American Journal of Obstetrics and Gynecology, 2021
Background Among non-pregnant individuals, diabetes mellitus (DM) and high body mass index (BMI) ... more Background Among non-pregnant individuals, diabetes mellitus (DM) and high body mass index (BMI) increase the risk of Covid-19 and its severity. Objective To determine whether DM and high BMI are risk factors for Covid-19 in pregnancy and whether gestational diabetes mellitus (GDM) is also associated with covid-19 diagnosis. Study Design INTERCOVID was a multinational study, conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women ≥18 years; 2071 were included in these analyses. For each woman diagnosed with Covid-19, two non-diagnosed women delivering or initiating antenatal care at the same institution were also enrolled. Main exposures were pre-existing DM or high BMI (overweight/obesity defined as ≥25 kg/m2), and GDM in pregnancy. Main outcome was a confirmed diagnosis of Covid-19 based on an RT-PCR test, antigen test, antibody test, radiological pulmonary findings, or ≥2 predefined Covid-19 symptoms at any time during pregnancy or delivery. Relationships of exposures and Covid-19 diagnosis were assessed using generalized linear models with a Poisson distribution and log link function, with robust standard errors to account for model misspecification. We also conducted sensitivity analyses: 1) restricted to those with an RT-PCR or antigen test in the last week of pregnancy; 2) restricted to those with an RT-PCR or antigen test during the entire pregnancy; 3) generating values for missing data using multiple imputation; and 4) analyses controlling for month of enrollment. In addition, among those who were diagnosed with Covid-19, we examined whether having GDM, DM, or high BMI, increased risk for having symptomatic vs. asymptomatic Covid-19. Results Covid-19 was associated with preexisting DM (RR=1.94, 95% CI=1.55, 2.42), overweight/obesity (RR=1.20; 95% CI=1.06, 1.37), and GDM (RR=1.21; 95% CI=0.99, 1.46). The GDM association was specifically among women requiring insulin, whether they were of normal-weight (RR=1.79, 95% CI=1.06, 3.01) or overweight/obese (RR=1.77, 95% CI=1.28, 2.45). A somewhat stronger association with Covid-19 diagnosis was observed among women with pre-existing DM, whether they were of normal weight (RR=1.93, 95% CI=1.18, 3.17) or overweight/obese (RR=2.32, 95% CI=1.82, 2.97). When the sample was restricted to those with a RT-PCR or antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation, or controlling for month of enrollment, the observed associations were comparable. Conclusion DM and overweight/obesity are risk factors for Covid-19 diagnosis in pregnancy, and insulin-dependent GDM is also associated with the disease. It is therefore essential that those women with these co-morbidities are vaccinated.
Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorio... more Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction. Material and methods This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low r...
International Journal of Gynecology & Obstetrics, 2020
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global health emergency... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global health emergency [1, 2], with Lombardy being the epicenter of this outbreak in Italy [3].
Background The impact of the Covid-19 infection on patients with chronic endocrine disease is not... more Background The impact of the Covid-19 infection on patients with chronic endocrine disease is not fully known. We describe here the first case of a pregnant woman with Covid-19 acute infection and non-classical congenital adrenal hyperplasia (NCAH). Case description A woman at 36 weeks of gestation was referred to our Maternity Hospital for premature rupture of membranes (PROM). Her medical history was positive for NCAH on chronic steroid replacement till the age of 17 years (cortisone acetate and dexamethasone, both in the morning). At admission, her naso-oro-pharyngeal swab resulted positive for SARS-CoV-2. Due to hyperpyrexia and late preterm PROM, cesarean section was planned, and she was started on a 100 mg-bolus of hydrocortisone, followed by continuous infusion of 200 mg/24 h. A female neonate in good clinical condition and with a negative nasopharyngeal Covid-19 swab was delivered. On second postpartum day, the mother was in good condition and was switched to oral steroid th...
International Journal of Environmental Research and Public Health, 2021
The new coronavirus emergency spread to Italy when little was known about the infection’s impact ... more The new coronavirus emergency spread to Italy when little was known about the infection’s impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother–child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother–newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery roo...
INTRODUCTION The aim of our study is to describe the management of a maternity ward in a referral... more INTRODUCTION The aim of our study is to describe the management of a maternity ward in a referral center during the COVID-19 pandemic and 2020 lockdown. METHODS This is a retrospective single-center study. We analyzed the records of all women consecutively admitted to our delivery ward during lockdown and compared them with those of women admitted in the same period in 2019. RESULTS The number of patients (1260) admitted to our department in 2020 was similar (1215) to that in 2019. Among patients admitted during lockdown, 50 presented with a Sars-CoV-2 infection (3.9%). In 2020, the number of antenatal check-ups was lower than in 2019 [7.9 (1.5) vs 8.2 (1.3), p<0.001] and the rate of labor inductions was higher [436 (34.6) vs 378 (31.1), p=0.008] although no difference in delivery mode was found. Moreover, women admitted during lockdown were more likely to give birth alone [140 (11.1) vs 50 (4.1), p<0.001]. However, during 2020, the rate of mother and newborn skinto-skin conta...
Pregnancy is a prothrombotic condition characterized by a procoagulant imbalance that serves to p... more Pregnancy is a prothrombotic condition characterized by a procoagulant imbalance that serves to protect women from bleeding but increases their risk for venous thromboembolism (VTE) [1]. Coronavirus disease 2019 (COVID-19) has not spared pregnant women with regards to VTE [2]. A coagulopathy that increases the risk of thrombosis has been reported in patients with severe COVID-19 infection [3]. At present, no data are available on the hemostatic status of pregnant women with COVID-19, and whether coagulation parameters are additionally influenced by COVID-19 remains unclear.
