Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health

doi:10.1111/1471-0528.17175

. 2022 Jul;129(8):1298-1307.

doi: 10.1111/1471-0528.17175.

Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health

Seemab Naqvi¹, Farnaz Naqvi¹, Sarah Saleem¹, Vanessa R Thorsten², Lester Figueroa³, Manolo Mazariegos³, Ana Garces³, Archana Patel^{4

5}, Prabir Das⁴, Avinash Kavi⁶, Shivaprasad S Goudar⁶, Fabian Esamai⁷, Musaku Mwenchanya⁸, Elwyn Chomba⁸, Adrien Lokangaka⁹, Antoinette Tshefu⁹, Sana Yousuf¹, Melissa Bauserman¹⁰, Carl L Bose¹⁰, Edward A Liechty¹¹, Nancy F Krebs¹², Richard J Derman¹³, Waldemar A Carlo¹⁴, Patricia L Hibberd¹⁵, Sk Masum Billah^{16

17}, Nalini Peres-da-Silva², Rashidul Haque¹⁶, William A Petri Jr¹⁸, Marion Koso-Thomas¹⁹, Tracy Nolen², Elizabeth M McClure², Robert L Goldenberg²⁰

Affiliations

¹ Aga Khan University, Karachi, Pakistan.
² RTI International, Durham, North Carolina, USA.
³ Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala.
⁴ Lata Medical Research Foundation, Nagpur, India.
⁵ Datta Meghe Institute of Medical, Sciences, Sawangi, India.
⁶ KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India.
⁷ Moi University School of Medicine, Eldoret, Kenya.
⁸ University of Zambia University Teaching Hospital, Lusaka, Zambia.
⁹ Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
¹⁰ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA.
¹² University of Colorado School of Medicine, Denver, Colorado, USA.
¹³ Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹⁴ University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁵ Boston University School of Public Health, Boston, Massachusetts, USA.
¹⁶ International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
¹⁷ University of Sydney, Sydney, New South Wales, Australia.
¹⁸ University of Virginia, Charlottesville, Virginia, USA.
¹⁹ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
²⁰ Columbia University School of Medicine, New York, New York, USA.

PMID: 35377514
PMCID: PMC9111322
DOI: 10.1111/1471-0528.17175

Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health

Seemab Naqvi et al. BJOG. 2022 Jul.

. 2022 Jul;129(8):1298-1307.

doi: 10.1111/1471-0528.17175.

Authors

Affiliations

¹ Aga Khan University, Karachi, Pakistan.
² RTI International, Durham, North Carolina, USA.
³ Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala.
⁴ Lata Medical Research Foundation, Nagpur, India.
⁵ Datta Meghe Institute of Medical, Sciences, Sawangi, India.
⁶ KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India.
⁷ Moi University School of Medicine, Eldoret, Kenya.
⁸ University of Zambia University Teaching Hospital, Lusaka, Zambia.
⁹ Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
¹⁰ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA.
¹² University of Colorado School of Medicine, Denver, Colorado, USA.
¹³ Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹⁴ University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁵ Boston University School of Public Health, Boston, Massachusetts, USA.
¹⁶ International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
¹⁷ University of Sydney, Sydney, New South Wales, Australia.
¹⁸ University of Virginia, Charlottesville, Virginia, USA.
¹⁹ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
²⁰ Columbia University School of Medicine, New York, New York, USA.

PMID: 35377514
PMCID: PMC9111322
DOI: 10.1111/1471-0528.17175

Abstract

Objective: To assess, on a population basis, the medical care for pregnant women in specific geographic regions of six countries before and during the first year of the coronavirus disease 2019 (COVID-19) pandemic in relationship to pregnancy outcomes.

Design: Prospective, population-based study.

Setting: Communities in Kenya, Zambia, the Democratic Republic of the Congo, Pakistan, India and Guatemala.

Population: Pregnant women enrolled in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry.

