Preterm births due to cesarean section, induced labor drop during COVID-19 pandemic
At the onset of the COVID-19 pandemic, the rate of preterm birth associated with cesarean section and induced labor was significantly lower than the predicted rate and remained lower throughout, data published in Pediatrics showed.
In July 2020, The New York Times reported anecdotal experiences from doctors around the world who were noticing fewer premature births amid COVID-19 lockdowns, which were reflected in their preliminary data assessments.
“I saw this article and instantly became interested in whether this occurred at scale in the U.S. and what the causes were,” Daniel Dench, PhD, assistant professor in the school of economics at Georgia Institute of Technology, told Healio.
Dench and colleagues used data from nearly 39 million singleton births — including home births — between 2010 and 2020 recorded by the National Center for Health Statistics that had data available on induction and cesarean delivery. They created regression models to compare the actual and predicted rates of preterm birth and low birth weight between March and December 2020.
Compared with the predicted rate of preterm births, the actual rate dropped by 5% starting in March 2020, which coincided with the enforcement of stay-at-home orders and the declaration of a national emergency.
“Preterm birth involving cesarean section and induced delivery explains most of this, falling beginning in March 2020 to December 2020 by 6.5% relative to trend, or 350 per 100,000 births,” Dench said.
However, the actual rate of preterm births not associated with cesarean or induced delivery was only 2% lower than predicted, he said.
An analysis of low birth weight rates also showed that the actual rate was consistently lower than predicted starting in March 2020.
Dench said more research on how these reductions in preterm births affect maternal and fetal outcomes is needed before clinical considerations can be made.
“It could be that these were iatrogenic preterm births that should have occurred because the life of the fetus or the mother was in danger,” Dench said. “If we find no change in maternal or fetal death/morbidities that could be related to these changes in preterm birth involving cesarean section and induced delivery, this would be evidence that these were mostly missing preterm births that should not have occurred. Further research could lead to insights about how to triage patients to in-person care to minimize risk for false positive iatrogenic preterm pregnancy.”
He also suggested studies examine what care and diagnoses did not occur due to pandemic restrictions. In addition to data on how changes in preterm birth rates have affected maternal and fetal health, this information could inform doctors “on what the optimal level of care is depending on patient risk,” Dench said.
References:
- Dench D, et al. Pediatrics. 2022;doi:10.1542/peds.2021-055495.
- Preston E. During coronavirus lockdowns, some doctors wondered: Where are the preemies? The New York Times. https://www.nytimes.com/2020/07/19/health/coronavirus-premature-birth.html. Published July 19, 2020. Accessed April 8, 2022.