COVID-19 increases the risk of pregnancy complications

Pregnant women with COVID-19 appear to be at greater risk for common pregnancy complications — in addition to health risks from the virus — than pregnant women without COVID-19, suggests a study funded by the National Institutes of Health.

Pregnant women with COVID-19 appear to be at greater risk for common pregnancy complications

The study, which included nearly 2,400 pregnant women infected with SARS-CoV-2, found that those with moderate to severe infection were more likely to have a cesarean delivery, to deliver preterm, to die around the time of birth, or to experience serious illness from hypertensive disorders of pregnancy, postpartum hemorrhage, or from infection other than SARS-CoV-2. They were also more likely to lose the pregnancy or to have an infant die during the newborn period. Mild or asymptomatic infection was not associated with increased pregnancy risks.

“The findings underscore the need for women of child-bearing age and pregnant individuals to be vaccinated and to take other precautions against becoming infected with SARS-CoV-2,” said Diana Bianchi, M.D., director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study. “This is the best way to protect pregnant women and their babies.”

The study was conducted by Torri D. Metz, M.D., of the University of Utah, Salt Lake City, and colleagues in the NICHD Maternal-Fetal Medicine Units Network. It appears in the Journal of the American Medical Association. Additional funding was provided by NIH’s National Center for Advancing Translational Sciences.

The study included more than 13,000 pregnant individuals from 17 U.S. hospitals, approximately 2,400 of whom were infected with SARS-CoV-2. Participants delivered between March 1 and December 31, 2020, before SARS-CoV-2 vaccination was available. The researchers compared outcomes among those with COVID-19 to those from uninfected patients and tabulated the study results as a primary outcome — whether the patient had died from any cause or had a serious illness or condition related to common obstetric complications. They also evaluated the results in terms of several secondary outcomes, including cesarean delivery, preterm birth, and fetal and newborn death.

Women face hell in stone mining

Women in the Western Area Rural District along the Freetown Peninsula are becoming too obvious and facing hell in stone mining for daily survival.

By Isaac Kamara

A survey undertaken by this medium reveals unlike in previous years when women are sparse in stone mining, many now, because of lack, are being forced to take on the hard laborious trade much to their peril.

A woman at Bonga Wharf community that identified herself as Adama Fullah said she joined in the trade two years ago.
“I’m a widow with three children, the brother of my late husband who has been helping me is now exhausted due to the high cost of living,” she said, stating that had she engaged in the trade, her children would have, probably, starved to death.

Adama lamented how hard and tedious the work is and could not as men do it because as a woman, she lacks the strength.

“It takes a lot of effort and struggle to get a 50kg bag of broken stones that I would sell every three days to keep my home going,” she lamented.

The Chairman of Bonga Wharf stone miners, Abdul Scott, said that the rate at which women are infiltrating the trade is unimaginable and very worrying.

“They are unable to do the hardest work but they keep coming in to avoid being starved of food and some other home needs,” he averred, adding that most times the men would break the bigger stones and sell to them, which they inturn break into smaller pieces of granite for onward sales with minimal profit.

Abdul said stone mining doesn’t befit women, noting how even men who engage in the work for a long period of years most times end up suffering from many ailments, including arthritis.
“So it is pathetic to see women coming into such difficult trade,” he stated.

Another location at Yams Farm community called Upper New York is also another stone mining point with a lot of women led by a chairlady, Marie Kaisamba, who said they have formed themselves into groups so that the work wouldn’t be tedious.

Man jailed for life for sexual assault of a child

Appeal Court Judge presiding over cases at the Sexual Offences Model Court, Hon. Justice Alhaji Mohamed Momo-Jah Stevens (JA) has today sentenced Joseph Lamin, a Charcoal Burner, for sexual assault of a 9-year-old girl.

Hon. Justice Alhaji Mohamed Momo-Jah Stevens

According to the particulars of offence, Joseph Lamin who was residing at York Road in Waterloo, on the 28th day of July, 2020 engaged in an act of sexual penetration of one Mary Wilson (not real name), a child. He was brought before the Sexual Offences Model Court for sexual penetration contrary to section 19 of the Sexual Offences Act No. 12 of 2012 as repealed and replaced by section 4 of the Sexual Offences (amendment) Act of 2019, Act No. 8 of 2019.

Representing the victim, state counsel MP Sesay, applied for trial by a Judge alone instead of a Judge and Jury pursuant to Section 144 (2) of the Criminal Procedure Act of 1965 as repealed and replaced by section 3 of the Criminal Procedure (amendment) Act of 1981. His application was granted.

