Implementation of universal testing for severe acute respiratory syndrome coronavirus 2 in pregnant women with intended admission for delivery

Universal Testing Policy for COVID-19 in Pregnancy: A Systematic Review

Background

The coronavirus disease (COVID-19) has spread at an accelerated rate. WHO reported that in the general population, the majority are either asymptomatic or mildly infected. In view of the high risk of SARS-CoV-2 transmission from a pregnant woman to her newborn, healthcare workers and other patients, it is a raised concern whether universal testing should be implemented in this targeted population. The current guidelines have not recommended a universal testing policy. In certain European countries, however, the policy was implemented by some hospitals in regions with high prevalence of COVID-19 infection.

Aim(s)

To assess the justification for universal screening of pregnant women for COVID-19 prior to admission in labor through systematic review of antenatal prevalence of asymptomatic infection, hence risk of inadvertent spread of infection.

Materials and Methods

Three databases confined to PubMed, Ovid and Science Direct were used to search for articles from November 2019 onwards published in the English language. The search was conducted using the keywords “COVID-19” or “coronavirus” or “SARS-CoV-2” and “pregnancy” or “pregnant” or “obstetric” or “labor” and “universal” or “testing” or “prevalence”. The review was registered with PROSPERO.

Results

The search result retrieved 34 studies, with the majority consisting of retrospective cohort studies, while other studies such as prospective cohort study, research letters and a case series were also identified. A total of 19,958 pregnant women were universally tested until the date of report. Overall, the prevalence of universal testing among pregnant women presenting to labor and delivery units are higher in Western regions. From the total number of pregnant women 5.3% tested positive and among these, the majority (75.5%) did not manifest any symptoms at the time of testing.

Conclusion

In areas with high prevalence of COVID-19 infection, the implementation of a universal testing policy among pregnant women presenting to labor and admission units may be cost effective in helping to curb disease transmission.

Systematic Trial Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020184248, PROSPERO: CRD42020184248.

The Epidemiology of COVID-19 in Pregnancy

As of November, 2021 there have been more than 250 million coronavirus disease-2019 (COVID-19) cases worldwide and more than 5 million deaths. Obstetric patients have been a population of interest given that they may be at risk of more severe infection and adverse pregnancy outcomes. The purpose of this review is to assess current epidemiology and outcomes research related to COVID-19 for the obstetric population. This review covers the epidemiology of COVID-19, symptomatology, transmission, and current knowledge gaps related to outcomes for the obstetric population.

Risk for postpartum depressive symptoms among pregnant women in a tertiary care setting with and without a positive COVID-19 test

OBJECTIVE

This study systematically examines risk for postpartum depressive symptoms based on COVID-19 positivity status during pregnancy.

METHODS

This is a retrospective matched cohort study of pregnant patients admitted to labor and delivery units from March through December 2020. Patients were administered three depression screening questions followed by the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

129 patients with positive COVID-19 tests (most with mild symptoms) were matched with 516 COVID-19 negative controls. We found no significant differences in rates of positive responses to screening questions (14/129, 10.9% vs. 72/516, 14.0%; p = .35) or EPDS scores >9 (6/97, 6.2% vs. 42/410, 10.2%; p = .22). Prior history of psychiatric illness was the only significant predictor of an EPDS score > 9 (adjOR 2.57, p = .002) or a positive brief screen for postpartum depressive symptoms (adjOR 2.93, p < .001).

CONCLUSIONS

No significant differences in the rates for postpartum depressive symptoms were observed among pregnant women with and without a positive COVID-19 test during pregnancy, suggesting that testing positive for COVID-19 during pregnancy was not associated with an increased risk for the development of depressive symptoms during the acute postpartum period. Overall rates of postpartum depression symptoms were low, perhaps owing to the higher socioeconomic status of the sample.