Effects of the Covid-19 pandemic on the continuity of sexual and reproductive health care in the maternity ward of a health and social promotion centre in Burkina Faso: a qualitative study (preprint)

The COVID-19 pandemic has significantly impacted the continuity of maternity care in Burkina Faso. This study aimed to compare the volumes of in-person visits and explore the experiences of healthcare providers and users regarding the continuity of healthcare in the maternity ward of a Health and Social Promotion Center (HSPC) before, during, and after the lockdown during the COVID-19 pandemic in Ouagadougou, Burkina Faso. Methods We conducted a multimethod, cross-sectional exploratory study with a phenomenological approach. Monthly health administrative data regarding family planning visits, antenatal visits, deliveries, and postnatal care before, during, and after COVID-19 were collected and compared. Qualitative data were collected through semi-structured interviews with family healthcare providers and users and thematically analyzed. Results The study found that the pandemic led to a decline in the demand for healthcare, as people were afraid of contracting COVID-19. This was particularly true for pregnant women who had recently given birth. The study also found that the pandemic disrupted the supply of essential medicines and medical supplies, which made it difficult for healthcare providers to provide quality care. The qualitative analysis allowed us to highlight three themes: the representation of respondents on COVID-19, their perception of the effectiveness of barrier measures and their analysis of the continuity of care in times of COVID-19: the picture of respondents on COVID-19, their perception of the efficacy of barrier measures and their analysis of the continuity of care in times of COVID-19. Despite these challenges, the study found that healthcare providers and users could find ways to maintain continuity of care. Conclusion The study concludes that the COVID-19 pandemic has significantly impacted the continuity of maternity care in Burkina Faso. However, healthcare providers and users have found ways to maintain continuity of care, and the study provides recommendations for improving continuity of care in the future.

Exploring Key Challenges for Healthcare Providers and Stakeholders in delivering adolescent sexual and Reproductive Health Services and information during the COVID-19 Pandemic in Malawi, Zambia and Zimbabwe: A Qualitative Study (preprint)

Introduction: This study aimed to explore the direct and indirect influences of COVID-19-related restrictions on adolescents and young people's SRHR in Malawi, Zambia, and Zimbabwe, with a focus on teenage pregnancy and access to and utilization of HIV testing and counselling services. Methods: A qualitative case study in a larger mixed-methods study design was used. Thirty-four interviews and four group discussions were conducted with relevant stakeholders in Malawi, Zambia and Zimbabwe. In Zambia, adolescents and young people were included and asked to describe their experience/perceptions of the impact of COVID-19 on their SRHR. Content and thematic analysis were used to analyze the data, Results: Priority shifts resulted in the focus of service provision to the COVID-19 response, shortages of already insufficient human resources due to infection and/or isolation, supply chain disruptions leading to shortages of important SRH-related commodities and supplies, compromised quality of services such as counselling for HIV and overall limited AYP’s access to SRH information. Suggestions for interventions to improve SRH services include the need for a disaster preparedness strategy, increased funding for ASRHR, the use of community health workers and community-based ASRHR strategies, and the use of technology and social media platforms such as mhealth. Conclusion:Disruption of SRH services for AYP due to pandemic related-restrictions, and diversion of resources/funding has had a ripple effect that may have long-term consequences for AYP throughout the East and Southern African region. This calls for further investment in AYP’s access to SRHR services as progress made may have been deterred.

