Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 75
Filter
1.
BJOG ; 129(2): 282-290, 2022 01.
Article in English | MEDLINE | ID: covidwho-1831885

ABSTRACT

OBJECTIVE: To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval. DESIGN: Nationwide cohort study. SETTING: Sweden. POPULATION: From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval. MAIN OUTCOME MEASURES: Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. RESULTS: During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02). CONCLUSIONS: Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. TWEETABLE ABSTRACT: Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.


Subject(s)
COVID-19 Testing , COVID-19 , Intensive Care Units, Neonatal/statistics & numerical data , Pregnancy Complications, Infectious , Pregnancy Outcome/epidemiology , SARS-CoV-2/isolation & purification , Apgar Score , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Premature Birth/epidemiology , Prenatal Care/methods , Prenatal Care/standards , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Stillbirth/epidemiology , Sweden/epidemiology
2.
J Med Life ; 15(1): 7-14, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1709142

ABSTRACT

Indonesia is currently experiencing the second wave of the COVID-19 pandemic, impacting maternal health services and maternal mortality. This research aims to investigate the use of antenatal care (ANC) during the COVID-19 second wave and the factors that play a role in this situation. A cross-sectional study was conducted during July 2021 on 344 pregnant women in primary, secondary, and tertiary maternal health care facilities in Pasuruan Regency, Indonesia. The data collection technique was simple random sampling, with face-to-face interviews assisted by questionnaires. Logistic regression and adjusted odds ratio with 95% CI and p<0.05 were performed to identify a significant relationship. 136 (39.5%) pregnant women did not use ANC services during the second wave of the COVID-19 outbreak. Husband's support (AOR=13.814, 95% CI: 8.090-23.588), believing that pregnant women are not afraid of contracting COVID-19 (AOR=6.501, 95% CI: 3.904-10.825), easy access to transportation (AOR=12.145, 95% CI: 6.186-23.846), ease of ANC fees (AOR=4.105, 95% CI: 2.424-6.950), no lockdown policy (AOR=3.130, 95% CI: 1.983-4.940), knowledge regarding COVID-19 (AOR=2.975, 95% CI: 1.793-4.938), COVID-19 information on social media (AOR=3.035, 95% CI: 1.179-7.815), COVID-19 prevention protocols in health facilities (AOR=8.478, 95% CI: 3.611-19.903) were predictors of ANC utilization. This encourages the importance of prioritizing health services for pregnant women during the pandemic, overcoming the fear of contracting COVID-19 through maternal education, husband support, easy access to ANC, and improving the quality of ANC service facilities.


Subject(s)
COVID-19 , Prenatal Care , Cross-Sectional Studies , Facilities and Services Utilization , Female , Humans , Indonesia/epidemiology , Pandemics , Patient Acceptance of Health Care , Pregnancy , Prenatal Care/methods , SARS-CoV-2
3.
Obstet Gynecol ; 138(4): 603-615, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1591562

ABSTRACT

OBJECTIVE: To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES: A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION: We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction. TABULATION, INTEGRATION, AND RESULTS: Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth. CONCLUSION: Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.


Subject(s)
Delivery of Health Care/methods , Prenatal Care/methods , COVID-19/epidemiology , Diabetes, Gestational/epidemiology , Female , Humans , Hypertension, Pregnancy-Induced/epidemiology , Infant, Newborn , Michigan , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Randomized Controlled Trials as Topic , SARS-CoV-2 , Telemedicine/methods
4.
BJOG ; 129(2): 282-290, 2022 01.
Article in English | MEDLINE | ID: covidwho-1598371

ABSTRACT

OBJECTIVE: To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval. DESIGN: Nationwide cohort study. SETTING: Sweden. POPULATION: From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval. MAIN OUTCOME MEASURES: Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. RESULTS: During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02). CONCLUSIONS: Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. TWEETABLE ABSTRACT: Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.


