COVID-19 outbreak and decreased hospitalisation of pregnant women in labour

Kumari, Vimla; Mehta, Kalpana; Choudhary, Rahul

doi:10.1016/s2214-109x(20)30319-3

Cited by 113 publications

(126 citation statements)

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“…Facilities that remained open were overwhelmed, particularly in LMICs, where many hospitals were already overcrowded. Further, pregnant individuals in many LMICs, with particularly dire numbers in India, were turned away from hospitals or denied ambulances and forced to endure labor on the streets or at home [75,76]. To mitigate this, hospitals limited the number of people per room and the duration of their stay and reduced postpartum stays.…”

Section: Healthcare Infrastructurementioning

confidence: 99%

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

et al. 2021

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Introduction The Covid-19 pandemic affects maternal health both directly and indirectly, and direct and indirect effects are intertwined. To provide a comprehensive overview on this broad topic in a rapid format behooving an emergent pandemic we conducted a scoping review. Methods A scoping review was conducted to compile evidence on direct and indirect impacts of the pandemic on maternal health and provide an overview of the most significant outcomes thus far. Working papers and news articles were considered appropriate evidence along with peer-reviewed publications in order to capture rapidly evolving updates. Literature in English published from January 1st to September 11 2020 was included if it pertained to the direct or indirect effects of the COVID-19 pandemic on the physical, mental, economic, or social health and wellbeing of pregnant people. Narrative descriptions were written about subject areas for which the authors found the most evidence. Results The search yielded 396 publications, of which 95 were included. Pregnant individuals were found to be at a heightened risk of more severe symptoms than people who are not pregnant. Intrauterine, vertical, and breastmilk transmission were unlikely. Labor, delivery, and breastfeeding guidelines for COVID-19 positive patients varied. Severe increases in maternal mental health issues, such as clinically relevant anxiety and depression, were reported. Domestic violence appeared to spike. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies implemented with little evidence. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands. Conclusion Pregnant women and mothers were not found to be at higher risk for COVID-19 infection than people who are not pregnant, however pregnant people with symptomatic COVID-19 may experience more adverse outcomes compared to non-pregnant people and seem to face disproportionate adverse socio-economic consequences. High income and low- and middle-income countries alike faced significant struggles. Further resources should be directed towards quality epidemiological studies. Plain English summary The Covid-19 pandemic impacts reproductive and perinatal health both directly through infection itself but also indirectly as a consequence of changes in health care, social policy, or social and economic circumstances. The direct and indirect consequences of COVID-19 on maternal health are intertwined. To provide a comprehensive overview on this broad topic we conducted a scoping review. Pregnant women who have symptomatic COVID-19 may experience more severe outcomes than people who are not pregnant. Intrauterine and breastmilk transmission, and the passage of the virus from mother to baby during delivery are unlikely. The guidelines for labor, delivery, and breastfeeding for COVID-19 positive patients vary, and this variability could create uncertainty and unnecessary harm. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies are implemented with little evidence in high and low/middle income countries. The social and economic impact of COVID-19 on maternal health is marked. A high frequency of maternal mental health problems, such as clinically relevant anxiety and depression, during the epidemic are reported in many countries. This likely reflects an increase in problems, but studies demonstrating a true change are lacking. Domestic violence appeared to spike. Women were more vulnerable to losing their income due to the pandemic than men, and working mothers struggled with increased childcare demands. We make several recommendations: more resources should be directed to epidemiological studies, health and social services for pregnant women and mothers should not be diminished, and more focus on maternal mental health during the epidemic is needed.

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Section: Healthcare Infrastructurementioning

confidence: 99%

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

et al. 2021

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“…The authors highlight that these are early data and that it will be essential to continue to monitor pregnancy outcomes in the future. However, countries including India and Nepal have reported an increase in stillbirth rates during the pandemic [18, 19]. It has been postulated that this may have resulted from indirect effects such as maternal reluctance to attend hospital when needed, for example, with reduced fetal movements, for fear of contracting infection.…”

Section: Effect Of Covid‐19 On Maternal Healthcarementioning

confidence: 99%

“…It has been postulated that this may have resulted from indirect effects such as maternal reluctance to attend hospital when needed, for example, with reduced fetal movements, for fear of contracting infection. Public information campaigns have an essential role in addressing womens’ concerns and reassuring them that it is safe to come to the hospital for emergency obstetric care [18].…”

Section: Effect Of Covid‐19 On Maternal Healthcarementioning

confidence: 99%

Pandemics and maternal health: the indirect effects of COVID‐19

Lucas

Bamber

2021

Anaesthesia

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Summary Infectious diseases can directly affect women and men differently. During the COVID‐19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of in‐person clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex‐based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID‐19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk‐benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID‐19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially for maternal health.

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“…This was not observed in the study in Ireland that was also based on hospital records 2 but was noted in the studies from Nepal 4 and India. 5 The equally concerning fall in outborn neonatal admissions also indicates that lockdown had a marked negative effect on healthcare-seeking behaviour among families of sick newborns. Our study is limited in being small, single centre and retrospective in nature.…”

Section: Open Accessmentioning

confidence: 99%

“…Studies from high-income countries (HICs) [1][2][3] have reported that COVID-19 lockdown measures markedly reduced preterm births, and this may shed light on mechanisms of preterm birth and possible preventive strategies. In contrast, reports from Nepal 4 and India, 5 low-income and middle-income countries (LMICs), noted that institutional deliveries reduced significantly during lockdown and preterm birth increased in Nepal. We are not aware of reports of the effects of lockdown on deliveries and preterm births from sub-Saharan Africa.…”

mentioning

confidence: 93%

Impact of COVID-19 lockdown measures on institutional delivery, neonatal admissions and prematurity: a reflection from Lagos, Nigeria

Ezenwa

Fajolu

Nabwera

et al. 2021

bmjpo

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We assessed the effect of COVID-19 lockdown on deliveries and neonatal admissions according to gestation in Lagos, Nigeria. During lockdown (April–June 2020), there was a marked fall of about 50% in in-hospital deliveries and admissions to the neonatal wards for both in and outborn infants compared with prelockdown (January–March 2020) and a comparison period (April–June 2019). However, the proportion of preterm infants was broadly similar in each period. Lockdown markedly reduced hospital deliveries and healthcare-seeking for sick newborns but did not influence the overall proportion of preterm births among in-house deliveries and outborn neonatal admissions.

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COVID-19 outbreak and decreased hospitalisation of pregnant women in labour

Cited by 113 publications

References 1 publication

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

Pandemics and maternal health: the indirect effects of COVID‐19

Impact of COVID-19 lockdown measures on institutional delivery, neonatal admissions and prematurity: a reflection from Lagos, Nigeria

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