Overall Survival Dips With Vitamin D Deficiency in Melanoma

Patients with melanoma who are deficient in vitamin D have significantly worse overall survival than those with higher levels, according to research presented at the 31st Congress of the European Academy of Dermatology and Venereology. Whereas the 5-year overall survival was 90% when vitamin D serum levels were above a 10 ng/mL threshold, it was 84% when levels fell below it. Notably, the gap in overall survival between those above and below the threshold appeared to widen as time went on. Dr Inés Gracia-Darder The research adds to existing evidence that "vitamin D levels can play an important and independent role in patients' survival outcomes," study investigator Inés Gracia-Darder, MD, told Medscape Dermatology. "The important application in clinical practice would be to know if vitamin D supplementation influences the survival of melanoma patients," said Gracia-Darder, a clinical specialist in dermatology at the Hospital Universitari Son Espases, Mallorca, Spain. Known Association, but Not Much Data "It is not a new finding," but there are limited data, especially in melanoma, said Julie De Smedt, MD, of KU Leuven in Leuven, Belgium, who was asked to comment on the results. Other groups have shown, certainly for cancer in general, that vitamin D can have an effect on overall survival. "Low levels of vitamin D are associated with the pathological parameters of the melanoma, such as the thickness of the tumor," De Smedt said in an interview, indicating that it's not just overall survival that might be affected. "So we assume that also has an effect on melanoma-specific survival," she added. That assumption, however, is not supported by the data Gracia-Darder presented, as there was no difference in melanoma-specific survival among the two groups of patients that had been studied. Retrospective Cohort Analysis Vitamin D levels had been studied in 264 patients who were included in the retrospective cohort analysis. All had invasive melanomas, and all had been seen at the Hospital Clinic of Barcelona between January 1998 and June 2021. Their mean age was 57 years, and the median follow-up was 6.7 years. 0

Brain activity patterns during sleep shed light on the neurobiology behind 22q11.2 Deletion Syndrome

The brain activity patterns during sleep shed light on the neurobiology behind a genetic condition called 22q11.2 Deletion Syndrome (22q11.2DS) and could be used as a biomarker to detect the onset of neuropsychiatric disorders in people with 22q11.2DS. 22q11.2DS is caused by a gene deletion of around 30 genes on chromosome 22 and occurs in 1 in 3000 births. It increases the risk of intellectual disability, autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and epileptic seizures. It is also one of the largest biological risk factors for schizophrenia. However, the biological mechanisms underlying psychiatric symptoms in 22q11.2DS are unclear. We have recently shown that the majority of young people with 22q11.2DS have sleep problems, particularly insomnia and sleep fragmentation, that are linked with psychiatric disorders. However, our previous analysis was based on parents reporting on sleep quality of their children, and the neurophysiology – what's happening to brain activity – has not yet been explored." Marianne van den Bree, co-senior author, Professor of Psychological Medicine at Cardiff University, UK An established way of measuring