Subject(s)
COVID-19 Testing , COVID-19 , Intensive Care Units, Neonatal/statistics & numerical data , Pregnancy Complications, Infectious , Pregnancy Outcome/epidemiology , SARS-CoV-2/isolation & purification , Apgar Score , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Cohort Studies , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Premature Birth/epidemiology , Prenatal Care/methods , Prenatal Care/standards , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Stillbirth/epidemiology , Sweden/epidemiology
5.
BMC Pregnancy Childbirth ; 21(1): 767, 2021 Nov 12.
Article in English | MEDLINE | ID: covidwho-1511733

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to regional or nationwide lockdowns as part of risk mitigation measurements in many countries worldwide. Recent studies suggest an unexpected and unprecedented decrease in preterm births during the initial COVID-19 lockdowns in the first half of 2020. The objective of the current study was to assess the effects of the two months of the initial national COVID-19 lockdown period on the incidence of very and extremely preterm birth in the Netherlands, stratified by either spontaneous or iatrogenic onset of delivery, in both singleton and multiple pregnancies. METHODS: Retrospective cohort study using data from all 10 perinatal centers in the Netherlands on very and extremely preterm births during the initial COVID-19 lockdown from March 15 to May 15, 2020. Incidences of very and extremely preterm birth were calculated using an estimate of the total number of births in the Netherlands in this period. As reference, we used data from the corresponding calendar period in 2015-2018 from the national perinatal registry (Perined). We differentiated between spontaneous versus iatrogenic onset of delivery and between singleton versus multiple pregnancies. RESULTS: The incidence of total preterm birth < 32 weeks in singleton pregnancies was 6.1‰ in the study period in 2020 versus 6.5‰ in the corresponding period in 2015-2018. The decrease in preterm births in singletons was solely due to a significant decrease in iatrogenic preterm births, both < 32 weeks (OR 0.71; 95%CI 0.53 to 0.95) and < 28 weeks (OR 0.53; 95%CI 0.29 to 0.97). For multiple pregnancies, an increase in preterm births < 28 weeks was observed (OR 2.43; 95%CI 1.35 to 4.39). CONCLUSION: This study shows a decrease in iatrogenic preterm births during the initial COVID-19-related lockdown in the Netherlands in singletons. Future studies should focus on the mechanism of action of lockdown measures and reduction of preterm birth and the effects of perinatal outcome.


Subject(s)
COVID-19/prevention & control , Labor, Induced/trends , Premature Birth/epidemiology , Premature Birth/etiology , Female , Health Policy , Humans , Iatrogenic Disease/epidemiology , Incidence , Infant, Extremely Premature , Infant, Newborn , Logistic Models , Netherlands/epidemiology , Pregnancy , Prenatal Care/methods , Prenatal Care/trends , Protective Factors , Retrospective Studies , Risk Factors
6.
Pediatr Clin North Am ; 68(5): 1055-1070, 2021 10.
Article in English | MEDLINE | ID: covidwho-1482855

ABSTRACT

COVID-19 has afflicted the health of children and women across all age groups. Since the outbreak of the pandemic in December 2019, various epidemiologic, immunologic, clinical, and pharmaceutical studies have been conducted to understand its infectious characteristics, pathogenesis, and clinical profile. COVID-19 affects pregnant women more seriously than nonpregnant women, endangering the health of the newborn. Changes have been implemented to guidelines for antenatal care of pregnant women, delivery, and newborn care. We highlight the current trends of clinical care in pregnant women and newborns during the COVID-19 pandemic.


Subject(s)
COVID-19/diagnosis , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome/epidemiology , Prenatal Care/methods , COVID-19/transmission , Delivery, Obstetric/statistics & numerical data , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy
7.
JBI Evid Implement ; 19(3): 245-256, 2021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1398206

ABSTRACT

INTRODUCTION AND AIMS: Pelvic floor muscle training (PFMT) enhances muscle strength and coordination, and prevents urinary incontinence associated with giving birth. The goal was to improve women's PFMT during pregnancy and postpartum in La Rioja, Spain. METHODS: This evidence implementation project used the JBI evidence implementation framework. First, we conducted the PFMT baseline audit: to assess the criteria for midwife training, we sent a questionnaire to all midwives. To measure the criteria for PFMT and urinary incontinence risk assessment, we reviewed the medical records of 60 women selected through consecutive sampling and 15 other women at risk of urinary tract infections (UTIs) for the inclusion criteria in a PFMT program. Second, we used the Getting Research into Practice guidelines to identify barriers to the fulfillment of each criterion and design and implement strategies to improve compliance. Finally, we repeated the audit to measure compliance and verify the changes. RESULTS: The midwives received updated PFMT, optimizing compliance with the first criterion from 67 to 100%. The remaining criteria -- providing PFMT for pregnant women, identifying women at high risk of incontinence, and facilitating a supervised PFMT program for women at high risk of UTIs -- went from 0% compliance to 17, 96, and 67%, respectively. CONCLUSION: This project was effective in building consensus, improving midwives' practice, and facilitating mothers' PFMT. The project continued during the novel coronavirus [coronavirus disease 2019 (COVID-19)] epidemic in Spain as the midwives, women, and managers were involved in the change because of a well designed registration system and the use of online tools for communication between midwives and women.


