The impact of mitigation measures on perinatal outcomes during the first nine months of the COVID-19 pandemic: A systematic review with meta-analysis

Hawco, Sarah; Rolnik, Daniel L.; Woolner, Andrea; Cameron, N J; Wyness, Victoria; Mol, Ben Willem J.; Black, Mairead

doi:10.1016/j.ejogrb.2022.05.007

Cited by 13 publications

(23 citation statements)

References 48 publications

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“…[5][6][7][8] The COVID-19 pandemic also led to a widespread disruption of antenatal, delivery, and postnatal care services as a result of social distancing measures, lockdowns, contagion anxiety, and a reallocation of personnel for managing crisis situations. [9][10][11] One unexpected effect observed early during the pandemic was a population decrease in preterm birth rates, with reductions in preterm birth reported from many, [12][13][14][15][16][17] but not all, 18 countries. Studies from the United States also showed conflicting findings, [19][20][21][22][23][24][25][26][27][28] although the studies were not comparable because of heterogeneity with regard to populations (hospital, multicenter, population-based), study period, and study design or analysis.…”

Section: Discussionmentioning

confidence: 99%

“…One unexpected effect observed early during the pandemic was a population decrease in preterm birth rates, with reductions in preterm birth reported from many, 12–17 but not all, 18 countries. Studies from the United States also showed conflicting findings, 19–28 although the studies were not comparable because of heterogeneity with regard to populations (hospital, multicenter, population-based), study period, and study design or analysis.…”

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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%

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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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“…There is mixed and “context-dependent” evidence on stillbirth as a direct and indirect outcome of the COVID-19 pandemic [ 13 ]. While some cohorts did not demonstrate a significant increase in stillbirth rate [ 7 , 8 , 14 , 15 ], growing evidence suggests that stillbirth might be a consequence of SARS-CoV-2 infection in pregnancy, especially during the period of Delta variant predominance [ 5 , 9 , 16 – 18 ]. As an indirect mechanism to explain the increased stillbirth rate, lockdown measures and fear of infection accounted for less access to healthcare, resulting in decreased quality of antenatal surveillance [ 14 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…While some cohorts did not demonstrate a significant increase in stillbirth rate [ 7 , 8 , 14 , 15 ], growing evidence suggests that stillbirth might be a consequence of SARS-CoV-2 infection in pregnancy, especially during the period of Delta variant predominance [ 5 , 9 , 16 – 18 ]. As an indirect mechanism to explain the increased stillbirth rate, lockdown measures and fear of infection accounted for less access to healthcare, resulting in decreased quality of antenatal surveillance [ 14 , 18 ]. On the side of direct mechanisms, it is known that SARS-CoV-2 infection triggers a host immune response in the form of a hyperinflammatory “cytokine storm” that causes endothelial dysfunction and coagulation abnormalities [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Fetal Deaths in SARS-CoV-2-Infected Pregnant Women: A Portuguese Case Series

Mira

Pereira

Dahlstedt-Ferreira

et al. 2022

Case Reports in Obstetrics and Gynecology

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Introduction. Stillbirth has been documented as an outcome of SARS-CoV-2 infection in pregnancy. Placental hypoperfusion and inflammation secondary to maternal immune response seem to play a role in the cascade of events that contribute to fetal death. The aim of our study is to report a perinatal outcome of SARS-CoV-2 infection in pregnancy adding information to the pool of data on COVID-19 pregnancy outcomes. Case Presentation. This is the first stillbirth case series occurring in pregnant women infected with SARS-CoV-2 in a Portuguese cohort. Between April 2020 and March 2021, we had 2680 births in our centre, of which 130 (4.95%) involved mothers infected with SARS-CoV-2. Of total births, there were 14 stillbirths (0.52%), accounting for the highest stillbirth rate we have had in the last 5 years. Among these 14 stillbirths, 5 (35.71%) occurred in SARS-CoV-2-infected mothers. We report the clinical features and placental histopathologic findings of 4 stillbirth cases that occurred in our hospital. Discussion. The stillbirth rate among SARS-CoV-2-infected pregnant women (5/130; 3.84%) was significantly increased compared to noninfected patients (9/2550; 0.35%). Most women (3/4) were asymptomatic for COVID-19, a surprising outcome, given the current literature. All cases had histologic exams showing placental signs of vascular malperfusion, although we acknowledge that 3/5 had obstetric conditions related to placental vascular impairment such as preeclampsia and HELLP syndrome. Conclusion. Stillbirth can be a perinatal consequence of SARS-CoV-2 infection in pregnancy, even in asymptomatic patients. We urge more studies to explore the association between SARS-CoV-2 infection and the risk of stillbirth.

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“…6,7 Numerous investigations have explored the COVID-19 pandemic's effect on obstetric outcomes. [8][9][10][11][12] While these have generally not demonstrated increased risk for perinatal complications during the pandemic, hypotheses driving these studies included that disruptions in routine antenatal care or patient abstention from acute evaluations during pregnancy may increase risk for adverse pregnancy outcomes. Additionally, with many health systems deploying telehealth platforms for routine pregnancy care for the first time in response to the pressures of the pandemic, the ability to replicate the quality and timeliness of traditional inperson care was unknown.…”

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confidence: 99%

Patterns of Prenatal Care Delivery and Obstetric Outcomes before and during the COVID-19 Pandemic

et al. 2022

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Objective. Healthcare providers and health systems confronted new challenges to deliver timely, high-quality prenatal care during the COVID-19 pandemic as the pandemic raised concerns that care would be delayed or substantively changed. This study describes trends in prenatal care delivery in 2020 compared to 2018–2019 in a large, commercially insured population and investigates changes in obstetric care processes and outcomes. Methods. This retrospective cohort study uses de-identified administrative claims for commercially insured patients. Patients whose entire pregnancy took place from March 1 to December 31 in years 2018, 2019 and 2020 were included. Trends in prenatal care, including in-person, virtual, and emergency department visits, were evaluated, as were prenatal ultrasounds. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included preterm birth and stillbirth. To determine whether COVID-19 pandemic-related changes in prenatal care had an impact on maternal outcomes, we compared the outcome rates during the pandemic period in 2020 to equivalent periods in 2018 and 2019. Results. In total, 35,112 patients were included in the study. There was a significant increase in the prevalence of telehealth visits, from 1.1–1.2% prior to the pandemic to 17.2% in 2020, as well as a significant decrease in patients who had at least one emergency department visit during 2020. Overall prenatal care and ultrasound utilization were unchanged. The rate of SMM across this period was stable (2.3–2.8%) with a statistically significant decrease in the preterm birth rate in 2020 (7.4%) compared to previous years (8.2–8.6%) [p < 0.05] and an unchanged stillbirth rate. Conclusion. At a time when many fields of healthcare were reshaped during the pandemic, these observations reveal considerable resiliency in both the processes and outcomes of obstetric care.

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The impact of mitigation measures on perinatal outcomes during the first nine months of the COVID-19 pandemic: A systematic review with meta-analysis

Cited by 13 publications

References 48 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

Fetal Deaths in SARS-CoV-2-Infected Pregnant Women: A Portuguese Case Series

Patterns of Prenatal Care Delivery and Obstetric Outcomes before and during the COVID-19 Pandemic

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