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Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: a multicenter cohort study.
Hui, Lisa; Marzan, Melvin Barrientos; Potenza, Stephanie; Rolnik, Daniel L; Pritchard, Natasha; Said, Joanne M; Palmer, Kirsten R; Whitehead, Clare L; Sheehan, Penelope M; Ford, Jolyon; Mol, Ben W; Walker, Susan P.
  • Hui L; Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia; Department of Obstetrics and Gynaecology, The Northern Hospital, Northern He
  • Marzan MB; Centre for Alcohol Policy Research, La Trobe University, Bundoora, Australia.
  • Potenza S; Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia.
  • Rolnik DL; Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Harvard School of Public Health, Harvard University, Cambridge, MA.
  • Pritchard N; Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia.
  • Said JM; Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Maternal-Fetal Medicine Department, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Australia.
  • Palmer KR; Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.
  • Whitehead CL; Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Department of Obstetrics and Gynaecology, the Royal Women's Hospital, Parkville, Australia.
  • Sheehan PM; Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Department of Obstetrics and Gynaecology, Box Hill Hospital, Eastern Health, Box Hill, Australia.
  • Ford J; Department of Obstetrics and Gynaecology, Frankston Hospital, Peninsula Health, Australia.
  • Mol BW; Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.
  • Walker SP; Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia.
Am J Obstet Gynecol ; 227(3): 491.e1-491.e17, 2022 09.
Article in English | MEDLINE | ID: covidwho-1859258
ABSTRACT

BACKGROUND:

The COVID-19 pandemic has been associated with a worsening of perinatal outcomes in many regions around the world. Melbourne, Australia, had one of the longest and most stringent lockdowns worldwide in 2020 while recording only rare instances of COVID-19 infection in pregnant women.

OBJECTIVE:

This study aimed to compare the stillbirth and preterm birth rates in women who were exposed or unexposed to lockdown restrictions during pregnancy. STUDY

DESIGN:

This was a retrospective, multicenter cohort study of perinatal outcomes in Melbourne before and during the COVID-19 lockdown. The lockdown period was defined as the period from March 23, 2020 to March 14, 2021. Routinely-collected maternity data on singleton pregnancies ≥24 weeks gestation without congenital anomalies were obtained from all the 12 public hospitals in Melbourne. We defined the lockdown-exposed cohort as those women for whom weeks 20 to 40 of gestation occurred during the lockdown and the unexposed control group as women from the corresponding calendar periods 12 and 24 months before. The main outcome measures were stillbirth, preterm birth, fetal growth restriction (birthweight < third centile), and iatrogenic preterm birth for fetal compromise. We performed multivariable logistic regression analysis to compare the odds of stillbirth, preterm birth, fetal growth restriction, and iatrogenic preterm birth for fetal compromise, adjusting for multiple covariates.

RESULTS:

There were 24,817 births in the exposed group and 50,017 births in the control group. There was a significantly higher risk of preterm stillbirth in the exposed group than the control group (0.26% vs 0.18%; adjusted odds ratio, 1.49; 95% confidence interval, 1.08-2.05; P=.015). There was also a significant reduction in the preterm birth of live infants <37 weeks (5.68% vs 6.07%; adjusted odds ratio, 0.93; 95% confidence interval, 0.87-0.99; P=.02), which was largely mediated by a significant reduction in iatrogenic preterm birth (3.01% vs 3.27%; adjusted odds ratio, 0.91; 95% confidence interval, 0.83-0.99; P=.03), including iatrogenic preterm birth for fetal compromise (1.25% vs 1.51%; adjusted odds ratio, 0.82; 95% confidence interval, 0.71-0.93; P=.003). There were also significant reductions in special care nursery admissions during lockdown (11.53% vs 12.51%; adjusted odds ratio, 0.90; 95% confidence interval, 0.86-0.95; P<.0001). There was a trend to fewer spontaneous preterm births <37 weeks in the exposed group of a similar magnitude to that reported in other countries (2.69% vs 2.82%; adjusted odds ratio, 0.95; 95% confidence interval, 0.87-1.05; P=.32).

CONCLUSION:

Lockdown restrictions in Melbourne, Australia were associated with a significant reduction in iatrogenic preterm birth for fetal compromise and a significant increase in preterm stillbirths. This raises concerns that pandemic conditions in 2020 may have led to a failure to identify and appropriately care for pregnant women at an increased risk of antepartum stillbirth. Further research is required to understand the relationship between these 2 findings and to inform our ongoing responses to the pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Premature Birth / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Infant / Infant, Newborn / Pregnancy Language: English Journal: Am J Obstet Gynecol 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: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Infant / Infant, Newborn / Pregnancy Language: English Journal: Am J Obstet Gynecol Year: 2022 Document Type: Article