Near-term pregnant women's attitude toward, concern about and knowledge of the COVID-19 pandemic

The effect of COVID-19 lockdown on admission rates in Maternity Hospital

Objectives

The COVID-19 pandemic had adverse health outcomes on individuals and communities. In this cross-sectional study we evaluated the admission rates in a tertiary-level hospital during the first wave of the pandemic (March 22, 2020 to August 31, 2020).

Methods

We compared the indications for admission during the first wave of the pandemic to a control period prior to the lockdown (November 9, 2019 to March 22, 2020).

Results

Most hospital admissions during the curfew period were obstetric emergencies (46.88%), which were significantly higher than the control group (38.19%) p ≤ 0.0001. Among the obstetric emergencies, cases in active labor (65.63%) were dominant. Significant rises in car deliveries (2.46%, p ≤ 0.0001) and admissions during the second stage of labor (6.43%, p ≤ 0.001) were noted. There was also an increased rate of admissions for early pregnancy complications, induction of labor, elective obstetric cases, and medical obstetric cases.

Conclusions

This study demonstrates that lockdown precautions implemented had a significant impact on the rate of admissions to Maternity Hospital. The data obtained may be a used to aid in designing robust policies for future pandemics to avoid adverse health outcomes.

Psychosocial impacts, preventive behaviours, and concerns associated with the COVID-19 pandemic for pregnant and non-pregnant women: A matched analysis from the International iCARE Study

BACKGROUND

 The COVID-19 pandemic negatively affected physical and psychological health worldwide. Pregnant women were likely more vulnerable to mental health difficulties due to the significant social, psychological, and hormonal changes they experience. During the pandemic, higher rates of antenatal depression and anxiety were observed compared to pre-pandemic rates. Increased mental health symptoms in pregnancy have been associated with adverse outcomes for child development. Understanding pandemic-specific preventive behaviours (i.e., mask use, physical distancing) and concerns may also be linked to maternal psychological well-being.

PURPOSE

To compare matched pregnant and non-pregnant women (N = 474) to assess COVID-19 psychosocial impacts, preventive behaviours, and concerns.

METHODS

This study used a matched analysis of data collected by the International COVID-19 Awareness and Responses Evaluation (iCARE) Study. Participants were matched on several demographic factors and analyses were adjusted for chronic illness and psychiatric disorder.

RESULTS

Linear regression analyses indicated that pregnant women did not significantly differ from matched non-pregnant women for psychosocial impacts (B = 0.11, SE = 0.08, p = 0.178). Those who reported a chronic illness (B=-0.19, SE = 0.09, p = 0.036) or a psychiatric disorder (B=-0.28, SE = 0.09, p = 0.003) were more likely to report more significant psychosocial impacts. Logistic regression analyses indicated that pregnant women were more likely to report staying at home rather than going to work (OR = 2.01, 95% CI 1.31-3.08, p = 0.002) and being concerned about being infected (OR = 1.61, 95% CI 1.05-2.46, p = 0.028).

CONCLUSIONS

Our findings in the context of the COVID-19 pandemic highlight the need to consider interventions targeting women, with chronic illnesses or psychiatric disorders, as they are often the most vulnerable.

Assessment of knowledge and practices of exclusive breastfeeding among rural women during the COVID-19 pandemic in Egypt: a cross sectional study

BACKGROUND

Worldwide exclusive breastfeeding is still recommended as a successful strategy even during the COVID -19 pandemic to lower infant morbidity and mortality. This study aimed to assess the knowledge and practices of exclusive breastfeeding among rural women during the COVID-19 pandemic.

METHODS

A descriptive cross-sectional study was conducted at EL-Morabeen Family Medicine Center in rural Damietta, Egypt among 178 lactating women who were chosen by using the purposive sampling technique. A developed structured questionnaire consisting of four parts was used to gather data from March to May 2022. Univariate analysis for descriptive data and bivariate analysis through the chi-square test were performed.

RESULTS

The current study revealed that 73% of the studied rural women did not receive any breastfeeding counseling during antenatal visits and 61.2% of them believed that coronavirus was transmitted through breastmilk. Only 15.2% of them breastfed their infant exclusively for 6 months, 88.2% of mothers delayed breastfeeding initiation after delivery and 48.3% administered the prelacteal feeds. A total of 98.3% of rural women had never made skin-to-skin contact, and 79.2% of them had not been vaccinated against COVID-19. Additionally, a statistically significant association between good knowledge and practice with highly educated women aged 26-30 years, with a monthly income of 4000-6000 L.E was found. Furthermore, only 26.4% and 26.1% of rural women had good knowledge and practice scores respectively.

CONCLUSION

Suboptimal breastfeeding practices, such as delayed onset of breastfeeding, low percentages of exclusivity, early weaning, prelacteal feeding administration, and lack of skin-to-skin contact during the COVID -19 pandemic were prevalent among the studied rural mothers. Breastfeeding counseling for all pregnant women and implementation of evidence-based practices in the health care system, such as the early initiation of breastfeeding and skin-to-skin contact, are recommended.

Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran.

METHODS

This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health).

RESULTS

A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions.

CONCLUSION

Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.

COVID-19 knowledge, attitudes, and practices among Iranian pregnant and postpartum women: A national study

BACKGROUND

To control the spread of COVID-19, Iran has adopted rigorous precautionary and preventive measures, particularly for vulnerable groups. Considering the effects of knowledge and attitudes about COVID-19 on adherence to preventive measures, we examined women's knowledge, attitudes, and practices (KAP) from pregnancy to 6 weeks postpartum about COVID-19 during this pandemic.

METHODS

In a cross-sectional study, 7363 women were recruited via an online questionnaire between June 23, 2021 and July 7, 2021. The questionnaire consisted of 27 questions, measuring KAP.

RESULTS

Most of the participants had a good understanding of COVID-19 (Mean: 7.30 out of 9, standard deviation [SD]: 1.27), but the knowledge of the disease's main symptoms and modes of transmission was at the lowest levels. The mean attitudes score was 31.47 out of 50 (SD: 7.70). The participants had good practices against COVID-19 with a mean score of 35.48 out of 40 (SD: 3.94). To reduce anxiety and fear during the pandemic, half of our participants strongly emphasized the role of family emotional support. Income status and educational levels were the most significant variables influencing KAP (p-value ≤0.001). A correlation was found between knowledge and practice scores (r = 0.205, p-value = 0.001).

CONCLUSION

Our findings may serve to formulate awareness-raising interventions and can be a guide to health policymakers and workers such as obstetricians, clinicians, and midwives for more effective educational communication emphasizing the COVID-19 symptoms and transmission modes and rendering appropriate counseling, particularly on the importance of emotional family support during the pandemic.

The impact of the coronavirus disease 2019 outbreak on decision-making styles and breastfeeding of pregnant women: a cross-sectional study

OBJECTIVE

This study was planned to examine the factors affecting the decision-making styles of pregnant women in the coronavirus disease 2019 epidemic, their choice of birth environment, and their decision to start breastfeeding.

METHODS

The study was conducted in a cross-sectional descriptive type. The study was conducted with 631 pregnant women who voluntarily participated between January 2020 and April 2021 and met the sample selection criteria. Women aged 18-45 years who had healthy singleton pregnancies were included. Pregnant women with signs or symptoms of coronavirus disease 2019 or suspected or diagnosed with birth were excluded from the study. The data were collected by the questionnaire method through the links shared with the pregnant women. Data Collection Form, Questionnaire for Birth and Breastfeeding in the coronavirus disease 2019 Period, and Melbourne Decision-Making Styles Scale-II were used as data collection tools.

RESULTS

The mean age of the pregnant women was found to be 28.56±6.36 years. Approximately 50.71% of the participants reported that they preferred normal vaginal delivery. It was reported that 56.1% of the pregnant women had a say in the decision-making process of the delivery method. It has been determined that there is a significant difference between the education status, employment status, pregnancy planning, family type, and the person who has a say in deciding the mode of delivery (p<0.05). The results of the analysis of worrying about starting breastfeeding according to the decision-making styles of the pregnant women in the sample group are examined. The difference between the scores of avoidant and procrastinating decision-making style, which is the sub-dimensions of the scale, and worrying about starting breastfeeding is statistically significant (p<0.029 and p<0.029, respectively).

