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Maternal-Newborn Health System Changes and Outcomes in Ontario, Canada, During Wave 1 of the COVID-19 Pandemic-A Retrospective Study.
Roberts, Nicole F; Sprague, Ann E; Taljaard, Monica; Fell, Deshayne B; Ray, Joel G; Tunde-Byass, Modupe; Biringer, Anne; Barrett, Jon F R; Khurshid, Faiza; Diaz, Sanober; Bellai-Dussault, Kara; Radke, Dana-Marie; Bisnaire, Lise M; Armour, Christine M; Joiner, Ian C; Walker, Mark C.
  • Roberts NF; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON. Electronic address: niroberts@bornontario.ca.
  • Sprague AE; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON.
  • Taljaard M; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
  • Fell DB; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.
  • Ray JG; Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON.
  • Tunde-Byass M; Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Obstetrics and Gynaecology, North York General Hospital, North York, ON.
  • Biringer A; Ray D. Wolfe Department of Family Medicine, Sinai Health System, University of Toronto, Toronto, ON.
  • Barrett JFR; Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON.
  • Khurshid F; Department of Pediatrics, School of Medicine, Queen's University, Kingston, ON.
  • Diaz S; Provincial Council for Maternal and Child Health, Toronto, ON.
  • Bellai-Dussault K; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON.
  • Radke DM; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON.
  • Bisnaire LM; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON.
  • Armour CM; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON; Department of Pediatrics, University of Ottawa, Ottawa, ON.
  • Joiner IC; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON.
  • Walker MC; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON; International and Global Health, Faculty of Medicine, University of Ottawa, Ottawa, ON; Champlain Maternal Newborn Regional Program, Ottawa, ON; Departmen
J Obstet Gynaecol Can ; 44(6): 664-674, 2022 06.
Article in English | MEDLINE | ID: covidwho-1587183
ABSTRACT

OBJECTIVE:

To determine the population-level impact of COVID-19 pandemic-related obstetric practice changes on maternal and newborn outcomes.

METHODS:

Segmented regression analysis examined changes that occurred 240 weeks pre-pandemic through the first 32 weeks of the pandemic using data from Ontario's Better Outcomes Registry & Network. Outcomes included birth location, length of stay, labour analgesia, mode of delivery, preterm birth, and stillbirth. Immediate and gradual effects were modelled with terms representing changes in intercepts and slopes, corresponding to the start of the pandemic.

RESULTS:

There were 799 893 eligible pregnant individuals included in the analysis; 705 767 delivered in the pre-pandemic period and 94 126 during the pandemic wave 1 period. Significant immediate decreases were observed for hospital births (relative risk [RR] 0.99; 95% CI 0.98-0.99), length of stay (median change -3.29 h; 95% CI -3.81 to -2.77), use of nitrous oxide (RR 0.11; 95% CI 0.09-0.13) and general anesthesia (RR 0.69; 95% CI 0.58- 0.81), and trial of labour after cesarean (RR 0.89; 95% CI 0.83-0.96). Conversely, there were significant immediate increases in home births (RR 1.35; 95% CI 1.21-1.51), and use of epidural (RR 1.02; 95% CI 1.01-1.04) and regional anesthesia (RR 1.01; 95% CI 1.01-1.02). There were no significant immediate changes for any other outcomes, including preterm birth (RR 0.99; 95% CI 0.93-1.05) and stillbirth (RR 1.11; 95% CI 0.87-1.42).

CONCLUSION:

Provincial health system changes implemented at the start of the pandemic resulted in immediate clinical practice changes but not insignificant increases in adverse outcomes.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Premature Birth / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Infant, Newborn / Pregnancy Country/Region as subject: North America Language: English Journal: J Obstet Gynaecol Can Journal subject: Gynecology / Obstetrics Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Premature Birth / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Infant, Newborn / Pregnancy Country/Region as subject: North America Language: English Journal: J Obstet Gynaecol Can Journal subject: Gynecology / Obstetrics Year: 2022 Document Type: Article