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A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70% and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother–neonate separation from birth is associated with late SARS-CoV-2 infection (OR 4.94 (95% CI: 1.98–13.08), p  = 0.0002; adjusted OR 6.6 (95% CI: 2.6–16), p  < 0.0001), while breastfeeding is not (OR 0.35 (95% CI: 0.09–1.18), p  = 0.10; adjusted OR 2.2 (95% CI: 0.7–6.5), p  = 0.148). Our findings add to the literature on neonatal SARS-CoV-2 infections. There are a growing number of reports of neonatal SARS-CoV-2 infections. Here, De Luca and colleagues systematically analyse 176 published cases to better understand the route of transmission, as well as the clinical features and outcomes of neonatal COVID-19.

SARS-CoV-2 outbreak is the first pandemic of the century. SARS-CoV-2 infection is transmitted through droplets; other transmission routes are hypothesized but not confirmed. So far, it is unclear whether and how SARS-CoV-2 can be transmitted from the mother to the fetus. We demonstrate the transplacental transmission of SARS-CoV-2 in a neonate born to a mother infected in the last trimester and presenting with neurological compromise. The transmission is confirmed by comprehensive virological and pathological investigations. In detail, SARS-CoV-2 causes: (1) maternal viremia, (2) placental infection demonstrated by immunohistochemistry and very high viral load; placental inflammation, as shown by histological examination and immunohistochemistry, and (3) neonatal viremia following placental infection. The neonate is studied clinically, through imaging, and followed up. The neonate presented with neurological manifestations, similar to those described in adult patients. Congenital infection of SARS-CoV-2 has been described, but the transmission routes remain unclear. Here, the authors report evidence of transplacental transmission of SARS-CoV-2 in a neonate born to a mother infected in the last trimester and presenting with neurological compromise.

Pregnant women are at increased risk for COVID-19, and COVID-19 vaccine is the most promising solution to overcome the current pandemic. This study was conducted to evaluate pregnant women's perceptions and acceptance of COVID-19 vaccination. A cross-sectional study was conducted from February 18 to April 5 2021. An anonymous survey was distributed in 7 French obstetrics departments to all pregnant women before a prenatal visit. All pregnant women attending a follow-up consultation were asked to participate in the study. An anonymous web survey was available through a QR code and participants were asked whether or not they would agree to be vaccinated against SARS-CoV-2, and why. The questionnaire included questions on the patients' demographics and their knowledge of COVID-19 vaccines. Of the 664 pregnant women who completed the questionnaire, 29.5% (95% CI 27.7; 31.3) indicated they would agree to be vaccinated against COVID-19. The main reason for not agreeing was being more afraid of potential side effects of the SARS-CoV-2 vaccine on the fetus than of COVID-19. Factors influencing acceptance of vaccination were: being slightly older, multiparity, having discussed it with a caregiver and acceptance of the influenza vaccine. Nearly one-third of pregnant women in this population would be willing to be vaccinated. In addition to studies establishing fetal safety, public health agencies and healthcare professionals should provide accurate information about the safety of COVID-19 vaccines.

To fight the COVID-19 pandemic, lockdown has been decreed in many countries worldwide. The impact of pregnancy as a severity risk factor is still debated, but strict lockdown measures have been recommended for pregnant women. To evaluate the impact of the COVID-19 pandemic and lockdown on the seroprevalence and circulation of SARS-CoV-2 in a maternity ward in an area that has been significantly affected by the virus. Prospective study at the Antoine Béclère Hospital maternity ward (Paris area, France) from May 4 (one week before the end of lockdown) to May 31, 2020 (three weeks after the end of lockdown). All patients admitted to the delivery room during this period were offered a SARS-CoV-2 serology test as well concomitant SARS-CoV-2 RT-PCR on one nasopharyngeal sample. A total of 249 women were included. Seroprevalence of SARS-CoV-2 was 8%. The RT-PCR positive rate was 0.5%. 47.4% of the SARS-CoV-2-IgG-positive pregnant women never experienced any symptoms. A history of symptoms during the epidemic, such as fever (15.8%), myalgia (36.8%) and anosmia (31.6%), was suggestive of previous infection. Three weeks after the end of French lockdown, SARS-CoV-2 infections were scarce in our region. A very high proportion of SARS-CoV-2-IgG-negative pregnant women, which is comparable to that of the general population, must be taken into consideration in the event of a resurgence of the pandemic. The traces of a past active circulation of the virus in this fragile population during the spring wave should encourage public health authorities to take specific measures for this independent at-risk group, in order to reduce viral circulation in pregnant patients.

