Date of Award

12-2023

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

DR. SARAH SALEEM

Second Advisor

SYED IQBAL AZAM

Third Advisor

DR SALEEM JESSANI

Department

Community Health Sciences

Abstract

Background: The COVID-19 pandemic has affected millions of individuals worldwide, putting vulnerable populations, including pregnant women and newborns, at a higher risk of developing negative effects. Coronavirus primarily affects the respiratory system, and pregnant women are more vulnerable to respiratory distress due to decreased residual lung capacity, increased oxygen demand from both the maternal and fetus' systems, which may be caused by changes in lung capacity and vasodilation. The primary objective of this study was to see if maternal SARS-Cov2 exposure during pregnancy or before delivery influenced any change in the risk of NICU admission and other maternal and neonatal factors that could change the odds of NICU admission among neonates delivered at public and private tertiary care hospitals in Karachi, Pakistan.
Methods: This hospital-based sub-study was conducted in two tertiary care hospitals in Pakistan (one private and one public) as part of a larger internationally implemented prospective cohort study across six countries funded by World Health Organization (WHO). Women at any stage of pregnancy were consented and enrolled in the research. Data collection included information on mother characteristics, medical and obstetric history, as well as current pregnancy outcomes. Firth logistic regression technique was employed to explore the relationship between neonatal ICU admissions (the main outcome variable) and other relevant maternal and fetal variables. Participants were categorized into two groups based on their exposure status during pregnancy related to COVID-19: Group 1 consisted of women who either contracted COVID-19 during pregnancy or tested positive for COVID-19 antibodies before delivery, while Group 2 comprised women who did not contract COVID-19 during pregnancy nor test positive for COVID-19 antibodies prior to delivery. Among 772 women enrolled in the study, only 23 reported COVID19 history with documented RT-PCR test with them.
Results: Babies who got admitted to the NICU in the COVID-19 exposed group were 10.4% (n=78/749) and 8.7% (n=2/23) in the COVID-19 unexposed group (p value = 0.15). The odds of NICU admission are 2.42 times among those exposed to COVID-19 as compared to those who are unexposed to COVID-19 when adjusted for preterm, low birth weight and comorbidities (AOR 2.42, 95% CI 0.62–9.4: p value 0.2). If the women had preterm birth the odds of neonatal ICU admission are 3.4 times [AOR 3.4, 95% CI 2–5.9; p value 0.001] compared to babies who are born full term. The odds of NICU admission among neonates with low birth weight was 4 times compare to babies who had normal weight [AOR 4, 95% CI 2.29–7.1; p value 0.001]. The neonates whose mothers having mode of delivery as emergency cesarean section is 2 times more likely to be admitted in NICU as compared to those babies delivered normally (vaginal delivery) [AOR 2, 95% CI 1.1–3.3; p value 0.02]. The neonates born to women who had comorbidity had an odd of NICU admission 2.13 times than the neonates whose mothers don’t have any comorbidity. [AOR 2.13, 95% CI 1.06–4.2; p value 0.03].
Conclusion: NICU admissions were not significantly associated with the Covid-19 exposure status. However, NICU admissions were significantly associated with the preterm birth, low birth weight, emergency c- section, and maternal co-morbidity. Based on our study, we do not have enough evidence to for making any specific recommendations regarding NICU admissions related to SARS-CoV-2 exposure. However, we strongly recommend that to reduce the risk of preterm birth, low birth weight, and maternal co-morbidity, it is essential to strengthen maternal health services by providing access to antenatal care during pregnancy, postnatal care, promotion of breast feeding in the early hours after delivery and ensuring that women have access to skilled birth attendants.

First Page

1

Last Page

75

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