Objective Previous studies comparing the COVID-19 pandemic period to prepandemic periods reported either no change or a decrease in extremely preterm birth (PTB) rates during the pandemic. 1, 2 These studies evaluated a limited number of potential PTB confounders and a short pandemic period. We aimed to determine the change in PTB rate and neonatal outcomes during the pandemic in comparison to prepandemic periods by evaluating multiple obstetrical characteristics, during more than three pandemic months. Study design We compared maternal, obstetrical and neonatal outcomes of singleton pregnancies at the Sheba Medical Center, Israel, during three periods: from 20/03/2020 (date of implementation of governmental state of lockdown) to 27/06/2020 (group 1), a parallel period in 2019 (group 2), and to another group that included the parallel annual periods in 2011-2019 (group 3) (see Table). We also compared maternal and pregnancy characteristics during the pandemic and corresponding prepandemic period in 2019 between pregnancies complicated by PTB <34 0/7 versus ≥34 0/7 weeks (see Table). Multivariate regression analysis was performed in order to study independent factors associated with PTB. The institutional review board approved this study (7068-20-SMC, 03/30/2020). Results There were 2,594 deliveries during the pandemic period (group 1) and 2,742 and 28,686 deliveries in the prepandemic periods (groups 2 and 3, respectively). Maternal and obstetrical characteristics did not differ between groups 1 and 2. Predelivery hemoglobin levels were higher in the pandemic period. PTB <34 0/7 weeks rate was significantly lower in the pandemic period compared to group 2 (OR 0.45 95% CI 0.30-0.68, p<0.001), as was the rate of composite neonatal outcome (OR 0.76 95% CI 0.59-0.96, p=0.023). Age, body mass index, parity, diabetes rates and hematologic characteristics differed between groups 1 and 3 with significantly higher predelivery hemoglobin levels in group 1. PTB <34 0/7 weeks rate was lower in the pandemic period (OR 0.60 95% CI 0.41-0.85, p=0.004). On multivariate regression analysis, delivering during the pandemic period was independently associated with a decreased risk for delivery <34 0/7 weeks (adjusted OR 0.29, 95% CI 0.15-0.56, p=0.001). Conclusion We observed more than 50% reduction in the rate of PTB <34 0/7 weeks of gestation, possibly resulting in improved neonatal outcome.

Highlights d TMEM18 expression is essential for adipocyte formation in vitro and in vivo d TMEM18 activates PPARG by upregulating PPARG1 promoter activity d TMEM18 and PPARG1 are dysregulated with obesity and adipose tissue dysfunction

There is growing interest in understanding how dysregulated autophagy may contribute to pathogenesis of disease. Most frequently, disease states are associated with diminished autophagy, mostly attributed to genetic variation in autophagy genes and/or to dysfunctional posttranscriptional mechanisms. In human adipose tissue (AT), in obesity, expression of autophagy genes is upregulated and autophagy is likely activated, associating with adipose dysfunction. This review explores the emerging role of transcriptional mechanisms regulating AT autophagy in obesity.

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