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11 results on '"Laurita Longo V"'

1. “An unnecessary cut?” multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review

Author

Laurita Longo, Valentina, Odjidja, E. N., Beia, T. K., Neri, M., Kielmann, K., Gittardi, I., Di Rosa, A. I., Boldrini, Marco Tobia Mario, Melis, G. B., Scambia, Giovanni, Lanzone, Antonio, Laurita Longo V., Boldrini M., Scambia G. (ORCID:0000-0003-2758-1063), Lanzone A. (ORCID:0000-0003-4119-414X), Laurita Longo, Valentina, Odjidja, E. N., Beia, T. K., Neri, M., Kielmann, K., Gittardi, I., Di Rosa, A. I., Boldrini, Marco Tobia Mario, Melis, G. B., Scambia, Giovanni, Lanzone, Antonio, Laurita Longo V., Boldrini M., Scambia G. (ORCID:0000-0003-2758-1063), and Lanzone A. (ORCID:0000-0003-4119-414X)

Abstract

Background: Improvements in medical technologies have seen over-medicalization of childbirth. Caesarean section (CS) is a lifesaving procedure proven effective in reducing maternal and perinatal mortality across the globe. However, as with any medical procedure, the CS intrinsically carries some risk to its beneficiaries. In recent years, CS rates have risen alarmingly in high-income countries. Many exceeding the World Health Organisation (WHO) recommendation of a 10 to 15% annual CS rate. While this situation poses an increased risk to women and their children, it also represents an excess human and financial burden on health systems. Therefore, from a health system perspective this study systematically summarizes existing evidence relevant to the factors driving the phenomenon of increasing CS rates using Italy as a case study. Methods: Employing the WHO Health System Framework (WHOHSF), this systematic review used the PRISMA guidelines to report findings. PubMed, SCOPUS, MEDLINE, Cochrane Library and Google Scholar databases were searched up until April 1, 2020. Findings were organised through the six dimensions of the WHOHSF framework: service delivery, health workforce, health system information; medical products vaccine and technologies, financing; and leadership and governance. Results: CS rates in Italy are affected by complex interactions among several stakeholder groups and contextual factors such as the hyper-medicalisation of delivery, differences in policy and practice across units and the national context, issues pertaining to the legal and social environment, and women’s attitudes towards pregnancy and childbirth. Conclusion: Mitigating the high rates of CS will require a synergistic multi-stakeholder intervention. Specifically, with processes able to attract the official endorsement of policy makers, encourage concensus between regional authorities and local governments and guide the systematic compliance of delivery units with its clinical guideline

