African American female doctor preparing a pregnant woman for a COVID-19 vaccination.

Congenital heart disease in a patient with COVID-19 infection during early pregnancy: a case report

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Background: Since the end of 2019, the world has been afflicted by a coronavirus pandemic caused by coronavirus 2 (severe acute respiratory syndrome) (SARS-CoV-2). COVID-19 causes a wide range of signs and symptoms with varying consequences. The impact of the COVID-19 infection on pregnant women and their fetuses is still under investigation.

Case presentation: A case of a 34-years-old non-vaccinated pregnant woman who had a COVID-19 infection in the first month of her pregnancy and went into premature labor at 34 weeks was reported. Congenital heart disease and hydrops were present in the fetus. The infant girl was cyanotic after delivery, experienced bradycardia, and was in poor overall condition; she was admitted to the NICU and died 5 days later.

Conclusions: Some theories suggest that SARS-CoV-2 may be transmitted vertically from mother to fetus. Congenital abnormalities can be caused by a variety of viruses. Although, congenital heart diseases can occur due to different causes, we suggest that COVID-19 may play a role in the development of congenital heart defects.

Keywords: COVID-19; Case report; Congenital heart disease; Pregnancy.

Read the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9419912/

Pregnant woman sitting on a couch, looking out the window with a concerned expression, wearing a mask.

Blog – Delta Danger in Pregnancy Scrutinized

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Research detects COVID variant in blood, placentas of women who had stillbirths, pregnancy complications

A growing body of evidence has linked the Delta variant of SARS-CoV-2, the virus that causes COVID-19, with an increased risk for pregnancy complications, including stillbirths. Now, for the first time, researchers at Massachusetts General Hospital and Brigham and Women’s Hospital have detected the Delta variant in the blood and placentas of women who had stillbirths and serious pregnancy complications, which they report in the Journal of Infectious Diseases.

Prior studies have indicated that COVID-19 poses a threat to pregnant women and fetuses. Recently, suspicion has arisen that the Delta variant of SARS-CoV-2 may be particularly dangerous during pregnancy. In late November, the Centers for Disease Control and Prevention reported that pregnant women with COVID-19 were four times likelier to have miscarriages than uninfected pregnant women during the period when the Delta variant was causing the majority of SARS-CoV-2 infections in the U.S. Stillbirth describes the death of a fetus after 20 weeks of pregnancy.

Earlier in the pandemic, before Delta became the dominant strain in the U.S., Andrea Edlow, a maternal-fetal medicine specialist at MGH, and several colleagues had studied 64 pregnant women with COVID-19 and found that none had detectable levels of SARS-CoV-2 in their blood or placentas. But as the Delta variant swept across the country in 2021, Edlow began to have her own suspicions. “It seemed like we were seeing even more sick moms and a disproportionate number of stillbirths,” Edlow said.

Edlow and her team received permission to analyze the nasal swabs, umbilical cord blood, and placentas of three women who had COVID-19 late in their pregnancies, none of whom had been vaccinated against the coronavirus. Two of the women had stillbirths and a third woman’s fetus experienced distress and was delivered by urgent cesarean birth (C-section). These blood and tissue samples underwent viral sequencing at BWH in the translational virology laboratory directed by Jonathan Li.

“This was definitely different from what we saw with the ancestral strain of SARS-CoV-2 during the first part of the pandemic.”

— Andrea Edlow, maternal-fetal medicine specialist at Massachusetts General Hospital
The results were striking. “All the moms had detectable virus in the bloodstream. All had high levels of detectable virus in their nasal swabs. All had infected placentas,” said Edlow. And viral sequencing confirmed that each woman was infected with the Delta variant of SARS-CoV-2. “This was definitely different from what we saw with the ancestral strain of SARS-CoV-2 during the first part of the pandemic.”Li notes that while COVID-19 is widely thought of as a pulmonary disease, studies indicate that when SARS-CoV-2 enters the bloodstream (known as viremia) it can travel throughout the body and cause organ failure and other severe complications. “Our testing showed that the virus was widely disseminated in these three patients,” Li said. That appears to have resulted in severe inflammation of the placenta, which likely caused the stillbirths and complications. “This represents another example of the systemic manifestations of COVID-19.”Why the Delta variant is a greater threat to pregnancy than earlier strains of SARS-CoV-2 is unknown, as is the potential impact of Omicron, the variant identified shortly after Thanksgiving. However, Edlow hopes these findings can help bolster public health messaging aimed at battling misinformation that leads pregnant women to fear COVID-19 vaccines. She notes that more than 170,000 pregnant women have been vaccinated and, reassuringly, there’s no evidence that the injections increased the risk for birth defects or any form of pregnancy complications. “Yet stillbirth, preterm birth, and poor neonatal outcomes are all associated with getting COVID-19,” Edlow said. “If you want to do the best thing for your baby, get vaccinated.”Edlow is also an assistant professor of obstetrics, gynecology, and reproductive biology and Li is an associate professor of medicine at Harvard Medical School.
Mother just gave birth, with doctors placing the newborn on her chest. The mother looks ecstatic.

Tips for Coping with a New Baby During COVID-19

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All babies cry. Most babies cry a lot from two weeks to two months of age. Some cry more than others, and some cry longer than others. For many new parents, crying is one of the most stressful parts of coping with a newborn.

In some cases, extreme stress and a temporary lapse of emotional control in a caregiver can lead to actions that result in abusive head trauma. In fact, the most common trigger for abusive head trauma is simply a crying baby. As an American Academy of Pediatrics policy statement points out, actions that lead to abusive head trauma often happen when caretakers experience stress and get to the end of their rope.

However, there is a bright side: The key to preventing actions that lead to abusive head trauma is to understand how common feelings of frustration, isolation, and exhaustion are during the first few months of an infant’s life.

