Association between the COVID-19 pandemic and fetal, neonatal, and maternal outcomes: An Alabama population-based study

ABSTRACT

Purpose of Study It is important to identify possible changes in fetal, neonatal, and maternal outcomes in relation to the beginning of the COVID-19 pandemic using population-based data to inform strategies to mitigate the impact of the pandemic on adverse pregnancy outcomes. Objective To test the hypothesis that the COVID-19 pandemic was associated with a higher rate of stillbirth and a lower rate of neonatal mortality. Methods Used Design: This population-based cohort study compares two epochs calendar weeks 9-52 (defined as week one starting on the first Sunday of the year) of the years 2016 to 2019 (baseline period)) and 2020 (pandemic period). Setting: Data from the Alabama Department of Public Health, Center for Health Statistics database of Alabama state residents who delivered in Alabama. Participants: All pregnant women with stillbirths ≥20 weeks and live births ≥22 weeks gestational age. Primary Outcomes: The stillbirth and neonatal mortality rate. Summary of Results Data on 237,625 pregnant women were included;46,816 were from the pandemic and 190,809 were from the baseline period. On bivariate analysis, the stillbirth rate did not differ (8.1 vs. 8.9/1000 births, p-value=0.104), but the neonatal mortality rate was lower (2.8 vs. 4.5/1000 live births, p-value<0.001), and the maternal mortality rate was higher (102.5 vs. 62.4/100,000 births, p-value=0.003) during the COVID-19 pandemic period as compared to the baseline period. On logistic regression analysis adjusting for socio-demographic variables (maternal race, age, education, and prenatal care), the pandemic period was associated with a decrease in stillbirth (OR=0.76, 95%CI=0.64, 0.91, pvalue= 0.002) and neonatal mortality rate (OR=0.62, 95% CI=0.51-0.75, p-value<0.001) but an increase in maternal mortality rate (OR=1.64, 95% CI=1.17-2.30, P-value=0.003) as compared to the baseline period. Conclusions The current population-based study shows that the COVID-19 pandemic period was associated with no change in the stillbirth rate, a lower neonatal mortality rate, and a higher maternal mortality rate compared to the baseline period.