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      Fear of COVID-19 when experiencing pregnancy or childbirth in the pandemic: what are the associated factors? Translated title: Miedo al COVID-19 al vivir el embarazo o el parto en la pandemia: ¿cuáles son los factores asociados? Translated title: Medo da COVID-19 ao vivenciar a gestação ou parto na pandemia: quais os fatores associados?

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          ABSTRACT

          Objective:

          to identify factors associated with fear of COVID-19 among women who experienced pregnancy or childbirth during the pandemic.

          Methods:

          a cross-sectional study, nested within a prospective cohort, using an online survey, from August 2021 to February 2022, based on descriptive data analysis.

          Results:

          of the 431 participants, 52.8% were postpartum women and 20.1% were pregnant women. With regard to fear of COVID-19, a mean score of 20.46 was obtained (moderate fear). The highest fear scores were present in women whose newborns were admitted to hospital in neonatal critical units (p=0.032), and the lowest among those covered by supplementary health (insurance) (p=0.016).

          Conclusion:

          among pregnant and postpartum women, high fear of COVID-19 translated into the possibility of having newborns admitted to hospital in a critical unit. The importance of supporting actions to support pregnant/postpartum women’s mental health in relation to COVID-19 or other threats that may influence the neonatal outcome stands out.

          RESUMO

          Objetivo:

          identificar fatores associados ao medo da COVID-19 entre mulheres que vivenciaram a gestação ou parto durante a pandemia.

          Métodos:

          estudo transversal aninhado à coorte prospectiva, por meio de inquérito online, no período de agosto de 2021 a fevereiro de 2022, a partir de análise descritiva dos dados.

          Resultados:

          dos 431 participantes, 52,8% eram puérperas e 20,1% gestantes. Com relação ao medo da COVID-19, obteve-se pontuação média de 20,46, (medo moderado). Os maiores escores de medo estiveram presentes em mulheres cujos recém-nascidos estavam internados em unidades críticas neonatais (p = 0,032) e os menores entre cobertos pela saúde suplementar (convênios) (p = 0,016).

          Conclusão:

          Entre gestantes e puérperas o alto medo da COVID-19 traduziu-se na possibilidade de ter o neonato internado em unidade crítica. Destaca-se a importância de subsidiar ações de suporte à saúde mental de gestantes/puérperas, com relação à COVID-19 ou outras ameaças, que possam influenciar o desfecho neonatal.

          RESUMEN

          Objetivo:

          identificar factores asociados al miedo al COVID-19 entre mujeres que vivieron el embarazo o el parto durante la pandemia.

          Métodos:

          estudio transversal, anidado dentro de una cohorte prospectiva, mediante encuesta en línea, de agosto de 2021 a febrero de 2022, basado en análisis de datos descriptivos.

          Resultados:

          de los 431 participantes, el 52,8% eran puérperas y el 20,1% eran gestantes. En cuanto al miedo al COVID-19 se obtuvo una puntuación media de 20,46 (miedo moderado). Las puntuaciones de miedo más altas estuvieron presentes en las mujeres cuyos recién nacidos fueron hospitalizados en unidades críticas neonatales (p=0,032), y las más bajas entre las cubiertas por el seguro complementario de salud (p=0,016).

          Conclusión:

          entre las mujeres embarazadas y puérperas, el alto temor a la COVID-19 se tradujo en la posibilidad de internar al recién nacido en una unidad de críticos. Se destaca la importancia de apoyar acciones para apoyar la salud mental de las mujeres embarazadas/en posparto en relación con el COVID-19 u otras amenazas que puedan influir en el resultado neonatal.

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          Most cited references35

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          Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio

          Background Cross-sectional studies with binary outcomes analyzed by logistic regression are frequent in the epidemiological literature. However, the odds ratio can importantly overestimate the prevalence ratio, the measure of choice in these studies. Also, controlling for confounding is not equivalent for the two measures. In this paper we explore alternatives for modeling data of such studies with techniques that directly estimate the prevalence ratio. Methods We compared Cox regression with constant time at risk, Poisson regression and log-binomial regression against the standard Mantel-Haenszel estimators. Models with robust variance estimators in Cox and Poisson regressions and variance corrected by the scale parameter in Poisson regression were also evaluated. Results Three outcomes, from a cross-sectional study carried out in Pelotas, Brazil, with different levels of prevalence were explored: weight-for-age deficit (4%), asthma (31%) and mother in a paid job (52%). Unadjusted Cox/Poisson regression and Poisson regression with scale parameter adjusted by deviance performed worst in terms of interval estimates. Poisson regression with scale parameter adjusted by χ2 showed variable performance depending on the outcome prevalence. Cox/Poisson regression with robust variance, and log-binomial regression performed equally well when the model was correctly specified. Conclusions Cox or Poisson regression with robust variance and log-binomial regression provide correct estimates and are a better alternative for the analysis of cross-sectional studies with binary outcomes than logistic regression, since the prevalence ratio is more interpretable and easier to communicate to non-specialists than the odds ratio. However, precautions are needed to avoid estimation problems in specific situations.
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            Functional Fear Predicts Public Health Compliance in the COVID-19 Pandemic

