The association between the COVID-19 pandemic and postpartum care provision.

BACKGROUND: The COVID-19 pandemic led to a rapid transformation in the healthcare system to mitigate viral exposure. In the perinatal context, one change included altering the prenatal visit cadence and increasing the utilization of telehealth methods. Whether this approach had inadvertent negative implications for postpartum care, including postpartum depression screening and contraceptive utilization, is unknown. OBJECTIVE: This study aimed to examine whether preventative health service utilization, including postpartum depression screening and contraceptive utilization, differed during the COVID-19 pandemic when compared with the prepandemic period. STUDY DESIGN: This retrospective cohort study included all pregnant patients who received prenatal care at 1 of 5 academic obstetrical practices and who delivered at Northwestern Memorial Hospital either before (delivery from September 1, 2018, to January 1, 2019) or during (delivery from February 1, 2020, to May 15, 2020) the COVID-19 pandemic. Completion of postpartum depression screening was assessed by reviewing standardized fields in the documentation associated with the screening in the electronic health record system. The method of contraception used was ascertained from the postpartum clinical documentation. Patients were classified as initiating long-acting reversible contraception use if they received NEXPLANON (etonogestrel implant) or an intrauterine device during the hospitalization for delivery or within 3 months following delivery. Bivariable and multivariable analyses were performed. RESULTS: Of the 2375 pregnant patients included in this study, 1120 (47%) delivered during the COVID-19 pandemic. Pregnant patients who delivered during the COVID-19 pandemic were significantly less likely to have undergone postpartum depression screening (45.5% vs 86.2%; P<.01); this association persisted after adjusting for potential confounders (adjusted odds ratio, 0.13; 95% confidence interval, 0.11-0.16). Pregnant patients who delivered during the COVID-19 pandemic also were significantly less likely to initiate long-acting reversible contraception use within 3 months of delivery (13.5% vs 19.6%; adjusted odds ratio, 0.67; 95% confidence interval, 0.53-0.84). CONCLUSION: The onset of the COVID-19 pandemic was associated with a decrease in the completion of postpartum depression screenings and fewer patients initiating long-acting reversible contraception use overall. These results can inform adaptations in healthcare delivery in the midst of the ongoing COVID-19 pandemic.

Maternal Antibody Response and Transplacental Transfer Following SARS-CoV-2 Infection or Vaccination in Pregnancy.

BACKGROUND: Pregnant persons are at increased risk of severe COVID-19 and adverse obstetric outcomes. Understanding maternal antibody response, duration, and transplacental transfer after SARS-CoV-2 infection and COVID-19 vaccination is important to inform public health recommendations. METHODS: This prospective observational cohort study included 351 pregnant people who had SARS-CoV-2 infection or COVID-19 vaccination during pregnancy. IgG and IgM to SARS-CoV-2 S1 receptor binding domain were measured in maternal and cord blood. Antibody levels and transplacental transfer ratios were compared across 1) disease severity for those with SARS-CoV-2 infection and 2) infection versus vaccination. RESULTS: There were 252 individuals with SARS-CoV-2 infection and 99 who received COVID-19 vaccination during pregnancy. Birthing people with more severe SARS-CoV-2 infection had higher maternal and cord blood IgG levels (p = 0.0001, p = 0.0001). Median IgG transfer ratio was 0.87-1.2. Maternal and cord blood IgG were higher after vaccination than infection (p = 0.001, p = 0.001). Transfer ratio was higher after 90 days in the vaccinated group (p < 0.001). Modeling showed higher amplitude and half-life of maternal IgG following vaccination (p < 0.0001). There were no significant differences by fetal sex. CONCLUSIONS: COVID-19 vaccination in pregnancy leads to higher and longer lasting maternal IgG levels, higher cord blood IgG, and higher transfer ratio after 90 days compared to SARS-CoV-2 infection. Greater infection severity leads to higher maternal and cord blood antibodies. Maternal IgG decreases over time following both vaccination and infection, reinforcing the importance of vaccination, even after infection, and vaccine boosters for pregnant patients.

Neighborhood deprivation and preterm delivery during the coronavirus 2019 pandemic.