CONCLUSION

The research findings show that situations such as epidemics affect the decisions of pregnant women, and breastfeeding situations and decision-making styles affect each other. For this reason, education programs and guides including guidance services and support systems should be published and pregnant women should be guided correctly.

The Godmother Project: A Virtual Initiative to Support Pregnant and Postpartum Women in Brazil During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic increased maternal distress and demand for social support and educational services, while restriction measures decreased the availability of these services.

PROJECT DESCRIPTION

The Godmother Project, a person-centered, WhatsApp-based support and health education initiative, was created after all in-person perinatal educational activities offered at 3 Brazilian hospitals were canceled in 2020. The project was developed in response to pregnant/postpartum women who called the hospitals with questions for health care professionals (HCPs). Health education nurses teamed up with staff from the communication department to design a project to (1) provide a direct communication channel between women and HCPs to answer health-related questions, (2) offer reliable virtual health education material, (3) identify women in need of additional assessment/referrals, (4) offer each woman continuous support from a specific nurse educator (Godmother), and (5) offer a virtual forum where women going through similar experiences could interact.

PROJECT DEVELOPMENT AND ROLLOUT

The project provides direct communication between WhatsApp groups of 25-30 pregnant/postpartum women and a Godmother. It also offers access to a virtual library of educational materials prepared in response to women's needs/demands. The project, which began in July 2020 with 1 WhatsApp group of 5 women and 1 Godmother, currently has 305 groups, 6,942 active participants, and 4 Godmothers. Enrollments and WhatsApp groups continued to increase despite reestablishment of in-person educational activities in 2022. The vast majority of 232 participants surveyed in December 2021 were very satisfied with the project, the Godmothers, and the educational materials.

CONCLUSIONS

Our findings suggest that WhatsApp groups of pregnant/postpartum women led by dedicated nurse educators can be an important tool to educate and support women during the perinatal period. This type of initiative may be especially important in contexts of physical distancing requirements or situations where social support is unavailable.

Effect of the COVID-19 pandemic on women's fertility intentions and its policy implications for China and the rest of the world: a perspective essay

The COVID-19 pandemic and its social, economic, and health implications have generally reduced women's fertility intentions in different countries. In this article, we aimed to review studies of the impact of COVID-19 infection on women's fertility intentions and interventions to provide a theoretical basis and practical benchmark for the development of effective intervention strategies in China, which lifted its zero COVID system in early December 2022.

Exploring the stress of olympic postponement due to COVID-19 on elite/international and world-class parenting and pregnant runners

The primary objective of this community-based participatory research is to explore the impacts of COVID-19 and the delayed Tokyo 2020 Olympic Games on world-class and elite/international-class parenting and pregnant athletes. Participants in this study include 11 female and 10 male parenting and/or pregnant middle and distance runners. Combined, the participants have competed at 26 Olympic Games and 31 World Championships. Drawing on the general concepts of stressors and psychological resilience, we use thematic analysis to develop four themes to understand the stressors for world-class and elite/international-class parenting and pregnant athletes due to COVID-19 and the delayed Tokyo 2020 Olympic Games: (1) lack of childcare support, (2) family planning, and (3) needing to stay away from sources of COVID-including their children. Despite the stressors identified in the aforementioned themes, we identified a fourth theme: (4) participants demonstrated adaptability to stress in spite of-or due to-their athlete-parent identities.

The effect of pregnant women’s health-seeking behavior and preference for mode of birth on pregnancy distress during the COVID-19 pandemic

In this study, the researchers investigated to the impact of pregnant women's health-seeking behavior and mode of birth preferences on pregnancy distress during the COVID-19 pandemic. This study was conducted with 351 pregnant women. The risk rate of pregnancy distress using the Tilburg Pregnancy Distress Scale (TPDS) cut-off point was 16.5%. 13.3% of pregnant women changed their mode of birth preferences due to the pandemic. The risk of pregnancy distress in women who changed their mode of birth preferences due to the pandemic increased 5.4 times more than in those who preferred vaginal birth before and during the pandemic (OR: 5.4, p<0.001). We determined that the increase in the Health Seeking Behavior Scale total scores had a reducing effect on pregnancy distress due to a lack of partner involvement for TPDS.

Knowledge and practices of breastfeeding mothers towards prevention of the emerging corona virus (COVID- 19)☆

Aim

To identify knowledge and practices of breastfeeding mothers towards prevention of the emerging corona virus (COVID- 19).

Material and Methods

Cross-sectional design was used in this study. Data was collected via social media applications. Three hundred and seventy breastfeeding mothers completed the on-line survey. Questionnaire was assessing knowledge and practices of COVID- 19 related to breastfeeding.

Results

The participating mothers have basic knowledge about COVID-19. Correct "Preventive measures" ranged from 84% to 99.7% but mothers have misconceptions regarding some modes of transmission, especially through blood & breast milk. In addition, they have a lack of understanding of how to deal with newborns of mothers infected or suspected to be infected with COVID-19 disease.

Conclusion

Participants have basic knowledge about COVID-19 in general but they have improper preventive breastfeeding practices against the disease in particular. Nurses and midwives have the main role to increase awareness of breastfeeding mothers regarding preventive measures of COVID-19.

'Pregnant women voice their concerns and delivery method preferences during the COVID-19 pandemic in Turkey'

OBJECTIVE

To evaluate pregnant women's voice their concerns and delivery method preferences during the COVID-19 pandemic in Turkey.

Methods: A cross-sectional study is survey based using an online survey platform. Three hundred pregnant women were included between 16 May and 12 June 2020 in Turkey. Sociodemographic features, obstetric features, concerns about COVID-19, delivery method preferences, and Brief Measure of Worry Severity were evaluated.

RESULTS

It was determined that the concerns of pregnant women about the pandemic were moderate (12.73 ± 6.838) and did not alter their delivery method preferences. However, the concerns of the pregnant women who planned to perform their delivery by caesarean section before COVID-19 and whose delivery method preferences changed during the pandemic process were higher (p < 0.05). Additionally, during the COVID-19 period, pregnant women often harbour concerns such as 'not knowing how it would affect my baby if I have to take medications for COVID-19 (90.3%)' 'getting infected by COVID-19 during my pregnancy (89.7%)' 'not having a healthy pregnancy until birth (89%)'.

CONCLUSIONS

Delivery method preferences of pregnant women did not change in the COVID-19 pandemic. On the other hand, COVID-19 pandemic is impacting on the pregnant women experiencing moderate concerns about their pregnancy, delivery, postpartum period, and their baby.

Knowledge, attitudes, and practices (KAP) towards COVID-19 pandemic among pregnant women in a tertiary hospital in Karachi, Pakistan

BACKGROUND

The aim of this study was to evaluate the knowledge, attitude, and practices (KAP) of the pregnant population during the COVID-19 pandemic in a tertiary care hospital.

METHODS

This cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. KAP towards COVID-19 was assessed using 21-item questionnaires. A score for each category was calculated and points were summed. The outcome variables of KAP were compared with demographic characteristics. Data were analyzed by using SPSS 19.

RESULTS

A total of 377 patients participated in the study. The majority of the patients were multiparous (36.8%) in the age group of 30-40years (42.4%). More than 90% of patients were aware of COVID-19 symptoms and mode of transmission. They were aware of no cure for disease and optimum social distance. Although < 50% of patients truly answered the questions regarding the impact of COVID-19 on the risk of congenital malformation, vertical transmission, and the effect of infection on the mode of delivery. Regarding attitude and practices,> 90% of patients were anxious about fetal and personal safety, they are using a facemask, sanitizing their hands regularly, and avoiding social gatherings. Univariate and multivariable linear regression analysis showed statistically significant results among demographic variables (age, parity, family members, occupational status, and source of information).

