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In response to the COVID-19 pandemic, health systems quickly implemented changes in care delivery with a goal of balancing patient-focused obstetric care with the need to protect pregnant persons and health care providers from infection. Yet, there is no consensus within the scientific community on the impact these measures have on obstetric outcomes in vulnerable populations. We aimed to assess the impact of the COVID-19 pandemic on rates of obstetric procedures and severe maternal morbidity (SMM) among births at an urban safety net institution. We used an interrupted time series design to calculate risk ratios (RRs) and 95% confidence intervals (CIs) comparing monthly rates of labor induction, cesarean births (overall and among nulliparous, term, singleton, vertex births), operative vaginal births, and SMM among births occurring at a public hospital before (March 1, 2016, to February 29, 2020) and during (March 1, 2020, to May 31, 2021) the COVID-19 pandemic. There were 10,714 and 2,736 births in the prepandemic and postpandemic periods, respectively. Overall, the rates of obstetric interventions and SMM were constant over the two time periods. There were no significant differences in rates of labor induction (42% during prepandemic period vs. 45% during pandemic period; RR, 1.12; 95% CI, 0.93–1.34), operative vaginal births (5% vs. 6%; RR, 1.24; 95% CI, 0.88–1.76), cesarean births (28% vs. 33%; RR, 1.10; 95% CI, 0.94–1.28), or nulliparous, term, singleton, vertex cesarean births (24% vs. 31%; RR, 1.27; 95% CI, 0.92–1.74). Rates of SMM (7% vs. 8%; RR, 1.19; 95% CI, 0.86–1.65) were also unchanged. Our findings indicate that the rapid implementation of measures to reduce viral transmission in the labor and delivery setting did not materially affect routine clinical management or rates of serious maternal complications. [ABSTRACT FROM AUTHOR]

An editorial is presented which expresses the views on the burden of respiratory syncytial virus (RSV) on infant health, focusing on recent developments in RSV prevention, including the approval of maternal RSV vaccines .Topics include the substantial burden of RSV-associated hospitalizations and deaths in infants, the efficacy of maternal RSV vaccines in preventing severe RSV-associated disease in young infants, and the potential association between maternal RSV vaccination and preterm birth.

The article discusses about protecting pregnant people and babies from the health effects of climate change. It mentions the toxic gases, volatile organic compounds, and particulate matter's exposure have been associated with an increased risk of gestational hypertension and gestational diabetes, conditions that can carry long-term health risks for the mother.

Vaccines administered to women during pregnancy can provide protection against serious infectious diseases for the mother, for the newborn, or both. Maternal immunization boosts the concentration of maternal antibodies that can be transferred across the placenta to directly protect infants too young to be immunized. In addition, indirect protection through prevention of maternal infection and through breast milk antibodies can be achieved through maternal immunization. In general, inactivated vaccines are considered safe for pregnant women and their fetuses, whereas live vaccines are avoided owing to the theoretical potential risk to the fetus. However, the risks and benefits of vaccination must be carefully weighed and whenever possible, protection to the mother and her infant should be prioritized. Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines are routinely recommended for all pregnant women in the United States. Seasonal inactivated influenza vaccine is recommended for all pregnant women in any trimester of pregnancy, mainly to protect the mother, but there is growing evidence that infants benefit from passive antibody protection against influenza complications. The Tdap vaccine is recommended during the third trimester of each pregnancy to provide optimal protection to infants who are at particularly high risk of pertussis complications and mortality in the first 3 months of life. The effects of maternal immunization on the prevention of maternal and infant disease have been demonstrated in observational and prospective studies of influenza and pertussis disease in the United States and worldwide. Maternal immunization has the potential to improve the health of mothers and young infants and therefore, other diseases of relevance during this period are now targets of active research and vaccine development, including group B streptococcus and respiratory syncytial virus. Similarly, several vaccines can be administered during pregnancy in special circumstances, when maternal health, travel, or other special situations arise. This article reviews the current recommendations for vaccination of women during pregnancy. [ABSTRACT FROM AUTHOR]

The 2009 H1N1 pandemic demonstrated the severe effects of influenza illness on pregnant women. This experience stimulated efforts to improve influenza vaccination coverage among pregnant women and resulted in a substantial increase in coverage from less than 30% before 2009 to more than 50% a few years later. As memories fade of the pandemic year, influenza vaccination coverage has stagnated at around 50%, despite considerable information becoming available on strategies to improve vaccination coverage during pregnancy. The American College of Obstetricians and Gynecologists, through its expert work groups, Committee Opinions, and other outreach efforts, has provided strong support for clinicians to implement these strategies into their practices. Influenza vaccination is the best way to safeguard pregnant women and their infants up to 6 months of age from the adverse outcomes associated with influenza. It is imperative for the obstetric community to redouble its efforts to implement strategies proven to work to improve vaccination coverage and to identify and test new strategies to increase the number of pregnant women and their infants protected from influenza. [ABSTRACT FROM AUTHOR]

