Judith M. Orvos, ELS

Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.

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The origin of the RNA—maternal or fetal—remains unclear but the findings point to a need for more research on possible vertical transmission of the virus.

The American Journal of Obstetrics and Gynecology

 the account reflects outcomes of polymerase chain reaction (PCR) testing of post-delivery samples from a series of women who were diagnosed with COVID-19 during pregnancy. 

The deliveries occurred between March 1, 2020 an April 20, 2020 at NYU Langone Health, as recorded in the patients’ electronic health records.

The authors identified 32 COVID-positive mothers who met the criteria, of whom 11 had placental or membrane samples tested with reverse transcription PCR (RT-PCR) within 30 minutes after delivery. 

Testing was done with the Cepheid Xpert Xpress SARS-CoV-2 assay. All of the women had severe to critical COVID-19 at time of delivery.

Placental swabs were taken from the amniotic surface after maternal blood has been cleared from it. Membrane samples were from between the amnion and chorion after manual separation of the membranes.

Of the 11 swabs, 3 were positive for SARS-CoV-2. None of the infants tested positive for the virus on Days 1 to 5 of life or had any symptoms of COVID-19. Seven of the deliveries were vaginal and four by cesarean; all 3 of the positive results were associated with cesarean deliveries.

Commenting on the origin of the SARS-CoV-2 RNA that was detected, the authors said it may have been maternal blood, amniotic fluid, or fetal membranes and amniotic sac. In the four infants delivered vaginally, the origin also could have been vaginal secretions. 

“Although there were no clinical signs of vertical transmission,” the authors said, “the findings indicate the possibility of intrapartum viral exposure.”

Penfield CA, Brubaker SG, Lighter J, Ratner AJ, Thomas KM, Meyer JA. Detection of severe acute respiratory syndrome coronavirus 2 in placental and fetal membrane samples. 

. 2020 May 8;100133. doi: 10.1016/j.ajogmf.2020.100133

Articles

In a first-of-its-kind report, investigators from New York City have described identification of SARS-CoV-2 RNS in placenta and membrane samples at time of delivery. 

SARS-CoV-2 detected in placenta and membrane samples

Adolescents whose parents use the drug may be at higher risk of substance abuse, according to results of a new nationwide study. 

The findings, published in JAMA Network Open, are from a cross-sectional study based on survey data from the 2015 to 2018 National Survey on Drug Use and Health (NS-DUH). 

Conducted by the Substance Abuse and Mental Health Services Administration (SAMSHA), NSDUH was designed to be nationally representative of substance use among the US civilian, noninstitutionalized population aged 12 years and older. 

Participants surveyed were adolescents aged 12 to 17 who lived with a sampled parent born between 1955 and 1984 and young adults aged 18 to 30 living with a samples parent born between 1955 and 1980. 

A maximum of two people were selected for the survey from any one dwelling unit, meaning that a child and both parents living in the same home were never all included. During the interviews, which lasted approximately 1 hour, the researchers collected information on lifetime use and past-year use of tobacco, alcohol, and illicit drugs (i.e. marijuana, cocaine, heroin, hallucinogens, inhalants, and methamphetamine) and misuse of prescription opioids, stimulants, sedatives, and tranquilizers. 

Parental use of marijuana was assessed at four levels: never use, lifetime use, less than 52 days of past-year use, and 52 days or more of past-year use. 

A total of 24,900 mother-offspring or father-offspring dyads were surveyed. Of the mothers living with adolescent off spring, 8.2% (95% CI, 7.3% to 9.2%) had used marijuana in the past year while 7.6% (95% CI, 6.2% to 9.2%) of mothers living with young adult offspring, compared with 9.6% and 9.0% of fathers, respectively. 

