How do perceptions of Covid-19 risk impact pregnancy-related health decisions? A convergent parallel mixed-methods study protocol. (preprint)

IntroductionPregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic. ObjectivesO_LIQuantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people. C_LIO_LIQualitative strand: Understand how pregnant peoples perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health. C_LI Methods and analysisThis is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020-December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation. Ethics and disseminationThis study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics. Strengths and limitations of this studyO_LIPopulation-based administrative data cohorts are very large, ensuring that analyses are high-powered. C_LIO_LIMixed-methods design will allow us to offer explanation for changes in healthcare use observed through administrative data. C_LIO_LICross-provincial design permits examination of the potential impacts of COVID-19 infection prevention and control policies on pregnant peoples health. C_LIO_LIUse of Canadian Index of Multiple Deprivation will allow us to examine differences in healthcare use according to economic, racial, and immigration factors. C_LIO_LITeam includes 5 co-investigators with lived experience of pandemic pregnancies. C_LI

Prenatal care disruptions and associations with maternal mental health during the COVID-19 pandemic (preprint)

As the novel coronavirus (COVID-19) spread across Canada in March 2020, provinces imposed strict lockdowns causing restrictions and disruptions to health care. These changes impacted how pregnant individuals received prenatal care and experienced childbirth. The additional stress caused by these changes may negatively affect the well-being of pregnant individuals and the developing child. This study investigated the impact of the pandemic on prenatal care and birth plans of pregnant individuals in Canada and potential associations with maternal mental health. Data from 4604 participants was collected from English- and French-speaking Canadians between April 5-June 1, 2020 as part of the Canada-wide Pregnancy During the COVID-19 Pandemic study. Symptoms of maternal depression, general anxiety, and pregnancy-related anxiety were assessed. Participants also answered questions about disruptions and changes to prenatal care and their birth plans due to the COVID-19 pandemic. Logistic regression was used to estimate associations between prenatal care disruptions and maternal mental health. Cancellation of prenatal appointments and birth plan changes (specifically changes to childcare during birth and change of support person attending the birth) were significantly associated with greater odds of experiencing clinically-elevated depression, anxiety, and/or pregnancy-related anxiety symptoms. These results illustrate the need for reliable and accessible prenatal care during the pandemic, such as the integration of mental health screenings and co-ordination of prenatal care providers.

Covid-19 vaccination intentions among Canadian parents of 9-12 year old children: results from the All Our Families longitudinal cohort (preprint)

Background: Acceptance of a COVID-19 vaccine is critical to achieving high levels of immunization. The objective of this study is to understand factors associated with COVID-19 vaccine intentions among parents and explore reasons underlying decision making. Methods: Participants from a longitudinal cohort were invited to participate in a COVID-19 impact survey in May-June 2020 (n=1321). Parents were asked about the impact of the pandemic and their intention to vaccinate their child against COVID-19 should a vaccine be approved. Past infant vaccination status was validated against public health records. Multinomial regression models were run to estimate associations between demographic factors, past vaccination status, and vaccine intention. Qualitative responses regarding factors impacting decision making were analyzed thematically. Results: Sixty percent of parents (n=798) intended to vaccinate their children, but 9% (n=113) said they did not intend to vaccinate and 31% (n=410) were unsure. Lower education and income were inversely associated with intention to vaccinate. Incomplete vaccination history was associated with intention not to vaccinate but not uncertainty. Qualitative responses revealed concerns over vaccine safety and efficacy, long term effects and a rushed vaccination process. Interpretation: Almost a third of parents remain unsure about vaccinating their children against COVID-19, even within a group with historically high uptake of infant vaccines. Given the many uncertainties about future COVID-19 vaccines, clear communication regarding safety will be critical to ensuring vaccine uptake.