Articles

Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Findings suggest that assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. The authors recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

Estimation of pregnancy losses attributable to exposure to ambient fine particles in south Asia: an epidemiological case-control study

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.

Number of Childhood and Adolescent Vaccinations Administered Before and After the COVID-19 Outbreak in Colorado

In this report, the authors assessed the number of childhood and adolescent vaccinations administered in the months before and after the start of the COVID-19 outbreak in Colorado. Findings suggest that since the onset of the COVID-19 pandemic, vaccination uptake in children and adolescents has shown a significant decrease in Colorado. While the clinical implications of our observation are not yet known, public health advocates should consider addressing this drop to avoid the potential for vaccine-preventable diseases.

Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic

This case series included 35 hospitalized children who met definitional and/or epidemiologic criteria for multisystem inflammatory syndrome in children (MIS-C), 83% of whom exhibited mucocutaneous symptoms that lasted from hours to days. Conjunctival injection, palmoplantar erythema, lip hyperemia, periorbital erythema and edema, strawberry tongue, and malar erythema were the most common findings. This study suggests that mucocutaneous findings, while polymorphous and transient, may aid in the recognition of MIS-C.

Changes in Preterm Birth Phenotypes and Stillbirth at 2 Philadelphia Hospitals During the SARS-CoV-2 Pandemic, March-June 2020

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.

Stillbirths During the COVID-19 Pandemic in England, April-June 2020

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 Bangladesh

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 controls

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 data

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.

Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance

The authors aimed to describe the incidence, characteristics, transmission, and outcomes of SARS-CoV-2 infection in neonates who received inpatient hospital care in the UK. The findings suggest that neonatal SARS-CoV-2 infection is uncommon in babies admitted to hospital. Infection with neonatal admission following birth to a mother with perinatal SARS-CoV-2 infection was unlikely, and possible vertical transmission rare, supporting international guidance to avoid separation of mother and baby. The high proportion of babies from Black, Asian, or minority ethnic groups requires investigation.

The Global Health Network welcomes the highly encouraging news on Pfizer/ Biontech COVID-19 vaccine

Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

Findings suggets that among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. 

Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil

The authors aimed to estimate the association of Programme for Improving Primary Care Access and Quality (PMAQ) with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. Findings suggest that PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.

A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method

The study aimed to investigate whether cesarean sections and labor induction increase by raising women's awareness of fetal movements through Mindfetalness. Further, we aimed to study perinatal health after implementing Mindfetalness in maternity care. Findings suggest that raising awareness about fetal movements through Mindfetalness decreased the rate of cesarean sections, labor inductions and small-for-gestational age babies.ma

Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study

The study aimed to study the impact of the COVID-19 mitigation measures implemented in the Netherlands in a stepwise fashion on March 9, March 15, and March 23, 2020, on the incidence of preterm birth. In this national quasi-experimental study, initial implementation of COVID-19 mitigation measures was associated with a substantial reduction in the incidence of preterm births in the following months, in agreement with preliminary observations elsewhere. Integration of comparable data from across the globe is needed to further substantiate these findings and start exploring underlying mechanisms.

Preterm birth and nativity among Black women with gestational diabetes in California, 2013-2017: a population-based retrospective cohort study

This retrospective cohort study used linked birth certificate and hospital discharge data for 8609 of the 100,691 self-identifying non-Hispanic Black women with gestational diabetes (GDM) who had a singleton live birth between 20 and 44 weeks gestation in California in 2013-2017. Findings suggest that foreign-born status remained protective of preterm birth (PTB), irrespective of severity and subtype. Preeclampsia, PTB, and GDM share pathophysiologic mechanisms suggesting a need to better understand differences in perinatal stress, chronic disease, and vascular dysfunction based on nativity in future epidemiologic studies and health services research.

Postpartum depression in mothers and fathers: a structural equation model

This is the first study to investigate the possible correlation between maternal post-partum depression (PPD), mother-in-law and daughter-in-law relationship satisfaction, maternal marital satisfaction, paternal marital satisfaction, and paternal PPD. It is important for future PPD interventions to target both maternal and paternal mental health, as well as the mechanisms identified that can lead to PPD.

Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support

The authors conducted an online survey with 1219 breastfeeding mothers in the United Kingdom with a baby 0-12 months old to understand the impact of the pandemic upon breastfeeding duration, experiences and support. The results highlighted two very different experiences: 41.8% of mothers felt that breastfeeding was protected due to lockdown, but 27.0% of mothers struggled to get support and had numerous barriers stemming from lockdown with some stopped breastfeeding before they were ready. 

Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre, international, randomised, placebo-controlled trial

In this prospective, multicentre, international, randomised, parallel, double-masked, placebo-controlled trial, women with type 2 diabetes during pregnancy were randomly assigned from 25 centres in Canada and four in Australia to receive either metformin 1000 mg twice daily or placebo, added to insulin. The study found several maternal glycaemic and neonatal adiposity benefits in the metformin group. Along with reduced maternal weight gain and insulin dosage and improved glycaemic control, the lower adiposity and infant size measurements resulted in fewer large infants but a higher proportion of small-for-gestational-age infants. Understanding the implications of these effects on infants will be important to properly advise patients who are contemplating the use of metformin during pregnancy.

Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion

The objective of this study was to compare neonatal intensive care unit (NICU) or special care nursery admission for deliveries with water immersion compared with deliveries in the matched control group without water immersion. Secondary outcomes included adverse neonatal diagnoses, maternal infections, and perineal lacerations. Findings suggest that hospital-based deliveries with second-stage water immersion had lower risk of NICU or special care nursery admission and perineal lacerations than matched deliveries in the control group without water immersion.