Metagenomic profiling of placental tissue suggests DNA virus infection of the placenta is rare

It is widely recognized that pathogens can be transmitted across the placenta from mother to foetus. Recent re-evaluation of metagenomic studies indicates that the placenta has no unique microbiome of commensal bacteria. However, viral transmission across the placenta, including transmission of DNA viruses such as the human herpesviruses, is possible. A fuller understanding of which DNA virus sequence can be found in the placenta is required. We employed a metagenomic analysis to identify viral DNA sequences in placental metagenomes from full-term births (20 births), pre-term births (13 births), births from pregnancies associated with antenatal infections (12 births) or pre-term births with antenatal infections (three births). Our analysis found only a small number of DNA sequences corresponding to the genomes of human herpesviruses in four of the 48 metagenomes analysed. Therefore, our data suggest that DNA virus infection of the placenta is rare and support the concept that the placenta is largely free of pathogen infection.

Vaccination against COVID-19 during Pregnancy and Lactation : An Overview

Pandemic of SARS2- COVID 19 has caused disastrous impact globally in terms of sickness, deaths, and overburden on heath infrastructure, employment, economy and psychological health. All countries are affected, to greater or lesser degree; be it from developed, developing or under-developed region. Pregnancy has been identified as one of the risk factor for severe COVID 19 illness by CDC. About two-thirds of women who test positive for COVID 19 have no symptoms. But the data suggest that symptomatic pregnant patient with COVID 19 are at increased risk of more severe illness as well as have increased risk for ICU admission, ventilator support and deaths in comparison to their symptomatic non-pregnant peers Pregnant patients with co-morbidities such as obesity and diabetes, hypertension, heart disease and asthma are further at higher risk of getting serious illness .Pregnant woman’s Age above 35 years and pregnancy above 28 weeks makes women more at risk of severe COVID illness. Stillbirths and pre-term births are twice high in pregnant women with COVID -19 sickness as compared to pregnant women without COVID-19 infection. Ethnicity has also been found to affect the severity of COVID 19 illness. It has been found that Black and Hispanic pregnant women had disproportionately higher rates of COVID-19 infection and death Further risk of ICU admission were higher in pregnant Asian, and Native Hawaiian /Pacific Islander women.

COVID-19 in women with rheumatic disease who are pregnant: Data from the COVID-19 Global Rheumatology Alliance

Objective To describe coronavirus disease-2019 (COVID-19) and pregnancy outcomes in patients with rheumatic disease who were pregnant at the time of infection. Methods Since March 2020 the COVID-19 Global Rheumatology Alliance (GRA) has collected cases of patients with rheumatic disease with COVID-19. We report details of pregnant women at the time of COVID-19 infection, including obstetric details separately ascertained from providers. Results We report on 39 patients, including 22 with obstetric detail available. The mean and median age was 33 years, range 24-45 years. Rheumatic disease diagnoses included: rheumatoid arthritis (n=9), systemic lupus erythematosus (n=9), psoriatic/other inflammatory arthritides (n=8) and anti-phospholipid antibody syndrome (n=6). Most had a term birth (16/22), with 3 pre-term births, one termination, one miscarriage and one woman yet to deliver at time of report. A quarter (n=10/39) of pregnant women were hospitalised following COVID-19 diagnosis. Two of 39 (5%) required supplemental oxygen (both hospitalised); no patient died. The majority did not receive specific medication treatment for their COVID-19 (n=32/39, 82%), seven patients received some combination of anti-malarials, colchicine, anti-IL-1beta, azithromycin, glucocorticoids, and lopinavir/ritonavir. Conclusion Women with rheumatic diseases who were pregnant at the time of COVID-19 had favourable outcomes. These data have limitations due to the small size and methodology, though they provide cautious optimism for pregnancy outcomes for women with rheumatic disease given the increased risk of poor outcomes that have been reported in other series of pregnant women with COVID-19.

