Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis.
Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis.
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DOI：
10.1016/j.eclinm.2021.100947
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发表时间：
2021-07
影响因子：
15.1
通讯作者：
Khalil A
中科院分区：
文献类型：
--
作者：
Townsend R;Chmielewska B;Barratt I;Kalafat E;van der Meulen J;Gurol-Urganci I;O'Brien P;Morris E;Draycott T;Thangaratinam S;Doare KL;Ladhani S;Dadelszen PV;Magee LA;Khalil A
COVID-19大流行对全球医疗保健系统产生了深远影响，孕产妇和胎儿的不良结局令人担忧。我们旨在评估COVID-19疫情期间孕产妇医疗保健服务提供及孕妇就医的变化。我们对有关疫情对孕产妇服务提供、获取和就诊影响的研究进行了系统性回顾和荟萃分析（CRD 42020211753）。我们根据PRISMA指南检索了MEDLINE和Embase，从2020年1月1日至2021年4月17日，以获得对照观察性研究和研究信函，这些研究报告了COVID-19大流行期间与之前相比，产妇寻求医疗保健和医疗保健交付的主要数据。排除病例报告和系列、系统性文献综述和预印本研究。对两项或多项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，使用风险比（RR）或发生率比（IRR）和95%置信区间（CI）合并数据。在识别的4743篇引文中，56篇被纳入系统综述，21篇被纳入荟萃分析。我们发现产前诊所就诊次数显着减少（IRR 0614，95% CI 0486-0776，P<00001，I2=54.6%）和计划外护理访视（IRR 0741，95% CI 0602-0911，P = 00046，I2=00%），虚拟或远程产前护理增加（IRR 4656，95% CI 7762-2794，P<00001，I2=90.6%）和计划外参加者住院（RR 1214，95% CI 1118-1319，P<00001，I2=00%）。GA用于1类剖腹产（CS）的比例下降（RR 0529，95% CI 0407-0690，P<00001，I2=00%）。分娩时硬膜外使用（P = 00896）或选择性CS使用GA（P = 079）没有显著变化。COVID-19大流行期间孕产妇寻求医疗保健和医疗保健提供的减少是全球性的，必须被视为可能导致大流行期间观察到的妊娠结局恶化。
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. 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). 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, P<00001, I2=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602–0911, P = 00046, I2=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762–2794, P<00001, I2=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118–1319, P<00001, I2=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407–0690, P<00001, I2=00%). There was no significant change in intrapartum epidural use (P = 00896) or the use of GA for elective CS (P = 079) 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.
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影响因子：
13.8
作者：
Duryea EL;Adhikari EH;Ambia A;Spong C;McIntire D;Nelson DB
通讯作者：
Nelson DB
DOI：
10.1016/s2214-109x(21)00079-6
发表时间：
2021-06
期刊：
The Lancet. Global health
影响因子：
--
作者：
Chmielewska B;Barratt I;Townsend R;Kalafat E;van der Meulen J;Gurol-Urganci I;O'Brien P;Morris E;Draycott T;Thangaratinam S;Le Doare K;Ladhani S;von Dadelszen P;Magee L;Khalil A
通讯作者：
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影响因子：
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作者：
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通讯作者：
Zaritsky, Eve
影响因子：
2
作者：
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通讯作者：
Clare, Camille A.
DOI：
10.3390/ijerph17165933
发表时间：
2020-08-01
影响因子：
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作者：
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通讯作者：
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