COVID-19 can raise awareness at the country level and locally so that preventive measures can be taken and appropriate, respectful clinical and bereavement care can be provided if stillbirth or newborn death occurs.Reducing preventable stillbirths and newborn deaths must be a global priority. This goal requires not only sustained, universal access to quality maternal and newborn care, it also requires the data to track and guide public health action. COVID-19 control needs to be fully integrated into maternal, child, and newborn health care so that the two can coexist. All outcomes must be counted. Ensuring all women and babies receive the right care, at the right time, from the right people, and that all perinatal outcomes are counted and reported has never been more important than it is now.

ImportanceWomen who experience depression during or within a year of pregnancy are at increased risk of morbidity and mortality. Although those living in low- and middle-income countries are thought to be at increased risk of perinatal depression, the true prevalence remains unclear.ObjectiveTo determine the prevalence of depression among individuals living in low- and middle-income countries during pregnancy and up 1 year post partum.Data SourcesMEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and the Cochrane Library were searched from database inception until April 15, 2021.Study SelectionStudies were included that reported the prevalence of depression using a validated method during pregnancy or up to 12 months post partum in countries defined by the World Bank as low, lower-middle, and upper-middle income.Data Extraction and SynthesisThis study followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Prevalence estimates were calculated using a random-effects meta-analysis model. Subgroup analyses were performed among women who were considered at increased risk of developing perinatal depression.Main Outcomes and MeasuresPoint prevalence of perinatal depression was the main outcome measured as percentage point estimates with corresponding 95% CIs.ResultsThe search identified 8106 studies, of which data were extracted from 589 eligible studies reporting outcomes of 616 708 women from 51 countries. The pooled prevalence of perinatal depression across all studies was 24.7% (95% CI, 23.7%-25.6%). The prevalence of perinatal depression varied slightly by country income status. The highest prevalence was found in lower-middle–income countries, with a pooled prevalence of 25.5% (95% CI, 23.8%-27.1%; 197 studies from 23 countries including 212 103 individuals). In upper-middle–income countries, the pooled prevalence was 24.7% (95% CI, 23.6%-25.9%; 344 studies from 21 countries including 364 103 individuals) and in low-income countries, the pooled prevalence was 20.7% (95% CI, 18.4%-23.0%; 50 studies from 7 countries including 40 502 individuals). The East Asia and the Pacific region had the lowest prevalence of perinatal depression at 21.4% (95% CI, 19.8%-23.1%) and was significantly increased in the Middle East and North Africa at 31.5% (95% CI, 26.9%-36.2%; between-group comparison: P < .001). In subgroup analyses, the highest prevalence of perinatal depression was found among women who experienced intimate partner violence, at 38.9% (95% CI, 34.1%-43.6%). revalence of depression was also high among women with HIV (35.1% [95% CI, 29.6%-40.6%]) and those who had experienced a natural disaster (34.8% [95% CI, 29.4%-40.2%]).Conclusions and RelevanceThis meta-analysis found that depression was common in low- and middle-income countries, affecting 1 in 4 perinatal women. Accurate estimates of the prevalence of perinatal depression in low- and middle-income countries are essential in informing policy, allocating scarce resources, and directing further research to improve outcomes for women, infants, and families.

No abstract

Considerable attention is paid to the treatment and clinical outcomes of ‘at-risk’ pregnancies but the level of worry experienced by these women has not been addressed. A multidisciplinary team, known as the Risk Associated Pregnancy (RAP) team, cared for 159 women with risk-associated pregnancies. Their level of worry was compared with that of 699 women with normal pregnancies (NPs): 360 receiving continuity of midwifery care and 339 receiving standard care. Underlying level of anxiety was similar among groups. Women managed by the RAP team reported a lower level of worry than women in either of the NP groups.

Objectives: To determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre‐eclampsia. Can routine urinalysis during pregnancy be discontinued in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit? Design: Prospective observational study. Setting: A metropolitan public hospital and a private hospital in Sydney (NSW). Participants: One thousand women were enrolled at their first antenatal visit (March to November 1999), and 913 completed the study. Outcome measures: The primary outcome was a diagnosis of de novo hypertension (gestational hypertension, pre‐eclampsia, or pre‐eclampsia superimposed on chronic hypertension). Results: Thirty‐five women had dipstick proteinuria at their first antenatal visit. In 25 (71%) of these women, further dipstick proteinuria was detected during pregnancy, and two (6%) were diagnosed with pre‐eclampsia. Of the 867 without dipstick proteinuria at the first visit, 338 (39%) had dipstick proteinuria (> 1+) at some time during pregnancy. There were no statistically significant differences in the proportion of women with and without dipstick proteinuria at their first visit who developed hypertension during pregnancy. Only six women developed proteinuria before the onset of hypertension. Women who had an abnormal result of a midstream urine test at their first visit, compared with women with a normal result, were more likely to have a urinary tract infection diagnosed during pregnancy; however, the numbers were small. Conclusion: In the absence of hypertension, routine urinalysis during pregnancy is a poor predictor of pre‐eclampsia. Therefore, after an initial screening urinalysis, routine urinalysis could be eliminated from antenatal care without adverse outcomes for women.

IntroductionGlobally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time.Methods and analysisAn international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences.Ethics and disseminationEthics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King’s College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.

No abstract

No abstract