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Kuandyk (Sabitova) A, Ortega MA, Ntegwa MJ, Sarria-Santamera A. Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature. Front Public Health 2024; 12:1346268. [PMID: 38655525 PMCID: PMC11036866 DOI: 10.3389/fpubh.2024.1346268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Background The COVID-19 pandemic has had a multifaceted impact on maternal and child services and adversely influenced pregnancy outcomes. This systematic review aims to determine the impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low- and middle-income countries. Methods The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: "impact' AND 'COVID-19' AND 'maternal and child health services' AND 'low- and middle-income countries. A narrative synthesis approach was used to analyse and integrate the results. Results Overall, 45 unique studies conducted across 28 low- and middle-income countries met the inclusion criteria for the review. The findings suggest the number of family planning visits, antenatal and postnatal care visits, consultations for sick children, paediatric emergency visits and child immunisation levels decreased compared to the pre-pandemic levels in the majority of included studies. An analytical framework including four main categories was developed based on the concepts that emerged from included studies: the anxiety of not knowing (1), overwhelmed healthcare systems (2), challenges perceived by healthcare professionals (3) and difficulties perceived by service users (4). Conclusion The COVID-19 pandemic disrupted family planning services, antenatal and postnatal care coverage, and emergency and routine child services. Generalised conclusions are tentative due to the heterogeneity and inconsistent quality of the included studies. Future research is recommended to define the pandemic's impact on women and children worldwide and prepare healthcare systems for future resurgences of COVID-19 and potential challenges beyond. Systematic review registration PROSPERO (CRD42021285178).
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Affiliation(s)
- Alina Kuandyk (Sabitova)
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Miguel-Angel Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | | | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan
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Carbone L, Raffone A, Travaglino A, Saccone G, Di Girolamo R, Neola D, Castaldo E, Iorio GG, Pontillo M, Arduino B, D'Alessandro P, Guida M, Mollo A, Maruotti GM. The impact of COVID-19 pandemic on obstetrics and gynecology hospitalization rate and on reasons for seeking emergency care: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2187254. [PMID: 36894183 DOI: 10.1080/14767058.2023.2187254] [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: 03/11/2023]
Abstract
BACKGROUND During the lockdown due to COVID-19 pandemic, utilization of emergency care units has been reported to be reduced for obstetrical and gynaecological reasons. The aim of this systematic review is to assess if this phenomenon reduced the rate of hospitalizations for any reason and to evaluate the main reasons for seeking care in this subset of the population. METHODS The search was conducted using the main electronic databases from January 2020 to May 2021. The studies were identified with the use of a combination of: "emergency department" OR "A&E" OR "emergency service" OR "emergency unit" OR "maternity service" AND "COVID-19" OR "COVID-19 pandemic" OR "SARS-COV-2" and "admission" OR "hospitalization". All the studies that evaluated women going to obstetrics & gynecology emergency department (ED) during the COVID-19 pandemic for any reason were included. RESULTS The pooled proportion (PP) of hospitalizations increased from 22.7 to 30.6% during the lockdown periods, in particular from 48.0 to 53.9% for delivery. The PP of pregnant women suffering from hypertensive disorders increased (2.6 vs 1.2%), as well as women having contractions (52 vs 43%) and rupture of membranes (12.0 vs 9.1%). Oppositely, the PP of women having pelvic pain (12.4 vs 14.4%), suspected ectopic pregnancy (1.8 vs 2.0), reduced fetal movements (3.0 vs 3.3%), vaginal bleeding both for obstetrical (11.7 vs 12.8%) and gynecological issues (7.4 vs 9.2%) slightly reduced. CONCLUSION During the lockdown, an increase in the proportion of hospitalizations for obstetrical and gynecological reasons has been registered, especially for labor symptoms and hypertensive disorders.
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Affiliation(s)
- Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Raffaella Di Girolamo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Daniele Neola
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Emanuele Castaldo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Gabriele Iorio
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Martina Pontillo
- Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Bruno Arduino
- Maternal-Child Department, AOU Federico II hospital, Naples, Italy
| | | | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Giuseppe Maria Maruotti
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Benyamini Raischer H, Garmi G, Malchi D, Nachshon AA, Inbar S, Romano S, Salim R. Impact of COVID-19 mandatory lockdown on maternal gestational weight gain and neonatal macrosomia rate at an academic medical center in Israel. J Matern Fetal Neonatal Med 2023; 36:2204391. [PMID: 37127549 DOI: 10.1080/14767058.2023.2204391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND In an effort to prevent the spread of coronavirus disease 2019 (COVID-19), governments restricted outdoor activities and imposed lockdown quarantine. This change in lifestyle probably affected individuals' eating habits and physical activity. OBJECTIVE To examine the effect of lockdown due to the COVID-19 pandemic on maternal antenatal weight gain, neonatal macrosomia, and other maternal and neonatal outcomes of women delivering at an academic medical center in Israel. METHOD A retrospective, two-period cohort study conducted at a university teaching medical center in Afula, Israel. The study period was between April and September 2020. This period signifies worsening in pandemic situations, during which citizens experienced strict prolonged lockdown measures. The parallel unexposed period (control period) was between April and September 2019. Singleton pregnancies delivered at >24 weeks were eligible. Primary outcome was incidence of macrosomia. Secondary outcomes included gestational weight gain, body mass index (BMI) at delivery, rates of gestational diabetes mellitus (GDM), mode of delivery, postpartum hemorrhage (PPH), and neonatal outcomes reflecting neonatal birth weight and condition at delivery. RESULTS A total of 4,765 women were included, 2,442 in the study group and 2,323 in the control group. The incidence of macrosomia was significantly higher in 2020 (6.2%) than in 2019 (4.9%), (p = .048; OR: 1.29; 95% CI: 1.002- 1.65). Women gained significantly more weight (median 1 kg more), weighed more at delivery (median 1 kg), and had higher BMI at delivery in 2020 compared with those in 2019 (p < .01). The incidence of GDM was 9.5% and 8.5% in the study and control groups respectively (p = .26; OR: 1.12; 95% CI: 0.92-1.37). Greater percentage of women did not perform the glucose challenge test in 2020 (9.9%) compared with those in 2019 (7.5%) (p = .003, OR: 1.36; 95% CI: 1.11-1.67). The incidence of any hypertension related to pregnancy was significantly higher in 2020 compared to 2019 (5.8% vs 4.4% respectively, (p = .042; OR: 1.32; 95% CI: 1.02-1.71). The proportion of women who smoked during pregnancy was also significantly higher in 2020 than in 2019 (5.1% vs 3.7%, respectively, p = .02; OR: 1.40; 95% CI: 1.06-1.86). Delivery mode did not differ, while the incidence of PPH was significantly higher in 2020 than in 2019 (5.6% vs 3.4%, respectively, p = .001; OR: 1.65; 95% CI: 1.25-2.19). Neonatal condition at delivery was comparable. CONCLUSION COVID-19-related lockdown was associated with the increased rate of macrosomic infants. This indirect effect of the pandemic is probably related to poorer maternal antenatal metabolic health status. Long-term consequences should be further examined.