brain activity during sleep is an electroencephalogram (EEG). This measures electrical activity during sleep and features patterns called spindles and slow-wave (SW) oscillations. These features are hallmarks of non-rapid eye movement (NREM) sleep and are thought to aid memory consolidation and brain development. "Because sleep EEG is known to be altered in many neurodevelopmental disorders, the properties and coordination of these alterations can be used as biomarkers for psychiatric dysfunction" explained lead author Nick Donnelly, Clinical Lecturer in General Adult Psychiatry at the University of Bristol, UK To explore this in 22q11.2DS, the team recorded sleep EEG over one night in 28 young people aged 6-20 years old with the chromosome deletion and in 17 unaffected siblings, recruited as part of the Cardiff University Experiences of Children with copy number variants (ECHO) study, led by Prof. van den Bree. They measured correlations between sleep EEG patterns and psychiatric symptoms, as well as performance in a recall test the next morning. Genetics & Genomics eBook Compilation of the top interviews, articles, and news in the last year. Download a copy today They found that the group with 22q11.2DS had significant alterations in sleep patterns including a greater proportion of N3 NREM sleep (slow-wave sleep) and lower proportions of N1 (the first and lightest sleep stage) and rapid eye movement (REM) sleep, compared with their siblings. Those carrying the chromosome deletion also had increased EEG power for both slow-wave oscillations and spindles. There was also an increase in the frequency and density of spindle patterns and stronger coupling between the spindle and slow-wave EEG features in the 22q112.DS group. These changes may reflect alterations in the connections within and between areas of the brain that generate these oscillations, the cortex and the thalamus. Participants also took part in a 2D object location task before sleep, where they had to remember where matching cards were on a screen. They were tested again on the same task in the morning, and the team found that in those with 22q11.2DS, higher spindle and SW amplitudes were associated with lower accuracy. By contrast, in participants without the chromosome deletion, higher amplitudes were linked to higher accuracy in the morning recall test. Finally, the team estimated the impact of the differences in sleep patterns on psychiatric symptoms in the two groups using a statistical method called mediation. They calculated the total effect of genotype on psychiatric measures and IQ, the indirect (mediated) effect of EEG measures, and then the proportion of the total effect that may be mediated by EEG patterns. They found that the effects on anxiety, ADHD and ASD driven by the 22q11.2 deletion were partially mediated by sleep EEG differences. "Our EEG findings together suggest a complex picture of sleep neurophysiology in 22q11.2DS and highlight differences that could serve as potential biomarkers for 22q11.2DS-associated neurodevelopmental syndromes," concluded co-senior author Matt Jones, Professorial Research Fellow in Neuroscience, University of Bristol, UK. "Further study will now need to clarify the relationship between psychiatric symptoms, sleep EEG measures and neurodevelopment, with a view to pinpointing markers of brain circuit dysfunction that could inform doctors which patients are most at risk, and support treatment decisions."