Subject(s)
Exercise Therapy/methods , Pelvic Floor/physiology , Postnatal Care/methods , Prenatal Care/methods , Urinary Incontinence/prevention & control , COVID-19/epidemiology , Female , Health Knowledge, Attitudes, Practice , Humans , Inservice Training , Midwifery , Pregnancy , Quality Improvement , SARS-CoV-2 , Spain , Urinary Tract Infections
8.
BMC Pregnancy Childbirth ; 21(1): 574, 2021 Aug 21.
Article in English | MEDLINE | ID: covidwho-1374107

ABSTRACT

SARS-Cov-2 (Severe Acute Respiratory Coronavirus 2) infection confers a non-negligible risk for younger pregnant women with diabetes, which is still less well investigated. This topic was recently addressed by a systematic scoping review in BMC Pregnancy and Childbirth, aiming to summarize the complex interaction between SARS-Cov-2 infection, pregnancy and diabetes. This commentary will summarize and discuss the main findings of this article and its implications for future research.


Subject(s)
COVID-19/epidemiology , Infectious Disease Transmission, Vertical/prevention & control , Maternal Health/statistics & numerical data , Pregnancy Complications, Infectious/epidemiology , Pregnancy in Diabetics/epidemiology , Prenatal Care/methods , Female , Humans , Infant, Newborn , Pregnancy , Primary Prevention/methods
9.
BMC Pregnancy Childbirth ; 21(1): 573, 2021 Aug 21.
Article in English | MEDLINE | ID: covidwho-1365334

ABSTRACT

BACKGROUND: Currently, we suffer from an increasing diabetes pandemic and on the other hand from the SARS-CoV-2 pandemic. Already at the beginning of the SARS-CoV-2 pandemic, it was quickly assumed that certain groups are at increased risk to suffer from a severe course of COVID-19. There are serious concerns regarding potential adverse effects on maternal, fetal, and neonatal outcomes. Diabetic pregnancies clearly need special care, but clinical implications as well as the complex interplay of diabetes and SARS-CoV-2 are currently unknown. We summarized the evidence on SARS-CoV-2 in diabetic pregnancies, including the identification of novel potential pathophysiological mechanisms and interactions as well as clinical outcomes and features, screening, and management approaches. METHODS: We carried out a systematic scoping review in MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection in September 2020. RESULTS: We found that the prognosis of pregnant women with diabetes mellitus and COVID-19 may be associated with potential underlying mechanisms such as a simplified viral uptake by ACE2, a higher basal value of pro-inflammatory cytokines, being hypoxemic as well as platelet activation, embolism, and preeclampsia. In the context of "trans-generational programming" and COVID-19, life-long consequences may be "programmed" during gestation by pro-inflammation, hypoxia, over- or under-expression of transporters and enzymes, and epigenetic modifications based on changes in the intra-uterine milieu. COVID-19 may cause new onset diabetes mellitus, and that vertical transmission from mother to baby might be possible. CONCLUSIONS: Given the challenges in clinical management, the complex interplay between COVID-19 and diabetic pregnancies, evidence-based recommendations are urgently needed. Digital medicine is a future-oriented and effective approach in the context of clinical diabetes management. We anticipate our review to be a starting point to understand and analyze mechanisms and epidemiology to most effectively treat women with SARS-COV-2 and diabetes in pregnancy.


