Journal club papers
- A prospective population-based cohort study investigating pregnant women admitted to hospital with SARS-COV-2 infection across the UK.
- Over 6 weeks, 427 pregnant women were hospitalised with confirmed infection.
- The median gestation on admission was 34 weeks (IQR 29 – 38 weeks), with most admitted during the third trimester (343/424).
- The most common symptoms were fever, cough and breathlessness. Older women, those with higher BMI or from a black or other ethnic minority group were at greater risk of hospital admission, with Asian (rate ratio 4.0; 95% CI 3.1, 5.1) and black women (RR 8.1; 95% CI 6.2, 10.5) at greatest risk.
- 41/427 (10%) women required ICU admission and 5/427 (1.2%) died, with three deaths as a result of COVID-19 complications.
- Of the 262 women who had given birth at the time of analysis, 66 (25%) gave birth preterm, with 53 iatrogenic preterm births and 32 of these (12% of total births) due to maternal respiratory compromise.
- Five babies died, three were stillborn and two died during the neonatal period. Of these deaths, three were unrelated to SARS-CoV-2 infection and for two stillbirths, it was unclear whether SARS-CoV-2 contributed to the death.
- Of the 265 live born infants, 77 (25%) were admitted to a neonatal unit.
- Twelve (5%) infants were positive for SARS-CoV-2, with 6 within the first 12 hours of birth.
This study confirms previous findings of mostly favourable outcomes following maternal COVID-19 infection. Rates of ICU admission and mortality were comparable to the general population of women of reproductive age in the UK. Reassuringly, transmission to infants was uncommon. These findings further highlight the racial disparities seen in COVID-19 infection, with a higher proportion of black and other minority groups affected and suffering complications. Given the UK has universal healthcare it is unlikely these racial differences are only linked to health inequities and further investigation is required.
A systematic review of 172 observational studies investigating 1) optimal distance, 2) the use of face masks and 3) eye protection to prevent viral transmission of COVID-19, SARS-CoV or MERS.
- 44 studies were included in the meta-analysis, including 8 studies of COVID-19.
- Compared to distances of <1m, physical distancing ≥1m reduced the risk of viral transmission (risk difference – 10.2% [95% CI -11.5, -7.5]).
- Risk of transmission was further decreased by increasing physical distancing (change in relative risk of 2.02 per m distance).
- The use of face masks was associated with the largest reduction in transmission (RD -14.3% [95% CI -15.9, -10.7]), with N95 or similar masks most effective when compared to disposable surgical or similar masks.
- Eye protection (RD -10.6% [95% CI -12.5, -7.7] also reduced the risk of transmission.
Although no intervention was associated with complete protection, these findings support the use of three simple interventions to mitigate COVID-19 transmission. Until a vaccine is widely available social distancing will remain a primary measure in the fight against viral transmission and in areas of increased transmission the use of face masks and eye protection should also be considered.
- A large Finnish population-based study of 670,097 children, investigating antenatal corticosteroid treatment and childhood mental and behavioural disorders at a median age of 5.8 years (IQR 3.1 – 8.7).
- Nested within the study were 4,128 pairs of term born siblings discordant for antenatal corticosteroid exposure.
- Antenatal corticosteroid treatment was associated with increased rates of mental and behavioural disorders during childhood in the whole population (12.01% exposed vs 6.45% unexposed; hazard ratio 1.33 [95% CI 1.26, 1.41]) and children born at term (8.89% vs 6.31%; HR 1.47 [95% CI 1.36, 1.69]).
- Exposed children were a median of 1.4 years younger at the time of first diagnosis for any mental or behavioural disorders when compared to unexposed children.
- Among children born preterm, those exposed to antenatal corticosteroids had significantly higher rates of mental and behavioural disorders (14.59% vs 10.71%), however hazard ratios were not statistically significant (HR 1.00; [95% CI 0.92, 1.09]).
- Among term born sibling pairs, corticosteroid exposure was also associated with increased rates of mental and behavioural disorders (6.56% vs 4.17; HR 1.38 [95% CI 1.21, 1.58]). This sibling pair analysis suggests these associations are not explained by familial confounding.
These findings suggest an increased risk of mental and behavioural disorders associated with antenatal corticosteroid exposure. In this study 45% of steroid exposed children were born at term. This highlights the difficulties in predicting who is at greatest risk of preterm birth and thus, who would benefit most from corticosteroids; where the short-term benefits of treatment would outweigh the potential for long term harm. With increasing calls to expand corticosteroid use to late-preterm and early term deliveries, these findings are timely and should spur further investigation of long-term childhood health and development.