Early suppression policies protected pregnant women from COVID-19 in 2020: A population-based surveillance from the Nordic countries.

INTRODUCTION: The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13-17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. MATERIAL AND METHODS: This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1-December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. RESULTS: In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. CONCLUSIONS: There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.

Are the Norwegian guidelines for ultrasound in prenatal diagnosis followed?

BACKGROUND: The Norwegian Biotechnology Act distinguishes between ultrasound as part of routine antenatal care and fetal diagnostic ultrasound. The Act is criticised for being unclear and difficult to comply with in clinical practice. The purpose of this study was to investigate whether doctors complied with the guidelines in the Biotechnology Act when they considered the case histories of women who wanted early ultrasound with fetal diagnosis. MATERIAL AND METHOD: We asked gynaecologists in private practice, experts in fetal medicine and lawyers and consultants in the Department of Biotechnology and Health Law at the Norwegian Directorate of Health to evaluate six hypothetical cases of women who wanted early ultrasound. RESULTS: We received responses from 64 of 139 (49 %) of private gynaecologists, 22 of 27 (81 %) of doctors at fetal medicine centres and 5 of 12 (42 %) respondents at the Directorate of Health. Only 29 of 86 (34 %) of the doctors responded that they strictly comply with the age criterion of 38 years. 33 of 64 /52 %) of private gynaecologists would measure nuchal translucency themselves, and 43 of 64 (67 %) have referred patients for fetal diagnosis on the indication of "anxiety". 16 of 22 (73 %) of doctors at fetal medicine centres were of the view that anxiety is an indication for fetal diagnostics. All respondents at the Directorate of Health responded that this is not correct according to the guidelines. INTERPRETATION: The majority of doctors did not strictly comply with the guidelines when they evaluated the case histories, and the guidelines were interpreted differently by doctors and respondents at the Directorate of Health.