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Affiliation(s)
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Daniel Malchi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | | | - Shiri Inbar
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Gurbuz H, Basol G, Altintas MM, Kuru B. The impact of the first wave of the COVID-19 pandemic on hospital admissions and treatment management of ectopic pregnancy. Turk J Emerg Med 2023; 23:238-243. [PMID: 38024190 PMCID: PMC10664196 DOI: 10.4103/tjem.tjem_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the clinical features and treatment strategies applied to the patients with ectopic pregnancy admitted to our tertiary care center before and during the pandemic. METHODS Women aged 18-45 years, who were admitted to the hospital with a diagnosis of ectopic pregnancy in the pre- and postpandemic periods, were included in this case-control study. RESULTS A total of 173 patients, 116 patients before the pandemic and 57 patients during the pandemic, were included in the study. The rate of admissions from the emergency department was higher during the pandemic than before the pandemic (P = 0.003). The rupture was detected significantly higher during the outbreak (13/116 [11.2%]) than before the pandemic (16/57 [28.1%]) (P = 0.009). While conservative treatment was applied more frequently in the prepandemic period, it was observed that patients were treated surgically more frequently during the pandemic period (P = 0.003). While laparoscopic surgery was preferred before the pandemic, laparotomy was applied to all patients during the pandemic (P < 0.001). CONCLUSIONS In the first wave of the outbreak, there were delays in the diagnosis of ectopic pregnancies, and these patients presented with ruptures more frequently than before the pandemic. Furthermore, surgical treatment methods were used more than conservative therapies during the outbreak.
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Affiliation(s)
- Hande Gurbuz
- Department of Anesthesiology and Reanimation, Bursa City Hospital, University of Health Sciences, Bursa, Turkey
| | - Gulfem Basol
- Department of Obstetrics and Gynecology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Mustafa Altintas
- Department of General Surgery, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Betul Kuru
- Department of Obstetrics and Gynecology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
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Ghanbari V, Khatony A, Janatolmakan M, Rezaeian S, Rostamnia L. Emergency care utilization and patients' outcome before and after COVID-19 national lockdown in Iran: a cross-sectional study. BMC Emerg Med 2023; 23:114. [PMID: 37775730 PMCID: PMC10542682 DOI: 10.1186/s12873-023-00887-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION COVID-19 rapidly spread throughout the world. Stay-at-home and social distance strategies accompanied by fear of contamination with COVID-19 caused significant disruptions in daily life. The study focused on the impact of the COVID-19 pandemic on emergency visit and patients' outcome in the emergency department (ED). METHOD Administrative and clinical data of 25-hospital EDs in Kermanshah province of Iran from February 20, 2020, to February 18, 2021, were retrospectively analyzed with the comparable periods in the previous year. The incidence rate ratio (IRR) was used to compare the differences between the pandemic and the pre-pandemic period. RESULT The number of ED visits decreased nearly 50% after the declaration of a national lockdown. Moreover, the proportion of patients triaged in ESI 1 and 2 levels increased by 40 and 52%, respectively. The ratio of patients admitted to intensive care units and discharged against medical advice also increased significantly. CONCLUSION Despite the number of ED visits sharply declining, the ratio of patients who came to EDs with higher acuity significantly increased. So, health authorities must sensitize the public about life-threatening signs and symptoms in such conditions.
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Affiliation(s)
- Vahid Ghanbari
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leili Rostamnia
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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de Freitas CL, Sarmento AC, de Medeiros KS, Leonardo MEM, Santos YHDS, Gonçalves AK. Maternal near miss: before and during the coronavirus disease 2019 pandemic. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230048. [PMID: 37792865 PMCID: PMC10547487 DOI: 10.1590/1806-9282.20230048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/09/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate and compare Maternal Near Miss prevalence and outcomes before and during the coronavirus disease 2019 pandemic. METHODS This retrospective study was carried out in a university maternity hospital of high complexity. The population was divided into two groups: G1, 1 year before the coronavirus disease 2019 pandemic period (August 2018-July 2019) and G2, 1 year during the pandemic period (August 2020-July 2021). All pregnant/postpartum women hospitalized up to 42 days after the end of pregnancy/childbirth were included, and pregnant women who were admitted with coronavirus disease 2019/flu symptoms were excluded. The association of variables with "Maternal Near Miss" was estimated using logistic regression. RESULTS A total of 568 women from G1 and 349 women from G2 fulfilled the Maternal Near Miss criteria. The prevalence of Maternal Near Miss in pre-pandemic was 144.1/1,000 live births and during the pandemic was 78.5/1,000 live births. In the analysis adjusted for G1, the factors of days of hospitalization (PR: 1.02, CI: 1.0-1.0, p<0.05), pre-eclampsia (PR: 0.41, CI: 1.4-2.2, p<0.05), and sepsis/severe systemic infection (PR: 1.79, CI: 0.3-0.4, p<0.05) were crucial for women with the Maternal Near Miss condition to have a greater chance of being admitted to the intensive care unit. In G2, low education (PR: 0.45, CI: 0.2-0.9, p<0.05), eclampsia (PR: 5.28, CI: 3.6-7.6, p<0.05), and use of blood products (PR: 6.48, CI: 4.7-8.8, p<0.05) increased the risk of admission to the intensive care unit. CONCLUSION During the pandemic, there was a lower prevalence of Maternal Near Miss in high-risk pregnancies, fewer hospitalizations, and more deaths compared to the non-pandemic period.
