The effect of maternal SARS-CoV-2 infection timing on birth outcomes: a retrospective multicentre cohort study

Piekos, Samantha N.; Roper, Ryan; Hwang, Yeon Mi; Sorensen, Tanya; Price, Nathan D.; Hood, Leroy; Hadlock, Jennifer

doi:10.1016/s2589-7500(21)00250-8

“…Preliminary surveillance results indicated that the Omicron VOC has a secondary attack rate of 10-13% and therefore factors that increase transmission, such as multi-occupancy housing and public-facing occupations, are important also for this variant. [22][23][24] Since socioeconomic deprivation is also a known independent risk factor for adverse pregnancy outcome, this could be a source of residual confounding in this study.…”

Section: Interpretation and Comparison With Related Studiesmentioning

confidence: 99%

Severity of maternal SARS-CoV-2 infection and perinatal outcomes during the Omicron variant dominant period: UK Obstetric Surveillance System national cohort study

Engjom

¹

,

Ramakrishnan

²

,

Vousden

³

et al. 2022

Preprint

3

0

1

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Objectives To describe the severity of maternal infection when the Omicron SARS-CoV-2 variant was dominant (15/12/21-14/01/22) and compare outcomes among groups with different vaccination status. Design Prospective cohort study Setting UK consultant-led maternity units Participants Pregnant women hospitalised with a positive SARS-CoV-2 PCR test up to 7 days prior to admission and/or during admission up to 2 days after giving birth. Main outcome measures Symptomatic or asymptomatic infection. Vaccination status. Severity of maternal infection (moderate or severe infection according to modified WHO criteria). Mode of birth and perinatal outcomes. Results Out of 1561 women admitted to hospital with SARS-CoV-2 infection, 449 (28.8%) were symptomatic. Among symptomatic women admitted, 86 (19.2%) had moderate to severe infection; 51 (11.4%) had pneumonia on imaging, 62 (14.3%) received respiratory support, and 19 (4.2%) were admitted to the intensive care unit (ICU). Three women died (0.7%). Vaccination status was known for 383 symptomatic women (85.3%) women; 249 (65.0%) were unvaccinated, 45 (11.7%) had received one vaccine dose, 76 (19.8%) had received two doses and 13 (3.4%) had received three doses. 59/249 (23.7%) unvaccinated women had moderate to severe infection, compared to 10/45 (22.2%) who had one dose, 9/76 (11.8%) who had two doses and 0/13 (0%) who had three doses. Among the 19 symptomatic women admitted to ICU, 14 (73.7%) were unvaccinated, 3 (15.8%) had received one dose, 1 (5.3%) had received two doses, 0 (0%) had received 3 doses and 1 (5.3%) had unknown vaccination status. Conclusion The risk of severe respiratory disease amongst unvaccinated pregnant women admitted with symptomatic SARS-CoV-2 infection during the Omicron dominance period was comparable to that observed during the period the wildtype variant was dominant. Most women with severe disease were unvaccinated. Vaccine coverage among pregnant women admitted with SARS-CoV-2 was low compared to the overall pregnancy population and very low compared to the general population. Ongoing action to prioritise and advocate for vaccine uptake in pregnancy is essential. SUMMARY BOX What is already known on this topic In non-pregnant adults, growing evidence indicates a lower risk of severe respiratory disease with the Omicron SARS-CoV-2 Variant of Concern (VOC). Pregnant women admitted during the periods in which the Alpha and Delta VOC were dominant were at increased risk of moderate to severe SARS-CoV-2 infection compared to the period when the original wildtype infection was dominant. Most women admitted to hospital with symptomatic SARS-CoV-2 infection have been unvaccinated. What this study adds One in four women who had received no vaccine or a single dose had moderate to severe infection, compared with one in eight women who had received two doses and no women who had received three doses The proportional rate of moderate to severe infection in unvaccinated pregnant women during the Omicron dominance period is similar to the rate observed during the wildtype dominance period One in eight symptomatic admitted pregnant women needed respiratory support during the period when Omicron was dominant

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“…A retrospective multicenter study in United States concluded that acute COVID-19 severity was not correlated with gestational age at delivery whereas separate cohort study in United States reported significant increase in preterm delivery among critical group compared to severe group. [22, 26] Our study reported preterm delivery rate of 40.7% among pregnant women needing ICU/ ECMO/ ventilated/ death whereas Pierce-Williams reported preterm delivery rate of 27% among severe group and 88% among critical group. [22]…”

Section: Discussionmentioning

confidence: 80%

Neonatal and Maternal Outcome of COVID-19 positive women in Sri Lanka: Secondary Analysis using National COVID-19 Positive Pregnant Women Surveillance

