A call for science preparedness for pregnant women during public health emergencies

Pregnant women & vaccines against emerging epidemic threats: Ethics guidance for preparedness, research, and response

Zika virus, influenza, and Ebola have called attention to the ways in which infectious disease outbreaks can severely - and at times uniquely - affect the health interests of pregnant women and their offspring. These examples also highlight the critical need to proactively consider pregnant women and their offspring in vaccine research and response efforts to combat emerging and re-emerging infectious diseases. Historically, pregnant women and their offspring have been largely excluded from research agendas and investment strategies for vaccines against epidemic threats, which in turn can lead to exclusion from future vaccine campaigns amidst outbreaks. This state of affairs is profoundly unjust to pregnant women and their offspring, and deeply problematic from the standpoint of public health. To ensure that the needs of pregnant women and their offspring are fairly addressed, new approaches to public health preparedness, vaccine research and development, and vaccine delivery are required. This Guidance offers 22 concrete recommendations that provide a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance was developed by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group - a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy - in consultation with a variety of external experts and stakeholders.

Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: a cross-sectional study

OBJECTIVES

To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak.

DESIGN

Cross-sectional study.

SETTING

Two cities in China--Wuhan (epicentre) and Chongqing (a less affected city).

POPULATION

A total of 1947 pregnant women.

METHODS

We collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID-19 (using a self-constructed five-point scale). The Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision-making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis.

MAIN OUTCOME MEASURES

Anxiety status and its influencing factors. Obstetric decision-making.

RESULTS

Differences were observed between cities in some background characteristics and women's attitudes towards COVID-19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city-based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding.

CONCLUSIONS

The outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision-making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics.

TWEETABLE ABSTRACT

The COVID-19 outbreak increased pregnant women's anxiety and affected their decision-making.

Maternity care providers' involvement in research

OBJECTIVE

Despite the widely acknowledged importance of research for improving patient care and outcomes, research in pregnant women is lacking. Many challenges innate to conducting research in pregnant women may discourage maternity care providers from engaging in research. Thus, the current study assessed maternity care providers' involvement in research, their perception of the relevance of research, as well as facilitators and barriers to participating in research.

STUDY DESIGN

A total sample of 145 maternity care providers were recruited from a large tertiary-referral university-based teaching maternity hospital. Maternity care providers included, midwives, nurses, sonographers, consultant obstetricians, and non-consultant hospital doctors. Participants completed a cross-sectional survey between May and October 2018.

RESULTS

The present study found that overall, 49.7% of maternity care providers who participated reported never taking part in conducting research. Medical staff were more likely to report being given the opportunity and to have ever conducted research compared to midwives (p < 0.05). Participants agreed that research is important to maintain the quality of care provided to women (Mean = 4.86/5 in agreeance). However, medical staff were more likely to report understanding research methodology and feeling competent to undertake research compared to midwives (Mean = 3.85 v 3.28, p = 0.002; Mean = 3.56 v 2.60, p < 0.05).

CONCLUSION

The findings suggest future strategies aimed at increased opportunities and additional research training will likely support maternity care providers', specifically midwives, involvement in conducting effective research studies in pregnancy. Such actions hold the potential to contribute research evidence lacking in pregnant women necessary to provide appropriate maternity care.

Influenza response planning for the centers of excellence for influenza research and surveillance: Science preparedness for enhancing global health security

BACKGROUND

The Centers of Excellence for Influenza Research and Surveillance (CEIRS) network, funded by the US National Institutes of Health, has been operational since 2007 and is tasked with conducting research to improve understanding of influenza viruses. Recently, CEIRS developed an Influenza Response Plan (IRP) to improve science preparedness for the network.

METHODS

Development of the IRP involved a collaborative process between project staff, CEIRS center directors or their designees, and NIAID CEIRS leadership (referred to as the Pandemic Planning Advisory Committee [PPAC]). Project staff identified and summarized the response capabilities of each center and then worked with the PPAC to identify and rank research priorities for an emergency response using a modified Delphi method.

RESULTS

Key elements of the response plan include tables of response capabilities for each CEIRS center, a framework that outlines and ranks research priorities for CEIRS during an emergency situation, and an operational strategy for executing the research priorities.

CONCLUSIONS

The CEIRS IRP highlights the importance of enhancing science preparedness in advance of an influenza pandemic or other influenza-related zoonotic incident to ensure that research can be carried out expeditiously and effectively in emergency situations and to improve global health security.

Simulation of a Spontaneous Vaginal Delivery and Neonatal Resuscitation in a Biocontainment Unit

This article describes a large-scale scenario designed to test the capabilities of a US biocontainment unit to manage a pregnant woman infected with a high-consequence pathogen, and to care for a newborn following labor and spontaneous vaginal delivery. We created and executed a multidisciplinary functional exercise with simulation to test the ability of the Johns Hopkins Hospital biocontainment unit (BCU) to manage a pregnant patient in labor with an unknown respiratory illness and to deliver and stabilize her neonate. The BCU Exercise and Drill Committee established drill objectives and executed the exercise in partnership with the Johns Hopkins Simulation Center in accordance with Homeland Security and Exercise Program guidelines. Exercise objectives were assessed by after-action reporting and objective measurements to detect contamination, using a fluorescent marker to simulate biohazardous fluids that would be encountered in a typical labor scenario. The immediate objectives of the drill were accomplished, with stabilization of the mother and successful delivery and resuscitation of her newborn. There was no evidence of contamination when drill participants were inspected under ultraviolet light at the end of the exercise. Simulation optimizes teamwork, communication, and safety, which are integral to the multidisciplinary care of the maternal-fetal unit infected, or at risk of infection, with a high-consequence pathogen. Lessons learned from this drill regarding patient transportation, safety, and obstetric and neonatal considerations will inform future exercises and protocols and will assist other centers in preparing to care for pregnant patients under containment conditions.

Preparing for biological threats: Addressing the needs of pregnant women

Intentional release of infectious agents and biological weapons to cause illness and death has the potential to greatly impact pregnant women and their fetuses. We review what is known about the maternal and fetal effects of seven biological threats: Bacillus anthracis (anthrax); variola virus (smallpox); Clostridium botulinum toxin (botulism); Burkholderia mallei (glanders) and Burkholderia pseudomallei (melioidosis); Yersinia pestis (plague); Francisella tularensis (tularemia); and Rickettsia prowazekii (typhus). Evaluating the potential maternal, fetal, and infant consequences of an intentional release of an infectious agent requires an assessment of several key issues: (1) are pregnant women more susceptible to infection or illness compared to the general population?; (2) are pregnant women at increased risk for severe illness, morbidity, and mortality compared to the general population?; (3) does infection or illness during pregnancy place women, the fetus, or the infant at increased risk for adverse outcomes and how does this affect clinical management?; and (4) are the medical countermeasures recommended for the general population safe and effective during pregnancy? These issues help frame national guidance for the care of pregnant women during an intentional release of a biological threat. Birth Defects Research 109:391-398, 2017.© 2017 Wiley Periodicals, Inc.