Coronavirus infection in pregnancy - RCOG

Coronavirus infection in pregnancy
Update: Tuesday 11 January 2022
Prepared by the RCOG Library team

New references
1. Acta Obstet Gynecol Scand. 2021 Dec 14. doi: 10.1111/aogs.14303. Online ahead of print.
Psychological well-being and worries among pregnant women in the first trimester during the early
phase of the COVID-19 pandemic in Denmark compared with a historical group: A hospital-based
cross-sectional study.
Broberg L, Rom AL, de Wolff MG, Høgh S, Nathan NO, Paarlberg LD, Christensen KB, Damm P,
Hegaard HK.
INTRODUCTION: A pandemic may negatively influence psychological well-being in the individual. We
aimed to assess the potential influence of the first national lockdown in Denmark (March to June
2020) due to the COVID-19 pandemic on psychological well-being and the content and degree of
worries among pregnant women in early pregnancy. MATERIAL AND METHODS: In this hospital-
based cross-sectional study based on self-reported data we compared psychological well-being and
worries among women who were pregnant during the first phase of the pandemic (COVID-19 group)
(n = 685), with women who were pregnant the year before (Historical group) (n = 787).
Psychological well-being was measured by the five-item World Health Organization Well-being
Index (WHO-5), using a score ≤50 as indicator of reduced psychological well-being. Differences in
WHO-5 mean scores and in the prevalence of women with score ≤50 were assessed using general
linear and log-binomial regression analyses. The Cambridge Worry Scale was used to measure the
content and degree of major worries. To detect differences between groups, Pearson's Chi-square
test was used. RESULTS: We found no differences in mean WHO-5 score between groups (mean
difference) 0.1 (95% CI -1.5 to 1.6) or in the prevalence of women with WHO-5 score ≤50
(prevalence ratio 1.04, 95% CI 0.83-1.29) in adjusted analyses. A larger proportion of women in the
COVID-19 group reported major worries about Relationship with husband/partner compared with
the Historical group (3% [n = 19] vs 1% [n = 6], p = 0.04), and 9.2% in the COVID-19 group worried
about the possible negative influence of the COVID-19 restrictions. CONCLUSIONS: Our findings
indicate that national restrictions due to the COVID-19 pandemic did not influence the psychological
well-being or the content and degree of major worries among pregnant women. However, a larger
proportion of women in the COVID-19 group reported major worries concerning Relationship with
husband/partner compared with the Historical group and 9.2% in the COVID-19 group worried
about the possible negative influence of the COVID-19 restrictions.
DOI: 10.1111/aogs.14303 PMID: 34904223

2. BMC Pregnancy Childbirth. 2021 Dec 13;21(1):828. doi: 10.1186/s12884-021-04300-8.
Associations between postpartum depression and assistance with household tasks and childcare
during the COVID-19 pandemic: evidence from American mothers.
Gildner TE, Uwizeye G, Milner RL, Alston GC, Thayer ZM.
BACKGROUND: The early postpartum period is recognized cross-culturally as being important for
recovery, with new parents receiving increased levels of community support. However, COVID-19-

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

related lockdown measures may have disrupted these support systems, with possible implications
for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at
different stages of the pandemic to test (i) if instrumental support access in the form of help with
household tasks, newborn care, and care for older children has varied temporally across the
pandemic, and (ii) whether access to these forms of instrumental support is associated with lower
postpartum depression scores. METHODS: This study used data from the COVID-19 And
Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States.
Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic
regression analysis tested whether birth timing during the pandemic was associated with odds of
reported sustained instrumental support. Linear regression analyses assessed whether instrumental
support was associated with lower depression scores as measured via the Edinburgh Postnatal
Depression survey. RESULTS: Participants who gave birth later in the pandemic were more likely to
report that the pandemic had not affected the help they received with household work and
newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly
throughout the pandemic. Additionally, respondents who reported that the pandemic had not
impacted their childcare access or help received around the house displayed significantly lower
depression scores compared to participants who reported pandemic-related disruptions to these
support types (p < 0.05). CONCLUSIONS: The maintenance of postpartum instrumental support
during the pandemic appears to be associated with better maternal mental health. Healthcare
providers should therefore consider disrupted support systems as a risk factor for postpartum
depression and ask patients how the pandemic has affected support access. Policymakers seeking to
improve parental wellbeing should design strategies that reduce disease transmission, while
facilitating safe interactions within immediate social networks (e.g., through investment in COVID-
19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a
potential tool to protect against depression, both during and after the COVID-19 pandemic.
DOI: 10.1186/s12884-021-04300-8 PMID: 34903201

3. Clin Pediatr (Phila). 2021 Dec 13:99228211065898. doi: 10.1177/00099228211065898. Online
ahead of print.
Impact of Prenatal SARS-CoV-2 Infection on Infant Emergency Department Visits and
Hospitalization.
Ungar SP, Solomon S, Stachel A, Demarco K, Roman AS, Lighter J.
To better understand the impact of prenatal severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection on infants, this study sought to compare the risk of hospital visits and of
postnatal SARS-CoV-2 infection between infants born to mothers with and without prenatal SARS-
CoV-2 infection. In this retrospective observational cohort study of 6871 mothers and their infants,
overall rates of emergency department (ED) visits and hospital admissions in the first 90 days of life
were similar for infants born to mothers with and without prenatal SARS-CoV-2 infection. Infants
born to negative mothers were more likely than infants of positive mothers to be hospitalized after
ED visit (relative risk: 3.76; 95% confidence interval: 1.27-11.13, P = .003). Five infants tested
positive; all were born to negative mothers, suggesting that maternal prenatal SARS-CoV-2 infection
may protect infants from postnatal infection. The lower acuity ED visits for infants born to mothers
with prenatal SARS-CoV-2 infection may reflect a heightened level of concern among these mothers.
DOI: 10.1177/00099228211065898 PMID: 34903074

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

4. Indian J Pediatr. 2021 Dec;88(12):1270. doi: 10.1007/s12098-021-03865-8. Epub 2021 Aug 10.
Is COVID in Neonates Really Mild?
Khamkar AM, Mahindre A, Pote PD, Suryawanshi P, Jose GE.
Extract: We describe 5 neonates who were hospitalized for COVID-19 in March 2021…. Based on
these cases, it is imperative to note that more neonates are symptomatic, requiring hospitalization.
Secondly, in the second wave of COVID-19 infection in India, we observe a paradigm shift of severity
from mild cases to SARS-CoV-2 pneumonia and encephalitis yet with a good prognosis.
DOI: 10.1007/s12098-021-03865-8 PMCID: PMC8353419 PMID: 34374935 [Indexed for MEDLINE]

