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.