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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 28
| Issue : 2 | Page : 93-98 |
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Impact of coronavirus disease (COVID-19) on reproductive health
Benedict A Falana1, Olawale O Obembe2, Opeyemi S Adeleke3, Gbenga A Adefolaju4, Olorunfemi S Tokunbo3
1 Department of Medical Biosciences, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa; Department of Anatomy, Faculty of Basic Medical Sciences College of Health Sciences, Osun State University, Osogbo, Nigeria
2 Department of Physiology, Faculty of Basic Medical Sciences College of Health Sciences, Osun State University, Osogbo, Nigeria
3 Department of Anatomy, Faculty of Basic Medical Sciences College of Health Sciences, Osun State University, Osogbo, Nigeria
4 Department of Anatomy, School of Medicine, University of Lancashire, Preston, UK
| Date of Submission | 26-Jun-2022 |
| Date of Decision | 17-Aug-2022 |
| Date of Acceptance | 20-Feb-2023 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Olawale O Obembe
Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, PMB 4494, Osogbo, Osun State
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijmh.IJMH_53_22
The coronavirus disease (COVID-19) is a communicable respiratory disease caused by a new strain of coronavirus that causes illness in humans. The disease is caused by a pathogen called Severe Acute Respiratory Syndrome Coronavirus-2 and can be transmitted from person to person through infected air droplets that are projected during sneezing or coughing. The coronavirus disease has generally affected all sectors of the society, including the health sector and reproductive health in particular. Reproductive health contributes greatly to physical and psychosocial comfort and closeness between individuals. Adequate and balanced reproductive health can be impaired and deprived by diseases, abuse, exploitation, unwanted pregnancy, and death. This review paper looked into possible effects of COVID-19 pandemic on reproductive health. Human and nonhuman primate literatures were examined to extract empirical data detailing the impact of COVID-19 on reproductive health. Literatures were sourced from Ovid MEDLINE, SCOPUS, the Cochrane Library, Ovid EMBASE, CINAHL Plus, PROQUEST, PUBMED, and Web of Science. Experimental and clinical evidence were used to examine whether COVID-19 adversely impacted on the reproductive health of infected and non-infected population. The global outbreak of COVID-19 has led to measures driven by the pandemic, to prevent further spread and effectual treatment of those affected. This has literally caused decrease in sexual and reproductive health care services due to global lockdowns and closures of health sectors deemed to be non-essential in combating the disease. Keywords: COVID-19, pandemic, reproductive health, virus
How to cite this article:
Falana BA, Obembe OO, Adeleke OS, Adefolaju GA, Tokunbo OS. Impact of coronavirus disease (COVID-19) on reproductive health. Int J Med Health Dev 2023;28:93-8 |
How to cite this URL:
Falana BA, Obembe OO, Adeleke OS, Adefolaju GA, Tokunbo OS. Impact of coronavirus disease (COVID-19) on reproductive health. Int J Med Health Dev [serial online] 2023 [cited 2023 May 28];28:93-8. Available from: https://www.ijmhdev.com/text.asp?2023/28/2/93/372150 |
| Introduction | |  |
The current pandemic of the coronavirus disease (COVID-19), which was supposedly believed to have originated from China has clearly become a rather disturbing Public Health Emergency of International Concern, affecting over 180 countries in the world. Over 221 million cases have been documented worldwide so far with around 4.6 million deaths as at December, 2021. The actual number of infected individuals has been estimated to be in multiples of actual official documented cases.[1],[2] The disease is caused by a pathogen called Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Presently, it is widely reported that humans are the main carriers of this pathogen, transmitting the disease from person-to-person. This means that a person can get infected by directly or indirectly coming in close contact with a human carrier or someone already infected with the disease. Direct ways of contracting the virus are usually through respiratory droplets of infected person, produced when a person coughs, sneezes, talks, shares handshake, hug, or kiss an infected person. Coronavirus may be contracted indirectly by touching an object or surface that has been contaminated by a carrier of the virus. The carrier can get infected by touching the face (mouth, nose or eyes) with the contaminated part of the body. When the virus comes in contact with a living tissue, it becomes activated, goes through incubation, and begins to proliferate. On the average, SARS-CoV-2 incubation period, that is the time between exposure and onset of the symptoms of the infection is between 5 and 14 days.[3] This is however dependent on several factors including the virus variant, age of infected person, status of the immune system, presence or absence of an underlying medical condition, etc.[4]