Subject(s)
COVID-19/epidemiology , Infectious Disease Transmission, Vertical/prevention & control , Maternal Health/statistics & numerical data , Pregnancy Complications, Infectious/epidemiology , Pregnancy in Diabetics/epidemiology , Prenatal Care/methods , Female , Humans , Infant, Newborn , Pregnancy , Primary Prevention/methods
10.
PLoS One ; 16(6): e0253446, 2021.
Article in English | MEDLINE | ID: covidwho-1278197

ABSTRACT

BACKGROUND: COVID-19 is a novel respiratory disease associated with severe morbidity and high mortality in the elderly population and people with comorbidities. Studies have suggested that pregnant women are more susceptible to COVID-19 compared to non-pregnant women. However, it's unclear whether pregnant women in Ghana are knowledgeable about COVID-19 and practice preventive measures against it. This study sought to assess the knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana. METHODS: A cross-sectional study was conducted using a structured questionnaire in the Nabdam district in Ghana. A total of 527 pregnant women were randomly sampled from health facilities offering antenatal care services in the district. Multivariable logistic regression analysis was used to assess the association between the predictors and outcome variables. RESULTS: The prevalence of adequate knowledge and good COVID-19 preventive practices were 85.6%, (95% CI: 82.57, 88.59) and 46.6%, (95% CI: 42.41, 50.95) respectively. Having at least a primary education, residing in an urban area, and receiving COVID-19 education at a health facility were positively associated with adequate knowledge on COVID-19. Factors positively associated with good COVID-19 preventive practices were older age, having at least a primary education, pregnant women with a chronic disease, and living in an urban area. Multiparity was negatively associated with good COVID-19 preventive practices. CONCLUSION: Although majority of women had adequate knowledge of COVID-19, less than half of them were engaged in good COVID-19 preventive practices. Education of pregnant women on COVID-19 preventive practices should be intensified at health facilities while improving upon the water, sanitation and hygiene need particularly in rural communities.


Subject(s)
COVID-19/prevention & control , Health Knowledge, Attitudes, Practice , Pregnant Women , Prenatal Care/statistics & numerical data , Preventive Medicine/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Educational Status , Female , Ghana/epidemiology , Humans , Logistic Models , Multivariate Analysis , Pandemics/prevention & control , Pregnancy , Prenatal Care/methods , Preventive Medicine/methods , Rural Population/statistics & numerical data , SARS-CoV-2/physiology , Surveys and Questionnaires , Young Adult
11.
PLoS One ; 16(6): e0252735, 2021.
Article in English | MEDLINE | ID: covidwho-1278177

ABSTRACT

BACKGROUND AND OBJECTIVE: During the COVID-19 pandemic the organization of maternity care changed drastically; this study into the experiences of maternity care professionals with these changes provides suggestions for the organization of care during and after pandemics. DESIGN: An online survey among Dutch midwives, obstetricians and obstetric residents. Multinomial logistic regression analyses were used to investigate associations between the respondents' characteristics and answers. RESULTS: Reported advantages of the changes were fewer prenatal and postpartum consultations (50.1%). The necessity and safety of medical interventions and ultrasounds were considered more critically (75.9%); 14.8% of community midwives stated they referred fewer women to the hospital for decreased fetal movements, whereas 64.2% of the respondents working in hospital-based care experienced fewer consultations for this indication. Respondents felt that women had more confidence in giving birth at home (57.5%). Homebirths seemed to have increased according to 38.5% of the community midwives and 65.3% of the respondents working in hospital-based care. Respondents appreciated the shift to more digital consultations rather than face-to-face consultations. Mentioned disadvantages were that women had appointments alone, (71.1%) and that the community midwife was not allowed to join a woman to obstetric-led care during labour and subsequently stay with her (56.8%). Fewer postpartum visits by family and friends led to more tranquility (59.8%). Overall, however, 48.0% of the respondents felt that the safety of maternity care was compromised due to policy changes. CONCLUSIONS: Maternity care professionals were positive about the decrease in routine care and the increased confidence of women in home birth, but also felt that safety in maternity care was sometimes compromised. According to the respondents in a future crisis situation it should be possible for community midwives to continue to deliver a personal handover after the referral of women to the hospital, and to stay with them.


