Stillbirths during SARS-CoV-2 virus pandemic: What has changed?

ABSTRACT

The coronavirus SARS-CoV-2 was identified as the causative agent for a series of atypical respiratory diseases in China in December 2019. This infection was officially declared a pandemic by the WHO on March 2020, and it has affected over 170 million people in the world. In Emilia-Romagna, there is a Surveillance System of stillbirth (SB) since 2014. It records and audits, in a multidisciplinary way, each single case reported by every birth centre of the Region. In this study, we compared SB information collected in the Surveillance System database in pandemic period (March to December 2020) with the ones in the same period, recorded in the previous 6 years. SB was defined according to WHO recommendation. The numbers of birth per years was obtained by Birth certificates (CedAP). During pandemic, there were 89 SB out of 25,225 births allowing a rate of 3.52/1000. For the same period, in the previous 6 years, SB rate ranged from 3.00 (83/27,625) in 2018 to 3.55 (91/26,493) in 2019. Overall, SB rate did not change. No cases of SB were detected in pregnant women affected by SARS-CoV-2 infection. Risk factors as maternal age, years of education, country of origin, gestational weight gain and smoking did not change, while an increased number of SB was recorded in multiparous women (OR 1.62, 95%IC 1.02-2.55) and in overweight ones (OR 1.64, 95%IC 1.03-2.62). Overall, the proportion of preterm births was not substantially different between pandemic period compared to the previous period (OR 1.34, IC95% 0.81-2.23). However, there was a significant increase of SB cases occurring at 22+0-24+6 weeks (OR 3.55, 95%IC 1.49-8.45). Moreover, we found almost double increase of small for gestational age (SGA) infants (OR 1.88, 95%IC 1.16-3.05) and SB related to multiple pregnancy (OR 2.15, 95%IC 1.01-4.56) in pandemic period. The multivariate analysis confirms a higher risk of SB in overweight mothers with SGA infants at 22+0-24+6 weeks during pandemic (respectively OR 1.65, 95%IC 1.01-2.69, OR 1.73, 95%IC 1.03-2.92, and OR 2.18, 95%IC 1.13-4.19) (Table 1). According to ReCoDe classification, there were not significant changes in the frequency of SB causes, compared to the previous period. However, there was a trend toward an increase of the placental abruption cases (17/89 vs 67/555 OR 1.72, 95%IC 0.96-3.09). The quality of pregnancy care was evaluated by using CESDI grade, where grades 2 and 3 refer to substandard care (2 different management might have made a difference to outcome;3 different management would have been reasonably expected to have made a difference to outcome). At audit, cases with grade 2 or 3 during pandemic was 6%, similar to the reference period (10%). No significantly changes occurred in the number of obstetric evaluations as well as in the number of ultrasounds exams. Globally, SARS-CoV-2 pandemic did not substantially influence SB incidence and pregnancy cares. The pandemic restrictions might have affected the access of women at risk to pregnancy services, especially in the first half of gestation, with subsequent low detection rate of SGA.