In the absence of urgent and adequate medical intervention, COVID-19 infection with co-morbidities may result in death within a period of 6–41 days.[4] The symptoms that have been attributed to the disease include persistent fever, dry cough, sputum production, general fatigue, headache, hemoptysis, diarrhea, dyspnea, and lymphopenia.[4],[5],[6] The disease was previously referred to as novel Coronavirus pneumonia caused by the pathogen called novel Corona virus, 2019-nCoV. The SARS-CoV-2 is preceded by other corona virus species, initially the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), which emerged in China almost 18 years ago and Middle East respiratory syndrome coronavirus (MERS-CoV),[7] which emerged in 2012.[8] The global outbreak of COVID-19 has led to measures driven by the pandemic, to prevent further spread and effectual treatment of those affected. This has literally caused decrease in sexual and reproductive health care services due to global lockdowns and closures of health sectors deemed to be non-essential in combating the disease and channeling of all available health personnel and materials to fight and prevent further outbreak.
| Materials and Methods | | |
This review examined several sources to gather all the information necessary to evaluate the impact of COVID-19 on reproductive health as such the search strategy was tailored toward electronic databases such as Ovid MEDLINE, SCOPUS, the Cochrane Library, Ovid EMBASE, CINAHL Plus, PROQUEST, PUBMED, and Web of Science. Search terms included, but were not limited to COVID-19, SARS-CoV-2, health educational practices, reproductive health, as well as a mixture of medical subject headings and keywords.
Inclusion criteria
Primary research studies (quantitate) that explored the impact of COVID-19 on reproductive health, as well as interventions that could promote reproductive wellbeing during and after the pandemic were eligible for inclusion. Searches were restricted to the past 5 years. Quality appraisal of all selected studies was carried out. Herein, a Critical Appraisal tool (CASP) 2018, having 10 appraisal questions was employed. Article screening software (Covidence) was used to manage this process.
Study selection
This assessment took into account all research that have a public audience, in accordance with the patient/population, intervention, comparison and outcomes (PICO) criteria for the study selection.[8] Studies with participants drawn from healthcare setting (such as patients or medical workers) were also examined. Studies that focused on identifying the impact of COVID-19 on reproductive health, the type of health interventions conducted, and all strategies designed to raise public awareness and improve reproductive health, were included.
After database screening, a total of 135 papers were found, and 88 records were left over after duplicates were eliminated. 88 abstracts and titles were scrutinized for inclusion. The title and abstracts were screened using Rayyan software.[9] 25 complete texts were evaluated for eligibility and inclusion in the study out of the 88 that were reviewed.
Reproductive health
Reproductive health is defined as a state of complete physical, mental, and social well-being, and not just the absence of underlying reproductive disease.[10] Reproductive health is a fundamental component of an individual’s overall health status and a central determinant of quality of life.[10],[11] It involves all reproductive processes, functions, and systems at all stages of human life. Reproductive health is a global concern. It is more important for women, particularly during their reproductive years,[10],[11] when they are capable of getting pregnant and giving birth, a span of years usually between puberty and menopause. The World Health Organization (WHO), definition of reproductive health shows how important it is for an individual to maintain their own sexual health status.[11] Sexual health is the integration of emotional, intellectual, and social aspects of sexual being in order to positively enrich personality, communication, relationships, and love.[10],[11],[12] There are three basic principles of sexual health. They are as follows:
- 1) The capacity to love and sway sexual and reproductive conduct
- 2) Liberty from psychological factors that may damage sexual relationships; and
- 3) Freedom from disease(s) that obstruct(s) or stand in the way of sexual and reproductive function.