Published
2020

2. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19

Author

Eran Hadar, Chiara Benedetto, Agnese Maria Chiara Rapisarda, Renato Augusto Moreira de Sá, Deena Elkafrawi, Daniela Luvero, Noa A Brzezinski Sinai, Alicia Martínez-Varea, Antonio Schiattarella, Anna Nunzia Della Gatta, Giovanni Scambia, Albert Lila, Luciano Di Tizio, Andrea Carosso, Giovanni Nazzaro, G. Schera, Giuseppe Rizzo, Giuseppe Maria Maruotti, Giusella D'Urso, Albaro José Nieto-Calvache, Ilenia Mappa, Ozlem Uyaniklar, Fabio Barra, Gilles Faron, Luigi Nappi, Jacopo Ferrari, Giulio Sozzi, Simone Ferrero, Mirjam Druškovič, Tanja Premru-Srsen, Leonardo Borrello, Fabiana Cecchini D, George Daskalakis, Giuliano Petriglia, Caroline Kadji, Felipe Mercado-Olivares, Zeliha Atak, Aylin Pelin Cil, Claudio Gustavino, Axelle Pintiaux, Pantaleo Greco, Rita Figueiredo, Stefano Cosma, Ludovica Puri, Valentina Esposito, Anupam Parange, Simone Garzon, Alessandra Gatti, Ioannis Kyvernitakis, Roberto Brunelli, Maddalena Morlando, Attilio Di Spiezio Sardo, Ignacio Cueto Hernández, Giuseppe Zoccali, Brian Rodriguez, Antonio Mollo, Flaminia Vena, Cihat Sen, Ciuhodaru Madalina, Felice Sorrentino, Francesca Di Sebastiano, Gennady T. Sukhikh, Ilma Floriana Carbone, Andrea Villasco, Blanka Zlatohlavkova, Gabriele Saccone, Erasmo Huertas, Marcel Malan, Leonardo Gucciardo, Eutalia Esposito, Otto Henrique May Feuerschuette, Sarah Dollinger, María de Los Angeles Anaya Baz, Jun Yoshimatsu, Sifa Turan, Vincente Diago, Alicia Yeliz Aykanat, Ignacio Herraiz, Javier Alfonso Schvartzman, Diego Gazzolo, Natalina Buono, Milan Stanojević, Erich Cosmi, Valentina De Robertis, Elena Costa, Angelo Cagnacci, Eleonora Valori, Nicoletta Biglia, Şerife Özlem Genç, Vincenzo Berghella, Francesco Maria Colaleo, Esther Vanessa Aguilar Galán, Gabriela Loscalzo, Marco Palumbo, Fabrizio Sandri, Irmeli Nupponen, Antonio Lanzone, Juan Antonio De León Luis, Amos Grunebaum, Giuseppe Bifulco, Marinella Lenzi, Serena Xodo, Fulvio Zullo, Ozhan Turan, Josefine Königbauer, Anna Luengo Piqueras, Nicola Volpe, Holger Maul, Chiara Taccaliti, Juan Manuel Burgos-Luna, Giovanni Sisti, Rosanna Esposito, Alfredo Ercoli, Panos Antsaklis, Dolores Esteban Oliva, Aly Youssef, Pedro Viana Pinto, Alberto Galindo, Asim Kurjak, Erhan Okuyan, Roberto Angioli, Maria Luisa Gonzalez-Duran, Ana Concheiro Guisan, Massimo Franchi, Maria Carmela Di Dedda, Giovanni Gerosolima, Francesco D'Antonio, Caroline Daelemans, Quintino Cesare Ianniciello, Pasquale De Franciscis, Maurizio Guida, Maria Cristina Rovellotti, Liana Ples, Frank A. Chervenak, Nicola Colacurci, Lilijana Kornhauser Cerar, Zulfiya Khodjaeva, Valentina Longo, Francesca Stollagli, Daniele Di Mascio, Mariavittoria Locci, Amadeo Sanchez, Angelo Sirico, Stefania Fieni, Rebeca Garrote Molpeceres, Pierluigi Benedetti Panici, Vito Chiantera, Esra Tustas Haberal, Liviu Cojocaru, Maria Elena Flacco, Antonella Cromi, Roberta Granese, Antonio Simone Laganà, Maria Giulia Lombana Marino, Silvia Visentin, Beatrice Bianchi, Roberta Venturella, Federica Laraud, Amanda Bermejo, Reyhan Gündüz, Marina Moucho, Zita Maria Gambacorti-Passerini, Danila Morano, Pedro Arango, Francesca Della Sala, Gaetana Di Donna, Jesús S Jimenez Lopez, Mariano Catello Di Donna, Giuliana Simonazzi, Snezana Zdjelar, Vedran Stefanovic, Cecilia Villalain, Antonio Coviello, Lars Hellmeyer, Antonella Giancotti, Elisa Bevilacqua, Igor Samardjiski, Riccardo Buscemi, Arianna Ramone, Marco Cerbone, Lorenza Driul, Danilo Buca, Tiziana Frusca, Elisa Done, Marco Liberati, José Morales Roselló, Fabio Ghezzi, Lorenzo Vasciaveo, Bernd Froessler, Alejandro Pittaro, Yolanda Cuñarro López, Andrew Carlin, Sakine Rahimli Ocakouglu, Giorgia Gattei, I. Cataneo, María José Suárez, Giada Ameli, Lamberto Manzoli, Kaisa Nelskylä, Ludovico Muzii, Peter Palm, Olus Api, Elisa Cueto, Martina Leombroni, Ksenia A. Gorina, HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, Children's Hospital, HUS Children and Adolescents, HUS Perioperative, Intensive Care and Pain Medicine, Anestesiologian yksikkö, Department of Diagnostics and Therapeutics, Dicle Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Gündüz, Reyhan, Di Mascio D., Sen C., Saccone G., Galindo A., Grunebaum A., Yoshimatsu J., Stanojevic M., Kurjak A., Chervenak F., Suarez M.J.R., Gambacorti-Passerini Z.M., De Los Angeles Anaya Baz M., Galan E.V.A., Lopez Y.C., De Leon Luis J.A., Hernandez I.C., Herraiz I., Villalain C., Venturella R., Rizzo G., Mappa I., Gerosolima G., Hellmeyer L., Konigbauer J., Ameli G., Frusca T., Volpe N., Schera G.B.L., Fieni S., Esposito E., Simonazzi G., Di Donna G., Youssef A., Della Gatta A.N., Di Donna M.C., Chiantera V., Buono N., Sozzi G., Greco P., Morano D., Bianchi B., Marino M.G.L., Laraud F., Ramone A., Cagnacci A., Barra F., Gustavino C., Ferrero S., Ghezzi F., Cromi A., Lagana A.S., Longo V.L., Stollagli F., Sirico A., Lanzone A., Driul L., Fabiana Cecchini D., Xodo S., Rodriguez B., Mercado-Olivares F., Elkafrawi D., Sisti G., Esposito R., Coviello A., Cerbone M., Morlando M., Schiattarella A., Colacurci N., De Franciscis P., Cataneo I., Lenzi M., Sandri F., Buscemi R., Gattei G., Della Sala F., Valori E., Rovellotti M.C., Done E., Faron G., Gucciardo L., Esposito V., Vena F., Giancotti A., Brunelli R., Muzii L., Nappi L., Sorrentino F., Vasciaveo L., Liberati M., Buca D., Leombroni M., Di Sebastiano F., Di Tizio L., Gazzolo D., Franchi M., Ianniciello Q.C., Garzon S., Petriglia G., Borrello L., Nieto-Calvache A.J., Burgos-Luna J.M., Kadji C., Carlin A., Bevilacqua E., Moucho M., Pinto P.V., Figueiredo R., Rosello J.M., Loscalzo G., Martinez-Varea A., Diago V., Lopez J.S.J., Aykanat A.Y., Cosma S., Carosso A., Benedetto C., Bermejo A., Feuerschuette O.H.M., Uyaniklar O., Ocakouglu S.R., Atak Z., Gunduz R., Haberal E.T., Froessler B., Parange A., Palm P., Samardjiski I., Taccaliti C., Okuyan E., Daskalakis G., De Sa R.A.M., Pittaro A., Gonzalez-Duran M.L., Guisan A.C., Genc S.O., Zlatohlavkova B., Piqueras A.L., Oliva D.E., Cil A.P., Api O., Antsaklis P., Ples L., Kyvernitakis I., Maul H., Malan M., Lila A., Granese R., Ercoli A., Zoccali G., Villasco A., Biglia N., Madalina C., Costa E., Daelemans C., Pintiaux A., Cueto E., Hadar E., Dollinger S., Sinai N.A.B., Huertas E., Arango P., Sanchez A., Schvartzman J.A., Cojocaru L., Turan S., Turan O., Di Dedda M.C., Molpeceres R.G., Zdjelar S., Premru-Srsen T., Cerar L.K., Druskovie M., De Robertis V., Stefanovic V., Nupponen I., Nelskyla K., Khodjaeva Z., Gorina K.A., Sukhikh G.T., Maruotti G.M., Visentin S., Cosmi E., Ferrari J., Gatti A., Luvero D., Angioli R., Puri L., Palumbo M., D'Urso G., Colaleo F., Rapisarda A.M.C., Carbone I.F., Mollo A., Nazzaro G., Locci M., Guida M., Di Spiezio Sardo A., Panici P.B., Berghella V., Flacco M.E., Manzoli L., Bifulco G., Scambia G., Zullo F., D'Antonio F., Di Mascio D, Sen C, Saccone G, Galindo A, Grünebaum A, Yoshimatsu J, Stanojevic M, Kurjak A, Chervenak F, Rodríguez Suárez MJ, Gambacorti-Passerini ZM, Baz MLAA, Aguilar Galán EV, López YC, De León Luis JA, Hernández IC, Herraiz I, Villalain C, Venturella R, Rizzo G, Mappa I, Gerosolima G, Hellmeyer L, Königbauer J, Ameli G, Frusca T, Volpe N, Luca Schera GB, Fieni S, Esposito E, Simonazzi G, Di Donna G, Youssef A, Della Gatta AN, Di Donna MC, Chiantera V, Buono N, Sozzi G, Greco P, Morano D, Bianchi B, Lombana Marino MG, Laraud F, Ramone A, Cagnacci A, Barra F, Gustavino C, Ferrero S, Ghezzi F, Cromi A, Laganà AS, Laurita Longo V, Stollagli F, Sirico A, Lanzone A, Driul L, Cecchini D F, Xodo S, Rodriguez B, Mercado-Olivares F, Elkafrawi D, Sisti G, Esposito R, Coviello A, Cerbone M, Morlando M, Schiattarella A, Colacurci N, De Franciscis P, Cataneo I, Lenzi M, Sandri F, Buscemi R, Gattei G, Sala FD, Valori E, Rovellotti MC, Done E, Faron G, Gucciardo L, Esposito V, Vena F, Giancotti A, Brunelli R, Muzii L, Nappi L, Sorrentino F, Vasciaveo L, Liberati M, Buca D, Leombroni M, Di Sebastiano F, Di Tizio L, Gazzolo D, Franchi M, Ianniciello QC, Garzon S, Petriglia G, Borrello L, Nieto-Calvache AJ, Burgos-Luna JM, Kadji C, Carlin A, Bevilacqua E, Moucho M, Pinto