The objective of the study was to examine whether the coronavirus disease 2019 (COVID-19) pandemic altered risk of adverse pregnancy-related outcomes and whether there were differences by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status among pregnant women. Findings suggest that in a geographically diverse U.S. cohort, the frequency of adverse pregnancy-related outcomes did not differ between those delivering before compared with during the pandemic, nor between those classified as positive compared with negative for SARS-CoV-2 infection during pregnancy.
An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeriaby Banke-Thomas et al.
The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.
Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weightingby Shifti DM et al.
The objective of the study was to assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia. Findings suggest that SBI has a significant effect on neonatal, infant and under-five mortality in Ethiopia. Interventions targeting SBI are warranted to reduce neonatal, infant and under-five mortality.
This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Findings from this study suggests that COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.
The objective of this study was to evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy. In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory.
Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort studyby Murphy et al
The authors aimed to identify and compare modifiable risk factors associated with adverse pregnancy outcomes in women with type 1 diabetes and those with type 2 diabetes and to identify effective maternity clinics. The data highlight persistent adverse pregnancy outcomes in women with type 1 or type 2 diabetes. Maternal glycaemia and BMI are the key modifiable risk factors. No maternity clinics were had appreciably better outcomes than any others, suggesting that health-care system changes are needed across all clinics.
Disease Severity, Pregnancy Outcomes and Maternal Deaths among Pregnant Patients with SARS-CoV-2 Infection in Washington Stateby Lokken et al
The objective of this study was to describe disease severity and outcomes of SARS-CoV-2 infections in pregnancy across Washington State including pregnancy complications and outcomes, hospitalization, and case fatality. Findings suggest that COVID-19 hospitalization and case fatality rates in pregnant patients were significantly higher compared to similarly aged adults in Washington State. This data indicates that pregnant patients are at risk for severe or critical disease and mortality compared to non-pregnant adults, as well as preterm birth.
Domestic violence and its relationship with quality of life in pregnant women during the outbreak of COVID-19 diseaseby Somayyeh Naghizadeh et al
This study aimed to investigate the prevalence of domestic violence and its relationship with quality of life in pregnant women during the COVID-19 pandemic. The findings of this study indicate a high prevalence of domestic violence and its relationship with a low quality of life during the COVID-19 pandemic. Therefore, the findings signify the importance of screening pregnant women in terms of domestic violence in respective centers as well as the necessity of conducting proper interventions to address domestic violence to improve the quality of life in women.
Estimation of pregnancy losses attributable to exposure to ambient fine particles in south Asia: an epidemiological case-control studyby Tao Xue et al
In this epidemiological case-control study, the authors collected data from Demographic and Health Surveys from India, Pakistan, and Bangladesh for the period 1998–2016 for women who reported at least one pregnancy loss and one or more livebirths. The authors assessed ambient exposure during gestation with satellite-based PM2·5 measurements for the period. The findings add to epidemiological evidence of the association between pregnancy loss and PM2·5. Suboptimal air quality contributes to a considerable fraction of total pregnancy loss in south Asia. Controlling PM2·5 pollution will promote maternal health in south Asia.
Changes in Preterm Birth Phenotypes and Stillbirth at 2 Philadelphia Hospitals During the SARS-CoV-2 Pandemic, March-June 2020by Handley et al
Given differences in preterm birth across populations, the authors examined a diverse urban cohort in the US to determine if preterm birth, spontaneous preterm birth, medically indicated preterm birth, and stillbirth rates have changed during the SARS-CoV-2 pandemic. This study did not detect significant changes in preterm or stillbirth rates during the SARS-CoV-2 pandemic in a racially diverse urban cohort from 2 Philadelphia hospitals. Although these data allow for disaggregation of spontaneous and medically indicated preterm births, no differences in overall rates of these phenotypes were detected.
This study assessed the National Health Service hospital admissions in England from April 1, 2019, to June 30, 2020, using annual Hospital Episode Statistics (HES) data (April 1, 2019, to March 31, 2020) and monthly data available as Secondary Uses Service (April 1 to June 30, 2020). Findings suggest that there was no evidence of any increase in stillbirths regionally or nationally during the COVID-19 pandemic in England when compared with the same months in the previous year and despite variable community SARS-CoV-2 incidence rates in different regions.
Vitamin D Treatment during Pregnancy and Maternal and Neonatal Cord Blood Metal Concentrations at Delivery: Results of a Randomized Controlled Trial in Bangladeshby Anne Marie Z Jukic et al
The authors examined maternal and neonatal cord blood levels of lead, cadmium, manganese, and mercury after supplementation with vitamin D during pregnancy. The findings suggest that vitamin D supplementation from the second trimester of pregnancy did not influence maternal cadmium, mercury, or manganese levels at delivery. Vitamin D was associated with nonsignificant increases in maternal lead and with significant increases in cord blood lead and cadmium. These associations were not dose dependent. Given that there are no safe levels of metals in infants, the observed increases in cord blood lead and cadmium require further exploration.
