Social contacts of pregnant women and COVID vaccination protection in 19 European countries

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In a recently published study medRxiv* Pre-print servers, researchers from the London School of Hygiene and Tropical Medicine and Hasselt University examined social contact patterns and uptake of coronavirus disease 2019 (COVID-19) vaccines among pregnant women from 19 European countries between March 2020 and Sep 2021.

To learn: Pregnancy during COVID-19: social contact patterns and vaccination protection of pregnant women from CoMix in 19 European countries. Credit: Nicoleta Ionescu/Shutterstock

background

It is important that pregnant women receive more psychosocial support during this critical labor phase to help them cope with their emotions and stress. However, due to reduced social contact during the 2020 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pregnant women have had to face additional challenges compounded by fears of contracting COVID-19 were aggravated.

About the study

In the present study, researchers used data from an online social contact survey, CoMix, which recruited and followed up nationally representative samples from 19 European countries. It collected information on the awareness, social contacts and health status of the adult population during the course of the COVID-19 pandemic. They also asked the study participants about their risk perception and their COVID-19 vaccination status.

The team analyzed data from pregnant women between the ages of 18 and 49 and age-matched non-pregnant women and men who participated in the CoMix study. They included all study participants for seven to ten rounds of interviews before exclusion.

The researchers used a clustered bootstrap to calculate the average proportion of people in quarantine and vaccinated by sex and pregnancy status. They used a generalized additive mixed model (GAMM) to calculate the mean adjusted contacts reported in different settings, including home, work, and other social settings. Researchers modeled the reported social contacts using a log-link function based on the assumption that they followed a negative binomial distribution.

The team retrieved the data on non-pharmaceutical interventions (NPIs) measured using an overall stringency index (SI) implemented during the OxCGRT project. SI provides a systematic way to quantify the severity of lockdown policies that restrict social behavior, with scores ranging from zero (least restrictive) to 100.

Number of surveys completed by pregnant women over time by country between March 23, 2020 and September 12, 2021. Not all countries are labeled.  The dashed line represents January 1, 2021.

Number of surveys completed by pregnant women over time by country between March 23, 2020 and September 12, 2021. Not all countries are labeled. The dashed line represents January 1, 2021.

study results

The authors made 4,129 observations in 1,041 pregnant women and found that they had fewer contacts than non-pregnant women. According to this, around 15 to 20% of the pregnant women remained in quarantine for most of the study period. In contrast, less than 20% of non-pregnant women and men reported being in isolation before May 2020 and only 5% since May 2020. Around 45-50% of pregnant women considered COVID-19 to be serious throughout the study period Threat, while ~25% of non-pregnant women did so as of August 2020. Risk perception was clearly higher among pregnant women; However, compared to men, non-pregnant women were more worried about transmitting the disease.

Percentage of participants reporting isolation or quarantine due to COVID-19, with a bootstrap-based 95% confidence interval.

Percentage of participants reporting isolation or quarantine due to COVID-19, with a bootstrap-based 95% confidence interval.

The authors observed a sharp increase in face mask use, i.e., ~70% in all groups in August 2020. Use remained constant in all groups until it dropped to 60% in July 2021. Throughout the study, pregnant women had a slightly lower mean number of daily contacts than nonpregnant women of the same age (3.6 vs. four). However, they socialized more outside the home than non-pregnant women (0.7 vs. 0.5-0.6). Social contacts also varied with the strictness of the NPIs and settings. Pregnant women generally had the fewest out-of-home contacts at all NPI levels. Conversely, they reported more contacts than nonpregnant subjects at all levels of restriction, as indicated by SI scores.

Between January and April 2021, immunization coverage against COVID-19 was higher among pregnant women than among non-pregnant women. Different European countries had different policies regarding COVID-19 vaccines depending on pregnancy status, and uptake was low among pregnant women even when the vaccine was available. In addition, studies have often raised concerns about the safety and side effects of COVID-19 vaccines on the fetus. As of May 2021, vaccination in non-pregnant women surpassed that of pregnant women.

As data on the safety and efficacy of COVID-19 vaccines in pregnancy become available, the authors strongly recommended that pregnant women be vaccinated as a priority. At the same time, policy makers should develop strategies to counter vaccine hesitancy among pregnant women, including post-vaccination surveillance and maternal and child follow-up.

Conclusions

During pregnancy there is an increased need for social contacts or personal support. Introduced during the COVID-19 pandemic, NPIs changed social behaviors that adversely affected pregnant women. In addition, there was an environment of constant confusion that prevented them from receiving a COVID-19 vaccination. Overall, the study data underscored the urgent need to acknowledge and provide accurate and clear information that could reassure pregnant women during the ongoing COVID-19 pandemic.

*Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be relied upon as conclusive, guide clinical practice/health behavior, or be treated as established information.

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