COVID-19 linked to decrease in obstetric intervention, increase in perinatal mortality

Key takeaways:

• COVID-19 onset was linked to brief decreases in preterm labor induction/cesarean delivery.
• Pandemic onset was also linked to increases in macrosomia, post-term births and perinatal mortality.

The onset of the COVID-19 pandemic was linked to a short decrease in obstetric interventions and an increase in perinatal mortality, according to a retrospective study published in Obstetrics & Gynecology.

“The onset of COVID-19 was associated with a brief decrease in obstetric intervention, especially preterm labor induction/cesarean section, and a transient increase in adverse perinatal outcomes, such as perinatal mortality, macrosomia and post-term births,” Sophie Simon, MBBS, MD, postdoctoral research fellow in the department of obstetrics and gynecology at the University of British Columbia, told Healio. “Modern obstetrics relies on identification of high-risk pregnancies, continuous maternal and fetal monitoring through regular antenatal care and appropriate intervention for the prevention of adverse perinatal outcomes. Obstetric intervention, such as clinician-initiated preterm labor for fetal compromise, helps prevent stillbirths and neonatal deaths. It is crucial to maintain obstetric services critical for healthy pregnancy outcomes during a pandemic while simultaneously implementing measures to curtail infection.”

Simon and colleagues conducted a retrospective study of 26,604,392 singleton live births and 155,214 singleton stillbirths in the U.S. from 2015 to 2021. Researchers obtained data from the natality, fetal death and linked live birth-infant death files of the National Center for Health Statistics.

The primary outcomes included preterm birth, preterm labor induction or preterm cesarean delivery, macrosomia, post-term birth and perinatal death.

The onset of the COVID-19 pandemic was associated with absolute decreases in preterm birth by 0.322 per 100 live births and preterm labor induction or cesarean delivery by 0.19 per 100 live births.

In addition, the onset of COVID-19 was also associated with absolute increases in macrosomia by 0.046 per 100 live births, post-term births by 0.015 per 100 live births and perinatal mortality by 0.501 per 1,000 total births.

Researchers observed larger changes in subpopulations at high risk. Among singleton births for women with prepregnancy diabetes, the onset of COVID-19 was associated with a decrease in preterm birth by 1.634 per 100 live births and preterm labor induction or cesarean delivery by 1.521 per 100 live births. In this subpopulation, COVID-19 onset was also associated with increases in macrosomia by 0.328 per 100 live births and perinatal mortality by 9.84 per 1,000 total births.

Most changes observed in the study reverse in the months following the COVID-19 pandemic onset.

“COVID-19 led to large increases in mortality among high-risk populations and affected the routine functioning of obstetric and other specialized services. Creating resilient health systems that can respond to future challenges is important, and we need to carry out research to address how health systems should function in future pandemics,” Simon said. “This includes strategic planning and policy with regard to resources, health personnel, infrastructure and related issues.”

For more information:

Sophie Simon, MBBS, MD, can be reached at sophie.simon@bcchr.ca.