ORCID Profile
0000-0003-4711-3857
Current Organisations
University of Barcelona
,
Instituto Nacional de Perinatologia
,
University of Oxford
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Publisher: Public Library of Science (PLoS)
Date: 16-06-2022
DOI: 10.1371/JOURNAL.PONE.0270150
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 in idual 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.
Publisher: Wiley
Date: 06-09-2021
DOI: 10.1002/UOG.23668
Abstract: To examine the possible risk factors amongst maternal characteristics, medical and obstetric history, pre‐ecl sia (PE)‐specific biomarkers and estimated‐risk group, according to The Fetal Medicine Foundation (FMF) algorithm, that are associated with the development of preterm PE with delivery at 37 weeks' gestation despite aspirin prophylaxis. This was a secondary analysis of data from the ASPRE trial. The study population consisted of women with singleton pregnancy who were deemed to be at high risk for preterm PE, based on the FMF algorithm that combines maternal factors, mean arterial pressure, uterine artery pulsatility index, serum pregnancy‐associated plasma protein‐A and placental growth factor (PlGF) at 11–13 weeks' gestation. High‐risk women were randomized to receive aspirin (150 mg/day) vs placebo from 11–14 until 36 weeks' gestation. The primary outcome was PE with delivery at 37 weeks' gestation (preterm PE). Multivariate logistic regression analysis was performed to identify independent predictors of preterm PE after adjusting for the use of aspirin and other covariates. Among 1592 high‐risk women, the incidence of preterm PE was 3.0% ( n = 48). The interaction between aspirin usage and history of chronic hypertension was significant in the prediction of preterm PE ( P = 0.042), which indicated that there was no treatment effect in high‐risk women who had chronic hypertension compared with those who did not. Adjusting for aspirin use, the interaction between aspirin and chronic hypertension and other covariates, independent predictors for the development of preterm PE were PlGF multiples of the median (MoM) (adjusted odds ratio (aOR), 0.226 (95% CI, 0.070–0.723)) and estimated‐risk group based on the FMF algorithm. Compared to women with an estimated risk of 1 in 51 to 1 in 100, those with an estimated risk of 1 in 2 to 1 in 10 had a 7‐fold higher risk of developing preterm PE (aOR, 6.706 (95% CI, 2.381–18.883)), and those with an estimated risk of 1 in 11 to 1 in 50 had a 3‐fold higher risk of preterm PE (aOR, 2.769 (95% CI, 1.105–6.939)). PlGF MoM was an independent predictor for preterm PE among women with an estimated risk of 1 in 2 to 1 in 10 (aOR, 0.055 (95% CI, 0.005–0.668)). Among women with an estimated risk of 1 in 11 to 1 in 100, the use of aspirin was an independent predictor of preterm PE (aOR, 0.276 (95% CI, 0.111–0.689)). The cut‐off for PlGF with the best performance for the prediction of preterm PE was 0.712 MoM, with an aOR of 3.677 (95% CI, 1.526–8.862). In pregnancies at high risk of preterm PE identified by screening at 11–13 weeks' gestation using the FMF algorithm, a very high‐risk result (estimated risk ≥ 1 in 50), compared to an estimated risk of 1 in 51 to 1 in 100, chronic hypertension, compared to no chronic hypertension, and low PlGF concentration ( 0.712 MoM), compared to PlGF ≥ 0.712 MoM, were associated with the development of preterm PE despite aspirin prophylaxis. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJGH-2022-009495
Abstract: 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. We screened ongoing studies in our sequential, prospective meta-analysis. We pooled in idual 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. 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. 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.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Raigam Jafet Martinez Portilla.