VINCENT DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

COVID-19 in Pregnancy

When the COVID-19 pandemic erupted, the Vincent Department of Obstetrics and Gynecology at Massachusetts General Hospital recognized it had a job to do — to provide exceptional care to infected pregnant women and their babies. Our strong commitment to science and evidence-based medicine ideally positioned us to launch the “COVID-19 in Pregnancy” research program in 2020. Three investigational avenues are underway, powered by a team of dedicated front-line clinicians and laboratory scientists.

Mother-Baby Biology

The Vincent Department of OB/GYN seeks to understand pregnant women’s immune response to COVID-19, the risk of transmission of the virus to babies, and how the maternal immune response and inflammation could potentially impact the developing fetus. This also is critical to understanding how pregnant women might respond to vaccines and therapies. To get answers, the department created the COVID-19 Biobank, an important resource created by faculty and fellows from our department, partnering with colleagues in Pediatrics and Infectious Disease. Our goal is to enroll 200 mother-baby pairs and study a variety of biospecimens collected throughout pregnancy and the postpartum period.

Principal Investigator
Andrea Edlow, MD, MSc
Investigator, Vincent Center for Reproductive Biology
Specialist in Maternal-Fetal Medicine, Vincent OB/GYN Division of Maternal-Fetal Medicine
Assistant Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School

Epidemiology and Outcomes

Between March and July 2020, the Vincent team cared for more than 300 pregnant women with COVID-19. But how infection affects pregnant women’s health and the health of their offspring is relatively unknown because only small numbers of pregnant women and children with COVID-19 have been described in the world’s literature. Previous experience with other coronaviruses and influenza suggests pregnant women may be susceptible to more severe disease and adverse pregnancy outcomes, such as preterm delivery and stillbirth. We are establishing and following clinical cohorts to understand COVID-19’s impact on women’s health during pregnancy and their infants.

Principal Investigator
Adeline Boatin, MD, MPH
Obstetrician/Gynecologist, Vincent Department of OB/GYN
Assistant Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
Affiliate Faculty, Program for Global Surgery and Social Change at Harvard Medical School and the Center for Global Health at Mass General

Pregnancy Experience During a Pandemic

As the COVID-19 pandemic has introduced an unprecedented context of global uncertainty, including its impact on pregnant women, we have designed a qualitative study in which 60 patients will be asked to share their experience being pregnant during the pandemic and how this crisis has affected their pregnancy care and birth experience as well as their mental health, social support systems, economic security, food security and coping strategies. We also hope to identify racial and ethnic inequities related to COVID-19, which can help inform clinical protocols and interventions to support pregnant, delivering and postpartum women during the later stages of this and future pandemics.

Principal Investigator
Ilona Goldfarb, MD, MPH
Specialist in Maternal-Fetal Medicine, Vincent OB/GYN Division of Maternal-Fetal Medicine
Instructor in Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
Associate Clerkship Director for OB/GYN, Director of Maternal-Fetal Medicine Sub-I, Harvard Medical School

What We've Learned So Far

To date, the Vincent Department of OB/GYN at Mass General has published the following articles on COVID-19 in professional journals (Vincent faculty and fellows in boldface). The expertise of Vincent OB/GYN faculty also is sought by the news media to inform the general public about COVID-19 (see Headline News).

Shook LL, Bordt EA, Meinsohn MC, Pepin D, De Guzman RM, Brigida S, Yockey LJ, James KE, Sullivan MW, Bebell LM, Roberts DJ, Kaimal AJ, Li JZ, Schust D, Gray KJ, Edlow, AG. Placental expression of ACE2 and TMPRSS2 in maternal severe acute respiratory syndrome coronavirus 2 infection: are placental defenses mediated by fetal sex? J Infect Dis. 2021 Dec;224:S647-S659.

Sullivan K, Belfort MB, Melvin P, Angelidou A, Peaceman A, Shui JE, Vaidya R, Singh R, Bartolome R, Patrizi S, Chaudhary N, Goldfarb IT, Culic I, Yanni D, Gupta M, Hudak M, Parker MG. Leveraging the Massachusetts perinatal quality collaborative to address the COVID-19 pandemic among diverse populations. J Perinatol. 2021 Nov;41:2674-2683. Epub 2021 Jul 5.