Orphanhood and caregiver death among children in the United States due to all-cause mortality 2000-2021: A Modeling Study (preprint)

Importance: Deaths of parents and grandparent caregivers linked to social and health crises threaten child wellbeing due to losses of nurturance, financial support, physical safety, family stability, and care. Little is known about the full burden of all-causes and leading cause-specific orphanhood and caregiver death beyond estimates from select causes. Objective: To estimate 2000-2021 prevalence and incidence trends of all-cause orphanhood and caregiver death among children <18, by cause, age, race/ethnicity, and state. Data Sources: National Center for Health Statistics (NCHS) birth, death, race/ethnicity, and population data to estimate fertility rates and identify causes of death; 1983-1998 ICD-9 causes-of-death harmonized to ICD-10 classifications; 1999-2021 ICD-10 causes-of-death; CDC WONDER for state-specific estimates; and American Community Survey for grandparent population estimates. Data extraction and synthesis: We extracted U.S. population-level death, birth, population size, race, and ethnicity data from NCHS and attributed to each deceased individual the average number of children left behind according to subgroup-specific fertility rates in the previous 0-17 years. We examined prevalence and incidence of orphanhood by leading causes-of-death, including COVID-19, the leading 5 causes-of-death for 1983-2021, and additional leading causes for ages 15-44. We extended these to obtain state-level outcome estimates. Main outcome measures: National incidence and prevalence of orphanhood and caregiver death from 2000-2021, with orphanhood by year, parental cause-of-death and sex, child age, race/ethnicity, and state. Results: From 2000-2021, orphanhood and custodial/co-residing grandparent caregiver loss annual incidence and prevalence trends increased 49.2% and 8.3%, respectively. By 2021, 2.9 million children (4% of all children) had experienced prevalent orphanhood and caregiver death. Populations disproportionately affected by orphanhood included 5.0% of all adolescents; 6.5%, 4.8%, and 3.9% respectively of non-Hispanic American Indian/Alaska Native, non-Hispanic Black, and non-Hispanic White children; and children in New Mexico and Southern and Eastern States. Parental death due to drug overdose during 2020-2021 surpassed COVID-19 as the leading cause of incident and prevalent orphanhood during the COVID-19 pandemic. Conclusions and Relevance: Policies, programs, and practices aimed at orphanhood prevention, identification, and linkage to services and support of nearly 3 million bereaved children are needed, foremost prioritizing rapidly increasing overdose-linked orphanhood.

Humoral immune response characteristics of the susceptible populations after the infection of SARS-CoV-2 BA.5 strain (preprint)

This study compared the humoral immune characteristics of children, elderly people, pregnant women, and adults infected with BA.5 and XBB strains in Guangzhou, China. It was found that binding and neutralizing antibodies the titers against distinct SARS-CoV-2 strains were low in the acute-phase sera of BA.5 infected patients, while the corresponding titers were significantly increased in the convalescent phase, the antibody titers against the Wuhan strain were the highest. Regardless of whether they were vaccinated, BA.5 infection did not induce high neutralizing antibodies against XBB. During the recovery phase, the titers of antiviral antibodies in the vaccinated population are more robust than those in the unvaccinated population. For BA.5 infections, the specific binding and neutralizing antibody titers in the children group were lower compared to other population groups. In the convalescence period of the disease, the titers of neutralizing antibodies against Wuhan, BA.5 and XBB strains induced by BA.5 infections are significantly correlated in pairs. XBB can induce a broader and balanced antiviral humoral immune response than BA.5 as a first-time infected strain. This finding can provide a reference for the judgment of the future epidemic law of SARS-CoV-2, and provide a scientific basis for developing novel COVID-19 vaccines, especially for discovering customized vaccines and immune strategies for different populations.

Challenges to research implementation during public health emergencies: anecdote of insights and lessons learned during the COVID-19 pandemic in Gujarat, India (preprint)

