Birth and early parenting during the COVID-19 pandemic: A cross-sectional study in the Austrian and German population

BACKGROUND

During the COVID-19 pandemic, new mothers and their babies represent a particularly vulnerable group. This study investigates the effects of the pandemic on the pregnancy and childbirth experience, as well as on postnatal stress and depression levels.

METHODS

An online survey was completed by 1964 Austrian and German mothers who gave birth during the COVID-19 pandemic. The survey included the Pregnancy Distress Questionnaire (PDQ), the Childbirth Experience Questionnaire (CEQ), the Edinburgh Postnatal Depression Score (EPDS), the Perceived Stress Score (PSS), and additional pregnancy- and pandemic-related questions. We conducted multilinear regression models in order to investigate which factors predict childbirth experience, stress and depression scores.

FINDINGS

There was a high prevalence of depression symptoms (42%), though the mean EPDS score was 8·71 (SD = 5·70), below the cut-off for depression of 10. The prevalence of high stress scores was 9%, and the mean PSS score was 17·7 (SD = 6·64), which indicates moderate perceived stress. The pandemic reduced the time spent with grandparents, as well as the help received by the mother from relatives and friends. Not receiving help was associated with higher stress and depression scores. In the multilinear regression models, the most important predictor for a negative childbirth experience was a high-risk pregnancy, while the strongest predictors for high stress and depression levels were low social support and negatively perceived pandemic repercussions on financial, social or health aspects of family life.

INTERPRETATION

The results suggest that the pandemic had an impact on maternal mental health. While the perceived consequences due to the pandemic negatively affected the postnatal depression and stress levels, perceived social support acted as a protective factor.

Germany vs. Austria: country-specific differences in becoming parents during the COVID-19 pandemic

Background

Becoming parents can be a big challenge, but how is this experience affected by the COVID-19 pandemic and its measures?

Methods

Between 18.05.2021 and 01.07.2021, we conducted an online-survey to gain insight into becoming parents during the COVID-19 pandemic in Germany and Austria. The sample mentioned in this report consists of biological mothers living in Austria (n = 952) and Germany (n = 1012) who gave birth between the 16th of March 2020 (the beginning of the first lockdown in Austria) and the time of completion of the study. The mothers’ current stress levels were assessed with the Perceived Stress Scale (PSS), and postnatal depression symptoms were quantified with the Edinburgh Postnatal Depression Scale (EPDS). Furthermore, we included questions to measure perceived social support and pandemic-related stress.

Results

Current stress levels (U = 555677.50, z = 5.90, p < .001) and postnatal depression symptoms (U = 546354.00, z = 5.15, p < .001) were significantly higher in the German sample as compared to the Austrian sample. Yet, Austrian mothers reported higher social support as compared to the German mothers (U = 387834.00, z = -7.48, p < .001). Furthermore, we found higher levels of perceived social support to be associated with lower current stress levels (rs = -.40, p < .001). On average, perceived stress was moderately high in both samples (MGermany = 18.58, SDGermany = 6.60; MAustria = 16.76, SDAustria = 6.57).

Conclusions

Stress levels and depression symptoms seem to be high and prevalent due to the pandemic and it is highly indicated to take action such as supporting families in need and emphasising social support in order to reduce mental health problems of parents as well as their children in the aftermath of the pandemic.

Key messages

• Findings underpin the protective role of social support against psychological distress in new parents and show the high strain at current.

• Action needs to be taken in order to support parents and children at risk.

The effects of the Covid-19 pandemic on the stress and depression levels of new mothers

Background

New mothers are a particularly vulnerable group during the COVID-19 pandemic, due both to the higher depression and stress levels associated with early child care and to the risk of a COVID-19 infection. We investigated the effects of the pandemic on the childbirth experience, stress and depression levels in this population.

