Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-19 Pandemic.
JAMA Netw Open
; 5(8): e2226531, 2022 08 01.
Article
in English
| MEDLINE | ID: covidwho-1990382
ABSTRACT
Importance Little is known about changes in obstetric outcomes during the COVID-19 pandemic. Objective:
To assess whether obstetric outcomes and pregnancy-related complications changed during the COVID-19 pandemic. Design, Setting, andParticipants:
This retrospective cohort study included pregnant patients receiving care at 463 US hospitals whose information appeared in the PINC AI Healthcare Database. The relative differences in birth outcomes, pregnancy-related complications, and length of stay (LOS) during the pandemic period (March 1, 2020, to April 31, 2021) were compared with the prepandemic period (January 1, 2019, to February 28, 2020) using logistic and Poisson models, adjusting for patients' characteristics, and comorbidities and with month and hospital fixed effects. Exposures COVID-19 pandemic period. Main Outcomes andMeasures:
The 3 primary outcomes were the relative change in preterm vs term births, mortality outcomes, and mode of delivery. Secondary outcomes included the relative change in pregnancy-related complications and LOS.Results:
There were 849â¯544 and 805â¯324 pregnant patients in the prepandemic and COVID-19 pandemic periods, respectively, and there were no significant differences in patient characteristics between periods, including age (≥35 years 153â¯606 [18.1%] vs 148 274 [18.4%]), race and ethnicity (eg, Hispanic patients 145â¯475 [47.1%] vs 143â¯905 [17.9%]; White patients 456â¯014 [53.7%] vs 433â¯668 [53.9%]), insurance type (Medicaid 366â¯233 [43.1%] vs 346â¯331 [43.0%]), and comorbidities (all standardized mean differences <0.10). There was a 5.2% decrease in live births during the pandemic. Maternal death during delivery hospitalization increased from 5.17 to 8.69 deaths per 100â¯000 pregnant patients (odds ratio [OR], 1.75; 95% CI, 1.19-2.58). There were minimal changes in mode of delivery (vaginal OR, 1.01; 95% CI, 0.996-1.02; primary cesarean OR, 1.02; 95% CI, 1.01-1.04; vaginal birth after cesarean OR, 0.98; 95% CI, 0.95-1.00; repeated cesarean OR, 0.96; 95% CI, 0.95-0.97). LOS during delivery hospitalization decreased by 7% (rate ratio, 0.931; 95% CI, 0.928-0.933). Lastly, the adjusted odds of gestational hypertension (OR, 1.08; 95% CI, 1.06-1.11), obstetric hemorrhage (OR, 1.07; 95% CI, 1.04-1.10), preeclampsia (OR, 1.04; 95% CI, 1.02-1.06), and preexisting chronic hypertension (OR, 1.06; 95% CI, 1.03-1.09) increased. No significant changes in preexisting racial and ethnic disparities were observed. Conclusions and Relevance During the COVID-19 pandemic, there were increased odds of maternal death during delivery hospitalization, cardiovascular disorders, and obstetric hemorrhage. Further efforts are needed to ensure risks potentially associated with the COVID-19 pandemic do not persist beyond the current state of the pandemic.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pregnancy Complications
/
Maternal Death
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Adult
/
Female
/
Humans
/
Infant, Newborn
/
Pregnancy
Country/Region as subject:
North America
Language:
English
Journal:
JAMA Netw Open
Year:
2022
Document Type:
Article
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