Population birth outcomes in 2020 and experiences of expectant mothers during the COVID-19 pandemic: A ‘born in Wales’ mixed methods study using routine data

Abstract

Background Pregnancy can be a stressful time and the COVID-19 pandemic has affected all aspects of life. This study aims to investigate the pandemic impact on pregnancy experience, rates of primary childhood immunisations and the differences in birth outcomes in during 2020 to those of previous years. Methods Self-reported pregnancy experience: 215 expectant mothers (aged 16+) in Wales completed an online survey about their experiences of pregnancy during the pandemic. The qualitative survey data was analysed using codebook thematic analysis. Population-level birth outcomes in Wales: Stillbirths, prematurity, birth weight and Caesarean section births before (2016–2019) and during (2020) the pandemic were compared using anonymised individual-level, population-scale routine data held in the Secure Anonymised Information Linkage (SAIL) Databank. Uptake of the first three scheduled primary childhood immunisations were compared between 2019 and 2020. Findings The pandemic had a negative impact on the mental health of 71% of survey respondents, who reported anxiety, stress and loneliness; this was associated with attending scans without their partner, giving birth alone, and minimal contact with midwives. There was no significant difference in annual outcomes including gestation and birth weight, stillbirths, and Caesarean sections for infants born in 2020 compared to 2016–2019. There was an increase in late term births (≥42 weeks gestation) during the first lockdown (OR: 1.28, p = 0.019) and a decrease in moderate to late preterm births (32–36 weeks gestation) during the second lockdown (OR: 0.74, p = 0.001). Fewer babies were born in 2020 (N = 29,031) compared to 2016–2019 (average N = 32,582). All babies received their immunisations in 2020, but there were minor delays in the timings of immunisations. Those due at 8-weeks were 8% less likely to be on time (within 28-days) and at 16-weeks, they were 19% less likely to be on time. Interpretation Whilst the pandemic had a negative impact on mothers’ experiences of pregnancy. Population-level data suggests that this did not translate to adverse birth outcomes for babies born during the pandemic.

COVID-19 induced birth sex ratio changes in England and Wales

“…Because a drop in the SRB might also be used to detect male fetal loss (Bruckner et al 2010), our results also indicate that there may have been an unrecognised excess of male fetal loss before 24 weeks gestation (miscarriages). This is because national level statistics from England (Gurol-Urganci et al 2022) and Wales (Jones et al 2022) did not indicate a rise in stillbirths throughout the COVID-19 period of the current investigation, in contrast to the aforementioned single centre study (Khalil et al 2020).…”

“…Excess male fetal loss, particularly in those who were 20 to 28 weeks (4-7 months) pregnant at the time of the major stressful event, has been linked to a drop in the SRB 3 months later (Bruckner et al 2010). A stillbirth is defined in England and Wales as a fetal death that occurs at ≥ 24 completed weeks of pregnancy, whereas a miscarriage happens at < 24 completed weeks (Gurol-Urganci et al 2022; Jones et al 2022). Thus, our findings indicating a decreased SRB in England and Wales in June 2020, 3 months after the declaration of the COVID-19 pandemic, imply an increase in miscarriage and stillbirth rates during the early part of the COVID-19 pandemic, disproportionately affecting male fetuses.…”

“…These particular stillbirths had no connection to clinically severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which indicates an indirect stillbirth mechanism possibly involving increased maternal stress and anxiety. Internationally, miscarriages are typically not included in such statistics (Gurol-Urganci et al 2022; Jones et al 2022). Because a drop in the SRB might also be used to detect male fetal loss (Bruckner et al 2010), our results also indicate that there may have been an unrecognised excess of male fetal loss before 24 weeks gestation (miscarriages).…”

COVID-19 induced birth sex ratio changes in England and Wales

“…Excess male fetal loss, particularly in those who were 20 to 28 weeks (4–7 months) pregnant at the time of the major stressful event, has been linked to a drop in the SRB 3 months later ( Bruckner, Catalano & Ahern, 2010 ). A stillbirth is defined in England and Wales as a fetal death that occurs at ≥ 24 completed weeks of pregnancy, whereas a miscarriage happens at <24 completed weeks ( Gurol-Urganci et al, 2022 ; Jones et al, 2022 ). Thus, our findings indicating a decreased SRB in England and Wales in June 2020, 3 months after the declaration of the COVID-19 pandemic, imply an increase in miscarriage and stillbirth rates during the early part of the COVID-19 pandemic, disproportionately affecting male fetuses.…”

“…These particular stillbirths had no connection to clinically severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which indicates an indirect stillbirth mechanism possibly involving increased maternal stress and anxiety. Internationally, miscarriages are typically not included in such statistics ( Gurol-Urganci et al, 2022 ; Jones et al, 2022 ). Because a drop in the SRB might also be used to detect male fetal loss ( Bruckner, Catalano & Ahern, 2010 ), our results also indicate that there may have been an unrecognised excess of male fetal loss before 24 weeks gestation (miscarriages).…”