Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study

Introduction The coronavirus disease 2019 (COVID-19) caused a global pandemic that resulted in devastating health, economic and social disruption. Pregnant mothers are susceptible to COVID-19 complications due to physiological and immunity changes in pregnancy. We aimed to assess the maternal vaccine acceptance of the COVID-19 vaccine. Methods A multi-center study across four teaching hospitals in the Klang Valley, Malaysia was conducted between September 2021 and May 2022. A survey was conducted using a self-administered electronic questionnaire. The survey instruments included;(1) maternal perception and attitude toward COVID-19 vaccination, (2) COVID-19 pregnancy-related anxiety, and 3) generalized anxiety disorder. Results The response rate was 96.6%, with a final number for analysis of 1,272. The majority of our women were Malays (89.5%), with a mean age (standard deviation, SD) of 32.2 (4.6). The maternal vaccine acceptance in our study was 77.1%. Household income (p < 0.001), employment status (p = 0.011), and health sector worker (p = 0.001) were independent predictors of maternal willingness to be vaccinated. COVID-19 infection to self or among social contact and greater COVID-19 pregnancy-related anxiety were associated with increased odds of accepting the SARS-CoV-2 vaccine. Women who rely on the internet and social media as a source of vaccine information were more likely to be receptive to vaccination (adjusted odd ratio, AOR 1.63;95% CI 1.14–2.33). Strong correlations were observed between maternal vaccine acceptance and the positive perception of (1) vaccine information (p < 0.001), (2) protective effects of vaccine (p < 0.001), and (3) getting vaccinated as a societal responsibility (p < 0.001). Discussion The high maternal vaccine acceptance rate among urban pregnant women in Malaysia is most likely related to their high socio-economic status. Responsible use of the internet and social media, alongside appropriate counseling by health professionals, is essential in reducing vaccine hesitancy among pregnant women.

Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study.

Introduction: The coronavirus disease 2019 (COVID-19) caused a global pandemic that resulted in devastating health, economic and social disruption. Pregnant mothers are susceptible to COVID-19 complications due to physiological and immunity changes in pregnancy. We aimed to assess the maternal vaccine acceptance of the COVID-19 vaccine. Methods: A multi-center study across four teaching hospitals in the Klang Valley, Malaysia was conducted between September 2021 and May 2022. A survey was conducted using a self-administered electronic questionnaire. The survey instruments included; (1) maternal perception and attitude toward COVID-19 vaccination, (2) COVID-19 pregnancy-related anxiety, and 3) generalized anxiety disorder. Results: The response rate was 96.6%, with a final number for analysis of 1,272. The majority of our women were Malays (89.5%), with a mean age (standard deviation, SD) of 32.2 (4.6). The maternal vaccine acceptance in our study was 77.1%. Household income (p < 0.001), employment status (p = 0.011), and health sector worker (p = 0.001) were independent predictors of maternal willingness to be vaccinated. COVID-19 infection to self or among social contact and greater COVID-19 pregnancy-related anxiety were associated with increased odds of accepting the SARS-CoV-2 vaccine. Women who rely on the internet and social media as a source of vaccine information were more likely to be receptive to vaccination (adjusted odd ratio, AOR 1.63; 95% CI 1.14-2.33). Strong correlations were observed between maternal vaccine acceptance and the positive perception of (1) vaccine information (p < 0.001), (2) protective effects of vaccine (p < 0.001), and (3) getting vaccinated as a societal responsibility (p < 0.001). Discussion: The high maternal vaccine acceptance rate among urban pregnant women in Malaysia is most likely related to their high socio-economic status. Responsible use of the internet and social media, alongside appropriate counseling by health professionals, is essential in reducing vaccine hesitancy among pregnant women.

Comparing Childbirth Experience Between Induced and Spontaneous Labour During Covid-19 Pandemic

Introduction: Every pregnant mother has a different expectation on each laboring experience and would want to imagine a pleasant journey about giving birth. A good childbirth experience boosts self-confidence, self-worth and feeling accomplishment. A bad childbirth experience leads to postpartum depression, fear of childbirth and some even experience post-traumatic stress disorder. Induction of labour (IOL) is a common procedure in obstetrics practice, done prior to onset of labour using mechanical or pharmacological methods. This questionnaire-based study was planned in order to improve our approach and service in making women more comfortable during the childbirth process albeit spontaneously or through IOL. Objective: To compare childbirth experience among induced labour and spontaneous labour and to evaluate their contributing factors. Methods: This was a cross sectional study where questionnaire was distributed to all postpartum women who had delivered in Hospital Cansellor Tuanku Muhriz who fulfilled inclusion and exclusion criteria. Suitable participants were identified at postnatal ward just after delivery. Results: A total of 314 women were recruited. Study showed no significant labour experiences difference among both IOL and spontaneous labour groups. Overall, both spontaneous and IOL groups had positive childbirth experience. Age, ethnicity body mass index labour analgesia and indication of IOL has influence in childbirth experiences. Conclusion: Childbirth experiences were comparably positive in both groups possibly due to patients understanding of labour process and healthcare factors.

