Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know

Adapting obstetric and neonatal services during the COVID-19 pandemic: a scoping review

BACKGROUND

The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction.

METHOD

Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations.

RESULTS

We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options.

INTERPRETATION

There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability.

[Co-infection of malaria and COVID-19 in patients admitted to the COVID Infectious Disease Department of the Libreville University Hospital Center]

The purpose of this study was to report the cases of co-infection of malaria and COVID-19, after systematic search for plasmodium in patients treated in the COVID Infectious Disease Department (SiCOV) of the Libreville University Hospital (LUH). We conducted a prospective, observational study in the LUH SiCOV from April to July 2020. Patients of both sexes, aged over 18 years, with positive Polymerase Chain Reaction (PCR) test for SARS-CoV-2 with thick blood smear result available, were included. For each patient, demographics (age, gender, weight, height), history and clinical and biological examination results were reported in the Excel file. Of a total of 253 patients who met the inclusion criteria, 8 had malaria associated with positive SARS-CoV-2 PCR. These were women (3) and men (5), with an average age of 36.9 years (25- 53 years). The mode of transmission was unknown in 7/8. All patients were febrile, 6/8 had headaches and 5/8 had respiratory discomfort. Less than half of patients had otolaryngeal (anosmia, ageusia) or digestive (diarrhea) manifestations. One patient with severe form died on day 5 of hospitalization. Clinical similarities between malaria and COVID-19 can lead to confusion in malaria endemic areas. The co-infection of malaria and COVID-19 did not result in severe clinical forms.

The use of convalescent plasma therapy in the management of a pregnant woman with COVID-19: a case report

The coronavirus disease 19 (COVID-19) is responsible for the current worldwide pandemic. Treatment and prophylaxis are still under investigation. Convalescent plasma therapy could be an alternative. We report a case of a 41-year-old patient, at 28 weeks of gestation, was hospitalized with COVID-19. On the 10^th day after onset of symptoms, the clinical picture worsened, and she required high-flow oxygen therapy (30L/minute), with 92% oxygen saturation, and chest X-ray showing mild bilateral opacities at lung bases. Blood tests showed D-dimer 1,004ng/mL, C-reactive protein 81mg/L, pro-calcitonin 0.05ng/mL and interleukine-6 42.9pg/mL. The therapy chosen was Tazocin^® 12g/day, vancomycin 2g/day, and methylprednisolone 40mg/day. In addition, convalescent plasma therapy was administered (275mL) uneventfully, including SARS-CoV-2 antibodies and neutralizing antibodies >1:160. The patient had a fast recovery. The early administration of convalescent plasma, with high titers of neutralizing antibodies, may be an alternative option for severe COVID-19 during pregnancy, until further studies demonstrate an efficient and safe treatment or prophylaxis.

Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021

OBJECTIVE

COVID-19 is a rapidly changing and developing emergency that requires constant re-evaluation of available data. We report a systematic review and meta-analysis based on all published high-quality data up to and including June 3, 2021 on the maternal and neonatal outcomes in pregnant women infected with COVID-19.

DATA SOURCES

PubMed, SCOPUS, MEDLINE, ClinicalTrials.gov, and Web of Science databases were queried from inception up to June 3, 2021.

STUDY ELIGIBILITY CRITERIA

We included all clinical studies (prospective and retrospective cohort studies, case-control studies, case series, and rapid communications) that reported data on any maternal and neonatal outcomes of pregnant women with COVID-19.

METHODS

The data were analyzed as pooled proportions or odds ratios and 95% confidence intervals in meta-analysis models.

RESULTS

We included 111 studies enrolling 42,754 COVID-19-positive pregnant women. From COVID-19-positive pregnant women, the incidence rates were 53.2% (95% confidence interval, 48-58.4) for cesarean delivery, 41.5% (95% confidence interval, 36.3-46.8) for spontaneous vaginal delivery, and 6.4% (95% confidence interval, 4.5-9.2) for operative delivery. The rates of some adverse neonatal events, including premature delivery (16.7%; 95% confidence interval, 12.8-21.5) and low birthweight (16.7%; 95% confidence interval, 12.8-21.5) were relatively high in mothers infected with COVID-19. Vertical transmission (3.5%; 95% confidence interval, 2.7-4.7), neonatal death (3%; 95% confidence interval, 2-4), stillbirth (1.9%; 95% confidence interval, 1.5-2.4), and maternal mortality (0.012%; 95% confidence interval, 0.010-0.014) were rare adverse events. The mean birthweight was 3069.7 g (95% confidence interval, 3009.7-3129.8 g). In the comparative analysis, COVID-19 significantly increased the risk of premature delivery (odds ratio, 1. 48 [95% confidence interval, 1.22-1.8]), preeclampsia (odds ratio, 1.6 [95% confidence interval, 1.2-2.1]), stillbirth (odds ratio, 2.36 [95% confidence interval, 1.24-4.462]), neonatal mortality (odds ratio, 3.35 [95% confidence interval, 1.07-10.5]), and maternal mortality (odds ratio, 3.08 [95% confidence interval, 1.5-6.3]). The pooled analyses were homogenous, with mild heterogeneity in premature delivery and preeclampsia outcomes.

CONCLUSION

The data must be interpreted with caution as limited data are available, and no complete assessment of bias is possible at this time. Our data suggest that pregnant women who test positive for COVID-19 seem to be at a higher risk of lower birth weights and premature delivery. There is no evidence at this time of the sharply increased maternal mortality that was seen previously with both the 2003 SARS and 2012 MERS pandemics.

The relationship between demographic factors and levels of self-care against coronavirus in pregnant women referred to maternity wards

Background

The adverse effects of coronavirus infection on pregnant women and their infants are not apparent. The best strategies to deal with this disease is avoiding the infection and preventing its transmission.

Purpose

the present study aimed to investigate the relationship between demographic factors and levels of self-care against coronavirus in pregnant women referred to maternity wards of Kerman, southeast Iran.

Method

The present descriptive study was conducted on 200 pregnant women who referred to maternity wards in Kerman in 2020 and met the inclusion criteria. The required information was collected using demographic and obstetric questionnaires and a self-care checklist.

Findings

The mean age of the participants was 28.89 ± 7.07. Iranian and Afghan citizens comprised 82 and 18% of the participants, respectively. The highest level of self-care measures against coronavirus in pregnant women was attributed to the use of face masks (74%), and the lowest was warning the personnel to wear masks (28%). There was a statistically significant relationship between the nationality of the participants and warning the personnel to wear facemasks (r = 0.183; p = 0.02), having a sick spouse (r=0.149;P = 0.039), and having a sick child (r = 0.191; p = 0.043), and between the husbands' job and the patients' demand for a private room (r = 0.173; p = 0.013). There was an inverse relationship between mothers' age and warning the personnel about paying attention to their hygiene (r = -0.145; p = 0.04).

Conclusions

The results indicated that most pregnant women in the present study were active in self-care against coronavirus. Using face masks was more widely followed than other self-care measures; moreover, there was a relationship between personal characteristics and self-care levels.

