Impact of COVID-19 Lockdowns on Rates of Adolescent Pregnancies: A Systematic Review (preprint)

Background: Education is known to protect adolescent girls from unplanned pregnancy. School closures were component of COVID-19 “lockdown measures”. The impact of these measures on adolescent pregnancy worldwideis unknown.  Methods: We performed a systematic review to find evidence of the impact of “lockdowns” and school closures on adolescent pregnancy events during the COVID-19 pandemic. Databases including Pubmed, EMBASE, CINAHL, WHO Index Medicus, and Literatura Latinoamericana y Caribe en Ciencias de la Salud (LILACS) were searched. Studies that provided data on pregnancy rates in girls aged 10-19 before, during, and after the onset of the COVID-19 pandemic (defined as March 2020) were eligible for inclusion. Extracted data included study design, study location, age of participants, exposure period, and percentage or pregnancy rate data. Findings: On August 21st, 2023, 3049 studies were screened, with 79 eligible for full-text review. Ten studies were included in the final review: Seven performed in Africa (Uganda, Kenya, South Africa, and Ethiopia), and three in the Americas (USA and Brazil). Adolescent pregnancy increased in six out of the seven African studies while a decrease or no change was noted in USA and Brazil.All studies were at a high risk of bias. Interpretation:   Adolescent pregnancy rates during the COVID-19 pandemic may have substantially increased in sub-Saharan Africa. Data scarcity and low-quality evidence are significant limitations. The dynamic relationship between lockdown measures and adolescent pregnancies warrants ongoing multifaceted research and adaptive policies to safeguard adolescent sexual and reproductive health during health crisis. Systematic Review Registration: PROSPERO registration number CRD42022308354.

COVID-19 in pregnant women in South Africa; a retrospective review (preprint)

Objective: To describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility in Gauteng, South Africa Design: Retrospective review Setting: An academic hospital in Johannesburg, South Africa Population: Two-hundred and four (204) pregnant women with COVID-19 admitted between 6 March and 30 August 2020 Methods: Patient data was captured on discharge or death from paper-based clinical files onto a digital database Main Outcome Measures: Rates of mortality and/or admission to ICU, symptomatic versus asymptomatic disease, maternal and fetal outcome and mode of delivery. Results: A final cohort of 204 pregnant women were included in the study. Thirty three (16.2%) women were critically ill, with 21 (10.3%) admitted to the ICU and 3 (1.5%) deaths related to COVID-19. Conclusions: COVID-19 related mortality in our cohort was higher than that seen internationally, likely due to differences in background maternal mortality rates and difficulty in accessing care.