The Medical report endorsed by Dr. O. Claudius-Cole revealed that the victim was in severe pain and was immediately rushed to the theatre room for surgery. It further revealed that there were several bruises on her cheeks and the left side of her face close to the mouth.

“Hymen was completely ruptured and the vaginia and anus was just one big hole. The rectum and anus were torn,” the medical report stated.

In her testimony, the victim told the court that after they were attacked by three unknown persons at around 3am in the morning, she escaped and took refuge in a nearby makeshift structure but she was chased by the accused person and two of his colleagues.

She went on to explain that she was ‘gang-raped’ wherein her virginity was destroyed. According to her, the two others ran away but the police later apprehended accused Mohamed Lamin. She said after the surgery, she was later hospitalised for one month and two weeks.

Four witnesses testified including the police investigator from the Water Police Family Support Unit who explained their visit to the crime scene.

Accused Joseph Lamin who pleaded not guilty relied on his statement at the police and there was no witness to that effect. He was represented by C. Taylor Young from the Legal Aid Board who later made his plea in mitigation.

The accused committed the offence in the company of another person or persons, before or after the commission of the offence the accused used a knife and threatened the victim to be quite.

Sierra Leone: Women still struggling for a safe and enabling environment

By Isaac Unisa Kamara.

The Director of Women Against Violence and Exploitation in Society, Sierra Leone (WAVES-SL), Hannah Yambasu, said on women’s day that women in Sierra Leone are still struggling to be empowered and realize equality.

Speaking during the International Women’s Day to commemorate the event at an interdenominational church gathering, Yambasu said, “We’re not celebrating Women’s Day but commemorating it because, we’re still struggling for a safe and enabling environment that favours our equal participation in leadership and our freedom from SGBV”.

“There still remains a need for the elimination of all forms of violence against women and their protection from the traditionally disenfranchised female population; particularly in rural settings which is key to societal development.”

She said the struggle for Gender Equity and Women’s Empowerment should not only be a concept but to be applied. Hence, the reason why her organization together with like-minded partners and the Ministry of Gender and Children’s Affairs are restless until they see a safe and enabling environment for women and girls.

The Director of Rehabilitation and Development Agency Sierra Leone (RADA/SL), Dr. Augustine G. Robinson, reechoed the need for women to be empowered.

“This is a season women should be in leadership,” he noted.

He also referenced Biblical and practical examples of women who were given leadership positions, noting that it is the perfect will of God for women to take leadership positions not only in church but also in every facet of the society.

Preterm birth, prolonged labor influenced by progesterone balance

New research by the National Institutes of Health found that unbalanced progesterone signals may cause some pregnant women to experience preterm labor or prolonged labor. The study in mice — published online in the Proceedings of the National Academy of Sciences — provides novel insights for developing treatments.

During pregnancy, the hormone progesterone helps to prevent the uterus from contracting and going into labor prematurely. This occurs through molecular signaling involving progesterone receptor types A and B, referred to as PGR-A and PGR-B. In this first-of-its-kind study, the scientists showed how unbalanced PGR-A and PGR-B signaling can affect pregnancy duration.

“We used genetically engineered mouse models to alter the ratio of PGR-A and PGR-B in the muscle compartment of the uterus, called the myometrium,” said senior author Francesco DeMayo, Ph.D., head of the National Institute of Environmental Health Sciences Reproductive and Developmental Biology Laboratory. “Our team found that PGR-A promotes muscle contraction and PGR-B prevents such contraction, and we identified the biological pathways influenced by both forms.”

Previous research showed that PGR-A regulates processes involved in initiating childbirth and that PGR-B affects molecular pathways related to maintaining the normal course of pregnancy. This study builds on those findings, revealing that the relative abundance of PGR-A and PGR-B may be critical in promoting healthy pregnancy. The public health implications are significant.

Preterm birth affects 10% of all pregnancies and is the primary cause of neonatal morbidity and mortality worldwide, while prolonged labor increases the risks of infection, uterine rupture, and neonatal distress, according to the researchers.

The scientists pointed out that care for preterm deliveries can result in high social and economic costs, with infants born preterm at greater risk for experiencing disorders ranging from blindness to cerebral palsy. Prolonged labor can harm both mother and infant and lead to cesarean delivery.