We conducted an international multicenter retrospective cohort study, PregOuTCOV, to examine the effect of gestational age at time of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on obstetric and neonatal outcomes. We included all singleton pregnancies with a live fetus at 10 weeks' gestation in which pregnancy outcomes were known. The exposed group consisted of patients infected with SARS-CoV-2, whereas the unexposed group consisted of all remaining patients during the same period. Primary outcomes were defined as composite adverse obstetric outcomes and composite adverse neonatal outcomes. Of 10,925 pregnant women, 393 (3.60%) were infected with SARS-CoV-2 (exposed group). After matching for possible confounders, we identified statistically significant increases in the exposed group of composite adverse obstetric outcomes at >20 weeks' gestation and of composite adverse neonatal outcomes at >26 weeks' gestation (p<0.001). Vaccination programs should target women early in pregnancy or before conception, if possible.

Background The prevalence of obesity in pregnancy is increasing worldwide, and it is associated with significant morbidity during labour and delivery. A benefit of increased doses of infused oxytocin during labour in obese women has been suggested by retrospective or underpowered studies. Thus, we aimed in a randomized double-blind controlled study at evaluating whether an increased oxytocin dose (compared to a standard dose) can reduce the rate of caesarean section without increasing maternal or neonatal morbidity. Methods PROXYMA is a French national multicentre, randomized, double-blind, controlled trial conducted in 14 maternity units. Adult primiparous obese women (body mass index ≥ 30 kg/m 2 ) with singleton pregnancy, spontaneous or induced onset of labour, cephalic presentation and term, ≥ 37 weeks of gestation, will be included after informed consent. Exclusion criteria are medical contra-indication for oxytocin or hypersensitivity, previous coagulation disorders, foetal growth restriction (inferior to 5th percentile), foetal major malformation or heart rate abnormalities before use of oxytocin (at the time of inclusion), scarred uterus of gynaecological origin, planned caesarean section before labour, or severe renal failure. Patients will be randomized in a 1:1 ratio and receive either high-dose (experimental group) or standard-dose (control group) oxytocin from prescription until delivery, with increments at least every 20 min, and oxytocin will be stopped instantly at birth. The inclusion of the patient and randomization of the oxytocin dose to be administered will take place at the time of the oxytocin prescription. An “out-of-protocol” healthcare professional (midwife / nurse) will be in charge of the preparation of the treatment, in order to ensure the double-blind design. The primary outcome will be the caesarean section rate in each group. Secondary outcomes include the comparison of maternal, foetal and neonatal-related complications during labour and birth. We aim at including 882 women based on a reduction in caesarean section rate of 7% in the experimental group, with a power of 80% and an alpha risk of 5%. Discussion Comparing two different oxytocin doses will provide clinicians with better knowledge of labour management in obese primiparous women to reduce the number of caesarean sections and associated morbidity. Trial registration Clinical Trials NCT04760496, registered on 18th february 2021. Project code number APHP200003 / EUDRACT No. : 2020-002640-23. Protocol Version N° 6.0 of 03/09/2024.

Prenatal care providers will play an important role in the acceptance of SARS-Cov-2 vaccination for pregnant women. To determine the perceptions of French prenatal care providers: midwives, general practitioners (GPs) and obstetricians and gynaecologists (Ob-Gyn) regarding SARS-CoV-2 vaccination during pregnancy. An anonymous online survey was sent to members of French professional societies representing prenatal practitioners. The participants were asked to answer questions on their characteristics and give their opinions of the SARS-CoV-2 vaccine for themselves and women who are pregnant or willing to become pregnant. Access to the survey was opened from January 11th, 2021, to March 1st, 2021. A total of 1,416 responses were collected from 749 Ob-Gyn, 598 midwives and 69 GPs. Most respondents (86.7% overall, 90.4% for Ob-GYN, 81.1% for GPs and 80.1% for midwives) agreed to receive the SARS-CoV-2 vaccine. Vaccination against SARS-CoV-2 would be offered to pregnant women by 49.4% 95%CI [48.1-50.8] of the participants. Midwives were less likely to recommend vaccination than GP and Ob-Gyn (37.5%, 50.7% and 58.8%, respectively). The multinomial logistic regression revealed that being an obstetrician, working in a group, usually offering a flu vaccine and wanting to be vaccinated against SARS-CoV-2 were positively associated with considering pregnant women for SARS-CoV-2 vaccination. Most French prenatal healthcare providers are favourable towards vaccinating pregnant women, but a large minority express reservation. More evidence on safety and involvement by professional organisations will be important to encourage the access of pregnant women to vaccination against SARS-CoV-2.

Fix data are available on the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a retrospective study of 100 pregnant women with SARS-CoV-2 infection in 4 obstetric units in the Paris metropolitan area of France during March 12-April 13, 2020. Among patients, 52 (52%) were hospitalized, 10 (10%) in intensive care units (ICUs). Women with higher body mass indexes (BMIs; median 30.7 kg/m ) were more likely to be hospitalized in ICUs than other women (median BMI 26.2 kg/m ). Women hospitalized in ICUs had lower lymphocyte count at diagnosis (median 0.77 × 10 cells/L) than women not hospitalized in ICUs (median lymphocyte count 1.15 × 10 cells/L). All women requiring oxygen >5 L/min were intubated. Clinical and laboratory evaluation of SARS-CoV-2-positive pregnant women at the time of diagnosis can identify patients at risk for ICU hospitalization.