American Journal of Obstetrics and Gynecology, 2021
Background Among non-pregnant individuals, diabetes mellitus (DM) and high body mass index (BMI) ... more Background Among non-pregnant individuals, diabetes mellitus (DM) and high body mass index (BMI) increase the risk of Covid-19 and its severity. Objective To determine whether DM and high BMI are risk factors for Covid-19 in pregnancy and whether gestational diabetes mellitus (GDM) is also associated with covid-19 diagnosis. Study Design INTERCOVID was a multinational study, conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women ≥18 years; 2071 were included in these analyses. For each woman diagnosed with Covid-19, two non-diagnosed women delivering or initiating antenatal care at the same institution were also enrolled. Main exposures were pre-existing DM or high BMI (overweight/obesity defined as ≥25 kg/m2), and GDM in pregnancy. Main outcome was a confirmed diagnosis of Covid-19 based on an RT-PCR test, antigen test, antibody test, radiological pulmonary findings, or ≥2 predefined Covid-19 symptoms at any time during pregnancy or delivery. Relationships of exposures and Covid-19 diagnosis were assessed using generalized linear models with a Poisson distribution and log link function, with robust standard errors to account for model misspecification. We also conducted sensitivity analyses: 1) restricted to those with an RT-PCR or antigen test in the last week of pregnancy; 2) restricted to those with an RT-PCR or antigen test during the entire pregnancy; 3) generating values for missing data using multiple imputation; and 4) analyses controlling for month of enrollment. In addition, among those who were diagnosed with Covid-19, we examined whether having GDM, DM, or high BMI, increased risk for having symptomatic vs. asymptomatic Covid-19. Results Covid-19 was associated with preexisting DM (RR=1.94, 95% CI=1.55, 2.42), overweight/obesity (RR=1.20; 95% CI=1.06, 1.37), and GDM (RR=1.21; 95% CI=0.99, 1.46). The GDM association was specifically among women requiring insulin, whether they were of normal-weight (RR=1.79, 95% CI=1.06, 3.01) or overweight/obese (RR=1.77, 95% CI=1.28, 2.45). A somewhat stronger association with Covid-19 diagnosis was observed among women with pre-existing DM, whether they were of normal weight (RR=1.93, 95% CI=1.18, 3.17) or overweight/obese (RR=2.32, 95% CI=1.82, 2.97). When the sample was restricted to those with a RT-PCR or antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation, or controlling for month of enrollment, the observed associations were comparable. Conclusion DM and overweight/obesity are risk factors for Covid-19 diagnosis in pregnancy, and insulin-dependent GDM is also associated with the disease. It is therefore essential that those women with these co-morbidities are vaccinated.
Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorio... more Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction. Material and methods This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low r...
International Journal of Gynecology & Obstetrics, 2020
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global health emergency... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global health emergency [1, 2], with Lombardy being the epicenter of this outbreak in Italy [3].
Background The impact of the Covid-19 infection on patients with chronic endocrine disease is not... more Background The impact of the Covid-19 infection on patients with chronic endocrine disease is not fully known. We describe here the first case of a pregnant woman with Covid-19 acute infection and non-classical congenital adrenal hyperplasia (NCAH). Case description A woman at 36 weeks of gestation was referred to our Maternity Hospital for premature rupture of membranes (PROM). Her medical history was positive for NCAH on chronic steroid replacement till the age of 17 years (cortisone acetate and dexamethasone, both in the morning). At admission, her naso-oro-pharyngeal swab resulted positive for SARS-CoV-2. Due to hyperpyrexia and late preterm PROM, cesarean section was planned, and she was started on a 100 mg-bolus of hydrocortisone, followed by continuous infusion of 200 mg/24 h. A female neonate in good clinical condition and with a negative nasopharyngeal Covid-19 swab was delivered. On second postpartum day, the mother was in good condition and was switched to oral steroid th...
International Journal of Environmental Research and Public Health, 2021
The new coronavirus emergency spread to Italy when little was known about the infection’s impact ... more The new coronavirus emergency spread to Italy when little was known about the infection’s impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother–child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother–newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery roo...
INTRODUCTION The aim of our study is to describe the management of a maternity ward in a referral... more INTRODUCTION The aim of our study is to describe the management of a maternity ward in a referral center during the COVID-19 pandemic and 2020 lockdown. METHODS This is a retrospective single-center study. We analyzed the records of all women consecutively admitted to our delivery ward during lockdown and compared them with those of women admitted in the same period in 2019. RESULTS The number of patients (1260) admitted to our department in 2020 was similar (1215) to that in 2019. Among patients admitted during lockdown, 50 presented with a Sars-CoV-2 infection (3.9%). In 2020, the number of antenatal check-ups was lower than in 2019 [7.9 (1.5) vs 8.2 (1.3), p<0.001] and the rate of labor inductions was higher [436 (34.6) vs 378 (31.1), p=0.008] although no difference in delivery mode was found. Moreover, women admitted during lockdown were more likely to give birth alone [140 (11.1) vs 50 (4.1), p<0.001]. However, during 2020, the rate of mother and newborn skinto-skin conta...
Pregnancy is a prothrombotic condition characterized by a procoagulant imbalance that serves to p... more Pregnancy is a prothrombotic condition characterized by a procoagulant imbalance that serves to protect women from bleeding but increases their risk for venous thromboembolism (VTE) [1]. Coronavirus disease 2019 (COVID-19) has not spared pregnant women with regards to VTE [2]. A coagulopathy that increases the risk of thrombosis has been reported in patients with severe COVID-19 infection [3]. At present, no data are available on the hemostatic status of pregnant women with COVID-19, and whether coagulation parameters are additionally influenced by COVID-19 remains unclear.
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Papers by Enrico Iurlaro