This systematic review and meta-analysis compares adverse neonatal outcomes among mothers exposed to marijuana during pregnancy vs mothers not exposed to marijuana during pregnancy in 16 cohort studies.

Objectives COVID-19 is a rapidly changing and developing emergency that requires constant re-evaluation of available data. We report a systematic review and meta analysis based on all published high quality data up to and including June 3rd 2021 on the maternal and neonatal outcomes in pregnant women infected with the Coronavirus Disease 2019 (COVID-19). Data Sources PubMed, SCOPUS, MEDLINE, ClinicalTrials.gov, and Web of Science databases were queried from inception up to June 3rd 2021. Study Eligibility Criteria We included all clinical studies (prospective and retrospective cohort studies, case-control studies, case series, and rapid communications) that reported data on any maternal and neonatal outcomes of pregnant women with COVID-19. Study Appraisal and Synthesis Methods Data were analyzed as pooled proportions or odds ratios (OR) and 95% confidence intervals (95% CI) in meta-analysis models. Results We included 111 studies enrolling 42754 COVID-19-positive pregnant women. From COVID-19-positive pregnant women, the incidence rate of cesarean section was 53.2% (95% CI: 48%–58.4%), 41.5% (95% CI: 36.3%–46.8%) for spontaneous vaginal delivery and 6.4% (95% CI: 4.5%–9.2%) for operative delivery. The rate of some adverse neonatal events was relatively high in mothers infected with COVID-19 including premature delivery (16.7%, 95% CI: 12.8%–21.5%), and low birthweight (16.7%, 95% CI: 12.8%–21.5%). Vertical transmission (3.5%, 95% CI: 2.7%–4.7%), neonatal death (3%, 95% CI: 2%–4%), stillbirth (1.9%, 95% CI: 1.5–2.4%) and maternal mortality (0.012% 95% CI: 0.010-0.014%) were rare adverse events. Mean birth weight was 3069.7g, 95% CI: 3009.7g–3129.8g). In the comparative analysis, COVID-19 significantly increased the risk of premature delivery (OR= 1. 48, [95% CI; 1 .22, 1.8]), preeclampsia (OR= 1. 6, [95% CI; 1.2, 2.1]), stillbirth (OR= 2.36, [95% CI 1.24, 4.462]), neonatal mortality (OR= 3.35, [95% CI; 1.07, 10.5]), and maternal mortality (OR= 3.08, [95% CI; 1.5, 6.3]). Pooled analyses were homogenous, with mild heterogeneity in premature delivery and preeclampsia outcomes. Conclusion Data must be interpreted with caution as limited data is available and no complete assessment of bias is possible at this time. Our data suggests that pregnant women who test positive for COVID-19 seem to be at higher risk for lower birth weights and premature delivery. There is no evidence at this time of the sharply increased maternal mortality that was seen with both the previous 2002 Middle East Respiratory Syndrome (MERS) and 2003 Severe Acute Respiratory Syndrome (SARS) pandemics.

ObjectiveThe adherence to public health recommendations to control COVID-19 spread is influenced by public knowledge, attitudes and practices (KAP). We performed this cross-sectional study to assess the levels and determinants of public KAP towards COVID-19 in a large, multinational sample.DesignCross-sectional study (survey).SettingThe questionnaire was distributed to potential respondents via online platforms.Participants71 890 individuals from 22 countries.MethodsWe formulated a four-section questionnaire in English, followed by validation and translation into seven languages. The questionnaire was distributed (May to June 2020) and each participant received a score for each KAP section.ResultsOverall, the participants had fair knowledge (mean score: 19.24±3.59) and attitudes (3.72±2.31) and good practices (12.12±1.83) regarding COVID-19. About 92% reported moderate to high compliance with national lockdown. However, significant gaps were observed: only 68.2% knew that infected individuals may be asymptomatic; 45.4% believed that antibiotics are an effective treatment; and 55.4% stated that a vaccine has been developed (at the time of data collection). 71.9% believed or were uncertain that COVID-19 is a global conspiracy; 36.8% and 51% were afraid of contacting doctors and Chinese people, respectively. Further, 66.4% reported the pandemic had moderate to high negative effects on their mental health. Female gender, higher education and urban residents had significantly (p≤0.001) higher knowledge and practice scores. Further, we observed significant correlations between all KAP scores.ConclusionsAlthough the public have fair/good knowledge and practices regarding COVID-19, significant gaps should be addressed. Future awareness efforts should target less advantaged groups and future studies should develop new strategies to tackle COVID-19 negative mental health effects.

Interstitial pregnancy is a rare, life-threatening condition that requires high clinical suspicion for diagnosis. Most cases are discovered after complications have occurred. Many authors have described laparoscopic management. Although previous systematic reviews have compared the attributes and complications associated with interstitial pregnancy, we endeavored to complete the first systematic review and meta-analysis to compare the laparoscopic treatment of interstitial pregnancy with the open approach in the modern age of laparoscopic surgery. We systematically searched PubMed, ClinicalTrials.gov, Scopus, Web of Science, and Cochrane until June 2020 using relevant keywords and screened them for eligibility. We found a statistically significant difference in blood loss between laparoscopic and open surgery (168 mL compared to 1,163 mL). Further, cumulative meta-analysis has revealed that blood loss in laparoscopy has been decreasing over time from 1991 to 2020. Laparoscopic patients took less operative time (63.2 minutes) compared to laparotomy patients (78.2 minutes). Patients in the laparoscopic group spent less time hospitalized (3.7 days) compared to laparotomy patients (5.2 days). Our findings add strength to the position that laparoscopic approaches to interstitial pregnancy can be considered first-line in most situations. The laparoscopic approach was found to have a mean blood loss of 168 mL, and this blood loss seems to decrease over time. Increased gravidity and duration of amenorrhea are positive factors that increase bleeding during the procedure. We are unable to find enough high-quality data to significantly compare successful pregnancy following surgery or risk of mortality in these populations.