Background: Health emergencies, including pandemics, are not entirely new occurrences; some notable ones occurred in the past. However, the scale of the COVID-19 pandemic is unprecedented. The COVID-19 pandemic exposed the unpreparedness of national health systems in effectively managing health emergencies. During the pandemic, controlling the spread of the virus and hopes of exiting into a post-pandemic era were reliant on research to improve patient care and inform government policies. Nonetheless, research implementation during health emergencies can be challenging in low-resourced settings. This paper presents anecdotes of experiences encountered in implementing a research project during the COVID-19 pandemic in Gujarat, India, and offers insights into ways research can be supported during health emergencies. Methods: We implemented a longitudinal study to investigate the impact of the COVID-19 pandemic, including SARS-CoV-2 infection, during pregnancy on birth outcomes, growth, and development in early childhood. The study utilises hospital records and databases to recruit women who were infected with SARS-CoV-2 during pregnancy and those with no known infection. Mother-infant pairs in the infected and uninfected group were then followed longitudinally for over 3 years. Results: Observations of challenges encountered during implementation of the research, including those related to planning, retrieval of hospital records, tracking, recruitment, and follow-up of eligible women were recorded by study staff, and the observations produced as anecdotes. The challenges observed are group into three overarching themes: a) individual factors, b) health system challenges, and c) research operational challenges. Some notable observations include misinformation, misconception, mistrust, underdeveloped health record systems, stigma, and hesitance. Conclusion: We believe early planning, effective communication, and community awareness are likely to be helpful in implementing a successful research project. Additionally, efforts at improving collaboration and co-creation between health practitioners, researchers and the public may benefit the implementation of research projects during a health emergency.

Quality of Care at childbirth during the COVID-19 pandemic: findings of the IMAgiNE EURO study in Belgium (preprint)

Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. Design A cross-sectional observational study. Setting Data of the IMAgiNE EURO study in Belgium. Participants Women giving birth in a Belgian facility from March 1, 2020, to May 1, 2023, responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources, and organizational changes related to COVID 19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann Kendall test. Results 897 women were included in the analysis, 67%(n=601) with spontaneous vaginal birth, 13.3%(n=119) with instrumental vaginal birth and 19.7%(n=177) with cesarean section. We found high QMNC scores but also specific gaps in all domains of QMNC. On provision of care, 21.0%(n=166) of women who experienced labor and 14.7%(n=26) of women with a cesarean reported inadequate pain relief; 64.7%(n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1%(n=279) reported unclear communication, 32.9%(n=295) reported that they were not involved in choices,11.5%(n=104) stated not being treated with dignity and 8.1%(n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). The multivariable analyses showed significantly lower QMNC scores for women with an instrumental vaginal birth. Over time there was a significant increase in QMNC score for experience of care and key organizational changes due to COVID-19. Conclusions and relevance Although overall QMNC scores were high, findings also suggest gaps in QMNC. Underlying causes of these gaps should be explored to design appropriate interventions and policies.

Comparing the gestational diabetes mellitus prevalence and oral glucose tolerance test characteristics before and after the COVID-19 outbreak in Hongshan District of Wuhan, China, 2018- 2021 (preprint)

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted the management and prevalence of gestational diabetes mellitus (GDM) among pregnant women worldwide. This study aimed to investigate the effects of the pandemic on GDM prevalence and oral glucose tolerance test (OGTT) characteristics in Hongshan District, Wuhan, China. Methods: We retrospectively analyzed data from 91,932 pregnant women screened for GDM before (January 1, 2018, to December 31, 2019) and after (January 1, 2020, to December 31, 2021) the onset of the COVID-19 pandemic. The study focused on changes in GDM prevalence, OGTT positive rates and glucose value distribution, and the diagnostic performance of OGTT. Results: The prevalence of GDM increased significantly from 14.5% (95% CI, 14.2-14.8%) pre-pandemic to 21.9% (95% CI, 21.5-22.4%) post-pandemic. A notable rise in OGTT positive rates was observed across all time points, with the most significant increase at the 0-hour mark. Regression analysis indicated a significant risk increase for GDM during the pandemic, even after adjusting for age. Diagnostic accuracy of the 0-hour OGTT improved in the pandemic era, with the area under the curve (AUC) rising from 0.78 to 0.79 and sensitivity from 0.56 to 0.58. Median OGTT values at all time points significantly increased post-pandemic, even after adjusting for age, indicating a shift in glucose metabolism among the study population. Conclusion: The COVID-19 pandemic has led to a significant increase in the prevalence of GDM among pregnant women in Hongshan District, Wuhan. This is evidenced by the elevated rates of positive OGTT and altered median glucose values, indicating a shift in glucose metabolism. These findings underscore the profound impact of the pandemic on maternal and neonatal health. They emphasize the imperative for continuous monitoring and the development of updated, localized diagnostic criteria for OGTT to enhance the identification and treatment of GDM during and after global health crises.