Genetic screening before pregnancy detects the risk in 44% of couples

Are would-be parents carrying a genetic risk of serious illnesses that they could potentially pass on to their children? In the USA, doctors recommend that couples have genetic screening before trying to conceive. Researchers at the University of Zurich have now shown that a maximal variant of this test detects the risk in 44percent of couples who are related by blood, and in just 5 percent of other couples. Non-hereditary newly acquired mutations are a major reason for the reduced detection rate in the latter. The use of biomarker and genetic tests during pregnancy is now extremely widespread. But what if both parents' genes were broadly analyzed for possible risks prior to conception? Are there any rare hereditary diseases in the genome that the father and/or mother are unknowingly carrying? If both parents have the same genetic defect in their genes and both pass this on to their child, this will often cause the child to have a serious illness. In many parts of the US, broad genetic testing is offered to prospective parents and is usually also recommended in early pregnancy. The screenings predominantly indicate recessively inherited genes that are non-gender specific - in other words, those that have an effect only if both gene copies carry a mutation. Recessive genes on the X chromosome are a special case, whereby healthy mothers can pass this gene onto their children. However, normally only sons suffer from the consequences this mutation as they carry only one X chromosome and therefore do not have a second gene copy to compensate for the defect. More than 3,000 hereditary factors tested Do these genetic tests for inherited risk factors deliver what they promise? Anita Rauch, director of medical genetics at the University of Zurich, and her team in Switzerland have now for the first time addressed this question by extensively studying the potential and pitfalls of such expanded carrier screening (ECS). To this end, the scientists tested sequence data from 700 parents who already had children with neurodevelopmental disorders. Many of the more than 3,000 investigated genes can cause intellectual disabilities, developmental disorders, autism and other disorders. In our study, we were able to show that this type of broad genetic testing can detect the risk of the child having a severe developmental disorder in about 44 percent of cases if the parents are related by blood - for instance as first or second cousins." Anita Rauch, director of medical genetics, University of Zurich Gaps in risk detection for non-consanguineous couples in particular The test still detected about 5 percent of cases in couples who were not blood-related - but only if all known recessive genes were investigated. According to the recommendations in the US, however, non-consanguineous couples should only be tested for common genes that are known to have a certain carrier frequency in the population. "Following the US recommendation would more than halve the risk detection rate, because rarer genes also play a part here," explains Rauch. Genetics & Genomics eBook Compilation of the top interviews, articles, and news in the last year. Download a copy today For children of non-consanguineous couples, a significantly higher proportion of developmental disorders are caused by non-hereditary de novo mutations, whereas in children of parents who are related to each other hereditary gene defects play a distinctly greater role. For this reason, the researchers state that the likelihood of detecting risks by analyzing the parents' genes is limited for non-consanguineous couples. Many pathogenic genes still not detected Further factors also impact the potential of these tests to detect problematic gene variants in known pathogenic genes: in particular, missense gene mutations, in which the genetic blueprint may or may not be altered, and inherited copy-number variants, in which the number of gene copies is incorrect, have been underestimated. Cases that cannot be detected are generally those in which an inherited and a newly acquired genetic defect occur at the same time. In addition, there are likely several thousands of as-yet unidentified genes that probably also cause developmental disorders. For instance, in the investigated study cohort, the cause of the developmental disorder in the respective children remained unexplained in about a 58percent of cases. Conscious decision for or against children Nevertheless, according to the researchers, the study provides data as to how meaningful expanded carrier screening is. Based on the high risk-detection rate for consanguineous parents, the researchers believe that such screening should certainly be offered to these couples. In all other cases, the benefits and disadvantages should be weighed up on a case-by-case basis to avoid creating unrealistic expectations. "If a couple is found to be at risk of having children with neurodevelopmental disorders, they will be fully aware and able to decide whether or not to have children together or to consider prenatal or preimplantation diagnostics," says Rauch. However, the results also show that the potential risk reduction strongly depends on the selected genes and variant classifications in the test. According to Rauch, there is still potential for improvement in the tests offered currently: "To improve the clinical benefit, all couples that want a broad genetic test should be considered for screening all recessive genes irrespective of the population prevalence of a gene variant. Laboratories should also use reasonable thresholds regarding when a genetic defect is considered pathogenic."

Sonographers can help enhance parents' emotional connection to the unborn baby during pregnancy

