COVID-19 in Pregnancy: A Current Review of Global Cases.

IMPORTANCE: There is great concern about the impact of COVID-19 in pregnancy due to the high morbidity and mortality associated with prior coronavirus infections. OBJECTIVE: The objective of this review is to summarize the current literature on the impact of COVID-19 on pregnant women and their newborns. EVIDENCE ACQUISITION: The search terms COVID-19 and pregnancy were used in Medline and Clinical Key databases. Only articles written in English with outcome data on both mothers and their newborns were incorporated. RESULTS: Pregnant women generally experience COVID-19 as a mild-moderate illness. However, approximately 5% become critically ill. Women with underlying comorbidities seem more likely to experience severe morbidity. Newborns also generally have a favorable course. Vertical transmission in the intrauterine period is possible but rare. Infection control measures need to be taken to prevent transmission during the peripartum period. There is a paucity of data on infections in the first and second trimesters, but research from those infected in the third trimester indicates a possible link with preterm birth. There is a significant percentage of asymptomatic cases. Racial disparities are also being noted with disproportionate numbers of racial/ethnic minorities being affected. CONCLUSIONS: COVID-19 is generally experienced by pregnant women and their newborns as a mild to moderate illness, although a minority become critically ill and mortality does occur. This is more likely among those with underlying comorbidities, as in the general population. Asymptomatic cases heighten the need for increased testing and infection control measures. Racial disparities highlight underlying vulnerabilities and the need for increased research and policy changes.

Promoting improved social support and quality of life with the CenteringPregnancy® group model of prenatal care.

This prospective cohort study compared women participating in CenteringPregnancy® group prenatal care (N = 120) with those in standard individual care (N = 221) to determine if participation in Centering was associated with improvements in perceived social support and quality of life, with concomitant decreases in screens of postpartum depression and improvements in breastfeeding rates. Participants completed surveys at the onset of prenatal care, in the late third trimester and in the postpartum period. Centering participants had higher scores of perceived social support from friends after participating in group care (p < 0.05) with associated improvements in quality of life in the psychological and relational domains (p < 0.05) compared to standard care participants who showed higher scores of perceived support from family (p < 0.05) but did not show concomitant improvements in quality of life. This did not translate to any significant difference in scores on postpartum depression screens but was associated with improvements in breastfeeding continuation rates among Centering participants in the postpartum period. This study indicates that Centering care is associated with improved perceptions of peer social support with associated improvements in quality of life and higher rates of continued breastfeeding.

Can we effectively use the two-item PHQ-2 to screen for postpartum depression?

BACKGROUND AND OBJECTIVES: Postpartum depression screening is widely advocated to identify and treat affected individuals given the significant impact of this disorder on patients and their families. An effective, efficient method is needed to improve compliance with screening, which has led to an increased interest in the use of the two-item Patient Health Questionnaire 2 (PHQ-2). The aim of this study was to determine the sensitivity and specificity of the PHQ-2 in screening for postpartum depression. METHODS: A prospective convenience study was conducted among 200 postpartum women attending their postpartum or 4- and 6-month well-child visits at a multiethnic family medicine residency center. The sensitivity and specificity of the PHQ-2 was determined by using the well validated Edinburgh Postnatal Depression Scale (EPDS) as the gold standard. Positive responses to either scale led to further evaluation and referral. RESULTS: The sensitivity of the PHQ-2 was 100%, and the specificity was 79.3% using the EPDS as the reference standard. In addition, the PHQ-2 identified an additional four/nine women who were subsequently diagnosed with postpartum depression based on follow up of their positive screens. CONCLUSIONS: This study supports previous findings indicating that the PHQ-2 can be an effective tool in screening for postpartum depression.

The patient medication list: can we get patients more involved in their medical care?

BACKGROUND: Patient involvement is essential to maintain accurate and updated medication lists, provide quality care, and decrease potential errors. The purpose of this study was to determine the acceptance of medication lists maintained by patients and if their use affected perceptions of patient and physician responsibility and patients' knowledge of their medical care. METHODS: A foldable, wallet-sized medication list card was distributed to a convenience sample of 104 patients>or=40 years of age at an outpatient residency site. They were also given a survey of demographic variables and the Patient Medication Scale, which measures their perceptions of patient responsibility, physician responsibility, and patients' knowledge of their medical care. They were contacted by phone 4 to 11 months later to ascertain if they were using the medication card and the Patient Medication Scale was readministered. RESULTS: Forty-two of 66 patients contacted after the intervention consented to a full interview. Thirty-eight percent (25 of 66) reported using the card. The patients using the card showed increased scores in perceived patient knowledge and patient responsibility, with no change in their perceptions of physician responsibility. Among the 41 respondents not using the card, approximately half indicated interest in using the card in the future or were using a card of their own. CONCLUSIONS: A significant percentage of patients were willing to use the medication list card. Use of the card also seemed to increase their sense of responsibility and perceived knowledge of their medical care.