Pregnant women with severe or critical COVID-19 have increased composite morbidity compared to non-pregnant matched controlsby DeBolt et al
The authors aim to describe the outcomes of severe and critical COVID-19 infection in pregnant versus non-pregnant reproductive aged women. Findings suggest that pregnant women with severe and/or critical COVID-19 are at increased risk for certain morbidities when compared to non-pregnant controls. Despite the higher comorbidities of diabetes and hypertension in the non-pregnant controls, the pregnant cases were at increased risk for composite morbidity, intubation, mechanical ventilation and ICU admission. These findings suggest that pregnancy may be associated with a worse outcome in women with severe and critical COVID-19. The study suggests that similar to other viral infections such as SARS-CoV and MERS-CoV, pregnant women may be at risk for greater morbidity and disease severity.
Cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine for malaria during pregnancy: an analysis using efficacy results from Uganda and Kenya, and pooled databy Fernandes et al
The authors aimed to estimate the cost-effectiveness of intermittent preventive treatment in pregnancy with dihydroartemisinin-piperaquine (IPTp-DP) versus IPTp-SP to prevent clinical malaria infection (and its sequelae) during pregnancy. Findings suggest that among HIV-negative pregnant women with high uptake of long-lasting insecticidal nets, IPTp-DP is cost-effective in areas with high malaria transmission and high sulfadoxine-pyrimethamine resistance. These data provide a comprehensive overview of the current evidence on the cost-effectiveness of IPTp-DP. Nevertheless, before a policy change is advocated, we recommend further research into the effectiveness and costs of different regimens of IPTp-DP in settings with different underlying sulfadoxine-pyrimethamine resistance.
What has women's reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveysby Abdul-Aziz Seidu et al
The authors examined the reproductive health decision-making (RHDM) capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). Findings suggest that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination.
Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019by Bearack et al
The authors developed a model that simultaneously estimated incidence of unintended pregnancy and abortion within a Bayesian framework. The findings suggest that between 1990–94 and 2015–19, the global unintended pregnancy rate has declined, whereas the proportion of unintended pregnancies ending in abortion has increased. As a result, the global average abortion rate in 2015–19 was roughly equal to the estimates for 1990–94. Our findings suggest that people in high-income countries have better access to sexual and reproductive health care than those in low-income countries. Our findings indicate that individuals seek abortion even in settings where it is restricted. These findings emphasise the importance of ensuring access to the full spectrum of sexual and reproductive health services, including contraception and abortion care, and for additional investment towards equity in health-care services.
Characteristics of Women of Reproductive Age With Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020by Ellington et al
The objective of the study was to assess the prevalence and severity of COVID-19 among pregnant U.S. women and determine whether signs and symptoms differ among pregnant and nonpregnant women. Findings suggest that among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women, but their risk for death is similar. To reduce occurrence of severe illness from COVID-19, pregnant women should be counseled about the potential risk for severe illness from COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families
The objective of this study was to summarize available evidence and provide perinatologists/neonatologists with tools for managing their patients. As the pandemic continues, more data will be available that could lead to changes in current knowledge and recommendations.
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 studyby Yu et al
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.
Medical and non-medical reasons for cesarean section delivery in Egypt: a hospital-based retrospective study.by Elnakib S. et al.
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 studyby Adhikari et al
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 trialsby Gabrysch et al
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.
Inherited predisposition to stillbirth: an intergenerational analysis of 26,788 mother-daughter pairsby Woolner AMF et al
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 Healthby Santana et al
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 Malawiby McCauley et al
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.
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 healthby Mya et al 2017
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 instrumentsby Nilver et al
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.
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
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 Scotlandby Iliodromiti et al
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.
Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry studyby Mombo-Ngoma et al
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.
Strategy for Standardization of Preeclampsia Research Study Design
Biobanks provide an important repository of samples for research purposes. However, for those samples to reflect the in vivo state, and for experimental reliability and reproducibility, careful attention to collection, processing and storage is essential.
Contraceptive use before first pregnancy by women in India (2005–2006): determinants and differentialsby Pandey et al 2015
This study attempts to identify the socio demographic determinants and differentials of contraceptive use or non use by a woman in India, before she proceeds to have her first child. The analysis was done using data from the third National Family Health Survey (2005–2006), India.
Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghanaby Maxwell et al
The objectives of this study were to estimate the relationship between the type of abortion provider (consultant physician, house officer, or midwife) and two separate outcomes: (1) the likelihood of adopting postabortion contraception; (2) postabortion contraceptors’ likelihood of receiving a long-acting and permanent versus a short-acting contraceptive method.
Stillbirth is strongly related to impaired fetal growth. However, the relationship between fetal growth and stillbirth is difficult to determine because of uncertainty in the timing of death and confounding characteristics affecting normal fetal growth. The study authors conducted a population-based case–control study of all stillbirths and a representative sample of live births in 59 hospitals in five geographic areas in the US. The study found that stillbirth is associated with both growth restriction and excessive fetal growth. These findings suggest that, contrary to current practices and recommendations, stillbirth prevention strategies should focus on both severe SGA and severe LGA pregnancies.
The Effect of Intermittent Antenatal Iron Supplementation on Maternal and Infant Outcomes in Rural Viet Nam: A Cluster Randomised Trialby Jai K Das
Anemia affects over 500 million women, and in pregnancy is associated with impaired maternal and infant outcomes. Intermittent antenatal iron supplementation is an attractive alternative to daily dosing; however, the impact of this strategy on infant outcomes remains unclear. This study compared the effect of intermittent antenatal iron supplementation with daily iron supplementation on maternal and infant outcomes in rural Viet Nam.