Repercusión de la covid-19 en la salud materno-infantil / Covid-19 repercussions on maternal and infantile health

RESUMEN El año 2020 ha sorprendido al planeta con la pandemia de la covid-19. Este artículo tiene como objetivo reflexionar sobre las repercusiones del nuevo coronavirus en la salud materno-infantil. Pese al poco tiempo transcurrido desde el inicio de la pandemia, en las embarazadas con covid-19 se han descrito algunas comorbilidades, así como alteraciones placentarias, abortos espontáneos, muertes fetales y maternas, e incremento en los partos por cesárea y nacimientos pretérminos. Los riesgos potenciales demandarán una vigilancia estrecha del comportamiento del embarazo en el futuro inmediato. Por otra parte, del total de la población afectada por la covid-19, los pacientes en edad pediátrica representan entre el 1 y el 2 %, y la mayoría presentan manifestaciones clínicas leves. No obstante, en los menores de un año cerca del 10 % puede evolucionar a formas severas o críticas. De especial interés ha sido la presentación del síndrome inflamatorio multisistémico en niños, debido a su gravedad y riesgo para la vida. En los recién nacidos, la infección por SARS-CoV-2 podría asociarse a dos formas, de acuerdo al momento de adquisición: la covid perinatal y la postnatal. Hasta el momento, las evidencias sobre la existencia de la vía de transmisión vertical son insuficientes, pero no pueden ser descartadas. En conclusión, por tratarse de un fenómeno en desarrollo, aún quedan muchas interrogantes sobre los efectos de la covid-19 en la salud materna e infantil, que demandarán en los próximos meses un gran esfuerzo por parte de investigadores, médicos de asistencia y directivos (AU).

ABSTRACT The year 2020 has surprised the planet with the covid-19 pandemics. This article is aimed to reflect on the repercussions of the novel coronavirus on maternal and infantile health. Despite of the short time elapsed from the onset of the pandemics, some comorbidities have been described in pregnant women with COVID-19, as well as placental anomalies, spontaneous abortions, stillbirths, maternal deaths, and an increasing number on cesarean section and preterm births. The potential risk will demand a close surveillance of pregnancy behavior in the near future. Moreover, pediatric patients are among 1 and 2% of the population affected by COVID-19, and most of them show mild clinical signs. Nevertheless, about 10% of the children aged less than a year may evolve to severe and critical forms. The multisystem inflammatory syndrome in children has been of special interest, due to its severity and risk for life. In newborns, SARS-CoV-2 infection could be associated to two forms according to the acquisition time: perinatal and postnatal COVID-19. Up to the moment, evidences on vertical transmission are insufficient, but they could not be discarded. In conclusion, as this is an ongoing phenomenon, many questions about the effects of COVID-19 on maternal and infantile health are pending; they will demand a crucial effort by researchers, health providers and decision makers (AU).

Maternal health care in India: A reflection of 10 years of National Health Mission on the Indian maternal health scenario.

OBJECTIVE: Maternal healthcare coverage is the outcome of health service availability and utilization, and includes antenatal care (ANC), care at delivery, and postnatal care. This study examines the contribution of India's National Health Mission (NHM) to maternal health through a pre-post comparison of rates of delivery at a healthcare institution and use of ANC along with inequalities in the determinants of one of the major maternal health outcomes-at least four ANC visits. METHODS: Data came from the Indian National Family Health Surveys conducted between 1992-93 and 2015-16. A multivariate logistic regression model was used to estimate the odds ratios (ORs) associated with the predictors of at least four ANC visits. RESULTS: Institutional delivery increased by 12.6 percentage points between 1992-93 and 2005-06 (the pre-NRHM era), and thereafter interventions through the National Rural Health Mission/NHM contributed to a significant increase of 40.2 percentage points from 2005-06 to 2015-16. However, both inter- and intra-state disparities persist even now. Overall, the proportion of pregnant women who have at least four ANC visits is as low as 51.2 percent. The likelihood of having at least four ANC visits is almost four times higher for women in the richest households compared with those in the poorest (OR: 3.59; 95% CI: 3.44-3.75) CONCLUSION: Future public health efforts should focus on removing inter- and intra-state disparities in institutional delivery and ensuring at least four ANC visits for pregnant women, to meet the infant and maternal mortality targets set out in the Sustainable Development Goals (SDG).

Morbilidad materna extremadamente grave. Un problema obstétrico en la salud pública y la atención al paciente grave / Extremely serious maternal morbidity. An obstetric problem in public health and seriously ill patient care

El concepto morbilidad materna extremadamente grave, se considera de gran utilidad al ser un indicador muy asociado a la muerte materna y un estadio intermedio en prácticamente la totalidad de las fallecidas. Como parte de la primera etapa de un proyecto de investigación se realizó una revisión del tema y se consultaron las bases de datos LILACS, EBSCO e HINARI. Los descriptores que se utilizaron fueron: mortalidad materna, morbilidad y paciente obstétrica grave. Los resultados de la búsqueda se limitaron a los últimos cinco años en idioma inglés, español, francés y portugués. La morbilidad materna extremadamente grave es un indicador muy asociado a la muerte materna y es considerada una alternativa válida para utilizarla como indicador de la calidad de los cuidados maternos. El interés creciente de integrar el análisis de la morbilidad materna extremadamente grave al estudio de la mortalidad materna, permite identificar los factores de riesgo presentes en las gestantes, desde un embarazo sin complicaciones hasta la muerte, pues se presenta en un mayor número de casos, y con el manejo de aquellos que evolucionaron favorablemente después de la gravedad extrema, se pueden evitar nuevas defunciones (AU).

