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Facing a Pandemic While Pregnant

Facing a Pandemic While Pregnant

Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study

This study aimed to clarify the clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19. In this retrospective, single-centre study, the authors included all pregnant women with COVID-19 who were admitted to Tongji Hospital in Wuhan, China. Clinical features, treatments, and maternal and fetal outcomes were assessed. Findings suggest that the maternal, fetal, and neonatal outcomes of patients who were infected in late pregnancy appeared very good, and these outcomes were achieved with intensive, active management that might be the best practice in the absence of more robust data. The clinical characteristics of these patients with COVID-19 during pregnancy were similar to those of non-pregnant adults with COVID-19 that have been reported in the literature.

The impact of underuse of modern methods of contraception among adolescents with unintended pregnancies in 12 low- and middle-income countries

The authors sought to explore the contribution of the underuse of modern methods of contraception (MMC) to the annual incidence of unintended pregnancies among adolescent women. Findings suggets that eight million out of 9.5 million unintended pregnancies occurring annually in twelve countries could have been prevented with the optimal use of MMC of contraception. MMC need to be further supported in order to further prevent unintended pregnancies globally.

Medical and non-medical reasons for cesarean section delivery in Egypt: a hospital-based retrospective study.

This study sought to (1) explore indications and risk factors for Caesarean section (CS) in public hospitals in four governorates in Egypt and (2) examine health care provider factors impacting the decision to perform a CS. Findings suggestA combination of both medical and non-medical factors drives the increase in CS rates. Our analysis however suggests that a substantial number of CS deliveries took place in the absence of strong medical justification. Health care provider factors seem to be powerful factors influencing CS rates in the study hospitals.

Risk of adverse perinatal outcomes among women with pharmacologically treated and untreated depression during pregnancy: A retrospective cohort study

This study examined the risks of adverse perinatal outcomes associated with antidepressant use during pregnancy. Both depression and antidepressant use were independently associated with the risk of adverse perinatal outcomes; however, the risk associated with antidepressants was higher over and above the risk associated with depression. This may reflect the biological effects of antidepressants, greater severity of depression in those treated, or both.

Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trials

This study is a secondary analysis of surveillance data on 119 244 pregnancies from two large population-based cluster-randomised controlled trials in Brong Ahafo, Ghana. Findings suggest that facility birth does not necessarily convey a survival benefit for women or babies and should only be recommended in facilities capable of providing emergency obstetric and newborn care and capable of safe-guarding uncomplicated births.

Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life A Randomized Clinical Trial

This cluster randomised trial assessed whether augmentation of a nurse home visitation program with an intimate partner violence intervention, starting in pregnancy, compared with the home visitation program alone, leads to improved maternal quality of life at 24 months after infant delivery? The trial included 492 pregnant women, randomization to the augmented program compared with nurse home visitation alone resulted in maternal quality-of-life scores at 24 months postdelivery of 311.3 vs 316.2 (measured using the WHOQOL-BREF scale; range, 0-400)—a difference that was not statistically significant. These findings do not support augmenting a nurse home visitation program with this complex, multifaceted intimate partner violence intervention.

Neurodevelopmental milestones and associated behaviours are similar among healthy children across diverse geographical locations

The latest findings from the international INTERGROWTH-21^st Project, that has monitored healthy, urban children from educated families across four continents from early pregnancy to 2 years of age, show that human neurodevelopment is not influenced by the colour of an individual’s skin.

Inherited predisposition to stillbirth: an intergenerational analysis of 26,788 mother-daughter pairs

The aim of the study was to investigate if there is an inherited predisposition to stillbirth transmitted from mother to daughter. The findings suggest that among the daughters, 384 had a history of one or more stillbirths (cases) while 26,404 only ever had livebirths (controls). We found no statistically significant association between mothers' history of stillbirth (adjusted Odds Ratio (aOR) 0.63; 95% CI 0.24-1.63) or miscarriage (aOR 1.01; 95% CI 0.71-1.42) and stillbirth in daughters.

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health

The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI. Findings suggest that twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.

Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawi

For every woman who dies during pregnancy and childbirth, many more suffer ill-health, the burden of which is highest in low-resource settings. The study sought to assess the extent and types of maternal morbidity. Findings from this study suggests that women suffer significant ill-health which is still largely unrecognised. Current antenatal and postnatal care packages require adaptation if they are to meet the identified health needs of women.

