key: cord-0745309-qbk7545a authors: Parra‐Saavedra, Miguel; Villa‐Villa, Isis; Pérez‐Olivo, José; Guzman‐Polania, Leidy; Galvis‐Centurion, Pablo; Cumplido‐Romero, Álvaro; Santacruz‐Vargas, Dario; Rivera‐Moreno, Eliana; Molina‐Giraldo, Saulo; Guillen‐Burgos, Hernán; Navarro, Edgar; Flórez‐Lozano, Karen; Barrero‐Ortega, Amanda; Sanz‐Cortes, Magdalena; Miranda, Jezid title: Attitudes and collateral psychological effects of COVID‐19 in pregnant women in Colombia date: 2020-09-11 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13348 sha: eff2892d4e2cb2b5ac520f929da3e51b51e5bcc1 doc_id: 745309 cord_uid: qbk7545a OBJECTIVE: To assess clinical impact, psychological effects, and knowledge of pregnant women during the COVID‐19 outbreak in seven cities in Colombia. Currently, there are uncertainty and concerns about the maternal and fetal consequences of SARS‐CoV‐2 infection during pregnancy. METHODS: A cross‐sectional web survey was carried out including pregnant women in seven cities in Colombia. Women were evaluated during the mitigation phase of the SARS‐CoV‐2 pandemic between April 13 and May 18, 2020. The questions evaluated demographic, knowledge, psychological symptoms, and attitudes data regarding the COVID‐19 pandemic. RESULTS: A total of 1021 patients were invited to participate, obtaining 946 valid surveys for analysis. The rate of psychological consequences of the pandemic was much larger than the number of patients clinically affected by the virus, with 50.4% of the entire cohort reporting symptoms of anxiety, 49.1% insomnia, and 25% reporting depressive symptoms. Poorly informed women were more likely to be younger, affiliated to the subsidized regime, and with lower levels of education. CONCLUSION: The knowledge of pregnant women about SARS‐CoV‐2 infection is far from reality and this seems to be associated with an indirect effect on the concern and psychological stress of pregnant women in Colombia. There is currently uncertainty regarding the impact of the infection caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) in pregnant women. [1] [2] [3] History has shown that emerg- 19) in pregnant women. 1, [8] [9] [10] [11] [12] [13] [14] [15] On the other hand, according to recent publications, the indirect effects in public health of the COVID-19 outbreak will probably be more severe than the outbreak itself. 16 Although mortality rates for COVID-19 appear to be low in children aged under 5 years and in women of reproductive age, these groups might be disproportionately affected by the disruption of routine health services, particularly in low-and middle-income countries. 16 Finally, the indirect psychological effects of COVID-19 in the entire population are also high according to recently published data. 9, 11 There is a paucity of data from low-resource countries describing the direct and collateral psychological effects of COVID-19 on pregnant women, neither the relationship of the potential psychological effects with other factors such as her degree of information, education, or healthcare coverage. Thus, the aim of the present study was to survey pregnant women in order to evaluate the direct and indirect psychological impact during the COVID-19 outbreak. A web-based cross-sectional survey of pregnant women was carried out. Pregnant women aged over 18 years were eligible to participate. Pregnant women, regardless of their gestational age, were evaluated during the mitigation phase of the SARS-CoV-2 pandemic between April 13 and May 18, 2020, in seven cities in Colombia. A standardized, self-administered questionnaire based on the knowledge, attitudes, and psychological effects, produced by the research group and adapted following WHO recommendations, 13 was sent to those patients whose providers were affiliated to the Atlantic Maternal Fetal Medicine Association (AMMFA) and the National Federation of Perinatology (FECOPEN) and who agreed to collaborate with the study. An electronic invitation to participate was sent to the patients' smartphones using a messenger app (WhatsApp), in which the objective of the survey was explained. Next, the link of the website of the survey was sent to mothers who voluntarily agreed to participate using the same messenger app. Before the beginning of the study, 65 questionnaires were administered to pregnant women in the cities in which the principal inves- The mothers' knowledge about the impact of COVID-19 on their pregnancy was evaluated based on six judgment questions (Supplementary File S1). Each correct answer was given 2 points, an incorrect answer was given 1 point, and an uncertain answer was given no points (for a maximum score of 12 points and a minimum of 0). Participants with scores of 7 points or higher and less than 7 points were considered well and poorly informed, respectively. Questions within the survey were organized into five domains based on the content and information that were attempting to assess attitudes towards the virus, its psychological effects, and women's knowledge about complications from SARS-CoV-2. Finally, the fourth and fith domains enquired about symptoms and tests performed. For the statistical analysis, descriptive analyses were conducted to describe the demographic characteristics and the participants' knowledge about COVID-19. Given that questions in the first two domains were subjective, responses were analyzed using descriptive statistics to determine the percentage of participants selecting each survey response of the total number of participants who answered the question. Second, the frequency of psychological symptoms stratified by patient knowledge was reported, and χ 2 was used to compare the differences between groups. Linear regression was utilized to assess the association between knowledge of SARS-CoV-2 and participant characteristics. Data were analyzed using R sotware. P values of less than 0.05 were considered statistically significant (two-sided tests). A total of 1021 participants received the questionnaires; however, 65 patients collected during the pilot phase were excluded from the analysis. In addition, surveys from 10 patients were removed from the analysis due to incomplete data. Thus, a total of 946 surveys were included in the analysis (response rate of 92.6%). Table 1 Maternal age (years) potential effects on their pregnancies. Participants with scores of 7 points or higher and less than 7 points were considered well and poorly informed, respectively. Based on the answers reflecting their knowledge about SARS-CoV-2, patients were classified as poorly or well informed (78.5% and 21.5%, respectively). The principal findings of the present study are: (1) A systematic scoping review of COVID-19 during pregnancy and childbirth Coronavirus disease 2019 (COVID-19) pandemic and pregnancy Coronavirus Disease 2019 (COVID-19) and pregnancy: What obstetricians need to know Public health approach to emerging infections among pregnant women influenza A(H1N1) virus illness among pregnant women in the United States Clinical assessment and brain findings in a cohort of mothers, fetuses and infants infected with ZIKA virus Serial head and brain imaging of 17 fetuses with confirmed Zika virus infection in Colombia, South America Clinical characteristics of 46 pregnant women with a SARS-CoV-2 infection in Washington State Psychological Impact of COVID-19 in pregnant women Seroprevalence and presentation of SARS-CoV-2 in pregnancy Psychological impact of COVID-19 quarantine measures in northeastern Italy on mothers in the immediate postpartum period Clinical characteristics and laboratory results of pregnant women with COVID-19 in Wuhan, China Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies Ministerio de protección social de Colombia Early estimates of the indirect effects of the coronavirus pandemic on maternal and child mortality in low-and middle-income countries Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases Vertical transmission of Coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: A review Coronavirus disease 2019 in pregnancy: A clinical management protocol and considerations for practice Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis The authors express their gratitude to the following doctors for their collaboration in carrying out this study: Rafael Campanella, Oscar Roncallo Navas, Carlos Becerra, Arturo Cardona, Dahiana Gallo, Esperanza Burgos, Leila Bolívar, Rodrigo Otero, Pola Royo, Francisco Camargo, Alexei Bermudez, Omar Lopez, and Fabian Nassir. The authors have no conflicts of interest.