Past-year marijuana use of was higher in adolescents whose mothers had lifetime marijuana use than in those whose mothers never used the drug (ARR 1.3; 95% CI, 1.1 to 1.6; P = .007), less than 52 days of past-year marijuana use (ARR 1.7; 95% CI, 1.1 to 2.7; P = .02), or 52 days or more of past year marijuana use (ARR 1.5; 95%CI, 1.1 to 2.2; P =.02). Similar trends were seen among young adults (P = .001, P = .049 and P = .002, respectively).

Looking at the father-offspring dy-ads, the authors found that adolescents whose fathers had less than 52 days of past-marijuana use were more likely to use marijuana than those whose fathers never used marijuana (ARR 1.8; 95% CI 1.2 to 2.7; P = .006). 

Compared with young adults whose fathers never used marijuana, young adults whose fathers had 52 days or more of past-year marijuana use were more likely to use marijuana (ARR 2.1; 95% CI 1.6 to 2.9; P < .001). 

Compared with their peers whose parents never used marijuana and after adjusting for covariates, adolescents whose mothers had lifetime marijuana use had a higher adjusted risks of past-year tobacco use, past-year marijuana use, or 52 days or more of past-year marijuana use (ARR 1.3; 95% CI 1.0 to 1.6; P = .03, ARR 1.5; 95% CI 1.0 to 2.1; P = .04, and ARR 1.6; 95% CI 1.1 to 2.3; P = .03, respectively). 

The adjusted risk was also higher for young adults whose mothers had lifetime marijuana use (ARR 1.2; 95% CI 1.0 to 1.5; P = .04). Compared with their peers whose parents had no past marijuana use and after adjusting for covariates, risk of past-year alcohol use was higher among adolescents whose mothers had lifetime marijuana use (ARR 12; 95% CI 1.1 to 1.4; P = .004) less than 52 days of past-year marijuana use (ARR 1.5; 95% CI 1.2 to 1.9; P = .002) or 52 days or more of past-year marijuana use (ARR 1.3; 95% CI 1.0 to 1.7; P = .04). 

After adjusting for covariates, parental marijuana use was not associated with opioid misuse by off spring. 

In the United States, marijuana use by adults has increased in recent years. 

Parental use and adolescent misuse of marijuana

ACOG notes that for an adolescent reproductive health visit, an internal pelvic exam may be appropriate if issues such as abnormal bleeding or discharge, or abdominal or pelvic pain is a concern, but that an adolescent may visit a gynecologist several times before a biannual exam is needed. 

If a speculum or bimanual exam is indicated, a thorough explanation should always precede the procedure. Patients can find information about a gynecologic visit in the ACOG FAQ document, “Your First Gynecological Visit (Espe-cially for Teens)”. Pap tests are not recommended until age 21.

Published in JAMA Internal Medicine, the new fi ndings are from a cross-sec-tional analysis of the National Survey of Family Growth (NSFG) from Septem-ber 2011 through September 2017 focused on a population-based sample of young women aged 15 to 20 years. The main outcomes were receipt of a BPE or a Pap test in the last 12 months and the proportion of potentially unnecessary examinations and tests.

Of the young women surveyed, 4.8% were pregnant, 22.3% had undergone testing for a sexually transmitted infection (STI) and 4.5% received treat-ment or medication for an STI in the past 12 months. 

Only 2.0% reported using an intrauterine device (IUD) and 33.5% used at least one other type of contraception in the past 12 months. Having a BPE was associated with having a Pap test (adjusted prevalence ratio [aPR] 7.12; 95% CI, 5.56 to 9.12), testing for STIs (aPR 1.60; 95% CI, 1.34 to 1.90) and using hormonal contraception other than an IUD (aPR 1.31; 95% CI, 1.11 to 1.54). 

It was also associated with being older (aPR 1.25; 95% CI, 1.08 to 1.45). Young women who had a Pap test were seven times more likely to also report receiving a BPE (aPR 7.12; 95% CI, 5.56 to 9.12). 

Using hormonal contraception other than an IUD was associated with a 31% higher risk of receiving a BPE than in women who did not use those forms of contraception. This is in spite of ACOG’s clear statement that “A pelvic examination is not necessary before initiating or prescribing contraception, other than an intrauterine device, or to screen for STIs.” 