Bordt EA, Shook LL, Atyeo C, Pullen KM, De Guzman RM, Meinsohn MC, Chauvin M, Fischinger S, Yockey LJ, James K, Lima R, Yonker LM, Fasano A, Brigida S, Bebell LM, Roberts DJ, Pépin D, Huh JR, Bilbo SD, Li JZ, Kaimal A, Schust D, Gray KJ, Lauffenburger D, Alter G, Edlow AG. Maternal SARS-CoV-2 infection elicits sexually dimorphic placental immune responses. Sci Transl Med. Epub 2021 Oct 19.

Atyeo C, DeRiso EA, Davis C, Bordt EA, De Guzman RM, Shook LL, Yonker LM, Fasano A, Akinwunmi B, Lauffenburger DA, Elovitz MA, Gray KJ, Edlow AG, Alter G. COVID-19 mRNA vaccines drive differential antibody Fc-functional profiles in pregnant, lactating, and non-pregnant women. Sci Transl Med. Epub 2021 Oct 19.

Shook L, Kishkovich T, Edlow A. Countering COVID-19 vaccine hesitancy in pregnancy: The “4 Cs.” Am J Perinatol. Epub 2021 October.

Shook L, Fallah P, Silberman J, Edlow A. COVID-19 vaccination in pregnancy and lactation: current research and gaps in understanding. Front Cell Infect Micro. 2021 Sep;11:899.

Gray KL, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, Medina Baez A, Shook LL, Cvrk D, James K, DeGuzman R, Brigida S, Diouf K, Goldfarb I, Bebell LM, Yonker LM, Fasano A, Rabi A, Elovitz MA, Alter G, Edlow AG. COVID-19 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol. 2021 Sep;225(3). Epub 2021 March 26.

Goodman A. The impact of isolation on mental health during the COVID-19 pandemic. Psychol. 2021 Aug;12(8):1211-1216.

Shook LL, Bordt EA, Meinsohn MC, Pepin D, De Guzman RM, Brigida S, Yockey LJ, James KE, Sullivan MW, Bebell LM, Roberts DJ, Kaimal AJ, Li JZ, Schust D, Gray KJ, Edlow AG. Placental expression of ACE2 and TMPRSS2 in maternal SARS-CoV-2 infection: are placental defenses mediated by fetal sex? J Infect Dis. Epub 2021 Jul 22.

Sinnott CM, Freret TS, Clapp MA, Reiff E, Little SE. Investigating decreased rates of nulliparous cesarean deliveries during the COVID-19 pandemic. Am J Perinatol. Epub 2021 Jul 19.

Bunnell ME, Koenigs KJ, Roberts DJ, Quade BJ, Hornick JL, Goldfarb IT. Third trimester stillbirth during the first wave of the SARS-CoV-2 pandemic: similar rates with increase in placental vasculopathic pathology. Placenta. 2021 Jun;109:72-74. Epub 2021 Apr 19.

Hammer KC, Fruh V, Linden K, Mahalingaiah S, A look into at-home fertility evaluations during the COVID-19 government mandated clinical closure. Fertil Steril. Epub 2021 May 04.

Jaffe EF, Lyerly AD, Goldfarb IT. Advancing research in pregnancy during COVID-19: missed opportunities and momentum in the US. Med. 2021 May 14;2(5):460-464.

Angelidou A, Sullivan K, Melvin PR, Shui JE, Goldfarb IT, Bartolome R, Chaudhary N, Vaidya R, Culic I, Singh R, Yanni D, Patrizi S, Hudak ML, Parker MG, Belfort MB. Association of maternal perinatal SARS-CoV-2 infection with neonatal outcomes during the COVID-19 pandemic in Massachusetts. JAMA Netw Open. 2021 Apr 1;4(4):e217523.

Jaffe E, Goldfarb IT, Lyerly AD. The costs of contradictory messages about live vaccines in pregnancy. Am J Public Health. 2021 Mar;111(3):498-503. Epub 2021 Jan 21.

