Health care in pregnancy during the COVID‐19 pandemic and pregnancy outcomes in six low‐ and‐middle‐income countries: Evidence from a prospective, observational registry of the Global Network for Women’s and Children’s Health

Abstract

Objective On a population basis, we assessed medical care for pregnant women in specific geographic regions of six countries before and during the first year of the COVID‐19 pandemic in relationship to pregnancy outcomes. Design Prospective, population‐based study. Setting Communities in Kenya, Zambia, the Democratic Republic of the Congo, Pakistan, India, and Guatemala. Population Pregnant women enrolled in the Global Network for Women’s and Children’s Health’s Maternal and Newborn Health Registry Methods Pregnancy/delivery care services and pregnancy outcomes in the pre‐COVID‐19 time‐period (March 2019‐February 2020) were compared to the COVID‐19 time‐period (March 2020‐February 2021). Main Outcome Measures Stillbirth, neonatal mortality, preterm birth, low birth weight, maternal mortality Results Across all sites, a small but statistically significant increase in home births occurred between the pre‐COVID and COVID periods. (18.9% vs 20.3%, aRR 1.12 95% CI 1.05, 1.19). Also, a small but significant decrease in the mean number of antenatal care visits (4.1 – 4.0, p= <0.0001) was seen during the COVID‐19 period. Of outcomes evaluated, overall, a small but significant decrease in low‐birthweight in the COVID‐19 period occurred (15.7% vs 14.6%, aRR 0.94 (0.89, 0.99), but we did not observe any significant differences in other outcomes. There was no change observed in maternal mortality or antenatal haemorrhage overall or at any of the sites. Conclusions Small but significant increases in home births and decreases in the ANC services were observed during the initial COVID‐19 period; however, there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birth weight or preterm birth rates during the COVID‐19 period as compared to the prior year. Further research should help elucidate the relationship between access to and use of pregnancy‐related medical services and birth outcomes over an extended period.

Substantial increase in stillbirth rate during the COVID-19 pandemic: results from a population-based study in the Indian state of Bihar

“…Significant concerns have been raised about adverse pregnancy outcomes due to COVID-19, with mixed evidence regarding stillbirths with some studies reporting an increase and some reporting no change in stillbirth rate (SBR) as a result of COVID-19 infection or lockdown 1 3–11. Much of the literature available on change in SBR is among women who had COVID-19 during pregnancy,2 3 6 8 12–15 with little evidence at the population level for births during the COVID-19 pandemic irrespective of COVID-19 during pregnancy 7 9 10 16. Large population-based estimates on pregnancy outcomes are missing from many countries with high number of cases of COVID-19, including from India 9…”

The Global Network COVID‐19 studies: a review

“…We divided the Global Network's COVID‐19 work into four separate studies. The first evaluated the indirect impact of the COVID‐19 pandemic on some healthcare services and the impact on several pregnancy outcomes 6 . The first observation was that although there were small reductions in physician deliveries in the first year of the pandemic, we could demonstrate no impact on any pregnancy‐related health outcomes.…”

The Impact of Coronavirus Disease-19 on Pregnancy Outcomes, A Case Series

“…These results are also similar to the previously published studies about COVID-19 pregnancies. Kumari et al reported a stillbirth rate of 2.7% (11), and another study investigating the pregnancy results of low-income countries found a 2.8% stillbirth rate during the COVID-19 pandemic (12). A prospective comparative study demonstrated the 5.1% stillbirth rate in COVID-19-infected mothers (13).…”