PV, Figueiredo R, Roselló JM, Loscalzo G, Martinez-Varea A, Diago V, Jimenez Lopez JS, Aykanat AY, Cosma S, Carosso A, Benedetto C, Bermejo A, May Feuerschuette OH, Uyaniklar O, Ocakouglu SR, Atak Z, Gündüz R, Haberal ET, Froessler B, Parange A, Palm P, Samardjiski I, Taccaliti C, Okuyan E, Daskalakis G, Moreira de Sa RA, Pittaro A, Gonzalez-Duran ML, Guisan AC, Genç ŞÖ, Zlatohlávková B, Piqueras AL, Oliva DE, Cil AP, Api O, Antsaklis P, Ples L, Kyvernitakis I, Maul H, Malan M, Lila A, Granese R, Ercoli A, Zoccali G, Villasco A, Biglia N, Madalina C, Costa E, Daelemans C, Pintiaux A, Cueto E, Hadar E, Dollinger S, Brzezinski Sinai NA, Huertas E, Arango P, Sanchez A, Schvartzman JA, Cojocaru L, Turan S, Turan O, Di Dedda MC, Molpeceres RG, Zdjelar S, Premru-Srsen T, Cerar LK, Druškovič M, De Robertis V, Stefanovic V, Nupponen I, Nelskylä K, Khodjaeva Z, Gorina KA, Sukhikh GT, Maruotti GM, Visentin S, Cosmi E, Ferrari J, Gatti A, Luvero D, Angioli R, Puri L, Palumbo M, D'Urso G, Colaleo F, Chiara Rapisarda AM, Carbone IF, Mollo A, Nazzaro G, Locci M, Guida M, Di Spiezio Sardo A, Panici PB, Berghella V, Flacco ME, Manzoli L, Bifulco G, Scambia G, Zullo F, D'Antonio F, Di Mascio, D., Sen, C., Saccone, G., Galindo, A., Grunebaum, A., Yoshimatsu, J., Stanojevic, M., Kurjak, A., Chervenak, F., Suarez, M. J. R., Gambacorti-Passerini, Z. M., De Los Angeles Anaya Baz, M., Galan, E. V. A., Lopez, Y. C., De Leon Luis, J. A., Hernandez, I. C., Herraiz, I., Villalain, C., Venturella, R., Rizzo, G., Mappa, I., Gerosolima, G., Hellmeyer, L., Konigbauer, J., Ameli, G., Frusca, T., Volpe, N., Schera, G. B. L., Fieni, S., Esposito, E., Simonazzi, G., Di Donna, G., Youssef, A., Della Gatta, A. N., Di Donna, M. C., Chiantera, V., Buono, N., Sozzi, G., Greco, P., Morano, D., Bianchi, B., Marino, M. G. L., Laraud, F., Ramone, A., Cagnacci, A., Barra, F., Gustavino, C., Ferrero, S., Ghezzi, F., Cromi, A., Lagana, A. S., Longo, V. L., Stollagli, F., Sirico, A., Lanzone, A., Driul, L., Fabiana Cecchini, D., Xodo, S., Rodriguez, B., Mercado-Olivares, F., Elkafrawi, D., Sisti, G., Esposito, R., Coviello, A., Cerbone, M., Morlando, M., Schiattarella, A., Colacurci, N., De Franciscis, P., Cataneo, I., Lenzi, M., Sandri, F., Buscemi, R., Gattei, G., Della Sala, F., Valori, E., Rovellotti, M. C., Done, E., Faron, G., Gucciardo, L., Esposito, V., Vena, F., Giancotti, A., Brunelli, R., Muzii, L., Nappi, L., Sorrentino, F., Vasciaveo, L., Liberati, M., Buca, D., Leombroni, M., Di Sebastiano, F., Di Tizio, L., Gazzolo, D., Franchi, M., Ianniciello, Q. C., Garzon, S., Petriglia, G., Borrello, L., Nieto-Calvache, A. J., Burgos-Luna, J. M., Kadji, C., Carlin, A., Bevilacqua, E., Moucho, M., Pinto, P. V., Figueiredo, R., Rosello, J. M., Loscalzo, G., Martinez-Varea, A., Diago, V., Lopez, J. S. J., Aykanat, A. Y., Cosma, S., Carosso, A., Benedetto, C., Bermejo, A., Feuerschuette, O. H. M., Uyaniklar, O., Ocakouglu, S. R., Atak, Z., Gunduz, R., Haberal, E. T., Froessler, B., Parange, A., Palm, P., Samardjiski, I., Taccaliti, C., Okuyan, E., Daskalakis, G., De Sa, R. A. M., Pittaro, A., Gonzalez-Duran, M. L., Guisan, A. C., Genc, S. O., Zlatohlavkova, B., Piqueras, A. L., Oliva, D. E., Cil, A. P., Api, O., Antsaklis, P., Ples, L., Kyvernitakis, I., Maul, H., Malan, M., Lila, A., Granese, R., Ercoli, A., Zoccali, G., Villasco, A., Biglia, N., Madalina, C., Costa, E., Daelemans, C., Pintiaux, A., Cueto, E., Hadar, E., Dollinger, S., Sinai, N. A. B., Huertas, E., Arango, P., Sanchez, A., Schvartzman, J. A., Cojocaru, L., Turan, S., Turan, O., Di Dedda, M. C., Molpeceres, R. G., Zdjelar, S., Premru-Srsen, T., Cerar, L. K., Druskovie, M., De Robertis, V., Stefanovic, V., Nupponen, I., Nelskyla, K., Khodjaeva, Z., Gorina, K. A., Sukhikh, G. T., Maruotti, G. M., Visentin, S., Cosmi, E., Ferrari, J., Gatti, A., Luvero, D., Angioli, R., Puri, L., Palumbo, M., D'Urso, G., Colaleo, F., Rapisarda, A. M. C., Carbone, I. F., Mollo, A., Nazzaro, G., Locci, M., Guida, M., Di Spiezio Sardo, A., Panici, P. B., Berghella, V., Flacco, M. E., Manzoli, L., Bifulco, G., Scambia, G., Zullo, F., D'Antonio, F., Di Mascio, Daniele, Sen, Cihat, Saccone, Gabriele, Galindo, Alberto, Grünebaum, Amo, Yoshimatsu, Jun, Stanojevic, Milan, Kurjak, Asım, Chervenak, Frank, Rodríguez Suárez, María José, Gambacorti-Passerini, Zita Maria, Baz, María de Los Angeles Anaya, Aguilar Galán, Esther Vanessa, López, Yolanda Cuñarro, De León Luis, Juan Antonio, Hernández, Ignacio Cueto, Herraiz, Ignacio, Villalain, Cecilia, Venturella, Roberta, Rizzo, Giuseppe, Mappa, Ilenia, Gerosolima, Giovanni, Hellmeyer, Lar, Königbauer, Josefine, Ameli, Giada, Frusca, Tiziana, Volpe, Nicola, Luca Schera, Giovanni Battista, Fieni, Stefania, Esposito, Eutalia, Simonazzi, Giuliana, Di Donna, Gaetana, Youssef, Aly, Della Gatta, Anna Nunzia, Di Donna, Mariano Catello, Chiantera, Vito, Buono, Natalina, Sozzi, Giulio, Greco, Pantaleo, Morano, Danila, Bianchi, Beatrice, Lombana Marino, Maria Giulia, Laraud, Federica, Ramone, Arianna, Cagnacci, Angelo, Barra, Fabio, Gustavino, Claudio, Ferrero, Simone, Ghezzi, Fabio, Cromi, Antonella, Laganà, Antonio Simone, Longo, Valentina Laurita, Stollagli, Francesca, Sirico, Angelo, Lanzone, Antonio, Driul, Lorenza, Cecchini D, Fabiana, Xodo, Serena, Rodriguez, Brian, Mercado-Olivares, Felipe, Elkafrawi, Deena, Sisti, Giovanni, Esposito, Rosanna, Coviello, Antonio, Cerbone, Marco, Morlando, Maddalena, Schiattarella, Antonio, Colacurci, Nicola, De Franciscis, Pasquale, Cataneo, Ilaria, Lenzi, Marinella, Sandri, Fabrizio, Buscemi, Riccardo, Gattei, Giorgia, Sala, Francesca Della, Valori, Eleonora, Rovellotti, Maria Cristina, Done, Elisa, Faron, Gille, Gucciardo, Leonardo, Esposito, Valentina, Vena, Flaminia, Giancotti, Antonella, Brunelli, Roberto, Muzii, Ludovico, Nappi, Luigi, Sorrentino, Felice, Vasciaveo, Lorenzo, Liberati, Marco, Buca, Danilo, Leombroni, Martina, Di Sebastiano, Francesca, Di Tizio, Luciano, Gazzolo, Diego, Franchi, Massimo, Ianniciello, Quintino Cesare, Garzon, Simone, Petriglia, Giuliano, Borrello, Leonardo, Nieto-Calvache, Albaro Josè, Burgos-Luna, Juan Manuel, Kadji, Caroline, Carlin, Andrew, Bevilacqua, Elisa, Moucho, Marina, Pinto, Pedro Viana, Figueiredo, Rita, Roselló, José Morale, Loscalzo, Gabriela, Martinez-Varea, Alicia, Diago, Vincente, Jimenez Lopez, Jesús S, Aykanat, Alicia Yeliz, Cosma, Stefano, Carosso, Andrea, Benedetto, Chiara, Bermejo, Amanda, May Feuerschuette, Otto Henrique, Uyaniklar, Ozlem, Ocakouglu, Sakine Rahimli, Atak, Zeliha, Haberal, Esra Tusta, Froessler, Bernd, Parange, Anupam, Palm, Peter, Samardjiski, Igor, Taccaliti, Chiara, Okuyan, Erhan, Daskalakis, George, Moreira de Sa, Renato Augusto, Pittaro, Alejandro, Gonzalez-Duran, Maria Luisa, Guisan, Ana Concheiro, Genç, Şerife Özlem, Zlatohlávková, Blanka, Piqueras, Anna Luengo, Oliva, Dolores Esteban, Cil, Aylin Pelin, Api, Olu, Antsaklis, Pano, Ples, Liana, Kyvernitakis, Ioanni, Maul, Holger, Malan, Marcel, Lila, Albert, Granese, Roberta, Ercoli, Alfredo, Zoccali, Giuseppe, Villasco, Andrea, Biglia, Nicoletta, Madalina, Ciuhodaru, Costa, Elena, Daelemans, Caroline, Pintiaux, Axelle, Yapar Eyi, Elif Gül, Cueto, Elisa, Hadar, Eran, Dollinger, Sarah, Brzezinski Sinai, Noa A, Huertas, Erasmo, Arango, Pedro, Sanchez, Amadeo, Schvartzman, Javier Alfonso, Cojocaru, Liviu, Turan, Sifa, Turan, Ozhan, Di Dedda, Maria Carmela, Molpeceres, Rebeca Garrote, Zdjelar, Snezana, Premru-Srsen, Tanja, Cerar, Lilijana Kornhauser, Druškovič, Mirjam, De Robertis, Valentina, Stefanovic, Vedran, Nupponen, Irmeli, Nelskylä, Kaisa, Khodjaeva, Zulfiya, Gorina, Ksenia A, Sukhikh, Gennady T, Maruotti, Giuseppe Maria, Visentin, Silvia, Cosmi, Erich, Ferrari, Jacopo, Gatti, Alessandra, Luvero, Daniela, Angioli, Roberto, Puri, Ludovica, Palumbo, Marco, D'Urso, Giusella, Colaleo, Francesco, Chiara Rapisarda, Agnese Maria, Carbone, Ilma Floriana, Mollo, Antonio, Nazzaro, Giovanni, Locci, Mariavittoria, Guida, Maurizio, Di Spiezio Sardo, Attilio, Panici, Pierluigi Benedetti, Berghella, Vincenzo, Flacco, Maria Elena, Manzoli, Lamberto, Bifulco, Giuseppe, Scambia, Giovanni, Zullo, Fulvio, and D'Antonio, Francesco