437Comparison of stillbirth trends in Wales and Western Australia using pooled routinely collected health data

Background As there are variations in stillbirth rates and trends, even among high income countries, international comparisons can provide insights into how reductions in stillbirths can be achieved. We compared stillbirth rates and trends over time in Wales and Western Australia (WA). Methods We pooled population-based data of all births of at least 24 weeks’ gestation occurring between 1993-2015 in Wales and WA, divided into 6 time-periods. The stillbirth rate per 1,000 births was estimated for each cohort in each time-period. Multivariable Poisson regression analyses, were performed to evaluate the interaction between cohort and time-period. relative risk (RRs) and 95% Confidence Intervals (CIs) for each time-period and cohort were calculated. Results The overall stillbirth rate declined by 15.9% in Wales and 40.4% in WA. Using WA and 1993-1996 as the reference group, the adjusted RRs for stillbirths at 39-41 weeks’ gestation in the most recent study period (2013-15) were 0.85 (95% CI 0.64 to 1.13) in Wales and 0.51 (95% CI 0.36 to 0.73) in WA. Conclusions The stillbirth rate disparities between Wales and WA have widened in the last two decades (especially among term births). Some of these differences may be partially explained by maternal lifestyle behaviours such as smoking, but we had insufficient population-level data to investigate their contribution. Key messages The stillbirth rate was persistently higher in Wales than WA from 1993 to 2015, with widening disparities after adjustment for important risk factors.

Uterine fibroids and risk of preterm birth by clinical subtypes: a prospective cohort study

Background Fibroids are present in approximately one in ten pregnancies and are inconsistently linked with preterm birth. We sought to determine the association between fibroids and preterm birth in a prospective cohort with standardized research ultrasounds for characterizing fibroids in early pregnancy while accounting for the clinical paths that precede preterm birth. Methods Participants who were pregnant or planning a pregnancy were recruited from communities in three states between 2000 and 2012. Members of this prospective cohort had a research ultrasound in the first trimester to establish pregnancy dating and to record detailed information about the presence, size, number, and location of fibroids. Baseline information from time of enrollment and a detailed first trimester interview contributed key information about candidate confounders. Birth outcomes, including clinical classification of type of preterm birth (preterm labor, preterm premature rupture of membranes, and medically indicated preterm birth) were cross-validated from participant report, labor and delivery records, and birth certificate data. Results Among 4,622 women with singleton pregnancies, 475 had at least one fibroid (10.3%) and 352 pregnancies resulted in preterm birth (7.6%). Prevalence of fibroids was similar for women with preterm and term births (10.2% vs. 10.3%). Fibroids were not associated with increased risk of preterm birth after taking into account confounding (risk ratio adjusted for race/ethnicity and maternal age, 0.88; 95% confidence interval, 0.62–1.24) nor any clinical subtype of preterm birth. No fibroid characteristic or combination of characteristics was associated with risk. Conclusions If fibroids increase risk of preterm birth, the effect is substantially smaller than previous estimates. Given lack of effect in a large population of women from the general population, rather than higher risk academic tertiary populations previously most studied, we encourage a reconsideration of the clinical impression that presence of fibroids is a major risk factor for preterm birth.

A Nationwide Study of the Prevalence and Initial Management of Atypical Genitalia in the Newborn in Scotland

Provision of optimum healthcare for infants with atypical genitalia requires a clear understanding of the occurrence of this condition. The objective of this study was to determine the prevalence of atypical genitalia and its initial management. A prospective, electronic survey of clinicians within managed clinical networks in Scotland was undertaken between 2013 and 2019. Notification from clinicians was sought for term neonates requiring specialist input for atypical genitalia. Additional information was also sought from the 4 regional genetics laboratories that provided details for neonates who had an urgent karyotype performed for atypical genitalia or sex determination. In total, the study identified 171 term infants who required some investigation for atypical genitalia in the neonatal period, providing a birth prevalence of 1:1,881 term births. Of the 171 infants, 97 (57%) had specialist input over the first 3 months of life, providing a birth prevalence of 1:3,318 term births that received specialist input for atypical genitalia. A total of 92 of these 97 cases had complete 3-month follow-up data, 62 (67%) presented within 24 h of birth, and age at presentation ranged from birth to 28 days. Age at sex assignment ranged from birth to 14 days, and in 63 cases (68%), sex assignment occurred at birth. Thus, the birth prevalence of a case of atypical genitalia where sex assignment was reported to be delayed beyond birth was estimated at 1:11,097 births. In 1 case sex was re-assigned at 3 months. Atypical genitalia requiring specialist input within the first month of life are rare in term newborns, and in only a third of these cases, sex assignment is delayed beyond birth. This study provides new clinical benchmarks for comparing and improving the delivery of care in centres that manage these conditions.