CONCLUSION

Pregnant patients demonstrated inadequate knowledge regarding the impact of COVID-19 on pregnancy. However positive attitude and practices on preventive measures were good. This highlights the need for health education for pregnant women for COVID-19 to improve knowledge on a constant basis.

Knowledge, attitude, and determinants of exclusive breastfeeding during COVID-19 pandemic among lactating mothers in Mekelle, Tigrai: a cross sectional study

Background

Due to the nutritive and immunologic benefits of breastmilk, children should be exclusively breastfed for the first 6 months of life, even during the corona virus pandemic. However, fear of transmission risk and pandemic-related restrictions could undermine the practice of breastfeeding. This study aimed to assess the knowledge, attitude, and determinants of exclusive breastfeeding (EBF) during COVID-19 among lactating mothers in Mekelle, Tigrai, Ethiopia.

Methods

A community based cross-sectional study was conducted among 621 lactating mothers living in Mekelle city, Tigrai, from April to June, 2021. Data were collected using an adapted form of a standard KAP questionnaire. Binary logistic regression was used to determine the independent determinants of EBF at a statistical significance of p < 0.05. The strength of the association was measured by odds ratio and 95% confidence interval.

Results

Four hundred (64.4%) mothers exclusively breastfed their children. Infants from female-headed households had twice (AOR 2.21; 95% CI 1.31, 3.71) higher odds of EBF. Higher educational status was associated with higher odds of EBF practice. A unit increase in parity was associated with a 23% increase in the odds of EBF. Mothers who received breastfeeding information had a 73% (AOR 1.73; 95% CI 1.17, 2.56) higher odds of EBF. Moreover, mothers with high knowledge score and positive attitude showed a 74% higher (AOR 1.74; 95% CI 1.20, 2.51) and more than double (AOR 2.35; 95% CI 1.50, 3.70) odds of EBF, respectively.

Conclusion

About two-thirds of the mothers practiced EBF. Household head, maternal educational, parity, breastfeeding information, knowledge of breastfeeding, and attitude towards EBF were significant determinants of EBF. Our study findings highlighted that programs that enhance women’s participation in education and decision-making could improve EBF practice. Besides, during the COVID-19 pandemic, providing lactating mothers with adequate and up-to-date breastfeeding information could be significant in improving EBF practice.

The relationship of probable clinical anxiety with attitude-behaviour, coping styles and social support in healthy pregnant women during the late period COVID-19 pandemic

The aim of the study is to investigate the prevalence of state and trait probable clinical anxiety and their relationship with socio-demographic factors, attitude-behaviour, coping styles and social support level in high-risk pregnant women in the late period of COVID-19 pandemic. The pregnant women followed up in the gynaecological outpatient clinic were evaluated during their admissions. About 191 healthy pregnant women were included in the study. Data were collected using the socio-demographic and pregnancy attitude-behaviour data form, STAI (Spielberger's State-Trait Anxiety Inventory), the Coping Styles Scale Brief Form (Brief-COPE) and the Multidimensional Scale of Perceived Social Support (MSPSS). Our study found that pregnant women had high anxiety levels (STAI-S:37.90 ± 8.88; STAI-T:42.46 ± 7.80) and probable clinical anxiety prevalences (STAI-S:81(42.4%); STAI-T:123(64.4%)) in the late period of the COVID-19 pandemic. The fact that COVID-19 determined the preference of the birth method and the level of knowledge about COVID-19 predicted state probable clinical anxiety. Educational status, concern for COVID-19 transmission to the baby during pregnancy/birth, behavioural disengagement, focussing on and venting emotions predicted trait probable clinical anxiety. Our results have emphasised the factors that should be taken into account and coping styles that may be functional to protect the mental well-being of healthy pregnants.IMPACT STATEMENTWhat is already known on this subject? The COVID-19 pandemic has been shown to increase the symptoms of stress, anxiety and depression of the general population and healthcare workers. There is limited studies about pregnant women.What do the results of this study add? According to our study, we can say that approximately half of the pregnant women in a pandemic need psychiatric evaluation due to probable clinical anxiety. The relationship between anxiety in the pandemic process and birth preference has been shown and coping styles in healthy pregnant women have been investigated for the first time, effective and ineffective coping styles have been shown. In addition, it has been found that the social support of pregnant women is effective in managing the pandemic process.What are the implications of these findings for clinical practice and/or further research? According to our current findings, a multidisciplinary approach in which pregnant women are screened with self-report psychiatry tests and appropriate pregnant women are consulted to psychiatry during pandemic processes will make it easier for obstetricians to manage the patient. Especially strengthening effective coping styles and social support will have a great effect in mental rehabilitation. In this respect, further studies on pregnant women are needed.

Examining the relationship between perinatal anxiety, COVID-19 phobia and birth type preferences: A cross-sectional study

AIM

To examine the relationship between the COVID-19 phobia and perinatal anxiety levels and birth type preferences of pregnant women in the third trimester.

DESIGN

This was designed a cross-sectional study using the non-random convenience sampling method following the STROBE checklist.

METHODS

The research was conducted with 315 pregnant women from April to May 2021. Data were collected using a personal information form, the COVID-19 Phobia Scale, and the Perinatal Anxiety Screening Scale (PASS).

RESULTS

We found a positive and moderate correlation between the total scores for perinatal anxiety and COVID-19 phobia. During the COVID-19 pandemic, 4.1% of the participants changed their birth type preferences and this change was statistically significant according to McNemar's test. During the COVID-19 pandemic, the women changed their birth type preferences in favour of caesarean section. However, there was no statistically significant difference between those who changed their birth type preferences and those who did not in terms of perinatal anxiety or COVID-19 phobia levels. Women with no access to prenatal follow-up visits due to the COVID-19 pandemic had higher mean PASS scores and higher mean scores for the perfectionism, control and trauma subscale. The scores for general worry and specific fears were lower among individuals who had obtained information about birth types in prenatal follow-up visits. Also, perinatal anxiety and COVID-19 phobia levels were higher among pregnant women who were worried about giving birth in hospital compared to those who were not worried.

CONCLUSION

We conclude that COVID-19 phobia has increased women's perinatal anxiety, causing them to change their birth type preferences in favour of caesarean section.

RELEVANCE TO CLINICAL PRACTICE

We recommended that healthcare professionals take COVID-19 phobia and perinatal anxiety into account when counselling pregnant women about birth types to improve prenatal care.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection. Data were obtained from pregnant women in the third trimester, who came to a regional hospital-affiliated obstetrics polyclinic for routine prenatal follow-up visits.

Knowledge and Expectations of Perinatal Care Among Pregnant Women During the COVID-19 Pandemic

Introduction

This study aimed to investigate the knowledge and expectations of pregnant women on perinatal care during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

A cross-sectional survey was conducted among pregnant women ≥21 years, without a history of confirmed COVID-19, attending antenatal clinics between August and September 2020 via a secure online platform. The survey consisted of 10 questions which evaluated the knowledge and expectations on perinatal and neonatal care during the current pandemic.

Results

A total of 313 pregnant women completed the survey. The mean age of the participants was 30 years (SD 4; range 22-43 years). The median gestational age was 25 weeks (range 4-40 weeks). The participants were predominantly multiparous (54%) and almost all (98%) had completed secondary level education. Majority of participants were aware of the spread of COVID-19 by respiratory secretions and contact (90%), and the importance of prevention strategies (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a pregnant woman with active COVID-19. Although 46% were concerned about increased transmission risk with antenatal clinic visits, only 37% were agreeable to teleconferencing of clinic appointments. Maternal age >35 years was significantly associated with agreement with separation of mother-infant after birth [AOR 1.89 (95% CI 1.05, 3.39)], restrictions of visitors during the postnatal period [1.92 (1.05, 3.49)] and having their confinement practices were affected [2.3 (1.26, 4.17)]. Pregnant women who were multiparous disagreed that breastfeeding was safe in women with active COVID-19 [0.42 (0.23, 0.75)].

Conclusions

There was significant uncertainty about the optimal delivery method and safety of breastfeeding with COVID-19 among expectant mothers, along with variable agreement with alterations to routine perinatal care.

