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

ABSTRACT

INTRODUCTION One of the main implemented provisions 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. The lifestyle of pregnant women has a fundamental impact on maternal health and fetal development. 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. Stressful situations, such as those caused by this new confinement, could be also the cause of overeating and of weight gain. Indeed, some studies suggested that psychological and emotional responses to the COVID-19 outbreak may have also increased the risk of developing dysfunctional eating behaviors and overeating as a consequence of boredom. Moreover, Body Mass Index (BMI) and maternal weight gain during pregnancy could be related to a higher rate of breech presentations. Fetal malpresentation is one of the main causes of the high rate of cesarean delivery. This pandemic could also influence women's attitude to routine checkups and pregnancy scans, antenatal appointments and consultations. METHODS This is a retrospective study including all consecutive patients who delivered at University Hospital Maggiore della Carità 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-value .018) and an increased percentage of patients with clinical checkups at Family Planning facilities in 2020 (p-value .04). The number of hospitalizations during pregnancy was 26 (8.9%) vs 10 (3.9%) with a significative reduction during 2020 (p-value .004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs 35.9%;p-value . 002), a reduction of amniorrhexis (11.3% vs 5.5% p-value .015), a reduction of supine positions with an increase of vertical and all fours positions in 2020 (49.3% vs 61.9% and 9.5% vs 12.4% respectively, p .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-value .019) as shown in Table 1. CONCLUSIONS It is the first time in modern, age that humankind faces a lockdown, so the short- and long-term effects are unknown. There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate possible psychological, behavioral, and epigenetic effects on obstetric outcomes.