Covid19 and Pregnancy: Infected Mothers and Premature Babies? (preprint)

Introduction: The emergency of the SARS-CoV-2 virus spread and its subsequent global pan-demic have raised significant concerns regarding its impact on pregnancy outcomes. This review aims to summarize the emerging data on the risk of preterm delivery in pregnant women infected with SARS-CoV-2. Materials and Methods: A systematic search was conducted from March 2020 to December 2023 using PubMed, following PRISMA guidelines. Studies correlating maternal COVID-19 infection with preterm birth were included. Results: Thirteen studies were analyzed, indicating a higher incidence of preterm birth in SARS-CoV-2 positive pregnant women compared to controls. The average incidence rate of pre-term birth in infected patients was 18.5%, with a median of 12.75%, while non infected women showed an average incidence of preterm birth of 10% with a median of 8.2%. Discussion: Studies suggest an association between SARS-CoV-2 infection during pregnancy and increased risk of preterm birth and cesarean section. Severity of symptoms and underlying comorbidities further elevate this risk. Notably, infections during the third trimester pose the highest risk of preterm birth. Conclusion: Preventing SARS-CoV-2 infection during pregnancy is crucial to mitigate adverse obstetric outcomes. Close monitoring and tailored interventions for infected pregnant women, particularly those in later trimesters and with comorbidities, are imperative to reduce the risk of preterm birth and improve maternal-fetal outcomes.

"She helped from the first minute to the last" - experiences of respectful maternal and newborn care during the COVID-19 pandemic in Nampula Province, Mozambique (preprint)

Pandemic-related health service adaptations raised concerns about provision of quality, respectful maternity care globally. Despite this, little research has focused on the experiences of those using intrapartum care during this time. This study aimed to elevate the voices and document the experiences of birthing people in Nampula Province, Mozambique during the COVID-19 pandemic. We conducted a longitudinal qualitative study from March-August 2021 and present an analysis of the 17 follow-up in-depth interviews conducted with participants who had a vaginal live birth. Interviews explored participants experience of labor and delivery care. They were conducted in Makua and Portuguese, audio-recorded, transcribed and translated. We applied thematic content analysis. Overall, participants did not express major concerns about COVID-19 or related service adaptations when describing their experiences of intrapartum care. Some noted its negative effects on elements of respectful care such as restricting birth companions. Overcrowding became more concerning due to the threat of infection. While unclear if affected by the pandemic, all participants who gave birth at a health facility reported experiencing at least one form of mistreatment, some recounting threats of cesarean delivery. Most explained that they and their newborns received care without their consent, especially regarding enemas and episiotomies. At the same time, respondents described a range of intrapartum experiences that included both respectful and disrespectful care. Most recalled positive verbal communication with their providers and many described receiving continuous attentive care. Participants explained that their satisfaction with childbirth services was tied to their birth outcome and their experience of respectful care. The findings indicate that steadfast commitments to quality care are critical to ensure families benefit from high-quality, respectful care at all times. The ramifications of the COVID-19 pandemic were limited but nonetheless signal a need for tighter connections between maternal health and emergency preparedness stakeholders.