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Affiliation(s)
| | | | | | | | | | - Ana Katherine Gonçalves
- Universidade Federal do Rio Grande Do Norte, Health Sciences Center – Natal (RN), Brazil
- Universidade Federal do Rio Grande Do Norte, Department of Obstetrics and Gynecology – Natal (RN), Brazil
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Bumburidi Y, Dzhalimbekova A, Malisheva M, Moolenaar RL, Horth R, Singer D, Otorbaeva D. Excess deaths directly and indirectly attributable to COVID-19 using routinely reported mortality data, Bishkek, Kyrgyzstan, 2020: a cross-sectional study. BMJ Open 2023; 13:e069521. [PMID: 37433726 DOI: 10.1136/bmjopen-2022-069521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Studies on excess deaths (ED) show that reported deaths from COVID-19 underestimate death. To understand mortality for improved pandemic preparedness, we estimated ED directly and indirectly attributable to COVID-19 and ED by age groups. DESIGN Cross-sectional study using routinely reported individual deaths data. SETTINGS The 21 health facilities in Bishkek that register all city deaths. PARTICIPANTS Residents of Bishkek who died in the city from 2015 to 2020. OUTCOME MEASURE We report weekly and cumulative ED by age, sex and causes of death for 2020. EDs are the difference between observed and expected deaths. Expected deaths were calculated using the historical average and the upper bound of the 95% CI from 2015 to 2019. We calculated the percentage of deaths above expected using the upper bound of the 95% CI of expected deaths. COVID-19 deaths were laboratory confirmed (U07.1) or probable (U07.2 or unspecified pneumonia). RESULTS Of 4660 deaths in 2020, we estimated 840-1042 ED (79-98 ED per 100 000 people). Deaths were 22% greater than expected. EDs were greater for men (28%) than for women (20%). EDs were observed in all age groups, with the highest ED (43%) among people 65-74 years of age. Hospital deaths were 45% higher than expected. During peak mortality (1 July -21 July), weekly ED was 267% above expected, and ED by disease-specific cause of death were above expected: 193% for ischaemic heart diseases, 52% for cerebrovascular diseases and 421% for lower respiratory diseases. COVID-19 was directly attributable to 69% of ED. CONCLUSION Deaths directly and indirectly associated with the COVID-19 pandemic were markedly higher than reported, especially for older populations, in hospital settings, and during peak weeks of SARS-CoV-2 transmission. These ED estimates can support efforts to prioritise support for persons at greatest risk of dying during surges.
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Affiliation(s)
- Yekaterina Bumburidi
- Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan
| | - Altynai Dzhalimbekova
- Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan
| | - Marina Malisheva
- Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan
- Central Asia Field Epidemiology Training Program, Bishkek, Kyrgyzstan
| | - Ronald L Moolenaar
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roberta Horth
- Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan
- Central Asia Field Epidemiology Training Program, Bishkek, Kyrgyzstan
| | - Daniel Singer
- Division of Global Health Protection, Central Asia Office, US Centers for Disease Control and Prevention, Almaty, Kazakhstan
| | - Dinagul Otorbaeva
- Office of Prevention of Infectious, Parasitic Diseases and Epidemiological Surveillance, State Sanitary Surveillance and Disease Prevention Department, Bishkek, Kyrgyzstan
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Lai HC, Juan PK, Chang SL, Tsai JF, Su YH, Su HW. Obstetric and Neonatal Outcomes Associated With Implementation of a COVID-19 Predelivery Screening Policy in a Taiwan Hospital. JAMA Netw Open 2023; 6:e233367. [PMID: 36929404 PMCID: PMC10020876 DOI: 10.1001/jamanetworkopen.2023.3367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
This cohort study examines obstetric and neonatal outcomes associated with predelivery screening policy implementation aimed to prevent COVID-19 in a Taiwan hospital.
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Affiliation(s)
- Hui-Chin Lai
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, National Yang-Ming-Chiao-Tung University School of Medicine, Taipei, Taiwan
- National Chung-Hsin University, Taichung, Taiwan
| | - Po-Kai Juan
- Department of Obstetrics and Gynecology, Wuri Lin Shin Hospital, Taichung, Taiwan
| | - Szu-Ling Chang
- Department of Medicine, National Yang-Ming-Chiao-Tung University School of Medicine, Taipei, Taiwan
- National Chung-Hsin University, Taichung, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming-Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Jen-Fu Tsai
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Han Su
- Department of Obstetrics, Gynecology, and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiu-Wei Su
- Department of Obstetrics, Gynecology, and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan
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Zhou FY, Li C, Qin KZ, Luo C, Huang HF, Wu YT. Delivery and neonatal outcomes of pregnant women during the Shanghai lockdown: A retrospective analysis. Front Pediatr 2023; 11:992908. [PMID: 36816385 PMCID: PMC9932883 DOI: 10.3389/fped.2023.992908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Shanghai witnessed an unprecedented outbreak of COVID-19 and experienced a strict lockdown from March 28, 2022 to May 31, 2022. Most studies to date are on the first lockdown after the outbreak in December 2019. This study aimed to examine the impact of lockdown on delivery and neonatal outcomes among uninfected pregnant women in the new phase of the COVID-19 outbreak. METHODS A retrospective analysis was conducted in the Obstetrics and Gynecology Hospital of Fudan University. Pregnant women without COVID-19 who delivered from March 28, 2022 to May 31, 2022 (lockdown group) and the same period in 2021 (non-lockdown group) were recruited for this study. Logistic regression models and 1 : 1 propensity score matching (PSM) were used to assess the effect of lockdown on delivery outcomes. RESULTS A total of 2,962 patients were included in this study, 1,339 of whom were from the lockdown group. Compared with the non-lockdown group, pregnant women giving birth during lockdown had an increased risk of term prelabor rupture of membranes (TPROM) (aOR = 1.253, 95% CI: 1.026-1.530), and decreased risks of postpartum hemorrhage (PPH) (aOR = 0.362, 95% CI: 0.216-0.606) and fetal malformation (aOR = 0.309, 95% CI: 0.164-0.582). The risk of large for gestational age (LGA) (aOR = 0.802, 95% CI: 0.648-0.992) and rate of admission to the neonatal intensive care unit (NICU) (aOR = 0.722, 95% CI: 0.589-0.885) also significantly declined. After 1 : 1 PSM, the impact of lockdown on the risk of TPROM (aOR = 1.501, 95% CI: 1.083-2.080), PPH (aOR = 0.371, 95% CI: 0.211-0.654), fetal malformation (aOR = 0.332, 95% CI: 0.161-0.684), LGA (aOR = 0.749, 95% CI: 0.594-0.945) and rate of admission to the NICU (aOR = 0.700, 95% CI: 0.564-0.869) all remained. There were no other delivery or neonatal outcomes affected by the lockdown after the COVID-19 outbreak. CONCLUSION This study indicated a significant increase in the risk of term PROM, significant decreases in the risk of PPH, fetal malformation and LGA, and a marked decline in the rate of admission to the NICU during Shanghai Lockdown.