As health care systems struggle to maintain adequate supplies of personal protective equipment, there is confusion and anxiety among obstetricians and others about how to best protect themselves, their coworkers, and their patients. Although use of personal protective equipment is a critical strategy to protect health care personnel from coronavirus disease 2019 (COVID-19), other strategies also need to be implemented on labor and delivery units to reduce the risk of health care-associated transmission, including screening of all pregnant women who present for care (case identification), placing a mask on and rapidly isolating ill pregnant women, and minimizing the number of personnel who enter the room of an ill patient (physical distancing). Although the mechanism of transmission of COVID-19 is not known with certainty, current evidence suggests that COVID-19 is transmitted primarily through respiratory droplets. Therefore, strict adherence to hand hygiene and consistent use of recommended personal protective equipment are cornerstones for reducing transmission. In addition, it is critical that health care professionals receive training on and practice correct donning (putting on) and doffing (removing) of personal protective equipment and avoid touching their faces as well as their facial protection to minimize self-contamination. [ABSTRACT FROM AUTHOR]

As the world confronts coronavirus disease 2019 (COVID-19), an illness caused by yet another emerging pathogen (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), obstetric care providers are asking what this means for pregnant women. The global spread has been swift, and many key questions remain. The case-fatality rate for persons cared for in the United States and whether asymptomatic persons transmit the virus are examples of questions that need to be answered to inform public health control measures. There are also unanswered questions specific to pregnant women, such as whether pregnant women are more severely affected and whether intrauterine transmission occurs. Although guidelines for pregnant women from the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention have been rapidly developed based on the best available evidence, additional information is critically needed to inform key decisions, such as whether pregnant health care workers should receive special consideration, whether to temporarily separate infected mothers and their newborns, and whether it is safe for infected women to breastfeed. Some current recommendations are well supported, based largely on what we know from seasonal influenza: patients should avoid contact with ill persons, avoid touching their face, cover coughs and sneezes, wash hands frequently, disinfect contaminated surfaces, and stay home when sick. Prenatal clinics should ensure all pregnant women and their visitors are screened for fever and respiratory symptoms, and symptomatic women should be isolated from well women and required to wear a mask. As the situation with COVID-19 rapidly unfolds, it is critical that obstetricians keep up to date. [ABSTRACT FROM AUTHOR]

Objective Postpartum preeclampsia (PE), defined as de novo PE that develops at least 48 hours following delivery, can be particularly dangerous as many patients are already discharged at that point. The goal of our study was to identify risk factors uniquely associated with the development of late postpartum preeclampsia (PPPE). Study Design In a retrospective cohort study of deliveries between July 1, 2016 and June 30, 2018 at a safety-net hospital in Atlanta, Georgia, we used multinomial logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between demographic, medical, and obstetric factors and development of PE, categorized as a three-level outcome: no PE, antepartum/intrapartum preeclampsia (APE) (diagnosed prior to or < 48 hours of delivery), and late PPPE (diagnosed ≥ 48-hour postpartum). Results Among 3,681 deliveries, women were primarily of ages 20 to 35 years (76.4%), identified as non-Hispanic Black (68.5%), and covered by public health insurance (88.6%). PE was diagnosed prior to delivery or within 48-hour postpartum in 12% (n = 477) of the study population, and 1.5% (57) developed PE greater than 48-hour postpartum. In the adjusted models, maternal age ≥ 35, race/ethnicity, nulliparity, a diagnosis of pregestational or gestational diabetes, and chronic hypertension were associated with increased odds of APE only, while maternal obesity (OR: 1.9; 95% CI: 1.0–3.5) and gestational hypertension (OR: 2.7; 95% CI: 1.5–4.8) were uniquely associated with PPPE. Multifetal gestations and cesarean delivery predicted both PPPE and APE; however, the association was stronger for PPPE. Conclusion Patients with obesity, gestational hypertension, multifetal gestations, or cesarean delivery may benefit from additional follow-up in the early postpartum period to detect PPPE. Key Points Late postpartum preeclampsia may go undetected, particularly in low-income patients. In a delivery cohort in Georgia, 1.5% of patients developed late postpartum preeclampsia. Maternal obesity and gestational hypertension were strongly associated only with late postpartum preeclampsia. [ABSTRACT FROM AUTHOR]

