Aga Khan University, Karachi, Pakistan.
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
BJOG. 2023 Nov;130 Suppl 3(Suppl 3):134-139. doi: 10.1111/1471-0528.17610. Epub 2023 Aug 2.
With the paucity of data available regarding COVID-19 in pregnancy in low- and middle-income countries (LMICs), near the start of the pandemic, the Global Network for Women's and Children's Health Research, funded by the National Institute of Child Health and Human Development (NICHD), initiated four separate studies to better understand the impact of the COVID-19 pandemic in eight LMIC sites. These sites included: four in Asia, in Bangladesh, India (two sites) and Pakistan; three in Africa, in the Democratic Republic of the Congo (DRC), Kenya and Zambia; and one in Central America, in Guatemala. The first study evaluated changes in health service utilisation; the second study evaluated knowledge, attitudes and practices of pregnant women in relationship to COVID-19 in pregnancy; the third study evaluated knowledge, attitude and practices related to COVID-19 vaccination in pregnancy; and the fourth study, using antibody status at delivery, evaluated changes in antibody status over time in each of the sites and the relationship of antibody positivity with various pregnancy outcomes. Across the Global Network, in the first year of the study there was little reduction in health care utilisation and no apparent change in pregnancy outcomes. Knowledge related to COVID-19 was highly variable across the sites but was generally poor. Vaccination rates among pregnant women in the Global Network were very low, and were considerably lower than the vaccination rates reported for the countries as a whole. Knowledge regarding vaccines was generally poor and varied widely. Most women did not believe the vaccines were safe or effective, but slightly more than half would accept the vaccine if offered. Based on antibody positivity, the rates of COVID-19 infection increased substantially in each of the sites over the course of the pandemic. Most pregnancy outcomes were not worse in women who were infected with COVID-19 during their pregnancies. We interpret the absence of an increase in adverse outcomes in women infected with COVID-19 to the fact that in the populations studied, most COVID-19 infections were either asymptomatic or were relatively mild.
由于缺乏关于低收入和中等收入国家（LMICs）中 COVID-19 妊娠的数据，在大流行开始时，由美国国立儿童健康与人类发展研究所（NICHD）资助的全球妇女和儿童健康研究网络在八个 LMIC 地点启动了四项独立的研究，以更好地了解 COVID-19 大流行的影响。这些地点包括：亚洲的四个，孟加拉国、印度（两个地点）和巴基斯坦；非洲的三个，刚果民主共和国（DRC）、肯尼亚和赞比亚；以及中美洲的一个，危地马拉。第一项研究评估了卫生服务利用的变化；第二项研究评估了与 COVID-19 妊娠相关的孕妇的知识、态度和做法；第三项研究评估了与 COVID-19 妊娠疫苗接种相关的知识、态度和做法；第四项研究使用分娩时的抗体状态，评估了每个地点的抗体状态随时间的变化以及抗体阳性与各种妊娠结局的关系。在全球网络中，在研究的第一年，医疗保健利用率几乎没有减少，妊娠结局也没有明显变化。与 COVID-19 相关的知识在各地点差异很大，但总体上很差。全球网络中孕妇的疫苗接种率非常低，远低于整个国家的疫苗接种率。关于疫苗的知识普遍较差，差异很大。大多数妇女不相信疫苗是安全有效的，但如果提供疫苗，略多于一半的妇女会接受。根据抗体阳性，在大流行期间，每个地点的 COVID-19 感染率都大幅上升。在感染 COVID-19 的孕妇中，大多数妊娠结局并没有更糟。我们将在感染 COVID-19 的孕妇中没有增加不良结局的原因解释为，在所研究的人群中，大多数 COVID-19 感染要么是无症状的，要么是相对轻微的。
