The COVID-19 pandemic has exacerbated pregnancy outcomes for women and babies around the world

Mother and baby pregnancy results worsened during the COVID-19 pandemic. This is a review of data from 40 studies representing 17 countries published today. Lancet Global Health The journal revealed.

Results vary from country to country, but analysis of pooled data shows a approximately one-third increase in stillbirth and maternal mortality during a pandemic compared to life before COVID-19 became established. Stillbirth rate: 1099 / 168,295 pregnancies during the pandemic and 1325 / 198,993 pregnancies before the pandemic; Maternal mortality rate: 530 / 1,237,018 pregnant during the pandemic and 698 / 2,224,859 pregnant before the pandemic).

Mental health results also deteriorated during the pandemic. Of the 10 studies included in the analysis reported on maternal mental health, 6 reported increased postpartum depression, maternal anxiety, or both.

Overall, the results were worse than in low- and middle-income countries. High-income countries Researchers say urgent action is needed to maintain safe obstetric care around the world, especially in global emergencies.

Although the effects of COVID-19 infection were not analyzed in this study pregnancy, It provides the first global assessment of the incidental effects of a pandemic on prenatal, childbirth, and postnatal outcomes.

Professor Asmakaril, the lead author of the study at St. George’s University in London, said: “The COVID-19 pandemic has had a serious impact on healthcare systems around the world. Service interruptions, national blockades, fears of participation in health Care facilities have the negative effects of COVID-19, but the virus itself. It means that it is expected to have health effects beyond death and illness caused by the pandemic. It is clear from our research and other studies that the confusion caused by the pandemic has led to avoidance. Deaths of both mothers and babies, especially in low- and middle-income countries. Within the scope of strategic response to pandemics and aftermath, prioritize safe, accessible and equitable maternity care and harmful pregnancy worldwide. Encourage policy makers and health leaders to reduce outcomes. “

According to national studies, pandemics affect the incidence of stillbirths and preterm births, which can result in reduced behavior for fear of infection and reduced provision of childbirth services.

In this latest study, researchers found data from 40 studies, including data from more than 6 million pregnancies, representing 17 countries published between January 1, 2020 and January 8, 2021. I reviewed. All studies compared pre-pandemic and pre-pandemic pregnancy results, but excluded studies that focused exclusively on SARS-CoV-2 infected women.

Of the studies included in the review, 12 reported stillbirth rates. Analysis of the pooled data showed that the likelihood of stillbirth increased by more than a quarter compared to the pre-pandemic case (stillbirth odds increased by 28% and stillbirth rate during the pandemic: 1,099 / 168,295 Pregnancy, pre-pandemic stillbirth rate: 1,325 / 198,993 pregnancies).

This review includes two studies investigating the impact of pandemics on maternal mortality, both from middle-income countries (one in India and one in Mexico). A pooled analysis of data from both studies found that the risk of mother dying during pregnancy or childbirth was increased by more than one-third compared to before the pandemic (maternal mortality: during the pandemic). , 530 / 1,237,018 Pregnancy vs. before pandemic: 698 / 2,224,859 Pregnancy).This finding was dominated by a study from Mexico that represented most of the pregnancies included in the analysis (Mexico study 3,452,141 / 3,468,086 pregnancies). [99.7%], Indian Study 9,736 / 3,468,086 Pregnancy [0.3%]).

In this review, there was no difference in the overall proportion of preterm births before and during the pandemic. However, pooled data from studies from high-income countries suggest that this setting reduced the odds of preterm birth by almost 10% during the pandemic. The authors state that this reduction does not require medically indicated early labor induction or caesarean section, but appears to be caused by a reduction in spontaneous preterm birth.They say this means that this is likely to change Healthcare provision Population behavior is a factor that can provide valuable lessons for understanding the underlying mechanisms of preterm birth.Probability of low and preterm birth Middle income country There was no change.

From three studies reporting the use of surgery for the treatment of ectopic pregnancies, an analysis of pooled data showed that after considering the size of the studies involved, the rate of surgery during pandemics was nearly 6 compared to before. Ectopic pregnancies in all studies during the period of pandemic 27/37, pre-pandemic 73/272 were found to be twice as high (ectopic pregnancies, if detected early, can usually be treated with drugs That is, the increase in this surgery may indicate that more women have delayed seeking treatment.

Researchers have found that the differences in results reported between different studies may be partially explained by the inefficiencies of the health care system of the country in which they were studied. However, differences in pandemic mitigation responses between countries did not appear to affect the findings. Researchers say that the increased adverse effects of pregnancy may be caused by pressure on the medical system caused by COVID-19 itself, rather than measures aimed at limiting the spread of the virus, such as blockade. It states that it suggests that there is.

This review found no changes in reports of other pregnancy complications during the pandemic, such as gestational diabetes and pregnancy disorders associated with hypertension. There were no changes in labor outcomes during the pandemic, including cesarean delivery, spontaneous delivery, and pregnancy rates requiring labor induction. Despite these numbers being stable, researchers say their findings clearly show that women and babies experienced worse health outcomes during the pandemic. .. They emphasize the need to prioritize safe, accessible and equitable obstetric care in this strategic response to the pandemic and in future health crises.

Dr. Erkan Kalafat, co-author of a study at Koc University in Turkey, said: One such learning opportunity is the apparent reduction in preterm birth observed in a high-income environment during a pandemic with the aim of identifying new preventive interventions that may benefit all women worldwide. It’s about investigating the underlying mechanism. “

The authors note that their findings have some limitations.In particular, the studies included in their analysis were different. Pregnancy result As defined and measured, it is difficult to compare the results between studies. This is of concern because few studies have been conducted from low-income and medium-income settings, and the analysis shows that the results vary considerably between high-income and low-income settings. The authors also state that the risk of publication bias for studies that report negative results cannot be ruled out, but no evidence of bias was found when testing this.

Dr. Jogender Kumar of the Graduate School of Medical Education in India, who was not involved in the study, said in a linked commentary: The detrimental results were much higher with LMIC. The results of these surveys highlight the differences in medical care between countries. “

He added: “In resource-poor countries, it is a challenge to provide adequate compensation for prenatal health care, obstetric emergencies, universal institutional births, and respectful obstetric care, even under normal circumstances. .. Pandemic We’ve widened this gap and revealed some problems with healthcare systems around the world, and even more so at LMIC. ”

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