A call for action for COVID-19 surveillance and research during pregnancy

Buekens, Pierre; Alger, Jackeline; Breart, Gérard; Cafferata, María Luisa; Harville, Emily W.; Tomasso, Giselle

doi:10.1016/s2214-109x(20)30206-0

Cited by 90 publications

(85 citation statements)

References 10 publications

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“…A call for action in April 2020 already anticipated that women during pregnancy and postpartum might be a vulnerable population for COVID‐19 due not only to biological or clinical factors, but also to social risks 40 . We believe that Brazil is currently facing the tragedy of the aforementioned prediction and that estimating its real dimension can contribute to reversal of the present disaster.…”

Section: Discussionmentioning

confidence: 97%

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID‐19 in Brazil: a surveillance database analysis

Takemoto

Menezes

Andreucci

et al. 2020

BJOG

101

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Objective To describe clinical characteristics of pregnant and postpartum women with severe COVID‐19 in Brazil and to examine risk factors for mortality. Design Cross‐sectional study based on secondary surveillance database analysis. Setting Nationwide Brazil. Population or sample 978 Brazilian pregnant and postpartum women notified as COVID‐19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020. Methods Data was abstracted from the Brazilian ARDS Surveillance System (ARDS‐SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. Main outcome measures Case fatality rate. Results We identified 124 maternal deaths, corresponding to a case fatality rate among COVID‐19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID‐19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect. Conclusions Negative outcomes of COVID‐19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period. Tweetable abstract A total of 124 COVID‐19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.

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Section: Discussionmentioning

confidence: 97%

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID‐19 in Brazil: a surveillance database analysis

Takemoto

Menezes

Andreucci

et al. 2020

BJOG

101

View full text Add to dashboard Cite

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“…Early mother–baby separation due to compulsory or voluntary quarantine may also have negative effects on infants’ feeding and early development [ 14 , 15 ]. Both researchers and frontline health professionals call for more attention on the long-term impact of pregnant patients and their babies [ 16 – 18 ]. However, there has been no empirical evidence on the chronic effects of Covid-19 in pregnancy so far.…”

Section: Introductionmentioning

confidence: 99%

Impact of Covid-19 in pregnancy on mother’s psychological status and infant’s neurobehavioral development: a longitudinal cohort study in China

Wang

Chen

et al. 2020

BMC Med

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Background Evidence concerning the long-term impact of Covid-19 in pregnancy on mother’s psychological disorder and infant’s developmental delay is unknown. Methods This study is a longitudinal single-arm cohort study conducted in China between May 1 and July 31, 2020. Seventy-two pregnant patients with Covid-19 participated in follow-up surveys until 3 months after giving birth (57 cases) or having abortion (15 cases). We collected data from medical records regarding Covid-19, delivery or abortion, testing results of maternal and neonatal specimens, and questionnaires of quarantine, mother–baby separation, feeding, and measuring of mothers’ mental disorders and infants’ neurobehavioral disorders. Results All cases infected in the first trimester and 1/3 of cases infected in the second trimester had an abortion to terminate the pregnancy. 22.2% of pregnant patients were suffering from post-traumatic stress disorder or depression at 3 months after delivery or induced abortion. Among 57 live births, only one neonate was positive of nucleic acid testing for throat swab, but negative in repeated tests subsequently. The median duration of mother–baby separation was 35 days (interquartile range 16 to 52 days). After the termination of maternal quarantine, 49.1% of mothers chose to prolong the mother–baby separation (median 8 days; IQR 5 to 23 days). The breastfeeding rate was 8.8% at 1 week after birth, 19.3% at the age of 1 month, and 36.8% at the age of 3 months, respectively. The proportion of “monitoring” and “risk” in the social–emotional developmental domain at the age of 3 months was 22.7% and 63.6%, respectively. After the adjustment of preterm, neonatal sex, admitted to NICU, and the mother’s Covid-19 condition, the negative associations were significantly identified (p < 0.05) between mother–baby separation days and three developmental domains: communication, gross motor, and personal–social. Conclusions There is no definite evidence on vertical transmission of SARS-CoV-2. In addition to control infection risk, researchers and healthcare providers should pay more attention to maternal mental health and infant’s feeding, closeness with parents, and early development.

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“…Buekens et al. 18 have called for research on pregnancy during the COVID-19 pandemic, recognising its potential psychological and social impact. This review is the first to systematically examine literature on the psychological impact of infectious disease outbreaks on pregnant women and factors associated with this impact.…”

Section: Introductionmentioning

confidence: 99%

Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review

2020

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Objectives Infectious disease outbreaks can be distressing for everyone, especially those deemed to be particularly vulnerable such as pregnant women, who have been named a high-risk group in the current COVID-19 pandemic. This paper aimed to summarise existing literature on the psychological impact of infectious disease outbreaks on women who were pregnant at the time of the outbreak. Study design The design of this study is a rapid review. Methods Five databases were searched for relevant literature, and main findings were extracted. Results Thirteen articles were included in the review. The following themes were identified: negative emotional states; living with uncertainty; concerns about infection; concerns about and uptake of prophylaxis or treatment; disrupted routines; non-pharmaceutical protective behaviours; social support; financial and occupational concerns; disrupted expectations of birth, prenatal care and postnatal care and sources of information. Conclusions Pregnant women have unique needs during infectious disease outbreaks and could benefit from up-to-date, consistent information and guidance; appropriate support and advice from healthcare professionals, particularly with regards to the risks and benefits of prophylaxis and treatment; virtual support groups and designating locations or staff specifically for pregnant women.

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A call for action for COVID-19 surveillance and research during pregnancy

Cited by 90 publications

References 10 publications

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID‐19 in Brazil: a surveillance database analysis

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID‐19 in Brazil: a surveillance database analysis

Impact of Covid-19 in pregnancy on mother’s psychological status and infant’s neurobehavioral development: a longitudinal cohort study in China

Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review

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