Subject(s)
COVID-19/prevention & control , Maternal Health Services/statistics & numerical data , Midwifery/statistics & numerical data , Prenatal Care/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , COVID-19/epidemiology , COVID-19/virology , Female , Home Childbirth/methods , Home Childbirth/statistics & numerical data , Hospitals/statistics & numerical data , Humans , Labor, Obstetric , Logistic Models , Male , Middle Aged , Netherlands , Pregnancy , Prenatal Care/methods , SARS-CoV-2/physiology , Surveys and Questionnaires/statistics & numerical data
12.
Obstet Gynecol ; 137(6): 1032-1040, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1217911

ABSTRACT

OBJECTIVE: To assess the effect of a consumer-based mobile meditation application (app) on wellness in outpatient obstetric and gynecology patients during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a randomized controlled trial at a university outpatient clinic of obstetric and gynecology patients during the COVID-19 pandemic. Women were randomly assigned to the intervention group, who was prescribed a mobile meditation app for 30 days, or the control group, which received standard care. The primary outcome was self-reported perceived stress. Secondary outcomes included self-reported depression, anxiety, sleep disturbance, and satisfaction with the meditation app. A sample size of 80 participants (40 per group) was calculated to achieve 84% power to detect a 3-point difference in the primary outcome. RESULTS: From April to May 2020, 101 women were randomized in the study-50 in the meditation app group and 51 in the control group. Analysis was by intention-to-treat. Most characteristics were similar between groups. Perceived stress was significantly less in the intervention group at days 14 and 30 (mean difference 4.27, 95% CI 1.30-7.24, P=.005, d=0.69 and mean difference 4.28, 95% CI 1.68-6.88, P=.002, d=0.69, respectively). Self-reported depression and anxiety were significantly less in the intervention group at days 14 and 30 (depression: P=.002 and P=.04; anxiety: P=.01, and P=.04, respectively). Sleep disturbance was significantly less in the intervention group at days 14 and 30 (P=.001 and P=.02, respectively). More than 80% of those in the intervention group reported high satisfaction with the meditation app, and 93% reported that mindfulness meditation improved their stress. CONCLUSION: Outpatient obstetric and gynecology patients who used the prescribed consumer-based mobile meditation app during the COVID-19 pandemic had significant reductions in perceived stress, depression, anxiety, and sleep disturbance compared with standard care. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04329533.


Subject(s)
Mindfulness , Pregnancy/psychology , Prenatal Care/methods , Primary Health Care/methods , Stress, Psychological/prevention & control , Adult , COVID-19 , Female , Gynecology , Humans , Meditation/psychology , Middle Aged , Mobile Applications , Obstetrics , Pandemics
13.
Clin Obstet Gynecol ; 64(2): 333-344, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1197047

ABSTRACT

Telehealth has expanded its reach significantly since its inception due to the advances in technology over the last few decades. Social determinants of health (SDOH) negatively impact the health of pregnant and postpartum women and need to be considered when deploying telehealth strategies. In this article, we describe telehealth modalities and their application to improve the SDOH that impact pregnancy and postpartum outcomes. Physicians and patients alike report satisfaction with telehealth as it improves access to education, disease monitoring, specialty care, prenatal and postpartum care. Ten years ago, we developed a program, Moms2B, to eliminate disparities in pregnancy outcomes for underserved women. Using a case study, we describe how Moms2B, devoted to improve the SDOH for pregnant women, transitioned from an in-person to a virtual format. Telehealth benefited women before the recent coronavirus disease 2019 pandemic and increasingly after emergency authorizations has allowed telehealth to flourish.


Subject(s)
Health Services Accessibility/organization & administration , Health Status Disparities , Healthcare Disparities , Perinatal Care/methods , Prenatal Care/methods , Social Determinants of Health , Telemedicine/methods , Female , Humans , Mobile Applications , Ohio , Outcome Assessment, Health Care , Perinatal Care/organization & administration , Poverty , Pregnancy , Pregnancy Outcome , Prenatal Care/organization & administration , Telemedicine/organization & administration
14.
Midwifery ; 99: 103013, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1185181

