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Bajaj M, Romero R, Myers L, Duncan J, Yeo L, Jani S, Natarajan G. Population-Level Study on Fetal Deaths and Preterm Births during SARS-CoV-2 Pandemic in the State of Michigan. Am J Perinatol 2024; 41:e236-e248. [PMID: 35709722 PMCID: PMC10065952 DOI: 10.1055/a-1878-0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to explore the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on preterm birth at different gestational ages and fetal death in the state of Michigan. STUDY DESIGN Data on live births and fetal deaths in the state of Michigan from March to November in the years 2017 through 2020 were obtained from Michigan Department of Health and Human Services (MDHHS). Preterm birth rate, fetal death rate (per 1,000 live births) overall and stratified by race and maternal comorbidities during the period of pandemic (March-November 2020) were compared with the same period (March-November) in the prepandemic years (2017-2019). RESULTS Of 328,879 live births and 1,470 fetal deaths during the study period, 77,983 live births and 242 fetal deaths were reported in 2020. Compared with prepandemic years, fetal death rate per 1,000 live births was significantly lower in 2020 (3.1 vs. 4.7 [2017], 5.2 [2018], 4.4 [2019], p-value <0.001). The adjusted risk for fetal death in 2020 was decreased (odds ratio [OR] = 0.64 [95% confidence interval (CI): 0.56-0.74], p <0.0001), compared with prepandemic years. Fetal death was significantly associated with African-American race, pregnancy hypertension and prepregnancy diabetes. No significant difference in the proportion of preterm births (<37 weeks' gestation) was noted between pandemic and prepandemic years (9.9 vs. 10.0%, p = 0.50). There was no significant difference in the risk of preterm birth across gestational age strata (<28, 28-316/7, 32-366/7, 37-416/7, and >42 weeks) between pandemic and prepandemic years on multinomial analysis. Significant associations with preterm birth across all years included African American race, lower level of maternal education, pregnancy-induced hypertension, chronic hypertension, prepregnancy diabetes, congenital anomalies, previous preterm birth, and prolonged rupture of membranes >12 hours. CONCLUSION Fetal death rate was significantly lower whereas preterm births remained unchanged during pandemic in comparison with prepandemic years in the state of Michigan. KEY POINTS · A decrease in fetal death rate was noted during SARS CoV-2 pandemic in the State of Michigan.. · Overall state-wide rates of preterm birth did not change in 2020, compared to previous years.. · Significant risk factors associated with preterm birth and fetal deaths did not differ between prepandemic and pandemic years..
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Affiliation(s)
- Monika Bajaj
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
- Detroit Medical Center, Detroit, Michigan
| | - Lindsey Myers
- Division for Vital Records and Health Statistics, Department of Health and Human Services, Lansing, Michigan
| | - Jeffrey Duncan
- Division for Vital Records and Health Statistics, Department of Health and Human Services, Lansing, Michigan
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sanket Jani
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
| | - Girija Natarajan
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
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Acosta E, Hug L, Cruz-Castanheira H, Sharrow D, Monteiro da Silva JH, You D. Changes in stillbirths and child and youth mortality in 2020 and 2021 during the COVID-19 pandemic. Int J Epidemiol 2024; 53:dyae057. [PMID: 38622491 PMCID: PMC11018542 DOI: 10.1093/ije/dyae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/10/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has been extensively studied for its impact on mortality, particularly in older age groups. However, the pandemic effects on stillbirths and mortality rates in neonates, infants, children and youth remain poorly understood. This study comprehensively analyses the pandemic influence on young mortality and stillbirths across 112 countries and territories in 2020 and 104 in 2021. METHODS Using data from civil registers and vital statistics systems (CRVS) and the Health Management Information System (HMIS), we estimate expected mortality levels in a non-pandemic setting and relative mortality changes (p-scores) through generalized linear models. The analysis focuses on the distribution of country-specific mortality changes and the proportion of countries experiencing deficits, no changes and excess mortality in each age group. RESULTS Results show that stillbirths and under-25 mortality were as expected in most countries during 2020 and 2021. However, among countries with changes, more experienced deficits than excess mortality, except for stillbirths, neonates and those aged 10-24 in 2021, where, despite the predominance of no changes, excess mortality prevailed. Notably, a fifth of examined countries saw increases in stillbirths and a quarter in young adult mortality (20-24) in 2021. Our findings are highly consistent between females and males and similar across income levels. CONCLUSION Despite global disruptions to essential services, stillbirths and youth mortality were as expected in most observed countries, challenging initial hypotheses. However, the study suggests the possibility of delayed adverse effects that require more time to manifest at the population level. Understanding the lasting impacts of the COVID-19 pandemic requires ongoing, long-term monitoring of health and deaths among children and youth, particularly in low- and lower-middle-income countries.
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Affiliation(s)
- Enrique Acosta
- Centre d’Estudis Demogràfics (CED), Barcelona, Spain
- Laboratory of Population Health, Max Planck Institute for Demographic Research (MPIDR), Rostock, Germany
| | - Lucia Hug
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, USA
| | | | - David Sharrow
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, USA
| | | | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, USA
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Moriarty KL, Oyenuga RO, Olafuyi O, Schwartz DA. Causes and Effects of COVID-19 Vaccine Hesitancy Among Pregnant Women and its Association with Adverse Maternal, Placental, and Perinatal Outcomes. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:73-84. [PMID: 38559465 PMCID: PMC10964823 DOI: 10.59249/lpoq5146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Populations identified to be severely affected by COVID-19, such as pregnant patients, require special consideration in vaccine counseling, access, and provider education. Maternal infection with COVID-19 poses a significant risk to the maternal-fetal dyad with known adverse placenta destruction [1-5]. Despite the widespread access and availability of vaccinations, vaccine hesitancy continues to persist and is highly prevalent in pregnant populations [6-9]. Addressing the multitude of social ecological factors surrounding vaccine hesitancy can aid in providing holistic counseling [10]. However, such factors are foremost shaped by maternal concern over possible fetal effects from vaccination. While changes in policy can help foster vaccine access and acceptance, increasing global provider education and incorporation of motivational interviewing skills are the first steps towards increasing maternal acceptance.
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Affiliation(s)
- Kristen Lee Moriarty
- Department of Obstetrics & Gynecology, University
of Connecticut School of Medicine, Farmington, CT, USA
| | - Roselyn O. Oyenuga
- Department of Obstetrics & Gynecology, University
of Connecticut School of Medicine, Farmington, CT, USA
| | - Olatoyosi Olafuyi
- Department of Obstetrics & Gynecology, University
of Connecticut School of Medicine, Farmington, CT, USA
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Kumar M, Puri M, Suka M, Chawla N, Kaur GP, Yadav R, Agrawal K, Biswas R. Impact of Action Taken in Response to Stillbirth Audit: A Success Story. J Obstet Gynaecol India 2023; 73:61-68. [PMID: 37916007 PMCID: PMC10616033 DOI: 10.1007/s13224-023-01808-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/07/2023] [Indexed: 11/03/2023] Open
Abstract
Objectives Study the impact of intra-facility interventions on the modifiable factors causing stillbirths (SB), using point-of-care quality improvement (POCQI) methodology. Material and Methods Stillbirth data during the 9 months pre-intervention period were reviewed to identify the common preventable causes. Two interventions, namely, ultrasound at 34-36 weeks gestation and intrapartum monitoring on a common customized labor chart for all health-care providers, were done. Post-intervention data were collected to observe the impact of the interventions. Results The stillbirth rate reduced from 212/5940 deliveries (35.7/1000) in the pre-intervention period to 165/5993 deliveries (27.7/1000) in the post-intervention period (p = 0.011). The intra-facility failure to identify FGR significantly reduced in the post-intervention group (p = 0.033), leading to 63% (RR 0.37) reduction in its risk. Using a common customized labor chart led to a significant decline in the inadequate monitoring as a provider-related cause of stillbirth (p < 0.001) leading to its 42% decline as contributor to modifiable cause of SB (RR 0.48). Conclusion Reviewing the perinatal death surveillance response (PDSR) data, identifying gaps in care, and using improvement methodology for instituting corrective measures play an important role in reducing intramural stillbirths.