5. J Affect Disord. 2022 Feb 1;298(Pt A):119-125. doi: 10.1016/j.jad.2021.10.102. Epub 2021 Oct 29.
COVID-19 and delayed antenatal care impaired pregnant women's quality of life and psychological
well-being: What supports should be provided? Evidence from Vietnam.
Nguyen LH, Nguyen LD, Ninh LT, Nguyen HTT, Nguyen AD, Dam VAT, Nguyen TT, Do HP, Vu TMT,
Tran BX, Latkin CA, Ho CSH, Ho RCM.
BACKGROUND: This study explored the associations between different structural and functional
supports with the quality of life (QOL) and mental well-being of pregnant women whose antenatal
care was delayed due to the COVID-19 pandemic in Vietnam. METHODS: A multi-center cross-
sectional study was performed on 868 pregnant women. The pregnant women's quality of life
questionnaire (QOL-GRAV), the Edinburgh Postnatal Depression Scale (EPDS), and the Perinatal
Infant Care Social Support (PICSS) instruments were employed. The satisfaction with care from
different sources was measured. Multivariate Tobit Regression models were used. RESULTS: Seventy
pregnant women (8.1%) reported that their antenatal care was influenced by the COVID-19. In this
group, a higher level of satisfaction with the care of parents-in-law and a higher score of emotional
support were associated with a better "Physical and Emotional changes" domain, while a higher
level of appraisal support was related to poorer "Physical and Emotional changes" domain. A higher
level of satisfaction with relatives' care and a higher score of emotional support were correlated
with a better "Life Satisfaction" domain. EPDS score was negatively correlated with satisfaction with
parents-in-law care and appraisal support. CONCLUSIONS: Our study highlighted that intervention
programs to improve the QOL and psychological well-being of pregnant women in epidemics such
as COVID-19 or other diseases in the future should involve other family members such as parents-
in-law and relatives as sources of support. LIMITATIONS: The cross-sectional design was unable to
draw causal relationships. Recall bias might occur. The convenient sampling method might limit the
generalizability of findings.
DOI: 10.1016/j.jad.2021.10.102 PMCID: PMC8573380 PMID: 34715160 [Indexed for MEDLINE]

6. J Public Health (Oxf). 2021 Dec 8;43(Suppl 3):iii12-iii18. doi: 10.1093/pubmed/fdab376.
COVID-19 outcomes among pregnant and nonpregnant women at reproductive age in Egypt.
BahaaEldin H, El Sood HA, Samy S, Khader Y, AbdelFatah M, Hassany M, Afifi S, Eid A.
BACKGROUND: To describe demographic, clinical and epidemiological characteristics of pregnant
and nonpregnant women with confirmed COVID-19 at reproductive age and determine risk factors
of COVID-19 severe outcomes during pregnancy. METHODS: A retrospective study for females aged
18-49 with confirmed COVID-19 by RT-PCR in Egypt, February-July 2020. Data were obtained from
Egypt National Surveillance, bivariate and multivariate analysis for demographic and clinical
characteristics and outcomes of COVID-19 between pregnant and nonpregnant women including
ICU admission, need for ventilator and death was performed. RESULTS: A total of 23 095 females

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

were identified, with mean (SD) age of 35.1 (8.1) year. Of those, 408 (1.8%) were pregnant, with
mean (SD) age of 29.3 (8.1) years. Compared to nonpregnant, pregnant patients were more likely to
be admitted to hospital (OR = 1.7 CI = 1.4-2.1), ICU (OR = 2.4, CI = 1.3-4.3), need ventilator
(OR = 3.9, CI = 2.1-7.4) and have severe outcome (OR = 3.0, CI = 1.9-4.7). Factors associated with
severe outcome included: pregnancy, age > 30 years, underlying medical conditions, and living in
rural areas. CONCLUSION: Pregnant women with COVID-19 are at higher risk of severe symptoms
and outcome including ICU admission, requiring ventilator and death. To reduce risk of severe
outcome, counseling about for seeking medical care and health education about COVID-19
preventive measures should be performed.
DOI: 10.1093/pubmed/fdab376 PMCID: PMC8660011 PMID: 34741171 [Indexed for MEDLINE]

7. J Trop Pediatr. 2021 Oct 6;67(5):fmab094. doi: 10.1093/tropej/fmab094.
Impact of COVID-19 Infection on Neonatal Birth Outcomes.
Vizheh M, Allahdadian M, Muhidin S, Valiani M, Bagheri K, Borandegi F, Ghasimi G.
INTRODUCTION: There is limited data on newborns born to mothers with COVID-19 infection. This
multicenter cohort study aimed to investigate the clinical characteristics and outcomes of neonates
born to mothers with and without COVID-19 infection to fill a gap in the literature review.
METHODS: The medical records of all neonates in Isfahan, Iran, between October 2020 and March
2021, were retrospectively reviewed. RESULTS: Among the 600 neonates in this study, 255 (42.5%)
were in the infected group and 345 (57.5%) were assigned to the control group as they were born to
non-infected mothers. In the infected group, sepsis, fever and pneumothorax were detected in 3
(1.2%), 3 (1.2%) and 4 (1.6%) neonates, respectively, compared with no case in the control group. In
the infected group, neonatal respiratory distress (NRDS) (32, 12.5%) was significantly higher than
the control group (27, 10.6%). Asphyxia in the infected group was 22(6.4%), compared with 19
(5.5%), in the control group. Preterm labor (PTL) (55, 21.65%), premature rupture of membranes
(PROMs) (24, 9.4%) and intra-uterine growth retardation (IUGR) (15, 5.9%) were significantly higher
in women with COVID-19 (45, 13.0%, 4, 1.2% and 7, 2.0%, respectively). Low birth weight (LBW)
accounted for 42 (16.5%) neonates in the infected group and 25 (7.2%) in the control group (p <
0.05). Of the 255 neonates born to infected mothers, 38 (14.9%) were admitted to the Neonatal
Intensive Care Unit (NICU), compared with 31 out of 345 (9.0%) in the control group (p < 0.05). RT-
PCR test results were positive in two newborns (0.8%), one of whom died of necrotizing
enterocolitis. CONCLUSION: As a result of maternal COVID-19 infections, neonates experienced
higher rates of sepsis, fever, pneumothorax, asphyxia and NRDS in addition to PTL, PROMs, IUGR,
and LBW.
Plain Language Summary: Contradictory results have been reported on the impact of COVID-19
infection on neonatal outcomes. We conducted a review of 600 cases of neonates, with 255 (42.5%)
in the COVID-19 infected and 345 (57.5%) in the control group. The results indicated that neonates
born to women with COVID-19 showed higher rates of sepsis, fever, pneumothorax, asphyxia and
neonatal respiratory distress in addition to preterm labor, premature rupture of membranes, intra-
uterin growth retardation and low birth weight.
DOI: 10.1093/tropej/fmab094 PMID: 34748020 [Indexed for MEDLINE]

8. Niger Postgrad Med J. 2021 Oct-Dec;28(4):240-246. doi: 10.4103/npmj.npmj_650_21.
Determinants of correct knowledge of coronavirus infection and COVID-19 disease pandemic among
pregnant women in South-West Nigeria.