Impact of COVID-19-Related Lockdown on Delivery and Perinatal Outcomes: A Retrospective Cohort Study

Objective: The magnitude and direction of effects on pregnancy outcomes of the lockdown imposed during COVID-19 have been uncertain and debated. Therefore, we aimed to quantify delivery and perinatal outcomes during the first nationwide lockdown due to the COVID-19 pandemic compared with the same durations of time for the pre- and post-lockdown periods. Study design: This was a retrospective cohort study of six university hospital maternity units distributed across France, each of which serves as the obstetric care referral unit within its respective perinatal network. Maternal and perinatal outcomes were compared between the lockdown period and same-duration (i.e., 55-day) periods before and after the 2020 lockdown (pre-lockdown: 22 January–16 March; lockdown: 17 March–10 May; post-lockdown: 11 May–4 July). We compared the overall rates of Caesarean delivery (CD), pre-labor CD, labor induction, operative vaginal delivery, severe postpartum hemorrhage (≥1 L), severe perineal tear, maternal transfusion, and neonatal mortality and morbidity (1- and 5-min Apgar scores < 7), hypoxia and anoxia (umbilical arterial pH < 7.20 or <7.10, respectively), and admission to a neonatal intensive care unit before discharge. Adjusted odds ratios were estimated using logistic regression, controlling for region of birth, maternal age category, multiparity, multiple pregnancies, diabetes, and hypertensive disorders. Results: The study sample consisted of 11,929 women who delivered consecutively at one of the six maternity units studied (4093 pre-lockdown, 3829 during lockdown, and 4007 post-lockdown) and their 12,179 neonates (4169 pre-lockdown, 3905 during lockdown, and 4105 post-lockdown). The maternal and obstetric characteristics of the women delivering during the lockdown period were alike those delivering pre- and post-lockdown on maternal age, parity, body mass index, rate of complication by hypertensive disorders or insulin-treated diabetes, and gestational age at delivery. Overall CD rates were similar during the three periods (23.6%, 24.8%, and 24.3% pre-lockdown, lockdown, and post-lockdown, respectively) and no outcome differed significantly during lockdown compared to pre- and post-lockdown. These findings were consistent across maternity units. Conclusion: The maternal and perinatal outcomes are reassuring regarding the performance of the health-care system during the COVID-19 lockdown studied. Such information is crucial, because additional COVID-19-related lockdowns might still be needed. They are also instructive regarding potential future pandemics.

Criminal of Adverse Pregnant Outcomes: A Perspective From Thyroid Hormone Disturbance Caused by SARS-CoV-2

Nowadays, emerging evidence has shown adverse pregnancy outcomes, including preterm birth, preeclampsia, cesarean, and perinatal death, occurring in pregnant women after getting infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the underlying mechanisms remain elusive. Thyroid hormone disturbance has been unveiled consistently in various studies. As commonly known, thyroid hormone is vital for promoting pregnancy and optimal fetal growth and development. Even mild thyroid dysfunction can cause adverse pregnancy outcomes. We explored and summarized possible mechanisms of thyroid hormone abnormality in pregnant women after coronavirus disease 2019 (COVID-19) infection and made a scientific thypothesis that adverse pregnancy outcomes can be the result of thyroid hormone disorder during COVID-19. In which case, we accentuate the importance of thyroid hormone surveillance for COVID-19-infected pregnant women.

Cardiotocographic features in COVID-19 infected pregnant women

OBJECTIVES

We aimed to evaluate the cardiotocograph (CTG) traces of 224 women infected with novel coronavirus 2019 (COVID-19) and analyze whether changes in the CTG traces are related to the severity of COVID-19.

METHODS

We designed a prospective cohort study. Two-hundred and twenty-four women who had a single pregnancy of 32 weeks or more, and tested positive for SARS-CoV-2 were included. Clinical diagnosis and classifications were made according to the Chinese management guideline for COVID-19 (version 6.0). Patients were classified into categories as mild, moderate, severe and the CTG traces were observed comparing the hospital admission with the third day of positivity.

RESULTS

There was no statistically significant relationship between COVID-19 severity and CTG category, variability, tachycardia, bradycardia, acceleration, deceleration, and uterine contractility, Apgar 1st and 5th min.

CONCLUSIONS

Maternal COVID-19 infection can cause changes that can be observed in CTG. Regardless of the severity of the disease, COVID-19 infection is associated with changes in CTG. The increase in the baseline is the most obvious change.

Self-Screening as an Effort to Prevent the Risk of Exposure to COVID-19 in Pregnant Women

BACKGROUND: Pregnant women in the era of the COVID-19 pandemic were listed as one of the vulnerable groups at risk of being infected with COVID-19 because during pregnancy there were changes in gestational physiology and immunological changes in the body’s system. Changes in the immune system that occur during pregnancy can make pregnant women more susceptible to coronavirus infection and more at risk of experiencing severe and fatal disease symptoms. AIM: The purpose of this study was to analyze the effect of self-screening on behavior to prevent the risk of being exposed to COVID-19 in pregnant women. METHODS: This type of research is experimental using a randomized controlled trial research design. This research was conducted for 2 weeks in August–September 2021. The population of this study was pregnant women in Surabaya. The sampling technique used consecutive sampling technique and was divided into two groups, namely, the intervention group with 39 respondents and the control group with 39 respondents. Data analysis used the Wilcoxon signed ranks test with a significance value of p < 0.05. The questionnaire used in this study was designed using a reference and behavioral theory approach with a reliability of 0.89 and a validity test that obtained a Cronbach alpha value of 0.86. RESULTS: The average behavior to prevent the risk of being exposed to COVID-19 before conducting a self-screening intervention in the intervention group was 1.92 (the behavior to prevent the risk of being exposed to COVID-19 was sufficient) and in the control group was 1.85 (the behavior to prevent the risk of being exposed to COVID-19 was sufficient) with p = 0.596 which means there is no difference in the average behavior to prevent the risk of being exposed to COVID-19, while after being given the self-screening intervention the average prevention behavior in the intervention group is 2.46 (the behavior to prevent the risk of being exposed to COVID-19 is good) and in the control group is 2.05 (the behavior of preventing the risk of being exposed to COVID-19 is good) with p = 0.000 which means that there is a difference in the average behavior of preventing the risk of being exposed to COVID-19 in the intervention group and the control group after being given a self-screening intervention. CONCLUSION: In general, this study proves that self-screening can foster behavior to prevent the risk of being exposed to COVID-19 in pregnant women.

Persistent Fetal SVT in a COVID-19 Positive Pregnancy

Background

Rapid introduction and spread of SARS-CoV-2 have posed unique challenges in understanding the disease, role in vertical transmission, and in developing management. We present a case of a patient with COVID-19 infection and fetus with new-onset fetal SVT.

Case

A 26-year-old gravida 4 para 2012 with third trimester COVID-19 infection was diagnosed with new onset fetal SVT. Successful cardioversion was achieved with flecainide. The patient was followed outpatient until induction of labor at 39 and 3/7 weeks of gestational age resulting in an uncomplicated vaginal delivery. Postpartum course was uncomplicated.

Conclusion

Fetal SVT is a potential complication of maternal COVID-19 infection. The use of transplacental therapy with flecainide is an appropriate alternative to digoxin in these cases.