Progesterone treatment aimed at preventing premature labor can help a subset of patients, but for other individuals, confounding factors may reduce effectiveness, noted Steve Wu, Ph.D., first author on the study and a staff scientist in DeMayo’s lab. Wu said that the research team found novel molecules that control uterine muscle contraction, and they could serve as future therapeutic targets. He added that the current study also may help to advance treatment for labor dystocia — the clinical name for abnormally slow or protracted labor.

“Although labor stimulation by oxytocin infusion is an approved measure to mitigate labor dystocia, serious side effects have been associated with this treatment,” said Wu. “Novel proteins that we identified as being part of progesterone signaling could serve as a key molecular switch of uterine contraction, through drug-dependent regulation of their activities,” he explained.

“Hormone signaling in pregnancy is complicated and involves both the hormone levels and the types of receptors in the uterus that sense the hormones,” said co-first author Mary Peavey, M.D., from the department of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “This publication sheds light on how hormones influence labor and can thus be used to help women when the uterus goes into labor too soon or for a prolonged period.”

NIH funds study to evaluate remdesivir for COVID-19 in pregnancy

A new study funded by the National Institutes of Health will evaluate the effects of remdesivir in pregnant women who have been prescribed the drug to treat COVID-19. The study, which will be conducted at 17 sites in the continental United States and Puerto Rico, aims to determine how pregnant women metabolize the drug and whether there are any potential side effects.

“Pregnant women with COVID-19 are at high risk for hospitalization, for intensive care admission and for needing ventilator support,” said Diana W. Bianchi, M.D., director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “There is an urgent need to identify effective treatments for this population and to determine whether drugs prescribed for other adults are appropriate for use in pregnancy.”

The study is funded by NICHD, the National Institute of Allergy and Infectious Diseases (NIAID), and the National Institute of Mental Health, all part of NIH. Called IMPAACT 2032, the study will be conducted by the NIH-funded International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network.

Originally developed to treat Ebola and Marburg virus infections, remdesivir was shown in a NIAID-funded clinical trial to accelerate recovery in patients with advanced COVID-19 disease. Remdesivir has since been approved by the U.S. Food and Drug Administration for the treatment(link is external) of COVID-19 in adults and children over age 12 years.

Although it has not been approved specifically for use in pregnancy, remdesivir can be prescribed to pregnant women if their physicians believe the drug may benefit them. However, physicians currently lack scientific evidence for the safety and efficacy of remdesivir for treating pregnant women with COVID-19. Because pregnancy may influence a drug’s effects, IMPAACT 2032 will compare remdesivir use in pregnant and non-pregnant women of reproductive age who are hospitalized with COVID-19.

The study will evaluate remdesivir’s pharmacokinetics—how a drug is absorbed, moves through the body and is broken down and eliminated in pregnant women and nonpregnant women of childbearing potential who receive it as part of clinical care. For women who received the drug within five days of delivery, samples from the plasma and umbilical cord will be analyzed for insight into remdesivir’s pharmacokinetics in the placenta. Breast milk will also be tested for remdesivir among women who are lactating. Researchers will also document potential side effects and adverse events that could occur with use of the drug.

NIH calls for greater inclusion of pregnant and lactating people in COVID-19 vaccine research

Longstanding obstacles to include pregnant and lactating people in clinical research have led to this population now deciding whether or not to receive a SARS-CoV-2 vaccine without the benefit of scientific evidence, writes Diana W. Bianchi, M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health, and colleagues. Their viewpoint article appears online in JAMA(link is external).

The manufacturers of currently available vaccines excluded pregnant and lactating people from the clinical trials needed to obtain Emergency Use Authorizations from the U.S. Food and Drug Administration. Now that the vaccines have been distributed, the U.S. Centers for Disease Control and Prevention and the FDA will obtain information from those who receive them on their potential impact during pregnancy, as well as information on infant outcomes. While these data will prove useful, pregnant people and their clinicians must make real-time decisions now about the vaccine based on little or no scientific evidence that applies specifically to them.

In 2016, the 21^st Century Cures Act established the Task Force on Research Specific to Pregnant Women and Lactating Women, representing multiple federal agencies, academia, industry and non-profit organizations. The Task Force developed recommendations on how to safely and ethically include pregnant and lactating people in clinical research. These recommendations must now be implemented to ensure pregnant people receive the same evidence that non-pregnant adults receive to make informed decisions about their medical care.

Recent findings from a National Institutes of Health study suggest COVID-19 during pregnancy can carry a higher risk for complications. Pregnant people need to be protected through research rather than from research, the authors contend.