A systematic review of twenty-three studies suggests that, during pregnancy, expectant parents' feelings towards their unborn baby (fetus) can be positively enhanced by sonographers (specialist healthcare professionals who are trained to perform pregnancy ultrasound scans) making imaging examinations a truly parent-centered experience. Such an experience can allay feelings of anxiety and stress in the parents, helping them to feel more informed about the health and well-being of their unborn baby, and reassured of their emotional investment in the ongoing pregnancy. Conducted by the Centre for Maternal and Child Health Research at City, University of London, the review provides a holistic interpretation of the current evidence on the effect of antenatal (before birth) imaging on expectant parents' feelings towards their unborn baby. To date, whilst the provision of ultrasound scans during pregnancy has been generally regarded as a positive experience for parents, and may predict the quality of the parent-child relationship after birth, there is evidence to suggest that the experience may also lead to increased anxiety and stress in parents, particularly those who are unable to interpret the scan images. Seventeen of the studies analyzed in the review related to the mother's experience only, five included both parents and one study recruited fathers only. Six central themes were developed from analysis of the included studies: the scan experience begins before the scan appointment; including parents looking forward to the scan, but being simultaneously apprehensive of the potential to receive unexpected news about their baby the scan as a pregnancy ritual; parents regarded scans as a milestone event, which they expected, and wanted feeling actively involved in the scan; with the presence of fathers at scans important, not only for maternal support, but also as attending fathers felt closer to their unborn baby than those who were not parents' priorities for knowledge and understanding of the scan change during pregnancy; at earlier stages of pregnancy, parents prioritized knowing that their pregnancy was viable, at later stages it was important for parents to know about the presence of fetal anomalies the importance of the parent–sonographer partnership during scanning; parents' confidence in their sonographer was linked with narration of the scan, and limiting the use of non-medical terminology humanized the fetus, and implied to parents that the sonographer recognized their unborn baby as an individual rather than a medical entity scans help to create a social identity for the unborn baby; many parents centered their news about pregnancies around a scan, with some waiting until their first scan to tell friends and family about their pregnancies, and sharing their scan pictures or videos so that their support circle had a sense of knowing the baby even before birth Related Stories COVID-19 pandemic has increased pregnancy complications and maternal death during delivery Study investigates the effect of vitamin D and fish oil on croup High-throughput proteomics reveals pregnancy-specific responses to COVID-19 The review also identified a lack of published research studies exploring the impact of fetal MRI (magnetic resonance imaging) on expectant parents' emotional connection to their unborn baby. Fetal MRI is becoming more commonly used to complement ultrasound imaging when a fetal anomaly is suspected. Hence, the authors stress that more research needs to be undertaken in this area to help understand the acceptability of this type of scan to parents and its potential effect on their feelings towards their unborn child. Lead author, Emily Skelton, is a sonographer, lecturer and College of Radiographers Doctoral Fellow within the Department of Radiography and Midwifery at City, University of London. We know how important scans during pregnancy are to provide clinical information about fetal growth and development, but there are additional benefits for expectant parents, who, in their transition to parenthood, may feel closer to their unborn babies after "seeing" them on scan. This review highlights the integral role of the sonographer in facilitating the developing connection between expectant parents and their unborn babies, through an informative, supportive and inclusive parent-centred approach to care that parents feel actively involved in."

Pregnancy duration food A mother's diet during pregnancy is linked to her child's food preferences

