Jeanne Sheffield

• Professor (Full) at Johns Hopkins Medicine

Pregnant individuals are at heightened risk for severe outcomes from many infectious diseases, including COVID-19. However, they were not included in the initial COVID-19 vaccine clinical trials and current rates of vaccine uptake among pregnant people remain below 15%. We defined the serological and cellular responses to COVID-19 mRNA booster vacc...

Shared decision making for infant feeding in the context of HIV in high-resourced settings is necessary to acknowledge patient autonomy, meet increasing patient requests and address the changing reality of perinatal HIV care. In low-to middle-income countries (LMIC), where the majority of individuals living with HIV reside, persons with HIV are rec...

Background: Rates of unintended pregnancy may be higher in women living with human immunodeficiency virus (WLWH) than in the general population, and it is unclear how populations of WLWH with intended and unintended pregnancy differ. We compared baseline characteristics and outcomes between WLWH with intended and unintended pregnancy. Materials and...

Importance In the US, more than 50 000 women experience severe maternal morbidity (SMM) each year, and the SMM rate more than doubled during the past 25 years. In response, professional organizations called for birthing facilities to routinely identify and review SMM events and identify prevention opportunities. Objective To examine SMM levels, pr...

Venous thromboembolism (VTE) as well as other embolic events including amniotic fluid embolism (AFE) remain a leading cause of maternal death in the United States and worldwide. The pregnant patient is at a higher risk of developing VTE including pulmonary embolism. In contrast, AFE is a rare, but catastrophic event that remains incompletely unders...

We aimed to determine if long-term fine particulate matter (PM2.5) concentrations are associated with increased risk of testing positive for COVID-19 among pregnant individuals who were universally screened at delivery and if socioeconomic status (SES) modifies this relationship. We used obstetric data from Columbia University Irving Medical Center...

Background Umbilical cord blood gas testing is a key component of objective pre- and perinatal evaluation of fetal acid base status to determine presence of intrapartum asphyxia and risk of neonatal encephalopathy. Heparinized cord blood is more likely to form small clots than other blood sources, which can interfere with, or preclude, sample analy...

Background Pregnant women were excluded from investigational trials of COVID-19 vaccines. Limited data are available to inform pregnant and postpartum women on their decisions to receive a COVID-19 vaccine. Methods The goal of this observational, prospective cohort study is to evaluate the immunogenicity and safety of various Emergency Use Authori...

We assessed breastfeeding outcomes for a cohort of infants born to women living with HIV (WLHIV) at an urban health care center in the United States. Ten infants were exclusively breastfed for a mean duration of 4.4 (1.0-8.6) months. All had negative HIV RNA PCRs at a median age of 16 months.

Adolescents (13-24 years of age) account for more than one-fifth of new HIV diagnoses yearly, and the United States has one of the highest rates of adolescent pregnancy among high resource countries. However, there is limited information on the characteristics and outcomes of adolescents living with HIV (ALWHIV) during pregnancy and differences wit...

Vaccination of frontline workers against COVID-19 is underway in some countries. With women comprising a majority of health, education, and other essential workforces, many on the front lines of the pandemic response will be pregnant at the time that they are offered COVID-19 vaccines. However, pregnant people were not included in any of the COVID-...

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the disease-causing pathogen of the COVID-19 pandemic, has resulted in morbidity and mortality worldwide. Pregnant women are more susceptible to severe COVID-19 disease and are at higher risk for preterm birth compared to uninfected pregnant women. Despite this evidence, the i...

Objective To study the impact of implementation of an evidence-based labor induction protocol on maternal and neonatal outcomes. Methods In February 2018, a contemporary labor induction protocol comprising standardized cervical ripening and early amniotomy was implemented on the labor and delivery unit at a large academic center along with compreh...

Importance The effects of SARS-CoV-2 infection on immune responses during pregnancy have not been systematically evaluated. Objective To assess the impact of SARS-CoV-2 infection during pregnancy on inflammatory and humoral responses in maternal and fetal samples and compare antibody responses to SARS-CoV-2 among pregnant and non-pregnant women....

Background Remdesivir is efficacious for severe COVID-19 in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. Methods Reported data span March 21 to June 16, 2020 for hospitalized pregnant women with PCR-confirmed SARS-CoV-2 infection and room...

Coronavirus disease 19 (COVID‐19), has recently emerged as a major threat to human health. Infections range from asymptomatic to severe (increased respiratory rate, hypoxia, significant lung involvement on imaging) or critical (multi‐organ failure or dysfunction or respiratory failure requiring mechanical ventilation or high flow nasal canula). Cur...

Introduction: Tenofovir alafenamide (TAF)-containing fixed-dose drug combinations (FDCs) are increasingly being used in managing pregnant women living with HIV. However, TAF is not currently recommended during pregnancy due to limited pharmacokinetic and safety data. TAF, a newer nucleotide phosphonamidate prodrug of tenofovir (TFV), achieves high...