Subjects
COVID-19 Vaccine, Infectious Disease Transmission, Perinatal Death, Abortion, Clinical Laboratory Technique, Miscarriage, Cohort Studies, 0302 clinical medicine, COVID-19 Testing, Pregnancy, Risk Factors, 3123 Gynaecology and paediatrics, Secondary analysis, Perinatal medicine, Abortion, Spontaneou, Medicine, Vertical, 030212 general & internal medicine, Viral, Pregnancy Complications, Infectious, coronavirus, perinatal morbidity, perinatal mortality, covid-19, Coronavirus, Abortion, Spontaneous, COVID-19, COVID-19 Vaccines, Clinical Laboratory Techniques, Coronavirus Infections, Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Infectious Disease Transmission, Vertical, Pandemics, Pneumonia, Viral, Pregnancy Outcome, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, Betacoronavirus, Fetal Death, 030219 obstetrics & reproductive medicine, Obstetrics, Infectious, Gestational age, Obstetrics and Gynecology, 3. Good health, Settore MED/40, Gestation, Human, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Coronaviru, Socio-culturale, Intrauterine device, 03 medical and health sciences, PARVOVIRUS B19 INFECTION, Coronavirus, perinatal morbidity, perinatal mortality, Adverse effect, Premature, Fetus, Betacoronaviru, Pandemic, Coronavirus Infection, business.industry, Risk Factor, Spontaneous, MORTALITY, Infant, Odds ratio, Pneumonia, medicine.disease, Newborn, Pregnancy Complications, Pediatrics, Perinatology and Child Health, Pregnancy Complications, Infectiou, Cohort Studie, business
Abstract

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8–0.9 per week increase; p Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Published
2021

3. Risk factors associated with severe perineal lacerations during vaginal delivery: a 10-year propensity score-matched observational study.