BACKGROUND: Prior studies have reported decreases in the preterm delivery incidence during the COVID-19 pandemic. However, the findings are inconsistent. Given the wide disparities in the pandemic's impact across communities, neighborhood deprivation may explain the observed variation in the relationship between the COVID-19 pandemic and preterm delivery. OBJECTIVE: To characterize the changes in the incidence of preterm delivery during the COVID-19 pandemic with attention to the effect modification introduced by neighborhood hardship. STUDY DESIGN: This retrospective cohort study included all the pregnant patients who delivered at an urban tertiary care hospital during the pandemic (April-November 2020) or before the pandemic (April-November 2019). We compared the incidence of preterm delivery, spontaneous preterm delivery, and medically indicated preterm delivery before 37 weeks' gestation across epochs. Planned analyses stratified the cohorts by neighborhood deprivation metrics defined by the residential zip code; the metrics included the median neighborhood household income and the hardship index (a composite index including dependency, educational attainment, unemployment, poverty, per capita income, and crowded housing). The Breslow-Day test for homogeneity assessed the association of the delivery epoch and neighborhood deprivation with the preterm delivery outcomes. RESULTS: Of 16,544 eligible deliveries, 8.7% occurred preterm. The incidences of preterm delivery (8.4% vs 9.0%; P=.17), spontaneous preterm delivery (5.0 vs 5.4%; P=.27), and medically indicated preterm delivery (3.2% vs 3.5%; P=.47) were similar in the pandemic and prepandemic epochs. However, the preterm delivery (odds ratio, 0.78; 95% confidence interval, 0.64-0.96) and spontaneous preterm delivery (odds ratio, 0.76; 95% confidence interval, 0.59-0.99) decreased from the prepandemic to the pandemic epoch in those living in neighborhoods <50th percentile for median income (Breslow-Day P values.047 and.036, respectively). Similarly, the preterm delivery (odds ratio, 0.78; 95% confidence interval, 0.64-0.97) and spontaneous preterm delivery (odds ratio, 0.74; 95% confidence interval, 0.57-0.98) decreased for those inhabiting the neighborhoods in the highest-hardship quartile (Breslow-Day P values.045 and.029, respectively). CONCLUSION: The populations residing in socioeconomically disadvantaged neighborhoods experienced reductions in preterm delivery during the COVID-19 pandemic. Neighborhood-level social determinants of health offer insight into the complex etiologies that contribute to preterm delivery and provide opportunities for public health and equity-focused prevention strategies.

Risk factors for severe acute respiratory syndrome coronavirus 2 infection in pregnant women.

Background: Risk factors for severe acute respiratory syndrome coronavirus 2 infection in pregnancy remain poorly understood. Identifying and understanding populations at a heightened risk of acquisition is essential to more effectively target outreach and prevention efforts. Objective: This study aimed to compare sociodemographic and clinical characteristics of pregnant women with and without severe acute respiratory syndrome coronavirus 2 infection and, among those with severe acute respiratory syndrome coronavirus 2, to compare characteristics of those who reported coronavirus disease symptoms and those who were asymptomatic at diagnosis. Study Design: This retrospective cohort study includes pregnant women who delivered or intended to deliver at Northwestern Memorial Hospital after initiation of a universal testing protocol on admission (April 8, 2020-May 31, 2020). Women were dichotomized by whether they had a positive test result for severe acute respiratory syndrome coronavirus 2. Among women with a positive test result, women were further dichotomized by whether they reported symptoms of coronavirus disease 2019. Bivariable analysis and parametric tests of trend were used for analyses. Logistic regression was used to control for potential confounders and to examine effect modification between race and ethnicity and any other identified risk factors. Results: During the study period, 1418 women met inclusion criteria, of whom 101 (7.1%) had a positive test result for severe acute respiratory syndrome coronavirus 2. Of the 101 women who had a positive test result, 77 (76.2%) were symptomatic at the time of diagnosis. Compared with women who had a negative test result for severe acute respiratory syndrome coronavirus 2, those with a positive test result were younger and were more likely to have public insurance, to identify as black or African American or Latina, to be unmarried, to be obese, to have preexisting pulmonary disease, and to have living children. An increasing number of living children was associated with an increasing risk of severe acute respiratory syndrome coronavirus 2 infection, and this finding persisted after controlling for potential confounders. There was no effect modification between race or ethnicity and having living children with regard to the risk of infection. There were no significant differences identified between women who were symptomatic and asymptomatic. Conclusion: Many risk factors for severe acute respiratory syndrome coronavirus 2 infection in pregnancy are similar to the social and structural determinants of health that have been reported in the general population. The observed association between severe acute respiratory syndrome coronavirus 2 infection and having children raises the possibility of children themselves being vectors of viral spread or behavior patterns of parents being mediators of acquisition.