Mixed Methods Study of the Experience of Pregnancy during the COVID-19 Pandemic

Objective

To understand the experiences of women who were pregnant during the initial stage of the COVID-19 pandemic, March 2020 to May 2020, and how they coped with stress.

Design

A convergent mixed-methods design.

Setting

Online survey that launched in April 2020.

Participants

A total of 185 pregnant women.

Methods

For the quantitative strand, we measured adaptation to coping with stress using the Brief Resilient Coping Scale. For the qualitative strand, we asked participants to describe the experience of being pregnant during the pandemic.

Results

The mean score on the Brief Resilient Coping Scale was 14.7, which indicated a medium-level resilient coper. Using Krippendorff’s content analysis, we identified four themes: Robbed of Enjoying the Expected Pregnancy Experiences, Anxiety and Fear in the Face of a Pandemic Pregnancy, Heightened Source of Worry With Birth on the Horizon, and Choosing Hope.

Conclusion

To meet the needs of pregnant women, perinatal nurses and other maternity care providers must understand the experience of pregnancy during times of upheaval, such as the onset of a global pandemic. Health care providers and nurses can help ensure ideal outcomes for pregnant women by recognizing the loss of the expected pregnancy experience, providing support through creative social outlets, and fostering hopeful optimism.

High-risk pregnant women's experiences of the receiving prenatal care in COVID-19 pandemic: a qualitative study

BACKGROUND

Women with high-risk pregnancies are among the most vulnerable groups that require additional precautionary measures against the spread of COVID-19 plus receiving prenatal care. Yet, there is limited information on the status of prenatal care in women with high-risk pregnancies. The purpose of this study was to explore the experiences of women with high-risk pregnancies who were receiving prenatal care during the COVID-19 pandemic.

METHODS

The present qualitative study was conducted on mothers with high-risk pregnancies from September 2020 to March 2021. Purposeful sampling continued until achieving data saturation. Ghaem, Ommolbanin, and Imam Reza in Mashhad, Iran served as the research environment. Face-to-face and semi-structured interviews were effective data collection methods. Each interview lasted between 20 to 45 min (on average 30). The total number of participants was 31. Data analysis was carried out simultaneously with data collection using the qualitative content analysis method developed by Granheim and Landman (2004).

RESULTS

Following the reduction and analysis of data from women in high-risk pregnancies, as well as their perceptions and experiences with health services during the COVID-19 pandemic, eight subcategories and three main categories were identified, including 1) "Negative psychology responses," 2) "Adoption behavior," and 3) "Adjustment of health services in mutual protection." Fear, anxiety, stress, feelings of loneliness, sadness, depression, guilt, doubt and conflict in receiving services were examples of negative psychological responses. The adaptive behaviors' category reflected the behaviors of women with high-risk pregnancies in the context of the COVID COVID-19 pandemic. The Adjustment of health services in mutual protection indicated that health workers took preventive and protective measures against COVID-19, which, in addition to protecting themselves and their clients against COVID-19, gave women a sense of security.

CONCLUSION

Receiving prenatal care during the COVID-19 pandemic presents challenges for women with high-risk pregnancies, negatively impacting their psychological state and health-seeking behavior. Supportive and preventive care can ensure that women with high-risk pregnancies receive optimal prenatal care that focuses on COVID-19 prevention. We recommend implementing screening, psychological counseling, and education for women with high-risk pregnancies, as well as ensuring that they have access to women-centered health care services.

Knowledge, attitudes, and practices related to the COVID-19 pandemic among pregnant women in Bangkok, Thailand

BACKGROUND

Pregnancy is associated with increased risk for severe COVID-19. Few studies have examined knowledge, attitudes, and practices (KAP) related to pregnancy during the pandemic. This study investigated the association between socio-demographic characteristics and KAP related to COVID-19 among pregnant women in an urban community in Thailand.

METHODS

A cross-sectional online survey was distributed among pregnant women in Bangkok, Thailand from July-August 2021. Binary logistic regression was conducted to test the association between socio-demographic characteristics and KAP related to COVID-19, and a Spearman's analysis tested correlations between KAP scores.

RESULTS

A total of 150 pregnancy survey responses were received. Most participants were third trimester (27-40 weeks gestation; 68.0%). Pregnancy had never been risked contracting COVID-19 (84.7%). Most expressed concerns about being infected with COVID-19 during pregnancy and following birth (94.0 and 70.0%, respectively). The results of binary logistic regression analysis found associations between knowledge and marital status (OR = 4.983, 95%CI 1.894-13.107). In addition, having a bachelor's degree or higher was associated with higher attitude scores (OR = 2.733, 95%CI 1.045-7.149), as was being aged 26-30 (OR = 2.413 95%CI 0.882-6.602) and 31-35 years of age (OR = 2.518-2.664, 95%CI 0.841-8.442). Higher practice scores were associated with having a bachelor's degree or higher (OR = 2.285 95%CI 1.110-6.146), and income ≥15,001 bath (OR = 4.747 95%CI 1.588-14.192). Correlation analysis found a weak positive correlation between knowledge and practice scores (r = 0.210, p-value = 0.01).

CONCLUSION

Participants overall had high KAP scores. This study can guide public health strategies regarding pregnant women and COVID-19. We recommend that interventions to improve and attitude and practice scores. Knowledge on pregnancy and COVID-19 should focus on reducing fear and improving attitudes toward the care of patients as well as the promotion of preventive practices.

Anxiety, attitudes-behaviors, coping styles, and social support among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic

OBJECTIVE

The purpose of this study was to investigate the prevalence of anxiety among high-risk pregnant women in the late period of the coronavirus disease 2019 pandemic and to evaluate the relationship between anxiety levels, attitudes-behaviors, coping styles, and other psychometric parameters.

METHODS

Pregnant women who were followed up in our gynecology outpatient clinic were evaluated during their admissions between November 15, 2020 and February 15, 2021. This cross-sectional study analyzes prospectively collected data from a university hospital. Inclusion criteria were those being at risk of pregnancy and between the age of 18 and 45 years, while exclusion criteria were mental retardation and the presence of serious psychiatric illness. The study included 140 participants. Sociodemographic and pregnant attitudes-behaviors data form, State-Trait Anxiety Inventory, Coping Styles Scale Brief Form (Brief-COPE), and Multidimensional Scale of Perceived Social Support were used to collect data.

RESULTS

Participants had high anxiety levels (State-STAI: 40.32±9.88; Trait-STAI: 42.71±7.32) and high prevalence of probable clinical anxiety [State-STAI: 84 (60.0%); Trait-STAI: 92 (65.7%)]. The fact concerning the transmission of the coronavirus disease 2019 to the baby during pregnancy/birth, extent to which coronavirus disease 2019 pandemic prevents regular pregnancy checkups, and family subgroup-Multidimensional Scale of Perceived Social Support predicted state probable clinical anxiety. Use of disinfectants predicted trait probable clinical anxiety. Employment status predicted state/trait probable clinical anxiety. The existence of trait probable clinical anxiety was significantly associated with behavioral disengagement and substance use which are considered ineffective coping styles. Participants without trait probable clinical anxiety had significantly more adopted positive reinterpretation, one of emotion-focused coping styles.

CONCLUSION

Based on our results, the concern of the transmission of the coronavirus disease 2019 to the babies during pregnancy/birth may be the main factor influencing anxiety among high-risk pregnant women.