When stem cells meet COVID-19: recent advances, challenges and future perspectives

Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory coronavirus 2 is currently spreading throughout the world with a high rate of infection and mortality and poses a huge threat to global public health. COVID-19 primarily manifests as hypoxic respiratory failure and acute respiratory distress syndrome, which can lead to multiple organ failure. Despite advances in the supportive care approaches, there is still a lack of clinically effective therapies, and there is an urgent need to develop novel strategies to fight this disease. Currently, stem cell therapy and stem cell-derived organoid models have received extensive attention as a new treatment and research method for COVID-19. Here, we discuss how stem cells play a role in the battle against COVID-19 and present a systematic review and prospective of the study on stem cell treatment and organoid models of COVID-19, which provides a reference for the effective control of the COVID-19 pandemic worldwide.

The sustained adverse impact of COVID-19 pandemic on mental health among pregnant women in Sri Lanka: a reassessment during the second wave

Objective

To study the change in trend of antenatal mental health and associated factors among a cohort of pregnant women during the second wave of COVID-19 using Hospital Anxiety and Depression Scale (HADS). Previous study using the same scale, during the first wave reported a higher prevalence of anxiety and depression.

Results

A descriptive cross-sectional study was carried out at the two large maternity hospitals in Colombo, Sri Lanka: Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW). Consecutively recruited 311 women were studied. Out of which, 272 (87.5%) were having uncomplicated pregnancies at the time of the survey and 106 (34.1%) were either anxious, depressed, or both. Prevalence of anxiety was 17.0% and depression 27.0%. Overall, continuing COVID-19 pandemic increased antenatal anxiety and depression. The trend was to aggravate depression more intensively compared to anxiety in this cohort of women studied. Special support is needed for pregnant mothers during infectious epidemics taking more attention to antenatal depression.

Neonatal outcome among pregnant women with COVID-19: a systematic review and meta-analysis

BACKGROUND

COVID-19 has raised many concerns about the possible side effects of pregnancy. There is currently no conclusive evidence of the vertical transmission of COVID-19. Accordingly, this paper is a Systematic Review and Meta-Analysis investigated neonatal outcomes among pregnant women with COVID-19.

METHODS

PubMed, Web of Science (WoS), EMBASE, ProQuest, Scopus, and Google Scholar were searched up to November 2020. The Cochran's Q-test and I² statistic were applied to assess heterogeneity, a random-effects model was used to estimate the pooled estimate of the mean, and a meta-regression method was utilized to investigate the factors affecting heterogeneity between studies.

RESULTS

Of 1132 studies, 23 were included in the analysis (sample size: 749 for neonates and 820 for mothers). Most of these studies (n = 13) were conducted in China. The pooled estimate for the mean of birth weight, APGAR score in min 1 and 5 was 3084.97 g (95% CI: 2993.66-3176.29), 8.76 (95% CI: 8.27-9.25), and 9.44 (95% CI: 9.18-9.70), respectively. Also, the pooled prevalence of premature birth, shortness of breath, and neonatal death was 17.80% (95% CI: 12.47-23.13), 8.43% (95% CI: 4.50-12.37), and 7.73% (95% CI: 2.00-13.47), respectively. The meta-regression results indicated that the mother's age, disease duration, and sample size had no significant effect on heterogeneity between studies (p-value all of them was >.05). Finally, 15 studies (65.22%) reported that vertical transmission did not occur.

CONCLUSION

The COVID-19 infection can have adverse outcomes for the newborn. Despite the positive test of neonates, the vertical transmission of COVID-19 from the infected mother to the fetus has not yet been conclusively proven; thus, further research is needed.

The experience of nursing professionals in high-risk obstetric emergency services in the face of the COVID-19 pandemic

Abstract Objective To analyze the strategies, challenges, and coping mechanisms of nursing professionals who worked in obstetric emergencies in the context of the COVID-19 pandemic. Method This was a qualitative descriptive exploratory study with nine nursing professionals who worked at a high-risk obstetric emergency service in Fortaleza, Ceará, Brazil. Data were collected using a focus group carried out in November 2021. The data were organized into themes and analyzed according to the current literature. Results Based on the experiences of the participants, three themes emerged: 1) coping mechanisms adopted in the COVID-19 pandemic; 2) challenges experienced by nursing professionals in their care activities in the pandemic; and 3) challenges and repercussions experienced by nursing professionals in care activities. The professionals reported unsafe and conflicting conditions in which care flows suffered unexpected changes and which created challenges to provide users with safe and empathetic care. Final considerations and implications for practice The professionals presented emotional and psychological fragility because of long work periods, constant changes in care flows and protocols, work overload, understaffing due to professionals infected with COVID-19 or medical leaves of absence due to depression or other psychological disorders.

Insights on Epidemiology, Pathogenesis, Diagnosis and Possible Treatment of COVID-19 Infection

The sudden outbreak of the novel coronavirus infection (COVID-19, SARS-CoV-2 virus) is posing a significant threat by affecting millions of people across the globe showing mild to severe symptoms of pneumonia and acute respiratory distress. The absence of precise information on primary transmission, diagnosis, prognosis, and therapeutics for patients with COVID-19 makes prevention and control tough. In the current scenario, only supportive treatment is available, which in turn possess a biggest challenge for scientists to develop specific drugs and vaccines for COVID-19. Further, India, with the second largest populated country and fluctuating climatic conditions quarterly, has high vulnerability towards COVID-19 infection. Thus, this highlights the importance of a better understanding of the COVID-19 infection, pathology, diagnosis and its treatment. The present review article has been intended to discuss the COVID-19 biology, mechanism of infection in humans with primary effects on pregnancy, the nervous system, diabetes, and cardiovascular disease. The article will also discuss the drug repurposing strategy as an alternative line of treatment and clinical practices recommended by the World Health Organization and other government agencies and represent the COVID-19 scenario with the Indian context.

Successful outcome of severe COVID-19 in pregnancy: individualised approach

A 32-year-old homemaker, 28 weeks pregnant, was admitted to a dedicated COVID-19 hospital with a history of dyspnoea for 1 day; oral and nasopharyngeal swabs were positive for SARS-CoV-2 on real-time PCR. She had type 1 respiratory failure and oxygen saturation of 88%, so was put on non-invasive ventilation. Treatment as per guidelines was started. Given her deteriorating condition, a decision to deliver was taken and induction of labour was done. Her condition improved after delivery; but on day 5, she was suspected to have rhino-orbital mucormycosis and antifungals were started. Her condition improved gradually and she was discharged home. This case highlights the importance of individualised decision-making in cases with COVID-19 infection in pregnancy and that prompt treatment of the complications like mucormycosis would be lifesaving.

Impact de la Covid-19 sur la fertilité et la sexualité durant le confinement : quelles pertes de chance ?

La pandémie de Covid-19 liée au virus SARSCoV-2 a imposé un confinement mondial des populations en mars 2020. Outre les effets sur la santé publique et la santé physique, la santé mentale et la santé sexuelle ont été impactées. Les projets personnels des individus ont été bouleversés avec un impact sur les projets de couple et notamment de parentalités. La sexualité des individus s’est adaptée, entraînant des changements importants liés à l’isolement et les incertitudes en lien avec la pandémie mondiale.

Factors associated with antenatal depression during the COVID-19 (SARS-CoV2) pandemic: A cross-sectional study in a cohort of Turkish pregnant women

PURPOSE

To determine the effect of the COVID-19 pandemic on antenatal depression in Turkish pregnant women.

