Exploring modifiable risk-factors for premature birth in the context of COVID-19 mitigation measures: A discussion paper

Abstract

During the COVID-19 pandemic, parents with sick or premature babies have faced challenges following admission to a neonatal unit due to the imposed lock-down restrictions on social contact, hospital visitation and the wearing of personal protective equipment. The negative short-term impact on neonatal care in relation to the prevention of proximity, contact and bonding between parents and babies is potentially significant. However, an interesting finding has been reported of a reduction in premature birth admissions to the neonatal intensive care unit during the pandemic, raising important questions. Why was this? Was it related to the effect of the modifiable risk-factors for premature birth? This discussion paper focuses on an exploration of these factors in the light of the potential impact of COVID-19 restrictions on neonatal care. After contextualising both the effect of premature birth and the pandemic on neonatal and parental short-term outcomes, the discussion turns to the modifiable risk-factors for premature birth and makes recommendations relevant to the education, advice and care given to expectant mothers.

Assessment of Seasonality and Extremely Preterm Birth in Denmark

“…The benefits of identifying preventable risk factors are substantial for both maternal and offspring health. 47 Few studies have distinguished between subtypes of preterm birth and may thus have missed important risk factors associated with gestational age in general or with extremely preterm births only.…”

Preterm births in South-West England before and during the COVID-19 pandemic: an audit of retrospective data

“…Our audit provided directions to revisit clinical practices such as organisational and workforce, including to ensure optimal neonatal staff to patient ratios and safe cot capacity. Additionally, investigating how best clinical services can adapt to provide family-centred care during the pandemic is important for infant and parental health outcomes [ 17 ]. Future research exploring the impact of lockdowns on behaviour change and support services during pregnancy is required to understand the implications of pandemics on pregnancy and preterm birth.…”

Threatened abortion, threatened premature labor, and preterm birth during the first state of emergency for COVID‐19 in 2020 in Japan

“… 17 Working long hours or engaging in stressful physical labor are known risk factors for preterm birth. 18 , 19 , 20 The potential mechanism for the decrease in preterm birth during the COVID‐19 lockdown is considered to be the reduction of infection‐related inflammation or physical stress due to hygiene practices and stay‐home obligations. 11 , 12 …”

“…17 Working long hours or engaging in stressful physical labor are known risk factors for preterm birth. [18][19][20] The potential mechanism for the decrease in preterm birth during the COVID-19 lockdown is considered to be the reduction of infection-related inflammation or physical stress due to hygiene practices and stayhome obligations. 11,12 In Japan, the national government first declared the state of emergency to seven prefectures on April 7, 2020, and officially ended the restriction on May 25, 2020.…”