Abstract：
BACKGROUND: Little research has been conducted on the impact of the coronavirus disease 2019 (COVID-19) pandemic on either birth outcomes or the ability of archival medical records to accurately capture these outcomes. Our study objective is thus to compare the prevalence of preterm birth, stillbirth, low birth weight (LBW), small for gestational age (SGA), congenital microcephaly, and neonatal bloodstream infection (NBSI) before and during the first wave of the COVID-19 pandemic in Kinshasa, Democratic Republic of Congo (DRC).
METHODS: We conducted a facility-based retrospective cohort study in which identified cases of birth outcomes were tabulated at initial screening and subcategorized according to level of diagnostic certainty using Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) definitions. Documentation of any birth complications, delivery type, and maternal vaccination history were also evaluated. The prevalence of each birth outcome was compared in the pre-COVID-19 (i.e., July 2019 to February 2020) and intra-COVID-19 (i.e., March to August 2020) periods via two-sample z-test for equality of proportions.
RESULTS: In total, 14,300 birth records were abstracted. Adverse birth outcomes were identified among 22.0% and 14.3% of pregnancies in the pre-COVID-19 and intra-COVID-19 periods, respectively. For stillbirth, LBW, SGA, microcephaly, and NBSI, prevalence estimates were similar across study periods. However, the prevalence of preterm birth in the intra-COVID-19 period was significantly lower than that reported during the pre-COVID-19 period (8.6% vs. 11.5%, p < 0.0001). Furthermore, the level of diagnostic certainty declined slightly across all outcomes investigated from the pre-COVID-19 to the intra-COVID-19 period. Nonetheless, diagnostic certainty was especially low for certain outcomes (i.e., stillbirth and NBSI) regardless of period; still, other outcomes, such as preterm birth and LBW, had moderate to high levels of diagnostic certainty. Results were mostly consistent when the analysis was focused on the facilities designated for COVID-19 care.
CONCLUSIONS: This study succeeded in providing prevalence estimates for key adverse birth outcomes using GAIA criteria during the COVID-19 pandemic in Kinshasa, DRC. Furthermore, our study adds crucial real-world data to the literature surrounding the impact of the COVID-19 pandemic on maternal and neonatal services and outcomes in Africa.
METHODS: We conducted a facility-based retrospective cohort study in which identified cases of birth outcomes were tabulated at initial screening and subcategorized according to level of diagnostic certainty using Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) definitions. Documentation of any birth complications, delivery type, and maternal vaccination history were also evaluated. The prevalence of each birth outcome was compared in the pre-COVID-19 (i.e., July 2019 to February 2020) and intra-COVID-19 (i.e., March to August 2020) periods via two-sample z-test for equality of proportions.
RESULTS: In total, 14,300 birth records were abstracted. Adverse birth outcomes were identified among 22.0% and 14.3% of pregnancies in the pre-COVID-19 and intra-COVID-19 periods, respectively. For stillbirth, LBW, SGA, microcephaly, and NBSI, prevalence estimates were similar across study periods. However, the prevalence of preterm birth in the intra-COVID-19 period was significantly lower than that reported during the pre-COVID-19 period (8.6% vs. 11.5%, p < 0.0001). Furthermore, the level of diagnostic certainty declined slightly across all outcomes investigated from the pre-COVID-19 to the intra-COVID-19 period. Nonetheless, diagnostic certainty was especially low for certain outcomes (i.e., stillbirth and NBSI) regardless of period; still, other outcomes, such as preterm birth and LBW, had moderate to high levels of diagnostic certainty. Results were mostly consistent when the analysis was focused on the facilities designated for COVID-19 care.
CONCLUSIONS: This study succeeded in providing prevalence estimates for key adverse birth outcomes using GAIA criteria during the COVID-19 pandemic in Kinshasa, DRC. Furthermore, our study adds crucial real-world data to the literature surrounding the impact of the COVID-19 pandemic on maternal and neonatal services and outcomes in Africa.
摘要：
背景：关于2019年冠状病毒病(COVID-19)大流行对出生结局或档案医疗记录准确捕获这些结局的能力的影响的研究很少。因此，我们的研究目的是比较早产的患病率，死产,低出生体重（LBW），小于胎龄（SGA），先天性小头畸形,以及在金沙萨第一波COVID-19大流行之前和期间的新生儿血流感染（NBSI），刚果民主共和国（DRC）。
方法：我们进行了一项基于机构的回顾性队列研究，该研究在初次筛查时将确定的出生结局病例列表，并使用妊娠免疫安全性评估全球一致性（GAIA）定义根据诊断确定性水平进行分类。任何出生并发症的文件，交货类型,并评估了母体疫苗接种史.在COVID-19前期比较了每种出生结局的患病率(即，2019年7月至2020年2月)和COVID-19(即，2020年3月至8月)通过两个样本z检验确定比例相等。
结果：总计，提取了14,300份出生记录。在COVID-19前期和COVID-19期间，22.0%和14.3%的怀孕中发现了不良分娩结局，分别。对于死产，LBW,SGA,小头畸形,NBSI,研究期间的患病率估计值相似.然而,COVID-19期间的早产患病率显着低于COVID-19前期间的报告（8.6%vs.11.5%,p<0.0001)。此外，从COVID-19前期到COVID-19内部的所有研究结局的诊断确定性水平略有下降.尽管如此，对于某些结果，诊断确定性特别低(即，死产和NBSI)，无论时期；仍然，其他结果,如早产和LBW，具有中等到较高的诊断确定性。当分析集中在指定用于COVID-19护理的设施上时，结果大多是一致的。
结论：这项研究成功地提供了在金沙萨COVID-19大流行期间使用GAIA标准对主要不良分娩结局的患病率估计，刚果民主共和国。此外，我们的研究为围绕COVID-19大流行对非洲孕产妇和新生儿服务及结局的影响的文献添加了重要的现实数据.
方法：我们进行了一项基于机构的回顾性队列研究，该研究在初次筛查时将确定的出生结局病例列表，并使用妊娠免疫安全性评估全球一致性（GAIA）定义根据诊断确定性水平进行分类。任何出生并发症的文件，交货类型,并评估了母体疫苗接种史.在COVID-19前期比较了每种出生结局的患病率(即，2019年7月至2020年2月)和COVID-19(即，2020年3月至8月)通过两个样本z检验确定比例相等。
结果：总计，提取了14,300份出生记录。在COVID-19前期和COVID-19期间，22.0%和14.3%的怀孕中发现了不良分娩结局，分别。对于死产，LBW,SGA,小头畸形,NBSI,研究期间的患病率估计值相似.然而,COVID-19期间的早产患病率显着低于COVID-19前期间的报告（8.6%vs.11.5%,p<0.0001)。此外，从COVID-19前期到COVID-19内部的所有研究结局的诊断确定性水平略有下降.尽管如此，对于某些结果，诊断确定性特别低(即，死产和NBSI)，无论时期；仍然，其他结果,如早产和LBW，具有中等到较高的诊断确定性。当分析集中在指定用于COVID-19护理的设施上时，结果大多是一致的。
结论：这项研究成功地提供了在金沙萨COVID-19大流行期间使用GAIA标准对主要不良分娩结局的患病率估计，刚果民主共和国。此外，我们的研究为围绕COVID-19大流行对非洲孕产妇和新生儿服务及结局的影响的文献添加了重要的现实数据.
