ABSTRACT
BACKGROUND: The COVID-19 pandemic led to regional or nationwide lockdowns as part of risk mitigation measurements in many countries worldwide. Recent studies suggest an unexpected and unprecedented decrease in preterm births during the initial COVID-19 lockdowns in the first half of 2020. The objective of the current study was to assess the effects of the two months of the initial national COVID-19 lockdown period on the incidence of very and extremely preterm birth in the Netherlands, stratified by either spontaneous or iatrogenic onset of delivery, in both singleton and multiple pregnancies. METHODS: Retrospective cohort study using data from all 10 perinatal centers in the Netherlands on very and extremely preterm births during the initial COVID-19 lockdown from March 15 to May 15, 2020. Incidences of very and extremely preterm birth were calculated using an estimate of the total number of births in the Netherlands in this period. As reference, we used data from the corresponding calendar period in 2015-2018 from the national perinatal registry (Perined). We differentiated between spontaneous versus iatrogenic onset of delivery and between singleton versus multiple pregnancies. RESULTS: The incidence of total preterm birth < 32 weeks in singleton pregnancies was 6.1 in the study period in 2020 versus 6.5 in the corresponding period in 2015-2018. The decrease in preterm births in singletons was solely due to a significant decrease in iatrogenic preterm births, both < 32 weeks (OR 0.71; 95%CI 0.53 to 0.95) and < 28 weeks (OR 0.53; 95%CI 0.29 to 0.97). For multiple pregnancies, an increase in preterm births < 28 weeks was observed (OR 2.43; 95%CI 1.35 to 4.39). CONCLUSION: This study shows a decrease in iatrogenic preterm births during the initial COVID-19-related lockdown in the Netherlands in singletons. Future studies should focus on the mechanism of action of lockdown measures and reduction of preterm birth and the effects of perinatal outcome.
Subject(s)
COVID-19/prevention & control , Labor, Induced/trends , Premature Birth/epidemiology , Premature Birth/etiology , Female , Health Policy , Humans , Iatrogenic Disease/epidemiology , Incidence , Infant, Extremely Premature , Infant, Newborn , Logistic Models , Netherlands/epidemiology , Pregnancy , Prenatal Care/methods , Prenatal Care/trends , Protective Factors , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVE: The coronavirus disease (COVID-19) pandemic has negatively affected many people's mental health with increased symptoms of stress, anxiety and depression in the general population. Anxiety and depression can have negative effects on pregnant women and result in poor neonatal outcomes. Therefore, we analyzed stress, anxiety and depression in pregnant women during the COVID-19 pandemic. MATERIALS AND METHODS: Cohort study of pregnant women during COVID-19 compared to pregnant women before COVID-19. Pregnant women were recruited through social media platforms from 21 May 2020 to 22 June 2020. Pregnant women ≥ 18 years of age, who master the Dutch language were included. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10) were analyzed. Demographic features were summarized using descriptive statistics. Possible differences in demographic variables between groups were compared using Mann Whitney U test and Chi-squared test. Significant demographic differences between groups were controlled for using logistical regression analysis or an independent one-way analysis of covariance. RESULTS: Thousand hundred and two pregnant women completed the questionnaires during COVID-19, and 364 pregnant women before COVID-19. We found no differences in clinically high levels of anxiety (HADS-A ≥ 8) and depression (HADS-D ≥ 8) in women during COVID-19 (19.5% and 13.2%, respectively) and women before COVID-19 (23.1% and 15.7%, respectively). A question was implemented whether participants related their stress level to COVID-19. Women who related their stress to the COVID-19 pandemic reported significantly higher overall stress levels on the PSS-10 compared to women with stress unrelated to COVID-19 (mean, 15.62; standard deviation [SD], 6.44 vs. mean, 10.28; SD, 5.48; p < 0.001). CONCLUSION: In contrast to previous studies, COVID-19 did not increase anxiety and depression levels in Dutch pregnant women. Women who related their perceived stress to the COVID-19 pandemic experienced higher stress levels than women who did not relate their stress to the COVID-19 pandemic, suggesting that interventions that specifically aim to reduce COVID-19 stress, may help to reduce overall stress levels in pregnant women during the pandemic.