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Affiliation(s)
- Fang-Yue Zhou
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Li
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Kai-Zhou Qin
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Chuan Luo
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - He-Feng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
| | - Yan-Ting Wu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
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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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Impact of COVID-19 by Pandemic Wave among Patients with Gastroenterology Symptoms in the Emergency Departments at a Medical Center in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127516. [PMID: 35742765 PMCID: PMC9223759 DOI: 10.3390/ijerph19127516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic has affected emergency department (ED) usage. This study examines changes in the number of ED visits for gastrointestinal (GI) bleeding and nonemergency GI conditions, such as acute gastroenteritis (AGE) and constipation, before the pandemic and at the peak and slack periods of the pandemic in Taiwan. This retrospective observational study was conducted at a referral medical center in northern Taiwan. We recorded the number of weekly ED visits for GI bleeding, AGE, and constipation from 2019 to 2021. We then compared the baseline period (calendar weeks 4–18 and 21–31, 2019) with two peak pandemic periods (period 1, calendar weeks 4–18, 2020; period 2, calendar weeks 21–31, 2021) and their corresponding slack periods. The decline in the number of ED visits during the two peak pandemic periods for GI bleeding (−18.4% and −30.2%) were not as substantial as for AGE (−64.1% and −76.7%) or for constipation (−44.4% and −63.6%), but GI bleeding cases were still significantly lower in number relative to the baseline. During the slack period, the number of ED visits for all three diagnoses rebounded but did not exceed the baseline. Our study revealed that there was a significant decline of GI complaint during the pandemic. This phenomenon was more prominent in nonemergency complaints (AGE and constipation) and less prominent in serious complaints (GI bleeding).
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Simon E, Gouyon J, Cottenet J, Bechraoui‐Quantin S, Rozenberg P, Mariet A, Quantin C. Impact of SARS-CoV-2 infection on risk of prematurity, birthweight and obstetric complications: A multivariate analysis from a nationwide, population-based retrospective cohort study. BJOG 2022; 129:1084-1094. [PMID: 35253329 PMCID: PMC9111136 DOI: 10.1111/1471-0528.17135] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the impact of maternal coronavirus disease 2019 (COVID-19) on prematurity, birthweight and obstetric complications. DESIGN Nationwide, population-based retrospective cohort study. SETTING National Programme de Médicalisation des Systèmes d'Information database in France. POPULATION All single births from March to December 2020: 510 387 deliveries, including 2927 (0.6%) with confirmed COVID-19 in the mother and/or the newborn. METHODS The group with COVID-19 was compared with the group without COVID-19 using the chi-square test or Fisher's exact test, and the Student's t test or Mann-Whitney U test. Logistic regressions were used to study the effect of COVID-19 on the risk of prematurity or macrosomia (birthweight ≥4500 g). MAIN OUTCOME MEASURES Prematurity less than 37, less than 28, 28-31, or 32-36 weeks of gestation; birthweight; obstetric complications. RESULTS In singleton pregnancies, COVID-19 was associated with obstetric complications such as hypertension (2.8% versus 2.0%, p < 0.01), pre-eclampsia (3.6% versus 2.0%, p < 0.01), diabetes (18.8% versus 14.4%, p < 0.01) and caesarean delivery (26.8% versus 19.7%, p < 0.01). Among pregnant women with COVID-19, there was more prematurity between 28 and 31 weeks of gestation (1.3% versus 0.6%, p < 0.01) and between 32 and 36 weeks of gestation (7.7% versus 4.3%, p < 0.01), and more macrosomia (1.0% versus 0.7%, p = 0.04), but there was no difference in small-for-gestational-age newborns (6.3% versus 8.7%, p = 0.15). Logistic regression analysis for prematurity showed an adjusted odds ratio (aOR) of 1.77 (95% CI 1.55-2.01) for COVID-19. For macrosomia, COVID-19 resulted in non-significant aOR of 1.38 (95% CI 0.95-2.00). CONCLUSIONS COVID-19 is a risk factor for prematurity, even after adjustment for other risk factors. TWEETABLE ABSTRACT The risk of prematurity is twice as high in women with COVID-19 after adjustment for factors usually associated with prematurity.
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Affiliation(s)
- Emmanuel Simon
- Gynaecology, Obstetrics, and Fetal MedicineUniversity HospitalDijonFrance
| | - Jean‐Bernard Gouyon
- Centre d'Etudes Périnatales Océan Indien (EA 7388)Centre Hospitalier Universitaire Sud RéunionLa RéunionSaint PierreFrance
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
| | | | - Patrick Rozenberg
- Department of Obstetrics and Gynaecology, Hôpital Intercommunal de PoissyUniversité Versailles Saint‐QuentinPoissyFrance
| | - Anne‐Sophie Mariet
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Inserm, CIC 1432DijonFrance
- Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials UnitDijon University HospitalDijonFrance
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Inserm, CIC 1432DijonFrance
- Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials UnitDijon University HospitalDijonFrance
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐Saclay, UVSQ, Univ. Paris‐Sud, Inserm, CESPVillejuifFrance
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Riley T, Nethery E, Chung EK, Souter V. Impact of the COVID-19 pandemic on perinatal care and outcomes in the United States: An interrupted time series analysis. Birth 2022; 49:298-309. [PMID: 34957595 DOI: 10.1111/birt.12606] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hospitals quickly adapted perinatal care to mitigate SARS-CoV-2 transmission at the onset of the COVID-19 pandemic. The objective of this study was to estimate the impact of pandemic-related hospital policy changes on perinatal care and outcomes in one region of the United States. METHODS This interrupted time series analysis used retrospective data from consecutive singleton births at 15 hospitals in the Pacific Northwest from 2017 to 2020. The primary outcomes were those hypothesized to be affected by pandemic-related hospital policies and included labor induction, epidural use, oxytocin augmentation, mode of delivery, and early discharge (<48 hours after cesarean and <24 hours after vaginal births). Secondary outcomes included preterm birth, severe maternal morbidity, low 5-minute Apgar score, neonatal intensive care unit (NICU) admission, and 30-day readmission. Segmented Poisson regression models estimated the outcome level shift changes after the pandemic onset, controlling for underlying trends, seasonality, and stratifying by parity. RESULTS No statistically significant changes were detected in intrapartum interventions or mode of delivery after onset of the pandemic. Early discharge increased for all births following cesarean and vaginal birth. Newborn readmission rates increased but only among nulliparas (aRR: 1.49, 95%CI: 1.17, 1.91). Among multiparas, decreases were observed in preterm birth (aRR: 0.90, 95%CI: 0.84, 0.96), low 5-minute Apgar score (aRR: 0.75, 95%CI: 0.68, 0.81), and term NICU admission rates (aRR: 0.85, 95%CI: 0.80, 0.91). CONCLUSIONS Increases in early discharge and newborn readmission rates among nulliparas suggest a need for more postpartum support during the pandemic. Decreases in preterm birth and term NICU admission among multiparas may have implications beyond the pandemic and deserve further study.
