Background : The COVID-19 pandemic led to a rapid transformation of the healthcare system in order to mitigate viral exposure. In the perinatal context, one change included altering the prenatal visit cadence and utilizing more telehealth methods. Whether this approach had inadvertent negative implications for postpartum care, including postpartum depression screening and contraceptive utilization, is unknown. Objective : To examine whether preventative health service utilization, including postpartum depression screening and contraceptive utilization, differed during the COVID-19 pandemic as compared to a pre-pandemic period. Study Design : This retrospective cohort study included all pregnant patients who underwent prenatal care within five academic obstetric practices and who delivered at Northwestern Memorial Hospital either before (delivery 9/1/2018-1/1/2019) or during (delivery 2/1/2020-5/15/2020) the COVID-19 pandemic. Completion of postpartum depression screening was assessed by reviewing standardized fields for documentation of this screening within the electronic health records. The method of contraception was ascertained from the postpartum clinical documentation. Patients were classified as initiating long-acting reversible contraception (LARC) if they received Nexplanon or an intrauterine device (IUD) during the delivery hospitalization or within three months following delivery. Bivariable and multivariable analyses were performed. Results : Of 2375 pregnant patients included in this study, 1120 (47%) delivered during the COVID-19 pandemic. Pregnant patients who delivered during the COVID-19 pandemic were significantly less likely to have postpartum depression screening performed (45.5% vs 86.2%, p<0.01); this association persisted after adjusting for potential confounders (aOR 0.13, 95% CI 0.11-0.16). Pregnant patients who delivered during the COVID-19 pandemic also were significantly less likely to initiate LARC methods within three months of delivery (13.5% vs 19.6%, aOR 0.67, 95% CI 0.53-0.84). Conclusion : The onset of the COVID-19 pandemic is associated with decreases in the completion of postpartum depression screening and fewer overall patients receiving LARC methods for contraception. These data can inform adaptations in healthcare delivery in the midst of the ongoing COVID-19 pandemic.

frequency with which the PP depression screen was performed. Two subgroup analyses were done: excluding women who did not attend a PP visit (either virtually or in person) and excluding women who tested positive for SARS-CoV2. RESULTS: Of 2375 women included in this study, 1120 (47%) delivered during the COVID-19 pandemic. Compared to women who delivered before the pandemic, women who delivered during the COVID-19 pandemic were more likely to be obese, have gestational diabetes, and have hypertensive disorders of pregnancy, and were less likely to be married and attend a PP visit (either virtually or in person, 90.4% vs 87.7%, p¼0.036). Women who delivered during the COVID-19 pandemic were significantly less likely to have PP depression screening (86.2% vs 45.5%, p<0.01) performed; this association persisted after controlling for potential confounders (Table ) and in a priori subgroup analyses. CONCLUSION: Perinatal health care system changes in response to the COVID-19 pandemic are associated with decreases in the frequency with which PP depression screening is performed. These data can inform ongoing adaptations in health care delivery in the midst of the COVID-19 pandemic.

Future attempts to better understand the cause of high cesarean delivery rates require a better understanding of the impact of a woman's place of birth and race on cesarean delivery rates.