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Affiliation(s)
- Manisha Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Manju Puri
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Millo Suka
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Nupur Chawla
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Gagan Preet Kaur
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Reena Yadav
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Kiran Agrawal
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
| | - Ratna Biswas
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India
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Beňová L, Semaan A, Afolabi BB, Amongin D, Babah OA, Dioubate N, Harissatou N, Kikula AI, Nakubulwa S, Ogein O, Adroma M, Anzo Adiga W, Diallo A, Diallo IS, Diallo L, Cellou Diallo M, Maomou C, Mtinangi N, Sy T, Delvaux T, Delamou A, Nakimuli A, Pembe AB, Banke-Thomas AO. Obstetric referrals, complications and health outcomes in maternity wards of large hospitals during the COVID-19 pandemic: a mixed methods study of six hospitals in Guinea, Nigeria, Uganda and Tanzania. BMJ Open 2023; 13:e076364. [PMID: 37730410 PMCID: PMC10514648 DOI: 10.1136/bmjopen-2023-076364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes. DESIGN Prospective observational mixed-methods study, combining monthly routine data (March 2019-February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave. SETTING Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda. PARTICIPANTS 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels. RESULTS Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%-40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures. CONCLUSIONS Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women's and care providers' needs, this can contribute to ensuring continuation of essential care provision during emergency.
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Affiliation(s)
- Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Dinah Amongin
- Department of Health Policy Planning and Management, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ochuwa Adiketu Babah
- Department of Obstetrics and Gynaecology, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Nafissatou Dioubate
- Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea
| | | | - Amani Idris Kikula
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Sarah Nakubulwa
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kawempe National Referral Hospital, Kampala, Uganda
| | - Olubunmi Ogein
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Moses Adroma
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Anzo Adiga
- Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | | | | | - Lamine Diallo
- Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea
| | | | - Cécé Maomou
- Service de la maternité, Hôpital Régional de Mamou, Mamou, Guinea
| | - Nathanael Mtinangi
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Telly Sy
- Service de la maternité, Hôpital National Ignace Deen, Conakry, Guinea
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Alexandre Delamou
- Département de santé publique, Centre National de Formation et de Recherche en Santé Rurale, Maférinyah, Forécariah, Guinea
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrea Barnabas Pembe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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Dandona R, Kumar GA, Akbar M, Dora SSP, Dandona L. Substantial increase in stillbirth rate during the COVID-19 pandemic: results from a population-based study in the Indian state of Bihar. BMJ Glob Health 2023; 8:e013021. [PMID: 37491108 PMCID: PMC10373740 DOI: 10.1136/bmjgh-2023-013021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION We report on the stillbirth rate (SBR) and associated risk factors for births during the COVID-19 pandemic, and change in SBR between prepandemic (2016) and pandemic periods in the Indian state of Bihar. METHODS Births between July 2020 and June 2021 (91.5% participation) representative of Bihar were listed. Stillbirth was defined as fetal death with gestation period of ≥7 months where the fetus did not show any sign of life. Detailed interviews were conducted for all stillbirths and neonatal deaths, and for 25% random sample of surviving live births. We estimated overall SBR, and during COVID-19 peak and non-peak periods per 1000 births. Multiple logistic regression models were run to assess risk factors for stillbirth. The change in SBR for Bihar from 2016 to 2020-2021 was estimated. RESULTS We identified 582 stillbirths in 30 412 births with an estimated SBR of 19.1 per 1000 births (95% CI 17.7 to 20.7); SBR was significantly higher in private facility (38.4; 95% CI 34.3 to 43.0) than in public facility (8.6; 95% CI 7.3 to 10.1) births, and for COVID-19 peak (21.2; 95% CI 19.2 to 23.4) than non-peak period (16.3; 95% CI 14.2 to 18.6) births. Pregnancies with the last pregnancy trimester during the COVID-19 peak period had 40.4% (95% CI 10.3% to 70.4%) higher SBR than those who did not. Risk factor associations for stillbirths were similar between the COVID-19 peak and non-peak periods, with gestation age of <8 months with the highest odds of stillbirth followed by referred deliveries and deliveries in private health facilities. A statistically significant increase of 24.3% and 68.9% in overall SBR and intrapartum SBR was seen between 2016 and 2020-2021, respectively. CONCLUSIONS This study documented an increase in SBR during the COVID-19 pandemic as compared with the prepandemic period, and the varied SBR based on the intensity of the COVID-19 pandemic and by the place of delivery.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Md Akbar
- Public Health Foundation of India, New Delhi, India
| | | | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Singh M, Puri M, Choudhary V, Kapur A, Triveni GS, Gunjan, Patel M, Kumari V. Impact of COVID-19 Pandemic on Maternofetal Outcome in Pregnant Women with Severe Anemia. Indian J Community Med 2023; 48:556-561. [PMID: 37662118 PMCID: PMC10470568 DOI: 10.4103/ijcm.ijcm_428_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Anemia is the most common nutritional disease in pregnancy with significant adverse maternofetal outcome. The objective of the present study is to study the impact of COVID-19 pandemic on the pregnancy outcomes of women with severe anemia. Methodology A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at LHMC and SSK Hospital, Delhi. The study included all antenatal women admitted at a gestational age of >26 weeks (third trimester) with severe anemia and hemoglobin level of 7 g/dL. In our study, a total of 4031 women were included as cases during study period (July to December 2022) and 6659 women as controls from pre-COVID-19 period (July to December 2019). Results In present study, a total of 4031 women delivered during study period as compared to 6659 in control period. In the present study, the prevalence of anemia was observed to be 74.7% in the study group and 51.6% in the control group (P < 0.001). Mean hemoglobin level was significantly lower in study group as compared to the control groups P<0.05. Microcytic hypochromic anemia was the most common morphological type of anemia in both groups. Serum ferritin, serum iron, serum B12, and folic acid levels among cases were significantly (P < 0.05) lower as compared to controls. Odds of fetal growth restriction were 1.4 times higher among study group as compared to control groups. The odds of newborn complications such as low birth weight were 2.49 (95% CI: 1.04-5.91) and need for nursery or NICU admission were 4.84 times (95% CI: 0.48-48.24) higher in cases as compared to controls. Low birth rate was higher in cases and was found to be statistically significant. Conclusion COVID-19 pandemic had indirect impact on adverse maternal and fetal outcome in women with severe anemia.