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

Abdus-Salam RA, Lawal TV, Lawal OO, Akinlusi FM, Bello OO, Morhason-Bello IO.
BACKGROUND: As the spread of COVID-19 continues, the disease and its sequels affect antenatal,
intrapartum and post-partum care, thus making pregnant women and their babies vulnerable. This
study assessed the knowledge of COVID-19 disease and determinants of correct knowledge among
pregnant women at the University College Hospital, Ibadan, Nigeria. METHODS: A cross-sectional
study was conducted among pregnant women. Data collected were analysed with STATA 16.0
software. Descriptive, bivariate and multinomial regression analyses were performed. The primary
outcomes were awareness of COVID-19 (yes/no), correct knowledge, and determinants. RESULTS:
Three hundred and eighty participants were interviewed. The mean age was 32 years (±4.78). A
little over a third (37%) were aged 30-34 years, married (97.1%), Yoruba (86.6%), had tertiary
education (89.0), in skilled occupation (54.6%) and not well-exposed to media (56.7%). The
knowledge of COVID-19 was good (15%), fair (79%), and poor (6%). About 19.6%, 66.7% and 13.7%
of participants who had poor, fair and good knowledge, respectively, believed that COVID-19 exists
(P = 0.007). The factors associated with good knowledge include occupation, income, level of
education and exposure to media (P value  70%.
Conclusions: We conclude that the AnCAn Scale holds good psychometric properties, and it
identifies and distinguishes 2 latent factors: (1) anxiety related to acquiring infection and (2) anxiety
related to spreading infection and social role obligations, which are compositely related to anxiety
specific to COVID-19 and pregnancy.

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

DOI: 10.4088/PCC.21m03038 PMID: 34861747 [Indexed for MEDLINE]

10. Ultrasound Obstet Gynecol. 2021 Dec;58(6):900-908. doi: 10.1002/uog.24787. Evidence of
possible SARS-CoV-2 vertical transmission according to World Health Organization criteria in
asymptomatic pregnant women.
Sevilla-Montoya R, Hidalgo-Bravo A, Estrada-Gutiérrez G, Villavicencio-Carrisoza O, Leon-Juarez M,
Villegas-Mota I, Espino-Y-Sosa S, Monroy-Muñoz IE, Martinez-Portilla RJ, Poon LC, Cardona-Pérez
JA, Helguera-Repetto AC; Collaborators.
Collaborators: Gonzalez-García LD, Mora-Vargas CD, Mateu-Rogell P, Rodriguez-Bosch M, Coronado-
Zarco I, Acevedo-Gallegos S, Aguinaga-Ríos M, Ramirez-Santes VH, Ortiz-Ramirez MA, Valdes-Flores
M, Cortes-Bonilla M.
OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission has
been investigated extensively. Recently, the World Health Organization (WHO) published strict
criteria to classify the timing of mother-to-child transmission of SARS-CoV-2 into different
categories. The aim of this study was to investigate the possibility of vertical transmission in
asymptomatic SARS-CoV-2-positive women. METHODS: Pregnant women attending for delivery at a
perinatology center in Mexico City, Mexico, who had a SARS-CoV-2-positive nasopharyngeal swab
24-48 h before delivery, were asymptomatic at the time of the test and had an obstetric indication
for Cesarean section were eligible for inclusion in this study. Amniotic fluid was collected during
Cesarean delivery, and neonatal oral and rectal swabs were collected at birth and at 24 h after birth.
SARS-CoV-2 detection was carried out using real-time reverse-transcription polymerase chain
reaction in all samples. Relevant medical information was retrieved from clinical records. The WHO
criteria for classifying the timing of mother-to-child transmission of SARS-CoV-2 were applied to the
study population. RESULTS: Forty-two SARS-CoV-2-positive asymptomatic pregnant women fulfilled
the inclusion criteria. Twenty-five (59%) women developed mild disease after discharge. Neonatal
death occurred in three (7%) cases, of which one had a positive SARS-CoV-2 test at birth and none
had coronavirus disease 2019-related symptoms. There were five (12%) cases with strong evidence
of intrauterine transmission of SARS-CoV-2, according to the WHO criteria, as amniotic fluid
samples and neonatal samples at birth and at 24 h after birth were positive for SARS-CoV-2. Our
results also showed that 40-60% of infected neonates would have been undetected if only one swab
(oral or rectal) was tested. CONCLUSION: This study contributes evidence to reinforce the potential
for vertical transmission of SARS-CoV-2 even in asymptomatic women and highlights the
importance of testing more than one neonatal sample in order to increase the detection rate of
SARS-CoV-2 in affected cases
DOI: 10.1002/uog.24787 PMCID: PMC8661610 PMID: 34580942 [Indexed for MEDLINE]

11. PLoS One. 2021 Dec 16;16(12):e0260006. doi: 10.1371/journal.pone.0260006. eCollection 2021.
Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A
retrospective cohort study.
Hedstrom A, Mubiri P, Nyonyintono J, Nakakande J, Magnusson B, Vaughan M, Waiswa P, Batra M.
BACKGROUND: During the early COVID-19 pandemic travel in Uganda was tightly restricted which
affected demand for and access to care for pregnant women and small and sick newborns. In this
study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before
and during the early phase of the COVID-19 pandemic. METHODS: We report outcomes from
admissions captured in an electronic dataset of a well-established newborn unit before (September

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

2019 to March 2020) and during the early COVID-19 period (April-September 2020) as well as two
seasonally matched periods one year prior. We report excess mortality as the percent change in
mortality over what was expected based on seasonal trends. FINDINGS: The study included 2,494
patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic
admissions decreased by 14%. Patients born outside the facility were older on admission than
previously (median 1 day of age vs. admission on the day of birth). There was an increase in
admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19
than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of
55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had
decreased antenatal care, restricted transport and difficulty with expenses and support. The
hospital had difficulty with maternity staffing and supplies. There was significant community and
staff fear of COVID-19. INTERPRETATION: Increased newborn mortality during the early COVID-19
pandemic at this facility was likely attributed to disruptions affecting maternal and newborn
demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to
public transit were significant barriers to maternal and newborn wellbeing, and require further
focus by national and regional health officials.
DOI: 10.1371/journal.pone.0260006 PMID: 34914748