High transferability of neutralizing antibodies against SARS-CoV-2 to umbilical cord blood in pregnant women with BNT162b2 XBB.1.5 vaccine - a retrospective cohort study (preprint)

Coronavirus disease 2019 (COVID-19), when contracted by pregnant women, can lead to severe respiratory illness, rapid disease progression, and higher rates of intensive care unit admission. COVID-19 infection during pregnancy is associated with an increased risk of preterm delivery, cesarean section, fetal dysfunction, preeclampsia, and perinatal death. Additionally, vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from pregnant women to their fetuses has been observed. While severe infections in neonates and infants are rare, newborns can experience serious consequences from COVID-19, despite their suboptimal humoral immune system protection. The amino acids in the structural proteins of SARS-CoV-2 are subjected to constant mutation. Since around January 2023, COVID-19, caused by infection with omicron-type SARS-CoV-2 variants, has been prevalent globally. Omicron-type SARS-CoV-2 variants can evade the immune response triggered by traditional mRNA-based COVID-19 vaccines, such as BNT162b2. Therefore, vaccination with a vaccine (BNT162b2 XBB.1.5) that can provide protection against omicron-type SARS-CoV-2 variants is recommended. Therefore, we examined the titers of anti-spike glycoprotein of SARS-CoV-2 IgG and IgA in the blood and umbilical cord blood obtained from pregnant women vaccinated with BNT162b2 XBB.1.5. The results showed that anti-spike glycoprotein of SARS-CoV-2 IgG and IgA titers were highest in the blood and cord blood obtained from pregnant women vaccinated with BNT162b2 XBB.1.5 at late gestational age (28-34 weeks). No serious side effects or adverse events caused by vaccination of pregnant women with BNT162b2 XBB.1.5 were observed in either pregnant women or newborns. In the future, to validate our findings, large cohort clinical studies involving numerous pregnant women must be conducted.

Parents’ Participation in Care during Neonatal Intensive Care Unit Stay in COVID-19 Era: A Quantitative Observational Study (preprint)

Background: During the stay in the neonatal intensive care unit, parents play a crucial role in the care of their infants. Recent studies reported a decrease in parental participation due to Coronavirus Disease (COVID-19) pandemic that determined restricted access policies in hospitals. The aim of this study is to describe the barriers to a good parents’ participation during the stay in the neonatal intensive care unit in the COVID-19 era. Methods: A quantitative observational study was carried out. Results: 270 parents participated in this study. Mothers’ participation in care seems to be higher as compared to fathers (p = 0.017). Parents who lived the birth of their first child reported a better level of participation in care when compared to those who lived the birth of their second born (p = 0.005). Parents of extremely preterm neonates reported a lower interaction with their infant if compared to parents of term newborns (p < 0.001). Conclusions: Some more disadvantaged categories have reported lower scores: cultural and linguistic minorities, parents of multiple children and fathers. COVID-19 pandemic made several Family Centred Care activities not possible with a higher impact on those who benefited the most of these facilities. This study was prospectively registered by the IRB-CRRM of the University “G. d’Annunzio” Chieti-Pescara on the 23/01/2024 with registration number CRRM;2023_12_07_01.

COVID-19 vaccine uptake and associated risk factors among first antenatal care attendees in Zambia, 2021-2022: a repeated cross-sectional study (preprint)

Introduction:   Pregnant women are considered a high-risk group for COVID-19, and a priority for vaccination. Routine antenatal (ANC) care provides an opportunity to track trends and factors associated with vaccine uptake. We sought to evaluate COVID-19 vaccine uptake among pregnant women attending ANC in Zambia.   Methods  We conducted a repeated cross-sectional study in 39 public health facilities in four districts in Zambia from September 2021 to September 2022. Pregnant women who were aged 15-49 years were enrolled during their first ANC visit. Every month, ~20 women per facility were interviewed during individual HIV testing and counseling. We estimated vaccine uptake as the proportion of eligible participants who self-reported having received the COVID-19 vaccine.   Results   A total of 9,203 pregnant women were screened, of which 9,111 (99%) were eligible and had vaccination status. Of the 9,111 included in the analysis, 1,818 (20%) had received the COVID-19 vaccine during the study period, with a trend of increasing coverage with time (0.5% in September 2020, 27% in September 2022). Conversely, 3,789 (42%) reported not being offered a COVID-19 vaccine. We found that older age, education, employment status, and prior COVID-19 infection were significantly associated with vaccine uptake.     Conclusion  COVID-19 vaccine uptake among pregnant women was lower than estimates from the general population (27% across the four districts in September 2022), pointing to missed opportunities to protect this high-risk group. ANC visits were a viable point for conducting COVID-19 surveillance. Incorporating the vaccine as part of the routine ANC package might increase coverage in this group.