The concept "extremely serious maternal morbidity" is considered very useful because it is an indicator closely associated to maternal death and an intermediate stage in practically the totality of maternal deceases. As a part of the first stage of a research project, a review on the theme was carried out, and LILACS, EBSCO and HINARI data bases were consulted. The used descriptors were: maternal mortality, morbidity and seriously ill obstetric patient. The results of the search were limited to the last five years in English, Spanish, French and Portuguese languages. Extremely serious maternal morbidity is an indicator very frequently associated to maternal death, and it is considered a suitable alternative for using it as an indicator of the maternal care quality. The increasing interest for integrating the analysis of extremely serious maternal morbidity to the study of maternal morbidity allows identifying the risk factors that are present in pregnant women, beginning from a pregnancy without complications and ending with death, because they are found in a bigger quantity of cases, and new deceases could be avoided with the management of those favourably evolving after the extreme seriousness (AU).

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

Implementing demand side targeting mechanisms for maternal and child health-experiences from national health insurance fund program in Rungwe District, Tanzania.

BACKGROUND: Low and middle income countries have adopted targeting mechanisms as a means of increasing program efficiency in reaching marginalized people in the community given the available resources. Design of targeting mechanisms has been changing over time and it is important to understand implementers' experience with such targeting mechanisms since such mechanisms impact equity in access and use of maternal health care services. METHODS: The case study approach was considered as appropriate method for exploring implementers' and decision-makers' experiences with the two targeting mechanisms. In-depth interviews in order to explore implementer experience with the two targeting mechanisms. A total of 10 in-depth interviews (IDI) and 4 group discussions (GDs) were conducted with implementers at national level, regional, district and health care facility level. A thematic analysis approach was adopted during data analysis. RESULTS: The whole process of screening and identifying poor pregnant women resulted in delay in implementation of the intervention. Individual targeting was perceived to have some form of stigmatization; hence beneficiaries did not like to be termed as poor. Geographical targeting had a few cons as health care providers experienced an increase in workload while staff remained the same and poor quality of information in the claim forms. However geographical targeting increase in the number of women going to higher level of care (district/regional referral hospital), increase in facility revenue and insurance coverage. CONCLUSION: Interventions which are using targeting mechanisms to reach poor people are useful in increasing access and use of health care services for marginalized communities so long as they are well designed and beneficiaries as well as all implementers and decision makers are involved from the very beginning. Implementation of demand side financing strategies using targeting mechanisms should go together with supply side interventions in order to achieve project objectives.

Effects of postpartum mobile phone-based education on maternal and infant health in Ecuador.

OBJECTIVE: To evaluate the effects of a mobile phone-based intervention on postnatal maternal health behavior and maternal and infant health in a middle-income country. METHODS: A prospective evaluation enrolled consecutive postpartum women at two public hospitals in Quito, Ecuador, between June and August 2012. Inclusion criteria were live birth, no neonatal intensive care admission, and Spanish speaking. Intervention and control groups were assigned via random number generation. The intervention included a telephone-delivered educational session and phone/text access to a nurse for 30days after delivery. Maternal and infant health indicators were recorded at delivery and 3months after delivery via chart review and written/telephone-administered survey. RESULTS: Overall, 102 women were assigned to the intervention group and 76 to the control group. At 3months, intervention participants were more likely to attend the infant's postnatal check-up (P=0.022) and to breastfeed exclusively (P=0.005), and less likely to feed formula (P=0.016). They used more effective forms of contraception (more implants P=0.023; fewer condoms P=0.036) and reported fewer infant illnesses (P=0.010). There were no differences in maternal acute illness or check-up attendance. CONCLUSION: Mobile phone-based postnatal patient education is a promising strategy for improving breastfeeding, contraceptive use, and infant health in low-resource settings; different strategies are needed to influence postpartum maternal health behavior.

Maternal distress and child neuroendocrine and immune regulation.

RATIONALE: Neuroendocrine-immune regulation is essential for maintaining health. Early-life adversity may cause dysregulation in the neuroendocrine-immune network through repeated activation of the stress response, thereby increasing disease risk. OBJECTIVE: This paper examined the extent to which maternal psychological well-being moderates neuroendocrine-immune relations in children. METHODS: We used data from a laboratory-based study of mothers and their five-year old children (n = 125 mother-child pairs) conducted from 2011 to 2013 in Baltimore, Maryland. Child saliva was assayed for markers of immune function (i.e., cytokines: interleukin [IL]-1ß, IL-6, IL-8, tumor necrosis factor alpha [TNF-α]) and hypothalamic-pituitary-adrenal activity (i.e., cortisol). A composite score for depressive symptoms, anxiety, and parenting stress characterized maternal psychological distress. Multilevel mixed models examined the relationship between maternal psychological well-being and child neuroendocrine-immune relations. RESULTS: Significant cytokine × maternal distress interactions indicated that as maternal distress increased, expected inverse cytokine-cortisol relations within children became weaker for IL-1ß, IL-6, and TNF-α. Sex-stratified models revealed that these interactions were only significant among girls. Among boys, there were inverse cytokine-cortisol relations for all cytokines, and, while in the same direction as observed among girls, the cytokine × maternal distress interactions were non-significant. CONCLUSION: The findings suggest that maternal distress is associated with child neuroendocrine-immune relations in saliva and may alter the sensitivity of inflammatory immune processes to cortisol's inhibitory effects. This desensitization may place the child at risk for inflammatory diseases. The findings support efforts for the early detection and treatment of at-risk mothers to protect maternal and child health and well-being.