Although there is much discussion about population health in academic medical centers, managed care organizations, and a variety of disciplines, it is not always clear what this term means. Population health describes the health outcomes of a group of individuals including health disparities, social determinants of health, and policies and interventions that link health outcomes with and patterns of health determinants. We describe some of the successes and challenges to addressing reproductive health issues in Georgia from a population health perspective, focusing on efforts to reduce teenage pregnancy and improve maternal health. [ABSTRACT FROM AUTHOR]

The authors reflect on the safety and efficacy of coronavirus disease 2019 (Covid-19) vaccination during pregnancy, including the potential protection of the vaccine against infant infection. Other topics include the multicenter study which analyzed the effectiveness of maternal vaccination against the hospitalization of infants younger than six months of age due to Covid-19 infections, and the effectiveness of the vaccine after the second dose was given.

Many of the survivors of the 2014-2015 epidemic of Ebola virus disease (EVD) in western Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women's pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors. [ABSTRACT FROM AUTHOR]

The Zika virus has spread rapidly in the Americas since its first identification in Brazil in early 2015. Prenatal Zika virus infection has been linked to adverse pregnancy and birth outcomes, most notably microcephaly and other serious brain anomalies. To determine whether Zika virus infection during pregnancy causes these adverse outcomes, we evaluated available data using criteria that have been proposed for the assessment of potential teratogens. On the basis of this review, we conclude that a causal relationship exists between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Evidence that was used to support this causal relationship included Zika virus infection at times during prenatal development that were consistent with the defects observed; a specific, rare phenotype involving microcephaly and associated brain anomalies in fetuses or infants with presumed or confirmed congenital Zika virus infection; and data that strongly support biologic plausibility, including the identification of Zika virus in the brain tissue of affected fetuses and infants. Given the recognition of this causal relationship, we need to intensify our efforts toward the prevention of adverse outcomes caused by congenital Zika virus infection. However, many questions that are critical to our prevention efforts remain, including the spectrum of defects caused by prenatal Zika virus infection, the degree of relative and absolute risks of adverse outcomes among fetuses whose mothers were infected at different times during pregnancy, and factors that might affect a woman's risk of adverse pregnancy or birth outcomes. Addressing these questions will improve our ability to reduce the burden of the effects of Zika virus infection during pregnancy. [ABSTRACT FROM AUTHOR]

Recent identification of local mosquito-borne transmission of malaria in Florida, Texas, and Maryland and increasing travel to malaria-endemic countries raise the likelihood that U.S. obstetricians might encounter a pregnant patient with malaria. Pregnancy increases the risk of becoming infected with malaria and of developing severe disease. Malaria during pregnancy also increases the risk of adverse pregnancy outcomes, including low birth weight, pregnancy loss, and preterm birth; thus, prevention and prompt diagnosis and treatment are essential. Diagnosis can be challenging during pregnancy among persons with partial immunity because placental sequestration of parasite-infected red blood cells can result in lower parasite levels in peripheral blood. Treatment for uncomplicated malaria depends on the expected resistance pattern, which is determined by the specific Plasmodium species identified and where infection was acquired. For severe disease, parenteral artesunate treatment needs to be initiated immediately. Given the dire consequences of malaria in pregnancy, prevention is crucial. For persons born and raised in endemic areas, interventions include use of insecticide-treated bed nets, intermittent preventive treatment, and prompt diagnosis and treatment of illness. U.S. pregnant persons should avoid travel to endemic countries; for unavoidable travel, pregnant travelers should receive chemoprophylaxis and avoid mosquito bites. Although the risk is low to U.S. pregnant persons who are not traveling internationally, avoiding mosquito bites is important, especially for pregnant persons residing in or visiting areas with recent local mosquito-borne transmission. [ABSTRACT FROM AUTHOR]

This month we focus on current research in maternal immunization. Dr. Jamieson discusses four recent publications, which are concluded with a "bottom line" that is a take-home message. A completed reference for each can be found in on this page along with direct links to abstracts. [ABSTRACT FROM AUTHOR]

This JAMA Insights in the Women's Health series reviews commonly used prescription and over-the-counter products during pregnancy, including safety data, available resources for guidance, and the need for clinicians to counsel patients before pregnancy, when possible, about medication use. [ABSTRACT FROM AUTHOR]