Reproductive health also means the right to a satisfying and safe sex life, which includes the undisturbed potential to reproduce (pregnancy and reproduction), and also the personal awareness and freedom to make meaningful decisions if to, when to, and how to often do so.[10],[11],[12] Reproductive health contributes greatly to physical and psychosocial comfort and closeness between individuals. Adequate and balanced reproductive health can be impaired and deprived by diseases, abuse, exploitation, unwanted pregnancy, and death.[10],[11],[12] Reproductive life-time of an individual does not necessarily begin with sexual advancement at puberty and terminate at menopause (or andropause for men) but it rather extends through the entirety of the individual’s length of existence and is of constant importance in the various phases of development and maturation even though the reproductive needs of the individual may differ according to a particular stage of life.[10],[11] However, there are cumulative effects across the one’s life cycle, and each stage of one’s life has important consequences that affect safety of the future. This could mean that when there is inability of an individual to deal with reproductive health challenges at any phase in life, it may lead to health problems in the future. This phenomenon is known as the life cycle standpoint for reproductive health.[10],[11] A lot of internal and external elements may contribute a threat to one’s ability to sustain reproductive health. The happenings and vulnerability from embryonic and fetal life till full adulthood may influence reproductive health condition. Other factors, which may influence reproductive status through an individual’s lifetime include genetic or hereditary factors, environmental factors, occupational factors, and behavioral factors.[13]
Reproductive and sexual health supports normal biological responsibilities such as pregnancy and parturition in women with the aim of reducing adverse consequences of sexual activity, maturation, and reproduction. Furthermore, to enhance safe and pleasant sexual relationships by managing issues such as sex discrimination, disparities in admittance to health services, prohibitive laws, sexual solidarity, victimization, and gender-based violence.[14] In terms of pregnancy, conception can be sustained effectively or prevented by contraception if pregnancy is not desired. Efficient sexual and reproductive health care services should be able to enhance prenatal, perinatal, postnatal, and neonatal care with the provision of high-quality services for family planning. The abolition of risky abortions, proscription, and treatment of sexually transmitted diseases such as Human immunodeficiency virus (HIV), reproductive tract infections, cervical cancer, and other gynecological morbidities promote healthy sexuality.[15]
Even though the larger aspect of sexual health focuses on women, men also hugely experience reproductive ill-health. Infertility in at least one-third of couples that go for infertility treatment has been reported to be caused by male factors, and some young men have been reported to be of rape, non-consensual sex, and of intimate partner violence.[16]
Epidemiology of COVID-19 and reproductive health
The coronavirus disease has generally affected all sectors of the society, including the health sector. As of September 2021, four dominant strains of SARS-CoV-2 have been reported to be spreading among global populace.[17] They are the alpha variant, which was first identified in the United Kingdom and officially referred to as B.1.1.7, beta variant first identified in South Africa and officially referred to as B.1.351, gamma variant first identified in Brazil and officially referred to as P.1, delta variant first identified in India and officially referred to as B.1.617.2, and the most recent omicron variant (B.1.1.529), which was first reported to WHO from South Africa on November 24, 2021.[17],[18] The pandemic has forced closure of nonessential societal sectors, which in one way or other affect sexual and reproductive health.[19],[20] The evolution of the delta variant was unwelcome, though not surprising. Within few months, the delta variant spread over 98 nations worldwide, and currently accounts for over 83% of reported covid-19 cases in the USA.[21] In Nigeria, six states and counting have reported the delta variant. It is more transmissible, impacts greater viral load on respiratory airways of infected patients, and is accompanied with more severe symptoms in comparison with other variants.[22]