Diet during pregnancy is an important factor in determining the health of the developing fetus and neonate after birth. However, there is little known about how diet quality during pregnancy affects the development of food-related traits in the offspring. A recent Appetite journal study examines the relationship between the quality of the mother’s diet during pregnancy and with appetitive traits of offspring at five years. Study: Maternal Dietary Quality During Pregnancy and Child Appetitive Traits At 5-Years-Old: Findings from The ROLO Longitudinal Birth Cohort Study. Image Credit: Dusan Petkovic / Shutterstock.com Study: Maternal Dietary Quality During Pregnancy and Child Appetitive Traits At 5-Years-Old: Findings from The ROLO Longitudinal Birth Cohort Study. Image Credit: Dusan Petkovic / Shutterstock.com Introduction Appetitive traits refer to sustained predispositions towards food. This can include food approach traits, such as food responsiveness, emotional overeating, and food enjoyment, as well as food avoidant traits, like the speed of eating, satiety responsiveness, and food fussiness. Diet during pregnancy is key to promoting a healthy birth and growth in the neonatal period. However, the impact of the mother’s diet during pregnancy could have more significant implications. Genetics & Genomics eBook Compilation of the top interviews, articles, and news in the last year. Download a copy today According to the “Development of Origins of Health and Diseases” theory, brief exposures during early life, including a poor maternal diet during pregnancy or even before conception, may influence the development of the offspring and risk for diseases later in life. There is some evidence suggesting an association between maternal food intake and fetal growth and development, as well as the effect of prenatal influences on the child’s acceptance of foods in early life. Appetitive traits are classified as either genetic or learned, with fussy eating and food responsiveness considered genetic traits, whereas emotional undereating and overeating are often learned from the child’s environment. Both of these traits interact with each other to determine food habits that persist throughout the child’s life. Sweet foods are typically preferred in infancy, whereas bitter flavors are often rejected. This preference could be explained as an innate mechanism to preserve an adequate intake of energy-rich foods while rejecting potential toxins. In addition to this inborn response, children develop patterns of taste and flavor acceptance from the maternal diet during pregnancy and breastfeeding. Thus, it is theorized that early repeated exposures to multiple flavors may promote a wider range of food acceptance later on. Taste buds become functional only during the third trimester and can then be stimulated by foods eaten by the mother through the amniotic fluid. However, the fetus experiences food odors and flavors earlier than this, which may determine food preferences later in life. About the study Earlier research has shown a strong correlation between excessive weight gain in childhood and the mother’s diet during pregnancy. Since appetitive traits are also important in childhood obesity, the current study examined how maternal diet was related to appetitive traits at five years of age in the offspring. The current study used the Alternative Healthy Eating Index (AHEI-P) by the United States Department of Agriculture. AHEI-P was modified for pregnancy to determine maternal diet quality from three-day food diaries. The researchers also examined the intake of sugar-sweetened beverages (SSBs) over the same period. The appetitive traits of the offspring were assessed by the Children’s Eating Behavior Questionnaire (CEBQ), which is parent-reported and includes eight eating behaviors and 35 items overall. Demographic information, breastfeeding, period of weaning, the point when solid food was started, and maternal educational levels were also recorded. Study findings The women included in the current study had a median age of 33 years and had an average maternal BMI of about 25. At the five-year time point, more than half of the women and about 25% of the children were considered overweight. The mean AHEI-P was 54 in pregnancy and 55 for the group who also had CEBQ data after five years. Notably, mothers with higher AHEI-P scores during the first and second trimesters of pregnancy had lower mean ‘Desire to Drink’ scores in their children at five years of age. The only association found in this analysis was for the Desire to Drink, with other appetitive traits failing to reveal any associations. Although little is known about how the presence of ‘Desire to Drink’ in children might contribute to their developmental and behavioral traits later in life, this characteristic may have long-term impacts on their appetite and dietary intake. Less than half of the women with CEBQ data drank SSBs in pregnancy. In the first two trimesters, this was associated with a higher Desire to Drink in children at five years of age. Women with the poorest diet quality were younger and had higher body weight at their first antenatal visit and after five years. However, the birthweight of the child, weight at five years, as well as other indices, failed to show any association with maternal diet quality.