From January 1 to April 3, 2015, 159 people from 18 states and the District of Columbia were reported as having measles. Most cases are part of an outbreak linked to a California amusement park. Because measles was eliminated in the United States in 2000, most U.S. clinicians are unfamiliar with the condition. We reviewed information on the current outbreak, measles manifestations, diagnostic methods, treatment, and infection-control recommendations. To identify information on measles and pregnancy, we reviewed reports with 20 or more measles cases during pregnancy that included data on effects on pregnant women or pregnancy outcomes. These reports were identified through MEDLINE from inception through February 2015 using the following strategy: (((pregnan*) AND measles) AND English[Language]) NOT review[Publication Type]. Reference lists also were reviewed to identify additional articles. Pregnant women infected with measles are more likely to be hospitalized, develop pneumonia, and die than nonpregnant women. Adverse pregnancy outcomes, including pregnancy loss, preterm birth, and low birth weight, are associated with maternal measles; however, the risk of congenital defects does not appear to be increased. No antiviral therapy is available; treatment is supportive. Early identification of possible cases is needed so that appropriate infection control can be instituted promptly. The recent measles outbreak highlights the role that obstetric health care providers play in vaccine-preventable illnesses; obstetrician-gynecologists should ensure that patients are up to date on all vaccines, including measles-containing vaccines, and should recommend and ideally offer a measles-containing vaccine to women without evidence of measles immunity before or after pregnancy. [ABSTRACT FROM AUTHOR]

The article reports on U.S. government efforts in rapidly detecting and treating persons with Ebola virus disease as of March 2015. Topics discussed include the implementation of screening of travelers who are entering the U.S. from Guinea, Liberia, and Sierra Leone. Information is also presented on a tiered approach to U.S. hospital and health care facility preparedness.

West Africa is currently in the midst of the largest Ebola outbreak in history. Although there have been no Ebola virus disease cases identified in the United States, two U.S. health care workers with Ebola virus disease were medically evacuated from Liberia to the United States in early August 2014. The Centers for Disease Control and Prevention has been working closely with other U.S. government agencies and international and nongovernmental partners for several months to respond to this global crisis. Limited evidence suggests that pregnant women are at increased risk for severe illness and death when infected with Ebola virus, but there is no evidence to suggest that pregnant women are more susceptible to Ebola virus disease. In addition, pregnant women with Ebola virus disease appear to be at an increased risk for spontaneous abortion and pregnancy-associated hemorrhage. Neonates born to mothers with Ebola virus disease have not survived. Although it is very unlikely that obstetrician-gynecologists (ob-gyns) in the United States will diagnose or treat a patient with Ebola virus disease, it is important that all health care providers are prepared to evaluate and care for these patients. Specifically, U.S. health care providers, including ob-gyns, should ask patients about recent travel and should know the signs and symptoms of Ebola virus disease and what to do if assessing a patient with compatible illness. This article provides general background information on Ebola and specifically addresses what is known about Ebola virus disease in pregnancy and the implications for practicing ob-gyns in the United States. [ABSTRACT FROM AUTHOR]

The article discusses the importance of monitoring the safety and health outcomes of assisted reproductive technology (ART). It discusses the significant role of the States Monitoring ART Collaborative project in monitoring the outcomes and adverse consequences of ART. A table is presented that shows the number of infants and preterm infants and the societal economic burden associated with preterm births conceived through assisted reproductive technology in the U.S. in 2010.

This commentary discusses the interplay of pregnancy and SARS-CoV-2 infection and explains why COVID-19 vaccination efforts should not exclude pregnant women. [ABSTRACT FROM AUTHOR]

This JAMA Insights review summarizes the epidemiology of SARS-CoV-2 infection in pregnant and lactating women, its effects on perinatal outcomes, and compiles guidance from the CDC, FDA, and obstetrics-gynecology specialty organizations on the safety of coronavirus vaccines during pregnancy and while breastfeeding. [ABSTRACT FROM AUTHOR]

The article discusses research into contribution of fertility treatments to increasing multiple birth rates in the U.S. The study used birth records gathered from the U.S. Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). It reports proportion of multiple births which resulted from medically-assisted conception such as in vitro fertilization (IVF). The link between advanced maternal age during fertility treatments and multiple births is noted.

To summarize the literature regarding susceptibility of pregnant women to infectious diseases and severity of resulting disease, we conducted a review using a PubMed search and other strategies. Studies were included if they reported information on infection risk or disease outcome in pregnant women. In all, 1454 abstracts were reviewed, and a total of 85 studies were included. Data were extracted regarding number of cases in pregnant women, rates of infection, risk factors for disease severity or complications, and maternal outcomes. The evidence indicates that pregnancy is associated with increased severity of some infectious diseases, such as influenza, malaria, hepatitis E, and herpes simplex virus (HSV) infection (risk for dissemination/hepatitis); there is also some evidence for increased severity of measles and smallpox. Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy. [ABSTRACT FROM AUTHOR]