Author

Laurita Longo V, Odjidja EN, Zanfini BA, Catarci S, Carducci B, Draisci G, Lanzone A, and Bevilacqua E

Abstract

Background: Severe perineal lacerations are rare obstetrical complications in high-income countries. However, the prevention of obstetric anal sphincter injuries is crucial because of their long-term consequences on a woman's digestive function, sexual-mental health, and well-being. The probability of obstetric anal sphincter injuries can be predicted by assessing antenatal and intrapartum risk factors., Objective: This study aimed to assess the incidence of obstetric anal sphincter injuries at a single institution for 10 years and to identify women more at risk by evaluating the relationship between antenatal and intrapartum risk factors and severe perineal tears. The main outcome measured in this study was the occurrence of obstetric anal sphincter injuries during vaginal delivery., Study Design: This was an observational retrospective cohort study conducted at a University Teaching Hospital in Italy. The study was conducted from 2009 to 2019 using a prospectively maintained database. The study cohort included all women with singleton pregnancy at term who delivered via vaginal delivery in cephalic presentation. Of note, data analysis was performed in 2 stages: a propensity score matching to balance possible differences between patients with obstetric anal sphincter injuries and those without and a stepwise univariate and multivariate logistic regression. A secondary analysis was performed to further evaluate the effect of parity, epidural anesthesia, and duration of the second stage of labor by adjusting for potential confounders., Results: Of 41,440 patients screened for eligibility, 22,156 met the inclusion criteria, and 15,992 were balanced after propensity score matching. Obstetric anal sphincter injuries occurred in 81 cases (0.4%), 67 (0.3%) after spontaneous delivery and 14 (0.8%) after vacuum delivery( P =.002). There was an increased odds of severe lacerations of nearly 2-fold for nulliparous women delivering by vacuum delivery (adjusted odds ratio, 2.85; 95% confidence interval, 1.19-6.81; P =.019), with a reciprocal reduction in women with spontaneous vaginal delivery (adjusted odds ratio, 0.35; 95% confidence interval, 0.15-0.84; P =.019) and at least 1 previous delivery (adjusted odds ratio, 0.51; 95% confidence interval, 0.31-0.85; P =.005). Epidural anesthesia was associated with a lower incidence of obstetric anal sphincter injuries (adjusted odds ratio, 0.54; 95% confidence interval, 0.33-0.86; P =.011). The risk of severe lacerations was independent of the duration of the second stage of labor (adjusted odds ratio, 1.00; 95% confidence interval, 0.99-1.00; P =.3), whereas the risk was reduced when mediolateral episiotomy was performed (adjusted odds ratio, 0.20; 95% confidence interval, 0.11-0.36; P <.001). Neonatal risk factors include head circumference (odds ratio, 1.50; 95% confidence interval, 1.18-1.90; P =.001) and vertex malpresentation (adjusted odds ratio, 2.71; 95% confidence interval, 1.08-6.78; P =.033). Induction of labor (adjusted odds ratio, 1.13; 95% confidence interval, 0.72-1.92; P =.6), frequent obstetrical examinations (adjusted odds ratio, 1.17; 95% confidence interval, 0.72-1.90), and women's supine position at birth (adjusted odds ratio, 1.25; 95% confidence interval, 0.61-2.55; P =.5) were further evaluated. Among severe obstetrical complications, shoulder dystocia increased the risk of obstetric anal sphincter injuries by nearly 4 times (adjusted odds ratio, 3.92; 95% confidence interval, 0.50-30.74; P =.2), whereas postpartum hemorrhage occurred 3 times more often in cases of delivery complicated by severe lacerations (adjusted odds ratio, 3.35; 95% confidence interval, 1.76-6.40; P <.001). The relationship among obstetric anal sphincter injuries, parity, and the use of epidural anesthesia was further confirmed in a secondary analysis. We found that primiparas who delivered without epidural anesthesia had the highest risk of obstetric anal sphincter injuries (adjusted odds ratio, 2.53; 95% confidence interval, 1.46-4.39; P =.001)., Conclusion: Severe perineal lacerations were found to be a rare complication of vaginal delivery. By using a robust statistical model, such as propensity score matching, we were able to investigate a broad range of antenatal and intrapartum risk factors, including use of epidural anesthesia, number of obstetrics examinations, and patient position at birth, which are usually underreported. Moreover, we found that women who delivered for the first time without epidural anesthesia had the highest risk of obstetric anal sphincter injuries., (© 2023 The Authors.)

Published
2023
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4. Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis.

Author

Smith ER, Oakley E, Grandner GW, Rukundo G, Farooq F, Ferguson K, Baumann S, Adams Waldorf KM, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Bevilacqua E, Bracero N, Brandt JS, Broutet N, Carrillo J, Conry J, Cosmi E, Crispi F, Crovetto F, Del Mar Gil M, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Fernandez Buhigas I, Flaherman V, Gale C, Godwin CL, Gottlieb S, Gratacós E, He S, Hernandez O, Jones S, Joshi S, Kalafat E, Khagayi S, Knight M, Kotloff KL, Lanzone A, Laurita Longo V, Le Doare K, Lees C, Litman E, Lokken EM, Madhi SA, Magee LA, Martinez-Portilla RJ, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Sahota D, Sakowicz A, Sanin-Blair J, Stephansson O, Temmerman M, Thorson A, Thwin SS, Tippett Barr BA, Tolosa JE, Tug N, Valencia-Prado M, Visentin S, von Dadelszen P, Whitehead C, Wood M, Yang H, Zavala R, and Tielsch JM

Subjects
Pregnancy, Infant, Newborn, Female, Humans, Prospective Studies, Thinness, SARS-CoV-2, Pregnancy Outcome epidemiology, Risk Factors, Postpartum Period, COVID-19 epidemiology, Premature Birth epidemiology, HIV Infections, Cardiovascular Diseases, Pregnancy Complications epidemiology, Hypertension
Abstract

Objective: This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes., Data Sources: We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020., Study Eligibility Criteria: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area., Methods: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis., Results: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12-2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27-13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87-22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83-70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26-2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20-3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28-2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18-2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25-2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15-4.81)., Conclusion: We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors., (Copyright © 2022. Published by Elsevier Inc.)