Mayopoulos GA, Ein-Dor T, Dishy GA, Nandru R, Chan SJ, Hanley LE, Kaimal AJ, Dekel S. COVID-19 is associated with traumatic childbirth and subsequent mother-infant bonding problems. J Affect Disord. 2021 Mar 1;282:122-125.

Bartsch YC, Wang C, Zohar T, Fischinger S, Atyeo C, Burke J, Kang J, Edlow AG, Fasano A, Nilles EJ, Woolley AE, Karlson EW, Hopke AR, Irimia D, Fischer ES, Ryan ET, Charles R, Julg BD, Lauffenburger DA, Yonker LM, Alter G.Humoral signatures of protective and pathological SARS-CoV-2 infection in children. Nature Medicine. Epub 2021 Feb 12.

Atyeo C, Pullen KM, Bordt EA, Fischinger S, Burke J, Michell A, Slein MD, Loos C, Shook LL, Boatin AA, Yockey LJ, Pepin D, Meinsohn MC, Nguyen NMP, Chauvin M, Roberts D, Goldfarb IT, Matute JD, James KE, Yonker LM, Bebell LM, Kaimal AJ, Gray KJ, Lauffenburger D, Edlow AG, Alter G. Compromised SARS-CoV-2-specific placental antibody transfer. Cell. 2021 Feb 4;184(3):628-642. Epub 2020 Dec 23.

Jering KS, Claggett BL, Cunningham JW, Rosenthal N, Vardeny O, Greene MF, Solomon SD. Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19. JAMA Intern Med. Epub 2021 Jan 15.

Reale, SC, Lumbreras‐Marquez MI, King, CH, BurnsSL, Fields KG, Diouf K, Goldfarb IT, Ciaranello AL, Robinson J, Gregory KE, Huybrechts KF, Bateman BT. Patient characteristics associated with SARS‐CoV‐2 infection in parturients admitted for labour and delivery in Massachusetts during the spring 2020 surge: a prospective cohort study. Paediatr Perinat Epidemiol. 2021 Jan;35(1)24-33.

Sheridan SD, Thanos JM, De Guzman RM, McCrea LT, Horng J, Fu T, Sellgren CM, Perlis RH, Edlow AG. Umbilical cord blood derived microglia-like cells to model COVID-19 exposure. Translational Psych. Epub 2021 Mar 19.

Edlow AG, Li JA, Collier AY, Atyeo C, James KE, Boatin AA, Gray KJ, Bordt EA, Shook LL, Yonker LM, Fasano A, Diouf K, Croul N, Devane S, Yockey LJ, Lima R, Shui J, Matute JD, Lerou PH, Akinwunmi BO, Schmidt A, Feldman J, Hauser BM, Caradonna TM, De la Flor D, D’Avino P, Regan J, Corry H, Coxen K, Fajnzylber J, Pepin D, Seaman, MS, Barouch DH, Walker BD, Yu XG, Kaimal AJ, Roberts DJ, Alter G. Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic. JAMA Netw Open. 2020 Dec 1;3(12):e2030455.

Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, Appleman L, Chiu ML, Fialkowski A, De la Flor D, Lima R, Bordt EA, Yockey LJ, D’Avino P, Fischinger S, Shui JE, Lerou PH, Bonventre JV, Yu XG, Ryan ET, Bassett IV, Irimia D, Edlow AG, Alter G, Li JZ, Fasano A. Pediatric Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2): clinical presentation, infectivity, and immune responses. J Pediatr. 2020 Dec; 227:45-52.

Afshar Y, Gaw SL, Flaherman VJ, Chambers BD, Krakow D, Berghella V, Shamshirsaz AA, Boatin AA, Aldrovandi G, Greiner A, Riley L, Boscardin WJ, Jamieson DJ, Jacoby VL. Clinical presentation of coronavirus disease 2019 (COVID-19) in pregnant and recently pregnant people. Obstetr Gynecol. 2020 Dec:136(6):1117-1125. Epub 2020 Oct 07.