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Affiliation(s)
- Taylor Riley
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Elizabeth Nethery
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esther K Chung
- Department of Pediatrics, University of Washington School of Medicine, and Seattle Children's Hospital, Seattle, Washington, USA
| | - Vivienne Souter
- Obstetrical Care Outcomes Assessment Program, Seattle, Washington, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Cash RE, Kaimal AJ, Clapp MA, Samuels-Kalow ME, Camargo CA. Change in emergency medical services-attended out-of-hospital deliveries during COVID-19 in the United States. PREHOSP EMERG CARE 2022; 27:303-309. [PMID: 35510878 DOI: 10.1080/10903127.2022.2074179] [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: 10/18/2022]
Abstract
Background: The COVID-19 pandemic disrupted access to routine in-person prenatal care, potentially leading to higher risk of out-of-hospital deliveries. Unplanned out-of-hospital deliveries pose a substantial risk of morbidity and mortality for pregnant patients and newborns. Our objective was to determine the change in rate of emergency medical services (EMS)-attended out-of-hospital deliveries during the COVID-19 pandemic. We hypothesized that COVID-19-related stay-at-home orders were associated with a higher rate of out-of-hospital deliveries during the initial wave of COVID-19.Methods: We conducted an interrupted time series analysis using the 2019 and 2020 National EMS Information System datasets. We included 9-1-1 scene activations for patients 12-50 years old with out-of-hospital deliveries who were treated and transported by EMS. We calculated the weekly rate of deliveries per 100,000 EMS emergency activations each year overall, and for each census division. The interruption modeled was the enactment of stay-at-home orders, with March 25-31 selected as when most orders had been enacted. We fit ordinary least squares regression models with Newey-West standard errors to adjust for autocorrelation, testing for a change in level and slope overall and by census division.Results: A total of 10,778 out-of-hospital deliveries were included, 58% (n = 6,254) in 2020. The mean weekly rate of out-of-hospital deliveries in 2019 was 29.4 per 100,000 activations (95% CI: 28.4 to 30.4) versus 33.0 (95% CI: 31.8 to 34.1) in 2020. There was an immediate increase of 6.3 deliveries per 100,000 activations (95% CI: 3.3 to 9.3) after the week of March 25-31, with a subsequent decrease of 0.3 deliveries per 100,000 per week after (95% CI: -0.4 to -0.2). There were also statistically significant immediate increases in out-of-hospital deliveries after March 25-31 in the New England, East North Central, West South Central, and Mountain divisions.Conclusion: EMS-attended out-of-hospital deliveries remained rare during the COVID-19 pandemic, but there was an immediate increase during the initial wave of the pandemic with evidence of geographic variation. Large-scale disruptions in the health care system may result in increases in uncommon patient presentations to EMS.
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Affiliation(s)
- Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anjali J Kaimal
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark A Clapp
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Graff I, De Broucker C, Vargas J, Vanoost A, Gondry J, Foulon A. [COVID-19 and lockdown: Impact on pregnancy complications]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:236-239. [PMID: 34915137 PMCID: PMC8668785 DOI: 10.1016/j.gofs.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Introduction L’apparition de la COVID-19 a entraîné la mise en place d’un confinement en France du 17 mars au 11 mai 2020. Notre étude a pour but d’évaluer l’impact du confinement sur le taux d’hospitalisation pour menace d’accouchement prématuré et sur le taux d’accouchement prématuré. Méthodes Étude épidémiologique rétrospective multicentrique réalisée sur la période du confinement du 15 mars au 31 mai 2020, comparée à la même période au cours des deux années précédentes (2018 et 2019) dans les hôpitaux de Picardie (Centre Hospitalier Universitaire Amiens Picardie, Centres Hospitaliers de Beauvais, Compiègne et Saint-Quentin). Résultats Au total, 608 patientes ont été incluses. Nous retrouvons une réduction significative du taux de rupture prématuré des membranes (16,9 % [73/432] en 2018/2019 vs 9,7 % [17/176] en 2020 ; p = 0,02), ainsi que du taux d’accouchement prématuré (9,3 % [276/2961] en 2018/2019 vs 6,8 % [96/1416] en 2020 ; p < 0,05) sur l’ensemble des hôpitaux. Notre étude met également en évidence une diminution des hospitalisations (207 en 2019 vs 176 en 2020). Conclusion Il est observé, au cours de la première période de confinement, une réduction du taux d’accouchement prématuré. Il serait, par ailleurs, intéressant d’évaluer l’impact psychologique du confinement.
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Affiliation(s)
- I Graff
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France
| | - C De Broucker
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France
| | - J Vargas
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France
| | - A Vanoost
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France
| | - J Gondry
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France.
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Quibel T, Winer N, Bussières L, Vayssière C, Deruelle P, Defrance M, Rozenberg P, Bouyer J, Dupuis N, Renaudin B, Dugave L, Banaszkiewicz N, Garabedian C, Ville Y. Impact of COVID-19-Related Lockdown on Delivery and Perinatal Outcomes: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11030756. [PMID: 35160207 PMCID: PMC8837050 DOI: 10.3390/jcm11030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Objective: The magnitude and direction of effects on pregnancy outcomes of the lockdown imposed during COVID-19 have been uncertain and debated. Therefore, we aimed to quantify delivery and perinatal outcomes during the first nationwide lockdown due to the COVID-19 pandemic compared with the same durations of time for the pre- and post-lockdown periods. Study design: This was a retrospective cohort study of six university hospital maternity units distributed across France, each of which serves as the obstetric care referral unit within its respective perinatal network. Maternal and perinatal outcomes were compared between the lockdown period and same-duration (i.e., 55-day) periods before and after the 2020 lockdown (pre-lockdown: 22 January–16 March; lockdown: 17 March–10 May; post-lockdown: 11 May–4 July). We compared the overall rates of Caesarean delivery (CD), pre-labor CD, labor induction, operative vaginal delivery, severe postpartum hemorrhage (≥1 L), severe perineal tear, maternal transfusion, and neonatal mortality and morbidity (1- and 5-min Apgar scores < 7), hypoxia and anoxia (umbilical arterial pH < 7.20 or <7.10, respectively), and admission to a neonatal intensive care unit before discharge. Adjusted odds ratios were estimated using logistic regression, controlling for region of birth, maternal age category, multiparity, multiple pregnancies, diabetes, and hypertensive disorders. Results: The study sample consisted of 11,929 women who delivered consecutively at one of the six maternity units studied (4093 pre-lockdown, 3829 during lockdown, and 4007 post-lockdown) and their 12,179 neonates (4169 pre-lockdown, 3905 during lockdown, and 4105 post-lockdown). The maternal and obstetric characteristics of the women delivering during the lockdown period were alike those delivering pre- and post-lockdown on maternal age, parity, body mass index, rate of complication by hypertensive disorders or insulin-treated diabetes, and gestational age at delivery. Overall CD rates were similar during the three periods (23.6%, 24.8%, and 24.3% pre-lockdown, lockdown, and post-lockdown, respectively) and no outcome differed significantly during lockdown compared to pre- and post-lockdown. These findings were consistent across maternity units. Conclusion: The maternal and perinatal outcomes are reassuring regarding the performance of the health-care system during the COVID-19 lockdown studied. Such information is crucial, because additional COVID-19-related lockdowns might still be needed. They are also instructive regarding potential future pandemics.
