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Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia.
Ultrasound Obstet Gynecol. 2021 11; 58(5):677-687.UO

Abstract

OBJECTIVE

To investigate the effect of restriction measures implemented to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the coronavirus disease 2019 (COVID-19) pandemic on pregnancy duration and outcome.

METHODS

A before-and-after study was conducted with cohort sampling in three maternity hospitals in Melbourne, Australia, including women who were pregnant when restriction measures were in place during the COVID-19 pandemic (estimated conception date between 1 November 2019 and 29 February 2020) and women who were pregnant before the restrictions (estimated conception date between 1 November 2018 and 28 February 2019). The primary outcome was delivery before 34 weeks' gestation or stillbirth. The main secondary outcome was a composite of adverse perinatal outcomes. Pregnancy outcomes were compared between women exposed to restriction measures and unexposed controls using the χ-square test and modified Poisson regression models, and duration of pregnancy was compared between the groups using survival analysis.

RESULTS

In total, 3150 women who were exposed to restriction measures during pregnancy and 3175 unexposed controls were included. Preterm birth before 34 weeks or stillbirth occurred in 95 (3.0%) exposed pregnancies and in 130 (4.1%) controls (risk ratio (RR), 0.74 (95% CI, 0.57-0.96); P = 0.021). Preterm birth before 34 weeks occurred in 2.4% of women in the exposed group and in 3.4% of women in the control group (RR, 0.71 (95% CI, 0.53-0.95); P = 0.022), without evidence of an increase in the rate of stillbirth in the exposed group (0.7% vs 0.9%; RR, 0.83 (95% CI, 0.48-1.44); P = 0.515). Competing-risks regression analysis showed that the effect of the restriction measures on spontaneous preterm birth was stronger and started earlier (subdistribution hazard ratio (HR), 0.81 (95% CI, 0.64-1.03); P = 0.087) than the effect on medically indicated preterm birth (subdistribution HR, 0.89 (95% CI, 0.70-1.12); P = 0.305). The effect was stronger in women with a previous preterm birth (RR, 0.42 (95% CI, 0.21-0.82); P = 0.008) than in parous women without a previous preterm birth (RR, 0.93 (95% CI, 0.63-1.38); P = 0.714) (P for interaction = 0.044). Composite adverse perinatal outcome was less frequent in the exposed group than in controls (all women: 2.1% vs 2.9%; RR, 0.73 (95% CI, 0.54-0.99); P = 0.042); women with a previous preterm birth: 4.5% vs 8.4%; RR, 0.54 (95% CI, 0.25-1.18); P = 0.116).

CONCLUSIONS

Restriction measures implemented to mitigate SARS-CoV-2 transmission during the COVID-19 pandemic were associated with a reduced rate of preterm birth before 34 weeks. This reduction was mainly due to a lower rate of spontaneous prematurity. The effect was more substantial in women with a previous preterm birth and was not associated with an increased stillbirth rate. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia.Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia.Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia.Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia.Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia.Monash Newborn, Monash Children's Hospital, Melbourne, Australia.Monash Newborn, Monash Children's Hospital, Melbourne, Australia. Department of Paediatrics, Monash University, Melbourne, Australia.Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia.Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia.Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Department of Obstetrics and Gynaecology, Women's and Newborn Program, Monash Health, Melbourne, Australia. Aberdeen Centre for Women's Health Research, School of Medicine, University of Aberdeen, Aberdeen, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34309931

