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A mother's perspective of consent for maternal and neonatal COVID-19 testing: can we do more?

02 July 2022
12 min read
Volume 30 · Issue 7

Abstract

Background

There is ongoing research on the effects of COVID-19 on pregnancy and whether vertical viral transmission occurs.

Aims

This study aimed to determine maternal opinions of COVID-19 testing for pregnant women and newborns in order to influence future clinical practice while advancing global knowledge of the impact of testing on patient experiences.

Methods

This service evaluation assessed the opinions of 292 pregnant women who were tested for COVID-19 along with their newborn babies using nasopharyngeal swabs and the SARS-CoV-2 reverse transcription polymerase chain reaction test between 28 April and 21 May 2020.

Results

Many women felt their own (60%) and their baby's (61%) swab was compulsory and did not feel sufficiently informed about the risks and benefits for themselves (43%) or their baby (52%) being tested. Some women did not understand the implications of a positive test for themselves (43%) or their baby (42%). Most participants reported they would agree to themselves (97%) and their baby (86%) being tested in future pregnancies.

Conclusion

Communication to pregnant women regarding the COVID-19 swabbing process is critical and requires improvement. This service evaluation highlighted where women felt under-informed. These areas should be covered in more detail for consenting women for COVID-19 testing in future.

After December 2019, when the first case of the novel 2019 coronavirus (SARS-CoV-2) was identified, the associated illness (COVID-19) became a significant international health concern. Declared a global pandemic by the World Health Organization (WHO, 2020) on 11 March 2020, COVID-19 remains one of the most catastrophic and unprecedented public health crises in decades. It resulted in over 534 million reported cases worldwide and 6.3 million deaths as of 16 June 2022 (WHO, 2022), with numbers continuing to rise as new strains with potentially more harmful effects are identified.

The impact of COVID-19 on pregnant women has been the cause of much controversy. The focus of current literature regarding this cohort of the population has been two-fold. Studies have either concentrated on the infection's effects on mother, baby and the pregnancy or evaluated the possibility of vertical transmission from a pregnant mother to her fetus in utero, during delivery or in the postpartum period. With regards to the former, several studies have highlighted that coronavirus infections lead to more severe complications and negative outcomes in pregnancy, including renal failure, disseminated intravascular coagulopathy, preterm deliveries, fetal growth restriction, a greater chance of intensive care admission, intubation and mechanical ventilation and spontaneous miscarriages, stillbirths or perinatal deaths (Schwartz and Graham, 2020). Normal physiological changes occurring during pregnancy are thought to underpin the rationale for pregnant women being more susceptible to developing these negative outcomes (Kourtis et al, 2014). Cardiopulmonary adaptations as a result of the gravid uterus predispose to hypoxaemia, while variations in sex hormone levels and their interaction with the immune system hinder pathogen elimination and exacerbate infection severity (Kourtis et al, 2014).

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