Congenital heart defects during COVID‐19 pandemic

Ultrasound in Obstetrics and Gynecology, Год журнала: 2024, Номер unknown

Опубликована: Ноя. 14, 2024

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnancy is associated increased maternal morbidity and mortality1, 2. Associations have also been reported placental complications, including stillbirth pre-eclampsia2, cases of vertical transmission the virus from mother to fetus documented, although these appear be rare3. Until recently, there has very little evidence suggest an association between disease 2019 (COVID-19) pandemic congenital anomalies4-6. In a study 35 123 singleton births California, USA, positive COVID-19 test was odds anomalies (odds ratio (OR), 1.69 (95% CI, 1.15–2.50))7. Other research found no anomalies8. However, November 2023, Wang et al. increase incidence situs inversus large birth cohort following lifting pandemic-associated restrictions China9. light this report, we sought evaluate whether change heart defects among live USA during pandemic. We obtained certificate data for Centers Disease Control Prevention's (CDC) publicly available national files December 2016 2022 effect on defects. The government requires submitted all irrespective gestational age or viability. Data are entered into standardized form by staff at hospital center where baby delivered. completed forms then local state vital statistics office checks performed any queries relevant center. Patient identifiers removed before National Center Health Statistics. Further details procedure collecting type information collected CDC website10. certificates collect one cardiac field, namely cyanotic defects, defined as transposition great arteries, tetralogy Fallot, pulmonary pulmonic valvular atresia, tricuspid truncus arteriosus, total/partial anomalous venous return without obstruction, coarctation aorta, hypoplastic left interrupted aortic arch11. An time series analysis monthly intervals used over time, using interruption. pre-interruption period 1 30 post-interruption 2020 2022, giving 36 timepoints 24 after excluded several reasons. First, earliest identified case SARS-CoV-2 infection 19 January 202012. Second, if causally exposure would take place early pregnancy, embryogenesis, not expect observe fewer than 6 months (since most occur 37 weeks' gestation later). Additionally, evolved population testing limited, so exact timing maximum pregnant people first trimester unknown. Lastly, vaccine made recommended American College Obstetricians Gynecologists July 2021, it could affected both symptoms people13. A secondary segmented regression conducted shorter 2021 followed additional segment slope equal that period, examine shift trend occurred once majority had vaccinated against infected SARS-CoV-2. Down evaluated pre- periods control. Poisson assess trends expressed OR. robust standard errors14. checked seasonality given disruptions seasonal patterns infectious period. autocorrelation Durbin–Watson (DHARMa package). calculated level OR projected out start estimate risk Estimates each were presented 12-month interval 95% CI. Statistical R package version 4.3.115. Since reporting includes confirmed pending cases, separate analyses only cases. As observed changes body mass index (BMI), prepregnancy diabetes mellitus prenatal care, which might impact detection logistic adjusted BMI (six categories plus unknown recorded certificate), mellitus, hypertension, age, parity month care initiated (four certificate) (Table 1). Unknown values included category analysis. There 11 054 415 7 087 583 Of these, 43 651 (0.39%) 26 957 (0.38%) births, respectively, non-reporting analysis, leaving 010 764 060 626 respectively. Cases generally anomalies, syndrome. 27 but Compared birthing individuals slightly more likely aged years older (20.0% vs 18.0%; P < 0.001), higher (median, 26.5 kg/m2 25.7 kg/m2; (2.1% 1.7%; 0.001) (1.1% 0.9%; hypertension (2.8% 2.0%; Birthing nulliparous (39.2% 38.4%; 0.001). significantly (65.4 56.5 per 100 000 births), while (23.0 24.4 births) (28.7 30.3 lower, drop statistically significant. During status (200.1 143.7 both). Table shows year. No either (P = 0.404 0.365, respectively), residuals significant 0.612 0.967, respectively). increasing 3.4% year (OR, 1.03 1.01–1.06)) 3, Figure 1a). estimated 11.1% 1.11 1.02–1.20)). similar model (adjusted (aOR), 1.12 1.01–1.23)). 0.027 analysis), decreasing (OR year, 0.96 0.91–1.01)). different 1, indicating flat. did unadjusted 0.81–1.15) aOR, 0.97 0.84–1.12), respectively) (Figure 1b). difference pre-trend projection similar. Thus, our demonstrate compared 1.02–1.20); 0.012). corresponding same 0.81–1.15); 0.648). reasons underlying finding uncertain, raises possibility fetal abnormalities. It postulated mediated through angiotensin-converting enzyme (ACE2) developing human embryos stages development (gametes, zygotes four-cell embryos)4, 5. hypothesized that, mechanism, penetrate cells stage affect cell transformation growth heart, organs develop begin functioning embryonic Caution needed when interpreting observation, other possible explanations. These include access pandemic, such limited ultrasound screening, completion reporting. lifestyle dietary but, even adjusting BMI, initiated, persisted. unrecognized confounding cannot excluded. If due course substantial underestimate direct infection. seroprevalence-based estimates prior 18–49-year group 12.6% 70.0% April (the term pregnancies 3 captured period)16, 17. entirely calculate get pre–post 1.11, under assumption infections rate group, need 2.1. antibodies vaccination protective effects abnormalities, higher. assume second half (from 2022) 14% 1.14 1.03–1.27)). This benefits use dataset able anomalies. unable subtype obtain cohort. Another limitation capture stillbirths, miscarriages terminations pregnancy. two studies decrease termination contributed defects18, 19. limitations, nothing limitations recently addressed linking pregestational early-pregnancy highlighting inadequate tracking history methodological flaws published studies, well restricted burden undiagnosed infections, particularly low- middle-income countries20. important implications link results warrant further support findings author upon reasonable request.

Язык: Английский

COVID-19 pandemic, pregnancy care, perinatal outcomes in Eastern Myanmar and North-Western Thailand: a retrospective marginalised population cohort

BMC Pregnancy and Childbirth, Год журнала: 2024, Номер 24(1)

Опубликована: Окт. 2, 2024

Язык: Английский