Adverse Mental Health Sequelae of COVID-19 Pandemic in the Pregnant Population and Useful Implications for Clinical Practice

The COVID-19 pandemic has increased risk of disturbances in the functioning of everyday life, directly or indirectly has influenced the risk of mental disorders in the most vulnerable populations, including pregnant women. The aim of this study was to analyze adverse mental health effects in the pregnant population during the COVID-19 pandemic, investigate risk factors for adverse mental health outcomes, identify protective factors, and create practical implications for clinical practice, bearing in mind the need to improve perinatal mental healthcare during such pandemics. Qualitative research was conducted in the electronic databases PubMed and Web of Sciences for the keywords COVID-19, pregnancy, depression, anxiety, and telemedicine for relevant critical articles (n = 3280) published from 2020 until October 2021, outlining the outcomes of control studies, meta-analysis, cross-sectional studies, face-to-face evaluation survey studies, remotely administered survey studies, and observational studies regarding the main topic; all were evaluated. Mental health problems among pregnant women linked to the COVID-19 pandemic, in most cases, show symptoms of depression, anxiety, insomnia, and PTSD and may cause adverse outcomes in pregnancy and fetus and newborn development, even at later stages of life. Therefore, useful implications for clinical practice for improving the adverse mental health outcomes of pregnant women associated with the COVID-19 pandemic are highly desirable. Our research findings support and advocate the need to modify the scope of healthcare provider practice in the event of a disaster, including the COVID-19 pandemic, and may be implemented and adopted by healthcare providers as useful implications for clinical practice.

Knowledge, Fear, and Anxiety Levels Among Pregnant Women During the COVID-19 Pandemic: A Cross-Sectional Study

This study aimed to evaluate pregnant women’s knowledge, fear, and anxiety levels during the coronavirus outbreak. This cross-sectional study was conducted on 170 pregnant women between May 20 and July 10, 2020. Data collection form for demographics and obstetric details, questionnaire on knowledge, attitudes, and practice toward COVID-19, and State-Trait Anxiety Inventory-I were used. The vast majority of pregnant women were afraid of being infected with the COVID-19 and causing mother-to-baby transmission. A positive correlation was found between fear of coronavirus transmission and the level of anxiety (p < .05). Risk perceptions regarding COVID-19 have affected the anxiety and knowledge levels of pregnant women. Based on the findings, knowledge levels, concerns, and fears about the risk of COVID-19 exposure have implications on the anxiety levels of pregnant women. Pregnant women experienced high stress and anxiety levels due to increased risk of COVID-19 transmission during face-to-face antenatal visits.

The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves

The global public health crisis caused by COVID-19 has lasted longer than many of us would have hoped and expected. With its high uncertainty and limited control, the COVID-19 pandemic has undoubtedly asked a lot from all of us. One important central question is: how resilient have we proved in face of the unprecedented and prolonged coronavirus pandemic? There is a vast and rapidly growing literature that has examined the impact of the pandemic on mental health both on the shorter (2020) and longer (2021) term. This not only concerns pandemic-related effects on resilience in the general population, but also how the pandemic has challenged stress resilience and mental health outcomes across more specific vulnerable population groups: patients with a psychiatric disorder, COVID-19 diagnosed patients, health care workers, children and adolescents, pregnant women, and elderly people. It is challenging to keep up to date with, and interpret, this rapidly increasing scientific literature. In this review, we provide a critical overview on how the COVID-19 pandemic has impacted mental health and how human stress resilience has been shaped by the pandemic on the shorter and longer term. The vast literature is dominated by a wealth of data which are, however, not always of the highest quality and heavily depend on online and self-report surveys. Nevertheless, it appears that we have proven surprisingly resilient over time, with fast recovery from COVID-19 measures. Still, vulnerable groups such as adolescents and health care personnel that have been severely impacted by the COVID-19 pandemic do exist. Large interindividual differences exist, and for future pandemics there is a clear need to comprehensively and integratively assess resilience from the start to provide personalized help and interventions tailored to the specific needs for vulnerable groups.

[Current evidence of SARS-CoV-2 infection in pregnancy: A scoping reviewEvidencias atuais sobre a infecto pelo SARS-COV-2 na gravidez: revisao do escopo]

Introduction

SARS-CoV-2 is a betacoronavirus as well as SARS-CoV and MERS-CoV, both associated with spontaneous miscarriage, preterm birth, maternal morbidity and mortality and a higher number of ICU admissions for pregnant women. Being a new virus, its effects on pregnancy are little known. This review aims to analyze the available evidence on SARS-CoV-2 in pregnancy.

Materials and Methods

A literature review was conducted in PubMed, ProQuest, Scopus, BVS and SciElo. Evidence criticism and information extraction were conducted using two instruments from the Joanna Briggs Institute, following the PRISMA-ScR guidelines.

Results

85 articles were included evidencing that most pregnant women with SARS-COV-2 suffered mild to moderate disease and were at a higher risk of death and complications compared to non-pregnant patients. Low risk of vertical transmission was documented and adverse perinatal outcomes were associated with severe maternal clinical manifestations. The effectiveness of treatment was inconclusive.

Discussion

Clinical presentation of infection in pregnant women, vertical transmission, treatment, disease severity and neonatal outcomes were discussed.

Conclusions

COVID-19 during pregnancy is a complication that generates greater morbidity and mortality, for which it is vital to develop further research on the understanding of the behavior, physiological and emotional implications and possible treatment. This review makes a rigorous analysis of the quality of studies and provides valuable information from evidence.

The socioeconomic apprehensions of a pregnant woman around COVID-19 – Do we need to be worried?

Introduction:

Coronavirus 2019 (COVID-19) pandemic has become the most severe intercontinental health challenge and pregnant women are deemed to be a special population group. The COVID-19-related restrictions on visiting the hospital for antenatal check-up and procedures may be distressing for them. The present study aims at assessing the level of anxiety and risk perception of pregnant women during the pandemic.

Materials and Methods:

This cross-sectional observational study included all pregnant women who were above 18 years of age, irrespective of their gestational age. They were administered the pre-designed, pre-tested questionnaire via face-to-face interview. The effect of the COVID-19 pandemic and its influence on women’s experience including her worries were collected. Data analysis was done using SPSS software version 22.

Results:

A total of 130 pregnant women with a mean maternal age of 26.1 ± 6.5 years were enrolled in the study. The mean gestational age of the women was 19 ± 4.7 weeks and most of them were in the second trimester (48.5%). Most of the pregnant women encountered the adverse socioeconomic influence of COVID-19 on their daily life (55.6% somewhat, 9.1% moderately so, 1.1% very much). Majority of them reported that they had limited their social activities (78.5%) and amorous relationship with their partner (30.8%). Also, around 59.2% of antenatal women experienced a moderate level and 40.7% had a mild level of anxiety.

Conclusion:

It is essential for obstetric providers to do prompt identification of mental health concerns in perinatal women and to liaise with mental health professionals to provide relevant interference.

Increased Risk for Maternal Anxiety during the COVID-19 Outbreak in Brazil among Pregnant Women without Comorbidities

OBJECTIVE

 To study maternal anxiety in pregnant women without comorbidities in the context of the COVID-19 outbreak in Brazil and to study maternal knowledge and concerns about the pandemic.

METHODS

 This is a secondary analysis from a national multicenter cross-sectional study performed in 10 cities, from June to August, 2020, in Brazil. Interviewed postpartum women, without medical or obstetrical comorbidities, were included in the present subanalysis. A structured questionnaire and the Beck Anxiety Inventory (BAI) were applied.

RESULTS

 Out of the 1,662 women, 763 (45.9%) met the criteria for the current analysis and 16.1% presented with moderate and 11.5% with severe maternal anxiety. Moderate or severe maternal anxiety was associated with high school education (odds ratio [OR]:1.58; 95% confidence interval [CI]:1.04-2.40). The protective factor was cohabiting with a partner (OR: 0.46; 95%CI: 0.29-0.73). There was a positive correlation between the total BAI score and receiving information about care in the pandemic (r_partial 0.15; p < 0.001); concern about vertical transmission of COVID-19 (r_partial 0.10; p = 0.01); receiving information about breastfeeding (r_partial 0.08; p = 0.03); concerns about prenatal care (r_partial 0.10; p = 0.01), and concerns about the baby contracting COVID-19 (r_partial 0.11; p = 0.004). The correlation was negative in the following aspects: self-confidence in protecting from COVID-19 (r_partial 0.08; p = 0.04), having learned (r_partial 0.09; p = 0.01) and self-confidence in breastfeeding (r_partial 0.22; p < 0.001) in the context of the pandemic.