Methods

This cross-sectional, explorative study included 1964 Austrian and German mothers who gave birth between 16.03.2020 and 01.07.2021 and completed an online survey between 18.05.2021 and 01.07.2021. This contained the Childbirth Experience Questionnaire (CEQ2), the Edinburgh Postnatal Depression Scale (EPDS), and the Perceived Stress Scale (PSS), as well as three custom-made scales: a birth risk score (risk factors for a poor birth outcome), a pandemic repercussions score (perceived effects on different aspects of personal life), and a social support score (how emotionally supported they feel). We computed post-hoc multilinear regression models to evaluate which factors can predict the CEQ2, PSS and EPDS scores.

Results

Mothers had a worse birth experience, perceived less stress and had more depressive symptoms during the pandemic than previously reported cohorts. The CEQ2 was predicted by the birth risk (negatively), the access to a midwife (positively) and the perception of sufficient access of the visitors in the hospital (positively) (adjusted R2 = 0.26, F(4, 1738) = 155.64, p &lt; 0.001). The PSS was predicted by the pandemic repercussions (positively), the social support (negatively), and the presence of a coping mechanism (negatively) (adjusted R2 = 0.28, F(4, 1959) = 195.1, p &lt; 0.001). The EPDS was similarly predicted by the same factors as the PSS (adjusted R2 = 0.28, F(4, 1959) = 189.59, p &lt; 0.001).

Conclusions

Social support and strong coping mechanisms can lower the stress and depression scores. Instructing the population about how to improve these factors might be a target for future social policies.

Key messages

• Compared to historical cohorts, mothers who gave birth during the pandemic had a worse birth experience, and, postnatally, perceived less stress but had more depressive symptoms.

• The visitors’ access to the hospital and the mother’s access to a midwife impacted the birth experience, while the social support and the coping mechanisms affected the stress and depression scores.

OS06.6.A Real-World Pattern of Care Study on Glioblastoma in the Austrian Population. Final results from 2014-2020

Background

The Austrian ABTR-SANO Glioblastoma Registry is the first population-based assessment of patterns of care for patients with Glioblastoma across Austrian healthcare institutions. The primary aim is to assess the real world effectiveness of administered therapies.

Material and Methods

Clinical data are collected via a common web-based IT platform “ABTR-SANO Net” since 2014. The database and the ongoing evaluation of clinical parameters, as well as interims analysis are provided in cooperation with a review board. First Outcome analysis, including patients from 2014-2020, was performed at the end of 2021.

Results

Eleven centers across Austria are involved, and the data of 1416 patients (m/f ratio: 1,35, median age: 66 years) were recently analyzed in detail. Age, extent of resection, as well as ECOG was associated with improved survival. Methylated MGMT Status also showed a moderate survival benefit. Patients with re-resection and re-radiation also exhibited improved survival, which however may be attributed to a selection bias.Second line treatment manly comprised of antiangiogenic treatment, followed by alkylated agents, re-radiation and re-surgery. Median overall survival of all patients was 344 days and clearly age dependent (best for &lt;50 years, worse for&gt;80 years).

Conclusion

This is the first population based outcome analysis of Glioblastoma in Austria. Results regarding prognostic markers and outcome are mostly comparable with international data. Robust population based data are important in order to monitor quality of health care, and to match the data with results from clinical studies.

P338 The road to zero-fluoroscopy catheter ablation in recurrent paroxysmal atrial fibrillation using ICE: training, learning, getting closer

INTRODUCTION

Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure.

PURPOSE

The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation.

METHODS

Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters.

RESULTS

Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded.

CONCLUSIONS

This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation.

Abstract P338 Figure. ICE-guided transseptal puncture

Efficient inscription of Bragg gratings in As2S3 fibers using near bandgap light

Efficient inscription of Fiber Bragg gratings (FBGs) in single-mode, thin cladding As(2)S(3) fibers is demonstrated by using near bandgap light at 532 nm. The FBGs with the reflectivity of over 80% can be induced in only 80-90 s, substantially faster than in previous reports. The dynamics of the grating growth are investigated in the photosensitivity process, showing a fast blue shift of the Bragg wavelength and then a somewhat slower red shift. The aging of the grating after fabrication is also reported, indicating a 37% decay of the grating strength.

