Impact of <scp>COVID</scp>‐19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia

Rolnik, Daniel L.; Matheson, Alexia; Liu, Y.; Chu, Shih-Ming; McGannon, Claire; Mulcahy, Brendan; Malhotra, Atul; Palmer, Kirsten; Hodges, Ryan; Mol, Ben W.

doi:10.1002/uog.23743

Cited by 45 publications

(36 citation statements)

References 38 publications

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“…There have been reports of a decline in preterm births after the onset of the COVID-19 pandemic in HICs 8 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , although findings are inconsistent. 37 , 38 , 39 , 40 , 41 , 42 Pooled estimates from a recent meta-analysis suggest a modest decrease in overall preterm birth in HICs only and also a reduction in spontaneous preterm birth but not medically indicated preterm birth, 8 although the latter finding rests on the results from only 2 hospital-based studies.…”

Section: Commentmentioning

confidence: 99%

Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study

Oakley

Örtqvist

Kinge

et al. 2022

American Journal of Obstetrics and Gynecology

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Background Although some studies have reported a decrease in preterm birth following the start of the COVID-19 pandemic, the findings are inconsistent. Objective This study aimed to compare the incidences of preterm birth before and after the introduction of COVID-19 mitigation measures in Scandinavian countries using robust population-based registry data. Study Design This was a registry-based difference-in-differences study using births from January 2014 through December 2020 in Norway, Sweden, and Denmark. The changes in the preterm birth (<37 weeks) rates before and after the introduction of COVID-19 mitigation measures (set to March 12, 2020) were compared with the changes in preterm birth before and after March 12 from 2014 to 2019. The differences per 1000 births were calculated for 2-, 4-, 8-, 12-, and 16-week intervals before and after March 12. The secondary analyses included medically indicated preterm birth, spontaneous preterm birth, and very preterm (<32 weeks) birth. Results A total of 1,519,521 births were included in this study. During the study period, 5.6% of the births were preterm in Norway and Sweden, and 5.7% were preterm in Denmark. There was a seasonal variation in the incidence of preterm birth, with the highest incidence during winter. In all the 3 countries, there was a slight overall decline in preterm births from 2014 to 2020. There was no consistent evidence of a change in the preterm birth rates following the introduction of COVID-19 mitigation measures, with difference-in-differences estimates ranging from 3.7 per 1000 births (95% confidence interval, −3.8 to 11.1) for the first 2 weeks after March 12, 2020, to −1.8 per 1000 births (95% confidence interval, −4.6 to 1.1) in the 16 weeks after March 12, 2020. Similarly, there was no evidence of an impact on medically indicated preterm birth, spontaneous preterm birth, or very preterm birth. Conclusion Using high-quality national data on births in 3 Scandinavian countries, each of which implemented different approaches to address the pandemic, there was no evidence of a decline in preterm births following the introduction of COVID-19 mitigation measures.

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Section: Commentmentioning

confidence: 99%

Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study

Oakley

Örtqvist

Kinge

et al. 2022

American Journal of Obstetrics and Gynecology

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“…Preterm infants (>20 weeks and < 37 weeks' gestation) born to mothers who conceived between 1 November 2019 and 29 February 2020, who were between 3 and 19 weeks pregnant at the beginning of lockdown (exposed group), compared to preterm infants conceived at the same time period the year before (control group) were included. [3] Conception was calculated based on gestational age from first day of the last menstrual period and confirmed with first trimester ultrasound. We compared neonatal outcomes of preterm infants born during lockdown in 2020 (exposed group) with preterm infants born in 2019 (control group).…”

Section: Methodsmentioning

confidence: 99%

“…While COVID-19 infection in pregnancy has been associated with an increased risk of preterm birth, [1] studies have suggested a reduction in preterm births in non-infected mothers during community lockdowns. [2,3] Very few studies have assessed what impact this has had on neonatal outcomes, and many previous studies are from countries with relatively high COVID-19 community transmission rates. Melbourne, Australia, experienced one of the world's strictest community transmission mitigation measures during two lockdowns (March-May, July-November) in 2020.…”

Section: Introductionmentioning

confidence: 99%

Neonatal outcomes of preterm infants born during COVID-19 community lockdowns in Melbourne, Australia