DESIGN AND METHODS

In this cross-sectional study, data were collected from 497 pregnant women between May and July 2020 using the Edinburgh Depression Scale (EDS) to determine the effect of obstetrics history, fear of hospitalization, concerns about the pandemic, birth, and the health of both mother and infant, on antenatal depression during the COVID-19 outbreak in Turkey.

FINDINGS

The general EDS mean score of the total group was determined as mean 13.70 ± 6.22, which was higher than the critical cutoff point of 13. According to the multiple linear regression model applied in the study, the best predictive variables for the mean EDS score were determined to be concerned about completing a healthy pregnancy (r = -0.45), social media and news programs related to COVID-19 increasing levels of concern (r = -0.31), fear of hospitalization as the birth approaches (r = -0.45), having bad dreams during the COVID-19 pandemic (r = -0.41), the request for an elective cesarean delivery because of fear of catching COVID-19 (r = -0.40), fear of breastfeeding the infant (r = -0.45), and concerns that their own health would be negatively affected because of the pandemic (r = - 0.39), and these variables affected the mean EDS score negatively (total variance 40.5%, R = 0.642).

PRACTICAL IMPLICATIONS

The COVID-19 pandemic has created an urgent need to implement specific antenatal programs to promote the psychological health of pregnant women and reduce antenatal depression during this or similar crises.

OUP accepted manuscript

STUDY QUESTION

How did the coronavirus disease 2019 (COVID-19) pandemic affect live birth numbers in Europe?

SUMMARY ANSWER

In 14 European countries with validated datasets on live birth numbers during the ongoing COVID-19 pandemic, excess mortality was inversely correlated with live birth numbers.

WHAT IS KNOWN ALREADY

Since March 2020, in order to minimize spread of severe acute respiratory syndrome coronavirus 2 and reducing strain on the health care systems, many national authorities have imposed containments and restricted both indoor and outdoor recreational activities. Historical events, such as electricity blackouts, have repeatedly been shown to exert incremental effects on birth numbers.

STUDY DESIGN, SIZE, DURATION

We evaluated the effect of the COVID-19 pandemic and the containments on reproduction and birth numbers in 14 European countries with complete and validated datasets, until March 2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The national demographic offices of 20 European countries were requested to provide the monthly birth numbers from 2015 to March 2021. Among them, 14 countries provided those data. Taking into account seasonal variations, the live birth numbers were compared with excess mortality at two different time intervals during the pandemic.

MAIN RESULTS AND THE ROLE OF CHANCE

At 9 months after the initiation of containments in many European countries, 11 of 14 European countries (78.5%) experienced a decline in live birth numbers, ranging between −0.5% and −11.4%. The decline in live birth numbers was most pronounced in eight European countries with the highest degree of excess mortality. From January to March 2021, live birth numbers continued to decline in 5 of 8 European countries with high excess mortality, whereas live births started to recover in 8 of 14 countries (57.1%).

LIMITATIONS, REASONS FOR CAUTION

The live birth numbers of some key European countries were not available.

WIDER IMPLICATIONS OF THE FINDINGS

The demographic changes linked to the COVID-19 pandemic may add to the overall socio-economic consequences, most particularly in those countries with pre-existing reduced reproduction rates.

STUDY FUNDING/COMPETING INTEREST(S)

This study did not receive specific funding. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Experiences of nurses providing maternity care in a public hospital during the COVID-19 pandemic in Nepal: A qualitative study

Maternity service providers have struggled to provide high-quality services to women and newborns during the ongoing COVID-19 pandemic which has substantially impacted health systems and disrupted maternity services globally. Nepal is a resources-limited country that reported a significant impact of the pandemic on maternal health services. It is therefore important to understand better the perspective of health care professionals in this context. This study intends to explore the experiences of nurses providing maternity care in the public sector during the COVID-19 pandemic in Nepal. A qualitative study using a phenomenological design was conducted. Altogether ten nurses working in maternity services were selected using purposive sampling technique. Data were collected by face-to-face in-depth interviews using a semi-structured interview guide. Thematic analysis was conducted using Clarke and Braun 2006 technique. The findings of the study were organized into codes, sub-themes and themes. The six themes identified were fear of COVID-19 at work, challenges at work, changes at work and services, motivations to work, stigma due to COVID-19, and impact on services. Participants described how maternity services could not be stopped during the pandemic. They had experienced decreased utilization of antenatal services as a consequence of 'lockdown' thereby leading to an increase in maternal and neonatal mortality. Respondents reported ineffective human resource management compromising the quality of care. The professional responsibility to cope with adverse circumstances and serve society is a major source of motivation that health workers relied upon to get them through the pandemic period. A wide range of challenges were faced by service providers during the pandemic which requires action and support of all levels of government, institutions and society-at-large to assure the continued provision of safe maternity care during such a protracted period of challenging work.

Ansiedade e depressão em profissionais de enfermagem de uma maternidade durante a pandemia de COVID-19

RESUMO Objetivo Estimar a prevalência de sintomas de ansiedade e depressão e seus fatores relacionados, entre os profissionais de enfermagem de uma maternidade, durante a pandemia de COVID-19. Método Estudo observacional, descritivo e transversal, realizado com 189 profissionais de enfermagem de uma maternidade de referência, em Fortaleza-Ceará. A coleta de dados ocorreu durante três meses − de agosto a outubro de 2020 −, e utilizou-se Formulário Sociodemográfico e Clínico e Escala Hospitalar de Ansiedade e Depressão. Os fatores relacionados para depressão ou ansiedade foram determinados pela análise bivariada, por meio do teste qui-quadrado (nominais) e Wilcoxon (numéricas), com significância de p<0,05. Resultados Estimou-se a prevalência de sintomatologia ansiosa e depressiva em 58,3% e 29,6% dos participantes, respectivamente. Cerca de 53,5% foram afastados por suspeita de COVID-19 e 58%, infectados pelo vírus. Observou-se que os profissionais que atuavam na emergência, clínica obstétrica e Unidade de Terapia Intensiva materna foram os mais expostos ao risco de ter depressão (p=0,01055). Conclusão e implicações para a prática Alta prevalência de sintomas de ansiedade e depressão entre os participantes, independentemente de estarem na linha de frente da pandemia ou não. A situação requer acolhimento às demandas da saúde mental.

Vivência dos profissionais de enfermagem em emergência obstétrica de alto risco frente à pandemia da COVID-19

Resumo Objetivo Analisar as estratégias, os desafios e os enfrentamentos dos profissionais de enfermagem que trabalhavam nas emergências obstétricas no contexto da pandemia de COVID-19. Método Estudo exploratório descritivo, qualitativo, realizado com nove profissionais de enfermagem de uma emergência obstétrica de alto risco, em Fortaleza-CE. Os dados foram coletados através da técnica grupo focal, em novembro de 2021, posteriormente foram organizados em temáticas e analisados de acordo com a literatura. Resultados A partir das experiências dos participantes emergiram três temas, a saber: 1) Estratégias de enfrentamento adotadas na pandemia por COVID-19; 2) Vivências experienciadas pelos profissionais de enfermagem durante suas atividades assistenciais na pandemia; 3) Desafios e reflexos experienciados pelos profissionais de enfermagem durante as atividades assistenciais. Os profissionais relataram condições inseguras e conflituosas em que os fluxos assistenciais sofreram mudanças inesperadas e dificuldades para agilizar um cuidado com segurança e empatia às usuárias do serviço. Considerações finais e implicações para a prática Percebeu-se ainda a fragilidade emocional e psicológica dos profissionais decorrente das extensas jornadas de trabalho, das constantes modificações dos fluxos e protocolos assistenciais, sobrecarga de trabalho, equipes insuficientes ocasionadas pelo afastamento de profissionais contaminados pelo vírus e por licença médica por desenvolver depressão ou outro distúrbio psicológico.