Although the full and lasting impact of the coronavirus disease 2019 (COVID-19) outbreak is yet to be determined, there is evidence that sex and gender play a significant role in determining patient outcomes across the globe. This roundtable discussion is a transcript of a seminar held by several representatives from Johns Hopkins University on the...

Background: Pharmacovigilance studies for the pregnancy population are an important tool to address the teratogenic and maternal effects of prescription drugs. Objectives: We sought to leverage existing data to provide empirical evidence that reflects current drug utilization by pregnant/lactating women for pharmacovigilance and effective study...

Zika virus, influenza, and Ebola have called attention to the ways in which infectious disease outbreaks can severely – and at times uniquely – affect the health interests of pregnant women and their offspring. These examples also highlight the critical need to proactively consider pregnant women and their offspring in vaccine research and response...

Zika virus (ZIKV) infection during pregnancy causes significant adverse sequelae in the developing fetus, and results in long-term structural and neurologic defects. Most preventive and therapeutic efforts have focused on the development of vaccines, antivirals, and antibodies. The placental immunologic response to ZIKV, however, has been largely o...

Facilitating inclusion of pregnant women in clinical research could help answer important questions about the effects of medication use during pregnancy and the ways in which pregnancy alters pharmacokinetics and drug effects.

Objective: To evaluate whether 17α-hydroxyprogesterone caproate use in preventing preterm birth increases the risk of gestational diabetes mellitus (GDM). Data sources: Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) were searched for studies published be...

Objective: To assess the additional benefits of 17-hydroxyprogesterone caproate (17-OHPC) therapy in preventing recurrent spontaneous preterm birth in women with an ultrasound-indicated cerclage. Methods: Electronic databases (Medline, Scopus, ClinicalTrials.gov, PROSPERO, Embase, Scielo and the Cochrane Central Register of Controlled Trials) were...

Introduction: To evaluate whether there are additional benefits of 17-hydroxyprogesterone caproate (17-OHPC) supplementation in preventing recurrent spontaneous preterm birth in women with a prophylactic cerclage. Material and methods: Electronic databases (MEDLINE, Scopus, ClinicalTrials gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Re...

Objective To evaluate for difference in outcomes between single- and double-balloon catheters for labor induction. Study Design We searched CINAHL, Embase, Cochrane Register, MEDLINE, ISI Web of Sciences, LILACs, and Google Scholar and retrieved studies through May 2017. Selection criteria included randomized controlled trials comparing single- ver...

Hepatitis C virus (HCV) is one of the leading causes of liver disease, affecting 130–150 million people worldwide (World Health Organization. Media Centre. Hepatitis C. Fact Sheet, 2016). The virus causes chronic liver disease in 70–85% of persons infected with HCV with associated sequelae such as cirrhosis, liver cancer, and death. While the most...

Chronic hepatitis B virus (HBV) is a significant threat to public health, with an estimated 240 million people living with the disease worldwide (http://www.who.int/mediacentre/factsheets/fs204/en/). HBV and the associated complications, such as cirrhosis and hepatocellular carcinoma, cause >600,000 deaths yearly (GBD 2013 Mortality and Causes of D...

Purpose of review: Cesarean sections are common surgical procedures performed in a healthy population and are unique because of a relatively high rate of postoperative infection. There have been many important advances in understanding the pathogenesis of infection and evaluation of interventions to prevent post cesarean section infections in the...

In order to better understand the potential value of genetics-informed drug dose guidance to obstetric healthcare providers at Johns Hopkins we administered a web-based needs assessment survey. The survey included questions about: 1) experience with adjusting drug doses during pregnancy; 2) comfort prescribing medications to pregnant women with chr...

At a think tank bringing together experts on fetal neuroimaging, obstetric infectious diseases, and public health, we discussed trends in all of these areas for Zika virus. There is a wide variety of imaging findings in affected fetuses, influenced by timing of infection and probably host factors. The resources for diagnosis and interventions also...

Zika virus is a single-stranded RNA virus from the Flaviviridae family. Transmission is typically from the bite of an infected mosquito though mother-to-child, sexual and blood donation transmissions can occur. Although maternal symptoms are uncommon and rarely severe, the consequences of congenital infections are devastating. The emergence of cong...

Syphilis remains a significant infectious agent in pregnancy with the potential to cause fetal manifestations with maternal infection. Cases of congenital syphilis infection have recently increased, consistent with a resurgence of syphilis infections in the United States. All pregnant women should be screened for syphilis infection; many cases of c...

At the 36th Annual meeting of the Society for Maternal-Fetal Medicine (SMFM), leaders in the field of maternal-fetal medicine (MFM) convened to address maternal outcome and care inequities from 3 perspectives: (1) education, (2) clinical care, and (3) research. Meeting attendees identified knowledge gaps regarding disparities within the provider co...

Objective: Infants whose mothers had syphilis during pregnancy were studied to determine how often exposed newborns with normal physical examinations and nonreactive nontreponemal serologic tests had abnormal laboratory or radiographic studies. Study design: Retrospective analysis of prospectively collected data from infants born to mothers with...

