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Introduction Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.Methods We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.Results We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.Conclusions This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

Summary: Background: The COVID-19 pandemic and associated policy responses have interrupted services, increased financial stress, and driven social isolation, with acute impacts for adolescents. This study explores relationships between gender, COVID-19 vulnerability, social protection, and adolescent wellbeing in three diverse contexts: Ethiopia, Jordan, and Palestine. Methods: This study presents findings from a quantitative phone survey with adolescents in Ethiopia, Jordan, and Palestine (n = 5752) on household-level vulnerability to COVID-19-related shocks, household-level social protection (cash transfers or food aid), and locally adapted outcome measures designed to capture the gendered impacts of COVID-19 (collected between November 22, 2020 and February 25, 2021). We examine the relationship between each outcome and household-level COVID-19 vulnerability and social protection (and their interaction) using multivariate regressions, adjusting for adolescent and household characteristics. Findings: For all adolescents, increased vulnerability to COVID-19-related shocks is associated with worse outcomes for resilient coping and time spent on domestic tasks and care work. Across samples, girls spent over two additional hours on domestic and care work compared to boys. Girls in more vulnerable households experienced greater gendered constraints on behaviour. We find no association between receipt of social protection and adolescent wellbeing, and find that it only moderates the effect of COVID-19 vulnerability for less vulnerable households. Disability status, being out of school, and experiencing child marriage are also associated with adverse outcomes. Interpretation: Our study highlights that the pandemic has exacerbated underlying gender inequalities across adolescents in three very different settings, and that existing social safety nets are not adequate to fully address these impacts, particularly for the most vulnerable. Funding: This work was supported by UK aid through a grant from the Foreign, Commonwealth & Development Office to the Gender and Adolescence: Global Evidence (GAGE) longitudinal research study; the EMERGE project (Bill & Melinda Gates Foundation grants: OPP1163682 and INV018007; PI Anita Raj) and the World Health Organization (WHO) Regional Office for the Eastern Mediterranean.

PurposeThe COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience.MethodsOur analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable Jordanians, living in camps, host communities and informal tented settlements. We utilize mixed-methods analysis combining multivariate regression with deductive qualitative tools to evaluate pandemic impacts and associated policy responses on adolescent wellbeing and mental health, at three and nine months after the pandemic onset. We also explore the role of support systems at individual, household, community, and policy levels.FindingsWe find the pandemic has resulted in severe economic and service disruptions with far-reaching and heterogenous effects on adolescent wellbeing. Nine months into the pandemic, 19.3% of adolescents in the sample presented with symptoms of moderate-to severe depression, with small signs of improvement (3.2 percentage points [pp], pConclusionsPre-existing social inequalities among refugee adolescents affected by forced displacement have been compounded during the COVID-19 pandemic, with related disruptions to services and social networks. To achieve Sustainable Development Goal targets to support healthy and empowered development in adolescence and early adulthood requires interventions that target the urgent needs of the most vulnerable adolescents while addressing population-level root causes and determinants of psychosocial wellbeing and resilience for all adolescent girls and boys.

Professional development for biomedical doctoral and postdoctoral trainees is vital, especially due to the increase in individuals pursuing non-faculty career paths. We created a professional development-focused discussion group between trainees and faculty/staff by utilizing a book club format in which monthly small group meetings occurred over an 8-month period. A pre- and post-survey consisting of Likert and free-response questions was completed by participants. Results demonstrated that after the book club, trainees: 1) were more knowledgeable about a variety of career paths; 2) had improved awareness of their interests in relation to their career; 3) were more knowledgeable of their transferrable skills; 4) were more comfortable engaging with their PI and completing/updating an Individual Development Plan; 5) were more likely to find mentors in addition to their PI to address career specific needs; and 6) were more likely to seek opportunities to conduct informational interviews or experiential learning. Additionally, we found that faculty/staff: 1) were more knowledgeable about careers outside of academia; 2) had greater consideration for their mentee's values and interests in relation to their career; 3) had a better understanding of their mentee's transferable skills; and 4) were more comfortable engaging with their mentee about their career path and addressing an Individual Development Plan. Overall, we found that the utilization of a book club consisting of trainees and faculty/staff as a professional development tool was beneficial for both groups of participants, and this format is feasible for use in biomedical education professional development.

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.

As of 2021, more than 80 million people worldwide have been displaced by war, violence, and poverty. An estimated 30 to 34 million of these are under age 18, and many are at risk of interrupting their education permanently—a situation aggravated in recent years by the global COVID-19 pandemic. In this article, we adopt an intersectional conceptual framework to explore the roles gender and other social inequalities have played in shaping adolescents' access to education during the COVID-19 pandemic. We examine two refugee populations: the Rohingya, who have been excluded from formal education opportunities in Bangladesh, and Syrian refugees in Jordan, who have access to formal education in their host country. We provide novel empirical data, as well as insights into the adolescent refugee experience and the short-term consequences for education resulting from the pandemic. In the article, we draw from quantitative survey data on 3,030 adolescents, and from in-depth qualitative interviews we conducted in the spring of 2020 with a subset of 91 adolescents who are part of an ongoing longitudinal study. We also conducted 40 key informant interviews with community leaders and service providers.

Although adolescents have been less susceptible to COVID-19-related morbidity and mortality than older people, the social containment policies put in place to curb the disease constrained their ability to thrive. This study explored changes in adolescent outcomes during the COVID-19 pandemic, particularly among vulnerable adolescents, focusing on education, economic participation, early marriage, self-reported health, and food security. We investigated the role of governmental and nongovernmental cash and food aid in mitigating negative effects. Using panel data collected both before (2017-20) and at two points during (2020-21) the pandemic on more than 7,000 adolescents from Bangladesh, Jordan, and Ethiopia, we found evidence of worsening outcomes across all measures except self-reported health. Declines were generally worse for more vulnerable adolescents. There is little evidence that aid mitigated negative impacts for adolescents in general or for vulnerable adolescents in particular. This research highlights the need for greater focus on developing social protection that is responsive to the multifaceted needs of adolescents.