12. Am J Perinatol. 2021 Dec 16. doi: 10.1055/s-0041-1739490. Online ahead of print.
Temporal Trend in SARS-CoV-2 Symptoms in Pregnant Women.
London V, Blitz MJ, Solmonovich R, Silver M, Minkoff H.
OBJECTIVE: The objective of this study was to examine temporal trends in the clinical
presentation of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) in pregnancy. STUDY DESIGN: This is a retrospective cohort study of pregnant women who
were universally screened for SARS-CoV-2 and tested positive. This multi-center study of
admissions to labor and delivery units in New York City and Long Island included all SARS-CoV-2-
infected pregnant women admitted to labor and delivery units between April 10th and June 4th
2020. Six Northwell Health hospitals and Maimonides Medical Center were included in the study.
The main measures of the study included patient reports of COVID-19 symptoms: fever, cough,
chest pain, shortness of breath, nausea, vomiting, and intensive care unit (ICU) admissions. The
main outcome measure was the percentage of all infected women who reported any of the above
symptoms. RESULTS: In total, 427 infected pregnant women were included in the study. There
was a statistically significant decline in the percentage of patients presenting with any symptoms
over the course of the study. In addition, disease severity, symptoms of fever, cough, and chest
pain/shortness of breath also significantly declined over time, and no ICU admissions were noted
after the third week of April. CONCLUSIONS: There was a temporal shift away from symptomatic
presentation in pregnant women diagnosed with SARS-CoV-2 over the course of the first months of
the epidemic in New York. Further studies are necessary to elucidate the cause of this change in
presentation among pregnant women, to determine whether this trend is also observed in other
patient populations. KEY POINTS: · Retrospective cohort review of 427 SARS-CoV-2-infected
pregnant women admitted to labor and delivery units.. · A significant decline in the percentage of
patients presenting with symptoms over time was noted.. · Further studies are necessary to
elucidate the cause of this change in presentation.. · Theories for the noted trend: viral evolution,
decreased viral inoculums, and prolonged polymerase chain reaction positivity..
DOI: 10.1055/s-0041-1739490 PMID: 34918329

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

13. J Matern Fetal Neonatal Med. 2021 Dec 16:1-10. doi: 10.1080/14767058.2021.2013464. Online
ahead of print.
Proning modus operandi in pregnancies complicated by acute respiratory distress syndrome
secondary to COVID-19.
Cojocaru L, Turan OM, Levine A, Sollecito L, Williams S, Elsamadicy E, Crimmins S, Turan S.
INTRODUCTION: Prone positioning has been widely utilized in ARDS management before and during
the COVID-19 pandemic due to its demonstrated mortality benefits. In pregnancy, proning requires
careful attention to often overlooked physiologic changes in pregnancy and additional technical
challenges accompanying a gravid abdomen. The purpose of this manuscript is to demonstrate a
proning technique that was successfully used at our institution to avoid premature delivery of the
fetus while improving maternal outcomes. All technical challenges are addressed in the instructional
videos using a pregnant model with twin gestation at 32 weeks. METHODS: We reviewed all the
patients' charts with positive SARS-CoV-2 from March 2020 until July 2020 and identified those who
developed ARDS. Subsequently, we identified four patients that were proned during the
antepartum period. We described their clinical course, including the change in ventilatory
parameters in relationship with proning timing. Stepwise instructions for self-proning and proning in
mechanically ventilated patients are illustrated in video format. RESULTS: During the study period,
we identified 100 pregnant patients with SARS-CoV-2 infection. Mechanical ventilation was required
in 8 of these patients. In four cases, proning was performed during the antepartum period. We
were able to improve the P/F ratio while decreasing FiO2 and avoiding iatrogenic preterm delivery.
Except for one case, where the patient self-extubated and required emergent delivery, all patients
were successfully extubated, followed for prenatal care, and delivered for usual obstetric
indications. CONCLUSION: Proning remains a well-proven intervention in ARDS and should be
considered in pregnant women when indicated. We recognize that proning might not be effective in
all cases. However, proning positioning is an option to improve oxygenation in patients with severe
hypoxemia when the next consideration is delivery of a premature infant or maternal cannulation
for extracorporeal membrane oxygenation.
DOI: 10.1080/14767058.2021.2013464 PMID: 34915799

14. J Reprod Infant Psychol. 2021 Dec 17:1-17. doi: 10.1080/02646838.2021.2013458. Online ahead
of print.
Experience of early motherhood during the first wave of the COVID-19 pandemic in Northern
Germany: a single-centre before and after comparison.
Perez A, Schepanski S, Göbel A, Stuhrmann LY, Singer D, Bindt C, Mudra S.
PURPOSE: To assess maternal mental health during the first weeks after birth including birth
experience, postpartum adjustment to early motherhood and the perception of newborn
behaviour, and how this may be influenced by the first wave of the COVID-19 pandemic. METHODS:
Ninety women who gave birth after the first enforcement of nation-wide disease control restrictions
in Germany between 16 March and 10 May 2020 were surveyed and compared with 101 women
who had given birth before the pandemic. Information on maternal mental health and maternal
perception of early motherhood and neonatal behaviour were assessed at 3-8 weeks postpartum.
RESULTS: Mothers who gave birth under the COVID-19-associated disease control restrictions did
not show significant differences in depression, anxiety and social support scales compared to
mothers before the pandemic. Birth experience was similar, while support during birth was

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

perceived to be higher under the COVID-19 restrictions. Confidence in caretaking of the newborn
and perception of neonatal behaviour were comparable between the two groups. Mothers
expressed significantly higher dissatisfaction with the maternal role during the pandemic.
CONCLUSIONS: Overall, maternal mental health and the perception of the newborn and early
caretaking during the first COVID-19 wave did not substantially differ from the perceptions of
mothers before the pandemic. A potential influence of the pandemic on higher dissatisfaction with
the maternal role may be associated with the pandemic conditions affecting everyday life and
should be addressed in postpartum care and in future qualitative and longitudinal studies.
DOI: 10.1080/02646838.2021.2013458 PMID: 34918988

