Social Media Misinformation about Pregnancy and COVID-19 Vaccines: A Systematic Review.

OBJECTIVE: The objectives of this study were to identify common social media misconceptions about COVID-19 vaccination in pregnancy, explain the spread of misinformation, and identify solutions to guide clinical practice and policy. METHODOLOGY: A systematic review was conducted and the databases Embase and Medline were searched from December 2019 to February 8, 2023, using terms related to social media, pregnancy, COVID-19 vaccines and misinformation. The inclusion criteria were original research studies that discussed misinformation about COVID-19 vaccination during pregnancy on social media. The exclusion criteria were review articles, no full text, and not published in English. Two independent reviewers conducted screening, extraction, and quality assessment. RESULTS: Our search identified 76 articles, of which 3 fulfilled eligibility criteria. Included studies were of moderate and high quality. The social media platforms investigated included Facebook, Google Searches, Instagram, Reddit, TikTok, and Twitter. Misinformation was related to concerns regarding vaccine safety, and its association with infertility. Misinformation was increased due to lack of content monitoring on social media, exclusion of pregnant women from early vaccine trials, lack of information from reputable health sources on social media, and others. Suggested solutions were directed at pregnancy care providers (PCPs) and public health/government. Suggestions included: (i) integrating COVID-19 vaccination information into antenatal care, (ii) PCPs and public health should increase their social media presence to disseminate information, (iii) address population-specific vaccine concerns in a culturally relevant manner, and others. CONCLUSION: Increased availability of information from reputable health sources through multiple channels could increase COVID-19 vaccine uptake in the pregnant population and help combat misinformation.

Optimal timing of labour induction in contemporary clinical practice.

Induction of labour (IoL) is generally conducted when maternal and foetal risks of remaining pregnant outweigh the risks of delivery. With emerging literature around non-medically indicated IoL, contemporary clinical practice has seen an increase in IoL at 39 weeks' gestation. This review highlights recent evidence on the most common indications for IoL including gestational diabetes, hypertensive disorders of pregnancy, intrahepatic cholestasis of pregnancy, and post-term pregnancies. It also summarizes the evidence related to the timing of IoL for other common conditions based on recent literature reviews.

Patients and Health Care Providers Identify Important Outcomes for Research on Pregnancy and Heart Disease.

BACKGROUND: A core outcome set for studies on cardiac disease in pregnancy is being developed. Incorporating perspectives of patients and health care providers (HCPs) is an essential step in developing this core outcome set, and eliciting these outcomes is the objective of this study. METHODS: We interviewed pregnant women with heart disease, family members, and HCPs, until data saturation was attained. Participants were asked to share experiences and perspectives, and comment on outcomes they deemed important. Interviews were recorded and transcribed verbatim, and interpretive analysis was used to translate experiences into measurable outcomes. These were classified under 5 core outcome areas, based on a taxonomy of outcomes for medical research. A comparison of the distribution of outcomes within outcome areas, between patients and HCPs, and between interviews and published literature is presented. RESULTS: We obtained 17 outcomes from 13 patients and 3 family members, mostly related to general wellness of the baby, congenital anomalies, mental health, and health care delivery; and 45 outcomes from 10 HCPs, which were mostly clinical. Outcomes in published literature when compared with participant interviews put greater emphasis on clinical outcomes (94% vs 76.5%, P = 0.03) and limited emphasis on life impact (0% vs 17.6%, P < 0.001). CONCLUSIONS: Although clinical outcomes are the main focus of published research in heart disease and pregnancy, patients and HCPs emphasize the importance of outcomes related to general maternal and fetal well-being and life impact, which are seldom reported. Including these outcomes in future studies is essential to facilitating patient-centred care for pregnant women with cardiac disease.

CONTEXTE: Les auteurs s'emploient actuellement à établir un ensemble de paramètres de base aux fins des études sur la cardiopathie durant la grossesse. L'intégration des points de vue des patientes et des professionnels de la santé constitue une étape essentielle à l'élaboration de cet ensemble de paramètres de base; c'est là l'objectif de l'étude présentée ici. MÉTHODOLOGIE: Nous avons interviewé des femmes enceintes atteintes d'une cardiopathie, des membres de leur famille et des professionnels de la santé jusqu'à ce que le seuil de saturation des données soit atteint. Les participants étaient invités à faire part de leur vécu et de leurs points de vue, et à fournir des commentaires quant aux paramètres qu'ils estimaient importants. Les entrevues ont été enregistrées puis transcrites mot à mot; nous avons ensuite utilisé une analyse interprétative pour traduire les expériences relatées en paramètres mesurables. Ces expériences ont été regroupées en cinq grandes catégories, en fonction d'une taxonomie des résultats mesurés dans le domaine de la recherche médicale. Nous comparons ici la répartition des paramètres dans les différentes catégories entre patientes et professionnels de la santé, et entre résultats des entrevues et littérature médicale publiée. RÉSULTATS: Nous avons cerné 17 paramètres auprès de 13 patientes et trois membres de leur famille, généralement associés au bien-être du bébé, aux anomalies congénitales, à la santé mentale et à la prestation des soins de santé, ainsi que 45 paramètres auprès de 10 professionnels de la santé, principalement de nature clinique. Les paramètres publiés dans la littérature médicale sont quant à eux plus axés sur les résultats cliniques que les paramètres dégagés à l'issue des entrevues (94 % vs 76,5 %, p = 0,03) et moins sur les répercussions sur la qualité de vie (0 % vs 17,6 %, p < 0,001). CONCLUSIONS: Bien que les études publiées sur la cardiopathie et la grossesse soient principalement axées sur les résultats cliniques, les patientes et les professionnels de la santé ont fait ressortir l'importance des paramètres liés au bien-être général de la mère et du fœtus et aux répercussions sur leur qualité de vie, dont font peu souvent état les études publiées. Il est essentiel d'inclure ces paramètres dans les futures études pour favoriser des soins centrés sur les besoins des femmes enceintes atteintes d'une cardiopathie.

Assessing Cardiac Risk in Pregnant Women With Heart Disease: How Risk Scores Are Created and Their Role in Clinical Practice.

Pregnancy, which is associated with profound cardiovascular changes and higher risk of thrombosis, increases the risk of cardiovascular complications in women with pre-existing heart disease. A comprehensive history and physical examination, 12-lead electrocardiogram, and transthoracic echocardiogram remain the foundation of assessing cardiac risk during pregnancy in women with heart disease. These are often combined to generate risk scores, which are statistically derived. Several statistically derived risk and 1 lesion-specific classification system are currently available. A suggested clinical approach to risk stratification is first to identify pregnancies in women with cardiac lesions at risk for serious or life-threatening maternal cardiac complications and for the remainder to use the Cardiac Disease in Pregnancy II (CARPREG II) risk score, integrating additional lesion-specific and patient-specific information. Conversely, clinicians can use the modified World Health Organization (mWHO) risk classification system and integrate general risk predictors and patient-specific information. Importantly, cardiac-risk assessment should always incorporate clinical judgement in addition to the use of risk scores or risk-classification systems. As pregnant women with heart disease are also at risk for obstetric and fetoneonatal complications, risk assessment should be performed by a multidisciplinary team, preferably before conception, or as soon as conception is confirmed, and repeated at regular intervals during the course of pregnancy.