Published
2023
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5. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis.

Author

Smith ER, Oakley E, Grandner GW, Ferguson K, Farooq F, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Tippett Barr BA, Bevilacqua E, Brandt JS, Broutet N, Fernández Buhigas I, Carrillo J, Clifton R, Conry J, Cosmi E, Crispi F, Crovetto F, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Flaherman VJ, Gale C, Gil MM, Gottlieb SL, Gratacós E, Hernandez O, Jones S, Kalafat E, Khagayi S, Knight M, Kotloff K, Lanzone A, Le Doare K, Lees C, Litman E, Lokken EM, Laurita Longo V, Madhi SA, Magee LA, Martinez-Portilla RJ, McClure EM, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Rukundo G, Sahota D, Sakowicz A, Sanin-Blair J, Söderling J, Stephansson O, Temmerman M, Thorson A, Tolosa JE, Townson J, Valencia-Prado M, Visentin S, von Dadelszen P, Adams Waldorf K, Whitehead C, Yassa M, and Tielsch JM

Subjects
Infant, Newborn, Pregnancy, Female, Humans, Prospective Studies, SARS-CoV-2, Pregnant Women, COVID-19
Abstract

Introduction: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies., Methods: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale., Results: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias., Conclusions: This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol., Competing Interests: Competing interests: CW declares a relationship with Ferring Pharmaceuticals COVID-19 Investigational Grant and NHMRC Fellowship (salary support). AP declares the following research grants to her institution: ‘H2020-Grant—Consortium member of Innovative medicine initiative call 13 topic 9 «ConcePTION», Efficacy and safety studies on Medicines EMA/2017/09/PE/11, Lot 4, WP 2 lead, Safety monitoring of COVID-19 vaccines in the EU—Reopening of competition no. 20 under a framework contract following procurement procedure EMA/2017/09/PE (Lot 3) (Euro 110,000), Federal Office of Public Health (207,000 CHF)’. EM declares a relationship with the National Institute for Health Research (project grant for PAN COVID study). DM declares a relationship with the Canadian Institutes of Health Research (payments to institution only), Public Health Agency of Canada (payments to institution only), BC Women’s Foundation (payments to institution only) and is a member of the COVID-19 Immunity Task Force sponsored by the Canadian government. TDM declares a relationship with Pfizer (site principal investigator for SARS-CoV-2 vaccination in pregnancy study, money paid to institution and member of Medical Advisory Board for SARS-CoV-2 vaccination in pregnancy study, money paid to TDM), NICHD (subcommittee chair for the NICHD Maternal-Fetal Medicine Units Network Gestational Research Assessments of COVID-19 (GRAVID) study) and Society for Maternal-Fetal Medicine (board member). EL declares a relationship with the US NIH (paid institution) and is an employee of AbbVie, but was employed at the University of Washington at the time of the study. KK declares a relationship with the Bill & Melinda Gates Foundation. VJF declares a relationship with the Bill & Melinda Gates Foundation (payments to institution), Yellow Chair Foundation (payments to institution), Robert Woods Johnson Foundation (payments to institution), CDC Foundation, California Health Care Foundation (payments to institution), Tara Health Foundation (payments to institution), UCSF Women’s Health Center of Excellence (payments to institution) and California Department of Health Care Services (payments made to institution). JS-B declares a relationship with the Ferring Pharmaceuticals, which gave a grant ($10 000) for the expenses of RECOGEST trial and is a part of the Columbian Federation of Perinatology. YA declares a relationship with the Bill & Melinda Gates Foundation (payments made to institution), CDC Foundation (payments made to institution), Robert Woods Johnson Foundation (payments made to institution) and UCLA Dean’s Office COVID-19 research (payments made to institution). RC declares a relationship with the NIH HD36801 (MFMU Network DCC). MCN declares a relationship with the BMGF (project grant made to institution), EDCTP, Sanofi, AstraZeneca, Pfizer (research grants made to institution), Sanofi Pasteur (payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events) and Sanofi Pasteur and Pfizer (payment for expert testimony). ESM declares a relationship with Pfizer (site principal investigator for phase 2/3 RCT of COVID vaccine during pregnancy). OS declares a relationship with the NordForsk Funding (Nordic research funding grant number: 105545), the Swedish Medical Products Agency (funding for reports on COVID-19 vaccines and pregnancy) and Karolinska Institutet (funding for COVID research and pregnancy: 2020-01567). EG declares a relationship with the Stavros Niarchos Foundation, Santander Foundation and ‘La Caixa’ Foundation (payments made to institution). SAM declares a relationship with BMGF (funded study in South Africa)., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Published
2023
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6. The Effect of Epidural Analgesia on Labour and Neonatal and Maternal Outcomes in 1, 2a, 3, and 4a Robson's Classes: A Propensity Score-Matched Analysis.

Author

Zanfini BA, Catarci S, Vassalli F, Laurita Longo V, Biancone M, Carducci B, Frassanito L, Lanzone A, and Draisci G

Abstract

Background: Lumbar epidural analgesia (EA) is the most commonly used method for reducing labour pain, but its impact on the duration of the second stage of labour and on neonatal and maternal outcomes remains a matter of debate. Our aim was to examine whether EA affected the course and the outcomes of labour among patients divided according to the Robson-10 group classification system. Methods: Patients of Robson’s classes 1, 2a, 3, and 4a were divided into either the EA group or the non-epidural analgesia (NEA) group. A propensity score-matching analysis was performed to balance the intergroup differences. The primary goal was to analyse the duration of the second stage of labour. The secondary goals were to evaluate neonatal and maternal outcomes. Results: In total, 21,808 cases were analysed. The second stage of labour for all groups was prolonged using EA (p < 0.05) without statistically significant differences in neonatal outcomes. EA resulted in a lower rate of episiotomies in nulliparous patients, with a higher rate of operative vaginal deliveries (OVD) (p < 0.05) and Caesarean sections (CS) (p < 0.05) in some classes. Conclusions: EA prolonged the duration of labour without affecting neonatal outcomes and reduced the rate of episiotomies, but also increased the rate of OVDs.

Published
2022
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7. Protocol for a sequential, prospective meta-analysis to describe coronavirus disease 2019 (COVID-19) in the pregnancy and postpartum periods.

