Preterm birth and stillbirth rates during the COVID-19 pandemic: a population-based cohort study

Abstract

reterm birth (birth before 37 weeks' gestation) is a leading cause of mortality and morbidities in the neonatal period, 1 childhood and adulthood. 2 Stillbirth has devastating consequences for families. 3 The causes of both preterm birth and stillbirth are multifactorial. During the pandemic, reports described reductions in preterm birth rates in Denmark, 4 the Netherlands, 5 Ireland 6 and the United States. 7 At the same time, increases in stillbirth rates were reported from the United Kingdom, 8 Italy, 9 Nepal 10 and India, 11 with or without changes in rates of preterm births. Meta-analyses have emerged with differing conclusions. 12,13 Some speculated reasons for reductions in preterm births included reductions in physical activity during pregnancy, reduced stress related to work-life balance, less exposure to infection, fewer medical interventions, reduced travel and pollution, 14 and improved hygiene and rest. Proposed reasons for increases in preterm birth rates include higher stress due to worry about the pandemic, employment or financial challenges, home schooling and reduced maternity services. 15 Less stringent fetal surveillance from reduced attendance at medical appointments for fear of infection, cancellation of face-to-face appointments and reduced staffing for maternity services are possible reasons for increased rates of stillbirths. Thus, it is important to evaluate preterm births and stillbirths simultaneously to understand the true impact. 16 Some previous reports compared preterm birth and stillbirth rates during the pandemic to similar time periods in the past few years. However, within a jurisdiction, these rates are known to fluctuate between epochs 17 and, thus, it is preferable to evaluate rates over longer periods to establish whether observed variations are usual (common cause variation) or unusual (special cause variation). Our objective was to evaluate whether the COVID-19 pandemic affected preterm birth or stillbirth rates in Ontario by comparing rates for the early COVID-19 pandemic time period with rates from the previous 17.5 years to identify patterns of variation.

Coronavirus disease 2019 pandemic and pregnancy and neonatal outcomes in general population: A living systematic review and meta‐analysis (updated Aug 14, 2021)

“…Of 9953 records in the initial search, 45 articles were eligible for inclusion, of which 44 were used in the quantitative synthesis 2 , 6 , 7 , 8 , 9 , 10 , 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 , 50 , 51 , 52 , 53 (Figure 1 ). Twenty‐six full‐text reports were excluded: reasons for the exclusions are provided in Appendix S2 .…”

“…Two studies did not report data settings. One study included in the previous version of this review, by Simpson et al, 55 was replaced by data from a new study Shah et al 49 because the latter contained a larger pandemic and pre‐pandemic period from the same province of Ontario, Canada. Liu et al 41 published another study from Canada, including data from Ontario.…”

“…Liu et al 41 published another study from Canada, including data from Ontario. As they reported Ontario data separately and for an overlapping period with Shah et al 49 , we extracted the data for Canada excluding Ontario from Liu et al to avoid double counting of data. Across the included studies, totals of 1 843 665 pregnancies during the pandemic period (excluding numbers from Been et al 54 ) and 23 564 552 pregnancies during the pre‐pandemic period were studied.…”

Infrequent Placental and Fetal Involvement in SARS-CoV-2 Infection: Pathology Data from a Large Medical Center

“…The role of COVID-19 infection in pregnancy loss is even less clear; however, a retrospective cohort study using a database of pregnant people giving birth in Ontario, Canada, between July 2002 and December 2020 did not find any cause variation (unusual pattern) in preterm birth or stillbirth rates during the first 12 months of COVID-19 pandemic compared with the previous 17.5 years [ 16 ].…”

El enigma del coronavirus – Covid-19 durante el Bicentenario de la Independencia del Perú – El síndrome poscovid – Las vacunas – La gestante

“…En una evaluación de 2,465,387 embarazos en un hospital de Ontario (Canadá), incluidos 13,781 que dieron lugar a un mortinato, la tasa media de nacimientos prematuros fue 7,96%, en comparación con el 7,87% de los 17,5 años anteriores, sin ninguna variación por causas especiales. La tasa media de mortinatalidad para la cohorte fue 0,56%, y de enero a diciembre de 2020, la tasa de mortinatalidad fue 0,53%, sin variación por causas especiales (31) . Hemos visto que, en el Perú el porcentaje de parto pretérmino aumentó durante la pandemia en la mayoría de las regiones.…”