ABSTRACT

OBJECTIVE: Evaluation of the mental health of pregnant women during the early and peak stages of the Covid-19 outbreak DESIGN: Online survey PARTICIPANTS: Pregnant women over the age of 18 years with no mental disorder during the pre-pregnancy period (N = 729). MEASUREMENTS AND FINDINGS: Mental disorders were assessed using the "Depression Anxiety Stress Scale" and social support was determined using the "Multidimensional Perceived Social Support Scale." Pregnant women had moderate levels of anxiety and depression and mild levels of stress. Anxiety, depression, and stress of moderate or high severity was reported in 62.2%, 44.6%, and 32.2% of the women, respectively. Pregnant women who lost their jobs during the pandemic period showed a 3-fold increase in the risk of anxiety, a 6-fold increase in the risk of depression, and a 4.8-fold increase in the risk of stress. An increase in the perception of social support has protective effects against all three mental disorders during pregnancy. In pregnant women with at least one obstetric risk, the risk of antenatal anxiety is 2 times higher than that in women with no risk. Similarly, women with a chronic physical illness before pregnancy have a higher risk of anxiety during pregnancy than healthy women. Financial strain has predictive value for anxiety and depression, and advanced age is a predictor for depression. KEY CONCLUSIONS: The incidence of mental disorders in pregnant women during the pandemic period was much higher than that during the pre-pandemic period. The high frequency of antenatal mental disorders can lead to an increase in the frequency of obstetric and maternal complications in the short and long term. IMPLICATIONS FOR PRACTICE: Early detection of inadequate social support and economic difficulties of pregnant women during the pandemic period is recommended for protecting their mental health. Pregnant women should have easy access to psychosocial support, and they should be provided obstetric counseling during the pandemic conditions.


Subject(s)
Anxiety , COVID-19 , Depression , Pregnancy Complications , Stress, Psychological , Unemployment/psychology , Adult , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/prevention & control , COVID-19/epidemiology , COVID-19/psychology , Depression/diagnosis , Depression/epidemiology , Depression/prevention & control , Female , Health Surveys , Humans , Maternal Health , Mental Health/trends , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Pregnancy Complications/psychology , Prenatal Care/methods , Prenatal Care/statistics & numerical data , SARS-CoV-2 , Social Support , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology , Stress, Psychological/prevention & control , Turkey/epidemiology
15.
JAMA Netw Open ; 4(4): e215854, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1182077

ABSTRACT

Importance: Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. Objective: To explore the association of audio-only virtual prenatal care with perinatal outcomes. Design, Setting, and Participants: This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included. Exposures: Prenatal care incorporating audio-only prenatal care visits. Main Outcomes and Measures: The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined. Results: The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended. Conclusions and Relevance: Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.


Subject(s)
Ambulatory Care/statistics & numerical data , COVID-19 , Delivery, Obstetric/statistics & numerical data , Prenatal Care/statistics & numerical data , Telemedicine/statistics & numerical data , Adult , Female , Humans , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Outcome , Prenatal Care/methods , SARS-CoV-2 , Texas/epidemiology
16.
Trop Med Int Health ; 26(6): 656-663, 2021 06.
Article in English | MEDLINE | ID: covidwho-1105378

ABSTRACT

OBJECTIVE: To assess adherence to COVID-19 preventive measures and its associated factors among pregnant women in Ghana. METHODS: This was a cross-sectional study conducted in the Nabdam district, Ghana. Data were collected from 527 pregnant women randomly selected from antenatal care clinics from 16 healthcare facilities. Descriptive statistics were used to assess the prevalence of adherence to COVID-19 preventive measures. Multivariable logistic regression was used to estimate the factors associated with COVID-19 preventive measures, whilst adjusting for potential confounders. RESULTS: The prevalence of wearing a face mask 18.0% (95% CI: 14.73%, 21.32%); of handwashing/hand sanitising 31.7% (95% CI: 27.70%, 35.67%), and of social distancing, 22.0% (95% CI: 18.46%, 25.56%). Multivariable logistic regression analysis revealed that knowledge of COVID-19 symptoms [Adjusted odds ratios (aOR): 2.86, 95% CI: 1.03, 7.89] and knowledge of COVID-19 transmission via contaminated surfaces/objects (aOR: 4.60, 95% CI: 1.23, 17.18) were associated with wearing a face mask. Pregnant women who knew that avoiding the touching of eyes, nose and mouth can prevent COVID-19 (aOR: 2.71, 95% CI: 1.01, 7.28), and knowledge of the virus being transmitted via contaminated objects/surfaces (aOR: 4.08, 95% CI: 1.42, 11.76), were associated with handwashing/hand sanitising. Knowledge of COVID-19 transmission via contaminated surfaces/objects (aOR: 15.27, 95% CI: 1.87, 124.43) was also associated with social distancing. CONCLUSION: The findings of our study suggest that knowledge of COVID-19 symptoms, transmission and preventive measures may play an important role in the practice of preventive measures against COVID-19 among pregnant women.


