31 October, from 65 000 at end August, says UK Health Security Agency.1 It’s not possible say what proportion this is all women, as doesn’t collect data linking vaccinations, pregnancies, and births. But Public Scotland2 showed that only 15% (615/4069) who gave birth August 2021 were fully vaccinated. Only 23% (165/704) aged 35-39 delivered their baby doses, compared with 71% adults 30-39 general population. Pat O’Brien, consultant obstetrician vice president Royal College Obstetricians Gynaecologists, believes there are main drivers. “The first natural understandable reluctance take anything unusual or new during pregnancy because fear it might harm baby,” he told The BMJ . The second initial advice Joint Committee on Vaccination Immunisation (JCVI) better avoid covid unless they high risk serious disease, a lack evidence safety. This changed emerged, JCVI advised April should be offered vaccine. O’Brien rejects accusations mixed messages. “We have more information about safety …

Language: Английский

Citations

61