Mulcahy

Rolnik

Matheson

et al. 2021

Preprint

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Background: Community lockdowns during the COVID-19 pandemic may influence preterm birth rates, but mechanisms are unclear. Methods: We compared neonatal outcomes of preterm infants born to mothers exposed to community lockdowns in 2020 (exposed group) to those born in 2019 (control group). Main outcome studied was composite of significant neonatal morbidity or death. Results: Median gestational age was 35+4 weeks (295 infants, exposed group) vs. 35+0 weeks (347 infants, control group) (p = 0.108). The main outcome occurred in 36/295 (12.2%) infants in exposed group vs. 46/347 (13.3%) in control group (p = 0.69). Continuous positive airway pressure (CPAP) use, jaundice requiring phototherapy, hypoglycaemia requiring treatment, early neonatal white cell and neutrophil counts were significantly reduced in the exposed group. Conclusions: COVID-19 community lockdowns did not alter composite neonatal outcomes in preterm infants, but reduced rates of some common outcomes, and early white cell and neutrophil counts.

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“…The COVID-19 pandemic has disrupted the delivery of maternity care, with a recent systematic review concluding that global maternal and fetal outcomes had worsened during the COVID-19 pandemic. 1 Some studies have reported increases in stillbirth and reductions in preterm birth, [2][3][4][5][6][7][8] while others reported no changes. [9][10][11][12][13] These differences are likely due to multiple factors, including differences in study methodology, 14 resource setting, severity of lockdown restrictions, and COVID-19 caseload.…”

Section: Introductionmentioning

confidence: 99%

Increase in preterm stillbirths and reduction in iatrogenic preterm births for fetal compromise: a multi-centre cohort study of COVID-19 lockdown effects in Melbourne, Australia

Hui

Marzan

Potenza

et al. 2021

Preprint

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Objectives: The COVID-19 pandemic has been associated with a worsening of perinatal outcomes in many settings due to the combined impacts of maternal COVID-19 disease, disruptions to maternity care, and overloaded health systems. In 2020, Melbourne endured a unique natural experiment where strict lockdown conditions were accompanied by very low COVID-19 case numbers and the maintenance of health service capacity. The aim of this study was to compare stillbirth and preterm birth rates in women who were exposed or unexposed to lockdown restrictions during pregnancy. Design: Retrospective multi-centre cohort study of perinatal outcomes before and during COVID-19 lockdown Setting: Birth outcomes from all 12 public maternity hospitals in metropolitan Melbourne Inclusion criteria: Singleton births without congenital anomalies from 24 weeks gestation. The lockdown-exposed cohort were those women for whom weeks 20- 40 of gestation would have occurred during the lockdown period of 23 March 2020 to 14 March 2021. The control cohort comprised all pregnancies in the corresponding periods one and two years prior to the exposed cohort. Main outcome measures. Odds of stillbirth, preterm birth (PTB), birth weight less than 3rd centile, and iatrogenic PTB for fetal compromise, adjusting for multiple covariates. Results: There were 24,017 births in the exposed and 50,017 births in the control group. There was a significantly higher risk of preterm, but not term, stillbirth in the exposed group compared with the control group (0.26% vs 0.18%, aOR 1.49, 95%CI 1.08 to 2.05, P = 0.015). There was also a significant reduction in preterm birth < 37 weeks (5.93% vs 6.23%, aOR 0.93, 95%CI 0.87 to 0.99, P=0.03), largely mediated by a reduction in iatrogenic PTB for live births (3.01% vs 3.27%, aOR 0.89, 95%CI 0.81 to 0.98, P = 0.015), including iatrogenic PTB for suspected fetal compromise (1.25% vs 1.51%, aOR 0.79, 95%CI 0.69 to 0.91, P= 0.001). There was no significant difference in the spontaneous PTB rate between the exposed and control groups (2.69% vs 2.82%, aOR 0.94, 95%CI 0.86 to 0.1.03, P=0.25). Conclusions: Lockdown restrictions in a high-income setting with low rates of COVID-19 disease were associated with a significant increase in preterm stillbirths and a significant reduction in iatrogenic PTB for suspected fetal compromise.

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Impact of COVID‐19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia

Cited by 45 publications

References 38 publications

Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study

Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study

Neonatal outcomes of preterm infants born during COVID-19 community lockdowns in Melbourne, Australia

Increase in preterm stillbirths and reduction in iatrogenic preterm births for fetal compromise: a multi-centre cohort study of COVID-19 lockdown effects in Melbourne, Australia

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