Pregnancy outcomes after COVID-19 vaccination and infection

In a recent study posted to the Research Square* preprint server, researchers assessed early pregnancy outcomes after coronavirus disease 2019 (COVID-19) vaccination and infection. Study: Early pregnancy outcomes following COVID-19 vaccination and SARS-CoV-2 infection: a national population-based matched cohort study. Image Credit: M M Vieira/Shutterstock Study: Early pregnancy outcomes following COVID-19 vaccination and SARS-CoV-2 infection: a national population-based matched cohort study. Image Credit: M M Vieira/Shutterstock Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has proven effective against the risk of contracting severe COVID-19 in pregnant women. However, studies have reported high levels of vaccine hesitancy among the pregnant population. Several factors potentially enforce COVID-19 vaccine hesitancy among pregnant women, such as the exclusion of pregnant women from vaccine trials in the initial phases, leading to inconsistent guidance in the early phases of the vaccination program due to a lack of safety-related data during those times. There is an urgent requirement to obtain concrete evidence concerning COVID-19 vaccine safety in early pregnancy to develop better vaccination policies. About the study In the present study, researchers performed a population-level matched cohort study that evaluated the association of miscarriage and ectopic pregnancy with COVID-19 vaccination. The team obtained data from the population-based and dynamic report on COVID-19 in the Pregnancy in Scotland (COPS) cohort, which comprised all ongoing and completed pregnancies recorded from 1 January 2015 onwards in Scotland. The data included information related to pregnancies, such as the estimated conception dates, while the completed pregnancies included information related to gestational age and pregnancy outcome. This data was extracted for all pregnant women aged between 11 and 55 at conception. National data related to COVID-19 infections and vaccination were also incorporated using unique identifiers into the study group. The COPS database included pregnancies having an estimated conception date up till 28 September 2021 and detected outcomes that occurred up to 31 January 2022. The team considered the primary exposure to the COVID-19 vaccine as the receipt of any SARS-CoV-2 vaccine available in Scotland, including BNT162b2, messenger ribonucleic acid (mRNA)-1273, and ChAdOx1-S at any dose such as first, second, et cetera. Eligible participants were vaccinated from six weeks before conception until the end of the outcome-specific period, defined as the period between 19 weeks and six days of gestation (19 + 6 weeks) for miscarriage and a duration of 2 + 6 weeks for ectopic pregnancy. Concerning study outcomes, all pregnancies were classified as ongoing or completed at 19 + 6 weeks. All completed pregnancies were further groups as per outcomes such as either miscarriage, ectopic pregnancy, or termination. The outcomes of interest were verified according to the International Classification of Diseases (ICD)-10 or Read Coded Clinical Terms diagnostic codes reported on the hospital discharge records. Related Stories Italian study finds SARS-CoV-2 in clinical samples collected before December 2019 Scientists develop a novel solution to evaluate airborne transmission of SARS-CoV-2 What is currently known about immune responses to COVID-19 vaccines and cellular immune responses against SARS-CoV-2? Furthermore, the team compared early pregnancy outcomes among women who did and did not have a confirmed COVID-19 infection. The exposure of interest for the study was confirmed COVID-19 diagnosis from six weeks before conception until the end of the outcome-specific period tested via reverse transcription (RT) polymerase chain reaction (PCR) test or a lateral flow device (LFD) test. Results The COPS study database comprised data related to 556,167 pregnancies reported by 361,606 women among which only 526,608 pregnancies were eligible for the study. These included 399,652 pregnancies recorded in the pre-pandemic period while 126,956 pregnancies were recorded in the contemporary pandemic period. The team noted that 18,780 pregnant women were immunized with the COVID-19 vaccine between six weeks before conception and 19 + 6 weeks of gestation. The study results showed that BNT162b2 vaccine was most frequently received by the pregnant women while one-fourth of the study cohort were vaccinated with two or more doses during the exposure period. Notably, by 19 + 6 weeks of gestation, almost 9% of the pregnancies from the vaccinated group ended in miscarriage as compared to 9.9% and 10.0% of pre-pandemic and contemporary controls. Moreover, primary analyses performed using pre-pandemic controls showed no considerable difference in the occurrence of miscarriage among vaccinated pregnant women. Compared to mRNA-vaccinated pregnant women, women who received the ChAdOx1-S vaccine had a higher chance of being categorized as either clinically or extremely vulnerable since they belonged to the most deprived regions. The subgroup analyses displayed no evidence that mRNA-vaccinated women were more likely to suffer from a miscarriage as compared to the pre-pandemic or contemporary controls. The team did observe that women vaccinated with ChAdOx1-S were more likely to experience a miscarriage in comparison to the pre-pandemic controls but not the contemporary controls. Furthermore, 10,570 pregnant women were vaccinated between six weeks before conception and 2 + 6 weeks of gestation. By 19 + 6 weeks of gestation, ectopic pregnancies accounted for almost 1.2% of the pregnancies in the vaccinated, 1.2% of pregnancies in the pre-pandemic controls, and 1.1% of pregnancies in the contemporary control groups. The team found no evidence favoring that women vaccinated during pregnancy had a higher chance of experiencing an ectopic pregnancy. Additionally, no evidence was found supporting that women infected with SARS-CoV-2 during pregnancy had a higher chance of suffering from ectopic pregnancy or miscarriage. Overall, the study findings showed no evidence of a higher risk of ectopic pregnancy or miscarriage among pregnant women after COVID-19 vaccination or infection. *Important notice Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

How is the COVID pandemic affecting perinatal mental health?