Author

Smith ER, Oakley E, He S, Zavala R, Ferguson K, Miller L, Grandner GW, Abejirinde IO, Afshar Y, Ahmadzia H, Aldrovandi G, Akelo V, Tippett Barr BA, Bevilacqua E, Brandt JS, Broutet N, Fernández Buhigas I, Carrillo J, Clifton R, Conry J, Cosmi E, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Flaherman V, Gale C, Gil MM, Godwin C, Gottlieb S, Hernandez Bellolio O, Kara E, Khagayi S, Kim CR, Knight M, Kotloff K, Lanzone A, Le Doare K, Lees C, Litman E, Lokken EM, Laurita Longo V, Magee LA, Martinez-Portilla RJ, McClure E, Metz TD, Money D, Mullins E, Nachega JB, Panchaud A, Playle R, Poon LC, Raiten D, Regan L, Rukundo G, Sanin-Blair J, Temmerman M, Thorson A, Thwin S, Tolosa JE, Townson J, Valencia-Prado M, Visentin S, von Dadelszen P, Adams Waldorf K, Whitehead C, Yang H, Thorlund K, and Tielsch JM

Subjects
Adolescent, Child, Female, Humans, Infant, Newborn, Meta-Analysis as Topic, Postpartum Period, Pregnancy, Prospective Studies, Retrospective Studies, SARS-CoV-2, COVID-19 epidemiology
Abstract

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis., Competing Interests: Clare Whitehead declares a a relationship with the following entities, Ferring Pharmaceuticals COVID19 Investigational, Grant, NHMRC Fellowship (salary support). Edward Mullins declares a relationship with the following entities National Institute for Health Research (Project grant for PAN COVID study). Deborah Money declares a relationship with the following entities, Canadian Institutes of Health Research (payments to my institution only), Public Health Agency of Canada (payments to institution only), BC Women’s Foundation (payments to institution only) and is a Member of the COVID-19 Immunity Task Force sponsored by the Canadian government. Torri D. Metz declares a relationship with the following entities, Pfizer (site Principal Investigator for SARS-CoV-2 vaccination in pregnancy study, money paid to institution and member of Medical Advisory Board for SARS-CoV-2 vaccination in pregnancy study, money paid to me), NICHD (subcommittee Chair for the NICHD Maternal-Fetal Medicine Units Network Gestational Research Assessments of COVID-19 (GRAVID) study), and Society for Maternal-Fetal Medicine (board member). Erica Lokken declares a relationship with the following entity, US NIH (paid institution). Karen L. Kotloff declares a relationship with the following entity, Bill and Melinda Gates Foundation. Siran He declares a relationship with the following entity, Bill and Melinda Gates Foundtion (payments made to institution). Valerie Flaherman declares a relationship with the following entities, Bill and Melinda Gates Foundation (payments to institution), Yellow Chair Foundation (payments to institution), Robert Woods Johnson Foundation (payments to institution), CDC Foundation, California Health Care Foundation (payments to institution), Tara Health Foundation (payments to institution), UCSF Women’s Health Center of Excellence (payments to institution) and California Department of Health Care Services (payments made to institution). Jose Sanin-Blair declares a relationship with the following entity, Ferring Pharmaceuticals which gave a grant ($10,000) for the expenses of RECOGEST trial and is a part of the Columbian Federation of Perinatology. Yalda Afshar declares a relationship with the following entities, Bill and Melinda Gates Foundation (payments made to institution), CDC Foundation (payments made to my institution), Robert Woods Johnson Foundation (payments made to institution), and UCLA Dean’s Office COVID-19 research (payments made to institution). Rebecca Clifton declares a relationship with the following entity, NIH HD36801 (MFMU Network DCC). Alice Panchaud declared a relationship with the European Medicines Agency (research grant to institution) and the Federal Office of Public Health Switzerland (research grant to institution).

Published
2022
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8. The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen-a prospective cohort study.

Author

Unger HW, Laurita Longo V, Bleicher A, Ome-Kaius M, Karl S, Simpson JA, Karahalios A, Aitken EH, and Rogerson SJ

Subjects
Cohort Studies, Female, Humans, Infant, Infant, Newborn, Iron, Pregnancy, Pregnancy Outcome epidemiology, Prospective Studies, Malaria epidemiology, Malaria prevention & control, Pregnancy Complications, Parasitic, Premature Birth
Abstract

Background: Iron deficiency (ID) has been associated with adverse pregnancy outcomes, maternal anaemia, and altered susceptibility to infection. In Papua New Guinea (PNG), monthly treatment with sulphadoxine-pyrimethamine plus azithromycin (SPAZ) prevented low birthweight (LBW; <2500 g) through a combination of anti-malarial and non-malarial effects when compared to a single treatment with SP plus chloroquine (SPCQ) at first antenatal visit. We assessed the relationship between ID and adverse birth outcomes in women receiving SPAZ or SPCQ, and the mediating effects of malaria infection and haemoglobin levels during pregnancy., Methods: Plasma ferritin levels measured at antenatal enrolment in a cohort of 1892 women were adjusted for concomitant inflammation using C-reactive protein and α-1-acid glycoprotein. Associations of ID (defined as ferritin <15 μg/L) or ferritin levels with birth outcomes (birthweight, LBW, preterm birth, small-for-gestational-age birthweight [SGA]) were determined using linear or logistic regression analysis, as appropriate. Mediation analysis assessed the degree of mediation of ID-birth outcome relationships by malaria infection or haemoglobin levels., Results: At first antenatal visit (median gestational age, 22 weeks), 1256 women (66.4%) had ID. Overall, ID or ferritin levels at first antenatal visit were not associated with birth outcomes. There was effect modification by treatment arm. Amongst SPCQ recipients, ID was associated with a 81-g higher mean birthweight (95% confidence interval [CI] 10, 152; P = 0.025), and a twofold increase in ferritin levels was associated with increased odds of SGA (adjusted odds ratio [aOR] 1.25; 95% CI 1.06, 1.46; P = 0.007). By contrast, amongst SPAZ recipients, a twofold increase in ferritin was associated with reduced odds of LBW (aOR 0.80; 95% CI 0.67, 0.94; P = 0.009). Mediation analyses suggested that malaria infection or haemoglobin levels during pregnancy do not substantially mediate the association of ID with birth outcomes amongst SPCQ recipients., Conclusions: Improved antenatal iron stores do not confer a benefit for the prevention of adverse birth outcomes in the context of malaria chemoprevention strategies that lack the non-malarial properties of monthly SPAZ. Research to determine the mechanisms by which ID protects from suboptimal foetal growth is needed to guide the design of new malaria prevention strategies and to inform iron supplementation policy in malaria-endemic settings., Trial Registration: ClinicalTrials.gov NCT01136850 ., (© 2021. The Author(s).)

Published
2021
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9. "An unnecessary cut?" multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review.