Citation

Rolnik, D L., et al. "Impact of COVID-19 Pandemic Restrictions On Pregnancy Duration and Outcome in Melbourne, Australia." Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 58, no. 5, 2021, pp. 677-687.
Rolnik DL, Matheson A, Liu Y, et al. Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia. Ultrasound Obstet Gynecol. 2021;58(5):677-687.
Rolnik, D. L., Matheson, A., Liu, Y., Chu, S., Mcgannon, C., Mulcahy, B., Malhotra, A., Palmer, K. R., Hodges, R. J., & Mol, B. W. (2021). Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia. Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 58(5), 677-687. https://doi.org/10.1002/uog.23743
Rolnik DL, et al. Impact of COVID-19 Pandemic Restrictions On Pregnancy Duration and Outcome in Melbourne, Australia. Ultrasound Obstet Gynecol. 2021;58(5):677-687. PubMed PMID: 34309931.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia. AU - Rolnik,D L, AU - Matheson,A, AU - Liu,Y, AU - Chu,S, AU - Mcgannon,C, AU - Mulcahy,B, AU - Malhotra,A, AU - Palmer,K R, AU - Hodges,R J, AU - Mol,B W, PY - 2021/07/08/revised PY - 2021/05/03/received PY - 2021/07/16/accepted PY - 2021/7/27/pubmed PY - 2021/11/6/medline PY - 2021/7/26/entrez KW - COVID-19 KW - coronavirus KW - lockdown KW - pandemic KW - pregnancy duration KW - pregnancy outcome KW - preterm birth KW - restrictions SP - 677 EP - 687 JF - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JO - Ultrasound Obstet Gynecol VL - 58 IS - 5 N2 - OBJECTIVE: To investigate the effect of restriction measures implemented to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the coronavirus disease 2019 (COVID-19) pandemic on pregnancy duration and outcome. METHODS: A before-and-after study was conducted with cohort sampling in three maternity hospitals in Melbourne, Australia, including women who were pregnant when restriction measures were in place during the COVID-19 pandemic (estimated conception date between 1 November 2019 and 29 February 2020) and women who were pregnant before the restrictions (estimated conception date between 1 November 2018 and 28 February 2019). The primary outcome was delivery before 34 weeks' gestation or stillbirth. The main secondary outcome was a composite of adverse perinatal outcomes. Pregnancy outcomes were compared between women exposed to restriction measures and unexposed controls using the χ-square test and modified Poisson regression models, and duration of pregnancy was compared between the groups using survival analysis. RESULTS: In total, 3150 women who were exposed to restriction measures during pregnancy and 3175 unexposed controls were included. Preterm birth before 34 weeks or stillbirth occurred in 95 (3.0%) exposed pregnancies and in 130 (4.1%) controls (risk ratio (RR), 0.74 (95% CI, 0.57-0.96); P = 0.021). Preterm birth before 34 weeks occurred in 2.4% of women in the exposed group and in 3.4% of women in the control group (RR, 0.71 (95% CI, 0.53-0.95); P = 0.022), without evidence of an increase in the rate of stillbirth in the exposed group (0.7% vs 0.9%; RR, 0.83 (95% CI, 0.48-1.44); P = 0.515). Competing-risks regression analysis showed that the effect of the restriction measures on spontaneous preterm birth was stronger and started earlier (subdistribution hazard ratio (HR), 0.81 (95% CI, 0.64-1.03); P = 0.087) than the effect on medically indicated preterm birth (subdistribution HR, 0.89 (95% CI, 0.70-1.12); P = 0.305). The effect was stronger in women with a previous preterm birth (RR, 0.42 (95% CI, 0.21-0.82); P = 0.008) than in parous women without a previous preterm birth (RR, 0.93 (95% CI, 0.63-1.38); P = 0.714) (P for interaction = 0.044). Composite adverse perinatal outcome was less frequent in the exposed group than in controls (all women: 2.1% vs 2.9%; RR, 0.73 (95% CI, 0.54-0.99); P = 0.042); women with a previous preterm birth: 4.5% vs 8.4%; RR, 0.54 (95% CI, 0.25-1.18); P = 0.116). CONCLUSIONS: Restriction measures implemented to mitigate SARS-CoV-2 transmission during the COVID-19 pandemic were associated with a reduced rate of preterm birth before 34 weeks. This reduction was mainly due to a lower rate of spontaneous prematurity. The effect was more substantial in women with a previous preterm birth and was not associated with an increased stillbirth rate. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. SN - 1469-0705 UR - https://www.unboundmedicine.com/medline/citation/34309931/Impact_of_COVID_19_pandemic_restrictions_on_pregnancy_duration_and_outcome_in_Melbourne_Australia_ L2 - https://doi.org/10.1002/uog.23743 DB - PRIME DP - Unbound Medicine ER -