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Rates of premature births declined in Melbourne, Australia, during the first half of the COVID-19 pandemic, according to a recent study from Monash University. In the United States, where the burden of COVID-19 has been much higher, researchers found that rates of late preterm births climbed a little higher than prepandemic rates. The increase was driven entirely by an increase among Black and Hispanic women, particularly Puerto Rican women, whose rate more than tripled.
These findings are from just two of the abstracts that researchers will present and discuss at the upcoming annual meeting of the Society of Maternal-Fetal Medicine (SMFM) — being held online from January 25 through 30. They represent two separate but interrelated themes likely to permeate this year’s conference: the pandemic, and health disparities.
“Given not just COVID but the current social and political climate in the United States and even worldwide, I think this conference comes at an ideal time for people to discuss their research regarding impact of racism, discrimination, and racial disparities on obstetric outcomes,” Tracy Manuck, MD, an associate professor of ob/gyn at the University of North Carolina at Chapel Hill (UNC), told Medscape Medical News. Manuck, who is also medical director of UNC’s Prematurity Prevention Program, will be co-moderating the session featuring the Australian research on prematurity during lockdown.
“The pandemic, as you know, disproportionately affects individuals of color, so it’s kind of a perfect opportunity to study both: obstetric outcomes and the pandemic, and something that disproportionately impacts minorities in the United States,” Manuck said.
More than two dozen presentations at the conference focus specifically on SARS-CoV-2 infection or on other aspects of the pandemic and how they affect women and newborns. From the effect of lockdowns on maternal-fetal health to COVID-19 morbidity in pregnancy to best practices for prenatal visits during the pandemic, it’s impossible to avoid discussing the effects of such a public health catastrophe when presenting research in the midst of one, experts said.
Woven through much of that research is a recurring issue that has drawn more and more attention in recent years — social determinants of health, and health disparities resulting from racism and related socioeconomic factors. The conference presentations include almost as many focused on disparities as on COVID-19, and several of those overlap.
“There are many, many questions both in obstetrics in general and related to the pandemic specifically that need further inquiry, including the health disparities that we’re seeing with severity of COVID and the populations that are getting COVID,” Cynthia Gyamfi Bannerman, MD, the SMFM 2021 program committee chair, told Medscape Medical News. Gyamfi, an ob/gyn at Columbia University and primary investigator of the Maternal-Fetal Medicine Units Network at the National Institutes of Health, expects COVID vaccines to be top of mind during the conference, even if the relevant data are not yet available.
“We desperately need research in pregnancy to understand what the implications of getting vaccinated are. That’s the question on everybody’s mind right now as the vaccine is getting rolled out,” Gyamfi said. “We have a lot of publications on the effects of COVID in pregnancy, and I think we all are very eager to collect data on people who have been vaccinated moving forward and compare them to an appropriate control group. All of our theoretical data and the animal data to date suggest it’s safe, but now we need data from folks who have been vaccinated as well.”
She also points out two of the late-breaking abstracts that relate to COVID: an encouraging study on the placental transfer of COVID antibodies, and one on maternal and neonatal outcomes from COVID during pregnancy. The latter study was based on a multistate cohort of more than 1200 patients.
“There will be debate on how the population will be affected — will there be more babies delivered preterm, will there be more growth-restricted babies — and we don’t have data on long-term outcomes of the mothers and children” who are exposed to COVID-19 during pregnancy, Bo Jacobsson, MD, PhD, a professor of ob/gyn at the University of Gothenburg, Gothenburg, Sweden, told Medscape Medical News. He expects discussions on COVID-19’s effects at the population, hospital, and individual levels as well as conversations among clinicians about the rare and complex COVID-19 cases they may have seen.
“The huge research effort that COVID has resulted in will offer important clues into how other disease-causing mechanisms could lead to problems in mothers and children,” such as improving understanding of fetal demise, malformations, or brain damage, Jacobsson said.
On the other hand, it’s important that COVID-19 doesn’t crowd out other important maternal issues, such as maternal mortality. It’s unlikely COVID-19 will overwhelm the conference program, given the breadth of research on the schedule.
“The program committee thought perhaps we would see a preponderance of COVID abstracts, but we were actually pleasantly surprised that we saw the breadth and depth of maternal fetal medicine,” Gyamfi said. “We didn’t know what to expect and how many abstracts we’d be able to get because of the limitations of doing research in the middle of the pandemic and many people having to pause their work. But many people were able to complete excellent studies, and I was very impressed with the quality of science this year, so I’m very excited for the meeting.”
Gyamfi participated in a Sera Prognostics advisory board meeting in 2018 and has received a donation from Hologic of a device to study prematurity. Jacobsson led a study funded by Natera.
Society of Maternal-Fetal Medicine: Abstracts 11 and 96.
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