Pregnancy outcomes with coronavirus pregnancy outcomes with coronavirus infection (COVID-19)

Introduction: The clinical therapy of COVID-19 infection during pregnancy is still insufficient and limited. The current literature on COVID-19 infection during pregnancy and childbirth is summarized in this article, with a focus on maternal and neonatal outcomes. Material and methods: From June 1 to September 7, 2020, a systematic search of pertinent medical subject heading (MeSH) terms, covered by the electronic databases Web of Science and Scopus, PubMed, Google Scholar, and SID key phrases including coronavirus or COVID-19 and pregnancy was undertaken. The search and selection criteria were restricted to English and Farsi literature. COVID-19 in pregnancy articles of all types were considered in the study. The references of relevant studies were also searched. After deleting duplicate and ineligible items, a total of 21 articles were collected. Result: We found 21 studies with a total of 6,569 pregnant women who had COVID-19 infection: only one publication provided disease severity: 368 (95.6%) mild cases, 14 (3.6%) severe cases, and three (0.8%) serious cases. A total of 6,569 women gave birth more often by caesarean than by vaginal delivery. With multiple organ dysfunction syndromes (MODS), some women developed symptoms that necessitated ICU admission. The most commonly administered treatments for pregnant women with COVID-19 were hydroxychloroquine, Beclomethasone, Calamine, diclofenac sodium, Methylprednisolone, Azithromycin, Ganciclovir, Chinese herbal medicine, and Oseltamivir. The most commonly reported symptoms were fever and cough, followed by rhinorrhea, chest tightness, dyspnea, nasal congestion, and myalgias. Maternal outcomes included premature rupture of membranes, maternal death (21), gestational diabetes, preeclampsia, placental abruption, fetal distress, anemia, preterm birth (< 37 weeks), and fetal growth restriction, miscarriage, hypertension, and influenza. Neonatal intensive care unit (NICU) admission, prematurity, birth weight 2,500 g, preterm delivery (37 weeks), fetal discomfort, neonatal asphyxia, stillbirth (5), and neonatal death (9) were among the outcomes for babies. All of the infants had good Apgar scores. Conclusion: Prenatal and neonatal outcomes appear to be favorable in the majority of cases. Pregnant women and babies should be considered particularly vulnerable populations in terms of COVID-19 preventive and management strategies.

Coronavirus Disease 2019 (COVID-19) and Pregnancy: A Narrative Review

A novel viral respiratory disease caused by severe acute respiratory syndrome, coronavirus 2 (SARS-COV-2), is responsible for a pandemic situation in the world. Pregnant women are susceptible to this virus due to physiologic changes in the immunologic system. The risk of some adverse pregnancy outcomes, such as death, stillbirth, preeclampsia, and intrauterine fetal distress, may increase in infected pregnant women. Infected women should be isolated and investigated, and they should admit to a designated hospital with adequate facilities and multi-disciplinary expertise to manage them. Furthermore, the chances of adverse neonatal complications, such as small for gestational age, large for gestational age, shortness of breath, thrombocytopenia with abnormal liver function, rapid heart rate, vomiting, and pneumothorax, may increase in an affected neonate. This study reviews the problems and guidelines of covid-19 in pregnancy.

Anxiety and depression in nursing professionals of a maternity during the COVID-19 pandemic

ABSTRACT Objective To estimate the prevalence of anxiety and depression symptoms and their related factors among nursing professionals in a maternity hospital during the COVID-19 pandemic. Method Observational, descriptive and cross-sectional study carried out with 189 nursing professionals from a reference maternity hospital in Fortaleza-Ceará. Data collection took place over three months, from August to October 2020, using the Sociodemographic and Clinical Form and the Hospital Anxiety and Depression Scale. Factors related to depression or anxiety were determined by bivariate analysis using the chi-square (nominal) and Wilcoxon (numerical) tests, with a significance of p<0.05. Results The prevalence of anxious and depressive symptoms was estimated in 58.3% and 29.6% of the participants, respectively. About 53.5% were removed due to suspected COVID-19 and 58% were infected with the virus. It was observed that professionals who worked in the emergency, obstetric clinic and maternal Intensive Care Unit were the most exposed to the risk of having depression (p=0.01055). Conclusion and implications for practice High prevalence of anxiety and depression symptoms among participants, regardless of whether they are on the front lines of the pandemic or not. The situation requires meeting the demands of mental health.

The role of Saudi women in crisis management within the family: The COVID-19 pandemic as a model

BACKGROUND

Women play a pivotal role in managing crises and diminishing their serious consequences both in the family and society. In the first place, the spread of coronavirus disease 2019 (COVID-19) is one of the most severe crises in the world. Accordingly, many precautionary measures have been taken in many countries, including Saudi Arabia, such as border closures, lack of movement, and quarantine procedures, leading to an unprecedented impact on the daily lifestyle, and contributing significantly to increasing pressures on women because of her multiroles in family and work. This study aims at identifying the role of women in managing family crises during COVID-19.

MATERIALS AND METHODS

This was a descriptive, cross-sectional study. An online survey was conducted using self-designed electronic questionnaire consisting knowledge about the role of Saudi women in managing family during COVID-19 crises. The questionnaire was applied to 324 Saudi working women in Riyadh and Najran, with an average age of 33 years.

RESULTS

The results indicate that the role of Saudi women during the COVID-19 crisis was approximately 82%. Moreover, results showed that the prevalence of the social, psychological, and professional role of Saudi women during crisis was 82.24%, 83.40%, and 78.80%, respectively, which indicates the importance of the role of Saudi women in managing family crises during COVID-19.

CONCLUSION

Based on these results, the study emphasizes the importance of urging responsible persons to provide a package of rescue and stimulus, including social protection measures. Furthermore, it empowers Saudi women in all sectors of society and provides them with all means of support to help them achieve their mandated role in society generally and in their families particularly.

Pregnancy and COVID-19: prevention, vaccination, therapy, and beyond

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has alarmed the world since its first emergence. As pregnancy is characterized by significant changes in cardiovascular, respiratory, endocrine, and immunological systems, there are concerns on issues like the course of disease in pregnant women, safety of medications, route of delivery and risk of obstetric complications. The aim of this review is to summarize the current literature in the management of pregnant women during the COVID-19 pandemic. Although more than 90% of pregnant women with COVID-19 recover without serious morbidity, rapid deterioration of disease and higher rates of obstetric complications may be observed. The risk of vertical transmission has not been clearly revealed yet. Decreasing the number of prenatal visits, shortening the time allocated for the examinations, active use of telemedicine services, limiting the number of persons in healthcare settings, combining prenatal tests in the same visit, restricting visitors during the visits, providing a safe environment in healthcare facilities, strict hygiene control, and providing personal protective equipment during the visits are the main strategies to control the spread of disease according to current guidelines. Although new medication alternatives are being proposed every day for the treatment of COVID-19, our knowledge about the use of most of these drugs in pregnancy is limited. Preliminary results are promising for the administration of SARS-CoV-2 vaccines in the pregnant population. Timing of delivery should be decided based on maternal health condition, accompanying obstetric complications and gestational age. Cesarean delivery should be performed for obstetric indications. Breast feeding should be encouraged as long as necessary precautions for viral transmission are taken. In conclusion, an individualized approach should be provided by a multidisciplinary team for the management of pregnant women with COVID-19 to achieve favorable outcomes.