CONCLUSION

 The anxiety of pregnant women without medical or obstetrical comorbidities was associated to high school educational level and not living with a partner during the COVID-19 pandemic. Self-confidence in protecting against COVID-19 and knowledge about breastfeeding care during the pandemic reduced maternal anxiety.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Becoming a Mother in the Shadow of COVID-19: A Grounded Theory Study

The current study aimed to explore the experiences and coping methods of primiparous (i.e., first-time) mothers during the coronavirus disease 2019 (COVID-19) pandemic. In-depth individual interviews were conducted with 17 primiparous mothers. Data were analyzed using Glaser's grounded theory analysis. A core theme emerged-Psychologically Worn Out Due to the Challenges of Becoming a Mother and Fear of Something Happening to the Baby-and was related to the following subthemes: postpartum mental health, maternal adjustment, maternal attachment, baby care, and coping methods. The study revealed that the COVID-19 pandemic negatively affects all aspects of motherhood in postpartum primiparous mothers. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Risk Perceptions, Knowledge and Behaviors of General and High-Risk Adult Populations Towards COVID-19: A Systematic Scoping Review

Objectives: The COVID-19 pandemic represents a major crisis for governments and populations. The public's risk perceptions, knowledge, and behaviors are key factors that play a vital role in the transmission of infectious diseases. Our scoping review aims to map the early evidence on risk perceptions, knowledge, and behaviors of general and high-risk adult populations towards COVID-19. Methods: A systematic scoping review was conducted of peer-reviewed articles in five databases on studies conducted during the early stages of COVID-19. Thirty-one studies meeting the inclusion criteria were appraised and analyzed. Results: The levels of risk perceptions, knowledge, and behaviors towards COVID-19 were moderate to high in both general and high-risk adult populations. Adults were knowledgeable about preventive behaviors. Our review identified hand-washing and avoiding crowded places as dominant preventive behaviors. Being a female, older, more educated, and living in urban areas was associated with better knowledge of COVID-19 and appropriate preventive behaviors. Conclusion: This review offers a first understanding of risk perceptions, knowledge and behaviors of adult populations during the early stages of the COVID-19 pandemic.

A scoping review of patient engagement activities during COVID-19: More consultation, less partnership

BACKGROUND

The COVID-19 pandemic has had a devastating impact on healthcare systems and care delivery, changing the context for patient and family engagement activities. Given the critical contribution of such activities in achieving health system quality goals, we undertook to address the question: What is known about work that has been done on patient engagement activities during the pandemic?

OBJECTIVE

To examine peer-reviewed and grey literature to identify the range of patient engagement activities, broadly defined (inclusive of engagement to support clinical care to partnerships in decision-making), occurring within health systems internationally during the first six months of the COVID-19 pandemic, as well as key barriers and facilitators for sustaining patient engagement activities during the pandemic.

METHODS

The following databases were searched: Medline, Embase and LitCOVID; a search for grey literature focused on the websites of professional organizations. Articles were required to be specific to COVID-19, describe patient engagement activities, involve a healthcare organization and be published from March 2020 to September 2020. Data were extracted and managed using Microsoft Excel. A content analysis of findings was conducted.

RESULTS

Twenty-nine articles were included. Few examples of more genuine partnership with patients were identified (such as co-design and organizational level decision making); most activities related to clinical level interactions (e.g. virtual consultations, remote appointments, family visits using technology and community outreach). Technology was leveraged in almost all reported studies to interact or connect with patients and families. Five main descriptive categories were identified: (1) Engagement through Virtual Care; (2) Engagement through Other Technology; (3) Engagement for Service Improvements/ Recommendations; (4) Factors Impacting Patient Engagement; and (5) Lessons Learned though Patient Engagement.

CONCLUSIONS

Evidence of how healthcare systems and organizations stayed connected to patients and families during the pandemic was identified; the majority of activities involved direct care consultations via technology. Since this review was conducted over the first six months of the pandemic, more work is needed to unpack the spectrum of patient engagement activities, including how they may evolve over time and to explore the barriers and facilitators for sustaining activities during major disruptions like pandemics.

An investigation of women's pregnancy experiences during the COVID-19 pandemic: A qualitative study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the physical and psychosocial health of pregnant women and their access to antenatal care and health services.

AIM

To examine women's pregnancy experiences during the COVID-19 pandemic.

MATERIALS AND METHODS

The study was conducted in a qualitative design with 14 pregnant women who were admitted to a state hospital pregnancy outpatient clinic for antenatal control. The data were collected using a semi-structured individual interview form and were analysed using the thematic analysis technique. COREQ checklist guide was followed in the study.

RESULTS

The pregnancy experiences of women in the COVID-19 pandemic were examined under 7 main themes: "physical health, psychosocial health, adaptation to pregnancy, pregnancy follow-ups, social life, spouse relationship and coping methods". Pregnant women have both positive and negative pregnancy experiences in the COVID-19 pandemic.

CONCLUSION

The study concluded that the pandemic has affected both the physical and psychosocial health of pregnant women, their social life, marital relationship and access to antenatal care services. Health professionals need to evaluate psychosocial health as well as the physical health of pregnant women, especially during the pandemic, and create a care plan accordingly. Midwives and other health professionals should improve the bio-psychosocial health of the pregnant/family via telehealth and counselling services.

Obstetric A&E unit admission and hospitalization for obstetrical management during COVID-19 pandemic in a third-level hospital of southern Italy

Background

The COronaVIrus Disease 2019 (COVID-19) has spread in Italy since February 2020, inducing the government to call for lockdown of any activity, apart primary needs, during the months March–May 2020. During the lockdown, a reduction of admissions and hospitalizations for ischemic diseases was noticed. Purpose of this study was to observe if there has been the same reduction trend in Accident & Emergency (A&E) unit admissions also for obstetric-gynecological conditions.

Methods

Medical records and electronic clinical databases were searched for all patients who were admitted to the obstetric A&E department or hospitalized at the Gynecology and Obstetrics Unit of University hospital of Naples Federico II, during the quarter March–May in the years 2019 and 2020. The mean ± standard deviation (SD) of monthly admission to the obstetric A&E department and hospitalization of the year 2020 was compared with that of the year 2019, using the unpaired T test with α error set to 0.05 and 95% confidence intervals (95% CI).

Results

Admissions were 1483 in the year 2020 and 1786 in 2019. Of total, 1225 (37.5%) women were hospitalized: 583 in the year 2020, 642 in 2019. Mean ± SD of patients monthly admitted to our obstetric A&E department was 494 ± 33.7 in the year 2020, and 595.3 ± 30.9 in 2019, with a mean difference of − 101.3 (95% CI − 103.5 to − 99.1; p < 0.0001). Mean ± SD of patients monthly hospitalized to our department was 194 ± 19.1 in the year 2020, 213.7 ± 4.7 in 2019, with a mean difference of − 19.7 (95% CI − 23.8 to − 15.6; p < 0.0001).

Conclusion

A significant decrease in the mean of monthly admissions and hospitalizations during the COVID-19 pandemic when compared to the previous year was found also for obstetric–gynecological conditions. Further studies are necessary to assess COVID-19 impact and to take the most appropriate countermeasures.

The Effect of COVID-19 Pandemic and Social Restrictions on Depression Rates and Maternal Attachment in Immediate Postpartum Women: a Preliminary Study

We aimed to evaluate the postpartum depression rates and maternal-infant bonding status among immediate postpartum women, whose last trimester overlapped with the lockdowns and who gave birth in a tertiary care center which had strong hospital restrictions due to serving also for COVID-19 patients, in the capital of Turkey. The low-risk term pregnant women who gave birth were given the surveys Edinburgh Postpartum Depression Scale (EPDS) and Maternal Attachment Inventory (MAI) within 48 h after birth. A total of 223 women were recruited. The median score obtained from the EPDS was 7 (7) and 33 (14.7%) of the women were determined to have a risk for postpartum depression. The median scores of the EPDS inventory of depressive women were 15 (3). The median MAI score of 223 women was 100 (26); and the MAI scores of women with depression were significantly lower than the controls [73 (39) vs. 101 (18) respectively, p < 0.001]. Evaluation of the factors that affect the psychological status of pregnant and postpartum women will lead the healthcare system to improve the implementations during the COVID-19 pandemic.

Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June 2020. A self-administered electronic questionnaire that included the knowledge and practice domains was distributed. A newly designed set of questions was used to evaluate (1) women’s perception of MCO and (2) maternal experience, which was subdivided into clinical care provision and maternal anxiety. The survey response rate was 93% with the final number for analysis of 415. The majority of women (95%) demonstrated an adequate level of knowledge on COVID-19, whilst 99% had a good practice. We found that tertiary education (p < 0.001), employment status (p = 0.03), higher household income (p < 0.001), and multiple sources of information (p < 0.001) were independent predictors of adequate maternal knowledge on COVID-19. Women with adequate knowledge also reported a more positive perception of MCO (p < 0.001) and better obstetric care experience (p = 0.037), as did those of Malay ethnicity. Younger (p < 0.001) and nulliparous (p = 0.01) women demonstrated greater anxiety levels. The majority of our women reported good practice and adequate knowledge, which contributed to a positive perception of MCO and better maternal obstetric experience. First-time mothers may benefit from extra support and reassurance during the pandemic to alleviate maternal anxiety.

Development of a Questionnaire to Assess the Psychosocial Effects of COVID-19 on Peripartum Women

Objective The social and behavioral changes brought about by the coronavirus disease 2019 (COVID-19) pandemic have led to adverse consequences on the psychosocial functioning of peripartum women. Therefore, we developed and validated a tool to assess the psychosocial effect of the pandemic among these women. Methods The questionnaire was developed using a scientifically accepted systematic methodology comprising literature search, focus-group discussion (FGD), expert evaluation, pretesting, and validation. Results The final questionnaire consists of 38 questions, and it has a Cronbach's α value of 0.90 and a Kaiser-Meyer-Olkin (KMO) value of 0.773. Conclusion The questionnaire has good reliability and face, content, and construct validity. It can be used to assess the psychosocial functioning of peripartum women in low middle-income countries and help perinatal mental health specialists to devise strategies to cope with the psychological impact of COVID-19-like pandemics on peripartum women.

Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses

BACKGROUND

Mental burden due to the SARS-CoV-2 pandemic has been widely reported for the general public and specific risk groups like healthcare workers and different patient populations. We aimed to assess its impact on mental health during the early phase by comparing pandemic with prepandemic data and to identify potential risk and protective factors.

METHODS

For this systematic review and meta-analyses, we systematically searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29, 2020, and screened reference lists of included studies. In addition, we searched PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing mental burden by the SARS-CoV-2 pandemic in the general population, healthcare workers, or any patients (eg, COVID-19 patients), with a broad range of eligible mental health outcomes, and matching studies evaluating prepandemic comparative data in the same population (if available) were included. We used multilevel meta-analyses for main, subgroup, and sensitivity analyses, focusing on (perceived) stress, symptoms of anxiety and depression, and sleep-related symptoms as primary outcomes.

RESULTS

Of 2429 records retrieved, 104 were included in the review (n = 208,261 participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15-0.65) and depression (SMD 0.67; 95% CI 0.07-1.27) were increased in the general population during the early phase of the pandemic compared with prepandemic conditions, mental burden was not increased in patients as well as healthcare workers, irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient Health Questionnaire) and older comparative data (published ≥5 years ago) were associated with increased mental burden. Across the three population groups, existing mental disorders, female sex, and concerns about getting infected were repeatedly reported as risk factors, while older age, a good economic situation, and education were protective.

CONCLUSIONS

This meta-analysis paints a more differentiated picture of the mental health consequences in pandemic situations than previous reviews. High-quality, representative surveys, high granular longitudinal studies, and more research on protective factors are required to better understand the psychological impacts of the SARS-CoV-2 pandemic and to help design effective preventive measures and interventions that are tailored to the needs of specific population groups.

The lived experiences of pregnant women during COVID-19 pandemic: a descriptive phenomenological study

Background

With the onset of the COVID-19 epidemic, pregnancy and childbirth for women are taking place in unusual circumstances. We explored the lived experiences of pregnant women during the COVID-19 pandemic to better understand their experience of pregnancy so that better support could be provided.

Methods

We used a descriptive phenomenological approach to understand the lived experience of pregnant women in COVID-19 pandemic. We collected data using a purposive sampling method through in-depth interviews in cyberspace with a semi-structured questionnaire. We used Colaizzi’s seven-step content analysis method to analyze the research data with the help of MAXQDA software version 2020.

Results

We conducted this descriptive phenomenology study on 19 pregnant women in a period between the 10th to the 20th of May, 2020. The participating women were already pregnant when the first signs of the epidemic appeared in the country and at the time of the interview. We acquired four themes including disruption of the tranquility and regular routines of daily life, new challenges caused by the epidemic, resilience and strength in facing the crisis, and adaptation with new conditions.

Conclusions

The pregnant women were under intense stress during the COVID-19 outbreak. The general mobilization the health system is necessary for alleviating pregnant women’s difficulties in situations like the COVID-19 epidemic. Virtual training classes and virtual counseling may enhance the peace and tranquility of pregnant women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03691-y.

Rebirth in a COVID hospital: a point of view

BACKGROUND

Since COVID-19 was declared a pandemic, governments have taken actions to limit the transmission of the virus such as lockdown measures and reorganization of the local Health System. Quarantine measures have influenced pregnant women's daily lives. The aim of this study was to understand the impact of the changes imposed by COVID-19 emergency on the well-being of pregnant women and how the transformation of Schiavonia Hospital into a dedicated COVID hospital affected their pregnancy experience.

METHODS

A cross-sectional survey was conducted. Pregnant women who gave birth in Schiavonia Hospital during the period May-September 2020 have been included. The assessment examined clinical characteristics, attitudes in relation to the pandemic and how it affected birth plans, perception of information received, and attitudes regards giving birth in a COVID hospital.

RESULTS

One hundred four women responded to the survey, with an enrolment rate of 58%. About the influence of COVID-19 pandemic, 51% of respondents reported changing some aspect of their lifestyle. The identification of Schiavonia Hospital as COVID hospital did not modify the trust in the facility and in the obstetrics ward for the 90% of women, in fact for the 85.6% it was the planned Birth Center since the beginning of pregnancy. The communication was complete and exhaustive for 82.7% of the respondents.

CONCLUSIONS

Despite the COVID hospital transformation, the women who came to give birth at Schiavonia Birth Center rated the healthcare assistance received at high level, evidencing high affection for the structure and the healthcare workers.

Positive Correlation Between General Public Knowledge and Attitudes Regarding COVID-19 Outbreak 1 Month After First Cases Reported in Indonesia

The increasing number cases of coronavirus disease (COVID-19) infections in the general population in Indonesia raises questions concerning the public’s knowledge and attitudes regarding this pandemic. To determine the correlation between the general public’s knowledge and attitudes regarding the COVID-19 outbreak 1 month after the first cases were reported in Indonesia. This cross-sectional study was conducted between early March and the end of April 2020 in the general population of Indonesia, beginning with the North Sumatra region, where the spread of COVID-19 in Indonesia began. Questionnaires were randomly distributed online in the red zone in Indonesia. Data were collected by collecting people’s responses to the questionnaire, which were distributed via WhatsApp (WA) application and were competed independently by the participants. A descriptive analysis was conducted to describe the demographic characteristics, knowledge, and attitudes of the general population. A total of 201 people had good knowledge (98%) and a positive attitude (96%) regarding the COVID-19 pandemic. The respondents had a negative attitude in relation to two aspects of the COVID-19 outbreak: having to always maintain a distance of 1.5 m when in crowds, and not being able to regularly exercise or eat nutritious food (78.6% and 79.1%, respectively). Most people in Indonesia have good knowledge and a positive attitude regarding the COVID-19 pandemic. However, negative attitudes were still found in this study, and as a result, transmission prevention measures cannot reach their maximum effectiveness by simply publicizing the increase in day-to-day cases to the general public.