15. Public Health. 2021 Nov 8;202:76-79. doi: 10.1016/j.puhe.2021.10.013. Online ahead of print.
Impact of COVID-19 public health safety measures on births in Scotland between March and May
2020.
Speyer LG, Marryat L, Auyeung B.
OBJECTIVE: To combat the widespread transmission of COVID-19, many countries, including the
United Kingdom, have imposed nationwide lockdowns. Little is known about how these public
health safety measures affect pregnant mothers and their offspring. This study aimed to explore the
impact of COVID-19 public health safety measures on births in Scotland. STUDY DESIGN: Cross-
sectional study. METHODS: Using routinely collected health data on pregnancy and birth in
Scotland, this study compares all births (N = 7342) between 24th March and May 2020 with births in
the same period in 2018 (N = 8323) to investigate the potential negative impact of public health
safety measures introduced in Scotland in spring 2020. Birth outcomes were compared using Mann-
Whitney-U tests and chi-square tests. RESULTS: Mothers giving birth during the pandemic tended to
combine breastfeeding and formula-feeding rather than exclusively breastfeed or exclusively
formula-feed, stayed in hospital for fewer days, and more often had an epidural or a spinal
anaesthetic compared to women giving birth in 2018. CONCLUSION: Overall, results suggest little
impact of public health safety measures on birth outcomes. Further research is needed to explore
the longer-term impacts of being born in the pandemic on both maternal mental health and child
development.
DOI: 10.1016/j.puhe.2021.10.013 PMID: 34922177

16. West Afr J Med. 2021 Nov 30;Vol. 38(11):1036-1041.
COVID-19 and Pregnancy: A Prospective Descriptive Study from a Tertiary Hospital in Nigeria.
Alasia D, Maduka O, Oputa VO, Orazulike N, Otokwala J, Osemwegie N, Ozah C, Inya JN, Omietimi S,
Ogan S, Ugboma H, Stanley P.
BACKGROUND: It is known that pregnant women are more susceptible to viral infectious diseases,
with an attendant risk of adverse foetal and maternal outcomes. The objective of this descriptive
study is to evaluate the epidemiologic and clinical pattern, as well as the obstetric and COVID-19
outcome among pregnant women seen at a tertiary hospital in Southern, Nigeria. METHODS: This
was a descriptive prospective study of all pregnant women seen and diagnosed with COVID-19
based on positive RT-PCR for SARS-COV-2, at the University of Port Harcourt Teaching Hospital, Port
Harcourt, Rivers State, Nigeria from March 2020 to August 2020. RESULTS: Seven (5.2%) pregnant
patients were diagnosed with COVID-19 out of 134 patients. The common presenting symptoms
were fever 4(57.1%), Productive cough 3 (42.9%), shortness of breath 3 (42.9%), myalgia 3 (42.9%),
rhinorrhoea 3 (42.9%), and anosmia 3 (42.9%). The majority (85.7%) of patients were in the second

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

and third trimesters at diagnosis. All deliveries occurred at term, with a mean gestational age of
38±0.82 weeks. Four patients (57.1%) had caesarean section (CS) deliveries for obstetric indications.
No adverse outcomes were recorded for mothers and babies with birth weight ranging from 2.5 to
3.5 Kg. No case fatality was recorded. CONCLUSION: In this study, pregnant women with COVID-19
did not have adverse maternal and foetal outcome. The pattern of symptoms and the presence of
severe disease also did not differ from what is observed in the general non-pregnant population.
The impact of COVID-19 on pregnancy is less severe when compared to other high consequence
viral infectious diseases.
PMID: 34919179

17. Am J Obstet Gynecol. 2021 Dec 16:S0002-9378(21)02688-0. doi: 10.1016/j.ajog.2021.12.024.
Online ahead of print.
Extracorporeal membrane oxygenation in pregnancy: a bridge to delivery and pulmonary recovery
for COVID-19-related severe respiratory failure.
Yin O, Richley M, Hadaya J, Mei J, Mok T, Fahim M, Pluym ID, Rao R, Martin C, Han CS, Benharesh P,
Afshar Y.
Extract: : This case series presents outcomes from the use of ECMO in pregnancy for acute
respiratory failure due to COVID-19. Our findings concur with the 2 other cases in the literature
DOI: 10.1016/j.ajog.2021.12.024 PMID: 34922925

19. Acta Endocrinol (Buchar). 2021 Apr-Jun;17(2):278-279. doi: 10.4183/aeb.2021.278.
RESUMING ADEQUATE SCREENING FOR GESTATIONAL DIABETES MELLITUS DURING THE ONGOING
COVID-19 PANDEMIC.
Panaitescu AM.
The novel coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on antenatal
care, forcing authorities to consider some medical services unessential in the pursuit of avoiding the
valid risk of patient contamination. The oral glucose tolerance test (OGTT) has been in some cases
overlooked for screening in pregnancy, with potential detrimental consequences in terms of not
diagnosing and treating gestational diabetes mellitus (GDM). The number of tests has dropped by
35% in 2020 in our hospital. We make a plea for resuming OGTT at 24-28 weeks gestation at least
for women considered at high risk.
DOI: 10.4183/aeb.2021.278 PMCID: PMC8665244 PMID: 34925581

19. J Obstet Gynaecol. 2021 Dec 20:1-5. doi: 10.1080/01443615.2021.1990232. Online ahead of
print.
Knowledge, perception, and protective measures of Turkish pregnant women towards COVID-19
pandemic and their effects on anxiety levels.
Demircan S, Demirçivi Bör E.
The aim of this study was to assess the knowledge of pregnant women regarding COVID-19 while
evaluating the ability of protective measures and their effects on the level of anxiety during this
pandemic. Using a prospective cross-sectional survey, 304 pregnant women attending prenatal
polyclinics were included in our study between June 10 and July 10, 2020. The mean age of
participants was 29.2 ± 6.0 years. The median gestational week was 25, ranging from 25 to 40 weeks
of gestation. There was no significant correlation between a gestational week or complicated
pregnancy and anxiety. Most participants possessed adequate knowledge and practical skills

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

concerning Covid-19. Women with adequate knowledge were found to be statistically related to a
high practice skills score and lower anxiety levels. Good knowledge levels are related to good
practice skills and lower anxiety levels. Although pregnancy is not currently considered a risk factor,
we believe it is vital to inform pregnant women about COVID-19 since they are naturally prone to
mental problems and respiratory infections during pregnancy. Therefore, healthcare professionals
should be encouraged to play an active role in this issue, replacing social media, a common source
of misinformation for this target demographic.Impact statementWhat is already known on this
subject? The prevalence of depression and anxiety symptoms among pregnant women increased
significantly after the declaration of human-to-human transmission and the increasingly rapid
spread of COVID-19.What do the results of this study add? Pregnant women with good knowledge
of COVID-19 were found to have adequate practice skills and lower anxiety levels.What are the
implications of these findings for clinical practice and/or further research? The act of informing
pregnant women is essential in reducing anxiety levels and taking more accurate measures against
COVID-19 because high levels of anxiety and depression can have long-term effects on maternal
and foetal health. To minimise the potential for information pollution on social media, health
professionals must play a more significant role in informing pregnant women and provide evidence-
based information to pregnant women about the effects of COVID-19 on pregnancy.
DOI: 10.1080/01443615.2021.1990232 PMID: 34927534