Kumarasinghe

¹

,

Kasturiaratchi

²

,

Jayakody

³

et al. 2022

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Objectives This study aims to describe the population level data on neonatal and maternal outcomes of COVID-19 positive pregnant women of Sri Lanka by secondary analysis using National COVID-19 Positive Pregnant Women Surveillance. Design Secondary analysis of surveillance data from the National COVID-19 positive pregnant women surveillance, Sri Lanka. Data of all pregnant women whose maternal and neonatal outcomes were reported in National Surveillance from 1st March 2020 to 31st October 2021 were included in the study. Associated factors for maternal and neonatal outcomes, namely POA at delivery, mode of delivery, birthweight, immediate place of newborn care, congenital abnormalities, and condition of neonate at completion of one month were calculated using univariate and multivariate Odds ratios. Results Maternal COVID-19 infection reported preterm birth rate of 11.9%, LSCS rate of 54.5%, low birthweight rate16.5% and 8.3% of the newborns requiring intensive care. Neonatal mortality rate was 9 per 1000 live births. Pre-pregnancy overweight and obesity increased the risk of preterm delivery compared to pregnant women with normal BMI by 46.7% (AOR=1.467, CI=1.111-1.938, P=0.007). In contrast, the risk of preterm delivery reduced by 82.4% (AOR=0.176, CI=0.097-0.317, p<0.001) and presence of any type of congenital abnormalities in newborns by 72.4% among the COVID-19 positive women who required only inward treatment in comparison to women with severe COVID-19 infection requiring intensive care (AOR=0.276, CI=0.112-0.683, p=0.005). Conclusion Increased severity of maternal COVID-19 infection and pre-pregnancy overweight/ obesity were associated with many adverse pregnancy and neonatal outcomes. Therefore, close observation and aggressive management of COVID-19 among the pregnant women should be considered to reduce the risk of progressing to severe illness.

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“…The ongoing war and humanitarian crisis in Ukraine has affected the care of patients and the efficiency of healthcare systems in the area, including both Eastern and non-Eastern European countries. Given these scenarios, it becomes especially important to analyze available clinical data to aid in TB prognosis and guide optimal treatment decisions for each patient (Falzon et al, 2018;Gröschel et al, 2018;Lange et al, 2020;Lino Ferreira da Silva Barros et al, 2021;Olaru et al, 2016) The increasing availability of patient EHR comprising multi-modal data can enable precision and personalized medicine initiatives to better understand TB and other diseases (Piekos et al, 2022). We analyzed EHR data from over 5000 patients across 10 countries from the NIH NIAID TB portals.…”

Section: Discussionmentioning

confidence: 99%

Integrative analysis of clinical health records, imaging and pathogen genomics identifies personalized predictors of disease prognosis in tuberculosis

Sambarey

¹

,

Smith

²

,

Chung

³

et al. 2022

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Tuberculosis (TB) afflicts over 10 million people every year and its global burden is projected to increase dramatically due to multidrug-resistant TB (MDR-TB). The Covid-19 pandemic has resulted in reduced access to TB diagnosis and treatment, reversing decades of progress in disease management globally. It is thus crucial to analyze real-world multi-domain information from patient health records to determine personalized predictors of TB treatment outcome and drug resistance. We conduct a retrospective analysis on electronic health records of 5060 TB patients spanning 10 countries with high burden of MDR-TB including Ukraine, Moldova, Belarus and India available on the NIAID-TB portals database. We analyze over 200 features across multiple host and pathogen modalities representing patient social demographics, disease presentations as seen in cChest X rays and CT scans, and genomic records with drug susceptibility features of the pathogen strain from each patient. Our machine learning model, built with diverse data modalities outperforms models built using each modality alone in predicting treatment outcomes, with an accuracy of 81% and AUC of 0.768. We determine robust predictors across countries that are associated with unsuccessful treatmentclinical outcomes, and validate our predictions on new patient data from TB Portals. Our analysis of drug regimens and drug interactions suggests that synergistic drug combinations and those containing the drugs Bedaquiline, Levofloxacin, Clofazimine and Amoxicillin see more success in treating MDR and XDR TB. Features identified via chest imaging such as percentage of abnormal volume, size of lung cavitation and bronchial obstruction are associated significantly with pathogen genomic attributes of drug resistance. Increased disease severity was also observed in patients with lower BMI and with comorbidities. Our integrated multi-modal analysis thus revealed significant associations between radiological, microbiological, therapeutic, and demographic data modalities, providing a deeper understanding of personalized responses to aid in the clinical management of TB.

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The effect of maternal SARS-CoV-2 infection timing on birth outcomes: a retrospective multicentre cohort study

Cited by 104 publications

References 31 publications

Severity of maternal SARS-CoV-2 infection and perinatal outcomes during the Omicron variant dominant period: UK Obstetric Surveillance System national cohort study

Severity of maternal SARS-CoV-2 infection and perinatal outcomes during the Omicron variant dominant period: UK Obstetric Surveillance System national cohort study

Neonatal and Maternal Outcome of COVID-19 positive women in Sri Lanka: Secondary Analysis using National COVID-19 Positive Pregnant Women Surveillance

Integrative analysis of clinical health records, imaging and pathogen genomics identifies personalized predictors of disease prognosis in tuberculosis

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