Banca de DEFESA: GERALDO MAGELA FERNANDES

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : GERALDO MAGELA FERNANDES
DATE: 06/11/2023
TIME: 14:00
LOCAL: Link da videoconferência: https://conferenciaweb.rnp.br/events/defesa-de-doutorado-de-heidiluise-sch
TITLE:

 Título em inglês: PANORAMA OF SOLUBLE INFLAMMATORY MEDIATORS AMONG PREGNANT WOMEN DIAGNOSED WITH COVID-19 AT THE DIFFERENT TRIMESTERS OF PREGNANCY, NEONATAL CLINICAL OUTCOMES AND THE INFANTS' ANTHROPOMETRIC PROFILE DURING THE FIRST YEAR OF LIFE: AN EXPLORATORY STUDY.

 

KEY WORDS:

Keywords: 1. COVID-19 2. SARS-CoV-2 3. Pregnancy 4. Inflammatory soluble
mediators 5. Clinical outcomes 6. Newborn

PAGES: 40
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Background: The description of the maternal, fetal and pediatric consequences of
SARS-CoV-2 infection occurring during pregnancy and investigating the underlying
mechanisms is crucial for a better understanding of the disease and providing evidence
for better care and treatments for the mother dyad -son, based on scientific evidence.
Objectives: To characterize the physiological changes that occur in the profile of
immunological mediators during pregnancy, to study changes in the immunological
response in pregnant women infected by SARS-CoV-2 in different trimesters of
pregnancy and to correlate them with clinical and anthropometric outcomes in their
newborns. born in the perinatal period and in the first year of the infants' lives.
Methods: Study carried out in two phases. In the first phase, a prospective
observational study designed to characterize the immunological status of pregnant
women with convalescent COVID-19 and panoramic analysis of the interaction
between soluble serum inflammatory mediators took place. A sample of 141 pregnant
women from all gestational periods comprised patients with convalescent SARS-CoV-2
infection between 3 and 20 weeks after the onset of symptoms (COVID, n=89) and a
control group of uninfected pregnant women whose material for analysis of serum 

inflammatory mediators was collected in the pre-pandemic period (CG, n=52). In the
second phase, a total of 262 newborns born to pregnant women who had SARS-CoV-2
infection with the onset of symptoms during the gestational period were divided into
three groups according to the trimester in which the maternal infection occurred: 1st
trimester (n=58), 2nd trimester (n=80) and 3rd trimester (n=124). In this group,
correlations were studied between the immunological profile of pregnant women and
the severity of maternal COVID with clinical and anthropometric outcomes of their
children at birth and during the first year of life.
Results: In the first phase of the study, levels of chemokines, pro-inflammatory
cytokines, regulatory cytokines and growth factors were quantified using a high-
throughput microsphere array. In the GC group, the majority of serum soluble
inflammatory mediators showed a progressive physiological decrease in the 2nd and
3rd trimester of pregnancy, while higher levels of chemokines, cytokines and growth
factors were observed in the COVID-19 patient group. Soluble serum inflammatory
mediator signatures and heatmap analysis indicated that the greatest increase
observed in the COVID group was related to pro-inflammatory cytokines (IL-6, TNF-,
IL-12, IFN- and IL-17 ) . Analysis of a larger set of biomarkers showed an increase in
the ratio of inflammatory mediators in the COVID/GC groups in the 2nd (three-fold
increase) and 3rd (three- to 15-fold increase) trimesters. Integrative network analysis
demonstrated that pregnancy in GC evolves with decreasing connectivity between
pairs of serum soluble inflammatory mediators towards the 3rd trimester. Although the
COVID group had a similar profile, the number of connections was notably lower
throughout the pregnancy. In the second phase of the study, a higher incidence of
pregnant women who developed more severe conditions when infected in the 3rd
trimester (p<0.001) and a higher incidence of prematurity (p=0.0246) was found. There
were no differences in anthropometric measurements at birth when neonates were
compared by the gestational trimester in which the maternal infection occurred or by
the severity of maternal COVID-19. Regarding longitudinal anthropometry follow-up in
the first year of life of this group of children, less weight gain was found in the first
month of life among infants whose mothers had COVID-19 in the 2nd and 3rd
trimesters of pregnancy compared to the 1st trimester group. (p=0.0152) and less
weight gain in the group whose mothers had severe COVID (p=0.0148). In relation to
length, there was no difference in gains over the first year of life between the groups,
but in the intra-group assessment, lower gains were observed in the first month of life
among children of mothers with severe COVID and with infection in the 3rd trimester of
pregnancy. . In relation to head circumference, the intragroup assessment showed a
smaller gain in the first month in all groups, which persisted in the 6th month of life

among infants, except in the group whose mothers had COVID in the 1st gestational
trimester. The improvement in head circumference gain occurred at 12 months, except
in the group of children of mothers with non-severe COVID.
Conclusion: In the group of pregnant women with COVID-19, a pronounced increase
in serum levels of soluble inflammatory mediators was found in the 3rd trimester,
associated with a decrease in the network interaction between them. Greater severity
of COVID in pregnant women was linked to a higher incidence of prematurity and
referral of newborns to the Neonatal Intensive Care Unit. There were no differences in
the anthropometric profile of the newborns at birth, regardless of the group. However,
the anthropometric profile of infants during the first year of life revealed distinct patterns
in terms of weight gain, length, and head circumference, when comparing the groups
based on the severity of maternal COVID and the gestational period during which the
SARS-CoV-2 infection occurred.

COMMITTEE MEMBERS:
Presidente - ***.432.421-** - ALEXANDRE ANDERSON DE SOUSA MUNHOZ SOARES - UnB
Interna - 2731816 - JULIANA FORTE MAZZEU DE ARAUJO
Externa ao Programa - 1721104 - MEIMEI GUIMARAES JUNQUEIRA DE QUEIROS - UnBExterno à Instituição - PAULO ROBERTO MARGOTTO
Externa à Instituição - MARTA DAVID ROCHA DE MOURA - ESCS