Zika virus (ZIKV) was considered an innocent pathogen while restricted to the African and Asian population; however, after reaching the Americas in March 2015, it became a global threat. Despite usually causing mild or no symptoms in infected adults, ZIKV displays a different behavior towards fetuses. When infected during gestation, fetuses have th...

While the origins of syphilis remain unknown, it has long been recognized as an infectious entity with complex pathophysiology. In this review, we highlighted the epidemiology and risk factors associated with syphilis. The incidence of syphilis in most populations showed a consistent upward trend until the 1940s with the introduction of penicillin...

The pandemic spread of Zika virus (ZIKV), a member of the flavivirus genus of the Flaviviridae family, has become a major public health concern. Reproductive specialists are particularly concerned over the spread of ZIKV as it is now known to have both sexual and transplacental routes of transmission resulting in fetal congenital abnormalities. Oth...

The identification of Zika virus as a significant teratogen has raised international concern, causing the World Health Organization to declare a Public Health Emergency of International Concern. This has allowed a global mobilization of experts in tropical infectious diseases, obstetrics, pediatrics, virology, public health policy, reproductive hea...

Global spread of Zika virus Zika virus was identified in Uganda in 1947; since then, it has enveloped the tropics, causing disease of varying severity. Lessler et al. review the historical literature to remind us that Zika's neurotropism was observed in mice even before clinical case reports in Nigeria in 1953. What determines the clinical manifest...

. Previous studies examining protease inhibitor use in pregnancy and the rate of preterm and small-for-gestational-age infants have yielded conflicting results. Methods . This was a retrospective study of HIV-infected women who delivered singleton infants at our institution between 1984 and 2014. Women with protease inhibitor use were compared to w...

To estimate the maternal and fetal risks of smallpox vaccination during pregnancy. MEDLINE, Web of Science, EMBASE, Global Health, ClinicalTrials.gov, and CINHAL from inception to September 2014. We included published articles containing primary data regarding smallpox vaccination during pregnancy that reported maternal or fetal outcomes (spontaneo...

Pregnant women are a vulnerable group who are needed in clinical research studies to advance prevention and treatment options for this population. Yet, pregnant women remain underrepresented in clinical research. Through the lens of the socioecological model, we highlight reported barriers and facilitators to recruitment and retention of pregnant w...

Clinical pharmacology studies that describe the pharmacokinetics and pharmacodynamics of drugs in pregnant women are critical for informing on the safe and effective use of drugs during pregnancy. That being said, multiple factors have hindered the ability to study drugs in pregnant patients. These include concerns for maternal and fetal safety, et...

Infections with herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2), both alpha herpesviruses, are highly prevalent worldwide. Both HSV types commonly cause genital infection, which, when acquired or reactivated during pregnancy, carries with it the risk of transmission to the fetus or neonate. Women who acquire primary or first-episode genital h...

Hepatitis B remains a significant health issue worldwide, and contributes significantly to the incidence of cirrhosis and hepatocellular carcinoma. Widespread adoption of hepatitis B vaccination strategies has lead to significant declines in acute hepatitis B infections. Current recommendations for vaccination in the non-pregnant population include...

Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the major multiple antibiotic-resistant bacterial pathogens causing serious community-associated and health care-associated infections. It is now pervasive in the obstetric population associated with skin and soft tissue infections, mastitis, episiotomy, and cesarean wound infections...

IntroductionPathophysiologyClinical FeaturesDiagnosisTreatmentFollow-upPreventionConclusions Suggested Reading

Although antibiotics have reduced the number of SPT-related postdelivery pelvic venous infections, diagnosing the underlying disease continues to be a challenge.

Because symptoms of early heart failure may mimic common pregnancy complaints, they are often missed. Diagnosis of this rare, often fatal, disorder is one of exclusion, with older, overweight, black women - especially those with multiple births - at greatest risk.

The prevalence of hepatitis A, B, C, and D viruses was studied in 467 military personnel with human immunodeficiency virus type 1 (HIV-1) infection. Antibody to hepatitis C virus (antiHCV) by first-generation ELISA was found in 136 (29%). Of sera repeatedly reactive for antiHCV by first-generation ELISA, two-antigen recombinant immunoblot assay (RI...

The activity of tosufloxacin (A-60969), a new oral quinolone, and clarithromycin (A-56268, TE-031), a new oral macrolide, was compared in vitro to that of other oral quinolones and beta-lactam antimicrobial agents against clinical isolates of ampicillin and/or chloramphenicol resistant Haemophilus influenzae, penicillin resistant Streptococcus pneu...

Tosufloxacin (A-60969 HCl), a new quinolone with broad activity against gram-positive and anaerobic organisms, was compared in vitro with other quinolones against bacterial pathogens of diarrhea. Tosufloxacin was the most active agent against Salmonella spp., Shigella spp., Campylobacter spp., Aeromonas hydrophila, and Vibrio spp. Temafloxacin (A-6...