            In the current context of the global pandemic of coronavirus disease-2019 (COVID-19), health professionals are working with social scientists to inform government policy on how to slow the spread of the virus. An increasing amount of social scientific research has looked at the role of public message framing, for instance, but few studies have thus far examined the role of individual differences in emotional and personality-based variables in predicting virus-mitigating behaviors. In this study, we recruited a large international community sample (N = 324) to complete measures of self-perceived risk of contracting COVID-19, fear of the virus, moral foundations, political orientation, and behavior change in response to the pandemic. Consistently, the only predictor of positive behavior change (e.g., social distancing, improved hand hygiene) was fear of COVID-19, with no effect of politically relevant variables. We discuss these data in relation to the potentially functional nature of fear in global health crises.
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              Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

              Background The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. Methods We did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753). Findings The search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07–1·54]; I 2=63%; 12 studies, 168 295 pregnancies during and 198 993 before the pandemic) and maternal death (1·37 [1·22–1·53; I 2=0%, two studies [both from low-income and middle-income countries], 1 237 018 and 2 224 859 pregnancies) during versus before the pandemic. Preterm births before 37 weeks' gestation were not significantly changed overall (0·94 [0·87–1·02]; I 2=75%; 15 studies, 170 640 and 656 423 pregnancies) but were decreased in high-income countries (0·91 [0·84–0·99]; I 2=63%; 12 studies, 159 987 and 635 118 pregnancies), where spontaneous preterm birth was also decreased (0·81 [0·67–0·97]; two studies, 4204 and 6818 pregnancies). Mean Edinburgh Postnatal Depression Scale scores were higher, indicating poorer mental health, during versus before the pandemic (pooled mean difference 0·42 [95% CI 0·02–0·81; three studies, 2330 and 6517 pregnancies). Surgically managed ectopic pregnancies were increased during the pandemic (OR 5·81 [2·16–15·6]; I 2=26%; three studies, 37 and 272 pregnancies). No overall significant effects were identified for other outcomes included in the quantitative analysis: maternal gestational diabetes; hypertensive disorders of pregnancy; preterm birth before 34 weeks', 32 weeks', or 28 weeks' gestation; iatrogenic preterm birth; labour induction; modes of delivery (spontaneous vaginal delivery, caesarean section, or instrumental delivery); post-partum haemorrhage; neonatal death; low birthweight (<2500 g); neonatal intensive care unit admission; or Apgar score less than 7 at 5 min. Interpretation Global maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. Some outcomes show considerable disparity between high-resource and low-resource settings. There is an urgent need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises. Funding None.
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                Author and article information

                Contributors
                Role: conception or design of the study/researchRole: final review with critical and intellectual participation in the manuscript
                Role: conception or design of the study/researchRole: final review with critical and intellectual participation in the manuscript
                Role: conception or design of the study/researchRole: final review with critical and intellectual participation in the manuscript
                Role: analysis and/or interpretation of the dataRole: final review with critical and intellectual participation in the manuscript
                Role: analysis and/or interpretation of the dataRole: final review with critical and intellectual participation in the manuscript
                Role: conception or design of the study/researchRole: analysis and/or interpretation of the dataRole: final review with critical and intellectual participation in the manuscript
                Role: analysis and/or interpretation of the dataRole: final review with critical and intellectual participation in the manuscript
                Journal
                Rev Bras Enferm
                Rev Bras Enferm
                reben
                Revista Brasileira de Enfermagem
                Associação Brasileira de Enfermagem
                0034-7167
                1984-0446
                08 December 2023
                2023
                : 76
                : Suppl 2
                : e20220755
                Affiliations
                [I ]Universidade Federal do Triângulo Mineiro. Uberaba, Minas Gerais, Brazil
                [II ]Universidade Estadual de Feira de Santana. Feira de Santana, Bahia, Brazil
                [III ]Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil
                [IV ]Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
                Author notes
                Corresponding author: Mariana Torreglosa Ruiz E-mail: mariana.ruiz@ 123456uftm.edu.br

                EDITOR IN CHIEF: Dulce Barbosa

                ASSOCIATE EDITOR: Hugo Fernandes

                Author information
                http://orcid.org/0000-0002-4375-1213
                http://orcid.org/0000-0001-5100-2733
                http://orcid.org/0000-0002-4308-5978
                http://orcid.org/0000-0001-7866-6353
                http://orcid.org/0000-0002-5831-8789
                http://orcid.org/0000-0002-5199-7328
                http://orcid.org/0000-0002-1194-3261
                Article
                00161
                10.1590/0034-7167-2022-0755
                10704700
                38088656
                5d0c0060-4c82-4f32-8e91-493bdd6d44a2

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 December 2022
                : 14 August 2023
                Categories
                Original Article

                covid-19,pregnancy,postpartum period,fear,pandemics,embarazo,periodo posparto,miedo,pandemias,gravidez,período pós-parto,medo

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