新冠疫情期间全球孕产妇护理服务的变化：一项系统综述与荟萃分析。

Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis.

作者信息

Townsend Rosemary, Chmielewska Barbara, Barratt Imogen, Kalafat Erkan, van der Meulen Jan, Gurol-Urganci Ipek, O'Brien Pat, Morris Edward, Draycott Tim, Thangaratinam Shakila, Doare Kirsty Le, Ladhani Shamez, von Dadelszen Peter, Magee Laura A, Khalil Asma

机构信息

Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.

Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom.

出版信息

EClinicalMedicine. 2021 Jun 19;37:100947. doi: 10.1016/j.eclinm.2021.100947. eCollection 2021 Jul.

DOI:10.1016/j.eclinm.2021.100947

PMID:34195576

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8233134/

Abstract

BACKGROUND

The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic.

METHODS

We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI).

FINDINGS

Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486-0776, <00001, I=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602-0911, = 00046, I=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762-2794, <00001, I=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118-1319, <00001, I=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407-0690, <00001, I=00%). There was no significant change in intrapartum epidural use ( = 00896) or the use of GA for elective CS ( = 079).

INTERPRETATION

Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.

摘要

背景

新冠疫情对全球医疗系统产生了深远影响，孕产妇和胎儿不良结局令人担忧地增加。我们旨在评估新冠疫情期间孕产妇医疗服务的提供情况以及孕妇寻求医疗服务的变化。

方法

我们对关于疫情对孕产妇服务的提供、可及性和就诊率影响的研究进行了系统评价和荟萃分析（CRD42020211753）。我们按照PRISMA指南，于2020年1月1日至2021年4月17日在MEDLINE和Embase中检索对照观察性研究和研究信函，这些研究报告了比较新冠疫情期间与疫情前孕产妇寻求医疗服务和医疗服务提供情况的原始数据。病例报告和系列、系统文献综述以及预印本研究被排除。对两项或更多研究中报告的可比结局进行荟萃分析。使用随机效应荟萃分析合并数据，采用风险比（RR）或发病率比（IRR）以及95%置信区间（CI）。

结果

在识别出的4743条引文中，56条纳入系统评价，21条纳入荟萃分析。我们发现，每周产前检查次数（IRR 0.614，95% CI 0.486 - 0.776，<0.0001，I² = 54.6%）和非预约护理就诊次数（IRR 0.741，95% CI 0.602 - 0.911，P = 0.0046，I² = 0.0%）显著减少，虚拟或远程产前护理（IRR 46.56，95% CI 7.762 - 279.4，<0.0001，I² = 90.6%）和非预约就诊者住院率（RR 1.214，95% CI 1.118 - 1.319，<0.0001，I² = 0.0%）增加。1类剖宫产（CS）中全身麻醉（GA）的使用减少（RR 0.529，95% CI 0.407 - 0.690，<0.0001，I² = 0.0%）。产时硬膜外麻醉的使用（P = 0.0896）或择期剖宫产中GA的使用（P = 0.79）无显著变化。