Characteristics of stillbirths during the Coronavirus 2019 (COVID-19) pandemic

Abstract

Limited data about the impact of COVID-19 or altered provision of prenatal care during the pandemic on rate of stillbirth exists. We sought to determine the incidence and characteristics of stillbirths during the COVID-19 pandemic compared to that of stillbirths that occurred in the pre-pandemic period. This is a retrospective cohort study of pregnant individuals who delivered stillbirths during two different time periods, March to September in 2017, 2018 and 2019 (pre-pandemic period) and March to September 2020 (pandemic period), at a large metropolitan hospital in a pandemic epicenter as designated by the Centers for Disease Control (CDC). Stillbirth rates were calculated as the number of cases per total number of live births. Comparisons were performed using Fisher’s exact tests. A two-sided significance level of 0.05 was used for all statistical tests. 9978 infants including 46 stillbirths and 3025 infants including 12 stillbirths were delivered during the pre-pandemic and pandemic periods, respectively . No difference in rate of stillbirths during the two time periods was found. Rates of co-morbid conditions in women who had a stillbirth were similar between the two periods. During the pandemic period, a higher proportion of stillbirths were suspected to be due to poorly controlled hypertension (p =0.04). Maternal outcomes were similar between the two cohorts. For women who delivered during the pandemic period, 3 women (25%) had a SARS-CoV-2 PCR that was positive at the time of stillbirth. The incidence of stillbirth during the pandemic period was similar to that during the pre-pandemic period. More stillbirths likely occurred due to poorly controlled hypertension, a potentially preventable cause of stillbirth, during the pandemic period. While the impact of the disease process of COVID-19 on stillbirth remains unknown, the disruption of the delivery of routine prenatal care during the pandemic period may have had unintended consequences with respect to the prevention and treatment of hypertension and the risk of potentially preventable stillbirths.