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Affiliation(s)
- Meenakshi Singh
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
| | - Manju Puri
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
| | - Vidhi Choudhary
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
| | - Aishwarya Kapur
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
| | - GS Triveni
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
| | - Gunjan
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
| | - Manisha Patel
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
| | - Vinita Kumari
- Department of Obstetrics and Gynaecology, Lady Harding Medical College, New Delhi, India
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Atkins B, Kindinger L, Mahindra MP, Moatti Z, Siassakos D. Stillbirth: prevention and supportive bereavement care. BMJ MEDICINE 2023; 2:e000262. [PMID: 37564829 PMCID: PMC10410959 DOI: 10.1136/bmjmed-2022-000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/26/2023] [Indexed: 08/12/2023]
Abstract
Around half of the two million stillbirths occurring worldwide each year are preventable. This review compiles the most up-to-date evidence to inform stillbirth prevention. Many general maternal health interventions also reduce the risk of stillbirth, for example, antenatal care attendance. This review focuses on specific aspects of care: glucose metabolism, targeted aspirin prophylaxis, clotting and immune disorders, sleep positions, fetal movement monitoring, and preconception and interconception health. In the past few years, covid-19 infection during pregnancy has emerged as a risk factor for stillbirth, particularly among women who were not vaccinated. Alongside prevention, efforts to address stillbirth must include provision of high quality, supportive, and compassionate bereavement care to improve parents' wellbeing. A growing body of evidence suggests beneficial effects for parents who received supportive care and were offered choices such as mode of birth and the option to see and hold their baby. Staff need support to be able to care for parents effectively, yet, studies consistently highlight the scarcity of specific bereavement care training for healthcare providers. Action is urgently needed and is possible. Action must be taken with the evidence available now, in healthcare settings with high or low resources, to reduce stillbirths and improve training and care.
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Affiliation(s)
- Bethany Atkins
- Institute for Women's Health, University College London, London, UK
- National Institute for Health and Care Research, London, UK
| | - Lindsay Kindinger
- King Edward Memorial Hospital for Women Perth, Perth, WA, Australia
- Fiona Stanley Hospital, Perth, WA, Australia
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Comparison of adverse pregnancy and birth outcomes using archival medical records before and during the first wave of the COVID-19 pandemic in Kinshasa, Democratic Republic of Congo: a facility-based, retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:31. [PMID: 36647021 PMCID: PMC9841139 DOI: 10.1186/s12884-022-05291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Little research has been conducted on the impact of the coronavirus disease 2019 (COVID-19) pandemic on either birth outcomes or the ability of archival medical records to accurately capture these outcomes. Our study objective is thus to compare the prevalence of preterm birth, stillbirth, low birth weight (LBW), small for gestational age (SGA), congenital microcephaly, and neonatal bloodstream infection (NBSI) before and during the first wave of the COVID-19 pandemic in Kinshasa, Democratic Republic of Congo (DRC). METHODS We conducted a facility-based retrospective cohort study in which identified cases of birth outcomes were tabulated at initial screening and subcategorized according to level of diagnostic certainty using Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) definitions. Documentation of any birth complications, delivery type, and maternal vaccination history were also evaluated. The prevalence of each birth outcome was compared in the pre-COVID-19 (i.e., July 2019 to February 2020) and intra-COVID-19 (i.e., March to August 2020) periods via two-sample z-test for equality of proportions. RESULTS In total, 14,300 birth records were abstracted. Adverse birth outcomes were identified among 22.0% and 14.3% of pregnancies in the pre-COVID-19 and intra-COVID-19 periods, respectively. For stillbirth, LBW, SGA, microcephaly, and NBSI, prevalence estimates were similar across study periods. However, the prevalence of preterm birth in the intra-COVID-19 period was significantly lower than that reported during the pre-COVID-19 period (8.6% vs. 11.5%, p < 0.0001). Furthermore, the level of diagnostic certainty declined slightly across all outcomes investigated from the pre-COVID-19 to the intra-COVID-19 period. Nonetheless, diagnostic certainty was especially low for certain outcomes (i.e., stillbirth and NBSI) regardless of period; still, other outcomes, such as preterm birth and LBW, had moderate to high levels of diagnostic certainty. Results were mostly consistent when the analysis was focused on the facilities designated for COVID-19 care. CONCLUSION This study succeeded in providing prevalence estimates for key adverse birth outcomes using GAIA criteria during the COVID-19 pandemic in Kinshasa, DRC. Furthermore, our study adds crucial real-world data to the literature surrounding the impact of the COVID-19 pandemic on maternal and neonatal services and outcomes in Africa.
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Farhadi R, Noori H, GhaffariSaravi V, Moosazadeh M. Stillbirth and Preterm Birth During Lockdown Periods in 5 Waves of COVID-19 Pandemic in Northern Iran: A Region-Wide Cohort Study in Mazandaran Province. Health Serv Res Manag Epidemiol 2023; 10:23333928231180561. [PMID: 37347050 PMCID: PMC10280785 DOI: 10.1177/23333928231180561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Conflicting reports for preterm birth and stillbirth during the lockdown imposed during the COVID-19 pandemic have emerged. Most of the studies are related to the initial waves of the pandemic. Objectives This study aims to evaluate changes in preterm birth and stillbirth rates during various waves of COVID-19 in northern Iran. Methods This is a retrospective cohort study to evaluate preterm birth and stillbirth rate based on weight distribution per 1000 live births during lockdown periods in 5 peaks of the COVID-19 pandemic using the regional data registration system at Mazandaran University of Medical Sciences in northern Iran. We compared these rates with the corresponding months 4 years before the pandemic. The odds ratio for the primary outcome was estimated by logistic regression. Results We observed an overall increased rate of preterm birth during the pandemic compared to the pre-pandemic period (4.7% vs 2.8%, P < .001). The overall stillbirth rate increased during the COVID-19 pandemic compared to the pre-pandemic period (7.48/1000 vs 5.41/1000, odds ratio: 1.38 [1.21-1.57]). This increase in the rate of stillbirth was significantly observed in the fifth wave of the COVID-19 pandemic (P < .001). Conclusion Our study showed that adverse pregnancy outcomes increased during lockdown periods of a global pandemic. Further studies from geographically diverse regions to evaluate different behavior changes during pregnancy and access to prenatal services, and its impact on pregnancy outcomes is recommended.
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Affiliation(s)
- Roya Farhadi
- Pediatric Infectious Diseases Research
Center, Communicable Diseases Institute, Mazandaran University of Medical
Sciences, Sari, Iran
| | - Hanieh Noori
- Pediatric Infectious Diseases Research
Center, Communicable Diseases Institute, Mazandaran University of Medical
Sciences, Sari, Iran
| | - Vajiheh GhaffariSaravi
- Pediatric Infectious Diseases Research
Center, Communicable Diseases Institute, Mazandaran University of Medical
Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical
Sciences, Sari, Iran
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11
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Nain S, Suman S, Meena D, Lal P, Kumar M, Puri M. Revisiting destructive operations to prevent second stage caesarean section in COVID times: A case series. Trop Doct 2023; 53:154-157. [PMID: 36112958 DOI: 10.1177/00494755221125839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Destructive operations diminish the bulk of the foetus for facilitating vaginal delivery. Procedures such as craniotomy or decapitation can be carried out to deliver a dead baby in appropriately selected cases. Ours is a retrospective case series at a single tertiary facility during the first wave of the COVID pandemic. From July 2020 to January 2021, six destructive operations (five craniotomies and one decapitation) were performed in women who had arrest of descent in the second stage of labour but had intrapartum foetal demise. The average operative time was 30 minutes with a mean hospital stay of 4.3 days, which was significantly less than CS, and with much less morbidity. None of these women had significant post-partum haemorrhage or sepsis. Destructive procedures should be considered for better obstetric future of the patient, and a lesser burden on the health facility. What was practiced in COVID times should be extended beyond.
