COVID-19 ‘led to rise in stillbirths, maternal deaths’

(SciDev.Net) - Immediate action is required to preserve safe maternity care worldwide, as the COVID-19 pandemic worsens global maternal and perinatal outcomes, especially in low- and middle- income countries (LMICs), a study warns.

The research, published in The Lancet Global Health (31 March), found increases in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression after analysing data on more than 6 million pregnancies. The review looked at 40 studies from 17 countries, conducted between 1 January, 2020 and 8 January, 2021.

Asma Khalil, a professor of obstetrics and maternal fetal medicine at St George’s University Hospital, London, and lead author of the study, said: “Disruption to services, nationwide lockdowns, and fear of attending healthcare facilities expose how the adverse effects of COVID-19 imply health consequences that extend beyond the deaths and disease caused by the virus itself.”

Although findings varied by country, analysis of pooled data showed that during the pandemic, and across all reviewed studies, stillbirth and maternal mortality rates increased by about one-third, while women requiring surgery for ectopic pregnancies grew almost six-fold.

Outcomes were worse in LMICs than in high-income countries, researchers say.

Khalil told SciDev.Net by email that the increase in surgery for ectopic pregnancies was most likely caused by delayed consultations for pregnant women, who may be reluctant to attend hospital or have difficulties getting there amid COVID-19 restrictions. If discovered early, ectopic pregnancies can typically be treated with medication.

“The same relationship was not observed in other complications, such as gestational diabetes or pregnancy disorders linked to high blood pressure, as these are often not an acute or emergency condition like ectopic pregnancy which could lead to bleeding inside the pregnant woman’s abdomen and could potentially lead to death when it is not urgently treated,” Khalil added. “Gestational diabetes is often diagnosed in the later third of the pregnancy and is usually not dealt with as an emergency.” The researchers also found a 10 per cent drop in preterm birth in high-income countries (HICs) – which was not seen in LMICs. This is likely caused by changes to behaviour during lockdowns resulting in a lower chance of women going into early or premature labour, Khalil explained.

However, mental health outcomes have worsened during the pandemic, the review found. Ten of the studies analysed included data on maternal mental health, of which six reported an increase in postnatal depression, maternal anxiety, or both.

Desirée Díaz Jiménez, a midwife with eight years of experience, who works in Malaga’s Maternal and Child Hospital, Spain, said: “In daily practice, we don’t see obstetric changes, but we do see repercussions at the psychological level. Mothers suffer a great emotional impact as during their stay at the hospital they may only be accompanied by one person, without family visits.”

Díaz Jiménez says the care provided today is somewhat different to that provided before the pandemic. Interactions between mothers and hospital staff are more distant, and if the pregnant woman has COVID-19, isolation may carry an element of social stigma.

Jogender Kumar and Praveen Kumar, from the Postgraduate Institute of Medical Education and Research in Chandigarh, India, welcome the way the study highlights disparities in healthcare within and across countries. However, they warn – in a comment article in the same edition of The Lancet Global Health – that most of the studies included in the review were single centre and may not be a true representation of community-level data. Blanca Murillo Ortiz, from the clinical epidemiology research unit of the Mexican Social Security Institute, believes that the diversity of health systems and safety measures adopted to face the pandemic make the review analysis controversial.

The investigation also presented fewer studies on LMICs compared to HICs, with Latin America only represented by two reports, from Mexico and Brazil.

Republished from SciDev.Net. You can read the full report here: https://bit.ly/3wKrnCE

cannot see their period in a hygienic and ethical way because they cannot afford pads.

“It is a needed project, and it would impact the lives of many immensely and I commend her for it…,” she said of the initiative, adding that her organisation would be helping with educational content.

While she topped President’s College in both of the years she was there, her grades were still not good enough for her to get into medical school immediately. She first had to complete a year of biology, which she said in retrospect was a blessing in disguise as it helped to prepare her for the five years in medical school.

“I had a very fun childhood. I hadn’t much but I didn’t know that back then because I was very, very happy. I grew up with my parents in a little house…and yeah, we didn’t have light for ten years. We didn’t have TV. And we had no water in the yard. However, all my basic needs were met. I had shelter. I had food and they clothed me. And I had love,” she said of her childhood.

Curtis and Shallon Douglas, according to Dr Pat, raised a champion daughter who still lives with them at the age of 30. This, she said, is because she is being financially savvy, and she will move when she has a home, and she can save for the future.

Her parents, she said, are very humble, and while they have to be proud of her they do not overtly display this. She shared that her parents invested in her as while she might not have had the fancy clothes and shoes (she was laughed at church because of the clothes she wore), she never had the need to beg for a textbook; this was always provided by her parents and she attended every lesson.

Her parents did not complete secondary school, but her father is a skilled man and he sat with her and helped her with long division.

“And my mother, even though she could not understand what is in my book, she would say ‘Pat what you did in school today? Let me see the book’ and she would box through it. That was support and I appreciated it…,” she said.

She described her parents as her “strength” and “rock” and while she loves her mother, her father has a special place in her heart, and she refers to him as “my boy”.

She added, “My father is so supportive. My father is my number one cheerleader. As big as I am, when I get home, my dad takes my shoes inside… maybe I am spoilt.”

Her father also ensures that her food is ready even though her mother tells him from to time that she is a big girl and could be married at her age.

She recalled that during her secondary school examinations, her dad woke her up early in the morning and stayed up with her. He “would make my Milo… and he would take the Trisco biscuits, butter it with nut butter and he would give it to me.

“Anything I want to do my father would support me. My mother would say you want to do everything. But my father would say ‘no leh she do it, she young. Make hay while the sun shines.’

“All respect and love to my father. I love my mother too, but daddy is the man.”

A member of the Golden Grove Seventh-Day Adventist church, Dr Pat said the church was also instrumental in her becoming the women she is today. Apart from the spiritual grounding, it also provided the platform for her to become a leader while the Pathfinder Club provided the needed discipline.

An African print enthusiast who loves headwraps, on any given day Dr Pat can be seen with an elegant headwrap and sometimes a matching outfit. She has been wrapping consistently since 2015 and for her it is more than a fashion statement; the headwrap makes her feel more confident and powerful and connects her to her roots.

“When I wear this [she points to her headwrap] I represent Africa… I normally say my roots are in Africa, my stems and branches are in Guyana and my fruits are international. I love my country, I am very patriotic,” she said.

The young doctor challenges young people to dream big and beyond their circumstances. She encourages them to write their plans down and take decisive steps to make them a reality. As a Christian she encourages them to pray as well and to make decisions not only for now, but that would benefit them in the future.