The Global Network COVID‐19 studies: a review

Abstract

With the paucity of data available regarding COVID‐19 in pregnancy in low‐ and middle‐income countries (LMICs), near the start of the pandemic, the Global Network for Women's and Children's Health Research, funded by the National Institute of Child Health and Human Development (NICHD), initiated four separate studies to better understand the impact of the COVID‐19 pandemic in eight LMIC sites. These sites included: four in Asia, in Bangladesh, India (two sites) and Pakistan; three in Africa, in the Democratic Republic of the Congo (DRC), Kenya and Zambia; and one in Central America, in Guatemala. The first study evaluated changes in health service utilisation; the second study evaluated knowledge, attitudes and practices of pregnant women in relationship to COVID‐19 in pregnancy; the third study evaluated knowledge, attitude and practices related to COVID‐19 vaccination in pregnancy; and the fourth study, using antibody status at delivery, evaluated changes in antibody status over time in each of the sites and the relationship of antibody positivity with various pregnancy outcomes. Across the Global Network, in the first year of the study there was little reduction in health care utilisation and no apparent change in pregnancy outcomes. Knowledge related to COVID‐19 was highly variable across the sites but was generally poor. Vaccination rates among pregnant women in the Global Network were very low, and were considerably lower than the vaccination rates reported for the countries as a whole. Knowledge regarding vaccines was generally poor and varied widely. Most women did not believe the vaccines were safe or effective, but slightly more than half would accept the vaccine if offered. Based on antibody positivity, the rates of COVID‐19 infection increased substantially in each of the sites over the course of the pandemic. Most pregnancy outcomes were not worse in women who were infected with COVID‐19 during their pregnancies. We interpret the absence of an increase in adverse outcomes in women infected with COVID‐19 to the fact that in the populations studied, most COVID‐19 infections were either asymptomatic or were relatively mild.

Improving maternal, neonatal and child health outcomes in low‐resource settings: Translating research evidence to practice – report from The Third International Conference on Maternal, Newborn and Child Health

“…evidence of a prior COVID-19 infection, adverse pregnancy outcomes including stillbirth, neonatal death, preterm birth and low birthweight were not increased. 20 , 21 The most important reason for the lack of association was that in this study, most infected women were asymptomatic, and of those who had symptoms, the symptoms were mild in nature. Very few women had severe disease.…”

“…Very few women had severe disease. 20 , 21 In a subset of the population studied, women who tested negative for antibodies early in their pregnancy and who later tested positive at delivery had similar results, suggesting that infection prior to pregnancy did not explain these results. Other studies suggesting more serious outcomes associated with COVID-19 exposure during pregnancy were often hospital-based and generally included COVID-positive women who were recruited in hospitals and were often quite ill. 20 , 21 The JNMC Research Unit also investigated whether putative COVID-19 symptoms could be used to diagnose COVID-19 infections during pregnancy.…”

“… 20 , 21 In a subset of the population studied, women who tested negative for antibodies early in their pregnancy and who later tested positive at delivery had similar results, suggesting that infection prior to pregnancy did not explain these results. Other studies suggesting more serious outcomes associated with COVID-19 exposure during pregnancy were often hospital-based and generally included COVID-positive women who were recruited in hospitals and were often quite ill. 20 , 21 The JNMC Research Unit also investigated whether putative COVID-19 symptoms could be used to diagnose COVID-19 infections during pregnancy. 22 In this analysis conducted by Kavi et al, compared with women who were antibody-negative, women who were antibody-positive had slightly more episodes of fever during pregnancy, but the differences in symptomatology between women who were antibody-positive and women who were antibody-negative were not enough to suggest the use of symptoms as a diagnostic tool for COVID-19 infection.…”

“…The Global Network’s COVID-19 studies, which prospectively assessed pregnancy outcomes with COVID-19 antibody status at delivery, took place in the eight sites of the NICHD Global Network from 2020 to 2022 and produced some very interesting results. 20 The increasing COVID-19 infection rate over time in pregnant women was documented by COVID-19 antibody testing at delivery, with the highest rates of antibody positivity found in the Indian sites. Interestingly, in women testing positive for antibodies who had not been vaccinated, i.e.…”

“…The use of COVID-19 vaccines in pregnant women at the sites increased dramatically from 2020 through to 2022 and the Indian sites had among the highest rates of vaccination across the Global Network. 20 The Global Network studied knowledge, attitudes and practices (KAP) related to COVID-19 and COVID-19 vaccinations across sites and time. 23 We were impressed with the wide variability of COVID-19 knowledge across the sites.…”