Factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women in Metro Manila, Philippines: a multicentre longitudinal cohort study

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Abstract

Objective

To determine the potential risk factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women.

Design

A multicentre prospective cohort study among eligible women in Metro Manila, Philippines, from 2020 to 2022.

Setting

Five national and local hospital research sites altogether recruited and screened 500 consenting eligible individuals.

Participants

Pregnant and non-pregnant participants meeting the eligibility criteria were admitted for a reverse-transcription PCR determination of SARS-CoV-2, pregnancy testing and ultrasound, and an interview with an administered questionnaire.

Exposures

Primary exposure was pregnancy; secondary exposures involve sociodemographic, lifestyle and obstetric-gynaecologic factors.

Outcome measure

Outcome being measured was COVID-19 status.

Results

The significant COVID-19 risk factors were: pregnancy (PR=1.184, 95% CI 1.096, 1.279), having a white-collar job (PR=1.123, 95% CI 1.02, 1.235), travelling abroad (PR=1.369, 95% CI 1.083, 1.173) and being infected by at least one vaccine-preventable disease (VPD) (PR=1.208, 95% CI 1.113, 1.310). Protective factors included having graduate-level education (PR=0.787, 95% CI 0.649, 0.954), immunisation against a VPD (PR=0.795, 95% CI 0.733, 0.862) and practising contraception (PR=0.889, 95% CI 0.824, 0.960).

Conclusion

This study is the first in the country to determine the risks influencing COVID-19 infection among unvaccinated pregnant and non-pregnant women. Pregnancy is a significant risk for COVID-19 among women in Metro Manila. Educational attainment and positive health behaviours seem to confer protection. Occupations and activities that increase the frequency of interactions, as well as history of communicable diseases may predispose women to COVID-19. Further studies are needed to elucidate the development of the disease in pregnant women, including the maternal and neonatal effects of COVID-19 via potential vertical mechanisms of transmission.

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Most cited references 26

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Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction.

Elisabeth Mahase (2020)

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COVID-19 in Healthcare Workers: A Living Systematic Review and Meta-analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes

Sergio Alejandro Gómez-Ochoa, Oscar Franco, Lyda Rojas … (2020)

Abstract Health care workers (HCW) are at the frontline response to the new coronavirus disease 2019 (COVID-19), being at a higher risk of acquiring the disease, and subsequently, exposing patients and colleagues. Searches in eight bibliographic databases were performed to systematically review the evidence on the prevalence, risk factors, clinical characteristics, and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCW. Ninety-seven studies (All published in 2020), including 230,398 HCW, met the inclusion criteria. From the screened HCW using RT-PCR and the presence of antibodies, the estimated prevalence of SARS-CoV-2 infection was 11% (95%CI; 7%-15%) and 7% (95% CI; 4%-11%), respectively. The most frequently affected personnel were the nurses (48%. 95%CI; 41%-56%), while most of the COVID-19 positive medical personnel were working in hospitalization/non-emergency wards during the screening (43%, 95%CI;28%-59%). Anosmia, fever and myalgia were identified as the only symptoms associated with HCW SARS-CoV-2 positivity. Among RT-PCR positive HCW, 40% (95%CI;17%-65%) did not show symptoms at the time of diagnosis. Finally, 5% (95%CI;3%-8%) of the COVID-19 positive HCW developed severe clinical complications, and 0.5% (95% CI; 0.02%-1.3%) died. HCW suffer a significant burden from COVID-19, with HCW working in hospitalization/non-emergency wards and nurses being the most infected personnel.

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Health Risks and Outcomes that Disproportionately Affect Women during the Covid-19 Pandemic: A Review

Jade A. Connor, Sarina Madhavan, Mugdha V. Mokashi … (2020)

Background The Covid-19 pandemic is straining healthcare systems in the US and globally, which has wide-reaching implications for health. Women experience unique health risks and outcomes influenced by their gender, and this narrative review aims to outline how these differences are exacerbated in the Covid-19 pandemic. Observations It has been well described that men suffer from greater morbidity and mortality once infected with SARS-CoV-2. This review analyzed the health, economic, and social systems that result in gender-based differences in the areas healthcare workforce, reproductive health, drug development, gender-based violence, and mental health during the Covid-19 pandemic. The increased risk of certain negative health outcomes and reduced healthcare access experienced by many women are typically exacerbated during pandemics. We assess data from previous disease outbreaks coupled with literature from the Covid-19 pandemic to examine the impact of gender on women’s SARS-CoV-2 exposure and disease risks and overall health status during the Covid-19 pandemic. Conclusions Gender differences in health risks and implications are likely to be expanded during the Covid-19 pandemic. Efforts to foster equity in health, social, and economic systems during and in the aftermath of Covid-19 may mitigate the inequitable risks posed by pandemics and other times of healthcare stress.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2023

