Effects of COVID-19 public health safety measures on births in Scotland between March and May 2020

ABSTRACT

BackgroundTo combat the wide-spread transmission of COVID-19, many countries, including the Scotland, have imposed nationwide lockdowns. This included changes to NHS maternity and ante/postnatal services and policies. Little is known about how these lockdown measures affect pregnant mothers and their offspring. This study aimed to explore the impact of COVID19 public health safety measures on birth outcomes in Scotland.MethodsUsing routinely collected health data on pregnancy and birth in Scotland, this study compares all births (N = 11220) between March and May 2020 to births in the same period in 2018 (N = 12428) to investigate the potential effects of lockdown measures introduced in Scotland in spring 2020. A variety of maternal and infant outcomes were analysed induction of labour (yes, no), mode of delivery (unassisted vaginal delivery, planned caesarean section, emergency caesarean section, other (e.g. use of forceps)), analgesia during labour (none, gas and air, opioids, epidural, spinal anaesthetic, general anaesthetics, other), birth outcome (livebirth, stillbirth, infant death), APGAR score (<3, 4-<7, >7), age of gestation, birthweight, length of hospital stay, and feeding method on discharge (breastfeeding, formula, mixed feeding, other). Data were analysed using Mann-Whitney U tests for continuous outcomes and chi-square tests of independence for nominal outcomes. If the chi-square test was significant (α < 0.05), post-hoc tests (Fisher’s exact tests) were conducted to examine all possible comparisons. These were corrected for multiple comparisons using Bonferroni adjustment.ResultsOverall there were few statistically significant differences between births in 2018 and 2020 women in 2020 were more likely to require spinal anaesthetics compared to using no pain relief air (P =.035), gas and air (P <.001) or opioids (P < .001) as well as more likely to have an epidural compared to using gas and air (P < .001) or opioids (P < .001). Mothers giving birth during the pandemic also tended to combine breastfeeding and formula-feeding on discharge (χ2(3) = 19.09, p <.001) post-hoc tests revealed that women were more likely to combine breastfeeding with formula-feeding than to exclusively breastfeed (P <.001) or exclusively formula-feed (P <.001). Finally, women stayed in hospital for fewer days (Z = -10.90, p <.001) and more often had an epidural or a spinal anaesthetic compared to women giving birth in 2018.ConclusionIn conclusion, findings of the current study suggest that lockdown measures implemented in Scotland as a response to the COVID-19 pandemic had limited effects on maternal and neonatal outcomes. While these findings are reassuring, future research is needed to gain better insights into the impact of COVID-19 and associated lockdown measures on maternal and child health.