Excess mortality caused by the COVID-19 pandemic negatively impacts birth numbers in European countries

Abstract

Study question How did the coronavirus disease 2019 (COVID-19) pandemic affect live birth numbers in Europe? SUMMARY ANSWER In 14 European countries with validated data sets on live birth numbers during the ongoing COVID-19 pandemic, excess mortality was inversely correlated with live birth numbers. What is known already Since March 2020, in order to minimise spread of severe acute respiratory syndrome coronavirus 2 and reducing strain on the health care systems, many national authorities have imposed containments and restricted both indoor and outdoor recreational activities. Historical events, such as electricity blackouts, have repeatedly been shown to exert incremental effects on birth numbers. Study design, size, duration We evaluated the effect of the COVID-19 pandemic and the containments on reproduction and birth numbers in 14 European countries with complete and validated data sets, until March 2021. Participants/Materials, setting, methods The national demographic offices of 20 European countries were requested to provide the monthly birth numbers from 2015 to March 2021. Fourteen countries provided those data. Taking into account seasonal variations, the live birth numbers were compared with excess mortality at two different time intervals during the pandemic. Main results and the role of chance Nine months after the initiation of containments in many European countries, 11 of 14 European countries (78.5%) experienced a decline in live birth numbers, ranging between -0.5% and -11.4%. The decline in live birth numbers was most pronounced in eight European countries with the highest degree of excess mortality. From January to March 2021, live birth numbers continued to decline in five of eight European countries with high excess mortality, whereas live births started to recover in eight of 14 countries (57.1%). Limitations, reasons for caution The live birth numbers of some key European countries were not available. Wider implications of the findings The demographic changes linked to the COVID-19 pandemic may add to the overall socioeconomic consequences, most particularly in those countries with pre-existing reduced reproduction rates. Study Funding/COMPETING INTEREST(S) This study did not receive specific funding. The authors have no conflicts of interest to declare. Trial registration number Not applicable.

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

“…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. De Geyter et al (2022) used P-scores to compare a 3-month period (October to December) with a previous reference for that period, whereas we used a comparison of monthly rates to identify the month with the largest decline in birth rate (January 2021). They also found an association between an excess of mortality in the general population and a decline in births after the first wave of the pandemic (De Geyter et al, 2022).…”

“…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. De Geyter et al (2022) used P-scores to compare a 3-month period (October to December) with a previous reference for that period, whereas we used a comparison of monthly rates to identify the month with the largest decline in birth rate (January 2021).…”

“…De Geyter et al (2022) used P-scores to compare a 3-month period (October to December) with a previous reference for that period, whereas we used a comparison of monthly rates to identify the month with the largest decline in birth rate (January 2021). They also found an association between an excess of mortality in the general population and a decline in births after the first wave of the pandemic (De Geyter et al, 2022). In our study, the mortality related to COVID-19 was higher in the countries that experienced a decline in births >10% in January (Table IV), but this difference did not reach statistical significance.…”

“…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). Based on national statistics on birth rates available, we aim to investigate if a similar trend is observed by including 24 European countries in the analysis.…”

Are preterm birth and very low birth weight rates altered in the early COVID (2020) SARS-CoV-2 era?

“…A more recent study from Australia showed decline in births <34 weeks GA during 2020–21 lockdowns but without significant change for births <28 weeks GA ( 9 ). A consortium of European nations, report decline in live birth rates, some with a subsequent rebound in early 2021 and excess COVID mortality as a putative reason for declining live births ( 10 , 11 ). Recent (2020–21) Canadian surveillance data suggest increased preterm birth risk among 6,012 SARS-CoV-2–affected pregnancies (11.05% vs. 6.76%; relative risk, 1.63 [95% CI, 1.52–1.76]), inclusive of milder disease not requiring hospitalization, compared to unaffected contemporaneous pregnancies ( 12 ).…”