Publication date (Electronic): 17 April 2023

Publication date PMC-release: 17 April 2023

Volume: 13

Issue: 4

Electronic Location Identifier: e070688

Affiliations

[1 ]departmentDepartment of Obstetrics and Gynecology , Ringgold_54725University of the Philippines Manila College of Medicine , Manila, Philippines

[2 ]departmentInstitute of Child Health and Human Development, National Institutes of Health , Ringgold_54725University of the Philippines Manila , Manila, Philippines

[3 ]departmentDepartment of Molecular Biology and Biochemistry , Ringgold_54733University of the Philippines Manila College of Medicine , Manila, Philippines

[4 ]departmentDepartment of Virology , Ringgold_433382Research Institute for Tropical Medicine , Muntinlupa, Philippines

[5 ]departmentDepartment of Pharmacology and Toxicology , Ringgold_54733University of the Philippines Manila College of Medicine , Manila, Philippines

[6 ]departmentDepartment of Obstetrics and Gynecology , Ringgold_425471Jose R Reyes Memorial Medical Center , Manila, Philippines

[7 ]departmentDepartment of Obstetrics and Gynecology , Dr Jose Fabella Memorial Hospital , Manila, Philippines

[8 ]departmentDepartment of Internal Medicine , Ospital ng Maynila Medical Center , Manila, Philippines

[9 ]departmentDepartment of Obstetrics and Gynecology , Ospital ng Maynila Medical Center , Manila, Philippines

[10 ]departmentDepartment of Obstetrics and Gynecology , Justice Jose Abad Santos General Hospital , Manila, Philippines

[11 ]departmentDepartment of Obstetrics and Gynecology , Sta Ana Hospital , Manila, Philippines

[12 ]Ringgold_54733University of the Philippines Manila College of Medicine , Manila, Philippines

[13 ]departmentInstitute of Clinical Epidemiology, National Institutes of Health , Ringgold_54725University of the Philippines Manila , Manila, Philippines

[14 ]departmentDepartment of Clinical Epidemiology , Ringgold_54725University of the Philippines Manila College of Medicine , Manila, Philippines

[15 ]departmentDepartment of Health Policy and Administration , Ringgold_54734University of the Philippines Manila College of Public Health , Manila, Philippines

Author notes

[Correspondence to ] Dr Erlidia F Llamas-Clark; efllamasclark@ 123456up.edu.ph

Author information

Erlidia F Llamas-Clark http://orcid.org/0000-0002-6296-8610

Emmanuel S Baja http://orcid.org/0000-0002-3888-8880

Article

Publisher ID: bmjopen-2022-070688

DOI: 10.1136/bmjopen-2022-070688

PMC ID: 10111183

PubMed ID: 37068908

SO-VID: 33147ba8-4ae7-4984-84a4-1ca4263b54e8

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 10 December 2022

Date accepted : 27 March 2023

Funding

Funded by: The Australian Awards and Alumni Engagement Program;

Award ID: N/A

Funded by: FundRef http://dx.doi.org/10.13039/501100011096, Philippine Council for Health Research and Development;

Award ID: N/A

Funded by: Philippine Obstetrical and Gynecological Society (POGS);

Award ID: N/A

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ScienceOpen disciplines: Medicine

Keywords: covid-19,epidemiologic studies,public health,obstetrics

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ScienceOpen disciplines: Medicine

Keywords: covid-19, epidemiologic studies, public health, obstetrics

Factors associated with having COVID-19 among unvaccinated pregnant and non-pregnant women in Metro Manila, Philippines: a multicentre longitudinal cohort study

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Abstract

Objective

Design

Setting

Participants

Exposures

Outcome measure

Results

Conclusion

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 26

Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction.

COVID-19 in Healthcare Workers: A Living Systematic Review and Meta-analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes

Health Risks and Outcomes that Disproportionately Affect Women during the Covid-19 Pandemic: A Review

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