Preterm Birth Rates and Racial Disparities during the COVID-19 Pandemic at a Single Institution in the Southeastern United States

Abstract

Objective The impact of 2021 vaccination and social restriction reversal on preterm birth (PTB) is unclear. We sought to compare the rates of PTB during the COVID pre- and post- vaccination periods with pre-pandemic rate. Study Design Retrospective cohort comparing all deliveries over 20 weeks at a single tertiary center during ‘early’ (3/2020-6/2020) vs. ‘late’ COVID (3/2021–6/2021), and 'late' COVID vs. pre-COVID (3-6/2014-2019). PTB<37weeks, <34weeks and <28weeks were compared and stratified by race/ethnicity. Results 16483 deliveries occurred including 2068 ‘early’ COVID, 2115 ‘late’ COVID and 12300 pre-COVID. The PTB rate during ‘late’ COVID was lower compared to ‘early’ COVID (12.1% vs 14.6%,p=0.02). Rate of PTB<34 was also lower during ‘late’ COVID (4.4% vs 5.7%, p=0.05). PTB<28 did not differ. When controlling for prior PTB, ‘late’ COVID remained associated with a decreased risk of PTB compared to ‘early’ COVID, aOR 0.82 [95%CI:0.68,0.98]. Although there was no difference in PTB among Hispanic individuals when comparing ‘late’ COVID versus pre-COVID, when further sub-divided, a small number of Hispanic Puerto Rican(PR) individuals had higher odds of PTB<37 during late’ COVID versus pre-COVID (aOR:4.29 [95%CI 1.12,16.4]) (Table). Additionally, White individuals had reduced odds of PTB<37 (aOR 0.80[95%CI 0.65, 0.98]) during ‘late’ COVID versus pre-COVID while the PTB rate was unchanged when comparing ‘late’ COVID versus pre-COVID in all other racial and ethnic groups. Conclusion During 2021, PTB rates decreased from rates observed in 2020 at the height of COVID restrictions. Among White birthing individuals, PTB decreased in 2021 compared to pre-COVID rates. This decrease was not observed in Black and Hispanic birthing individuals. These data highlight the continued racially disparate impact of the COVID pandemic on PTB rates.

Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic

“…One unexpected effect observed early during the pandemic was a population decrease in preterm birth rates, with reductions in preterm birth reported from many, 12–17 but not all, 18 countries. Studies from the United States also showed conflicting findings, 19–28 although the studies were not comparable because of heterogeneity with regard to populations (hospital, multicenter, population-based), study period, and study design or analysis.…”