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Affiliation(s)
- Shilpi Nain
- 28856Department Of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, India
| | - Shalini Suman
- 28856Department Of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, India
| | - Deepika Meena
- 28856Department Of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, India
| | - Prabha Lal
- 28856Department Of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, India
| | - Manisha Kumar
- 28856Department Of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, India
| | - Manju Puri
- 28856Department Of Obstetrics and Gynaecology, Lady Hardinge Medical College, Delhi, India
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12
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Magnus MC, Oakley LL, Hansen AV, Örtqvist AK, Petersen TG, Mortensen LH, Bliddal M, Andersen AMN, Stephansson O, Håberg SE. Fetal death after the introduction of COVID-19 mitigation measures in Sweden, Denmark and Norway: a registry-based study. Sci Rep 2022; 12:20625. [PMID: 36450919 PMCID: PMC9709372 DOI: 10.1038/s41598-022-25036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
It remains unclear whether the rate of fetal death has changed during the COVID-19 pandemic. We assessed the impact of COVID-19 mitigation measures on fetal death in Sweden (449,347 births), Denmark (290,857 pregnancies) and Norway (261,057 pregnancies) using robust population-based registry data. We used Cox regression to assess the impact of the implementation of pandemic mitigation measures on March 12th, 2020, on miscarriage (fetal loss before gestational week 22) and stillbirth (fetal loss after gestational week 22). A total of 11% of 551,914 pregnancies in Denmark and Norway ended in miscarriage, while the proportion of stillbirths among 937,174 births across the three countries was 0.3%. There was no difference in the risk of fetal death during the year following pandemic mitigation measures. For miscarriage, the combined hazard ratio (HR) for Norway and Denmark was 1.01 (95% CI 0.98, 1.03), and for stillbirth, the combined HR for all three countries was 0.99 (95% CI 0.89, 1.09). We observed a slightly decreased risk of miscarriage during the first 4 months, with an HR of 0.94 (95% CI 0.90, 0.99) after lockdown. In conclusion, the risk of fetal death did not change after the implementation of COVID-19 pandemic mitigation measures in the three Scandinavian countries.
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Affiliation(s)
- Maria C. Magnus
- grid.418193.60000 0001 1541 4204Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - Laura L. Oakley
- grid.418193.60000 0001 1541 4204Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway ,grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne V. Hansen
- grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark ,grid.437930.a0000 0001 2248 6353Statistics Denmark, Copenhagen, Denmark
| | - Anne K. Örtqvist
- grid.4714.60000 0004 1937 0626Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,Department of Obstetrics and Gynaecology, Visby County Hospital, Visby, Sweden
| | - Tanja G. Petersen
- grid.7143.10000 0004 0512 5013Open, Odense University Hospital, Odense, Denmark
| | - Laust H. Mortensen
- grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark ,grid.437930.a0000 0001 2248 6353Statistics Denmark, Copenhagen, Denmark
| | - Mette Bliddal
- grid.10825.3e0000 0001 0728 0170OPEN, University of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne-Marie Nybo Andersen
- grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Olof Stephansson
- grid.4714.60000 0004 1937 0626Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Women’s Health, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Siri E. Håberg
- grid.418193.60000 0001 1541 4204Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
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13
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Lydon MM, Vilanculos J, Martinez A, Barata A, Keyes E. Effects of the COVID-19 pandemic on maternal and perinatal health service utilisation and outcomes in Mozambique: an interrupted time series analysis. BMJ Open 2022; 12:e062975. [PMID: 36385027 PMCID: PMC9670093 DOI: 10.1136/bmjopen-2022-062975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To measure the effects of the COVID-19 pandemic on maternal and perinatal health services and outcomes in Mozambique. DESIGN This is an observational study analysing routine service delivery data using interrupted time series analysis. We used 43 months of district-level panel data with April 2020 as the point of interruption, adjusting for seasonality and population growth to analyse service utilisation outcomes. SETTING The 222 public health facilities in Nampula Province, Mozambique, from January 2018 to July 2021. OUTCOME MEASURES The change in the number of antenatal care (ANC) visits and facility deliveries, and the change in the rate of adverse birth outcomes at pandemic onset and over time compared with expected levels and trends, respectively. RESULTS There were no significant disruptions to ANC at pandemic onset. Following this, there was a significant monthly increase of 29.8 (18.2-41.4) first ANC visits and 11.3 (5.5-17.2) ANC visits within the first trimester per district above prepandemic trends. There was no significant change in the number of fourth ANC visits completed. At the onset of COVID-19, districts experienced a significant decrease of 71.1 (-110.5 to -31.7) facility deliveries, but the rate then increased significantly above prepandemic trends. There was no significant increase in any adverse birth outcomes during the pandemic. Conversely, districts observed a significant monthly decrease of 5.3 uterine rupture cases (-9.9 to -0.6) and 19.2 stillbirths (-33.83 to -4.58) per 100 000 facility deliveries below prepandemic trends. There was a significant drop of 23.5 cases of neonatal sepsis/100 000 facility deliveries per district at pandemic onset. CONCLUSION Despite pandemic interference, Nampula Province saw no disruptions to ANC, only temporary disruptions to facility deliveries and no increases in adverse birth outcomes. ANC visits surprisingly increased, and the rates of uterine rupture, stillbirth and neonatal sepsis decreased, suggesting that Nampula Province may offer insights about health system resilience.
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Affiliation(s)
- Megan M Lydon
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, Durham, North Carolina, USA
| | | | - Andres Martinez
- Behavioral, Epidemiological and Clinical Sciences, FHI 360, Durham, North Carolina, USA
| | | | - Emily Keyes
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, Durham, North Carolina, USA
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14
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Begum J, K S, Sahu P. The Unforeseen Impact of the COVID-19 Pandemic on Dismal Pregnancy and Fetal Outcomes. Cureus 2022; 14:e31044. [DOI: 10.7759/cureus.31044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
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15
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Hawco S, Rolnik DL, Woolner A, Cameron NJ, Wyness V, Mol BW, Black M. The impact of mitigation measures on perinatal outcomes during the first nine months of the COVID-19 pandemic: A systematic review with meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 274:117-127. [PMID: 35640440 PMCID: PMC9106593 DOI: 10.1016/j.ejogrb.2022.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/15/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Worldwide reports have produced conflicting data on perinatal outcomes during the COVID-19 pandemic. This systematic review and meta-analysis addressed the effect of mitigation measures against COVID-19 on preterm birth, stillbirth, low birth weight, and NICU admission during the first nine months of the pandemic. A search was performed using MEDLINE, Embase and SCOPUS for manuscripts published up until 24th May 2021. Studies that reported perinatal outcomes (preterm birth, stillbirth, low birth weight, NICU admission) during the COVID-19 pandemic with a pre-pandemic control period were included. Risk of bias assessment was performed using ROBINS-I tool. RevMan5 was used to perform meta-analysis with random-effects models. A score of the stringency of mitigation measures was calculated from the Oxford COVID-19 Government Response Tracker. Thirty-eight studies of moderate to serious risk of bias were included, with varied methodology, analysis and regional mitigation measures, using stringency index scores. There was no overall effect on preterm birth at less than 37 weeks (OR 0.96, 95% CI 0.92–1.00). However, there was a reduction in preterm birth at less than 37 weeks (OR 0.89, 95% CI 0.81–0.98) and 34 weeks (OR 0.56, 95% CI 0.37–0.83) for iatrogenic births and in singleton pregnancies. There was also a significant reduction in preterm births at less than 34 weeks in studies with above median stringency index scores (OR 0.71, 95% CI 0.58–0.88). There was no effect on risk of stillbirth (OR 1.04, 95% CI 0.90–1.19) or birth weight. NICU admission rates were significantly reduced in studies with above median stringency index scores (OR 0.87, 95% CI 0.78–0.97). The reduction in preterm births in regions with high mitigation measures against SARS-CoV-2 infection is likely driven by a reduction in iatrogenic births. Variability in study design and cohort characteristics need to be considered for future studies to allow further investigation of population level health measures of perinatal outcomes.
