Discussion
Our results suggest that despite the discomfort from having a swab taken, screening of the inpatient maternity population is acceptable to women with generally positive effects on themselves, their babies, and their families. Nulliparous women are more likely to perceive the positive impacts of screening on their care, their babies care, and the impact on their families as compared to multiparous women.
This patient survey also highlighted that there is a high ethnic diversity, a high number of occupants per house and a low employment rate amongst our pregnant women, which is consistent with the general population of Newham borough.[16] These factors, in addition to the high population density in the area are likely to be contributing factors to Newham the highest age-standardised COVID-19 related mortality rate in the UK. [17]
Universal screening provides the opportunity to use COVID-19 status to appropriately assign beds and personal protective equipment (PPE), thereby minimising spread amongst both healthcare staff, patients, and visitors. This is particularly important in highly populated areas such as Newham, as overcrowding is a major factor in the transmission of diseases with epidemic potential.[18]
There are minimal and diverse data regarding the population prevalence of asymptomatic pregnant women. Sutton et al, in a study carried out in New York, identified that 13.7% of asymptomatic pregnant women tested positive for COVID-19,[19] with Vintzileos et al reporting a similar value of 13%.[20] However, Tassis et al, in a study carried out in Italy, identified that only 0.8% of asymptomatic pregnant women tested positive for COVID-19.[21] These discrepancies arise from the different prevalence’ of COVID-19 depending on the country of study and the point on the pandemic curve that the study was performed. Since prevalence cannot be extrapolated from other populations, it is vital that we continue to perform repeated testing in asymptomatic COVID-19 individuals, in order to effectively guide public health measures aimed at limiting the reproducibility of the virus and the spread of the infection. We showed that such a policy would be well accepted by consumers’, which is key in the implementation of new policies.
Strengths of this study include the timely manner with which it was conducted, during a time-critical period during the ongoing COVID-19 pandemic. Newham Hospital is one of the first maternity hospitals in the UK to initiate a screening programme for COVID-19 within its maternity department. Demographics of the population surveyed were similar to the demographic diversity of the local population.
Limitations of this study include the response rate, which may lead to a non-response bias. However, the similarity in demographics between the pre-screening and post-screening cohorts may be evidence against a major response bias. The post-screening survey was performed by telephone consultation, therefore may be more prone to response bias. Finally, the survey design aimed to explore patient’s attitudes and acceptability of universal screening and was therefore not a validated questionnaire.