What may happen if you are pregnant during COVID-19 lockdown? A retrospective study about peripartum outcomes.

BACKGROUND: One of the provisions implemented to contain the spread of COVID-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. METHODS: This is a retrospective study including all consecutive patients who delivered at the Maggiore della Carità Hospital in Novara, Italy, in April-May 2017 (group 1, N.=294), a period prior to the pandemic, and during the same months in 2020 (group 2, N.=256) during and immediately after lockdown. Clinical data were extracted from the report "Childbirth Assistance Certificate (CedAP) - Birth Event Analysis." RESULTS: Demographic characteristics were similar between the two study groups, except for a decreased number of married couples in group 2 (P=0.018) and an increased percentage of patients with clinical checkups at family planning facilities in 2020 (P=0.04). The number of hospitalizations during pregnancy was 26 (8.9%) vs. 10 (3.9%) with a significative reduction during 2020 (P=0.004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs. 35.9%; P=0. 002), a reduction of amniorrhexis (11.3% vs. 5.5% P=0.015), a reduction of supine positions with an increase of vertical and all four positions in 2020 (49.3% vs. 61.9% and 9.5% vs. 12.4% respectively, P=0.023), and a reduction of left occipito-anterior presented part (63.2% vs. 55.4%) in favor of right occipito-anterior (34.7% vs. 41.2%, P=0.019). CONCLUSIONS: There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate psychological, behavioral, and epigenetic effects of maternal physical inactivity on obstetric outcomes.

High rates of neonatal polycythemia and hyperbilirubinemia during the first phase of COVID-19 pandemic in Italy: a single-center experience.

In our third-level Neonatal Unit in Northern Italy, we recorded a high rate of neonatal hyperbilirubinemia requiring phototherapy in March-November 2020, during the first phase of COVID-19 pandemic, compared to the previous year (198/1348, 14.2%, vs 141/1432, 9.8%, p = 0.0004). Supposing it could be the result of neonatal polycythemia, we evaluated capillary hematocrit (Hct) and the rate of hyperbilirubinemia in all newborns ≥36 weeks gestational age born in December 2020. Out of 73 neonates, 37 had Hct ≥65% (50.7%). However, as capillary blood samples may overestimate Hct by 5-15%, even downsizing all values by 15%, Hct was still ≥65% in 9/73 neonates (12.3%), much higher than 0.4-5% prevalence of polycythemia reported in healthy newborns. All those newborns were singleton and healthy, with no clinical signs of hyperviscosity and no underlying factors predisposing to polycythemia. Out of 73 newborns, 13 (17.8%) developed hyperbilirubinemia requiring phototherapy. Their mean Hct value was 66.3 ± 8.2%. Since hyperbilirubinemia is common in the offspring of women with SARS-CoV-2 infection and we recorded increased rates of neonatal hyperbilirubinemia in the first phase of COVID-19 pandemic, it could be hypothesized that even asymptomatic Sars-CoV2 infection during pregnancy might cause placental vascular malperfusion, eliciting polycythemia in the fetus as a compensatory response, that could be the link between COVID-19 in the mothers and hyperbilirubinemia in the newborns.