20. JMIR Infodemiology. 2021 Dec 7;1(1):e31774. doi: 10.2196/31774. eCollection 2021 Jan-Dec.
COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal
App-Embedded Survey.
Bohnhoff J, Davis A, Bruine de Bruin W, Krishnamurti T.
BACKGROUND: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals' choice of
specific protective health behaviors during pregnancy may be affected by information sources.
OBJECTIVE: This study examined the association between COVID-19 information sources and
engagement in protective health behaviors among a pregnant population in a large academic
medical system. METHODS: Pregnant patients completed an app-based questionnaire about their
sources of COVID-19 information and engagement in protective health behaviors. The voluntary
questionnaire was made available to patients using a pregnancy app as part of their routine
prenatal care between April 21 and November 27, 2020. RESULTS: In total, 637 pregnant responders
routinely accessed a median of 5 sources for COVID-19 information. The most cited source (79%)
was the Centers for Disease Control and Prevention (CDC). Self-reporting evidence-based protective
actions was relatively common, although 14% self-reported potentially harmful behaviors to avoid
COVID-19 infection. The CDC and other sources were positively associated with engaging in
protective behaviors while others (eg, US president Donald Trump) were negatively associated with
protective behaviors. Participation in protective behaviors was not associated with refraining from
potentially harmful behaviors (P=.93). Moreover, participation in protective behaviors decreased
(P=.03) and participation in potentially harmful actions increased (P=.001) over the course of the
pandemic. CONCLUSIONS: Pregnant patients were highly engaged in COVID-19-related information-
seeking and health behaviors. Clear, targeted, and regular communication from commonly accessed
health organizations about which actions may be harmful, in addition to which actions offer
protection, may offer needed support to the pregnant population.
DOI: 10.2196/31774 PMCID: PMC8664132 PMID: 34926994

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

21. Acta Paediatr. 2021 Dec 21. doi: 10.1111/apa.16229. Online ahead of print.
Preterm birth during the COVID-19 pandemic: parental experience.
Marino LV, Collaço N, Johnson MJ, Darlington AS.
DOI: 10.1111/apa.16229 PMID: 34932838

22. Clin Psychol Psychother. 2021 Dec 21. doi: 10.1002/cpp.2703. Online ahead of print.
Characterizing Worry Content and Impact in Pregnant and Postpartum Women with Anxiety
Disorders During COVID-19.
Green SM, Furtado M, Inness BE, Frey BN, McCabe RE.
The novel COVID pandemic has had a substantial impact on global mental health, including those
populations that are inherently vulnerable such as pregnant and postpartum (perinatal) women.
Anxiety disorders (ADs) are the most common mental health disorders during the perinatal period,
affecting up to 1 in 5 women. However, since the onset of the pandemic, up to 60% of perinatal
women are experiencing moderate to severe levels of anxiety. Given the substantial increase in
perinatal anxiety during COVID, we sought to better understand its phenomenology by
characterizing the collective worry content and impact of COVID using a content analysis. Eighty-
four treatment-seeking pregnant (n = 35) and postpartum (n = 49) women with a principal AD,
participated in this study between April and October 2020. In addition to completing questionnaire
measures and a semi-structured diagnostic interview, participants were asked to 1) describe their
top excessive and uncontrollable worries; 2) describe additional COVID and non-COVID worries; and
3) describe how the pandemic had affected their lives. All responses were given verbally and
transcribed verbatim by assessors. A content analysis led to the emergence of various COVID and
non-COVID worry and impact themes. One third of participant's principal worries were specific to
COVID, and 40% of COVID worries were specific to the perinatal context. Understanding the worry
content and impact of COVID may improve symptom detection and inform the development of
targeted treatment strategies to support the mental health needs of perinatal women with ADs
throughout the pandemic and thereafter. Understanding pandemic-specific worries is important for
perinatal symptom screening and may allow for the development of targeted treatment strategies
to address COVID-specific worries and impact.
DOI: 10.1002/cpp.2703 PMID: 34931741

23. HERD. 2021 Dec 21:19375867211065178. doi: 10.1177/19375867211065178. Online ahead of
print.
The Impact of Restrictive Family Presence Policies in Response to COVID-19 on Family Integrated
Care in the NICU: A Qualitative Study.
McCulloch H, Campbell-Yeo M, Richardson B, Dol J, Hundert A, Dorling J et al
OBJECTIVES: To conduct a needs assessment with families and their healthcare team to understand
the impact of restrictive family presence policies in the neonatal intensive care unit (NICU) in
response to COVID-19. BACKGROUND: In response to the COVID-19 pandemic, significant restrictive
family presence policies were instituted in most NICUs globally intended to protect infants, families,
and HCPs. However, knowledge on the impact of the stress of the pandemic and policies restricting
family presence in the NICU on vulnerable neonates and their families remains limited. METHODS:
Individuals were eligible to participate if they were a caregiver of an infant requiring NICU care or a
healthcare provider (HCP) in the NICU after March 1, 2020. Semi-structured interviews were
conducted using a virtual communication platform, and transcripts were analyzed using inductive

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

thematic qualitative content analysis. RESULTS: Twenty-three participants were interviewed (12
families and 11 HCPs). Three themes emerged: (1) successes (family-integrated care, use of
technology), (2) challenges (lack of standardized messaging and family engagement, impact on
parental wellbeing, institutional barriers, and virtual care), and (3) moving forward (responsive and
supportive leadership). CONCLUSIONS: Our findings highlight the significant impact of family
restrictions on the mental well-being of families, physical closeness with parents, and empathetic
stress to HCPs. Further study of potential long-term impact is warranted.
DOI: 10.1177/19375867211065178 PMID: 34931565