Subject(s)
COVID-19/prevention & control , Infection Control/statistics & numerical data , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2 , Adult , Cross-Sectional Studies , Female , Ghana , Hand Disinfection , Humans , Infection Control/methods , Logistic Models , Masks , Multivariate Analysis , Physical Distancing , Pregnancy , Prenatal Care/methods , Surveys and Questionnaires , Young Adult
18.
Enferm Clin (Engl Ed) ; 31: S100-S106, 2021 Feb.
Article in Spanish | MEDLINE | ID: covidwho-1065071

ABSTRACT

AIM: To compile recommendations and evidence on the practical management of pregnant women with COVID-19 in order to clarify standards of obstetric care in the face of this new disease. METHOD: Scoping review based on literature searches in national and international health science databases (PubMed/Medline, Biblioteca Virtual en Salud, SciELO, Cochrane and CUIDEN) and websites, and additionally by a "snowball" system. MeSH terms were used: "COVID-19", "Pregnancy", "Delivery, Obstetric", "Pregnant Women" and "Maternal". As limits in the search Spanish and English languages were selected. No limits were established in relation to the year of publication or type of article. RESULTS: A total of 49 documents and articles were detected, of which 27 were analyzed, 18 were used, and 9 were discarded because they did not contain practical recommendations. The recommendations were grouped into 10 subjects: Prevention of infection in pregnant women; prevention of infection in health care personnel attending pregnant women; form of presentation and severity in pregnant women; maternal-fetal transmission (vertical and perinatal); maternal-fetal control of the pregnant woman with COVID-19; control of the severely pregnant woman with COVID-19; treatment of the pregnant woman with COVID-19; management and route of termination of labor; neonatal outcomes in women with COVID-19, and breastfeeding. CONCLUSIONS: Lack of strong evidence to support many of the recommendations for pregnant women with COVID-19, as they are based on previous experience with SARS-CoV and MERS-CoV infections. Further studies are needed to confirm the appropriateness of many of the recommendations and guidelines for action in the specific case of pregnant women and COVID-19.


Subject(s)
COVID-19/prevention & control , Occupational Diseases/prevention & control , Practice Guidelines as Topic , Pregnancy Complications, Infectious/prevention & control , SARS-CoV-2 , Adult , Breast Feeding , COVID-19/transmission , Female , Health Personnel , Humans , Infectious Disease Transmission, Vertical/prevention & control , Lactation , Pregnancy , Pregnancy Outcome , Pregnant Women , Prenatal Care/methods
19.
Am J Obstet Gynecol MFM ; 2(3): 100154, 2020 08.
Article in English | MEDLINE | ID: covidwho-1064742

ABSTRACT

The novel coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 has become a pandemic. It has quickly swept across the globe, leaving many clinicians to care for infected patients with limited information about the disease and best practices for care. Our goal is to share our experiences of caring for pregnant and postpartum women with novel coronavirus disease 2019 in New York, which is the coronavirus disease 2019 epicenter in the United States, and review current guidelines. We offer a guide, focusing on inpatient management, including testing policies, admission criteria, medical management, care for the decompensating patient, and practical tips for inpatient antepartum service management.


Subject(s)
COVID-19 Testing , COVID-19 , Delivery, Obstetric , Postnatal Care , Pregnancy Complications, Infectious , Prenatal Care , Adult , COVID-19/blood , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , Delivery, Obstetric/methods , Delivery, Obstetric/trends , Female , Humans , Infectious Disease Transmission, Vertical/prevention & control , New York , Obstetrics and Gynecology Department, Hospital/organization & administration , Obstetrics and Gynecology Department, Hospital/trends , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Postnatal Care/methods , Postnatal Care/standards , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/blood , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Prenatal Care/methods , Prenatal Care/standards , SARS-CoV-2/isolation & purification
SELECTION OF CITATIONS
SEARCH DETAIL