Pregnant during the COVID-19 pandemic: Knowledge, concerns, attitudes and practices of Pakistani women

INTRODUCTION

Data regarding pregnancy and related outcomes with COVID-19 are inconsistent, which leads to difficulties in counselling pregnant women. This brings uncertainty to pregnant women regarding mode of birth, transmission and issues that may occur in case they contract the disease. We conducted this study to assess the knowledge about COVID-19 risk during pregnancy and childbirth and to assess the concerns, attitudes, and practices of pregnant women during the pandemic.

METHODS

A cross-sectional survey was carried out among 376 consenting pregnant women attending antenatal clinics in Karachi, Pakistan, between 1 July and 16 July 2020, using pretested questionnaires.

RESULTS

A total of 376 pregnant women participated in the survey. Participants had inadequate knowledge about COVID-19 risk during pregnancy, including potential vertical transmission (58.5%), preferred route of delivery (52%), safety of breastfeeding (50%), birth defects (44.7%), rooming in and skin-to-skin contact (58.5%). The majority (85.1%) had a high concern score, and negative attitude (62.8%). Only 43.6% said that they would not hide their symptoms, while 37.2% stated that they will deliver at hospital if they tested positive. Only 30.9% of respondents had good practices. During visits, 39.4% maintained social distancing and sanitized hands while only 37.2% said that they did not bring more than one person with them.

CONCLUSIONS

The study population had inadequate knowledge, negative attitude, and poor practices regarding pregnancy during the COVID-19 pandemic. More than half of the respondents thought that concealing symptoms and delivering at home would be better. Awareness programs are urgently needed.

Health care providers' awareness of breastfeeding practice recommendations during COVID-19 pandemic and associated factors in Northwest Ethiopia, 2021: A multicenter study

BACKGROUND

Prevention of coronavirus disease 2019 (COVID-19) transmission to newborns is one of the basic components of perinatal care in the era of the COVID-19 pandemic. As such, scientific evidence is compulsory for evidence-based practices. However, there was a scarcity of evidence on health care providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic in Ethiopia, particularly in the study setting.

OBJECTIVE

The study aimed at assessing healthcare providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic and associated factors among healthcare providers in northwest Ethiopia, 2021.

METHODS

A multicenter cross-sectional study was conducted among 405 healthcare providers working in hospitals of Gondar province from November 15, 2020, to March 10, 2021. A simple random sampling technique was employed to select the study subjects. Data were collected via a structured-self-administered questionnaire. EPI INFO version 7.1.2 and SPSS version 25 were used for data entry and analysis respectively. Binary logistic regression analyses were done to identify associated factors and the adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p-value of <0.05 was used to declare significant association.

RESULTS

The healthcare providers' awareness of breastfeeding practice recommendations during the COVID-19 pandemic was 40.7% (95% CI: 35.9, 45.6). Working in a tertiary hospital (AOR = 3.69; 95% CI: 2.24, 6.08), using COVID-19 guideline updates (AOR = 3.34; 95% CI: 2.1, 5.3), being trained on COVID-19 (AOR = 2.78; 95% CI: 1.74, 4.47), owning a smartphone and/or a computer (AOR = 2.26; 95% CI: 1.39, 3.68), and perceiving that COVID-19 is dangerous (AOR = 1.78; 95% CI: 1.05, 3.01) were factors positively associated with healthcare providers' awareness of breastfeeding practice recommendations during the pandemic of COVID-19.

CONCLUSION

Only two in five healthcare providers were aware of recommendations on breastfeeding practice during the COVID-19 pandemic and related to information of accessibility information on COVID-19. Therefore, expanding COVID-19 related information through the provision of COVID-19 training and guidelines to all levels of hospitals would improve health care providers' awareness of breastfeeding practice recommendations amid the COVID-19 pandemic.

Dyspnea and COVID-19: A Review of Confounding Diagnoses during the Postpartum Period

The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of blood volume occur. This period is conducive to the occurrence of thromboembolic events. In the context of the SARS-CoV-2 pandemic, the virus responsible for COVID-19, the attention of the scientific community and health professionals has been focused on obtaining insights on different aspects of this disease, including etiology, transmission, diagnosis, and treatment. Regarding the pregnancy-postpartum cycle, it is opportune to review the clinical conditions that can occur during this period and to investigate dyspnea as a postpartum symptom in order to avoid its immediate association with COVID-19 without further investigation, which can lead to overlooking the diagnosis of other important and occasionally fatal conditions.

Obstetric and perinatal outcomes in pregnant women with COVID-19: an interim analysis

The coronavirus disease (COVID-19) has affected the health-care system worldwide. The effect of COVID-19 on obstetric and perinatal outcomes is yet to be completely ascertained. A hospital-based prospective observational study was conducted at the Department of Obstetrics & Gynecology, AIIMS Rishikesh from July to December 2020. A total of 60 COVID-positive pregnant women were included. Obstetric and perinatal outcomes were compared with 60 COVID-negative pregnant women. A subgroup comparison was also performed between symptomatic and asymptomatic pregnant women with COVID-19. Majority of COVID-positive pregnant women were asymptomatic (81.7%). Eleven patients were symptomatic, out of which 9 (15%) had mild disease and only 2 (3.3%) had severe pneumonia. There was an increased likelihood of early pregnancy loss (5%), oligohydramnios (21.7%), preterm birth (31.7%), and cesarean section (53.3%). The occurrence of preterm birth was significantly higher in symptomatic women than asymptomatic women (p = .01). Oligohydramnios was significantly more frequent in COVID-positive than COVID-negative pregnant women (p = .048). Preterm birth and cesarean rate were slightly higher in COVID-positive group but the difference was not statistically significant. Other obstetric outcomes were comparable in both groups. The majority of women with COVID-19 infection in pregnancy remain asymptomatic or have mild symptoms. Still, it may lead to maternal death and poor fetal outcomes in form of early pregnancy loss, prematurity, oligohydramnios, intrapartum fetal distress, and increased cesarean rate. Therefore, COVID-19 preventive measures should be strictly implemented and followed.

Flowers and thorns in pregnancy: experiences during the COVID-19 pandemic

OBJECTIVE

To understand the repercussions of COVID-19 on the path of pregnancy.

METHOD

Qualitative, participatory action research (PAR) study, based on Paulo Freire's Research Itinerary. A virtual culture circle was held in October 2020, with the participation of 12 pregnant women, living in the South and Southeast regions of Brazil.

RESULTS

In the virtual culture circle, pregnant women talked and critically reflected on two generating themes: flowers and thorns in the course of pregnancy. They meant living in the virtual culture circle as spaces for sharing experiences, welcoming and learning, among others.

CONCLUSIONS

For the participants, pregnancy during the pandemic brought difficulties such as social isolation, absence from work and the university, fears, anxieties, loneliness and insecurities. However, it also improved health care, intensifying self-care and investment in family relationships.