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Affiliation(s)
- Thibaud Quibel
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (M.D.); (P.R.)
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, Centre de Recherche en Épidé-miologie et Santé des Populations (CESP), Paris Saclay University, 78180 Montigny-le-Bretonneux, France;
- Correspondence: ; Tel.: +33-01-39275131; Fax: +33-01-39274479
| | - Norbert Winer
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, 44035 Nantes, France; (N.W.); (N.B.)
- UMR PhAN 1280 NUN INRAE F-44000 University Nantes, 44035 Nantes, France
| | - Laurence Bussières
- Obstetrics, and Fetal Medicine and Surgery Department, Hôpital Necker-Enfants Maladies, AP-HP, 75007 Paris, France; (L.B.); (B.R.); (Y.V.)
- EHU 7328 PACT, Université de Paris, 75006 Paris, France
| | - Christophe Vayssière
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 31059 Toulouse, France; (C.V.); (N.D.)
- UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation), Toulouse III University, 31062 Toulouse, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Avenue Moliere, 67000 Strasbourg, France;
| | - Manon Defrance
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (M.D.); (P.R.)
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France; (M.D.); (P.R.)
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, Centre de Recherche en Épidé-miologie et Santé des Populations (CESP), Paris Saclay University, 78180 Montigny-le-Bretonneux, France;
| | - Jean Bouyer
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, Centre de Recherche en Épidé-miologie et Santé des Populations (CESP), Paris Saclay University, 78180 Montigny-le-Bretonneux, France;
| | - Ninon Dupuis
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 31059 Toulouse, France; (C.V.); (N.D.)
| | - Benoit Renaudin
- Obstetrics, and Fetal Medicine and Surgery Department, Hôpital Necker-Enfants Maladies, AP-HP, 75007 Paris, France; (L.B.); (B.R.); (Y.V.)
| | - Louise Dugave
- CHU Lille, Department of Obstetrics, 59000 Lille, France; (L.D.); (C.G.)
| | - Nathalie Banaszkiewicz
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, 44035 Nantes, France; (N.W.); (N.B.)
| | - Charles Garabedian
- CHU Lille, Department of Obstetrics, 59000 Lille, France; (L.D.); (C.G.)
- University Lille, ULR 2694 METRICS, 59000 Lille, France
| | - Yves Ville
- Obstetrics, and Fetal Medicine and Surgery Department, Hôpital Necker-Enfants Maladies, AP-HP, 75007 Paris, France; (L.B.); (B.R.); (Y.V.)
- EHU 7328 PACT, Université de Paris, 75006 Paris, France
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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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Geng Y, Zhao W, Liu W, Tang J, Zhang H, Ke W, Yao R, Xu J, Lin Q, Li Y, Huang J. Term Neonatal Complications During the Second Localized COVID-19 Lockdown and Prolonged Premature Rupture of Membranes at Home Among Nulliparas With Reference Interval for Maternal C-Reactive Protein: A Retrospective Cohort Study. Front Pediatr 2022; 10:787947. [PMID: 35463873 PMCID: PMC9024135 DOI: 10.3389/fped.2022.787947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/21/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The COVID-19 lockdown extended premature rupture of membranes (PROM) expectant time among nulliparas and increased the risk of term neonatal complications. This study investigated the impact of term nulliparas with PROM delays at home on neonatal outcomes during the COVID-19 lockdown period, considering the clinical diagnostic application of maternal C-reactive protein (CRP). METHODS This study collected 505 term nulliparous women who underwent PROM at home from five provinces in a non-designated hospital of China in 2020. We analyzed PROM maternal information at home and neonatal complications in the COVID-19 regional lockdown and compared related information in the national lockdown. Poisson regression models estimated the correlation of PROM management at home, maternal CRP, and neonatal morbidity. We constructed two diagnostic models: the CRP univariate model, and an assessed cut-off value of CRP in the combined model (CRP with PROM waiting time at home). RESULTS In the regional lockdown, PROM latency at home and the severity of neonatal complications were extended and increased lower than in the nationwide lockdown, but term neonatal morbidity was not reduced in the COVID-19 localized lockdown. Prolonged waiting time at home (≥8.17 h) was associated with increasing maternal CRP values and neonatal morbidity (adjusted risk ratio 2.53, 95% CI, 1.43 to 4.50, p for trend <0.001) in the regional lockdown period. In the combined model, CRP ≥7 mg/L with PROM latency ≥8.17 h at home showed higher diagnostic sensitivity and AUC than only CRP for initial assessing the risk of adverse neonatal complications in COVID-19 regional lockdowns (AUC, 0.714 vs. 0.534; sensitivity, 0.631 vs. 0.156). CONCLUSION The impact of the acute COVID-19 national blockade on the PROM newborns' health could continue to the COVID-19 easing period. Maternal CRP reference interval (≥7 mg/L) would effectively assess the risk of term neonatal morbidity when nulliparas underwent prolonged PROM expectant at home (≥8.17 h) during the second COVID-19 lockdown.
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Affiliation(s)
- Yang Geng
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Weihua Zhao
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wenlan Liu
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jie Tang
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hui Zhang
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Weilin Ke
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Runsi Yao
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Ji Xu
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qing Lin
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yun Li
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianlin Huang
- Department of Obstetrics and Gynecology and Center for Perinatal Medical Health, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Effects of COVID-19 pandemic period on neonatal mortality and morbidity. Pediatr Neonatol 2022; 63:78-83. [PMID: 34776364 PMCID: PMC8548836 DOI: 10.1016/j.pedneo.2021.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Corona Virus Disease 2019 (COVID-19) in pregnant women has important impacts on perinatal and neonatal outcomes. However, there are a limited number of studies investigating the effect of the pandemic period on newborns. With this study, we aimed to determine the impact of the 2020 COVID-19 outbreak on prenatal care, obstetric outcomes, neonatal mortality and morbidity. METHODS The retrospective results of patients hospitalized to the Tertiary Neonatal Intensive Care Unit between 1 March and 30 May 2020, the first peak period of the pandemic in our country, were compared with the data of the same period of the previous year. RESULTS A total of 307 cases were included in our study. The mean gestational weeks of the neonates hospitalized in the Neonatal Intensive Care Unit during the COVID-19 period were higher than those in the control group (p: 0.003). During the pandemic period, an increase was found in the frequency of pregnant women presenting to obstetric emergency services in emergencies requiring acute intervention (p: 0.01). Compared to the control group, there was an increase in the number of infants with small for gestational age (SGA) diagnosis, 5th-minute Apgar score of <7, and newborns with a diagnosis of hypoxic-ischemic encephalopathy who were treated with hypothermia in the study group (p < 0.05). No difference was found in terms of maternal and neonatal mortality (p > 0.05). CONCLUSIONS During the COVID-19 pandemic, it was shown that pregnant women disrupted their regular antenatal care, and more pregnant women were admitted to the obstetric emergency department with emergencies requiring acute intervention. This led to an increase in the number of cases diagnosed with SGA and hypoxic-ischemic encephalopathy in newborns. Our results will be useful for better management of current and future pandemic periods.
