Use of Electronic Medical Records to Estimate Changes in Pregnancy and Birth Rates During the COVID-19 Pandemic

Abstract

IMPORTANCEThe influence of the COVID-19 pandemic on fertility rates has been suggested in the lay press and anticipated based on documented decreases in fertility and pregnancy rates during previous major societal and economic shifts. Anticipatory planning for birth rates is important for health care systems and government agencies to accurately estimate size of economy and model working and/or aging populations. OBJECTIVE To use projection modeling based on electronic health care records in a large US university medical center to estimate changes in pregnancy and birth rates prior to and after the COVID-19 pandemic societal lockdowns. DESIGN, SETTING, AND PARTICIPANTSThis cohort study included all pregnancy episodes within a single US academic health care system retrospectively from 2017 and modeled prospectively to 2021. Data were analyzed September 2021.EXPOSURES Pre-and post-COVID-19 pandemic societal shutdown measures. MAIN OUTCOMES AND MEASURESThe primary outcome was number of new pregnancy episodes initiated within the health care system and use of those episodes to project birth volumes.Interrupted time series analysis was used to assess the degree to which COVID-19 societal changes may have factored into pregnancy episode volume. Potential reasons for the changes in volumes were compared with historical pregnancy volumes, including delays in starting prenatal care, interruptions in reproductive endocrinology and infertility services, and preterm birth rates. RESULTSThis cohort study documented a steadily increasing number of pregnancy episodes over the study period, from 4100 pregnancies in 2017 to 4620 in 2020 ( 28284 total pregnancies; median maternal [interquartile range] age, 30 [27-34] years; 18 728 [66.2%] White women, 3794 [13.4%]Black women; 2177 [7.7%] Asian women). A 14% reduction in pregnancy episode initiation was observed after the societal shutdown of the COVID-19 pandemic (risk ratio, 0.86; 95% CI, 0.79-0.92; P < .001). This decrease appeared to be due to a decrease in conceptions that followed the March 15 mandated COVID-19 pandemic societal shutdown. Prospective modeling of pregnancies currently suggests that a birth volume surge can be anticipated in summer 2021.CONCLUSIONS AND RELEVANCE This cohort study using electronic medical record surveillance found an initial decline in births associated with the COVID-19 pandemic societal changes and an anticipated increase in birth volume. Future studies can further explore how pregnancy episode volume changes can be monitored and birth rates projected in real-time during major societal events.

Impact of the first wave of the COVID-19 pandemic on birth rates in Europe: a time series analysis in 24 countries

“…the first lockdown, a rebound in births also occurred in 13 countries. This trend in birth rates seems to be similar to what has been described in other high-income countries or following previous crises (Aassve et al, 2020;Ullah et al, 2020;Aassve et al, 2021;Stout et al, 2021). The decline we found is larger than the one previously described by De Geyter et al (2022) in 11 European countries, which is mainly explained by a difference in the methods used to assess the variation in births in Europe.…”

“…A cohort study in the USA using electronic medical record surveillance found an initial decline in pregnancy events during and after the first epidemic peak of the COVID-19 outbreak, and predicted an increase in births remote from the outbreak (Stout et al, 2021). A first analysis of the European datasets found a drop of À0.5% to À11.4% in livebirths after the initiation of containments in 11 of 14 countries included, and the authors associated this decrease to high excess mortality during the first wave of the COVID-19 pandemic (De Geyter et al, 2022).…”

The COVID-19 Pandemic Significantly Impacts Pregnancy Planning and Mental Health of Women With Inflammatory Bowel Disease

“…4,20 In fact, a 14% reduction in pregnancy rates has been observed during the COVID-19 pandemic, compared with before, largely due to a decrease in rates of conception. 21 Whether the pandemic has also resulted in a decline in rates of pregnancies in women with IBD remains to be determined in future study. Similarly, though initial data suggests no increase in the risk of adverse pregnancy outcomes in women with IBD during the pandemic, this also remains to be confirmed in larger analyses.…”

Key issues in the effectiveness of public financial tools to support childbearing the example of Hungary during the COVID-19 crisis

“…The impact of fiscal policies in crisis management has been felt through the operation of health care systems, income policies and family policy incentives. Using US hospital data, Stout et al [ 50 ] found an initial decline in the number of births associated with the social changes of the COVID-19 pandemic, followed by an expected growth in it after the lockdown.…”