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Affiliation(s)
- Sarah Hawco
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
| | - Andrea Woolner
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Natalie J Cameron
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia; Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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16
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Yang J, D'Souza R, Kharrat A, Fell DB, Snelgrove JW, Shah PS. COVID-19 pandemic and population-level pregnancy and neonatal outcomes in general population: A living systematic review and meta-analysis (Update#2: November 20, 2021). Acta Obstet Gynecol Scand 2022; 101:273-292. [PMID: 35088409 DOI: 10.1111/aogs.14318] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 12/30/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Conflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the coronavirus disease 2019 (COVID-19) pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta-analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre-pandemic periods. MATERIAL AND METHODS We searched the PubMed and Embase databases and reference lists of articles published up until November 20, 2021, and included English language studies that compared outcomes between the COVID-19 pandemic time period with pre-pandemic time periods. Risk of bias was assessed using the Newcastle-Ottawa scale. We conducted random-effects meta-analysis using the inverse variance method. RESULTS Fifty-two studies with low-to-moderate risk of bias, reporting on 2 372 521 pregnancies during the pandemic period and 28 518 300 pregnancies during the pre-pandemic period, were included. There was significant reduction in unadjusted estimates of PTB (43 studies, unadjusted odds ratio [uaOR] 0.95, 95% CI 0.93-0.98), but not in adjusted estimates (five studies, adjusted OR [aOR] 0.94, 95% CI 0.74-1.19). This reduction was noted in studies from single centers/health areas (29 studies, uaOR 0.90, 95% CI 0.85-0.94) but not in regional/national studies (14 studies, uaOR 0.99, 95% CI 0.99-1.01). There was reduction in spontaneous PTB (nine studies, uaOR 0.91, 95% CI 0.88-0.94) but not in induced PTB (eight studies, uaOR 0.90, 95% CI 0.79-1.01). There was no difference in the odds of stillbirth between the pandemic and pre-pandemic time periods (32 studies, uaOR 1.07, 95% CI 0.97-1.18 and three studies, aOR 1.18, 95% CI 0.86-1.63). There was an increase in mean birthweight during the pandemic period compared with the pre-pandemic period (nine studies, mean difference 21 g, 95% CI 13-30 g). The odds of maternal mortality were increased (five studies, uaOR 1.15, 95% CI 1.05-1.26); however, only unadjusted estimates were available, and the result was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB. CONCLUSIONS The COVID-19 pandemic may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no statistically significant difference in stillbirths between pandemic and pre-pandemic periods.
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Affiliation(s)
- Jie Yang
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ashraf Kharrat
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John W Snelgrove
- Department of Obstetrics and Gynaecology and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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17
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Schwartz DA, Avvad-Portari E, Babál P, Baldewijns M, Blomberg M, Bouachba A, Camacho J, Collardeau-Frachon S, Colson A, Dehaene I, Ferreres JC, Fitzgerald B, Garrido-Pontnou M, Gerges H, Hargitai B, Helguera-Repetto AC, Holmström S, Irles CL, Leijonhfvud Å, Libbrecht S, Marton T, McEntagart N, Molina JT, Morotti R, Nadal A, Navarro A, Nelander M, Oviedo A, Oyamada Otani AR, Papadogiannakis N, Petersen AC, Roberts DJ, Saad AG, Sand A, Schoenmakers S, Sehn JK, Simpson PR, Thomas K, Valdespino-Vázquez MY, van der Meeren LE, Van Dorpe J, Verdijk RM, Watkins JC, Zaigham M. Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries. Arch Pathol Lab Med 2022; 146:660-676. [PMID: 35142798 DOI: 10.5858/arpa.2022-0029-sa] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Perinatal death is an increasingly important problem as the COVID-19 pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for SARS-CoV-2. DESIGN.— Case-based retrospective clinico-pathological analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.— All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25/68) and chronic villitis (32%; 22/68). The majority (19, 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
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Affiliation(s)
| | - Elyzabeth Avvad-Portari
- Department of Pathology, Fernandes Figueira Institute, FIOCRUZ - Rio de Janeiro, Brazil (Avvad-Portari)
| | - Pavel Babál
- Department of Pathology, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Babál)
| | - Marcella Baldewijns
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns)
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden (Blomberg)
| | - Amine Bouachba
- Institut de Pathologie Multisite des Hospices Civils de Lyon, Lyon, France; SOFFOET-Société Française de Foetopathologie, Paris, France (Bouachba)
| | - Jessica Camacho
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Camacho)
| | - Sophie Collardeau-Frachon
- Department of Pathology, Hopital Femme-Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and SOFFOET-Société Française de Foetopathologie, Paris France (Collardeau-Frachon)
| | - Arthur Colson
- Department of Obstetrics, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium (Colson)
| | - Isabelle Dehaene
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Dehaene)
| | - Joan Carles Ferreres
- Pathology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Barcelona, Spain (Ferreres)
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Republic of Ireland (Fitzgerald)
| | - Marta Garrido-Pontnou
- Pathology Department, Hospital Universitari Vall d'Hebron, Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain (Garrido-Pontnou)
| | - Hazem Gerges
- Department of Obstetrics and Gynaecology, Doncaster and Bassetlaw NHS Teaching Hospitals, Women's Hospital, Doncaster, United Kingdom (Gerges)
| | - Beata Hargitai
- Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Hargitai)
| | - A Cecilia Helguera-Repetto
- Immunobiochemistry Department, National Institute of Perinatology, Mexico City, Mexico (Helguera-Repetto)
| | - Sandra Holmström
- Department of Obstetrics and Gynaecology, Halland Hospital, Varberg, Sweden (Holmström)
| | - Claudine Liliane Irles
- Department of Physiology and Cellular Development, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City, Mexico (Irles)
| | - Åsa Leijonhfvud
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden (Leijonhfvud)
| | - Sasha Libbrecht
- Department of Pathological Anatomy, Antwerp University Hospital, Edegem, Belgium (Libbrecht)
| | - Tamás Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham, United Kingdom (Marton)
| | - Noel McEntagart
- Histopathology, Rotunda Hospital, Dublin, Republic of Ireland (McEntagart)
| | - James T Molina
- Pathology and Laboratory Medicine, CHRISTUS Hospital St. Elizabeth, 2830 Calder St, Beaumont, Texas (Molina)
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, Connecticut (Morotti)
| | - Alfons Nadal
- Pathology Department, Hospital Clínic, Barcelona, Spain (Nadal).,Department of Basic Clinical Practice, School of Medicine, Universitat de Barcelona, and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (Nadal)
| | - Alexandra Navarro
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Navarro)
| | - Maria Nelander
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Nelander)
| | - Angelica Oviedo
- Department of Pathology and Laboratory Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico (Oviedo)
| | | | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Department of Pathology, Karolinska University Hospital, Stockholm, Sweden (Papadogiannakis)
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark (Petersen)
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Roberts)
| | - Ali G Saad
- Pediatric Pathology and Neuropathology, Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, Florida (Saad)
| | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Karolinska University Hospital, Solna, Stockholm, Sweden (Sand)
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Schoenmakers)
| | - Jennifer K Sehn
- Department of Pathology, St. Louis University School of Medicine, St. Louis, Missouri (Sehn)
| | - Preston R Simpson
- Department of Pathology, CHRISTUS Hospital St. Elizabeth, 2830 Calder St., Beaumont, Texas (Simpson)
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health - Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas)
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (van der Meeren).,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands (van der Meeren)
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium (Van Dorpe)
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Verdijk)