24. Int J Equity Health. 2021 Dec 20;20(1):260. doi: 10.1186/s12939-021-01588-y.
Breastfeeding media coverage and beliefs during the COVID-19 pandemic in Mexico: implications
for breastfeeding equity.
Vilar-Compte M, Gaitán-Rossi P, Rhodes EC, Cruz-Villalba V, Pérez-Escamilla R.
BACKGROUND: Because breastfeeding offers short- and long- term health benefits to mothers and
children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-
CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are
thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination.
WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19
pandemic, even among women with COVID-19; but conflicting practices have been adopted, which
could widen existing inequities in breastfeeding. This study aims to describe how information about
breastfeeding was communicated in Mexican media during the pandemic and assess Mexican
adults' beliefs regarding breastfeeding among mothers infected with COVID-19. METHODS: We
conducted a retrospective content analysis of media coverage on breastfeeding in Mexico between
March 1 and September 24, 2020, excluding advertisements. For the content analysis, we
performed both a sentiment analysis and an analysis based on strengths, weaknesses,
opportunities, and threats (SWOT) for breastfeeding promotion. Additionally, we conducted a
descriptive analysis of nationally representative data on adults' beliefs about breastfeeding from
the July 2020 round of the ENCOVID-19 survey in Mexico and stratified the results by gender, age,
and socioeconomic status. RESULTS: A total of 1014 publications on breastfeeding were identified on
the internet and television and in newspapers and magazines. Most information was published
during World Breastfeeding Week, celebrated in August. The sentiment analysis showed that 57.2%
of all information was classified as positive. The SWOT analysis indicated that most information
focused on current actions, messages, policies, or programs that enable breastfeeding (i.e.,
strengths) or those not currently in place but that may enable breastfeeding (i.e., opportunities) for
breastfeeding promotion. However, ENCOVID-19 survey results showed that 67.3% of adults living
in households with children under 3 years of age believe that mothers with COVID-19 should not
breastfeed, and 19.8% do not know whether these mothers should breastfeed. These beliefs
showed differences both by gender and by socioeconomic status. CONCLUSIONS: While the
Mexican government endorsed the recommendation on breastfeeding during the COVID-19
pandemic, communication was sporadic, inconstant and unequal across types of media. There was a
widespread notion that mothers with COVID-19 should not breastfeed and due to differences on
beliefs by socioeconomic status, health inequities could be exacerbated by increasing the risk of
poorer breastfeeding practices and preventing vulnerable groups from reaping the short and long-
term benefits of breastfeeding.
DOI: 10.1186/s12939-021-01588-y PMID: 34930273

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

25. JAMA Pediatr. 2021 Dec 21. doi: 10.1001/jamapediatrics.2021.5683. Online ahead of print.
Maternal and Neonatal SARS-CoV-2 Immunoglobulin G Antibody Levels at Delivery After Receipt of
the BNT162b2 Messenger RNA COVID-19 Vaccine During the Second Trimester of Pregnancy.
Kugelman N, Nahshon C, Shaked-Mishan P, Cohen N, Sher ML, Gruber M, Marom I, Zolotarevsky A,
Lavie O, Damti A, Zilberlicht A, Bardicef M, Kedar R.
IMPORTANCE: BNT162b2 messenger RNA (mRNA) COVID-19 vaccination in the third trimester was
found to be associated with a strong maternal humoral IgG response that crossed the placenta and
approached maternal titers in the newborn. OBJECTIVE: To evaluate maternal and neonatal SARS-
CoV-2 immunoglobulin G (IgG) antibody levels at birth after mRNA COVID-19 vaccination during the
second trimester of pregnancy. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort
study, conducted at a single medical center in Haifa, Israel, from May to July 2021, included women
with a singleton pregnancy over 24 weeks of gestation at least 7 days after receipt of their second
COVID-19 vaccine dose who were not known to be previously infected with COVID-19. EXPOSURES:
BNT162b2 (Pfizer/BioNTech) vaccination. MAIN OUTCOMES AND MEASURES: The primary outcomes
were SARS-CoV-2 IgG antibody titers measured in the parturient at admission and in the umbilical
cord blood within 30 minutes after delivery. Secondary outcomes were the correlation between
antibody titers, feto-maternal characteristics, maternal adverse effects after vaccination, and time
interval from vaccination to delivery. RESULTS: Antibody levels were measured for 129 women
(mean [SD] age, 31.9 [4.9] years) and 114 neonates, with 100% of the tests having positive results.
The mean (SD) gestational age at administration of the second vaccine dose was 24.9 (3.3) weeks.
Neonatal IgG titers were 2.6 times higher than maternal titers (median [range], 3315.7 [350.1-
17 643.5] AU/mL vs 1185.2 [146.6-32 415.1] AU/mL). A positive correlation was demonstrated
between maternal and neonatal antibodies (r = 0.92; 95% CI, 0.89-0.94). Multivariable analysis
revealed that for each week that passed since receipt of the second vaccine dose, maternal and
neonatal antibody levels changed by -10.9% (95% CI, -17.2% to -4.2%; P = .002) and -11.7% (95% CI, -
19.0 to -3.8%; P = .005), respectively. For each 1-year increase in the mother's age, maternal and
neonatal antibody levels changed by -3.1% (95% CI, -5.3% to -0.9%; P = .007) and -2.7% (95% CI, -
5.2% to -0.1%; P = .04), respectively. CONCLUSIONS AND RELEVANCE: In this cohort study, receipt of
the BNT162b2 mRNA COVID-19 vaccine during the second trimester of pregnancy was associated
with maternal and neonatal humoral responses, as reflected in maternal and neonatal SARS-CoV-2
IgG antibody levels measured after delivery. These findings support COVID-19 vaccination of
pregnant individuals during the second trimester to achieve maternal protection and newborn
safety during the pandemic.
DOI: 10.1001/jamapediatrics.2021.5683 PMID: 34932066

26. medRxiv. 2021 Dec 13:2021.12.09.21267423. doi: 10.1101/2021.12.09.21267423. Preprint.
Evaluation of transplacental transfer of mRNA vaccine products and functional antibodies during
pregnancy and early infancy.
Prahl M, Golan Y, Cassidy AG, Matsui Y, Li L, Alvarenga B, Chen H, Jigmeddagva U, Lin CY, Gonzalez
VJ, Chidboy MA, Warrier L, Buarpung S, Murtha AP, Flaherman VJ, Greene WC, Wu AHB, Lynch KL,
Rajan J, Gaw SL.
Studies are needed to evaluate the safety and effectiveness of mRNA SARS-CoV-2 vaccination during
pregnancy, and the levels of protection provided to their newborns through placental transfer of
antibodies. We evaluated the transplacental transfer of mRNA vaccine products and functional anti-

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

SARS-CoV-2 antibodies during pregnancy and early infancy in a cohort of 20 individuals vaccinated
during pregnancy. We found no evidence of mRNA vaccine products in maternal blood, placenta
tissue, or cord blood at delivery. However, we found time-dependent efficient transfer of IgG and
neutralizing antibodies to the neonate that persisted during early infancy. Additionally, using phage
immunoprecipitation sequencing, we found a vaccine-specific signature of SARS-CoV-2 Spike protein
epitope binding that is transplacentally transferred during pregnancy. In conclusion, products of
mRNA vaccines are not transferred to the fetus during pregnancy, however timing of vaccination
during pregnancy is critical to ensure transplacental transfer of protective antibodies during early
infancy.
DOI: 10.1101/2021.12.09.21267423 PMCID: PMC8687468 PMID: 34931197