Individuals with severe maternal morbidity at delivery were 40–50% more likely to be readmitted in the year after delivery than individuals without severe maternal morbidity. OBJECTIVE: To conduct a cohort study to estimate risk for readmission through 1 year postpartum and the most common readmission diagnoses for individuals with and without severe maternal morbidity (SMM) at delivery. METHODS: Using national health care claims data from IBM MarketScan Commercial Research Databases (now known as Merative), we identified all delivery hospitalizations for continuously enrolled individuals 15–49 years of age that occurred between January 1, 2016, and December 31, 2018. Severe maternal morbidity at delivery was identified using diagnosis and procedure codes. Individuals were followed for 365 days after delivery discharge, and cumulative readmission rates were calculated for up to 42 days, up to 90 days, up to 180 days, and up to 365 days. We used multivariable generalized linear models to estimate adjusted relative risks (aRR), adjusted risk differences, and 95% CIs for the association between readmission and SMM at each of the timepoints. RESULTS: The study population included 459,872 deliveries; 5,146 (1.1%) individuals had SMM during the delivery hospitalization, and 11,603 (2.5%) were readmitted within 365 days. The cumulative incidence of readmission was higher in individuals with SMM than those without at all timepoints (within 42 days: 3.5% vs 1.2%, aRR 1.44, 95% CI 1.23–1.68; within 90 days: 4.1% vs 1.4%, aRR 1.46, 95% CI 1.26–1.69); within 180 days: 5.0% vs 1.8%, aRR 1.48, 95% CI 1.30–1.69; within 365 days: 6.4% vs 2.5%, aRR 1.44, 95% CI 1.28–1.61). Sepsis and hypertensive disorders were the most common reason for readmission within 42 and 365 days for individuals with SMM (35.2% and 25.8%, respectively). CONCLUSION: Severe maternal morbidity at delivery was associated with increased risk for readmission throughout the year after delivery, a finding that underscores the need for heightened awareness of risk for complications beyond the traditional 6-week postpartum period. [ABSTRACT FROM AUTHOR]

The article presents a study focusing on maternal and infant antiretroviral regimens to prevent postnatal HIV-1 transmission. It shows that in resource limited settings where no suitable alternative to breastfeeding is available, antiretroviral prophylaxis given to mothers or infants might decrease HIV transmission. It also showed that weaning at 6 months could increase the morbidity of infant. INSET: Panel: Research in context.

Abstract: Background: Vasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population. Study design: We conducted an analysis of data from male and female samples of the 2006–2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15–44 years. Results: Among married men, 13.1% reported vasectomies (95% confidence interval 10.4%–16.3%), compared to 21.1% (17.8%–24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization. Conclusions: Efforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits. [Copyright &y& Elsevier]

The article presents the data for the treatment and prevention of influenza pandemic in pregnant women, especially before, during and after the 2009 H1N1 outburst. The US Centers for Disease Control and Prevention (CDC) recognized the high risk associated with pregnancy and thus published guidelines for their treatment. The data demonstrates that the use of the influenza vaccination is the best way for the prevention of the pandemic in pregnant women and new born children.

The article discusses the negative effects of coinfection with human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV). Both viruses can cause chronic disease, cancer and death and are not eliminated with the use of current therapies. An overview of high HBV infection rates which also reflect a failure of maternal and child health programs is given. Coinfection with HIV causes higher levels of hepatitis B viremia that progresses to chronic hepatitis B.

Objective: This study examined a possible association of dietary exposure to polybrominated biphenyls (PBBs), a brominated flame retardant, and self-reported abnormal Pap test results and cervical dysplasia as a precursor to cervical cancer. Methods: Women in Michigan who ingested contaminated poultry, beef, and dairy products in the early 1970s were enrolled in a population-based cohort study in Michigan. Serum PBB and serum polychlorinated biphenyl (PCB) concentrations were measured. Reproductive history and health information, including Pap test results, were self-reported by participants. Results: Of the women, 23% (223 of 956) reported an abnormal Pap test. In unadjusted analyses, self-reporting an abnormal Pap test was associated with younger age, current smoking (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.19-2.17), and longer duration of lifetime use of oral contraceptives (≥10 years; HR 1.92, 95% CI 1.21-3.06). When adjusting for PCB exposure, age at the interview, and smoking history, there was a slightly elevated risk of self-reporting an abnormal Pap test among the highly exposed women compared to women with nondetectable PBB concentrations (PBB≥13 μg/L, HR 1.23, 95% CI 0.74-2.06); however, the CI was imprecise. When breastfeeding duration after the initial PBB measurement was taken into account, there was a reduced risk of self-reporting an abnormal Pap test among the highly exposed women who breastfed for ≥12 months (HR 0.41, 95% CI 0.06-3.03; referent group: women with nondetectable PBB concentrations who did not breastfeed). Conclusions: It remains important to evaluate the potential reproductive health consequences of this class of chemicals as well as other potential predictors of abnormal Pap tests. [ABSTRACT FROM AUTHOR]

