Primary objectives:

1. Document gaps and impact of changes in antenatal care (ANC), delivery, and post-natal care (PNC) due to health system changes during the Covid-19 pandemic in Indonesia.

• Estimate gaps in ANC, delivery, and PNC due to Covid-19;
• Estimate the impact of care gaps on maternal and neonatal health: pregnancy weight gain, blood pressure, haemoglobin level, blood sugar, delivery care, gestational age at birth, birth weight.

2. Estimate the excess morbidity and mortality among pregnant women and newborns due to maternal exposure or infection with SARS-CoV-2.

Importance:

Longitudinal analysis of maternal care for ~4000 women before and after the pandemic indicates ~40% reduction in overall ANC, with the most significant reductions in ANC2 and ANC3. Longitudinal follow-up of 1100 women under routine ANC care indicates ~2% of women are swab positive and asymptomatic at the first ANC visit, with ~32% being antibody positive; and ~34% becoming antibody-positive during pregnancy. Associations with birth weight, preterm birth and other pregnancy-related morbidities are underway. The goal of the work is to guide targeted strengthening of specific high impact components of maternal care during the pandemic and to define priority for resources to mitigate the impact of SARS-CoV-2, such as maternal vaccination.