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Watkins)
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Sweden (Zaigham).,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden (Zaigham)
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Gurram Venkata SKR, Shah PS, Beltempo M, Yoon E, Wood S, Hicks M, Daboval T, Wong J, Wintermark P, Mohammad K. Outcomes of infants with hypoxic-ischemic encephalopathy during COVID-19 pandemic lockdown in Canada: a cohort study. Childs Nerv Syst 2022; 38:1727-1734. [PMID: 35676388 PMCID: PMC9177131 DOI: 10.1007/s00381-022-05575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate change in the severity of hypoxic-ischemic encephalopathy (HIE) and associated morbidities between pre- and during COVID-19 pandemic periods in Canada. METHODS We conducted a retrospective cohort study extracting the data from level-3 NICUs participating in Canadian Neonatal Network (CNN). The primary outcome was a composite of death in the first week after birth and/or stage 3 HIE (Sarnat and Sarnat). Secondary outcomes included rate and severity of HIE among admitted neonates, overall mortality, brain injury on magnetic resonance imaging (MRI), neonates requiring resuscitation, organ dysfunction, and therapeutic hypothermia (TH) usage. We included 1591 neonates with gestational age ≥ 36 weeks with HIE during the specified periods: pandemic cohort from April 1st to December 31st of 2020; pre-pandemic cohort between April 1st and December 31st of 2017, 2018, and 2019. We calculated the odds ratio (OR) and confidence intervals (CI). RESULTS We observed no significant difference in the primary outcome (15% vs. 16%; OR 1.08; 95%CI 0.78-1.48), mortality in the first week after birth (6% vs. 6%; OR 1.10, 95%CI 0.69-1.75), neonates requiring resuscitation, organ dysfunction, TH usage, or rate of brain injury. In the ad hoc analysis, per 1000 live births, there was an increase in the rate of infants with HIE and TH use. CONCLUSIONS Severity of HIE, associated morbidities, and mortality were not significantly different during the pandemic lockdown compared to a pre-pandemic period in Canada. Anticipated risks and difficulties in accessing healthcare have not increased the mortality and morbidities in neonates with HIE in Canada.
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Affiliation(s)
| | - Prakesh S. Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Marc Beltempo
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children’s Hospital, McGill University, Montreal, QC Canada
| | - Eugene Yoon
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Stephen Wood
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Matthew Hicks
- Department of Pediatrics, Division of Neonatal-Perinatal Care, Stollery Children’s Hospital, University of Alberta, Edmonton, AB Canada
| | - Thierry Daboval
- Department of Pediatrics, Division of Neonatology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada
| | - Jonathan Wong
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Pia Wintermark
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children’s Hospital, McGill University, Montreal, QC Canada
| | - Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Calgary, Canada. .,Department of Pediatrics, Section of Neonatology, Alberta Children's Hospital, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada.
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19
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Semaan A, Dey T, Kikula A, Asefa A, Delvaux T, Langlois EV, van den Akker T, Benova L. "Separated during the first hours"-Postnatal care for women and newborns during the COVID-19 pandemic: A mixed-methods cross-sectional study from a global online survey of maternal and newborn healthcare providers. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000214. [PMID: 36962168 PMCID: PMC10022345 DOI: 10.1371/journal.pgph.0000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/23/2022] [Indexed: 01/22/2023]
Abstract
Routine postnatal care (PNC) allows monitoring, early detection and management of complications, and counselling to ensure immediate and long-term wellbeing of mothers and newborns; yet effective coverage is sub-optimal globally. The COVID-19 pandemic disrupted availability and quality of maternal and newborn care despite established guidelines promoting continuity of essential services. We conducted a cross-sectional global online survey of 424 maternal and newborn healthcare providers from 61 countries, to explore PNC provision, availability, content and quality following the early phase of the COVID-19 pandemic. The questionnaire (11 languages), included four multiple-choice and four open-text questions on changes to PNC during the pandemic. Quantitative and qualitative responses received between July and December 2020 were analysed separately and integrated during reporting. Tightened rules for visiting postpartum women were reported in health facilities, ranging from shorter visiting hours to banning supportive companions and visitors. A quarter (26%) of respondents reported that mothers suspected/confirmed with COVID-19 were routinely separated from their newborns. Early initiation of breastfeeding was delayed due to waiting for maternal SARS-CoV-2 test results. Reduced provision of breastfeeding support was reported by 40% of respondents in high-income countries and 7% in low-income countries. Almost 60% reported that women were discharged earlier than usual and 27% perceived a reduction in attendance to outpatient PNC. Telemedicine and home visits were mostly reported in high-income countries to ensure safe care provision. Beyond the early phase of the COVID-19 pandemic, severe disruptions to content and quality of PNC continued to exist, whereas disruptions in availability and use were less commonly reported. Depriving women of support, reducing availability of PNC services, and mother-newborn separation could lead to negative long-term outcomes for women, newborns and families, and deny their rights to respectful care. Protecting these essential services is imperative to promoting quality woman-centred PNC during and beyond the pandemic.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Teesta Dey
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom
| | - Amani Kikula
- Muhimbili University of Health and Allied Sciences, Upanga-West, Dar es salaam, Tanzania
| | - Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Thomas van den Akker
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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20
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Yang J, D'Souza R, Kharrat A, Fell DB, Snelgrove JW, Murphy KE, Shah PS. Coronavirus disease 2019 pandemic and pregnancy and neonatal outcomes in general population: A living systematic review and meta-analysis (updated Aug 14, 2021). Acta Obstet Gynecol Scand 2021; 101:7-24. [PMID: 34730232 PMCID: PMC8653307 DOI: 10.1111/aogs.14277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022]
Abstract
Introduction Conflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the coronavirus disease 2019 (COVID‐19) pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta‐analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre‐pandemic periods. Material and methods We searched PubMed and Embase databases, reference lists of articles published up until August 14, 2021 and included English language studies that compared outcomes between the COVID‐19 pandemic time period and the pre‐pandemic time periods. Risk of bias was assessed using the Newcastle–Ottawa scale. We conducted random‐effects meta‐analysis using the inverse variance method. Results Forty‐five studies with low‐to‐moderate risk of bias, reporting on 1 843 665 pregnancies during the pandemic period and 23 564 552 pregnancies during the pre‐pandemic period, were included. There was significant reduction in unadjusted estimates of PTB (35 studies, unadjusted odds ratio [uaOR] 0.95, 95% CI 0.92–0.98), but not in adjusted estimates (six studies, adjusted OR [aOR] 0.95, 95% CI 0.80–1.13). This reduction was noted in studies from single centers/health areas (25 studies, uaOR 0.90, 95% CI 0.86–0.96) but not in regional/national studies (10 studies, uaOR 0.99, 95% CI 0.95–1.02). There was reduction in spontaneous PTB (six studies, uaOR 0.89, 95% CI 0.81–0.96) and induced PTB (five studies, uaOR 0.89, 95% CI 0.81–0.97). There was no difference in the odds of stillbirth between the pandemic and pre‐pandemic time periods (24 studies, uaOR 1.11, 95% CI 0.97–1.26 and four studies, aOR 1.06, 95% CI 0.81–1.38). There was an increase in mean birthweight during the pandemic period compared with the pre‐pandemic period (six studies, mean difference 17 g, 95% CI 7–28 g). The odds of maternal mortality were increased (four studies, uaOR 1.15, 95% CI 1.05–1.26); however, only unadjusted estimates were available and the result was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB. Conclusions The COVID‐19 pandemic may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no statistically significant difference in stillbirth between pandemic and pre‐pandemic periods.