Introduction The aim of this study is to evaluate the benefit of cytogenetic testing by amniocentesis after an ultrasound diagnosis of isolated bilateral talipes equinovarus. Material and methods This multicenter observational retrospective study includes all prenatally diagnosed cases of isolated bilateral talipes equinovarus in five fetal medicine centers from 2012 through 2021. Ultrasound data, amniocentesis results, biochemical analyses of amniotic fluid and parental blood samples to test neuromuscular diseases, pregnancy outcomes, and postnatal outcomes were collected for each patient. Results In all, 214 fetuses with isolated bilateral talipes equinovarus were analyzed. A first‐degree family history of talipes equinovarus existed in 9.8% (21/214) of our cohort. Amniocentesis was proposed to 86.0% (184/214) and performed in 70.1% (129/184) of cases. Of the 184 karyotypes performed, two (1.6%) were abnormal (one trisomy 21 and one triple X syndrome). Of the 103 microarrays performed, two (1.9%) revealed a pathogenic copy number variation (one with a de novo 18p deletion and one with a de novo 22q11.2 deletion) (DiGeorge syndrome). Neuromuscular diseases (spinal muscular amyotrophy, myasthenia gravis, and Steinert disease) were tested for in 56 fetuses (27.6%); all were negative. Overall, 97.6% (165/169) of fetuses were live‐born, and the diagnosis of isolated bilateral talipes equinovarus was confirmed for 98.6% (139/141). Three medical terminations of pregnancy were performed (for the fetuses diagnosed with Down syndrome, DiGeorge syndrome, and the 18p deletion). Telephone calls (at a mean follow‐up age of 4.5 years) were made to all parents to collect medium‐term and long‐term follow‐up information, and 70 (33.0%) families were successfully contacted. Two reported a rare genetic disease diagnosed postnatally (one primary microcephaly and one infantile glycine encephalopathy). Parents did not report any noticeably abnormal psychomotor development among the other children during this data collection. Conclusions Despite the low rate of pathogenic chromosomal abnormalities diagnosed prenatally after this ultrasound diagnosis, the risk of chromosomal aberration exceeds the risks of amniocentesis. These data may be helpful in prenatal counseling situations. This study confirms the need to offer amniocentesis for isolated bilateral talipes equinovarus and suggests that molecular genetic tests such as gene panels or whole exome sequencing may increase the diagnostic yield in fetuses with this condition.

Introduction In the absence of prenatal etiology explaining small for gestational age (SGA), a blood workup may be performed postpartum to look for maternal thrombophilia if a newborn is confirmed to be growth‐restricted at birth. The literature regarding thrombophilia factors and fetal growth restriction is discordant. The main objective was to assess the prevalence and type of maternal thrombophilia among women delivering newborns of birthweight below the 3rd percentile and undergoing a postpartum thrombophilia workup and placental analysis. Material and Methods This was a single‐center retrospective observational cohort study in a tertiary care French maternity. The study population included all women delivering a liveborn infant with severe SGA, defined as a birthweight below the 3rd percentile according to French charts between January 2014 and December 2018. Data from thrombophilia workups (antiphospholipid antibodies, protein C assay, protein S assay, antithrombin assay, factor V Leiden mutation, and factor II G 20210A mutation search) were collected from medical records. Placental pathology analysis, if available, was also collected. The primary endpoint was the prevalence of positive expanded thrombophilia workup (inherited or acquired). Results A total of 733 patients were included in our study, 401 of whom (54.7%) underwent a postpartum thrombophilia workup. The overall prevalence of hereditary thrombophilia was 6.7%, 95% confidence interval (4.3 to 9.2) and of acquired thrombophilia was 2.0%, 95% confidence interval (0.6 to 3.4). Among hereditary anomalies, heterozygous factor V mutation and heterozygous factor II mutation were the most frequently observed, respectively, 4% and 1.7%. Concerning the presence of antiphospholipid antibodies, triple positivity was present in one patient (0.2%). The presence of a single antiphospholipid antibody was more frequently observed in 3 patients (0.7%). Conclusions Among patients with a severe SGA infant and postpartum investigation of maternal thrombophilia, an extensive workup of postpartum thrombophilia contributed to a low proportion of positive findings. This suggests that the prescription of such a workup should be targeted, based on personal and family medical history. In fact, testing for inherited thrombophilia should be reserved for patients with a personal or family history of thrombosis. Testing for antiphospholipid antibodies should follow ACR/EULAR criteria.