The article presents a study on the accuracy of clinical diagnosis of bacterial vaginosis (BV) through human immunodeficiency virus (HIV) infection status. The research uses test statistics of 871 HIV-infected and 439 HIV-uninfected women to measure the agreement between Amsel criteria and Nugent scoring, in which sensitivity analysis was performed to assess the prevalence of the disease. The result shows that there is a lack of agreement between clinical and laboratory methods in BV diagnosis.

Objective: To evaluate associations between common vaginal infections and human papillomavirus (HPV).Study Design: Data from up to 15 visits on 756 HIV-infected women and 380 high-risk HIV-uninfected women enrolled in the HIV Epidemiology Research Study (HERS) were evaluated for associations of bacterial vaginosis, trichomoniasis, and vaginal Candida colonization with prevalent HPV, incident HPV, and clearance of HPV in multivariate analysis.Results: Bacterial vaginosis (BV) was associated with increased odds for prevalent (aOR = 1.14, 95% CI: 1.04, 1.26) and incident (aOR = 1.24, 95% CI: 1.04, 1.47) HPV and with delayed clearance of infection (aHR = 0.84, 95% CI: 0.72, 0.97). Whereas BV at the preceding or current visit was associated with incident HPV, in an alternate model for the outcome of incident BV, HPV at the current, but not preceding, visit was associated with incident BV.Conclusion: These findings underscore the importance of prevention and successful treatment of bacterial vaginosis. [ABSTRACT FROM AUTHOR]

The article discusses a study which assessed the factors that facilitate or halt influenza vaccination in pregnant women in Georgia and Rhode Island. The rates of seasonal influenza vaccination among pregnant women were estimated in 2006 and 2007. Study authors found that multiparous women are less likely to receive seasonal influenza vaccine compared to primiparous women. They noted that need to establish strategies to promote seasonal influenza vaccine among pregnant women, and the role of health care providers in enhancing influenza vaccination.

Abstract: Background: The Centers for Disease Control and Prevention (CDC) recently adapted global guidance on contraceptive use from the World Health Organization (WHO) to create the United States Medical Eligibility Criteria for Contraceptive Use (MEC). This guidance includes recommendations for use of specific contraceptive methods by people with certain characteristics or medical conditions. Study Design: CDC determined the need and scope for the adaptation, conducted 12 systematic reviews of the scientific evidence and convened a meeting of health professionals to discuss recommendations based on the evidence. Results: The vast majority of the US guidance is the same as the WHO guidance and addresses over 160 characteristics or medical conditions. Modifications were made to WHO recommendations for six medical conditions, and recommendations were developed for six new medical conditions. Conclusion: The US MEC is intended to serve as a source of clinical guidance for providers as they counsel clients about contraceptive method choices. [Copyright &y& Elsevier]

Pandemic Influenza: Special Considerations for Pregnant Women was a meeting convened by the Centers for Disease Control and Prevention in 2008 to obtain input from experts and key partners regarding clinical management of pregnant women and related public health actions to be taken during a pandemic. Meeting goals were to discuss issues specific to pregnant women, identify gaps in knowledge, and develop a public health approach for pregnant women in the event of a pandemic. The meeting focused on 4 main topics: prophylaxis and treatment with influenza antiviral and other medications, vaccine use, nonpharmaceutical interventions and health care planning, and communications. Participants reviewed the available evidence to guide action in each of these areas and identified areas of critical needs for future research. (Am J Public Health. 2009;99: S248-S254. doi:10.2105/AJPH.2008.152900) [ABSTRACT FROM AUTHOR]

The article focuses on a study which summarized cases of pandemic H1N1 influenza virus infection identified in pregnant women in the U.S. during the first month of the outbreak and deaths associated with this infection during the first two months of the outbreak. The U.S. Centers for Disease Control and Prevention (CDC), following initial reports of infection among pregnant women, has began collecting additional information on cases and deaths in this population with H1N1 as part of enhanced surveillance. The study revealed 34 confirmed or probable cases of H1N1 in pregnant women from 13 states between April 15 to May 18, 2009. With this findings, the study interpreted that pregnant women are at increased risk for complications from H1N1 infection.

