Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: a multicenter cohort study

Hui, Lisa; Marzan, Melvin Barrientos; Potenza, Stephanie; Rolnik, Daniel L.; Pritchard, Natasha; Said, Joanne; Palmer, Kirsten; Whitehead, Clare; Sheehan, Penelope M.; Ford, Jolyon; Mol, Ben Willem J.; Walker, Susan

doi:10.1016/j.ajog.2022.04.022

Cited by 23 publications

(21 citation statements)

References 25 publications

(13 reference statements)

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“…Pandemic-related reductions in preterm labor induction or cesarean delivery have been reported previously. 16,28,30,31,[42][43][44][45][46][47] One study, which also used National Center for Health Statistics data on singleton live births in the United States, showed similar patterns in preterm birth and preterm labor induction or cesarean delivery. 28 The causes of the disruption in routine obstetric services were multifactorial and included patient and health system factors such as the shift to virtual antenatal care appointments and reductions in the use of routine ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14]25,29 However, the seemingly beneficial effect of the pandemic on preterm birth rates occurred concurrently with a reported increase in stillbirth rates, [15][16][17] and an alternative explanation for the two phenomena is a pandemic-associated reduction in obstetric intervention. 16,28,30,31 In addition, reductions in obstetric intervention at term gestation could have affected postterm birth, macrosomia, and perinatal mortality rates.…”

Section: Discussionmentioning

confidence: 99%

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Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic

Simon,

John,

Lisonkova

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To quantify pandemic-related changes in obstetric intervention and perinatal outcomes in the United States. METHODS: We carried out a retrospective study of all live births and fetal deaths in the United States, 2015–2021, with data obtained from the natality, fetal death, and linked live birth–infant death files of the National Center for Health Statistics. Analyses were carried out among all singletons; singletons of patients with prepregnancy diabetes, prepregnancy hypertension, and hypertensive disorders of pregnancy; and twins. Outcomes of interest included preterm birth, preterm labor induction or preterm cesarean delivery, macrosomia, postterm birth, and perinatal death. Interrupted time series analyses were used to estimate changes in the prepandemic period (January 2015–February 2020), at pandemic onset (March 2020), and in the pandemic period (March 2020–December 2021). RESULTS: The study population included 26,604,392 live births and 155,214 stillbirths. The prepandemic period was characterized by temporal increases in preterm birth and preterm labor induction or cesarean delivery rates and temporal reductions in macrosomia, postterm birth, and perinatal mortality. Pandemic onset was associated with absolute decreases in preterm birth (decrease of 0.322/100 live births, 95% CI 0.506–0.139) and preterm labor induction or cesarean delivery (decrease of 0.190/100 live births, 95% CI 0.334–0.047) and absolute increases in macrosomia (increase of 0.046/100 live births), postterm birth (increase of 0.015/100 live births), and perinatal death (increase of 0.501/1,000 total births, 95% CI 0.220–0.783). These changes were larger in subpopulations at high risk (eg, among singletons of patients with prepregnancy diabetes). Among singletons of patients with prepregnancy diabetes, pandemic onset was associated with a decrease in preterm birth (decrease of 1.634/100 live births) and preterm labor induction or cesarean delivery (decrease of 1.521/100 live births) and increases in macrosomia (increase of 0.328/100 live births) and perinatal death (increase of 9.840/1,000 total births, 95% CI 3.933–15.75). Most changes were reversed in the months after pandemic onset. CONCLUSION: The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a transient decrease in obstetric intervention (especially preterm labor induction or cesarean delivery) and a transient increase in perinatal mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic

Simon,

John,

Lisonkova

et al. 2023

Obstetrics &Amp; Gynecology

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“…Iatrogenic pre-maturity associated with SARS-CoV-2 could lead to an increase in neonatal morbidity and mortality [56,57], but it seems necessary and justified for the prevention and reduction of stillbirth [40]. During the one of the most severe lockdowns in Australia, iatrogenic pre-maturity was significantly reduced, but pre-term stillbirths significantly increased [58], which emphasizes the relevance of regular antepartum fetal surveillance and adequate obstetric care. Maternal obesity can cause technical difficulties in fetal monitoring and assessment, contributing to the risk of stillbirth [59].…”

Section: Discussionmentioning

confidence: 99%

Association of Pre-Pregnancy Obesity and COVID-19 with Poor Pregnancy Outcome

Mihajlovic

Nikolic

Miličić

et al. 2023

JCM

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Background and Objectives: During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index with clinical, laboratory, and radiology diagnostic parameters as well as pregnancy complications and maternal outcomes in pregnant patients with COVID-19. Materials and Methods: Clinical status, laboratory, and radiology diagnostic parameters and pregnancy outcomes were analyzed for pregnant women hospitalized between March 2020 and November 2021 in one tertiary-level university clinic in Belgrade, Serbia, due to infection with SARS-CoV-2. Pregnant women were divided into the three sub-groups according to their pre-pregnancy body mass index. For testing the differences between groups, a two-sided p-value <0.05 (the Kruskal–Wallis and ANOVA tests) was considered statistically significant. Results: Out of 192 hospitalized pregnant women, obese pregnant women had extended hospitalizations, including ICU duration, and they were more likely to develop multi-organ failure, pulmonary embolism, and drug-resistant nosocomial infection. Higher maternal mortality rates, as well as poor pregnancy outcomes, were also more likely to occur in the obese group of pregnant women. Overweight and obese pregnant women were more likely to develop gestational hypertension, and they had a higher grade of placental maturity. Conclusions: Obese pregnant women hospitalized due to COVID-19 infection were more likely to develop severe complications.

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“…In a retrospective, multicentre cohort study of perinatal outcomes in Melbourne before and during the COVID-19 lockdown (from March 2020 to March 2021), 24 817 births exposed to lockdown were compared to 50 017 births before the pandemic 51 . There was a higher risk of preterm stillbirth in the exposed group than the control group (0.26% vs 0.18%, aOR=1.49, p=0.015).…”

Section: Social Impact Of Covid-19 Pandemic On Obstetric Carementioning

confidence: 99%

Pregnancy outcomes after SARS-CoV-2 infection: the current evidence

Kong

2023

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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Many questions have been raised about SARS-CoV-2 infection complicating pregnancy such as whether pregnancy increases the susceptibility to SARS-CoV-2 infection, whether SARS-CoV-2 infection in pregnancy is associated with more severe disease and higher mortality, and whether SARS CoV-2 infection during various stages of pregnancy is associated with increased risks of adverse pregnancy and neonatal outcomes. Moreover, there are controversies on the association between SARS-CoV-2 infection and the development of pregnancy complications such as preeclampsia, preterm delivery, and fetal growth restriction. In addition to the direct impact of COVID-19 infection on pregnancy outcomes, social restriction measures and changes in healthcare system during the COVID pandemic are reported to lead to adverse pregnancy outcomes such as increased stillbirths. This review aims to summarise the current evidence in the literature on these issues.

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Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: a multicenter cohort study

Cited by 23 publications

References 25 publications

Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic

Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic

Association of Pre-Pregnancy Obesity and COVID-19 with Poor Pregnancy Outcome

Pregnancy outcomes after SARS-CoV-2 infection: the current evidence

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