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Affiliation(s)
- Jie Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ashraf Kharrat
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John W Snelgrove
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kellie E Murphy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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21
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Ornaghi S, Fumagalli S, Guinea Montalvo CK, Beretta G, Invernizzi F, Nespoli A, Vergani P. Indirect impact of SARS-CoV-2 pandemic on pregnancy and childbirth outcomes: A nine-month long experience from a university center in Lombardy. Int J Gynaecol Obstet 2021; 156:466-474. [PMID: 34669973 PMCID: PMC9087530 DOI: 10.1002/ijgo.13990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 01/23/2023]
Abstract
Objective To determine the impact on perinatal health of changes in social policies and obstetric care implemented to curb SARS‐CoV‐2 transmission. However, robust data on the topic are lacking since most of the studies has examined only the first few months of the outbreak. Methods A retrospective analysis of prospectively collected data on uninfected and asymptomatically infected women giving birth between March and November 2020 and in the same time frame of 2019 at our tertiary care center in Lombardy, northern Italy. Perinatal outcomes were compared according to the year (2019 versus 2020) and to the trimester (March–May, June–August, September–November) of childbirth, corresponding to the three phases of the pandemic (first wave, deceleration, second wave) and covering a 9‐month period. Results We identified increased rates of gestational diabetes mellitus, spontaneous preterm birth, and neuraxial analgesia in 2020 versus 2019, with different temporal distributions: gestational diabetes mellitus and spontaneous preterm birth were more prevalent during the deceleration and the second wave phase, whereas epidural analgesia was more prevalent during the first wave. Conclusion By assessing a prolonged time frame of the pandemic, we show that pandemic‐related control measures, as applied in Lombardy, impacted relevant perinatal outcomes of women giving birth at our center.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Simona Fumagalli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | | | - Greta Beretta
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Invernizzi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Antonella Nespoli
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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22
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Vaccaro C, Mahmoud F, Aboulatta L, Aloud B, Eltonsy S. The impact of COVID-19 first wave national lockdowns on perinatal outcomes: a rapid review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:676. [PMID: 34615505 PMCID: PMC8532086 DOI: 10.1186/s12884-021-04156-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the emergence of COVID-19, preventative public health measures, including lockdown strategies, were declared in most countries to control viral transmission. Recent studies and anecdotes have reported changes in the prevalence of perinatal outcomes during national COVID-19lockdowns.The objective of this rapid review was to evaluate the impact of COVID-19 lockdowns on the incidence of low birth weight (LBW), preterm birth (PTB), and stillbirth. METHODS Two reviewers searched EMBASE, CORD-19, LitCovid (PubMed), WHO Global research on corona virus disease (COVID-19), and MedRxiv for studies published in English from the first reports on COVID-19 until 17 July 2021. Perinatal outcomes of interest included LBW (< 2500 g), PTB (< 37 weeks), and stillbirth. RESULTS Of the 1967 screened articles, 17 publications met the inclusion criteria (14 cohort studies, 1 case control and 2 cross-sectional studies). Studies included data from Denmark, UK, Ireland, Nepal, Italy, Israel, Botswana, Australia, China, Netherlands, Saudi Arabia, Austria, Zimbabwe, India, and Spain. The total sample size ranged from 3399 to 1,599,547 pregnant women. Thirteen studies examined PTB with conflicting results, reporting both an increase and a decrease in PTB incidence, with odds ratios [95% CI] ranging from 0.09 [0.01, 0.40] to 1.93 [0.76, 4.79]. Three studies found a decrease in LBW rates during lockdowns, one of which was statistically significant, with a rate ratio of 3.77 [1.21, 11.75]. Ten studies examined stillbirth rates, including four studies reporting a statistically significant increase in stillbirth rates, with adjusted relative risk ranging from 1.46 [1.13, 1.89] to 3.9 [1.83, 12.0]. Fourteen studies contained data that could be combined in a meta-analysis comparing perinatal outcomes before and during lockdown. We found that lockdown measures were associated with a significant risk of stillbirth with RR = 1.33 [95% CI 1.04, 1.69] when compared to before lockdown period. However, lockdown measures were not associated with a significant risk of PTB, LBW and VLBW compared to prepandemic periods. CONCLUSIONS This review provides clues about the severity of the indirect influence of COVID-19 lockdown implementation; however, the criteria that lead to unexpected changes in LBW, PTB, and stillbirth remains unclear. Large studies showed conflicting results, reporting both increases and decreases in selected perinatal outcomes. Pooled results show a significant association between lockdown measures and stillbirth rates, but not low birth weight rates. Further studies examining the differences in other countries' lockdowns and sociodemographic groups from low to middle-income countries are needed. Exploration of perinatal outcomes during COVID-19 lockdown poses an opportunity to learn from and make changes to promote the reduction of the leading causes of childhood mortality worldwide.
