COVID-19 and maternal and perinatal outcomes
Authors: Zeus Aranda, Isabel R Fulcher, Bethany Hedt-Gauthier, Jean Claude Mugunga, Thierry Binde
Journal: The Lancet Global Health (2021)

In their systematic review and meta-analysis, Barbara Chmielewska and colleagues1Chmielewska B Barratt I Townsend R et al.Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis.Lancet Glob Health. 2021; 9: e759-e772Summary Full Text Full Text PDF PubMed Scopus (627) Google Scholar note significant increases in maternal death and stillbirths during the COVID-19 pandemic. They link these outcomes to reduced access to maternal health services, stating that in low-income and middle-income countries (LMICs), remote antenatal care appointments are less feasible because of technological shortcomings in these countries. As the authors note, the experiences and outcomes in different countries have varied widely during the pandemic and their review only included a few papers from LMICs. For this reason, we find it crucial to share our experiences at our six Partners In Health project sites in Haiti, Lesotho, Liberia, Malawi, Mexico, and Sierra Leone. Since May, 2020, we have continuously monitored health services using the model described by Fulcher and colleagues.2Fulcher IR Boley EJ Gopaluni A et al.Syndromic surveillance using monthly aggregate health systems information data: methods with application to COVID-19 in Liberia.Int J Epidemiol. 2021; (published online May 31.)https://doi.org/10.1093/ije/dyab094Crossref PubMed Scopus (10) Google Scholar In four sites (Haiti, Liberia, Mexico, and Sierra Leone), we did observe moderate declines in antenatal care and facility-based deliveries, but in most cases services rebounded back to what was expected by mid-2020. In the other sites, we did not observe any significant decline in maternal health services during the pandemic. Our experience sheds light on health services in LMICs during the pandemic, which are often under-represented in the literature. Importantly, although access to technology might be a barrier at some of our programme sites, many non-technological solutions were implemented to ensure the continuity of maternal health services. First, it is important to note that lockdowns have differed from country to country. Our programme sites in Lesotho, Malawi, and Mexico reported fewer mobility constraints than those in Haiti, Liberia, and Sierra Leone. Second, programmes have adopted home-grown solutions to maintain access to care, and each country produced a different adaptation. Lesotho, Malawi, and Mexico adopted strategies to safely maintain community health worker programmes, which have been previously shown to be a key factor in the uptake of maternal services,3Kachimanga C Dunbar EL Watson S et al.Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi.BMC Pregnancy Childbirth. 2020; 20: 22Crossref PubMed Scopus (14) Google Scholar despite the pandemic restrictions. Sierra Leone focused on communication campaigns to inform the population about COVID-19 infection and the importance of maintaining other health services. Liberia promoted providers' capacity building on the safe provision of maternal health care during COVID-19 and strengthening their supply chain, whereas Haiti restructured clinic spaces so that pregnant women could still receive care at the same time as distancing at the facility. Importantly, all sites benefited from long-standing and close collaboration between Partners In Health and public health systems to ensure the continuity of essential health services, using lessons learned by the organisation through its experience in other infectious disease outbreaks in the past. The COVID-19 pandemic has affected every country, but every country has been affected differently. We hope that this Correspondence adds perspective on the effect of the pandemic on maternal health service use in LMICs, and identifies the strategies adopted by sites to maintain services during this health emergency. We declare no competing interests. COVID-19 and maternal and perinatal outcomesThe International Stillbirth Alliance welcomes the systematic review by Barbara Chmielewska and colleagues (June, 2021),1 particularly its inclusion of stillbirths, because these are often missing from the global agenda. The 28% increased pooled odds in reported stillbirth during the COVID-19 pandemic is concerning. We wish to highlight some data limitations that will impede action to reduce these preventable deaths. Full-Text PDF Open AccessCOVID-19 and maternal and perinatal outcomesWe echo the call made by Barbara Chmielewska and colleagues1 for better data to capture the effects of COVID-19 on maternal outcomes. Our own systematic review (PROSPERO CRD42020219889, in progress) specifically focuses on the amount of maternal mortality as measured by the maternal mortality ratio, and our findings so far concur with their conclusion of an increase, but we advise caution in the interpretation of this trend. Full-Text PDF Open AccessCOVID-19 and maternal and perinatal outcomesWe commend Barbara Chmielewska and colleagues1 for undertaking a timely and comprehensive systematic review on a topic of pivotal global health importance. The increase in maternal mortality and stillbirths during the COVID-19 pandemic, particularly in low-resource settings, is of considerable concern. Although a substantial number of studies were collated, many have a substantial risk of bias. For example, of the 18 included studies assessing the link between the pandemic and preterm birth, only two had a quasi-experimental design, many did not have detailed methods, few adjusted for potential confounding factors, and only three included population-level data. Full-Text PDF Open AccessCOVID-19 and maternal and perinatal outcomes – Authors' replyWe thank all correspondents for their interest in our report.1 A common point is the need for better quality studies in this area, which we wholeheartedly echo. Quality and consistency in reporting, particularly of key outcomes such as maternal death, stillbirth, and preterm birth, are essential if we are to tackle these scourges of maternity care. Full-Text PDF Open AccessEffects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysisGlobal maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. Some outcomes show considerable disparity between high-resource and low-resource settings. There is an urgent need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises. Full-Text PDF Open Access