Methods: Pregnancy/delivery care services and pregnancy outcomes in the pre-COVID-19 time-period (March 2019-February 2020) were compared with the COVID-19 time-period (March 2020-February 2021).

Main outcome measures: Stillbirth, neonatal mortality, preterm birth, low birthweight and maternal mortality.

Results: Across all sites, a small but statistically significant increase in home births occurred between the pre-COVID-19 and COVID-19 periods (18.9% versus 20.3%, adjusted relative risk [aRR] 1.12, 95% CI 1.05-1.19). A small but significant decrease in the mean number of antenatal care visits (from 4.1 to 4.0, p = <0.0001) was seen during the COVID-19 period. Of outcomes evaluated, overall, a small but significant decrease in low-birthweight infants in the COVID-19 period occurred (15.7% versus 14.6%, aRR 0.94, 95% CI 0.89-0.99), but we did not observe any significant differences in other outcomes. There was no change observed in maternal mortality or antenatal haemorrhage overall or at any of the sites.

Conclusions: Small but significant increases in home births and decreases in the antenatal care services were observed during the initial COVID-19 period; however, there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birthweight, or preterm birth rates during the COVID-19 period compared with the previous year. Further research should help to elucidate the relationship between access to and use of pregnancy-related medical services and birth outcomes over an extended period.

Keywords: COVID-19; Global Network; health care; low and middle-income countries; pregnancy.

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Conflict of interest statement

None declared. Completed disclosure of interests form available to view online as supporting information.

Figures

**FIGURE 1**
Consort diagram. Note: The Maternal and Newborn Health Registry geographic clusters included in this analysis were ongoing from 2019 to 2021. However, the Guatemalan clusters were reduced in size after 2019. Abbreviation: MTP, medical termination of pregnancy

See this image and copyright information in PMC

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References

1. Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID‐19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr. 2021;175:817–26. - PMC - PubMed
1. Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID‐19). Obstet Gynecol. 2021;137(4):571–80. - PMC - PubMed
1. Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, et al. Association of SARS‐CoV‐2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA. 2022;327:748–59. - PMC - PubMed
1. Figueiro‐Filho EA, Yudin M, Farine D. COVID‐19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries. J Perinat Med. 2020;48(9):900–11. - PubMed
1. Kumari V, Mehta K, Choudhary R. COVID‐19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Global Health. 2020;8(9):e1116–7. - PMC - PubMed

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[1] Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID‐19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr. 2021;175:817–26. - PMC - PubMed

[2] Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID‐19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr. 2021;175:817–26. - PMC - PubMed

[3] Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID‐19). Obstet Gynecol. 2021;137(4):571–80. - PMC - PubMed

[4] Metz TD, Clifton RG, Hughes BL, Sandoval G, Saade GR, Grobman WA, et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID‐19). Obstet Gynecol. 2021;137(4):571–80. - PMC - PubMed

[5] Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, et al. Association of SARS‐CoV‐2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA. 2022;327:748–59. - PMC - PubMed

[6] Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, et al. Association of SARS‐CoV‐2 infection with serious maternal morbidity and mortality from obstetric complications. JAMA. 2022;327:748–59. - PMC - PubMed

[7] Figueiro‐Filho EA, Yudin M, Farine D. COVID‐19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries. J Perinat Med. 2020;48(9):900–11. - PubMed

[8] Figueiro‐Filho EA, Yudin M, Farine D. COVID‐19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries. J Perinat Med. 2020;48(9):900–11. - PubMed

[9] Kumari V, Mehta K, Choudhary R. COVID‐19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Global Health. 2020;8(9):e1116–7. - PMC - PubMed

[10] Kumari V, Mehta K, Choudhary R. COVID‐19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Global Health. 2020;8(9):e1116–7. - PMC - PubMed

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Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health

Affiliations

Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women's and Children's Health

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Conflict of interest statement

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