The article presents a research on the influence of highly active antiretroviral therapy (HAART) on human papillomavirus (HPV) clearance and cervical cytology. HIV Patients involved in the HIV Epidemiology Study were analyzed semiannually from 1996 to 2000 and cervical pap tests were gathered for cytology. Results show that among women with preexisting abnormal cervical cytology, HAART was related to the enhanced HPV clearance but not with Pap test regression.

Objective: The purpose of this study was to describe the epidemiology of coinfection with hepatitis C virus (HCV) and HIV among a cohort of pregnant Thai women.Methods: Samples from 1771 pregnant women enrolled in three vertical transmission of HIV studies in Bangkok, Thailand, were tested for HCV.Results: Among HIV-infected pregnant women, HCV seroprevelance was 3.8% and the active HCV infection rate was 3.0%. Among HIV-uninfected pregnant women, 0.3% were HCV-infected. Intravenous drug use by the woman was the factor most strongly associated with HCV seropositivity. Among 48 infants tested for HCV who were born to HIV/HCV coinfected women, two infants were HCV infected for an HCV transmission rate of 4.2% (95% 0.51-14.25%).Conclusions: HCV seroprevalence and perinatal transmission rates were low among this Thai cohort of HIV-infected pregnant women. [ABSTRACT FROM AUTHOR]

Planning for a future influenza pandemic should include considerations specific to pregnant women. First, pregnant women are at increased risk for influenza-associated illness and death. The effects on the fetus of maternal influenza infection, associated fever, and agents used for prophylaxis and treatment should be taken into account. Pregnant women might be reluctant to comply with public health recommendations during a pandemic because of concerns regarding effects of vaccines or medications on the fetus. Guidelines regarding nonpharmaceutical interventions (e.g., voluntary quarantine) also might present special challenges because of conflicting recommendations about routine prenatal care and delivery. Finally, healthcare facilities need to develop plans to minimize exposure of pregnant women to ill persons, while ensuring that women receive necessary care. [ABSTRACT FROM AUTHOR]

The article examines risk factors for cesarean delivery among Puerto Rican women. Distribution of mothers' age, education, parity, level of prenatal care, pregnancy weight gain, medical risk factors, labor induction, labor or delivery complications and infant birth weight among births in Puerto Rico in 2002 were compared with births in the area in 1996.

Highly active antiretroviral therapy (HAART) has improved the outlook of HIV-infected patients, but it has several side effects, particularly when it is used during pregnancy. Prior to the advent of HAART, HIV-infected women were at increased risk for adverse pregnancy outcomes. This report describes hospital use among pregnant HIV-infected women in the United States in the HAART era and compares hospitalizations for select morbidities in pregnant HIV-infected vs. uninfected women. In 2003, the majority of HIV-infected pregnant women were hospitalized in urban hospitals in the South and had Medicare or Medicaid as the expected payer. HIV-infected pregnant women had longer hospitalizations and incurred higher hospitalization charges than uninfected women. In addition, HIV-infected pregnant women were more likely to be hospitalized for major puerperal sepsis, sexually transmitted infections, urinary tract infections, bacterial infections, liver disorders, and preterm labor/delivery than uninfected women, even after adjusting for sociodemographic factors and comorbid conditions. No significant differences were observed in the rates of preeclampsia and antepartum hemorrhage in the two groups. HIV-infected pregnant women in the United States in the era of HAART remain at higher risk for several morbidities and adverse obstetrical outcomes than uninfected women. [ABSTRACT FROM AUTHOR]

This JAMA Insights Clinical Update discusses what is known about the epidemiology and effects of SARS-CoV-2 infection in pregnancy, and summarizes Centers for Disease Control and Prevention (CDC) and professional organization (AAP and ACOG) recommendations for care of pregnant women with COVID-19. [ABSTRACT FROM AUTHOR]

A key component of the response to emerging infections is consideration of special populations, including pregnant women. Successful pregnancy depends on adaptation of the woman's immune system to tolerate a genetically foreign fetus. Although the immune system changes are not well understood, a shift from cell-mediated immunity toward humoral immunity is believed to occur. These immunologic changes may alter susceptibility to and severity of infectious diseases in pregnant women. For example, pregnancy may increase susceptibility to toxoplasmosis and listeriosis and may increase severity of illness and increase mortality rates from influenza and varicella. Compared with information about more conventional disease threats, information about emerging infectious diseases is quite limited. Pregnant women's altered response to infectious diseases should be considered when planning a response to emerging infectious disease threats. [ABSTRACT FROM AUTHOR]

The article compares the incidence of vulvar, vaginal and perianal intraepithelial neoplasia among HIV-infected women with a group of high-risk HIV-uninfected controls in Providence, Rhode Island. Pap tests and cervicovaginal lavage for human papillomavirus detection and typing were performed at baseline and every six months. Unadjusted hazard ratios were computed for development of vulvar, vaginal and perianal intraepithelial neoplasia using univariable Cox proportional hazards models.