Author

Laurita Longo V, Odjidja EN, Beia TK, Neri M, Kielmann K, Gittardi I, Di Rosa AI, Boldrini M, Melis GB, Scambia G, and Lanzone A

Subjects
Cesarean Section adverse effects, Delivery of Health Care economics, Delivery of Health Care legislation & jurisprudence, Female, Hospitals, Private statistics & numerical data, Hospitals, Public statistics & numerical data, Humans, Italy epidemiology, Liability, Legal, Practice Patterns, Physicians', Pregnancy, Cesarean Section statistics & numerical data
Abstract

Background: Improvements in medical technologies have seen over-medicalization of childbirth. Caesarean section (CS) is a lifesaving procedure proven effective in reducing maternal and perinatal mortality across the globe. However, as with any medical procedure, the CS intrinsically carries some risk to its beneficiaries. In recent years, CS rates have risen alarmingly in high-income countries. Many exceeding the World Health Organisation (WHO) recommendation of a 10 to 15% annual CS rate. While this situation poses an increased risk to women and their children, it also represents an excess human and financial burden on health systems. Therefore, from a health system perspective this study systematically summarizes existing evidence relevant to the factors driving the phenomenon of increasing CS rates using Italy as a case study., Methods: Employing the WHO Health System Framework (WHOHSF), this systematic review used the PRISMA guidelines to report findings. PubMed, SCOPUS, MEDLINE, Cochrane Library and Google Scholar databases were searched up until April 1, 2020. Findings were organised through the six dimensions of the WHOHSF framework: service delivery, health workforce, health system information; medical products vaccine and technologies, financing; and leadership and governance., Results: CS rates in Italy are affected by complex interactions among several stakeholder groups and contextual factors such as the hyper-medicalisation of delivery, differences in policy and practice across units and the national context, issues pertaining to the legal and social environment, and women's attitudes towards pregnancy and childbirth., Conclusion: Mitigating the high rates of CS will require a synergistic multi-stakeholder intervention. Specifically, with processes able to attract the official endorsement of policy makers, encourage concensus between regional authorities and local governments and guide the systematic compliance of delivery units with its clinical guidelines.

Published
2020
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10. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Author

Di Mascio D, Sen C, Saccone G, Galindo A, Grünebaum A, Yoshimatsu J, Stanojevic M, Kurjak A, Chervenak F, Rodríguez Suárez MJ, Gambacorti-Passerini ZM, Baz MLAA, Aguilar Galán EV, López YC, De León Luis JA, Hernández IC, Herraiz I, Villalain C, Venturella R, Rizzo G, Mappa I, Gerosolima G, Hellmeyer L, Königbauer J, Ameli G, Frusca T, Volpe N, Luca Schera GB, Fieni S, Esposito E, Simonazzi G, Di Donna G, Youssef A, Della Gatta AN, Di Donna MC, Chiantera V, Buono N, Sozzi G, Greco P, Morano D, Bianchi B, Lombana Marino MG, Laraud F, Ramone A, Cagnacci A, Barra F, Gustavino C, Ferrero S, Ghezzi F, Cromi A, Laganà AS, Laurita Longo V, Stollagli F, Sirico A, Lanzone A, Driul L, Cecchini D F, Xodo S, Rodriguez B, Mercado-Olivares F, Elkafrawi D, Sisti G, Esposito R, Coviello A, Cerbone M, Morlando M, Schiattarella A, Colacurci N, De Franciscis P, Cataneo I, Lenzi M, Sandri F, Buscemi R, Gattei G, Sala FD, Valori E, Rovellotti MC, Done E, Faron G, Gucciardo L, Esposito V, Vena F, Giancotti A, Brunelli R, Muzii L, Nappi L, Sorrentino F, Vasciaveo L, Liberati M, Buca D, Leombroni M, Di Sebastiano F, Di Tizio L, Gazzolo D, Franchi M, Ianniciello QC, Garzon S, Petriglia G, Borrello L, Nieto-Calvache AJ, Burgos-Luna JM, Kadji C, Carlin A, Bevilacqua E, Moucho M, Pinto PV, Figueiredo R, Morales Roselló J, Loscalzo G, Martinez-Varea A, Diago V, Jimenez Lopez JS, Aykanat AY, Cosma S, Carosso A, Benedetto C, Bermejo A, May Feuerschuette OH, Uyaniklar O, Ocakouglu SR, Atak Z, Gündüz R, Haberal ET, Froessler B, Parange A, Palm P, Samardjiski I, Taccaliti C, Okuyan E, Daskalakis G, Moreira de Sa RA, Pittaro A, Gonzalez-Duran ML, Guisan AC, Genç ŞÖ, Zlatohlávková B, Piqueras AL, Oliva DE, Cil AP, Api O, Antsaklis P, Ples L, Kyvernitakis I, Maul H, Malan M, Lila A, Granese R, Ercoli A, Zoccali G, Villasco A, Biglia N, Madalina C, Costa E, Daelemans C, Pintiaux A, Cueto E, Hadar E, Dollinger S, Brzezinski Sinai NA, Huertas E, Arango P, Sanchez A, Schvartzman JA, Cojocaru L, Turan S, Turan O, Di Dedda MC, Molpeceres RG, Zdjelar S, Premru-Srsen T, Cerar LK, Druškovič M, De Robertis V, Stefanovic V, Nupponen I, Nelskylä K, Khodjaeva Z, Gorina KA, Sukhikh GT, Maruotti GM, Visentin S, Cosmi E, Ferrari J, Gatti A, Luvero D, Angioli R, Puri L, Palumbo M, D'Urso G, Colaleo F, Chiara Rapisarda AM, Carbone IF, Mollo A, Nazzaro G, Locci M, Guida M, Di Spiezio Sardo A, Panici PB, Berghella V, Flacco ME, Manzoli L, Bifulco G, Scambia G, Zullo F, and D'Antonio F

Subjects
COVID-19, COVID-19 Testing, COVID-19 Vaccines, Clinical Laboratory Techniques, Cohort Studies, Coronavirus Infections diagnosis, Coronavirus Infections epidemiology, Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Infectious Disease Transmission, Vertical statistics & numerical data, Pandemics, Pneumonia, Viral diagnosis, Pneumonia, Viral epidemiology, Pregnancy, Pregnancy Complications, Infectious epidemiology, Pregnancy Outcome, Reverse Transcriptase Polymerase Chain Reaction, Risk Factors, SARS-CoV-2, Abortion, Spontaneous epidemiology, Betacoronavirus genetics, Betacoronavirus isolation & purification, Coronavirus Infections complications, Fetal Death, Perinatal Death, Pneumonia, Viral complications, Pregnancy Complications, Infectious virology
Abstract

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Published
2020
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11. Coronavirus disease 2019 and viral hepatitis coinfection: Provide guidelines for integrated screening and treatment.

Author

Odjidja EN, Laurita Longo V, Rizzatti G, and Bandoh S

Subjects
COVID-19 virology, Coinfection virology, Hepatitis, Viral, Human virology, Humans, Male, Mass Screening methods, Pandemics, SARS-CoV-2 drug effects, COVID-19 diagnosis, Coinfection diagnosis, Coinfection drug therapy, Hepatitis, Viral, Human diagnosis, Hepatitis, Viral, Human drug therapy, COVID-19 Drug Treatment
Published
2020
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