Jaffe E, Lyerly AD, Goldfarb IT. Pregnant women’s perceptions of risks and benefits when considering participation in vaccine trials. Vaccine. 2020 Oct 14;38(44)6922-6929. Epub 2020 Sep 03.

Safaee Fakhr B, Wiegand SB, Pinciroli R, Gianni S, Morais CCA, Ikeda T, Miyazaki Y, Marutani E, Di Fenza R, Larson GM, Parcha V, Gibson LE, Chang MG, Arora P, Carroll RW, Kacmarek RM, Ichinose F, Barth WH Jr, Kaimal A, Hohmann EL, Zapol WM, Berra L. High concentrations of nitric oxide inhalation therapy in pregnant patients with severe coronavirus disease 2019 (COVID-19). Obstet Gynecol. 2020 Dec;136(6):1109-1113. Epub 2020 Aug 26.

Soffer MD, Shook LL, James K, Sawyer MR, Ciaranello A, Mahrouk R, Bernstein SN, Boatin AA, Edlow AG, York-Best C, Kaimal AJ, Goldfarb IT. Protocol-driven intensive outpatient management of pregnant patients with symptomatic COVID-19. Open Forum Infect Dis. 2020 Nov;7(11):ofaa524.

Daubman B-R, Black L, Goodman A. Recognizing moral distress in the COVID-19 pandemic: lessons from global disaster response. J Hosp Med. 2020 Nov;15(11):696-698. Epub 2020 Sept 23.

Burwick RM, Yawetz S, Stephenson KE, Collier AY, Sen P, Blackburn BG, Kojic EM, Hirshberg A, Suarez JF, Sobieszczyk ME, Marks KM, Mazur S, Big C, Manuel O, Morlin G, Rose SJ, Naqvi M, Goldfarb IT, DeZure A, Telep L, Tan SK, Zhao Y, Hahambis T, Hindman J, Chokkalingam AP, Carter C, Das M, Osinusi AO, Brainard DM, Varughese TA, Kovalenko O, Sims MD, Desai S, Swamy G, Sheffield JS, Zash R, Short WR. Compassionate use of remdesivir in pregnant women with severe coronavirus disease 2019. Clin Infect Dis. Epub 2020 Oct 08.

Sawyer MR, Jaffe EF, Naqvi M, Sarma A, Barth WH, Goldfarb IT. Establishing better evidence on remote monitoring for postpartum hypertension: a silver lining of the coronavirus pandemic. AJP Rep. 2020 Jul;10(03): e315-e318. Epub 2020 Sep 23.

Duzyj CM, Thornburg LL, Han CS. Practice modification for pandemics: a model for surge planning in obstetrics. Obstet Gynecol. 2020 Aug;136(2):237–251. Epub 2020 Jun 02.

Goldfarb IT, Clapp MA, Soffer MD, Shook LL, Rushfirth K, Edlow AG, Boatin AA, Kaimal AJ, Barth WH Jr, Bryant AS. Prevalence and severity of coronavirus disease 2019 (COVID-19) illness in symptomatic pregnant and postpartum women stratified by Hispanic ethnicity. Obstet Gynecol. 2020 Aug;136(2):300–302. Epub 2020 Jun 02.

Duzyj Buniak C, Khachadoorian-Elia H, Berkowitz LR. The positives of the pause: lessons learned from the COVID-19 pandemic. ACOG Frontline Voices: Members stories from the COVID-19 pandemic. Epub 2020 May 26.

Kaimal A, Goldfarb I, Aurora M, Hanley L. How does SARS-CoV-2 change peri- and postpartum care? FLARE 2020.

Shook L, Shui JE, MD, Boatin AA, Devane S, Natalie Croul N, Yonker LM, Matute JD, Lima RS, Schwinn M, Cvrk D, Gardner L, Azevedo R, Stanton S, Bordt EA, Yockey LJ, Fasano A, Li JZ, Yu XG, Kaimal AJ, Lerou PH, Edlow AG. Rapid establishment of a COVID-19 perinatal biorepository: early lessons from the first 100 women enrolled. BMC Med Res Methodol. 2020 Aug 26;20(1)215.