A recent review published in the journal Progress in Neurology and Psychiatry discusses the adverse effects of the ongoing coronavirus disease 2019 (COVID-19) pandemic on perinatal mental health. Study: Perinatal mental health during the COVID‐19 pandemic. Image Credit: Pormezz / Shutterstock.com Study: Perinatal mental health during the COVID‐19 pandemic. Image Credit: Pormezz / Shutterstock.com Background The initial few weeks following childbirth are physically, emotionally, and mentally taxing. Perinatal depression can occur as early as before conception or as late as approximately one-year post-delivery. Although women with pre-existing mental disorders are at an increased risk of relapse during the perinatal period, these disorders may also arise for the first time in women with no prior history of the condition. In fact, mental disorders, which are associated with poor maternal and child outcomes, are considered a major complication that women endure during the perinatal period and affect nearly one in five pregnant women. The impact of the COVID-19 pandemic on perinatal mental health During the COVID-19 pandemic, pregnant women were especially vulnerable to the psychological effects of lockdowns and other restrictions that were put in place to reduce the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Increased social isolation due to lockdowns and social distancing measures, combined with other socioeconomic stressors like financial hardships and occupational changes, have contributed to the development of mental health disorders, particularly in the perinatal population. Additional factors were also found to increase the likelihood of mental disorders in perinatal women during the COVID-19 pandemic. Travel restrictions, for example, increased the potential for relationship conflict, controlling behaviors, and, in some instances, domestic abuse and violence. Furthermore, social distancing limited contact with friends, family, and support from healthcare providers, which also contributed to anxiety in these individuals. Despite the need for moral and emotional support from their peers, pregnant women often remained isolated from their support systems during the pandemic. Related Stories Scientists develop a novel solution to evaluate airborne transmission of SARS-CoV-2 Study investigates the effect of vitamin D and fish oil on croup What is currently known about immune responses to COVID-19 vaccines and cellular immune responses against SARS-CoV-2? The replacement of in-person maternity care and perinatal mental health services with virtual visits, as well as new policies prohibiting partners from accompanying patients to their in-person visits, also contributed to the isolation of expectant mothers. The absence of customary birthing experiences also caused grief for many. Concerns regarding the exposure of pregnant women and their unborn children to SARS-CoV-2 also increased anxiety in this patient population. In general, pregnant women with COVID-19 are more likely to necessitate intensive care unit (ICU) admission than non-pregnant women with COVID-19 of the same reproductive age. Due to persisting disparities amongst various socioeconomic populations, pregnant women of minority ethnic groups are at a heightened risk for acquiring COVID-19 during the perinatal period as compared to pregnant women of other races. Alcohol consumption has also been found to increase in the general population during the pandemic. In fact, one non-perinatal American study reported that this increase is more pronounced in women than men. It should be noted that the potential for domestic violence, abuse, and mental illness increases with alcohol abuse. Global surveys report that healthcare personnel who were working in perinatal mental health settings at the onset of the pandemic identified several obstacles to assessing and providing care to perinatal women, as well as their infants and extended families. During remote consultations and follow-ups, staff often reported challenges regarding their ability to detect early signs of mental illness. Additional concerns on how to assess and encourage the interactions between the mother and infant through teleconsultations have also been described. Guidance for improving clinical care The COVID-19 pandemic has highlighted the importance of improving current perinatal mental healthcare services. For example, it is evident that virtual appointments are beneficial to some working mothers. The current pandemic also emphasized the need for collaborative care between professionals in mental health and other organizations capable of assisting vulnerable perinatal women. Several organizations have proposed guidelines to improve support for women suffering mental health problems during the pandemic. These guidelines emphasize the importance of recognizing the unpredictability of the current political climate and empowering women with information so that they can be equipped to handle the continuously changing situation. A better understanding of the experiences of perinatal women during the pandemic could guide the adaptation and formulation of services for providing support aimed at improving perinatal mental health.