End-user feedback of rapid diagnostics in rural Kenya (preprint)

Underserved communities in low-resource countries are disproportionately impacted by communicable diseases when compared to those in developed countries. These communities have limited access to life saving diagnostic laboratory tests making it difficult to treat communicable diseases like SARS-CoV-2 and Human Immunodeficiency Virus (HIV). Rapid diagnostic tests, like the COVID-19 antigen (Ag) test, play a crucial role in underserved communities by enabling fast and inexpensive diagnosis in low-resource settings. Unfortunately, these rapid test platforms often lack the accuracy and precision of their laboratory-based analogs, resulting in a need for improved rapid diagnostics. The World Health Organization’s (WHO) ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free, and Deliverable to end-users) criteria are often referenced in the development of diagnostic tests. In this work, we aim to provide guidance to the “user-friendly” component of ASSURED through end-user surveys taken in rural Kenya. In these surveys, we examine the user-friendliness of two of the most commonly used rapid diagnostic tests, the COVID-19 Ag test and pregnancy test, by assessing participants’ familiarity with the tests, their opinion of test appearance, and the perceived complexity of the operator’s workflow. We also examine community acceptance and desire for a self-test for the highly stigmatized HIV. We intend these results to help guide developers of future rapid diagnostic tests intended for low-resource communities.

Indigenous Peoples’ evaluation of health risks when facing mandatory evacuation for birth during the COVID-19 pandemic: An Indigenous feminist analysis (preprint)

Background Indigenous Peoples living on Turtle Island are comprised of First Nations, Inuit, and Métis people and because of the Government of Canada’s mandatory evacuation policy, those living in rural and remote regions of Ontario are required to travel to urban, tertiary care centres to give birth. When evaluating the risk of travelling for birth, Indigenous Peoples understand, evaluate, and conceptualise health risks differently than Eurocentric biomedical models of health. Also, the global COVID-19 pandemic changed how people perceived risks to their health. Our research goal was to better understand how Indigenous parturients living in rural and remote communities conceptualised the risks associated with evacuation for birth before and during the COVID-19 pandemic.Methods To achieve this goal, we conducted semi-structured interviews with 11 parturients who travelled for birth during the pandemic and with 5 family members of those who were evacuated for birth.Results Participants conceptualised evacuation for birth as riskier during the COVID-19 pandemic and identified how the pandemic exacerbated existing risks of travelling for birth. In fact, Indigenous parturients noted the increased risk of contracting COVID-19 when travelling to urban centres for perinatal care, the impact of public health restrictions on increased isolation from family and community, the emotional impact of fear during the pandemic, and the decreased availability of quality healthcare.Conclusions Using Indigenous Feminist Methodology and Indigenous Feminist Theory, we critically analysed how mandatory evacuation for birth functions as a colonial tool and how conceptualizations of risk empowered Indigenous Peoples to make decisions that reduced risks to their health during the pandemic. With the results of this study, policy makers and governments can better understand how Indigenous Peoples conceptualise risk related to evacuation for birth before and during the pandemic, and prioritise further consultation with Indigenous Peoples to collaborate in the delivery of the health and care they need and desire.