Aspirin for the prevention of preterm and term preeclampsia: Systematic review and meta-analysis

The authors performed a systematic review and meta-analysis that evaluated the prophylactic effect of aspirin during pregnancy. Sixteen trials including 18,907 participants provided data for preterm and term preeclampsia. Findings suggest that Aspirin reduces the risk of preterm preeclampsia but not term preeclampsia, and only when it is initiated at ≤16 weeks of gestation and at a daily dose of ≥100 mg.

Management of pregnancy at and beyond 41 completed weeks of gestation in low-risk women: a secondary analysis of two WHO multi-country surveys on maternal and newborn health

This study is a secondary analysis of the WHO Global Survey (WHOGS) and the WHO Multi-country Survey (WHOMCS) conducted in Africa, Asia, Latin America and the Middle East. There were 33,003 women with low risk singleton pregnancies at ≥41 completed weeks from 292 facilities in 21 countries. Compared to induction of labour (IOL), ECS significantly increased risk of NICU admission while EM was significantly associated with decreased risk of CS. ECS should not be recommended for women at 41 completed weeks of pregnancy. However, the choice between IOL and EM should be cautiously considered since the available evidences are still quite limited.

Measuring women’s childbirth experiences: a systematic review for identification and analysis of validated instruments

Women’s childbirth experience can have immediate as well as long-term positive or negative effects on their life, well-being and health. When evaluating and drawing conclusions from research results, women’s experiences of childbirth should be one aspect to consider. Researchers and clinicians need help in finding and selecting the most suitable instrument for their purpose. The aim of this study was therefore to systematically identify and present validated instruments measuring women’s childbirth experience. This systematic review provides an overview of existing instruments measuring women’s childbirth experiences and can support researchers to identify appropriate instruments to be used, and maybe adapted, in their specific contexts and research purpose.

New NIHR Themed Review: Better Beginnings

This themed review brings together NIHR research on different aspects of health before, during and after pregnancy. It features:

• 46 published studies
• 28 ongoing studies or interim results
• Questions for clinicians, commissioners, public health professionals and othe

Factors associated with spontaneous abortion: a cross-sectional study of Chinese populations

The present study is aimed to explore the association between spontaneous abortion (SA) and socioeconomic status (SES) and provides reference for policy makers to improve strategies on maternal health promotion. Generally women with lower SES status had a higher risk of SA. Lower income and educational attainment were inversely associated with the risk of SA. Women with agricultural and related work had a significantly higher prevalence of SA. Interventions could be targeted more on women with low SES to increase both health profits as well as economic gains for health programs.

Customised and Noncustomised Birth Weight Centiles and Prediction of Stillbirth and Infant Mortality and Morbidity: A Cohort Study of 979,912 Term Singleton Pregnancies in Scotland

This is a population-based linkage study of 979,912 term singleton pregnancies in Scotland, United Kingdom, between 1992 and 2010. At term, birth weight remains strongly associated with the risk of stillbirth and infant death and neonatal morbidity. Partial customisation does not improve prediction performance. Consideration of early term delivery or closer surveillance for those with a predicted birth weight ≤25th or ≥85th centile may reduce adverse outcomes. Replication of the analysis with fully customised centiles accounting for ethnicity is warranted.

COLLECT Database

Do you need an online database to support your perinatal research studies? The Global Pregnancy Collaboration (CoLab) has created a standard pregnancy database available for online use by interested investigators in both low- and middle-income and in high-income countries.

Challenges to Collaboration and Solutions

COLLABORATION TO UNDERSTAND COMPLEX DISEASES: PREECLAMPSIA AND ADVERSE PREGNANCY OUTCOMES The strategy of intellectual collaboration has accelerated modern research and research success. Identified by Professor Robert Adams in 2013 as the Fourth Age of Research collaboration is evident through ever increasing numbers of international  multicenter publications. These tend to provide positive benefits in terms of citation; indeed universities with a lower percentage of home grown papers have higher research incomes. The European Commission has placed collaboration at the heart of its research strategy and reported on the economic benefits. Emerging economies such as those of South America have also recognized the benefit of international collaboration. Much of the effort has been bottom up, that is, through researcher led collaborations, such as in the field of genetics, for example, genomics. Cancer, diabetes mellitus, and Alzheimer disease research have all benefited through extensive collaborative efforts.

Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry study

This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa. Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa.