8 research outputs found
Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study
Objective
To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection.
Methods
Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant.
Results
Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021.
Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants.
Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering â„ 2 weeks after infection (95 % CI 0.3â1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies.
Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2.
Conclusions
Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering â„ 2 weeks after infection. We suggest that cliniciansâ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection
In their own words:abused children's perceptions of care provided by their birth parents and foster carers
There are many theories as to what form good-quality parenting should take. Attachment theory emphasises providing a secure base through sensitive responding at times of emotional need. Social learning theory outlines the need for firm limits in addition to the promotion of positive interchanges. These theories are supported by numerous quantitative research studies investigating which parenting styles are associated with better outcomes for children in general and for those with additional needs due to prior abuse or emotional and behavioural difficulties. However, there have been few systematic qualitative studies asking children themselves about their care experiences, particularly with abused or neglected children who are now safe in foster care. Using an adapted version of the Child Attachment Interview, we interviewed 12 children aged 13 to 15 years, who had been taken into care due to abuse and fostered for at least six months, with the aim of exploring their attachment to their birth parents, foster carers and attitudes to different parenting styles in general. Transcripts were analysed using the qualitative technique of Interpretative Phenomenological Analysis. Overall, the abused children spoke more positively of foster care than the care provided by their birth parents. Parenting techniques mentioned in positive terms were a clear disciplinary style, setting firm boundaries, nurturing care, enjoyable time together and mentoring further development. Negative themes included angry or inconsistent disciplinary styles, failure to set appropriate boundaries, rejecting and neglectful behaviour, a lack of joint activities, a chaotic lifestyle and parental illness. This study provides a unique perspective on parenting, as the children studied have experienced both poor parenting and reasonably normal care. The findings are applicable to care provided for fostered children and could be relevant to the upbringing of children in general. </jats:p
Pregnancy and neonatal outcomes of COVID -19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries
Objective
Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARSâCoVâ2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVIDâ19 (PANâCOVID) study and the American Academy of Pediatrics (AAP) Section on NeonatalâPerinatal Medicine (SONPM) National Perinatal COVIDâ19 Registry.
Methods
This was an analysis of data from the PANâCOVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARSâCoVâ2 infection at any stage in pregnancy, and the AAPâSONPM National Perinatal COVIDâ19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARSâCoVâ2 from 14âdays before delivery to 3âdays after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PANâCOVID results are presented overall for pregnancies with suspected or confirmed SARSâCoVâ2 infection and separately in those with confirmed infection.
Results
We report on 4005 pregnant women with suspected or confirmed SARSâCoVâ2 infection (1606 from PANâCOVID and 2399 from AAPâSONPM). For obstetric outcomes, in PANâCOVID overall and in those with confirmed infection in PANâCOVID and AAPâSONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (<â37âweeks' gestation) in 12.0% of all women in PANâCOVID, in 16.1% of those women with confirmed infection in PANâCOVID and in 15.7% of women in AAPâSONPM. Extreme preterm delivery (<â27âweeks' gestation) occurred in 0.5% of cases in PANâCOVID and 0.3% in AAPâSONPM. Neonatal SARSâCoVâ2 infection was reported in 0.9% of all deliveries in PANâCOVID overall, in 2.0% in those with confirmed infection in PANâCOVID and in 1.8% in AAPâSONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a smallâforâgestationalâage (SGA) neonate were 8.2% in PANâCOVID overall, 9.7% in those with confirmed infection and 9.6% in AAPâSONPM. Mean gestationalâageâadjusted birthâweight Zâscores were â0.03 in PANâCOVID and â0.18 in AAPâSONPM.
Conclusions
The findings from the UK and USA registries of pregnancies with SARSâCoVâ2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PANâCOVID study, although not in the AAPâSONPM study. The data presented support strong guidance for enhanced precautions to prevent SARSâCoVâ2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy. Copyright © 2021 ISUOG. Published by John Wiley & Sons Ltd