Helpful tips

Usually, new parents can seek out social supports and external help—but what happens when we are restricted in our movements and our contacts? What happens when families face childcare challenges and more ongoing fallout from the COVID-19 pandemic? Here are a few suggestions:

  • Try all the soothing tricks. Crying babies want to be soothed. You may need to try a few things, over and over, before they calm. Try holding them, feeding them, swaddling them, gently rocking them, singing to them. If these don’t work, put the baby down and take a break. Be sure your baby is in a safe sleep environment (on their back on a firm sleep surface with a tight-fitting sheet, away from soft blankets, toys, pillows, and other bedding materials). While some babies cry for a long time, many parents are surprised at how rapidly babies will cry themselves to sleep.
  • Pay attention to your own needs. The challenges of new mothers can certainly feel overwhelming sometimes. Rest as much as you can—try sleeping when the baby does. Find time for yourself when your partner or other caring adult watches the baby. Put on your headphones, give a friend or relative a call, have a cup of tea, or just relax.
  • Connect with others. Social distancing during the COVID-19 outbreak can be isolating. Try video chats or social media to stay in touch. If you’re a friend or relative on the receiving end of these calls, listen first before offering suggestions. Imagine you are with the young parent, they are crying on your shoulder, and you are offering reassurance without any words. Keeping this image in mind can help you provide the social support that all new parents need.
  • Use your “helpers.” Engage older siblings as much as you can by encouraging them to be your special helpers, so they can help out in developmentally appropriate ways.
  • Seek help. Depression is the most common mental illness in the United States. If you had a history of depression before your baby was born, you may be at higher risk for postpartum depression. Speak with your provider sooner rather than later to help foresee this potential condition. Many doctors, nurses, and mental health providers are now set up for telehealth visits and may be able to help you by video or phone.
  • Reach out. If you are a friend, relative, or neighbor to a family with a newborn, this is the time to reach out. Think about ways you can help. In addition to social support, can you buy diapers or other baby supplies? Can you drop off food or treats for the siblings or adults? Can you safely supervise older children outdoors? Maybe they could come along with you when you walk your dog!
  • Help a co-worker out. If you are a co-worker of a parent returning to work (especially during social distancing) after parental leave, be kind and supportive. If you see or hear the baby on the call, say Hi!
  • Find a forum. New mothers may find it helpful to discuss their experiences with other new mothers. In addition to seeking help from friends, relatives, neighbors, and medical professionals, look for discussion forums and communities of moms dedicated to sharing problems, stories, and tips with each other online (see the list of resources below).
  • Your pediatrician is here to help. Never hesitate to call for advice. Your pediatricians is an excellent resource for understanding your baby and your own needs, including those related to postpartum depression.
  • Resources. Here are a few key resources that may be helpful to you at home:

Parents Say COVID-19 Harming Child’s Mental Health

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Even as U.S. schools reach the end of a severely disrupted 2019-2020 academic year, they are considering ways for students and staff to safely return to classrooms in the fall. Administrators will be working to understand and address students’ learning loss after months of remote schooling and to meet the increased social and emotional needs of children since the pandemic — all while blunting the potential spread of COVID-19 in schools.

 

The potential for heightened mental health challenges confronting schools in the fall is evident in new Gallup Panel polling of parents with school-aged children conducted via the web in May. Nearly three in 10 (29%) say their child is “already experiencing harm” to their emotional or mental health because of social distancing and closures. Another 14% indicate their children are approaching their limits, saying they could continue social distancing a few more weeks until their mental health suffers. While children make up relatively few cases among confirmed COVID-19 patients in the U.S., these survey results suggest that pandemic response measures are taking a toll on the wellbeing of some.

The results are based on interviews with more than 1,200 parents of children in grades kindergarten through 12 whose school is closed to in-person instruction. Ninety-seven percent of parents say their child’s school is currently closed. The sample is drawn from Gallup’s probability-based online panel.

It’s not just children who are suffering. In early April, Gallup found that 15% of U.S. adults reported that they themselves were already experiencing harm to their own emotional or mental health because of social distancing practices and closures; 18% said they would be suffering in just a few more weeks. One month later, the percentage of adults already experiencing harm increased to 22%, and 13% indicated their emotional and mental health would suffer in a few more weeks. Still, in the same time period in May, more parents indicate that their children’s emotional or mental health is already suffering.

Parents with less than a college degree (33%) are more likely than those with a college degree or higher (24%) to say their child’s emotional or mental health is already suffering. There may be additional stressors for children whose parents have less educational attainment, as they are disproportionately affected by increased unemployment rates.

Parents were asked to reflect on the impact of various challenges they’ve faced with remote learning. They are most likely to say that being separated from classmates and teachers is a major challenge (45%).

Among those who say separation is a major challenge of remote learning, more than four in 10 (45%) indicate their child’s emotional and mental health is already suffering. Among all parents surveyed, relatively few (14%) say that being separated from classmates and teachers is not a challenge, but this group is less likely to indicate (8%) their child’s emotional and mental health is currently experiencing harm.

Implications

Some parents are already concerned for the emotional and mental health of their children in the midst of pandemic response measures. School closures not only upended most students’ learning mode, it deeply disrupted students’ social networks and interactions with classmates and teachers.

As social distancing restrictions ease and schools begin to plan ways to support children’s learning and growth in the upcoming school year, they will also need to consider ways to help support children’s social and emotional needs as they reacclimate to school and in-person learning. The challenge will be amplified because schools will be experimenting with new processes intended to stave off the persistent threat that the coronavirus poses to public health.

Collaboration between schools, families, community leaders and health officials will be even more critical to support children’s needs in and out of school.