Mother-to-child transmission of HIV infection in Romania: Results from an education and prevention programme

A pilot prevention of mother-to-child transmission (PMTCT) programme was implemented in Constanta County, Romania, between 2000 and 2002. The programme consisted of clinician training, routine antenatal HIV counselling and testing and the care of HIV-infected pregnant women and their infants. A total of 11,423 pregnant women (10,192 (89%) white Europeans, 862 (7.5%) Rroma, 369 (3.2%) Central Asians) were tested during the pilot, at a median of 24 weeks' gestation. Rapid HIV testing at delivery was introduced during the pilot, to supplement the antenatal testing, both of which required informed consent. Overall seroprevalence was 1.75 per 1,000 (95% confidence interval (CI) 1.07-2.70 per 1,000). HIV infection was associated with having a high-risk partner, prostitution and non-Caucasian ethnicity. Twelve infected women completed their pregnancies, of whom seven received antenatal antiretroviral therapy (ART); all neonates received prophylactic ART and five were delivered by elective caesarean section. Three infants were HIV-infected, giving a vertical transmission rate of 25% (95% CI 5.49-57.2%); all three were born to mothers not identified as infected until delivery, and who therefore received no antenatal ART. A key challenge for PMTCT in Romania will be the prompt identification of pregnant HIV-infected women, to allow the optimum application of interventions.

The role of some prostaglandin analogues in experimental intoxication produced by carbon tetrachloride in rats

Prostaglandins are synthesized ubiquitously in the body from unsaturated fatty acids and they act as paracrine messengers. We have studied the influence of a prostaglandin analogue on experimental induced hepatopathy. The tested compound is a synthetic isopropyl ester of PGF2 alpha (IPEF) and as hepato-toxic agent we used CCl4. We worked on four groups of 4 adult male rats each. Group I received no substance; Group II received CCl4 0.1 ml/bw/per os, single dose, for three days; Group III received CCl4 as series I and IPEF 15 micrograms/bw i.p., single dose daily, one hour before CCl4 administration; Group IV received CCl4 as series I and IPEF 50 micrograms/bw i.p., single dose daily. Twenty-four hours after the last administration, samples of blood were taken and ALT, AST, LDH as well as conjugate and unconjugate bilirubin were determined. We also determined MDH, GSH and glutathion peroxidase, in liver homogenate. Our data show that MDH levels are increased in Group I (20.81 +/- 3.15 microM/microgram protein) as compared with both Group III (8.44 +/- 1.32 microM/microgram protein) and IV (7.31 +/- 1.92 microM/microgram protein) which might suggest that prostaglandin analogue IPEF decreases the polyunsaturated fatty acids degradation, at both low and high level. ALAT levels for group that received CCl4 (782 +/- 20.8 U/L) are significantly higher than those for group III (264 +/- 15.4 U/L) and IV (227 +/- 8.4 U/L) which received IPEF at low, respectively high dose. Our data suggest that the synthetic prostaglandin analogue presents stabilizing membrane effects (plasmatic and membrane of some cellular organelles) and reduces peroxide radicals production.

[Mucosal antrectomy with truncal vagotomy in duodenal ulcer resection to exclude the pylorus)]

The duodenal ulcers with which the surgeon is confronted increasingly take on tumoural postbulbar forms, penetrating in the pancreas or liver pedicle. Such a duodenal stump can neither be anastomized to the residual stomach ulcer inversed safely. Therefore it has become increasingly necessary to find a tight inversion method. One of the authors (D. Gavriliu) updated mucous antrectomy + truncular vagotomy and Reichel-Polya gastrectomy, which leaves an adequate seromuscular cuff for a double closing suture of the duodenum; after ablation of the antral mucosa the patient benefits by a veritable humoral antrectomy. In point of fact the operation is increasingly applied (truncular vagotomy + antrectomy and Reichel-Polya gastrectomy), with the difference however that antrectomy only removes the mucosa, and the advantage of ensuring perfect closure of the duodenal stump.