Context Timely testing of women in labor with undocumented human immunodeficiency virus (HIV) status could enable immediate provision of antiretroviral prophylaxis. Objectives To determine the feasibility and acceptance of rapid HIV testing among women in labor and to assess rapid HIV assay performance. Design, Setting, and Patients The Mother-Infant Rapid Intervention At Delivery (MIRIAD) study implemented 24-hour counseling and voluntary rapid HIV testing for women in labor at 16 US hospitals from November 16, 2001, through November 15, 2003. A rapid HIV-1 antibody test for whole blood was used. Main Outcome Measures Acceptance of HIV testing; sensitivity, specificity, and predictive value of the rapid test; time from blood collection to patient notification of results. Results There were 91 707 visits to the labor and delivery units in the study, 7381 of which were by eligible women without documentation of HIV testing. Of these, 5744 (78%) women were approached for rapid HIV testing and 4849 (84%) consented. HIV-1 test results were positive for 34 women (prevalence = 7/1000). Sensitivity and specificity of the rapid test were 100% and 99.9%, respectively; positive predictive value was 90% compared with 76% for enzyme immunoassay (EIA). Factors independently associated with higher test acceptance included younger age, being black or Hispanic, gestational age less than 32 weeks, and having had no prenatal care. Lower acceptance was associated with being admitted between 4 PM and midnight, particularly on Friday nights, but this may be explained in part by fewer available personnel. Median time from blood collection to patient notification of result was 66 minutes (interquartile range, 45-120 minutes), compared with 28 hours for EIA (P<.001). Conclusions Rapid HIV testing is feasible and delivers accurate and timely test results for women in labor. It provides HIV-positive women prompt access to intrapartum and neonatal antiretroviral prophylaxis,... [ABSTRACT FROM AUTHOR]

Examines the risk factors for HIV transmission from a breastfeeding mother to child in Cote d'Ivoire. Maternal prophylaxis at 36 weeks of gestation; Treatment of oral zidovudine; Effect of viral loads.

Background: Although increasing attention has been focused on the adequacy of the informed consent process for participation in research studies, there has been little systematic evaluation of the process, particularly when consent is obtained in the labor and delivery setting. The Mother Infant Rapid Intervention at Delivery (MIRIAD) study is an ongoing multisite study initiated by the Centers for Disease Control and Prevention (CDC) designed to evaluate the feasibility of offering 24-hour counseling and voluntary rapid HIV testing and antriretroviral therapy when indicated to women with unknown HIV status who are in labor. Methods: To address concerns about obtaining informed consent from women in labor, we have completed focus groups, conducted a pilot of the informed consent process among women in labor, developed flip-charts to enhance comprehension, and plan an ongoing evaluation of the informed consent process throughout the course of the MIRIAD study. Results: In the pilot study, approximately 70% of women were able to state in their own words the purpose and benefits of the research study. Substantially fewer women (25%) were able to state one or more risks of the study. Conclusions: We hope that the MIRIAD study will make a valuable contribution by defining best approaches for informed consent and will provide guidance when it is necessary to obtain consent from laboring women for crucial interventions. [ABSTRACT FROM AUTHOR]

: ObjectiveTo estimate the incremental societal costs and effectiveness of a second human immunodeficiency virus (HIV) antibody test during the third trimester of pregnancy compared with no second test.: MethodsWe used a decision tree in this cost-effectiveness analysis to model outcomes among pregnant women in high-risk communities and nationwide who received an initial, negative HIV antibody test during the first trimester. The main outcome measure was discounted costs per year of infant life saved.: ResultsIn high-risk communities with estimated HIV incidence of 6.2 per 1000 person-years, a second HIV test compared with no second test would detect 192 infections in women, prevent approximately 37 infant infections, and save 655 infant life-years per 100,000 women tested. Net savings would be $5.2 million. Applied to an estimated national incidence of .17 per 1000 person-years, a second test would detect 5.3 infections in women, prevent 1.3 infant infections, and save 23.3 infant life-years per 100,000 women tested. Net costs would be $1.06 million, or $45,708 for each year of infant life saved. A second test would result in net savings in populations with HIV incidence of 1.2 per 1000 person-years or higher.: ConclusionHealth care providers serving women in communities with an HIV incidence of 1 per 1000 person-years or higher should strongly consider implementing a second voluntary universal HIV test during the third trimester. Providers serving lower-risk communities should pilot second testing to assess community-specific costs. [Copyright &y& Elsevier]