Looking at the impact of insurance, the authors found that young women with public or no insurance were less likely to receive a BPE than those with private insurance. Race/ethnicity and STI treatment were not found to be associated with having a BPE when adjusting for other covariates. 

Among US young women aged 15 to 20 years surveyed in the years 2011 to 2017, approximately 2.6 million reported having received a BPE in the last 12 months. Th e authors estimated that more than half (54.5%) or 1.4 million of those exams may have been unnecessary. 

An estimated 1.6 million of the women, the researchers say, may have had an unnecessary Pap test during the same period. Based on the results of their analysis and assuming that a Medicare payment for a screening BPE of $37.97 and for a screening Pap test of is $44.78, as was the case in 2014, the authors estimate that the potentially unnecessary BPEs and Pap tests would have cost more than $123 million in 1 year. 

Commenting on the findings, the researchers concluded that they “suggest the need for education for health care professionals, parents, and young women themselves to improve awareness of professional guidelines and the limitations and harms of routine pelvic examination and Pap test and to ensure that these tests and examinations are performed only when medically necessary among young women.” 

Qin J, Saraiya M, Martinez G, Sawaya GF. Prevalence of potentially unneces-sary bimanual pelvic examinations and papanicolaou tests among adolescent girls and young women aged 15-20 years in the United States. JAMA Intern Med. June 2020. doi:10.1001/jamainternmed.2019.5727

Results of a nationally representative study indicate that many young women receive bimanual pelvic exams (BPEs) and Pap tests that may be unnecessary, and not in compliance with the latest guidance from the American College of Obstetricians and Gynecologists (ACOG). 


Too many teen pelvic exams and Pap tests?

, the study focused on trends in Los Angeles and Indianapolis and looked at not only domestic violence but crimes such as burglary, assault, and vehicle theft.

For the research, the authors analyzed daily counts of calls for service in the two cities beginning on January 2, 2020 and ending on April 21 for Los Angeles and April 18 for Indianapolis. Those time periods were defined as after shelter-in-place orders were given. Excluded from the analysis were time periods between school closings and shelter-in-place orders.

The objective was to compare full social distancing effects (post stay-at-home orders) to a baseline with no social distancing orders yet implemented. Expected police call rate change was computed by multiplying the estimated coefficient of residential mobility by the average residential mobility index post-shelter-in-place minus the average pre-school closing.

Significant increases in domestic violence calls were found in both Los Angeles and Indianapolis (expected call rate increases of 13.5495 and 15.2112; 

In contrast, call rate changes for burglary in Los Angeles and Indianapolis declined by 19.2740 and 2.3061, respectively. For robbery and battery, rates declined in both in Los Angeles and stayed the same in Indianapolis.

“The marginal decline in residential burglaries, marginal increase in auto thefts, and increase in domestic violence calls points to shifts in crime patterns to which police departments will necessarily have to respond,” said the authors. 

They noted, however, that “despite domestic violence having been one of the crimes least reported to the police, with approximately half of domestic victimization being unreported, our results indicate that calls concerning domestic violence significantly increased in both Indianapolis and Los Angeles.”

Mohler G, Bertozzi AL, Carter J, Short MB, Sledge D, Tita GE, et al. Impact of social distancing during COVID-19 pandemic on crime in Los Angeles and Indianapolis. 

. 2020;68:101692. https://doi.org/10.1016/j.jcrimjus.2020.101692

A new analysis by researchers who analyze crime statistics shows that in two major metropolitan areas, domestic violence reports increased during the COVID-19 pandemic.

Author | Judith M. Orvos, ELS

Articles

SARS-CoV-2 detected in placenta and membrane samples

Parental use and adolescent misuse of marijuana

Too many teen pelvic exams and Pap tests?

Domestic violence reports increase in two major cities during COVID-19