The health sector aims to protect the human race by curbing the pandemic. Difficult decisions are being made in balancing the demands of a direct response, leading to exposure and risk of further disruptions in important reproductive and sexual health services, especially for mothers, neonates, children, and youths.[23] This is potentially capable of leading to preventable mortality and morbidity in these groups of people. During public health emergencies, human and financial resources are frequently diverted from health programs to tackle the epidemic.[24] The response to previous pandemics has shown how general sexual and reproductive health can be affected but are often ignored because they are not usually regarded as direct effects of infection but rather as consequences of having to shut down other systems in spite of controlling the outbreak at stake.[19] This has been proved using the recent Ebola virus pandemic in West Africa, which lasted between 2013 and 2016, with the resultant death of about 3600 mothers, neonates, and stillbirths due to decreased maternal and neonatal care as a result of disrupted sexual and reproductive health care services as published in a data analysis from Sierra Leone’s Health Management Information System.[25] Some reports stated that deaths caused by measles, malaria, acquired immune deficiency syndrome (AIDS), and tuberculosis as a result of normal health system deprivations during the Ebola virus epidemic exceeded deaths from the virus itself.[26],[27]
Potential effects of COVID-19 on reproductive health
In pregnant women, several anatomical and physiological changes occur during and after pregnancy.[28] Regardless of the specific response driven toward treating COVID-19, it is important that efforts should be made simultaneously to provide pregnant women with safe delivery system during child birth and adequate range of prenatal and postnatal care. Accessible health systems provide sequential control measures to prevent infection and thus ensure safe pregnancies and childbirth to prevent maternal and neonatal deaths that might occur as a result of denied access or improper care.[29]
Worthy of note is the pathogenesis of SARS-CoV-2. It invades host cell by binding with angiotensin-converting enzyme II (ACE2) receptor. The ACE2 has been identified as a receptor that mediates entry of SARS-CoV-2 into human cells. In men, ACE2 has been widely reported to be highly expressed in the prostate tissues, testicular Leydig interstitial cells, Sertoli cells, and the seminiferous ductal cells. Also, SARS-CoV-2 has been reported to be expressed in human semen, and in recovered patients, spermiogenesis has been reported to be adversely affected, with obvious decline in sperm motility and testosterone level.[30] In the women, ACE2 has been expressed in the ovarian follicles, uterus, and vagina. In addition, ACE2 expression has been reported to be higher in the human placenta. These suggests possible pathogenicity of SARS-CoV-2 in human reproductive physiology, possibly affecting sperm fertility, ovarian functionality, oocyte quality, embryo transfer, peri-implantation embryo development, and gestation.[21]
During pregnancy, SARS-CoV-2 infection poses a significant risk to maternal health and the fetus, causing premature birth (20.8%), fetal distress (26.7%), premature rupture of fetal membranes (13.0%), and Caesarean section (92.6%). Moreover, approximately 2% of fetal deaths and 0.4% of neonatal deaths have been attributed to COVID-19 in South Korea. However, recent reports have shown that in general, the neonatal mortality due to COVID-19 ranges between 0.5% and 2.5% worldwide.[21]
Global lockdowns, travel restrictions, and closure of clinics or other health sectors imposed by government authorities due to COVID-19 epidemic can also affect safe abortion services and result in people rather going for unsafe abortions. The WHO describes an unsafe abortion as one performed by individuals who lack required skills to do so, or if performed in an environment that does not meet the minimum medical standards required.[31] Resultant increase in unsafe abortions would eventually lead to an increase in maternal deaths.
The widespread of the disease also has consequential effects, which has led to alteration in the production of important pharmaceutical components of contraceptives, distribution of those contraceptives as well as the methods used in contraception, and effective use of contraceptives and transportation.[32] In the same sense, global restriction of movements due to lockdown in countries leads to suspension of non-essential sexual and reproductive health services such as abortion care and sex therapy.[33] Hospitals, clinics, and other health facilities might have been restricted for isolation and treatment of the people infected with the virus, the personnel and materials used to provide reproductive and sexual health services may be used to fulfill other necessities related to treating COVID patients. Shunt or reduction in the use of contraceptives when necessary would eventually lead to increase in unintended or unwanted pregnancies.
