Antenatal Screening Tests Performance during the First Wave of Coronavirus Disease 2019: Lessons Learned for Future Pandemics

Abstract

Background: We aimed to explore screening test utilization and performance during pregnancy amidst pandemic, examining both nulliparous and multiparous women, and to compare screening test performance before and during the pandemic in multiparous women. Methods: A cross-sectional study of 500 pregnant women at Galilee Medical Center, Israel, explored the effects of coronavirus disease 2019 (COVID-19) on screening test performance during the first wave of the pandemic. Sociodemographic and data regarding screening test performance (including nuchal translucency (NT)), first-trimester biochemical test, early fetal scan, alpha-fetoprotein testing, second fetal scan, glucose tolerance test, diphtheria, tetanus, and acellular pertussis (Tdap) vaccination, and third-trimester ultrasonographic fetal growth assessment) were collected via face-to-face interviews using a medical questionnaire. Logistic regression was performed to identify factors that influenced screening test performance. Results: 234 (46%) women did not perform at least one screening test during their pregnancy. Of these, 42% attributed their decision to the impact of the COVID-19 pandemic. Among these, 18.8% were anxious about potential exposure, 16.2% cited medical staff isolations and cancelations, 5.6% reported being infected with COVID-19 or in self-isolation, and 4.3% faced challenges related to local quarantine. Of our cohort, 9.2% reported refusing emergency department (ED) referral due to anxiety regarding possible exposure. Only 44.3% of multiparous women performed all the screening tests during the pandemic, compared with 70.8% before the pandemic (p < 0.001). Nearly half of this inadequate screening were directly associated with the pandemic. Women who reported inadequate pandemic-related screening test performance tended to be multiparous (adjusted odds ratio [aOR] = 6.43), to have low-risk pregnancies (aOR = 2.6), and to be members of Muslim and Druze minorities (aOR = 4.89 and aOR = 3.83, respectively). Conclusions: This study highlights the negative effect of the COVID-19 pandemic on antenatal screening test performance especially among women of minority ethnic backgrounds. Optimizing antenatal care services, grouping of tests, and on-site vaccinations may increase the adequacy of screening test performance. Implementing telehealth strategies emerges as an essential tool to enhance antenatal care compliance during pandemics.

Keywords

• antenatal care
• covid-19
• pandemic
• telehealth
• public health policy