Dysregulated Exosomes Result in Suppression of the Immune Response of Pregnant COVID-19 Convalescent Women.

A successful pregnancy outcome is dependent on a delicate balance between inflammatory and anti-inflammatory processes throughout the different trimesters. Interruption in this balance can lead to an adverse outcome resulting in pregnancy loss. Since late 2019, the emergence of the new SARS-CoV-2 virus has affected lives worldwide, including pregnant women; therefore, there is an urgent need to address different approaches in relation to prevention, diagnostics, and therapeutics. Early pregnancy is affected by SARS-CoV-2 infection leading to fetal demise. Available evidence also suggests that 90% of pregnant women infected with the SARS-CoV-2 virus seem to be asymptomatic. Nonetheless, it is still unclear how COVID-19 affects exosome production in pregnant women recovered from COVID-19 and how these exosomes regulate the adaptive immune response. In this study, we found several exosomes including CD9, CD31, CD40, CD45, CD41b, CD42a, CD62P, CD69, CD81, CD105, and HLA-DRDPDQ in the plasma of COVID-19-recovered pregnant women were significantly less abundant than the control group. Furthermore, to understand how these exosomes affect the adaptive immune response, we co-cultured the peripheral blood mononuclear cells (PBMCs) from healthy control (HC) pregnant women with exosomes of either Preg-HC or Preg-recovered COVID-19 women. We identified that Preg-recovered COVID-19 women have reduced capacity for the inflammatory cytokine TNF-α from cytotoxic CD8+ T cells. In summary, our study highlights that pregnant recovered COVID-19 women have reduced production of several exosomes and possess fewer immunogenic properties. Our study implicates that exosomes can control inflammation and antigen presentation capacity of immune cells, thus limiting the infection in pregnant women.

Psychological Distress and COVID-19 Related Anxiety among Malaysian Women during the COVID-19 Pandemic.

The combination of COVID-19 outbreaks and nationwide lockdown led to an increased prevalence of psychological distress among the population, especially women, as they have to cope with greater family and work demands. We aimed to identify the factors contributing to psychological distress among Malaysian women during the COVID-19 pandemic. A cross-sectional study was conducted between October 2020 and April 2021, in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered questionnaire was distributed among women, which consisted of (1) Participant's demographics, (2) COVID-19 knowledge and awareness, (3) Depression, Anxiety, Stress Scale-21 (DASS-21), and (4) COVID-19-related anxiety. Chi-square test and univariate analysis were performed to determine the significant factors associated with psychological distress. The mean scores for knowledge, COVID-19 anxiety, and DASS-21 subcomponents were compared using the Mann-Whitney U test. A total of three hundred and thirty-eight women completed the survey. The majority of respondents demonstrated adequate knowledge (95.6%) on COVID-19. The proportion of our women who reported symptoms of depression, anxiety, and stress were 17.2%, 25.1%, and 0.9%, respectively, resulting in a prevalence of psychological distress of 27.8%. Low education level (p = 0.017), unemployment (p = 0.028), loss of income (p = 0.033), and hospital admission for surgical procedures (p = 0.021) were significantly associated with a higher psychological burden. A greater level of COVID-19 anxiety was found among Malays (p = 0.027), pregnant women (p = 0.013), and those who suffered a loss of income (p = 0.038) during this pandemic. The COVID-19 pandemic had a negative effect on women's psychological wellbeing, especially those from the lower socio-economic background. Therefore, adequate information, as well as support, must be provided to the vulnerable groups during the ongoing pandemic, to lessen their psychological burden.

Universal Testing Policy for COVID-19 in Pregnancy: A Systematic Review

Background The coronavirus disease (COVID-19) has spread at an accelerated rate. WHO reported that in the general population, the majority are either asymptomatic or mildly infected. In view of the high risk of SARS-CoV-2 transmission from a pregnant woman to her newborn, healthcare workers and other patients, it is a raised concern whether universal testing should be implemented in this targeted population. The current guidelines have not recommended a universal testing policy. In certain European countries, however, the policy was implemented by some hospitals in regions with high prevalence of COVID-19 infection. Aim(s) To assess the justification for universal screening of pregnant women for COVID-19 prior to admission in labor through systematic review of antenatal prevalence of asymptomatic infection, hence risk of inadvertent spread of infection. Materials and Methods Three databases confined to PubMed, Ovid and Science Direct were used to search for articles from November 2019 onwards published in the English language. The search was conducted using the keywords “COVID-19” or “coronavirus” or “SARS-CoV-2” and “pregnancy” or “pregnant” or “obstetric” or “labor” and “universal” or “testing” or “prevalence”. The review was registered with PROSPERO. Results The search result retrieved 34 studies, with the majority consisting of retrospective cohort studies, while other studies such as prospective cohort study, research letters and a case series were also identified. A total of 19,958 pregnant women were universally tested until the date of report. Overall, the prevalence of universal testing among pregnant women presenting to labor and delivery units are higher in Western regions. From the total number of pregnant women 5.3% tested positive and among these, the majority (75.5%) did not manifest any symptoms at the time of testing. Conclusion In areas with high prevalence of COVID-19 infection, the implementation of a universal testing policy among pregnant women presenting to labor and admission units may be cost effective in helping to curb disease transmission. Systematic Trial Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020184248, PROSPERO: CRD42020184248.

