Associations of COVID-19 Lockdown with Gestational Length and Preterm Birth in China

Abstract

BackgroundThe effects of COVID-19 lockdown measures on maternal and fetal health remain unclear. We examined the associations of COVID-19 lockdown with gestational length and preterm birth (PTB) in a Chinese population.MethodsWe obtained medical records of 595396 singleton live infants born between 2015 and 2020 in 5 cities in Guangdong Province, South China. The exposed group (N=101900) included women who experienced the COVID-19 Level I lockdown (1/23-2/24/2020) during pregnancy, while the unexposed group (N=493496) included women who were pregnant during the same calendar months in 2015-2019. Cumulative exposure was calculated based on days exposed to different levels of emergency responses with different weighting. Generalized linear regression models were applied to estimate the associations of lockdown exposure with gestational length and risk of PTB (<37 weeks).ResultsThe exposed group had a shorter mean gestational length than the unexposed group (38.66 vs 38.74 weeks: adjusted β=-0.06 week [95%CI, -0.07, -0.05 week]). The exposed group also had a higher risk of PTB (5.7% vs 5.3%; adjusted OR=1.08 [95%CI, 1.05, 1.11]). These associations seemed to be stronger when exposure occurred before or during the 23rd gestational week (GW) than during or after the 24th GW. Similarly, higher cumulative lockdown exposure was associated with a shorter gestational length and a higher risk of PTB.ConclusionsThe COVID-19 lockdown measures were associated with a slightly shorter gestational length and a moderately higher risk of PTB. Early and middle pregnancy periods may be a more susceptible exposure window.

High-risk pregnant women’s experiences of the receiving prenatal care in COVID-19 pandemic: a qualitative study

“…COVID-19 in pregnancy has been associated with complications such as premature rupture of the membranes (PPROM) and preterm delivery [ 12 , 13 ], fetal distress, and fetal growth restriction as a result of maternal hypoxia. The rate of cesarean section is also reported to be 96.4%, possibly indicating that iatrogenic reasons (fear of obstetrics) can also be a factor [ 14 , 15 ].…”

“…Maternal psychological distress (such as stress, anxiety, and depression) has consequences for both mother and fetus, and has been found to be a risk factor in children and associated with adult neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), schizophrenia spectrum disorders, antisocial behavior, and depressive symptoms [ 21 ]. As a result, it is necessary to cope with the psychological distress caused by COVID-19 in the presence of its prevalence to avoid the side effects of fetal growth and neurodevelopmental disorders [ 12 , 13 ].…”