Impact of the COVID-19 Pandemic on Obstetricians/Gynecologists

Objective

To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on obstetricians/gynecologists (OB/GYNs).

Participants and Methods

A 49-item survey was distributed to OB/GYNs through the websites and electronic mailing lists of professional OB/GYN organizations. The survey was open from June 22, 2020, through November 22, 2020. Of the 122 initiated surveys, 89 were completed (73.0% completion rate); 72 respondents answered at least one open-ended question and were included for qualitative analysis.

Results

Respondents reported policy changes, limited personal protective equipment availability, patient compliance with safety protocols and personal protective equipment use, staff shortages, and concerns about COVID-19 exposure as primary stressors related to the pandemic. Respondents felt that the pandemic had a negative professional impact on their relationships with patients and colleagues. Workplace and pandemic stressors resulted in feelings of anxiety and frustration; physical effects were also reported. Some respondents indicated that they were considering early retirement or leaving the profession as a result of the pandemic, which suggests that OB/GYNs may be at increased risk for burnout.

Conclusion

The COVID-19 pandemic will have important long-term effects on OB/GYN well-being and workforce retention. Proactive support for OB/GYNs is needed to combat burnout and counteract workforce attrition. Implementing peer support programs that promote healthy emotional processing following adverse events may mitigate these feelings and reduce OB/GYN burnout.

Resolution of Ethical Dilemmas Using Basic Ethical Principles in Cases of Pregnancy with Severe Symptoms of Coronavirus Disease 2019 Complications

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus. CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications. CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.

Suicide due to fear of COVID-19, in the last month of pregnancy, leads to neonatal seizure: A case report

Introduction

and importance: Limited data are available about various effects of COVID-19 on pregnancy. On the other hand, the COVID-19 pandemic could exacerbate anxiety or schizophrenia symptoms.

Case presentation

The patient is a 5-day-old newborn, whom his mother suffers from schizophrenia, depression and anxiety disorders. The young pregnant mother gets delusions of being infected with Covid-19, thus attempts suicide with Sertraline, Clonazepam, Quetiapine and Rispeirdone, although she was in the last week of pregnancy. The newborn baby referred to our neonatal ward with seizure and apnea. Phenytoin and caffeine were administered leading to some degree of symptom relief, but due to the dermatologic reactions of phenytoin, they were replaced with levetiracetam.

Clinical discussion

The Covid-19 may increase levels of anxiety and depression or exacerbation of schizophrenia symptoms, especially in pregnant women suffering from mental disorders. In addition, there are evidence supporting the occurrence of neonatal malformations as a result of exposure to antipsychotic drugs during the first trimester of pregnancy.

Conclusion

Investigating the role of antidepressant and antipsychotic drugs in the perinatal period, especially near delivery has received less attention so far; thus further studies are required to determine the safety of these drugs.

•

The COVID-19 pandemic could exacerbate anxiety or schizophrenia symptoms.

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The pregnancy may be associated with a fear of COVID-19.

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Antipsychotic drugs may cause neonatal malformations.

Impact of the SARS-CoV-2 pandemic and first lockdown on pregnancy monitoring in France: the COVIMATER cross-sectional study

BACKGROUND

In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, consultations and pregnancy monitoring examinations had to be reorganised urgently. In addition, women themselves may have postponed or cancelled their medical monitoring for organisational reasons, for fear of contracting the disease caused by SARS-CoV-2 (COVID-19) or for other reasons of their own. Delayed care can have deleterious consequences for both the mother and the child. Our objective was therefore to study the impact of the SARS-CoV-2 pandemic and the first lockdown in France on voluntary changes by pregnant women in the medical monitoring of their pregnancy and the associated factors.

METHODS

A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult (> 18 years old) pregnant women during the first French lockdown (March-May 2020). A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPRs).

RESULTS

Almost one women of five (23.4%) reported having voluntarily postponed or foregone at least one consultation or pregnancy check-up during the lockdown. Women who were professionally inactive (aPR = 1.98, CI95%[1.24-3.16]), who had experienced serious disputes or violence during the lockdown (1.47, [1.00-2.16]), who felt they received little or no support (1.71, [1.07-2.71]), and those who changed health professionals during the lockdown (1.57, [1.04-2.36]) were all more likely to have voluntarily changed their pregnancy monitoring. Higher level of worry about the pandemic was associated with a lower probability of voluntarily changing pregnancy monitoring (0.66, [0.46-0.96]).

CONCLUSIONS

Our results can guide prevention and support policies for pregnant women in the current and future pandemics.

The Impact of the Coronavirus Disease 19 Pandemic on Early Pregnancy Outcomes Among Patients Undergoing In Vitro Fertilization Treatment

Objective: To determine if pregnancy rates (PRs) or pregnancy loss rates (PLRs) were altered in patients undergoing single, euploid frozen-thawed embryo transfer (FET) during the initial peak of the Coronavirus Disease 19 (COVID-19) pandemic.

Materials and Methods: This was a retrospective cohort study performed in a single academic center. Patients undergoing single, euploid FET cycles from January to May 2017–2020 were included. Cycles with FET performed in January–May of 2020 (“COVID-surge cohort”) were compared to cycles with FET performed in January–May of 2017–2019 (“pre-COVID cohort”). Pregnancy rate (PR), clinical pregnancy rate (CPR), pregnancy loss rate (PLR), and clinical pregnancy loss rate (CLR) were compared between the cohorts.

Results: A total of 2629 single, euploid FET cycles were included: 2070 from January to May, 2017–2019 and 559 from January to May 2020. PR was similar when comparing FET performed from January to May 2020 (COVID-surge) to those performed from January to May, 2017–2019 (pre-COVID) (77.6% vs. 73.7%, p = 0.06), while CPR was higher among the COVID-surge compared to the pre-COVID cohort (65.5% vs. 60.0%, p = 0.02). No differences were seen in PLR and CLR among the COVID-surge and pre-COVID cohorts (28.3% vs. 32.0%, p = 0.08; 15.0% vs. 16.5%, p = 0.50). PR, CPR, PLR, and CLR were similar when comparing individual months between the cohorts. Adjusted analysis showed no differences in PR, CPR, PLR, or CLR when comparing the cohorts overall or when comparing corresponding individual months in the two time periods.

Conclusion: PRs and PLRs were not decreased when SARS-CoV-2 transmission was widespread in our geographic area, suggesting that high COVID-19 transmission does not compromise early pregnancy outcomes.

Pregnancy as a Risk Factor of Severe COVID-19

Since first being identified in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an etiological agent behind Coronavirus disease 19 (COVID-19), has caused three waves of a global pandemic, with a fourth in progress. Despite its high percentage of asymptomatic and low-symptomatic courses of illness, the SARS-CoV-2 pandemic has claimed a higher death toll than the SARS-CoV and MERS-CoV epidemics because of its high infectivity when compared to the other coronaviruses. High COVID-19 mortality is associated with age and other coexisting morbidities, as well as healthcare quality. According to several studies, pregnant women are at a higher risk of severe COVID-19 infection and adverse pregnancy outcomes (caesarean delivery, pre-term birth, low birth weight, preeclampsia, ICU admission, and need for mechanical ventilation). In our review of recent literature, we focused on the effects of COVID-19 in pregnant women, emphasizing the subcellular pathophysiology of SARS-CoV-2. In this paper, we concentrate on the pathophysiology of sub-cellular changes in COVID-19 and endeavor to highlight the aspects that manifest in physiological pregnancy and potentially create a higher risk of SARS-CoV-2 infection and acute COVID-19 symptoms. Understanding how pregnancy-associated changes can cause a synergistic effect with COVID-19 may point us in the right direction for future prophylaxis and treatment for women undergoing COVID-19 during pregnancy.

