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.

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Preterm and small-for-gestational-age (SGA) infants are more susceptible to vaccine-preventable diseases. To evaluate routine vaccination timeliness in these high-risk groups, a full birth cohort of infants (n = 41,502) born in 2017 and 2018 in Tuscany was retrospectively followed up until 24 months of age. Infants were classified by gestational age (GA) and SGA status. The vaccinations included: hexavalent (HEXA), measles-mumps-rubella, varicella, pneumococcal conjugate (PCV), and meningococcal C conjugate. Time-to-event (Kaplan–Meier) analyses were conducted to evaluate the timing of vaccination according to GA; logistic models were performed to evaluate the associations between GA and SGA with vaccination timeliness. Time-to-event analyses show that the rate of delayed vaccine receipt increased with decreasing GA for all the vaccinations, with a less marked gradient in later vaccine doses. Compared to full-term infants, very preterm infants significantly showed an increased odds ratio (OR) for delayed vaccination in all the vaccinations, while moderate/late preterm infants only showed an increased OR for HEXA-1, HEXA-3, PCV-1, and PCV-3. SGA infants had a significantly higher risk of delayed vaccination only for HEXA-1 and PCV-1 compared to non-SGA infants. In conclusion, vaccinations among preterm and SGA infants showed considerable delay. Tailored public health programs to improve vaccination timeliness are required in these high-risk groups.

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