Pregnancy outcomes in Italy during COVID‐19 pandemic: A population‐based cohort study

Abstract

Objective To compare the estimates of preterm birth (PTB; 22–36 weeks' gestational age, GA) and stillbirth rates during COVID‐19 pandemic in Italy with those recorded in the three previous years. Design A population‐based cohort study of live‐ and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (1 March 2020–31 March 2021, n = 362 129) to an historical period (January 2017–February 2020, n = 1 117 172). The cohort covered 84.3% of the births in Italy. Methods Poisson regressions were run in each Region and meta‐analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021. Main outcome measures The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32–36 weeks' GA), very PTB (<32 weeks' GA), and extremely PTB (<28 weeks' GA), overall and stratified into singleton and multiples. Results The pandemic period compared with the historical one was associated with a reduced risk for PTB (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.88–0.93), late PTB (RR 0.91, 95% CI 0.88–0.94), very PTB (RR 0.88, 95% CI 0.84–0.91) and extremely PTB (RR 0.88, 95% CI 0.82–0.95). In multiples, point estimates were not very different, but had wider CIs. No association was found for stillbirths (RR 1.01, 95% CI 0.90–1.13). A linear decreasing trend in PTB rate was present in the historical period, with a further reduction after the lockdown. Conclusions We demonstrated a decrease in PTB rate after the introduction of COVID‐19 restriction measures, without an increase in stillbirths.

Antenatal visits and obstetric outcomes during nationwide COVID-19 lock down period in a tertiary hospital of Nepal

“…Our study reveals a significant reduction in rate of preterm delivery (8.7% in COVID-19 lockdown period compared to 13.02% in non COVID 19 period) similar to a study conducted in Italy which also showed a reduced relative risk ratio of preterm births by 0.91 with confidence interval CI (0.88-0.93). 13 This study was similar to a study conducted in Canada in 2020 with a preterm births of 84/1000 live births and 92.7/1000 live births (p=0.007) in COVID-19 and non COVID-19 period respectively. 14 Similarly, another study conducted in Tennessee in 2020 also revealed reduction in preterm births 10.2% and 11.3% in COVID-19 and non COVID-19 period with p value of 0.003 .…”

Impact of the First and Second Lockdown for COVID-19 Pandemic on Preterm Birth, Low Birth Weight, Stillbirth, Mode of Labor, and of Delivery in Lombardy, Italy

“…During the second lockdown, the stillbirth rate did not differ compared to the years from 2010 to 2019 [ 26 ]. No increase in the stillbirth rate was also observed in the previously cited Italian study on several regions when comparing the first wave period with previous years (up to 2017) [ 23 ].…”

“…There was also an increase, but not a significant one, in very PTB [ 22 ]. Another study, covering 10 Italian regions and based on regional health systems, indicated that the pandemic period (1 March to 31 March 2020) compared with the historical one (January 2017 to February 2020) was associated with a reduced risk for PTB (odds ratio (OR) = 0.90; 95%CI: 0.87–0.93) [ 23 ].…”

SARS‐CoV‐2 infection during pregnancy and perinatal outcomes in Estonia in 2020 and 2021: A register‐based study

“…5 A big cohort study from Italy found no association of COVID-19 on preterm birth or stillbirth rates. 6 The findings from UK and US registries showed increased risk of preterm delivery and maternal mortality, whereas stillbirth, low birthweight and early neonatal death rates were not affected. 7 Reduction in preterm birth rates and elective cesarean section (CS) was observed in Iceland with no change in induction of labor.…”