27. PLoS One. 2021 Dec 21;16(12):e0261492. doi: 10.1371/journal.pone.0261492. eCollection 2021.
Maternal mortality associated with COVID-19 in Brazil in 2020 and 2021: Comparison with non-
pregnant women and men.
Gonçalves BMM, Franco RPV, Rodrigues AS.
OBJECTIVE: Mortality rates of pregnant and postpartum women grew in the second COVID-19
pandemic year. Our objective is to understand this phenomenon to avoid further deaths. METHODS:
We collected data from SIVEP-Gripe, a nationwide Brazilian database containing surveillance data
on all severe acute respiratory syndrome caused by COVID-19, between the first notified case
(February 2020) until the 17th epidemiological week of 2021. We stratified patients into maternal
women (which includes pregnant and postpartum women), non-maternal women and men and
divided them by time of diagnosis in two periods: first period (February to December 2020) and
second period (the first 17 epidemiological weeks of 2021 before pregnant and postpartum women
were vaccinated). RESULTS: During the second period, all patients had higher risk of presenting
severe COVID-19 cases, but the maternal population was at a higher risk of death (OR of 2.60 CI
95%: 2.28-2.97)-almost double the risk of the two other groups. Maternal women also had a higher
risk of needing intensive care, intubation and of presenting desaturation in the second period.
Importantly, maternal women presented fewer comorbidities than other patient groups, suggesting
that pregnancy and postpartum can be an important risk factor associated with severe COVID-19.
CONCLUSION: Our results suggest that the Gama variant, which has been related to greater
virulence, transmissibility and mortality rates leads to more severe cases of COVID-19 for pregnant
and postpartum women.
DOI: 10.1371/journal.pone.0261492 PMID: 34932589
Conflict of interest statement: The authors have declared that no competing interests exist.

28. Rev Bras Ginecol Obstet. 2021 Dec;43(12):932-939. doi: 10.1055/s-0041-1740234. Epub 2021
Dec 21.
Increased Risk for Maternal Anxiety during the COVID-19 Outbreak in Brazil among Pregnant
Women without Comorbidities.
Nomura RMY, Ubinha ACF, Tavares IP, Costa ML, Opperman MLDR, Brock MF, Trapani A Jr, Damásio
LCVDC, Reis NSV, Borges VTM, Zaconeta ACM, Araujo ACPF, Ruano R.
OBJECTIVE: To study maternal anxiety in pregnant women without comorbidities in the context of
the COVID-19 outbreak in Brazil and to study maternal knowledge and concerns about the
pandemic. METHODS: This is a secondary analysis from a national multicenter cross-sectional
study performed in 10 cities, from June to August, 2020, in Brazil. Interviewed postpartum women,

Coronavirus infection in pregnancy. Update Tuesday 11 January 2022

without medical or obstetrical comorbidities, were included in the present subanalysis. A structured
questionnaire and the Beck Anxiety Inventory (BAI) were applied. RESULTS: Out of the 1,662
women, 763 (45.9%) met the criteria for the current analysis and 16.1% presented with moderate
and 11.5% with severe maternal anxiety. Moderate or severe maternal anxiety was associated with
high school education (odds ratio [OR]:1.58; 95% confidence interval [CI]:1.04-2.40). The protective
factor was cohabiting with a partner (OR: 0.46; 95%CI: 0.29-0.73). There was a positive correlation
between the total BAI score and receiving information about care in the pandemic (rpartial 0.15;
p < 0.001); concern about vertical transmission of COVID-19 (rpartial 0.10; p = 0.01); receiving
information about breastfeeding (rpartial 0.08; p = 0.03); concerns about prenatal care (rpartial
0.10; p = 0.01), and concerns about the baby contracting COVID-19 (rpartial 0.11; p = 0.004). The
correlation was negative in the following aspects: self-confidence in protecting from COVID-19
(rpartial 0.08; p = 0.04), having learned (rpartial 0.09; p = 0.01) and self-confidence in breastfeeding
(rpartial 0.22; p < 0.001) in the context of the pandemic. CONCLUSION: The anxiety of pregnant
women without medical or obstetrical comorbidities was associated to high school educational level
and not living with a partner during the COVID-19 pandemic. Self-confidence in protecting against
COVID-19 and knowledge about breastfeeding care during the pandemic reduced maternal anxiety.
DOI: 10.1055/s-0041-1740234 PMID: 34933387

29. Women Health. 2021 Dec 21:1-13. doi: 10.1080/03630242.2021.2014020. Online ahead of print.
Association Between Awareness, Perceived Severity, and Behavioral Control of COVID -19 With Self-
Care and Anxiety in Pregnancy: A Cross-Sectional Study.
Khazaeian S, Khazaeian S, Fathnezhad-Kazemi A.
COVID-19 pandemic has caused a tidal wave of anxiety and stress among Iranians, especially
pregnant women. This study aimed to assess the association between knowledge, perceived
severity, and controllability of COVID-19 with self-care and health anxiety specially in pregnancy.
This cross-sectional study was performed on 440 pregnant women. Data were collected using
demographic-obstetrics characteristics, as well as the questionnaires of knowledge, perceived
severity, and perceived controllability of the COVID-19, health anxiety, and self-care. Self-care was
positively correlated with knowledge, perceived severity, and perceived controllability of the COVID-
19. Nonetheless, health anxiety had a significant and inverse association with knowledge and
perceived controllability, while there was a positive and significant correlation between perceived
severity and health anxiety. Based on linear regression, three variables of knowledge, perceived
severity, and perceived controllability of the COVID-19 could explain 46.3 and 17.5% of variations in
self-care and health anxiety, respectively. It is suggested that due to the critical importance of
prenatal care, managers, and health-care providers promote the use of such methods as telehealth
and home-based caregivers, especially in areas with inadequate access to health care. So, the
pregnant women can be followed up and receive medical care devoid of any stress and anxiety.
DOI: 10.1080/03630242.2021.2014020 PMID: 34933664

30. Am J Obstet Gynecol. 2021 Dec 20:S0002-9378(21)02696-X. doi: 10.1016/j.ajog.2021.12.032.
Online ahead of print.
Diabetes mellitus, maternal adiposity, and insulin-dependent gestational diabetes are associated
with Covid-19 in pregnancy: The INTERCOVID Study.
Eskenazi B, Rauch S, Iurlaro E, Gunier RB, Rego A, Gravett MG, et al.