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Unicamp leads WHO study in Brazil on the impact of covid-19 on pregnancy

Preliminary results show that only half of pregnant women with symptoms have been tested in participating maternity hospitals

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A group of professors and researchers from the Faculty of Medical Sciences (FCM), which leads a Brazilian network of studies in Reproductive and Perinatal Health from the Center for Comprehensive Attention to Women's Health (Caism) at Unicamp, will coordinate a simultaneous study in several maternity hospitals in the country about the impacts of Covid-19 on pregnancy, at the invitation of the World Health Organization (WHO). In addition to Brazil, at least six other countries will participate in the research: Argentina, Chile, India, Bangladesh, Iran and Kenya.

Since the beginning of the pandemic, researchers from this network – which has existed for more than 12 years and brings together almost 30 maternity hospitals across the country, most of them linked to universities – had already been collecting samples and data to try to understand how the new coronavirus can affect pregnant women and newborns, an initiative called the Brazilian Network for Covid-19 Studies in Obstetrics (Rebraco). The first phase of the study included resources from the Teaching, Research and Extension Support Fund (Faepex), the Pro-Rectorate of Research at Unicamp, and other public notices and funding agencies, allowing the monitoring of pregnant women and data collection in 16 maternity hospitals in the network throughout 2020.

Now, the researchers will count on an initial investment of 220 thousand dollars from the World Health Organization, an amount that will be used mainly to prepare the 10 maternity wards and teams selected to participate in the second phase of the study, focusing on the application of a generic protocol developed by WHO, which will be adapted to the reality of each center. The forecast is to receive at least another 800 thousand dollars from the Organization over the next two years, to be able to accompany pregnant women and babies during prenatal care, childbirth and the postpartum period, that is, the period of up to six weeks after birth.

Only half of pregnant women with symptoms are being tested

Among the data collected in the first phase of the study, it is noteworthy that only half of pregnant women with symptoms of coronavirus infection have been tested in participating maternity hospitals. According to Professor Maria Laura Costa do Nascimento, one of the research coordinators, the ideal would be, as recommended by the Ministry of Health, to carry out universal testing – that is, to test all women admitted for childbirth, regardless of the presence of symptoms. “Most places are only able to test hospitalized cases, which is a limitation for understanding the prevalence of the disease in a risk group such as pregnant women”, she laments.

Until September last year, among Rebraco's maternity hospitals, only Caism was able to carry out universal testing – today, only three other centers in the network were enabled and are able to do the same. For professor José Guilherme Cecatti, who also leads the study in Brazil, it is notable that there is a lack of tests for university centers, while news continues to circulate about the existence of tests losing their validity in the country.

The scenario further reinforces the importance and impact of the resources that will be invested by the WHO in the study, which in large part will be used to expand testing in participating maternity hospitals. As Maria Laura explains, it will be possible to test pregnant women at three stages: at the beginning of prenatal care, in the third trimester of pregnancy, and at birth. “This way we will have an idea of ​​how many patients are positive, and how many were negative and positive throughout the pregnancy. This is the opportunity we have now: to follow women even before the disease”, she reinforces. To this end, both serological tests will be carried out, which indicate whether the pregnant woman has had contact with the coronavirus at some point, and PCR tests, which reveal active infection.

The WHO protocol also involves collecting samples, during birth, from pregnant women who test positive: the idea is to investigate the presence of the virus in the umbilical cord, placenta, amniotic fluid and other materials that will be stored for later analysis. Another difference of the research will be that it will allow us to monitor, at the same time, groups of pregnant women with and without Covid-19, in order to compare the effects of exposure to the coronavirus in the long term, a methodology called a cohort study.

Researcher Renato Souza, who is also part of the team coordinating the study, also highlights the application that is being created to improve monitoring of pregnant women, avoiding trips to health centers and unnecessary exposure to the virus. “It’s actually opening another channel of communication with these women. We saw, as health professionals and in our surveys too, how much care ended up moving away during the pandemic”, he explains.

According to Professor Cecatti, two other projects related to the cohort study will be carried out by the network with funding from the WHO: one on the characteristics of the health system, and another that involves a qualitative analysis of the experience of pregnant women, partners and health professionals during the pandemic. “This entire group brings a certain professional and scientific maturity to the group, which allows us to be aligned with several other research groups, development institutions and universities around the world, forming partnerships that are important not only from a scientific point of view, but also to generate knowledge in which Brazil is involved”, he highlights.

 

Covid-19 and pregnancy: what scientists already know

According to Professor Maria Laura, there is already a consensus that pregnant women are part of the risk group for Covid-19, that is, that pregnancy increases the chances of a woman developing a serious illness and needing intensive therapy, which It usually happens mainly in the third trimester of pregnancy. The risk of premature births or cesarean section is also increased in infected pregnant women, which applies especially to severe cases of the disease. Complications such as pre-eclampsia (increased blood pressure during pregnancy) are still the subject of debate among scientists, although there is evidence that the coronavirus helps trigger responses similar to those of pre-eclampsia in its severe form.

But there is also good news. Researchers already know that coronavirus infection does not appear to be associated with an increased risk of fetal malformation, and also that the transmission of the disease from mother to baby, the so-called vertical transmission, has proven to be a possible event, although rare and generally without severity for the child's health. The safety of breastfeeding has also been confirmed.

Therefore, while scientists continue to search for the missing answers, the guidance for pregnant women and their companions is to keep prenatal care up to date, reinforce preventive care and social isolation, and seek medical care even when symptoms do not appear to be related. to covid-19.

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Unicamp leads WHO study in Brazil on the impact of covid-19 on pregnancy

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