Preterm births in South-West England before and during the COVID-19 pandemic: an audit of retrospective data

Abstract

The COVID-19 lockdown had a series of intended and unintended consequences, including reduced infections and changes in activities and behaviours. Some of these changes may have been beneficial to perinatal outcomes; however, other factors such as reduced access to face-to-face healthcare may have contributed negatively to antenatal care. The aim of this audit was to evaluate neonatal admissions in the South-West of England during the COVID-19 pandemic in 2020 and the previous two years 2018–2019. Anonymised birth and neonatal admission rates from January to December 2020 was obtained and compared to data from 2018 to 2019. The results demonstrate a decreasing in neonatal unit admissions between 2018 and 2020, 9.48% of live births in 2018 (95% CI 9.17, 9.80) to 8.89% (95% CI 8.65, 9.13) in 2020 ( p = 0.002). Conclusion : There were no significant differences across gestational groups. It is unclear without nationwide data whether our observed trends, decreased neonatal admissions over the past 3 years, are generalisable and related to the COVID-19 pandemic. Future research exploring the impact of lockdowns on behaviour change during pregnancy and support services is warranted to understand the implications of pandemics on pregnancy and preterm birth. What is Known: • The COVID-19 lockdown had a series of intended and unintended consequences; some of which may have been beneficial to perinatal outcomes. • Research suggests that preterm births have not significantly changed overall, but they have decreased in high-income countries. What is New: • In our audit, analysing retrospective data of regional birth and neonatal admission from the South-West of England, we observed a decrease in live birth rates between 2018 and 2020. • A reduction in neonatal unit admissions was observed from 2018 to 2020 with no significant differences across gestational groups. The reduction from 2019 to 2020 was smaller than that from 2018 to 2019 implying that the COVID-19 pandemic in 2020 was not necessarily implicated.

SARS-CoV-2 Seroconversion and Pregnancy Outcomes in a Population of Pregnant Women Recruited in Milan, Italy, between April 2020 and October 2020

“…Our results on preterm birth were consistent with data from several studies [ 5 , 27 , 29 , 40 , 41 , 42 , 43 , 44 ], although others report an increased risk of preterm delivery among pregnant women with SARS-COV-2 infection [ 4 , 32 , 33 , 37 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. However, Khalil et al suggest that, during COVID-19 disease, iatrogenic preterm delivery is increased rather than spontaneous [ 52 ].…”

Stillbirth and Preterm Birth During Lockdown Periods in 5 Waves of COVID-19 Pandemic in Northern Iran: A Region-Wide Cohort Study in Mazandaran Province

“…The decrease in premature births in this study has been maintained even in the period of COVID-19 and, unlike our study, it did not affect the increase in stillbirths. 18 Contrary to some studies that reported a decrease in the hospitalization of premature babies during the lockdown period of COVID-19 at the beginning of the pandemic, 6,16,[19][20][21] a retrospective study on 46 neonatal intensive care units from 17 different countries, showed that the number of extreme preterm hospitalizations did not change significantly during the lockdown period. The selected countries were selected from different regions of Western and Eastern Europe, Asia, and North America, and there were no statistical differences between the levels of lockdown restrictions.…”

“…The decrease in premature births in this study has been maintained even in the period of COVID-19 and, unlike our study, it did not affect the increase in stillbirths. 18 …”

Increasing Preterm Delivery and Small for Gestational Age Trends in South Carolina during the COVID-19 Pandemic

“…Worldwide, multiple studies and meta-analyses have highlighted the diverse effects of the COVID-19 pandemic on PTD, with potential influences from local factors and healthcare practices that could impact outcomes. A meta-analysis of non-US studies [29], some hospital and population-based studies in the United Kingdom (UK) [7,30] and Canada [31,32], one hospital-based study in Philadelphia [33], and a population-based study in California [34] spanning different time periods in 2020, found no changes in PTD rates at the onset of the pandemic. In contrast, several studies in different countries [35][36][37][38], one of which was among privately insured women [39], a population-based study in Tennessee [40], and another meta-analysis within this time period [41], also reported a decrease in overall PTD rates or in specific subgroups [42].…”