Background: Allergic diseases in offspring are suggested to originate from fetal life. The role of in-utero stress exposures in early childhood allergic diseases development has not been completely elucidated. We aimed to determine the effect of exposures to different kinds of maternal stressed-affective factors during pregnancy on the risk of childhood allergy during first 2 years of life. Methods: A sample of 4178 children born in 2016-2018 from the Shanghai Maternal-Child Pairs Cohort were included in this study. Indicators for maternal stressed-affective factors included life events stress at early and late pregnancy, respectively, and prenatal depression and anxiety at late pregnancy, which were measured by the Life Events Scale for Pregnant Women (LESPW), Self-Rating Anxiety Scale (SAS) and Center for Epidemiologic Studies, Depression Scale (CES-D). The children’s allergic diseases or manifestations were assessed through the questionnaires at 2,6,12,24 months after birth, respectively, including eczema, atopic dermatitis, food allergy, wheezing, asthma, and allergic rhinitis. The impacts of maternal stressed-affective factors on child allergic diseases were analyzed using multivariable binary logistic regression adjusting for potential covariates. Results: During the first 2 years of life, all forms of allergic disease were continuously reported, with allergic diseases of skin preceded the development of other atopic diseases. Children whose mothers had high life events stress during the early pregnancy or the late pregnancy would have an increased risk of eczema at 2 months respectively (AdjOR:1.30, 95%CI:1.01-1.67; AdjOR:1.64, 95%CI:1.14-2.36). Children whose mothers with high life events stress in late pregnancy were also more likely to have food allergy at 6 months (AdjOR:3.22, 95%CI:1.27-8.12). Maternal prenatal anxiety may lead to offspring’s childhood wheeze at 24 months (AdjOR:2.15, 95%CI:1.09-4.27). Conclusions: Maternal stressed-affective factors could have effects on offspring’s allergic diseases, especially eczema at 2 months. Understanding the temporal-specific effects of maternal stressed-affective factors may better inform prevention strategies.

Streamline maternal health care provision to mitigate the risk for pregnant women under COVID-19 pandemicHong Jiang1, Mu Li2, Huijing Shi1*, Xu Qian11School of Public Health; Global Health Institute; National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai 200032, China;2School of Public Health; China Studies Centre, Room 313, Edward Ford Building, University of Sydney, Sydney 2006, Australia*Corresponding author: Huijing Shi, [email protected], School of Public Health; Global Health Institute; NHC Key Laboratory of Health Technology Assessment, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai 200032, China;The novel Coronavirus Disease 2019 (COVID-19) outbreak started in Wuhan City China in early December 20191,2, and has rapidly spread across the world. The pandemic has strained health system3, which presents a huge challenge to maintain other essential health services, including maternal health care. As the first country to experience the COVID-19 outbreak, there are lessons could be learnt for establishing a better preparedness mechanism from a service delivery perspective to provide essential maternal health care and mitigate health risk for pregnancy women.First, all health facilities providing antenatal care should apply high standard of precaution to ensure pregnant women are not exposed to the COVID-19 transmission. This includes setting up a triage area to screen for COVID-19 symptoms and contact history with confirmed cases before pregnant women entering antenatal clinics. People with COVID-19 exposure history, suspected cases or COVID-19 patients should be separated from other pregnant women and placed in designated areas. This will also protect antenatal care providers. Appointment is required in advance for antenatal service to ensure adequate social distancing and manage the patient flow in health facilities.Second, as routine service provision might be disrupted, perinatal care availability and any changes to service provision should be disseminated widely, preferably through online platforms4. Women with low risk pregnancy may reduce the risk of contracting COVID-19 by reducing the number of antenatal visits. Women with pregnancy complications and other health conditions should contact their antenatal care provider to seek specific advice. Communication and counselling can be provided to pregnant and postnatal women online, including recognizing warning signs of going to hospital urgently. During movement restriction or self-isolation guidance of keeping healthy diet and physical activity, and mental health support are important for the well-being of pregnant women.Third, balancing the demands of emergency responding to COVID-19 and maintaining essential perinatal health service at national, provincial and local levels. Guidelines on conditions that require continuing antenatal care and those can be delayed should be developed5. Designated hospitals for treating pregnant women with COVID-19 should be enlisted to ensure they will receive appropriate care from a multi-disciplinary team6. At the provincial/regional level, health authorities should adapt to local context and develop uniformed perinatal operational guidelines across all local health facilities and monitor the equitable access to service and service quality. Local health facilities are responsible for disseminating service information via official channels, e.g. account on social media platforms such as WhatsApp, Facebook, and providing services following the provincial/regional operational guidelines.As the pandemic intensifies globally7,8, the experience and lessons of China on the response and streamline health system may help other counties to mitigate adverse impact of the pandemic on maternal and newborns.Disclosure of interestsWe declare no competing interests.