Increase of stillbirth and decrease of late preterm infants during the COVID-19 pandemic lockdown

Curtis, Mario De; Villani, Leonardo; Polo, Arianna

doi:10.1136/archdischild-2020-320682

Cited by 106 publications

(167 citation statements)

References 3 publications

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“…Of 3592 abstracts screened, 192 were relevant for full-text review and 40 met the inclusion criteria for systematic review ( figure 1 ). 4 , 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 A list of excluded studies with reasons for exclusion is provided in the appendix (p 6) . Reporting on resource use or service reconfiguration outcomes is summarised in the appendix (p 27) .…”

Section: Resultsmentioning

confidence: 99%

“…Of the 40 included studies, 31 for which comparable outcomes were also reported in at least one other study were included in the meta-analysis. 4 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 37 , 38 , 40 , 42 , 45 , 46 , 47 , 48 , 49 Table 1 shows the characteristics of the 40 included studies, all of which used a historical cohort design. 17 countries were represented, with substantial variation in pandemic mitigation measures among countries.…”

Section: Resultsmentioning

confidence: 99%

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Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Chmielewska

Barratt

Townsend

et al. 2021

The Lancet Global Health

802

820

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Background The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. Methods We did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753). Findings The search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07–1·54]; I 2 =63%; 12 studies, 168 295 pregnancies during and 198 993 before the pandemic) and maternal death (1·37 [1·22–1·53; I 2 =0%, two studies [both from low-income and middle-income countries], 1 237 018 and 2 224 859 pregnancies) during versus before the pandemic. Preterm births before 37 weeks' gestation were not significantly changed overall (0·94 [0·87–1·02]; I 2 =75%; 15 studies, 170 640 and 656 423 pregnancies) but were decreased in high-income countries (0·91 [0·84–0·99]; I 2 =63%; 12 studies, 159 987 and 635 118 pregnancies), where spontaneous preterm birth was also decreased (0·81 [0·67–0·97]; two studies, 4204 and 6818 pregnancies). Mean Edinburgh Postnatal Depression Scale scores were higher, indicating poorer mental health, during versus before the pandemic (pooled mean difference 0·42 [95% CI 0·02–0·81; three studies, 2330 and 6517 pregnancies). Surgically managed ectopic pregnancies were increased during the pandemic (OR 5·81 [2·16–15·6]; I 2 =26%; three studies, 37 and 272 pregnancies). No overall significant effects were identified for other outcomes included in the quantitative analysis: maternal gestational diabetes; hypertensive disorders of pregnancy; preterm birth before 34 weeks', 32 weeks',...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Chmielewska

Barratt

Townsend

et al. 2021

The Lancet Global Health

802

820

View full text Add to dashboard Cite

show abstract

“…Since the start of the COVID-19 pandemic and implementation of travel restrictions across the world, coverage and quality of maternal and neonatal care has deteriorated. A regional study in Italy reported a three-fold increase in stillbirths and a decrease in late preterm births (32 to <37 weeks’ gestation) during the 2020 lockdown relative to the same period in 2019 and a nationwide study in Denmark reported a reduction in extremely preterm births (<28 weeks) during lockdown compared with the previous 5 years, highlighting the indirect impact of COVID-19 on pregnancy outcomes [ 35 , 36 ]. There is still limited knowledge on mechanisms by which the pandemic has impacted routine care of small and sick newborns.…”

Section: Discussionmentioning

confidence: 99%

Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection

et al. 2021

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Background COVID-19 is disrupting health services for mothers and newborns, particularly in low- and middle-income countries (LMIC). Preterm newborns are particularly vulnerable. We undertook analyses of the benefits of kangaroo mother care (KMC) on survival among neonates weighing ≤2000 g compared with the risk of SARS-CoV-2 acquired from infected mothers/caregivers. Methods We modelled two scenarios over 12 months. Scenario 1 compared the survival benefits of KMC with universal coverage (99%) and mortality risk due to COVID-19. Scenario 2 estimated incremental deaths from reduced coverage and complete disruption of KMC. Projections were based on the most recent data for 127 LMICs (~90% of global births), with results aggregated into five regions. Findings Our worst-case scenario (100% transmission) could result in 1,950 neonatal deaths from COVID-19. Conversely, 125,680 neonatal lives could be saved with universal KMC coverage. Hence, the benefit of KMC is 65-fold higher than the mortality risk of COVID-19. If recent evidence of 10% transmission was applied, the ratio would be 630-fold. We estimated a 50% reduction in KMC coverage could result in 12,570 incremental deaths and full disruption could result in 25,140 incremental deaths, representing a 2·3–4·6% increase in neonatal mortality across the 127 countries. Interpretation The survival benefit of KMC far outweighs the small risk of death due to COVID-19. Preterm newborns are at risk, especially in LMICs where the consequences of disruptions are substantial. Policymakers and healthcare professionals need to protect services and ensure clearer messaging to keep mothers and newborns together, even if the mother is SARS-CoV-2-positive. Funding Eunice Kennedy Shriver National Institute of Child Health & Human Development; Bill & Melinda Gates Foundation; Elma Philanthropies; Wellcome Trust; and Joint Global Health Trials scheme of Department of Health and Social Care, Department for International Development, Medical Research Council, and Wellcome Trust.

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“…In maternity care however, consequences of the imposed restrictions have been mixed. Early reports from some countries suggest that although stillbirth rates increased (3)(4)(5), rates of preterm birth actually decreased (5)(6)(7)(8)(9). It is not clear if there is a similar trend in Australia.…”

Section: Introductionmentioning

confidence: 99%

Preterm birth rates in a large tertiary Australian maternity centre during COVID-19 mitigation measures

Gallo

Gallo²,

Borg

et al. 2020

Preprint

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ObjectivesTo compare the prevalence of live preterm birth rates during COVID-19 restriction measures with infants born during the same weeks in 2013-2019 in Queensland, Australia.Design, setting, participantsDeidentified obstetric and neonatal data were extracted from the Mater Mothers’ electronic healthcare records database. This is a supra-regional tertiary perinatal centre.Main outcome measuresLogistic regressions were used to examine preterm birth rates during the beginning of COVID-19 restrictions (16 March-17 April; “early”; 6,955 births) and during the strictest part of COVID-19 restrictions (30 March-1 May; “late”; 6,953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Stillbirth rates were also examined (16 March-1 May).ResultsA reduction in planned moderate/late preterm births was observed primarily during the early restriction period compared with the same calendar weeks in the previous seven years (29 versus an average of 64 per 1,000 births; adjusted odds ratio [aOR] 0.39, 95% CI 0.22-0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two-week non-significant spike in spontaneous preterm births from late-April to early-May, 2020.ConclusionsPlanned births for moderate/late preterm infants more than halved during early COVID-19 mitigation measures. Together with evidence from other nations, the COVID-19 pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth.

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Increase of stillbirth and decrease of late preterm infants during the COVID-19 pandemic lockdown

Cited by 106 publications

References 3 publications

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis

Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection

Preterm birth rates in a large tertiary Australian maternity centre during COVID-19 mitigation measures

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