COVID-19 Preventive Measure Practices and Knowledge of Pregnant Women in Guraghe Zone Hospitals

BACKGROUND

The COVID-19 pandemic is caused by a severe acute respiratory syndrome coronavirus which emerged in Wuhan. Recently this virus has rapidly spread throughout Ethiopia. The current preventive measure practices and knowledge have gaps. Therefore this study aimed to assess COVID-19 preventive measure practices and knowledge of pregnant women in Guraghe Zone hospitals.

METHODS AND MATERIALS

This cross-sectional study was conducted from July 27-August 27, 2020 among pregnant women in Guraghe zone hospitals. Systematic random sampling technique were employed to select 403 participants. Data were checked manually for completeness, cleaned, and stored in Epi Data and exported to SPSS for further analysis. Variables which have a P-value less than 0.25 on bivariate analysis were taken to multivariate analysis. A P-value of less than 0.05 and 95% confidence level was used as a cut-off point for presence of association in multivariate analysis.

RESULTS

COVID-19 preventive measure practice and knowledge of pregnant women visiting Guraghe Zone hospitals was 76.2% and 54.84%, respectively. Those aged 20-24 (AOR=1.22, 95% CI=1.15-22.24), 25-29 (AOR=1.32, 95% CI=1.20-20.25), and 30-34 (AOR=2.57, 95% CI-2.32-43.38) were more likely to practice COVID-19 preventive measures. Those residing in urban area (AOR=2.16, 95% CI=1.24-3.77) and perceiving that COVID-19 is worst for people with chronic disease (AOR=5.12, 95% CI=1.73-15.17) were more likely to practice COVID-19 preventive measures.

CONCLUSION

COVID-19 preventive measure practices and knowledge were low. Age, residence, and perception of COVID-19 on chronic disease were independent factors associated with preventive measure practices. Pregnant women aged ≥35 need to be counseled on practices of preventing COVID-19 by their healthcare providers.

The effects of COVID-19 on pregnancy and implications for reproductive medicine

COVID-19 was officially declared a pandemic in March 2020. Since then, our understanding of its effects on pregnancy have evolved rapidly. Emerging surveillance data and large cohort studies suggest that pregnancy is associated with an increased risk of intensive care unit hospitalization, invasive ventilation, and death. Pregnancies complicated by SARS-CoV-2 infection are associated with increased likelihood of cesarean delivery and preterm birth. Intrauterine transmission occurs, but seems to be rare. Critical gaps remain, and rigorous high-quality data are needed to better ascertain pregnancy risks and to inform antenatal and obstetrical management.

Impact of COVID-19 on psychosocial functioning of peripartum women: A qualitative study comprising focus group discussions and in-depth interviews

Objective

Peripartum is a period of profound hormonal changes in the body and COVID‐19 seems to have an additional impact on these women's psychosocial functioning. This calls for a need to address the psychosocial and behavioural impact of COVID‐19 on peripartum women's lives.

Methods

Three focus group discussions and ten in‐depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive sampling. In verbatim transcription was done, followed by thematic analysis to extract key conceptual themes.

Results

Fourteen pregnant and eleven postpartum women were included. The mean age was 28.5 years. Two major domains were identified: 1) the psychological domain including the categories of thoughts, emotions, and behaviour, and 2) the social domain comprising categories of relationships with family members and friends, perceived loss of social support, doctor‐patient relationship, and social determinants of health.

Conclusion

The pandemic has indeed affected the psychosocial functioning of peripartum women. The study results might prove to be helpful for clinicians and mental health specialists who can suggest and develop different coping strategies for peripartum women during this pandemic.

An Integrated Approach to Improve Maternal Mental Health and Well-Being During the COVID-19 Crisis

The ongoing COVID-19 pandemic has led to disruption of normal life across the globe, severely affecting the already vulnerable populations such as the pregnant women. Maternal mental health and well-being is a public health priority and the evidence about the impact of COVID-19 on mental health status of pregnant women is gradually emerging. The findings of the recently published studies suggest that increased risk perception about contracting COVID-19, reduced social support, increase in domestic violence, disruption of antenatal care, and economic consequences of COVID-19 mitigation strategies can lead to adverse mental health outcomes in antenatal period. There is a significant increase in antenatal depression and anxiety since the onset of COVID-19 and social determinants of health (e.g., younger age, lower education, lower income) are associated with these poor outcomes. In this paper, we propose an integrated approach to improve the mental health and well-being of pregnant women. Physical activity and/or mind-body interventions like yoga can be practiced as self-care interventions by pregnant women. Despite social distancing being the current norm, efforts should be made to strengthen social support. Evidence-based interventions for perinatal depression should be integrated within the health system and stepped, collaborative care using non-specialist health workers as key human resource be utilized to improve access to mental health services. Use of digital platforms and smartphone enabled delivery of services has huge potential to further improve the access to care. Most importantly, the COVID-19 related policy guidelines should categorically include maternal mental health and well-being as a priority area.

Attitudes and precaution practices towards COVID-19 among pregnant women in Singapore: a cross-sectional survey

Background

COVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects. It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitudes and precaution practices of non-infected pregnant women towards the COVID-19 outbreak in Singapore.

Methods

An online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Multiple linear regression analysis was performed to examine women’s precaution practices among six independent socio-demographic variables, including age, ethnicity, education, front-line jobs, history of miscarriage and type of antenatal clinic (general, high risk).

Results

A total of 167 survey responses were obtained over 8 weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n = 127), were of Chinese ethnicity (55%, n = 91), attained tertiary education (62%, n = 104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, β 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (β 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (β 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, β 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, β 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, β 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, β 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home.

Conclusion

Social demographical factors including age > 36 years old, Malay ethnicity, employment in front line jobs and attendance at high-risk clinics are likely to influence the attitudes and precaution practices among pregnant women towards COVID-19 in Singapore. Knowledge gained from our cross-sectional online survey can better guide clinicians to communicate better with pregnant women. Hence, it is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental well being.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03378-w.

Breastfeeding during the novel coronavirus (COVID-19) pandemic: guidelines and challenges

COVID-19 pandemic has raised questions on pregnant women and newborns' management. Guidelines, issued by most international agencies and national bodies, recommend rooming-in and direct breastfeeding. In the early days of this pandemic, breastfeeding practices have been challenged by fear among both parents and healthcare workers occasionally resulting in mother-newborn separation. We herein review current breastfeeding guidelines and discuss remaining questions and challenges. As we are facing the second wave of this pandemic, more information is gathered, especially regarding possible virus transmissibility through breastfeeding, enabling more definite instructions about breastfeeding practices.

Knowledge and Attitude regarding COVID-19 among Pregnant Women in Southwestern Iran in the Early Period of its Outbreak: A Cross-Sectional Study

Both knowledge and attitude can play key roles in the prevention of novel COVID-19. This cross-sectional study was conducted on a statistical sample of pregnant women in southwestern Iran between March and April 2020 to evaluate their knowledge and attitude toward this condition. So, pregnant mothers registered in antenatal clinics affiliated to Shiraz University of Medical Sciences were called and asked to fill in a three-part online questionnaire including sociodemographic characteristics, obstetric/medical history, and knowledge/attitude toward COVID-19. P-values < 0.05 were considered statistically significant. The mean score of knowledge among 540 respondents was 34 (±4.1) out of 43. Also, 44.3% answered more than 80% of the items correctly. Higher knowledge scores were accordingly associated with marriage duration, area of residence, health insurance coverage, socioeconomic status (SES), and self-rated health status. However, a strong relationship was found between knowledge, SES, and health insurance coverage with reference to multivariate analysis results. Moreover, majority of the pregnant women and their households expressed their concern about using preventive measures against COVID-19. Although most respondents were moderately worried about becoming infected with COVID-19, 264 (48.9%) cases reported that they were very much anxious about their newborns being infected with COVID-19 and 388 (71.9%) individuals asserted that they were worried about their mortality due to this infection. Besides, most mothers maintained that they had some degrees of rumination, which could interfere with their routine daily chores. Hence, health policy-makers should pay much focus on educating pregnant mothers to help them prevent mental exhaustion.