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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.
Am J Obstet Gynecol. 2022 09; 227(3):491.e1-491.e17.AJ

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.

Links

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Authors+Show Affiliations

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 Health, Epping, Australia; Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Australia. Electronic address: lisa.hui@unimelb.edu.au.
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.

MeSH

COVID-19Cohort StudiesCommunicable Disease ControlFemaleFetal Growth RetardationHumansIatrogenic DiseaseInfantInfant, NewbornPandemicsPregnancyPremature BirthRetrospective StudiesStillbirth

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35452655

Citation

Hui, Lisa, et al. "Increase in Preterm Stillbirths in Association With Reduction in Iatrogenic Preterm Births During COVID-19 Lockdown in Australia: a Multicenter Cohort Study." American Journal of Obstetrics and Gynecology, vol. 227, no. 3, 2022, pp. 491.e1-491.e17.
Hui L, Marzan MB, Potenza S, et al. Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: a multicenter cohort study. Am J Obstet Gynecol. 2022;227(3):491.e1-491.e17.
Hui, L., Marzan, M. B., Potenza, S., Rolnik, D. L., Pritchard, N., Said, J. M., Palmer, K. R., Whitehead, C. L., Sheehan, P. M., Ford, J., Mol, B. W., & Walker, S. P. (2022). Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: a multicenter cohort study. American Journal of Obstetrics and Gynecology, 227(3), e1-e17. https://doi.org/10.1016/j.ajog.2022.04.022
Hui L, et al. Increase in Preterm Stillbirths in Association With Reduction in Iatrogenic Preterm Births During COVID-19 Lockdown in Australia: a Multicenter Cohort Study. Am J Obstet Gynecol. 2022;227(3):491.e1-491.e17. PubMed PMID: 35452655.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increase in preterm stillbirths in association with reduction in iatrogenic preterm births during COVID-19 lockdown in Australia: a multicenter cohort study. AU - Hui,Lisa, AU - Marzan,Melvin Barrientos, AU - Potenza,Stephanie, AU - Rolnik,Daniel L, AU - Pritchard,Natasha, AU - Said,Joanne M, AU - Palmer,Kirsten R, AU - Whitehead,Clare L, AU - Sheehan,Penelope M, AU - Ford,Jolyon, AU - Mol,Ben W, AU - Walker,Susan P, Y1 - 2022/04/19/ PY - 2022/03/07/received PY - 2022/04/03/revised PY - 2022/04/06/accepted PY - 2022/4/23/pubmed PY - 2022/8/30/medline PY - 2022/4/22/entrez KW - COVID-19 KW - cohort studies KW - pregnancy outcome KW - premature birth KW - stillbirth SP - 491.e1 EP - 491.e17 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 227 IS - 3 N2 - 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. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/35452655/Increase_in_preterm_stillbirths_in_association_with_reduction_in_iatrogenic_preterm_births_during_COVID_19_lockdown_in_Australia:_a_multicenter_cohort_study_ DB - PRIME DP - Unbound Medicine ER -