Impact of the COVID‐19 pandemic on perinatal care and outcomes in the United States: An interrupted time series analysis

Riley, Taylor; Nethery, Elizabeth; Chung, Esther K.; Souter, Vivienne

doi:10.1111/birt.12606

Cited by 14 publications

(23 citation statements)

References 67 publications

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“…[8][9][10][11][12][13] ). Conversely, data from Nepal, Uruguay and California showed increases of 11-30% in preterm birth rates [14][15][16] , whereas national data from Canada, Spain, Sweden and the United States indicated small or no changes [17][18][19][20][21][22] . In parallel, studies from low-and middle-income countries (LMICs; Nepal and Nigeria) and HICs (the UK and Italy) reported increases in stillbirth rates of 2-22% (refs.…”

Section: Association Between Lockdown and Preterm Birthmentioning

confidence: 88%

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

et al. 2023

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Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value <0.0001), second (0.96, 0.92–0.99, 0.03) and third (0.97, 0.94–1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96–1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88–1.14, 0.98), third (0.99, 0.88–1.12, 0.89) and fourth (1.01, 0.87–1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02–1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03–1.15, 0.002), third (1.10, 1.03–1.17, 0.003) and fourth (1.12, 1.05–1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.

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Section: Association Between Lockdown and Preterm Birthmentioning

confidence: 88%

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

et al. 2023

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“…By late winter, MAWS and individual community midwives were sharing resources and offering support as the pandemic spread. Pregnant people and their newborns were considered vulnerable populations whose health care could not be suspended 33 . Midwives coped with increased client caseloads as local hospitals were overwhelmed with ill patients.…”

Section: Growth Of Smooth Transitionsmentioning

confidence: 99%

“…In addition, many families sought home birth options out of fear of the hospital environment 1,5 . This growing strain on hospitals led to creative options to serve patients, such as early discharge 33 . Smooth Transitions hospitals used established relationships to expedite new agreements with community midwives, who performed early discharge home visits consisting of routine postpartum evaluations, newborn metabolic and hearing screenings, plus weight, jaundice, and feeding assessments.…”

Section: Growth Of Smooth Transitionsmentioning

confidence: 99%

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Smooth Transitions: Enhancing Interprofessional Collaboration when Planned Community Births Transfer to Hospital Care

Hays

Denmark

Levine

et al. 2022

J Midwife Womens Health

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In Washington state, planned community births are attended by direct entry licensed midwives (LMs) and certified nurse‐midwives (CNMs). The most recently published vital statistics data from 2018 reported that 3.6% of the 84,648 births in Washington occurred at home or in freestanding birthing centers. Approximately 16.2% of planned home birth and birth center clients experience intrapartum or early postpartum transfer to the hospital, while 1.8% of their newborns do. The safety of and satisfaction with these types of referrals depends on multisystem processes performed by a variety of health care professionals. Smooth Transitions is a quality improvement (QI) initiative in Washington state that was developed to enhance interprofessional collaboration between community‐based midwives, emergency medical services (EMS), and hospital personnel to improve the quality of hospital transfers from planned community settings. Key interventions to date have included (1) information sharing to dispel misconceptions and provide context regarding community births and midwives; (2) co‐creation of transfer guidelines; (3) regularly held interprofessional meetings to review transfers and build relationships; and (4) ongoing review of qualitative feedback that captures the perspectives of all involved. Responses on questionnaires and audits indicate that Smooth Transitions has had a positive impact on provider, staff, and patient experiences with hospital transfers. Future endeavors will include strengthening quantitative data collection processes to measure safety indicators, expanding relationships with EMS, and building a case review process that is legally protected. By engaging representatives of all stakeholder groups and addressing community‐to‐hospital transfers as a multisystems issue, replication of the Smooth Transitions QI Program nationally could promote increased community midwifery integration by enhancing the referral experience for both patients and caregivers.

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“… 18 In the USA, newborn readmission rates among first-time mothers were higher after the pandemic, while multiparous women were less likely to experience preterm birth rates, low Apgar scores and hospital readmissions. 19 Furthermore, it is possible that early studies considering outcomes only at the very start of the pandemic may have overlooked impacts on expectant mothers who were exposed to social mitigation measures for longer durations of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Study protocol: examining the impacts of COVID-19 mitigation measures on pregnancy and birth outcomes in Scotland—a linked administrative data study

et al. 2023

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IntroductionThis protocol outlines aims to test the wider impacts of the COVID-19 pandemic on pregnancy and birth outcomes and inequalities in Scotland.Method and analysisWe will analyse Scottish linked administrative data for pregnancies and births before (March 2010 to March 2020) and during (April 2020 to October 2020) the pandemic. The Community Health Index database will be used to link the National Records of Scotland Births and the Scottish Morbidity Record 02. The data will include about 500 000 mother–child pairs. We will investigate population-level changes in maternal behaviour (smoking at antenatal care booking, infant feeding on discharge), pregnancy and birth outcomes (birth weight, preterm birth, Apgar score, stillbirth, neonatal death, pre-eclampsia) and service use (mode of delivery, mode of anaesthesia, neonatal unit admission) during the COVID-19 pandemic using two analytical approaches. First, we will estimate interrupted times series regression models to describe changes in outcomes comparing prepandemic with pandemic periods. Second, we will analyse the effect of COVID-19 mitigation measures on our outcomes in more detail by creating cumulative exposure variables for each mother–child pair using the Oxford COVID-19 Government Response Tracker. Thus, estimating a potential dose–response relationship between exposure to mitigation measures and our outcomes of interest as well as assessing if timing of exposure during pregnancy matters. Finally, we will assess inequalities in the effect of cumulative exposure to lockdown measures on outcomes using several axes of inequality: ethnicity/mother’s country of birth, area deprivation (Scottish Index of Multiple Deprivation), urban-rural classification of residence, number of previous children, maternal social position (National Statistics Socioeconomic Classification) and parental relationship status.Ethics and disseminationNHS Scotland Public Benefit and Privacy Panel for Health and Social Care scrutinised and approved the use of these data (1920-0097). Results of this study will be disseminated to the research community, practitioners, policy makers and the wider public.

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Impact of the COVID‐19 pandemic on perinatal care and outcomes in the United States: An interrupted time series analysis

Cited by 14 publications

References 67 publications

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Smooth Transitions: Enhancing Interprofessional Collaboration when Planned Community Births Transfer to Hospital Care

Study protocol: examining the impacts of COVID-19 mitigation measures on pregnancy and birth outcomes in Scotland—a linked administrative data study

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