An increase in cesarean section rate during the first wave of COVID-19 pandemic in Iran.

BACKGROUND: The COVID-19 pandemic and its impact on healthcare services is likely to affect birth outcomes including the delivery mode. However, recent evidence has been conflicting in this regard. The study aimed to assess changes to C-section rate during the COVID-19 pandemic in Iran. METHODS: This is a retrospective analysis of electronic medical records of women delivered in the maternity department of hospitals in all provinces of Iran before the COVID-19 pandemic (February-August 30, 2019) and during the pandemic (February-August 30, 2020). Data were collected through the Iranian Maternal and Neonatal Network (IMAN), a country-wide electronic health record database management system for maternal and neonatal information. A total of 1,208,671 medical records were analyzed using the SPSS software version 22. The differences in C-section rates according to the studied variables were tested using the χ2 test. A logistic regression analysis was conducted to determine the factors associated with C-section. RESULTS: A significant rise was observed in the rates of C-section during the pandemic compared to the pre-pandemic (52.9% vs 50.8%; p = .001). The rates for preeclampsia (3.0% vs 1.3%), gestational diabetes (6.1% vs 3.0%), preterm birth (11.6% vs 6.9%), IUGR (1.2% vs 0.4%), LBW (11.2% vs 7.8%), and low Apgar score at first minute (4.2% vs 3.2%) were higher in women who delivered by C-section compared to those with normal delivery (P = .001). CONCLUSIONS: The overall C-section rate during the first wave of COVID-19 pandemic was significantly higher than the pre-pandemic period. C-section was associated with adverse maternal and neonatal outcomes. Thus, preventing the overuse of C-section especially during pandemic becomes an urgent need for maternal and neonatal health in Iran.

COVID-19 and beliefs about tobacco use: an online cross-sectional study in Iran.

There is mixed evidence surrounding the relationship between tobacco use and COVID-19 infection/progression. The current study investigates beliefs and tobacco use behaviors and COVID-19 infection among a sample of smokers and never-smokers. Data were collected using an online survey distributed through Telegram, a cloud-based social media networking application in Iran from April 1 to May 31, 2020. The study participants included never-smokers (n = 511), current (past-month) waterpipe smokers (n = 89), current cigarette smokers (n = 158), and ex-smokers (n = 172). Multinomial logistic regression was used to compare tobacco use groups with never- smokers on beliefs, controlling for potential confounders. The study participants (n = 944) was mostly male (64%), had > high school education (76%), and lived in an urban area (91%), with mean ± SD age of 35.3 ± 10.8. Key findings of this study are that compared with never-smokers: (1) cigarette smokers were less likely to believe that smoking cigarette can lead to spreading COVID-19; (2) waterpipe smokers were more likely to believe that smoking waterpipe at home was a safe practice, that waterpipe protects against COVID-19, and smoking waterpipe may lead to a more rapid recovery from COVID-19; (3) both waterpipe and cigarette smokers believed that using e-cigarettes in public places was a safe practice during the COVID-19 pandemic; and (4) more than half of the ex-smokers stopped smoking due to COVID-19 and most of them planned to continue abstaining from smoking after the pandemic. Our findings underscore the need to raise awareness about the unsupported claims of a lower hazard of using tobacco products or possible protective effects against COVID-19 and to promote cessation programs.