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20
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Kyriacou C, Cooper N, Robinson E, Parker N, Barcroft J, Kundu S, Letchworth P, Sur S, Gould D, Stalder C, Bourne T. Ultrasound characteristics, serum biochemistry and outcome of ectopic pregnancies presenting during COVID-19 pandemic. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:909-915. [PMID: 34605083 PMCID: PMC8661840 DOI: 10.1002/uog.24793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe and compare the characteristics of ectopic pregnancies (EPs) in the year prior to vs during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This was a retrospective analysis of women diagnosed with an EP on transvaginal sonography conducted at a center in London, UK, providing early-pregnancy assessment, between 1 January 2019 and 31 December 2020. Women were identified via the Astraia ultrasound reporting system using coded and non-coded outcomes of EP or pregnancy outside the uterine cavity. Data related to predefined outcomes were collected using Astraia and Cerner electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. RESULTS There were 22 683 consultations over the 2-year period. Following consultation, a similar number and proportion of EPs were diagnosed in 2019 (141/12 657 (1%)) and 2020 (134/10 026 (1%)). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at the first transvaginal sonography scan and at diagnosis were similar, and no difference in location, size or morphology of EP was found between the two cohorts. Serum human chorionic gonadotropin (hCG) levels at the time of EP diagnosis were higher in 2020 than in 2019 (1005 IU/L vs 665 IU/L; P = 0.03). The proportions of women according to type of final EP management were similar, but the rate of failed first-line management was higher during vs before the pandemic (16% vs 6%; P = 0.01). The rates of blood detected in the pelvis (hemoperitoneum) on ultrasound (23% vs 26%; P = 0.58) and of ruptured EP confirmed surgically (9% vs 3%; P = 0.07) were similar in 2019 vs 2020. CONCLUSIONS No difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of EP between women diagnosed before vs during the COVID-19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first-line conservative management measures were higher during the pandemic. Our findings suggest that women continued to access appropriate care for EP during the COVID-19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome in our population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Kyriacou
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - N. Cooper
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - E. Robinson
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - N. Parker
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - J. Barcroft
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - S. Kundu
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - P. Letchworth
- St Mary's Hospital, Department of Obstetrics and GynaecologyImperial College LondonLondonUK
| | - S. Sur
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - D. Gould
- St Mary's Hospital, Department of Obstetrics and GynaecologyImperial College LondonLondonUK
| | - C. Stalder
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
| | - T. Bourne
- Tommy's National Centre for Miscarriage Research, Department of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea HospitalImperial College LondonLondonUK
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
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21
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Carbone L, Raffone A, Travaglino A, Sarno L, Conforti A, Gabrielli O, De Vivo V, De Rosa M, Migliorini S, Saccone G, Locci M, Alviggi C, Mollo A, Guida M, Zullo F, Maruotti GM. Obstetric A&E unit admission and hospitalization for obstetrical management during COVID-19 pandemic in a third-level hospital of southern Italy. Arch Gynecol Obstet 2021; 305:859-867. [PMID: 34455467 PMCID: PMC8403252 DOI: 10.1007/s00404-021-06212-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Laura Sarno
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Alessandro Conforti
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Olimpia Gabrielli
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Valentino De Vivo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Martina De Rosa
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sonia Migliorini
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Gabriele Saccone
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Mariavittoria Locci
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Carlo Alviggi
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
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22
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Townsend R, Chmielewska B, Barratt I, Kalafat E, van der Meulen J, Gurol-Urganci I, O'Brien P, Morris E, Draycott T, Thangaratinam S, Doare KL, Ladhani S, Dadelszen PV, Magee LA, Khalil A. Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis. EClinicalMedicine 2021; 37:100947. [PMID: 34195576 PMCID: PMC8233134 DOI: 10.1016/j.eclinm.2021.100947] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic. METHODS We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI). FINDINGS Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486-0776, P<00001, I2=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602-0911, P = 00046, I2=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762-2794, P<00001, I2=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118-1319, P<00001, I2=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407-0690, P<00001, I2=00%). There was no significant change in intrapartum epidural use (P = 00896) or the use of GA for elective CS (P = 079). INTERPRETATION Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.
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Affiliation(s)
- Rosemary Townsend
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
| | - Barbara Chmielewska
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Imogen Barratt
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | - Erkan Kalafat
- Middle East Technical University, Faculty of Arts and Sciences, Department of Statistics, Ankara, Turkey
- Koc University, School of Medicine, Department of Obstetrics and Gynaecology, Istanbul, Turkey
| | - Jan van der Meulen
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Ipek Gurol-Urganci
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Pat O'Brien
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Edward Morris
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Tim Draycott
- The Royal College of Obstetricians and Gynaecologists, London, United Kingdom
- North Bristol NHS Trust Department of Women's Health, Westbury on Trym, United Kingdom
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
- Immunisation and Countermeasures Division, Public Health England, United Kingdom
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
- Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
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23
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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: 567] [Impact Index Per Article: 189.0] [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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24
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Kugelman N, Toledano‐Hacohen M, Karmakar D, Segev Y, Shalabna E, Damti A, Kedar R, Zilberlicht A. Consequences of the COVID-19 pandemic on the postpartum course: Lessons learnt from a large-scale comparative study in a teaching hospital. Int J Gynaecol Obstet 2021; 153:315-321. [PMID: 33523481 PMCID: PMC9087621 DOI: 10.1002/ijgo.13633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the consequences of COVID-19 pandemic restrictions on the postpartum course. METHODS A retrospective cross-sectional study compared women who gave birth between March and April 2020 (first wave), between July to September 2020 (second wave), and a matched historical cohort throughout 2017-2019 (groups A, B, and C, respectively). Primary outcomes were postpartum length of stay (LOS), presentations to the emergency department (ED), and readmissions 30 days or longer after discharge. Following Bonferroni correction, p < 0.016 was considered statistically significant. RESULTS In total, 3377 women were included: 640, 914, and 1823 in groups A, B, and C, respectively. LOS after birth (both vaginal and cesarean) was shorter in groups A and B compared to the control group (2.28 ± 1.01 and 2.25 ± 0.93 vs 2.55 ± 1.10 days, p < 0.001). Rates of ED presentations 30 days after discharge were higher in groups C and B compared to group A (6.63% and 6.45% vs 3.12%, p = 0.006). Rates of readmissions 30 days after discharge were 0.78%, 1.42%, and 1.09% (groups A, B, and C, respectively), demonstrating no statistical difference (p = 0.408). CONCLUSION During the COVID-19 pandemic, there was a reduction or no change in rates of ED presentations and readmissions, despite the shortened LOS after delivery. A shift in policy regarding the postpartum LOS could be considered.