COVID-19 Pandemic and Maternal Psychological Wellbeing During the Malaysian Movement Control Order: A Cross-Sectional Study.

Background: COVID-19 pandemic had resulted in nationwide lockdown as a disease control measure. Potential harm to self and baby due to COVID-19 infection as well as uncertainties about delivery are among contributors to maternal anxiety. We aimed to assess the prevalence of psychological distress among pregnant women during the Malaysian Movement Control Order (MCO). Methods: A cross-sectional study was conducted between May and June 2020 in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered electronic questionnaire was distributed which included the following; (1) Depression, Anxiety and Stress Scale-21 (DASS 21), (2) Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), (3) MCO effect questionnaire, and (4) newly designed COVID-19 pregnancy-related anxiety. Chi-square test and logistic regression were performed to determine significant associations whilst mean scores comparison were conducted through Mann-Whitney-U-test. Results: Four hundred and fifteen women were included in the final analysis. The prevalence of psychological distress among our cohort was 14.7%; with a two-fold increase of risk among the non-Malays (AOR 1.98, 95% CI 1.00-3.89) whilst a greater number of social support showed a protective effect (AOR 0.51, 95%CI 0.28-0.92). Malay ethnicity (p < 0.001) alongside greater household income (p = 0.014) were positive predictors of a higher sense of maternal wellbeing. Multiparous women and those of higher economic status experienced the more negative effect of the MCO. Around 88% of our women reported a higher level of COVID-19 pregnancy-related anxiety. Younger (p = 0.017) and first-time mothers (p = 0.039) were more likely to be anxious. Although adequate maternal knowledge on COVID-19 was associated with a greater sense of maternal wellbeing (p = 0.028), it was also linked to a higher level of COVID-19 related anxiety (AOR 3.54, 95% 1.29-9.70). Conclusion: There was a relatively low prevalence of psychological distress among expectant mothers in Malaysia during the first wave of the COVID-19 pandemic. Expectant mothers should receive accurate and reliable information on the effect of COVID-19 on pregnancy to relieve some maternal anxiety. Maternal health screening is important to identify individuals who would benefit from extra support and mental health intervention, especially in prolonged lockdown.

Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study.

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June 2020. A self-administered electronic questionnaire that included the knowledge and practice domains was distributed. A newly designed set of questions was used to evaluate (1) women's perception of MCO and (2) maternal experience, which was subdivided into clinical care provision and maternal anxiety. The survey response rate was 93% with the final number for analysis of 415. The majority of women (95%) demonstrated an adequate level of knowledge on COVID-19, whilst 99% had a good practice. We found that tertiary education (p < 0.001), employment status (p = 0.03), higher household income (p < 0.001), and multiple sources of information (p < 0.001) were independent predictors of adequate maternal knowledge on COVID-19. Women with adequate knowledge also reported a more positive perception of MCO (p < 0.001) and better obstetric care experience (p = 0.037), as did those of Malay ethnicity. Younger (p < 0.001) and nulliparous (p = 0.01) women demonstrated greater anxiety levels. The majority of our women reported good practice and adequate knowledge, which contributed to a positive perception of MCO and better maternal obstetric experience. First-time mothers may benefit from extra support and reassurance during the pandemic to alleviate maternal anxiety.

The Psychological Impact of Movement Restriction during the COVID-19 Outbreak on Clinical Undergraduates: A Cross-Sectional Study.

The COVID-19 pandemic has resulted in a Movement Control Order (MCO) in Malaysia and the subsequent closure of all educational institutions. We aimed to examine the psychological impact of the MCO among clinical undergraduates. A cross-sectional study was conducted using self-reported questionnaires that were distributed online using the Depression, Anxiety and Stress Scale-21 (DASS 21), Short Warwick Edinburgh Mental Well-Being Scale (SWEMWBS), and the newly designed MCO effect questionnaire. Seven hundred seventy-two students completed the survey. The prevalence of psychological distress was 52.8%, with around 60% of respondents reporting disruption to their daily lives. Older (p = 0.015) and more senior students (p < 0.001) were less likely to be anxious than their younger and junior counterparts, respectively. A greater number of social support (three or more) was linked to a lower score of depression (p = 0.005) and stress (p = 0.045). Undergraduates who received family support demonstrated lower depression scores (p = 0.037) and higher mental wellbeing (p = 0.020) compared to those without. Government support was independently associated with a lesser risk of depressive symptoms (Adjusted odds ratio, AOR 0.68; 95% confidence interval, CI 0.47-0.99) and a greater sense of mental wellbeing (AOR 1.54; 95% CI 1.06-2.22). The present finding provides evidence of a high prevalence of psychological distress among clinical undergraduates during the COVID-19 pandemic. Appropriate social support is important in alleviating anxiety and stress and promoting greater mental wellbeing amongst students during the nationwide quarantine.