Pregnant patients with severe or critical coronavirus disease 2019 (COVID-19), but not those with mild or moderate COVID-19, were at increased risk for perinatal complications compared with asymptomatic patients.

Objective The aim of the study was to evaluate pregnant women's attitudes toward COVID-19 illness and vaccination and identify factors associated with vaccine acceptability. Study Design This was a cross-sectional survey among pregnant women enrolled in a prospective COVID-19 cohort study in Salt Lake City, UT, Birmingham, AL, and New York, NY, from August 9 to December 10, 2020. Women were eligible if they were 18 to 50 years old and <28 weeks of gestation. Upon enrollment, women completed surveys regarding concerns about COVID-19 illness and likelihood of getting COVID-19 vaccine if one were available during pregnancy. Vaccine acceptability was defined as a response of “very likely” or “somewhat likely” on a 4-point Likert scale. Factors associated with vaccine acceptability were assessed with multivariable logistic regression. Results Of 939 pregnant women eligible for the main cohort study, 915 (97%) consented to participate. Among these 915 women, 39% self-identified as White, 23% Black, 33% Hispanic, and 4% Other. Sixty-two percent received an influenza vaccine last season. Seventy-two percent worried about getting sick with COVID-19. If they were to get sick, 92% worried about harm to their pregnancy and 80% about harm to themselves. Only 41% reported they would get a vaccine. Of women who were unlikely to get vaccinated, the most frequently cited concern was vaccine safety for their pregnancy (82%). Non-Hispanic Black and Hispanic women had lower odds of accepting a vaccine compared with non-Hispanic White women (adjusted odds ratios [aOR] 0.4, 95% CI 0.2–0.6 for both). Receipt of influenza vaccine during the previous season was associated with higher odds of vaccine acceptability (aOR 2.1, 95% CI 1.5–3.0). Conclusion Although most pregnant women worried about COVID-19 illness, <50% were willing to get vaccinated during pregnancy. Racial and ethnic disparities in plans to accept COVID-19 vaccine highlight the need to prioritize strategies to address perceived barriers among groups at high risk for COVID-19. Key Points

A s the prevalence of obesity grows in the United States, rates of surgical weight-loss procedures have increased significantly, with women (particularly those of reproductive age) accounting for many of these surgeries. How this affects pregnancy is not clearly understood. The authors of this meta-analysis estimated bariatric surgery rates among women aged 18 to 45 years and reviewed the literature on the effects of these procedures on fertility rates and pregnancy outcomes.The authors searched the Nationwide Inpatient Sample (1998Sample ( to 2005 and databases of Medline, EMBASE, Controlled Clinical Trials Register, and the Cochrane Database of Reviews of Effectiveness between 1984 and February 2008 for references on bariatric surgery in women of reproductive age. Of the 260 screened articles, 75 reviews and studies were considered eligible, with information abstracted about study design, fertility, nutritional, neonatal, and pregnancy outcomes after all types of bariatric surgery.The incidence of bariatric surgery in the United States increased 800% between 1998 and 2005 (growing from 12,480 to 113,500 cases annually). Women aged 18 to 45 years made up 49% of all patients undergoing weight-loss surgery (>50,000 cases annually) for the 3 most recent years. Lower maternal complications, approaching the level of nonobese controls, were found among women who had bariatric surgery before pregnancy when compared with obese women without surgery in 3 matched cohort studies. Women who underwent laparoscopic adjustable gastric band surgery had lower rates of gestational diabetes (0% vs. 22.1%; P<0.05) and preeclampsia (0% vs. 3.1%; P<0.05). These findings were supported by 13 other retrospective bariatric cohort trials. Overall, neonatal outcomes after laparoscopic adjustable gastric band were similar or better than in obese women without surgery, in terms of premature delivery (7.7% vs. 7.1%), low birth weight (7.7% vs. 10.6%; P<0.05), and macrosomia (7.7% vs. 14.6%; P<0.05). There were no significant differences in neonatal outcomes after gastric bypass surgery compared with nonobese controls or obese women who did not have surgery. These findings were supported by 10 studies. Six studies addressed fertility outcomes after bariatric surgery, but these were small and provided no clear results. Twenty reports found complications requiring surgical intervention during pregnancy, primarily for the relief of bowel obstruction, in parturients who had undergone bariatric surgery. The effect of bariatric surgery on the rate of cesarean section was unclear. There also was no strong evidence to guide pregnancy delay following bariatric surgery, although the typical recommendation reported in this article was 1 year.The authors concluded that available evidence suggests that rates of adverse maternal and neonatal outcomes may be lower in women who undergo weight-loss surgeries before becoming pregnant. Most of these studies, however, had design deficiencies, such as small patient numbers and potential selection bias. They reco...

BACKGROUND: Although in 2013 the American College of Obstetricians and Gynecologists recommended early screening for gestational diabetes in obese women, no studies demonstrate an improvement in perinatal outcomes with this strategy. OBJECTIVE: We sought to determine whether early screening for gestational diabetes improves perinatal outcomes in obese women. MATERIALS AND METHODS: Randomized controlled trial comparing early gestational diabetes screening (14À20 weeks) to routine screening (24À28 weeks) in obese women (body mass index !30 kg/m 2 ) at 2 tertiary care centers in the United States. Screening was performed using a 50-g, 1-hour glucose challenge test followed by a 100-g, 3-hour glucose tolerance test if the initial screen was !135 mg/dL. Gestational diabetes was diagnosed using CarpenterÀCoustan criteria. Women not diagnosed at 14 to 20 weeks were rescreened at 24 to 28 weeks. Exclusion criteria were pre-existing diabetes, major medical illness, bariatric surgery, and prior cesarean delivery. The primary outcome was a composite of macrosomia (>4000 g), primary cesarean delivery, hypertensive disease of pregnancy, shoulder dystocia, neonatal hyperbilirubinemia, and neonatal hypoglycemia (assessed within 48 hours of birth). RESULTS: A total of 962 women were randomized, and outcomes were available for 922. Of these 922 women, 459 (49.8%) were assigned to early screen and 463 (50.2%) to routine screen. Baseline characteristics were balanced between groups. In the early screening group, 69 (15.0%; 95% confidence interval, 11.9À18.6%) were diagnosed with gestational diabetes: 29 (6.3%; 95% confidence interval, 4.3À8.9%) at <20 weeks and 40 (8.7%; 95% confidence interval, 6.3À11.7%) at >24 weeks. Of those randomized to routine screening, 56 (12.1%; 95% confidence interval, 9.3À15.4%) had gestational diabetes. Early screening did not reduce the incidence of the primary outcome (56.9% in the early screen versus 50.8% in the routine screen, P ¼ .07; relative risk, 1.12; 95% confidence interval, 0.99À1.26). CONCLUSION: Early screening for gestational diabetes in obese women did not reduce the composite perinatal outcome.

BACKGROUND-Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes. METHODS-We studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU). RESULTS-Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5%