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Affiliation(s)
- Nir Kugelman
- Department of Obstetrics & GynecologyCarmel Medical CenterHaifaIsrael
- Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
| | - Mirit Toledano‐Hacohen
- Department of Obstetrics & GynecologyCarmel Medical CenterHaifaIsrael
- Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
| | | | - Yakir Segev
- Department of Obstetrics & GynecologyCarmel Medical CenterHaifaIsrael
- Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
| | - Eiman Shalabna
- Department of Obstetrics & GynecologyCarmel Medical CenterHaifaIsrael
- Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
| | - Amit Damti
- Department of Obstetrics & GynecologyCarmel Medical CenterHaifaIsrael
- Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
| | - Reuven Kedar
- Department of Obstetrics & GynecologyCarmel Medical CenterHaifaIsrael
- Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
| | - Ariel Zilberlicht
- Department of Obstetrics & GynecologyCarmel Medical CenterHaifaIsrael
- Rappaport Faculty of MedicineTechnion‐Israel Institute of TechnologyHaifaIsrael
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Millevert C, Van Hees S, Siewe Fodjo JN, Wijtvliet V, Faria de Moura Villela E, Rosso B, Gil-Nagel A, Weckhuysen S, Colebunders R. Impact of COVID-19 on the lives and psychosocial well-being of persons with epilepsy during the third trimester of the pandemic: Results from an international, online survey. Epilepsy Behav 2021; 116:107800. [PMID: 33571838 PMCID: PMC8803628 DOI: 10.1016/j.yebeh.2021.107800] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of the coronavirus disease 2019 (COVID-19) measures on the lives and psychosocial well-being of persons with epilepsy (PWE) during the third trimester of the COVID-19 pandemic. METHODS A structured questionnaire investigating different aspects of the lives and psychosocial well-being of PWE during the COVID-19 pandemic was developed. Persons with epilepsy were invited via social media to anonymously respond to a secure web-based online questionnaire (www.icpcovid.com). Responses were collected between July 26th and December 3rd, 2020. Hospital anxiety and depression scales (HADS) were used to screen respondents for depression (HADS-D) and anxiety (HADS-A). RESULTS Responses of 407 PWE were included in the analysis; 304 (74.7%) respondents were female and 245 (60.2%) living in Europe, 157 (38.6%) in South America, and 5 (1.2%) in Canada. Seventy-six (18.7%) reported a decrease of income during the COVID-19 lockdown, and 122 (30.0%) experienced difficulties in obtaining anti-seizure medication (ASM), mostly (72/122, 59.0%) due to unavailability. Seizure frequency increased in 122 (30.0%); 295 (72.5%) screened positive for anxiety, and 159 (39.1%) for depression. Hundred eighty-eight (46.2%) reported reluctance to seek medical care; 27.3% believed that epilepsy was associated with an increased risk of COVID-19 disease. Forty-six (74.2%) of 62 PWE who were followed up by telephone or video consult were satisfied with this consult. Fifty-five respondents, most (89.1%) of whom were from Europe, had also participated in a previous survey during the early months of the pandemic. In this subgroup, although there was no difference in prevalence of a positive screening for depression or anxiety, mean scores on HADS-A and HADS-D increased from 6.65 ± 3.99 to 7.27 ± 4.01 (p = 0.418), and from 5.84 ± 4.43 to 6.60 ± 4.45 (p = 0.371), respectively. CONCLUSIONS The COVID-19 pandemic continues to impact the psychosocial and somatic well-being of PWE. To minimize this impact, ensuring uninterrupted access to ASM is essential. Teleconsultations are valid alternatives for continued follow-up, but should include attention to psychosocial well-being. Persons with epilepsy should be more actively informed that epilepsy is not a risk factor for developing (more severe) COVID-19 disease.
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Affiliation(s)
- Charissa Millevert
- Department of Neurology, University Hospital Antwerp, Belgium; VIB-Center for Molecular Neurology, VIB, University of Antwerp, Belgium
| | - Stijn Van Hees
- Global Health Institute, University of Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | - Veerle Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | - Barbara Rosso
- Department of Neurology, Italian Hospital of Buenos Aires, Argentina
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Sarah Weckhuysen
- Department of Neurology, University Hospital Antwerp, Belgium; VIB-Center for Molecular Neurology, VIB, University of Antwerp, Belgium
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26
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Du M, Yang J, Han N, Liu M, Liu J. Association between the COVID-19 pandemic and the risk for adverse pregnancy outcomes: a cohort study. BMJ Open 2021; 11:e047900. [PMID: 33622959 PMCID: PMC7907630 DOI: 10.1136/bmjopen-2020-047900] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The secondary impacts of the COVID-19 pandemic on adverse maternal and neonatal outcomes remain unclear. In this study, we aimed to evaluate the association between the COVID-19 pandemic and the risk for adverse pregnancy outcomes. DESIGN We conduced retrospective analyses on two cohorts comprising 7699 pregnant women in Beijing, China, and compared pregnancy outcomes between the pre-COVID-2019 cohort (women who delivered from 20 May 2019 to 30 November 2019) and the COVID-2019 cohort (women who delivered from 20 January 2020 to 31 July 2020). The secondary impacts of the COVID-2019 pandemic on pregnancy outcomes were assessed by using multivariate log-binomial regression models, and we used interrupted time-series (ITS) regression analysis to further control the effects of time-trends. SETTING One tertiary-level centre in Beijing, China PARTICIPANTS: 7699 pregnant women. RESULTS Compared with women in the pre-COVID-19 pandemic group, pregnant women during the COVID-2019 pandemic were more likely to be of advanced age, exhibit insufficient or excessive gestational weight gain and show a family history of chronic disease (all p<0.05). After controlling for other confounding factors, the risk of premature rupture of membranes and foetal distress was increased by 11% (95% CI, 1.04 to 1.18; p<0.01) and 14% (95% CI, 1.01 to 1.29; p<0.05), respectively, during the COVID-2019 pandemic. The association still remained in the ITS analysis after additionally controlling for time-trends (all p<0.01). We uncovered no other associations between the COVID-19 pandemic and other pregnancy outcomes (p>0.05). CONCLUSIONS During the COVID-19 pandemic, more women manifested either insufficient or excessive gestational weight gain; and the risk of premature rupture of membranes and foetal distress was also higher during the pandemic.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jie Yang
- Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Na Han
- Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Centre, Beijing, China
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