The COVID-19 Health Impact on Long-term Child Development in Scotland (CHILDS) study

COVID-19（COV）使孕妇暴露于新型冠状病毒的潜在感染，相关的公共卫生措施从根本上改变了孕妇及其子女的医疗保健和支持的性质。我们的目标是了解在大流行中出生（包括病毒本身的潜在感染）如何影响儿童到5岁的发育。我们特别强调理解社会不平等的作用，这已被证明是大流行病期间健康和福祉研究的一个重要因素。COV具有高度传染性，孕妇感染病毒的风险特别高，因为怀孕是一种“免疫抑制状态”，使身体抵抗感染的能力降低。早期证据表明，怀孕期间感染COV会导致流产和早产的风险增加。研究已经确定，母亲在怀孕期间感染也会影响儿童的长期发育，尽管到目前为止还不可能对COV的这些影响进行调查。大量证据表明，怀孕期间的感染、产妇的心理健康、怀孕和分娩期间的支持都对儿童的发育有重要作用。为控制这一流行病而采取的必要公共卫生和社会措施大大中断了对孕妇和新生儿母亲的支助。妇女得到的产前护理、助产士预约、面对面的支持以及来自慈善机构、朋友和家人的非正式和专业支持更少。大多数医疗服务提供者对家庭分娩和非紧急剖腹产进行了限制。初步研究表明，社会不平等是决定这些变化对发展成果和一系列更直接的健康成果的影响的一个重要因素。在某些情况下，增加隔离似乎减少了非COV感染，并为母乳喂养提供了更好的环境。其他研究指出，在大流行期间，孕产妇环境更差，心理健康挑战和家庭暴力增加。我们的工作将探讨社会不平等在解释这些不同的结果的重要作用。这项研究将研究COV和相关PHSM（包括医疗保健提供的变化）对整个苏格兰孕妇及其子女的影响。我们将使用从医疗保健、教育和社会护理记录中定期收集的数据。这将使该小组能够详细了解在大流行病期间出生的约99 000名5岁以下儿童的怀孕、孕产妇和儿童健康及发育情况;并与大流行病之前出生的约200 000名儿童的相同信息进行比较。在苏格兰，每个公民都有一个社区健康指数（CHI）号码，这使得母亲和儿童的数据可以联系起来，同时保持完全匿名。CHI系统由NHS管理，并使用完善的协议，以确保仅向研究团队提供相关数据。本研究主要关注三个领域：1）了解妊娠期COV感染如何影响5岁以下儿童的健康和发育。2）了解大流行期间采取的公共卫生和社会措施（PSHM）对幼儿发育的影响。3）根据大流行检查社会不平等对母亲和儿童发育结果的作用。本研究将有效地建立在已进行的广泛工作基础上，并将最大限度地利用现有基础设施和医疗保健审查。这项研究将为苏格兰和全球的医疗保健提供者和政策制定者提供一个独特的参考点，了解在大流行中出生的人的需求，从而改善资源的针对性，并更好地了解政策如何改善这些关键的生命早期阶段的结果。

COVID-19 (COV) has exposed pregnant women to potential infection with a novel coronavirus and the associated public health measures have radically altered the nature of healthcare and support for pregnant women and their children. We aim to understand how being born in the pandemic (including potential infection with the virus itself) affects child development to age 5. We place particular emphasis on understanding the role of social inequality, which has already been shown to be a significant factor in studies of health and wellbeing during the pandemic. COV is highly contagious and pregnant women are at particular risk of viral infection because pregnancy is an 'immuno-suppressive condition', making the body less able to fight infection. Early evidence suggests that COV infection during pregnancy leads to increased risk for miscarriage and premature birth. Studies have established that maternal infection during pregnancy can also affect long term child development, though investigation of these effects for COV have not been possible until now. A broad body of evidence suggests that infection during pregnancy, maternal mental health, support during pregnancy and birth all have important roles in how children develop. Support for pregnant women and new mothers has been substantially disrupted by the Public Health and Social Measures (PHSM) necessary to contain the pandemic. Women have received less antenatal care, fewer midwife appointments, less face-to-face support and less informal and professional support from charities, friends and family. Most healthcare providers have placed restrictions on home births and non-emergency caesarean sections. Initial studies suggest that Social Inequality is an important factor in determining the effect of these changes on developmental outcomes and a range of more immediate health outcomes. In some cases, increased isolation appears to have reduced non-COV infections and provided a better environment for breastfeeding. Other research points to a poorer maternal environment, with increased mental health challenges and domestic violence during the pandemic. Our work will explore the important role of Social Inequality in explaining these different outcomes. This study will examine the effects of COV and the related PHSM (including changes to healthcare provision) on pregnant women and their children across the whole of Scotland. We will use routinely collected data from healthcare, education and social care records. This will allow the team to build a detailed understanding of pregnancy, maternal and child health and development for approximately 99,000 children born during the pandemic, up to the age of 5; to be compared with the same information for approximately 200,000 children born before the pandemic. In Scotland each citizen has a Community Health Index (CHI) number, which allows data for mothers and children to be linked whilst remaining entirely anonymous. The CHI system is managed by the NHS and uses well established protocols to ensure only relevant data are provided to the research team. There are three main focus areas for this study:1) Understanding how COV infection during pregnancy affects child health and development up to the age of 5.2) Understanding the impact of Public Health and Social Measures (PSHM) taken during the pandemic on early child development.3) Examining the role of social inequality on mother and child development outcomes in light of the pandemic.The study will efficiently build on extensive work already being conducted and will maximise the use of existing infrastructure and health care reviews. The study will provide a unique reference point for healthcare providers and policy-makers in Scotland and globally about the needs of those born in the pandemic, allowing improved targeting of resources and a better understanding of how policy can improve outcomes at these crucial early stages of life.