Rates of Positive M-CHAT-R Screenings by Pandemic Birth and Prenatal SARS-CoV-2 Exposure (preprint)

Maternal stress and viral illness during pregnancy are associated with neurodevelopmental conditions in offspring. Children born during the COVID-19 pandemic, including those exposed prenatally to maternal SARS-CoV-2 infections, are reaching the developmental age for the assessment of risk for neurodevelopmental conditions. We examined associations between birth during the COVID-19 pandemic, prenatal exposure to maternal SARS-CoV-2 infection, and rates of positive screenings on the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). Data were drawn from the COVID-19 Mother Baby Outcomes (COMBO) Initiative. Participants completed the M-CHAT-R as part of routine clinical care (COMBO-EHR cohort) or for research purposes (COMBO-RSCH cohort). Maternal SARS-CoV-2 status during pregnancy was determined through electronic health records. The COMBO-EHR cohort includes n=1664 children (n=442 historical cohort, n=1222 pandemic cohort; n=997 SARS-CoV-2 unexposed prenatally, n=130 SARS-CoV-2 exposed prenatally) who were born at affiliated hospitals between 2018-2023 and who had a valid M-CHAT-R score in their health record. The COMBO-RSCH cohort consists of n=359 children (n=268 SARS-CoV-2 unexposed prenatally, n=91 SARS-CoV-2 exposed prenatally) born at the same hospitals who enrolled into a prospective cohort study that included administration of the M-CHAT-R at 18-months. Birth during the pandemic was not associated with greater likelihood of a positive M-CHAT-R screen in the COMBO-EHR cohort. Maternal SARS-CoV-2 was associated with lower likelihood of a positive M-CHAT-R screening in adjusted models in the COMBO-EHR cohort (OR=0.40, 95% CI=0.22 - 0.68, p=0.001), while analyses in the COMBO-RSCH cohort yielded similar but non-significant results (OR=0.67, 95% CI=0.31-1.37, p=0.29).These results suggest that children born during the first 18 months of the COVID-19 pandemic and those exposed prenatally to a maternal SARS-CoV-2 infection are not at greater risk for screening positive on the M-CHAT-R.

Factors Associated with Changes in Reproductive Outcomes during the first year of COVID- 19 pandemic in Burkina Faso: A multinomial analysis from a longitudinal study using PMA 2030 data (preprint)

Background:The advent of COVID-19 pandemic has dramatically affected women’s life and livelihoods. In the past decade, the promotion of family planning contributed to reduced poverty and averted poor maternal and child outcomes. There is evidence that these gains may be threatened by social restrictions following COVID-19 outbreak. Methods:We used data from a longitudinal survey collected by the Performance Monitoring Accountability in Burkina Faso. Data were collected over one-year period, from before (November 2019–February 2020) and during (November 2020–February 2021) COVID-19 pandemic. We evaluate changes in reproductive outcomes with respect to changes in health and economic circumstances as well as sociodemographic conditions among 1372 women aged 15-49 at risk of pregnancy and potential contraceptive users. Bivariate and multivariate multinomial logistic regression were performed to examine correlates of reproductive outcomes. Results:Half (52%) of women did not change their reproductive status. While, 29% had childbearing, 19% started using a contraceptive method. In the multivariate analysis, childbearing was relatively higher among women exposed to family planning promotion, healthcare utilization, but relatively lower among those employed without cash paid and those who experienced household income loss. As of contraception, women exposed to family planning promotion were also associated with a relatively higher contraceptive use while concerns about getting COVID-19 infection had the opposite effect. Conclusion:After a year period of COVID-19 outbreak, contraceptive adoption increased significantly, but at a slower pace which was not enough to reduce childbearing. The most vulnerable women may remain at greater risk of unintended pregnancies and poor maternal and child outcomes. Therefore, family planning programs should direct their efforts into combatting misinformation and reaching out women in communities in the context of COVID-19 restrictions.