Post Traumatic Growth for Gestational Diabetic Patients During COVID-19: Role of Partner Supportive Communication and Family Environment

Purpose

Leading a normal life and managing daily psychological or physical stress is hard for everybody but when a person is diagnosed with gestational diabetes mellitus (GDM) during a widespread pandemic, the battle is inescapable. This research aimed to explore some positive dimensions that can lessen the adversities of these women.

Design and Methods

We assessed all 200 cases of GDM who were registered in the maternity wards of the government and private hospitals of South Punjab, Pakistan. Respondents were diagnosed with GDM during the first wave of COVID-19. Post-traumatic growth (PTG) inventory, Family environment scale, and Partner supportive communication (PSC) scale were used. SEM and moderation analysis was conducted to test the hypothesized relationship among the variables.

Results

Result showed that elicitation of thoughts and feelings (β = 0.109, t-value = 3.501, p = 0.001), effective listening (β = −0.144, t-value = 1.928, p = 0.054), and communication towards partner (β = −0.209, t-value = 4.850, p = 0.005) significantly moderated the relationship between family environment and post traumatic growth.

Practical Implications

This research is beneficial for health practitioners because the trauma of being diagnosed with such a disease can be alleviated by the role of family environment and PSC.

Healthcare Considerations for Special Populations during the COVID-19 Pandemic: A Review

The coronavirus disease 2019 (COVID-19) has emerged as a threat to human health and public safety. People of all ages are susceptible to severe acute respiratory syndrome coronavirus 2 infection. However, the clinical manifestations of this infection differ by age. This study purposes to describe healthcare considerations for special populations, such as children, pregnant and lactating women, and older adults, who may have unique healthcare needs, in the pandemic situation. To realize the research purpose, we conducted a review of the practice guidelines of public documents and qualified studies that were published online/offline during a specific period. The review identified current knowledge on care for newborns, children in schools, pregnant women (from antenatal to postpartum care), and older adults suffering from high-risk conditions. Subsequently, we summarize vaccination guidance for special populations and, finally, discuss the issues currently affecting special populations. Therefore, this current knowledge on care for special populations helps nurses to provide accurate information on vaccinations aimed at preventing COVID-19 and protecting the masses from infection. Currently, the scarcity of information on COVID-19 variants necessitates further research on measures to reduce pandemic spread.

Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study

BACKGROUND

To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic.

METHODS AND FINDINGS

We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (±5.9) years old versus 30.5 (±5.4) years old, respectively, p < 0.001), obesity (0.7% versus 0.3%, respectively, p < 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, p < 0.001), and history of hypertension (0.9% versus 0.3%, respectively, p < 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, p < 0.001) and primiparity (0.3% versus 0.4%, respectively, p < 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis (p = 0.28). When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, p < 0.001), mortality (0.2% versus 0.005%, p < 0.001), preeclampsia/eclampsia (4.8% versus 2.2%, p < 0.001), gestational hypertension (2.3% versus 1.3%, p < 0.03), postpartum hemorrhage (10.0% versus 5.7%, p < 0.001), preterm birth at <37 weeks of gestation (16.7% versus 7.1%, p < 0.001), <32 weeks of gestation (2.2% versus 0.8%, p < 0.001), <28 weeks of gestation (2.4% versus 0.8%, p < 0.001), induced preterm birth (5.4% versus 1.4%, p < 0.001), spontaneous preterm birth (11.3% versus 5.7%, p < 0.001), fetal distress (33.0% versus 26.0%, p < 0.001), and cesarean section (33.0% versus 20.2%, p < 0.001). Rates of pregnancy terminations ≥22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected.

CONCLUSIONS

We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women.

Perspectives on administration of COVID-19 vaccine to pregnant and lactating women: a challenge for low- and middle-income countries

Women who are in the pregnancy-puerperal cycle or are lactating have been deliberately excluded from participating in COVID-19 vaccine clinical trials that aimed to evaluate either the efficacy of the vaccines in inducing the formation of neutralizing antibodies or the investigational products' safety profile. The exclusion of pregnant and lactating women from such studies certainly and inequitably denies these women access to COVID-19 vaccines, since these products have become increasingly available to nonpregnant people and even to those who are pregnant and are in high-income settings. In this clinical opinion article, we discuss some aspects of the prolonged pandemic, the emergence of viral variants, the risks of severe complications of COVID-19 in pregnant women, and the disproportionate impact of the above on low- and middle-income countries. We argue that the decision to receive the COVID-19 vaccine should be a joint decision between the pregnant or lactating women and the healthcare providers, while considering the available data on vaccine efficacy, safety, the risks of SARS-CoV-2 infection in pregnant women, and the women's individual risks for infection and serious illness. The various types of vaccines that are already in use and their safety, effectiveness, and the potential risks and benefits of their administration to pregnant or lactating women are also reviewed.

Management of pregnant women with COVID-19: A tertiary pandemic center experience on 1416 cases

The aim of this study is to share the comprehensive experience of a tertiary pandemic center on pregnant women with COVID-19 and to compare clinical outcomes between pregnancy trimesters. The present prospective cohort study consisted of pregnant women with COVID-19 who were followed up at Ankara City Hospital between March 11, 2020 and February 20, 2021. Clinical characteristics and perinatal outcomes were compared between the pregnancy trimesters. A total of 1416 pregnant women (1400 singletons and 16 twins) with COVID-19 were evaluated. Twenty-six (1.8%) patients were admitted to the intensive care unit (ICU) and maternal mortality was observed in six (0.4%) cases. Pregnancy complications were present in 227 (16.1%) cases and preterm labor was the most common one (n = 42, 2.9%). There were 311, 433, and 672 patients in the first, second, and third trimesters of pregnancy, respectively. Rates of mild and severe/critic COVID-19 were highest in the first and second trimesters, respectively. The hospitalization rate was highest in the third trimester. Pregnancy complications, maternal mortality, and NICU admission rates were similar between the groups. The course of the disease and obstetric outcomes may be different among pregnancy trimesters. A worse course of the disease may be observed even in pregnant women without any coexisting health problems.

Planned home birth assistance: challenges during the COVID-19 pandemic

OBJECTIVE

To understand the challenges faced by urban midwives in assisting planned home births during the COVID-19 pandemic.

METHODS

Qualitative study, based on the Collective Subject Discourse methodological framework, carried out with eight professionals, members of a birth care collective from the northeast region of Brazil. Data was collected between September and October of 2020 using the focus group technique.

RESULTS

The collective discourses revealed five central ideas: Changing assistance strategy; Dealing with frustration; Facing the fear of contamination; Avoiding exposure to the virus; and Keeping distance during the care process.

FINAL CONSIDERATIONS

The challenging condition the pandemic brings to the care of planned home births is made evident, being marked by the need for collective protection and the pressure of following health recommendations. The study also points out the need for official protocols and good quality information based on scientific evidence and humanizing principles to guide health care.