Breastfeeding and presence of the companion of woman's choice during COVID-19 pandemic in Italy: regional population-based routine data and best practices at birth

OBJECTIVES: to describe the monthly trend of breastfeeding during hospitalization and the presence of companion of woman's choice during labour and birth, and the key regional responders' perspective of homogeneity/heterogeneity of the presence of the support person, before, during (February-May 2020), and after the first COVID-19 pandemic wave in a few Italian Regions. DESIGN: two-phase study. SETTING AND PARTICIPANTS: data from the italian birth certificate of six Italian Regions between 01.01.2019 and 31.03.2021 were analysed. Semi-structured interviews were conducted with the key regional respondents. MAIN OUTCOME MEASURES: the frequency distributions of breastfeeding and the presence of companion of woman's choice were calculated as a whole and for each Region. RESULTS: the infant feeding practices experienced smaller changes during COVID-19 pandemic than the presence of the companion of woman's choice during labour and birth, from January 2019 to March 2021. The highest value of exclusive breastfeeding was recorded in September 2020 (72.1%; 95%CI 71.3-72.8) in all Regions, while the lowest was recorded in March 2021 (62.5%; 95%CI 61.5-63.4). The presence of companion of woman's choice during labour and birth decreased during the pandemic and did not return to pre-pandemic levels. The highest value of presence of father during birth was recorded in March 2019 (59.0%; 95%CI 58.2-59.8), while the lowest in April 2020 (50.0%; 95%CI 49.1-50.8). The main emerging themes were: the existence of national, regional and local indications; the facilitators (e.g., Baby-Friendly Hospital Initiative implementation, strong motivation of the staff) and the critical points (e.g., inadequate analysis of the clinical-epidemiological context, inhomogeneous indications) of management of the support person presence. CONCLUSIONS: the emergency has changed the provision of health services that not always guaranteed the application of best practices. It would be desirable to work for assessing the appropriateness of the birth certificate data to collect more accurate information and to provide clinical recommendations.

Streptococcus agalactiae in pregnancy and the impact of recommendations on adherence to guidelines: an Italian area-based study.

INTRODUCTION: Streptococcus agalactiae, a species of ß-haemolytic streptococcus belonging to Lancefield's group B (GBS), is known as a common infecting agent transmitted to infants during childbirth, causing sepsis, meningitis, or both, with a high incidence of mortality. Following the observation of a great variability between regional laboratories both in the methodology and in the results of tests for the detection of GBS in pregnancy, with high percentages of false negative results, in 2010 the Department for Health Policies of Piedmont, Italian region, issued specific recommendations for adhere to international guidelines. Our aim was to assess whether the impact of the publication of the recommendations has been lasting over time. METHODS: We analyzed the regional birth certificate register from 2006 to 2018, to evaluate the annual number of deliveries, the number of Streptococcus agalactiae tests in pregnancy and the percentage of positive culture results. We also evaluated the consistency of the percentage of positive tests with the expectations based on the guidelines and compared the two time periods before and after introduction of regional recommendations using a multivariate regression model. RESULTS: The mean proportion of women tested for GBS vaginal-rectal swabs during pregnancy increased from 83.5% in 2006 to 90.7% in 2018 with the biggest rise in 2010, the t-test for the comparison of the two means was statistically significant (p < .001). The mean positivity rate increased from 12.7% to 19.2%, with a rise in 2010, with a significant t-test (p < .001). CONCLUSION: The results suggested a significant impact of the recommendations on the compliance and results regarding the carrying out and culture of vagino-rectal swabs for GBS, with better appropriateness of peripartum antibiotic therapy and possible reduction of GBS related neonatal sepsis.

Selection bias and patterns of confounding in cohort studies: the case of the NINFEA web-based birth cohort.

BACKGROUND: Several studies have examined the effects of sample selection on the exposure-outcome association estimates in cohort studies, but the reasons why this selection may induce bias have not been fully explored. AIMS: To investigate how sample selection of the web-based NINFEA birth cohort may change the confounding patterns present in the source population. METHODS: The characteristics of the NINFEA participants (n=1105) were compared with those of the wider source population-the Piedmont Birth Registry (PBR)-(n=36 092), and the association of two exposures (parity and educational level) with two outcomes (low birth weight and birth by caesarean section), while controlling for other risk factors, was studied. Specifically the associations among measured risk factors within each dataset were examined and the exposure-outcome estimates compared in terms of relative ORs. RESULTS: The associations of educational level with the other risk factors (alcohol consumption, folic acid intake, maternal age, pregnancy weight gain, previous miscarriages) partly differed between PBR and NINFEA. This was not observed for parity. Overall, the exposure-outcome estimates derived from NINFEA only differed moderately from those obtained in PBR, with relative ORs ranging between 0.74 and 1.03. CONCLUSIONS: Sample selection in cohort studies may alter the confounding patterns originally present in the general population. However, this does not necessarily introduce selection bias in the exposure-outcome estimates, as sample selection may reduce some of the residual confounding present in the general population.