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Affiliation(s)
- Christine Vaccaro
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Farida Mahmoud
- Faculty of Pharmacy, Universite de Montreal, Montréal, Canada
| | - Laila Aboulatta
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Basma Aloud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
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23
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Nair M, MaatHRI writing group, on behalf of the MaatHRI collaborators. Reproductive health crisis during waves one and two of the COVID-19 pandemic in India: Incidence and deaths from severe maternal complications in more than 202,000 hospital births. EClinicalMedicine 2021; 39:101063. [PMID: 34585123 PMCID: PMC8461242 DOI: 10.1016/j.eclinm.2021.101063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic in India has adversely affected many aspects of population health. We need detailed evidence of the impact on reproductive health in India so that lessons can be learnt. METHODS Hospital-based repeated monthly survey of nine severe maternal complications and death in 15 hospitals across five states in India covering a total of 202,986 hospital births, December-2018 through to May-2021. We calculated incidence rates (with 95% confidence intervals (CIs)) per 1000 hospital births, case-fatality and rate ratios (RR) with 95% CIs. Linear regression was used to examine the association between the Government Response Stringency Index (GRSI) for India and changes in hospital births, incidence and case-fatality. FINDINGS There was a significant decrease in hospital births per month during the pandemic period with a 4.8% decrease per 10% increase in the GRSI scores (p < 0.001). The overall incidence of severe complications in the pandemic period was not significantly different from the pre-pandemic period, but hospital admissions from septic abortion was 56% higher (RR=1.56; 95% CI=1.22-1.99; p < 0.001). The overall case-fatality of complications increased by 23% (RR=1.23; 95% CI=1.03-1.46; p = 0.022) and remained high across the different phases of the pandemic with a notable significant increase in deaths from heart failure in pregnancy. INTERPRETATION Our study supports the legitimacy of the calls made to maintain sexual and reproductive health services as essential services during the pandemic. Lessons learnt should be used to avert the ongoing reproductive health crisis while India plans to manage a third wave of the pandemic. FUNDING The MaatHRI platform and this study are funded by a Medical Research Council Career Development Award to MN (Ref:MR/P022030/1). The funder has no role in the study design, data collection, analysis, or writing the paper.
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Key Words
- CIs, Confidence Intervals
- Case-fatality
- DIC, Disseminated intravascular coagulation
- FIGO, International Federation of Gynaecology and Obstetrics
- GRSI, Government Response Stringency Index
- Incidence
- India
- MaatHRI, Maternal and perinatal Health Research collaboration, India
- Maternal complications
- Maternal death
- PPH, Postpartum haemorrhage
- RR, Rate ratios
- SARS-CoV-2
- SARS-CoV-2, Severe acute respiratory syndrome caused by the Coronavirus 2
- Septic abortion
- WHO, World Health Organisation
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24
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Leisher SH. COVID-19 and maternal and perinatal outcomes. LANCET GLOBAL HEALTH 2021; 9:e1061. [PMID: 34297956 DOI: 10.1016/s2214-109x(21)00296-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/14/2021] [Indexed: 01/27/2023]
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25
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Yang J, D'Souza R, Kharrat A, Fell DB, Snelgrove JW, Murphy KE, Shah PS. COVID-19 pandemic and population-level pregnancy and neonatal outcomes: a living systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100:1756-1770. [PMID: 34096034 PMCID: PMC8222877 DOI: 10.1111/aogs.14206] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
Introduction Conflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the COVID‐19 pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta‐analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre‐pandemic periods. Material and methods We searched PubMed and Embase databases, reference lists of articles published up until 14 May 2021 and included English language studies that compared outcomes between the COVID‐19 pandemic time period and pre‐pandemic time periods. Risk of bias was assessed using the Newcastle–Ottawa scale. We conducted random‐effects meta‐analysis using the inverse variance method. Results Thirty‐seven studies with low‐to‐moderate risk of bias, reporting on 1 677 858 pregnancies during the pandemic period and 21 028 650 pregnancies during the pre‐pandemic period, were included. There was a significant reduction in unadjusted estimates of PTB (28 studies, unadjusted odds ratio [uaOR] 0.94, 95% confidence [CI] 0.91–0.98) but not in adjusted estimates (six studies, adjusted OR [aOR] 0.95, 95% CI 0.80–1.13). The reduction was noted in studies from single centers/health areas (uaOR 0.90, 95% CI 0.86–0.94) but not in regional/national studies (uaOR 0.99, 95% CI 0.95–1.03). There was reduction in spontaneous PTB (five studies, uaOR 0.89, 95% CI 0.82–0.98) and induced PTB (four studies, uaOR 0.90, 95% CI 0.81–1.00). There was no reduction in PTB when stratified by gestational age <34, <32 or <28 weeks. There was no difference in stillbirths between the pandemic and pre‐pandemic time periods (21 studies, uaOR 1.08, 95% CI 0.94–1.23; four studies, aOR 1.06, 95% CI 0.81–1.38). There was an increase in birthweight (six studies, mean difference 17 g, 95% CI 7–28 g) during the pandemic period. There was an increase in maternal mortality (four studies, uaOR 1.15, 95% CI 1.05–1.26), which was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB. Conclusions The COVID‐19 pandemic time period may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no difference in stillbirth between the pandemic and pre‐pandemic period.
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Affiliation(s)
- Jie Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ashraf Kharrat
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - John W Snelgrove
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kellie E Murphy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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26
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Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, O'Brien P, Morris E, Draycott T, Thangaratinam S, Le Doare K, Ladhani S, von Dadelszen P, Magee L, Khalil A. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021; 9:e759-e772. [PMID: 33811827 PMCID: PMC8012052 DOI: 10.1016/s2214-109x(21)00079-6] [Citation(s) in RCA: 570] [Impact Index Per Article: 190.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. METHODS We did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753). FINDINGS The search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07-1·54]; I2=63%; 12 studies, 168 295 pregnancies during and 198 993 before the pandemic) and maternal death (1·37 [1·22-1·53; I2=0%, two studies [both from low-income and middle-income countries], 1 237 018 and 2 224 859 pregnancies) during versus before the pandemic. Preterm births before 37 weeks' gestation were not significantly changed overall (0·94 [0·87-1·02]; I2=75%; 15 studies, 170 640 and 656 423 pregnancies) but were decreased in high-income countries (0·91 [0·84-0·99]; I2=63%; 12 studies, 159 987 and 635 118 pregnancies), where spontaneous preterm birth was also decreased (0·81 [0·67-0·97]; two studies, 4204 and 6818 pregnancies). Mean Edinburgh Postnatal Depression Scale scores were higher, indicating poorer mental health, during versus before the pandemic (pooled mean difference 0·42 [95% CI 0·02-0·81; three studies, 2330 and 6517 pregnancies). Surgically managed ectopic pregnancies were increased during the pandemic (OR 5·81 [2·16-15·6]; I2=26%; three studies, 37 and 272 pregnancies). No overall significant effects were identified for other outcomes included in the quantitative analysis: maternal gestational diabetes; hypertensive disorders of pregnancy; preterm birth before 34 weeks', 32 weeks', or 28 weeks' gestation; iatrogenic preterm birth; labour induction; modes of delivery (spontaneous vaginal delivery, caesarean section, or instrumental delivery); post-partum haemorrhage; neonatal death; low birthweight (<2500 g); neonatal intensive care unit admission; or Apgar score less than 7 at 5 min. INTERPRETATION Global maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. Some outcomes show considerable disparity between high-resource and low-resource settings. There is an urgent need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises. FUNDING None.
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Affiliation(s)
- Barbara Chmielewska
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Imogen Barratt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Rosemary Townsend
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK
| | - Erkan Kalafat
- Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey; Department of Obstetrics and Gynaecology, School of Medicine, Koc University, Istanbul, Turkey
| | - Jan van der Meulen
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ipek Gurol-Urganci
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Pat O'Brien
- The Royal College of Obstetricians and Gynaecologists, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Edward Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Tim Draycott
- The Royal College of Obstetricians and Gynaecologists, London, UK; North Bristol NHS Trust Department of Women's Health, Westbury on Trym, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, UK
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, UK; Immunisation and Countermeasures Division, Public Health England, London, UK; British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Laura Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, UK.
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