Knowledge, attitudes and expectations of perinatal care during the COVID-19 pandemic

ABSTRACT

There is limited evidence regarding the transmission of SARS-CoV-2 from mother to infant, as well as the optimal management of infected women and infant during pregnancy, labor and early postnatal period. The knowledge, concerns and expectations of women with regards to care during the COVID-19 pandemic is currently unclear. This study aimed to investigate the knowledge and expectations of pregnant women on perinatal and neonatal care during the COVID-19 pandemic in Singapore. A cross-sectional survey was administered via a secure online platform to pregnant women attending antenatal clinics between August-September 2020. Participants aged > 21 years who were pregnant and had no history of confirmed COVID-19 were included in the study. The survey consisted of 10 questions to evaluate the knowledge and expectations of these women on the perinatal and neonatal care during this pandemic. 313 pregnant women completed the survey during the study period. The mean age of the participants was 30 years (SD 4;range 22-43 years). The median gestational age of women at survey participation was 25 weeks (range 4-40 weeks). The participants were predominantly multiparous (54%) and 98% had completed secondary level education. Majority were cognizant of the spread of COVID- 19 by respiratory secretions and contact (90%), and the importance of hand hygiene and face-masking (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 to the fetus was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a mother with active COVID-19. There was no significant association between the sociodemographic factors evaluated and maternal agreement with the possibility of in-utero SARS-CoV-2 transmission and the risk associated with vaginal delivery in women with COVID-19. Although 46% of participants were concerned about the increased risk of contracting COVID-19 during routine clinic appointments at the hospital, only 37% were agreeable with teleconferencing their appointments. More than half (56%) of the participants reported that their postnatal confinement plans were affected by the pandemic. Majority of participants were aware of modes of transmission and the prevention strategies of SARS-CoV-2. However, there were significant gaps identified in their knowledge related to the risk of in-utero transmission and safety of breastfeeding, and significant variability to the agreement with alterations to the perinatal care. We recommend provision of evidence-based information early to expectant mothers by the healthcare professionals, to reduce misinformation and anxiety related to the current pandemic.