Effect of and Interventions in Prevention and Management of Maternal Anemia in the Advent of COVID-19 (preprint)

Background There were many unknowns for pregnant women during the COVID-19 pandemic. Most of these could have been silent however lethal and anemic conditions could escalate the worsening of pregnancy outcomes. Existing evidence indicate that, array of factors is associated with the ability of compromising maternal anemia, some directly and others indirectly. Objective This review aimed at ascertaining the pooled effect of several anemia interventions. Specifically, the aim of this study was to establish if pregnancy status is associated with COVID-19 severity characterized by a cytokine storm. Methods We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to studies suitable for inclusion in this meta-analysis. Studies examining women of reproductive age on any maternal anemia intervention were included. The risk of bias was assessed using the Cochrane risk of bias tool. Review Manager 5.4.1 was used to calculate rate ratios (RRs) with 95% CIs, which were depicted using forest plots. Quantitative variables were summarized in total numbers and percentages. The effect on prevention, control, management and or treatment of anemia was calculated and compared between the intervention and the comparator arms. Heterogeneity was evaluated with the Cochran Q statistic and Higgins test. Results A total of 11 articles including data for 6,129 were included. With sensitivity analysis, the interventions had a utility of 39% on maternal anemia prevention and management (random effects model RR 0.61, 95% CI 0.43, 0.87; P = 0.006) (X-squared 6=286.98, P<.00001; I-squared=97%). All the interventions against maternal anemia showed an effect of 17% (fixed-effect model RR 0.83, 95% CI 0.79-0.88; P<.00001) (X-squared 7;24=2.93, P=0.57;I-squared = 0%). Education to pregnant women showed a 28% effect (RR 0.72 95% CI 0.58, 0.89), medicinal administration 19% (RR 0.81 95% CI 0.73, 0.90), iron supplementation 17% (RR 0.83 95% CI 0.75, 0.92) and I.V Ferric Carboxy-maltose 15% (RR 0.85 95% CI 0.74, 0.97) (I-squared = 0%). Interventions in African region had a higher (16%) and significant effect compared to other regions (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.001) (X-squared 7;25=176.53, P<.00001;I-squared = 7%). Multiple center studies had a significant predictive effect (16%) compared to single center studies (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.00001)(967;25=176.53, P<.00001; I-squared=97%) .The year 2020 recorded the highest effect of maternal anemia interventions at 28% (random-effects model RR 0.72, 95% CI 0.67-0.78; P<.00001) (967;23=167.34, P<.00001; I-squared =98%) Conclusion In the advent of COVID-19, maternal anemia interventions were compromised demonstrated by a low effectiveness trend from the year 2020 to the year 2022. During this period, even the most effective and recommended interventions against maternal anemia were somehow affected.

COVID-19 during pregnancy alters circulating extracellular vesicle cargo and their effects on trophoblast (preprint)

SARS-CoV-2 infection and the resulting coronavirus disease (COVID-19) complicate pregnancies as the result of placental dysfunction which increases the risk of adverse pregnancy outcomes. While abnormal placental pathology resulting from COVID-19 is common, direct infection of the placenta is rare. This suggests maternal response to infection is responsible for placental dysfunction. We hypothesized that maternal circulating extracellular vesicles (EVs) are altered by COVID-19 during pregnancy and contribute to placental dysfunction. To examine this, we characterized maternal circulating EVs from pregnancies complicated by COVID-19 and tested their functional effect on trophoblast cells in vitro. We found the timing of infection is a major determinant of the effect of COVID-19 on circulating EVs. Additionally, we found differentially expressed EV mRNA cargo in COVID-19 groups compared to Controls that regulates the differential gene expression induced by COVID-19 in the placenta. In vitro exposure of trophoblasts to EVs isolated from patients with an active infection, but not EVs isolated from Controls, reduced key trophoblast functions including hormone production and invasion. This demonstrates circulating EVs from subjects with an active infection disrupt vital trophoblast function. This study determined that COVID-19 has a long-lasting effect on circulating EVs and circulating EVs are likely to participate in the placental dysfunction induced by COVID-19.