Deprivation of sexual and reproductive health services, because it is deemed as non-essential, could also greatly affect adolescents, people in humanitarian settings, transgender or people who categorize themselves as LGBTQI, people going through gender-based violence, HIV/AIDS patients, prisoners, disabled, and people of low socioeconomic status.[34],[35] Furthermore, global responses to epidemics further worsen gender-based violence and other health inequalities.[36],[37],[38]
An improved danger of miscarriage or fetal malformations has now no longer been documented in pregnant women who are inflamed with COVID-19, in line with the US Centre for Disease Control (CDC). On the basis of records from different coronaviruses, inclusive of SARS and MERS, the American College of Obstetricians and Gynecologists notes that pregnant women who get COVID-19 can be at an increased risk. However, such records are extraordinarily limited, and the contamination might not be the direct motive of preterm birth. Currently, only small studies have reported a limited number of cases that are available to answer a number of questions related to miscarriage or fetal malformations. Most of the women in these case reports had COVID-19 during the third trimester of pregnancy. These include:
- A study of nine pregnant women who were infected with COVID-19 and had symptoms showed that one of their babies was affected by the virus. The virus was not present in amniotic fluid, the babies’ throats or in breast milk.
- Another view at of 38 women inflamed with COVID-19 discovered that not one of the newborns examined wonderful for the disease.
- Two toddlers born to moms inflamed with SARS-CoV-2 confirmed that the toddlers had expanded types of antibodies to the virus however did now no longer display any medical proof of contamination with the virus.
- Another case file reading 33 pregnant ladies inflamed with SARS-CoV-2 discovered that three in their newborns have been additionally inflamed with the virus and had medical symptoms and symptoms of contamination, in addition to affirmation of COVID-19 contamination. It is doubtful whether or not those newborns have been inflamed while with inside the womb or if those infections have been received after birth, because the newborns have been examined once they have been days old. The opportunity of vertical transmission (passing the virus from mother to baby) has not been ruled out.
The risk of passing the infection to a fetus appears to be very low. Currently there is no evidence of any fetal malformations or results because of maternal contamination with COVID-19. If a female has a contamination with an excessive fever for the duration of the first trimester, it’s most secure to apply acetaminophen to decrease temperature so as to protect the developing foetus from danger. Prenatal consultations are essential for maternal fitness and fetal wellbeing. However, given the worldwide pandemic we’re facing, many obstetricians are making use of virtual online antenatal consultations to decongest the COVID-19 wards and limit contacts. Several health authorities have recommended that pregnant women discuss with their obstetrician about their prenatal care and maintain appointments as long as their obstetrician considers it is adequate and suitable. In recent times, there is no confirmation of the virus in breast milk and the amniotic fluid. Although the virus is spread through respiratory droplets, mothers should wash their hands and consider wearing a face mask to minimize infants’ exposure to the virus. The Royal College of Obstetricians and Gynecologists recommends that mothers infected with COVID-19 expression in the breast milk to allow someone else to feed the infant. The use of proper hand hygiene and cleaning of breast pump parts is highly essential too. However, the CDC states that hand washing and wearing a face mask should minimize risks to the infant.
| Conclusion | | |
The decrease in sexual and reproductive health services provision due to global lockdowns and closures of health sectors affects the entire range of people who require sexual and reproductive health care delivery in one way or the other, and directly or indirectly lead to an increase in unwanted pregnancies, unsafe abortions, stillbirths, maternal deaths, and neonatal death, as well as gender-based violence. To prevent these from happening, government and concerned private sectors must classify sexual and reproductive health care services (such as safe abortion, contraceptive services, and maternal and newborn care) as essential and the sector should be made available, regardless of the severity of the pandemic.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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