Abstract
Objective: The effect of lockdowns during the coronavirus (COVID-19) pandemic on pregnancy outcomes remains uncertain. We aimed to evaluate the association between the COVID-19-related lockdown and pregnancy outcomes in maternity hospitals in France. Study design: This was a retrospective cohort study from six tertiary referral hospitals in different regions of France. Three 55-day periods were compared: pre-lockdown from 22 January 2020, lockdown from 17 March 2020, and post-lockdown from 11 May 2020 to 4 July 2020. We included all women who delivered singleton or multiple pregnancies, who delivered at ≥24 weeks of gestation and with birthweights ≥500 g. We documented gestational ages at the delivery of liveborn and stillborn infants (‘stillbirths’). These were categorized as having a very low birthweight (VLBW, <1500 g), or a low birthweight (LBW, <2500 g). Adjustments were made for place of birth, maternal age, parity and diabetes, and hypertensive disorders, as well as for multiple pregnancies. Results: In total, 11,929 women delivered in the six selected centers. This figure is constituted of 4093, 3829, and 4007 deliveries in the pre-lockdown (1), peri-lockdown (2), and post-lockdown (3) periods, respectively. There were no differences in pregnancy outcomes between these three periods. Overall, birth rates <27+6 weeks, between weeks 28+0 and 31+6, and between 32+0 and weeks 36+6 were 1.0%, 1.9%, and 4.4%, respectively. After adjustment, these rates were stable between periods 1 and 2 (adjusted odds ratio, aOR 0.90; 95% confidence interval, CI 0.69–1.19) and between periods 2 and 3 (aOR 1.04; 95% CI 0.80–1.36). Although more VLBW neonates were born during lockdown (3.5% vs. 2.6%, p = 0.03), this difference did not persist after adjustment (aOR 0.84, CI 95% 0.64–1.10). The LBW rates were similar during the three periods at 12.5% overall. The stillbirth rate was unaffected by the lockdown. Conclusion: The pregnancy outcomes (preterm birth, LBW, VLBW, and stillbirth rates) were not modified by the COVID-19 lockdown in our cohort study in France. Considering the discrepancies in results and methodological issues in previous published studies, there is not sufficient evidence to conclude that such lockdowns have any impact on perinatal outcomes.
Highlights
Lockdowns have been used by several health authorities to mitigate the effects of the COVID-19 pandemic on public health, which was caused by strains of the SARS-CoV-2 virus [1]
The significant decrease in late preterm infants during the lockdown period could be attributed to lifestyle changes including resting at home, reduced physical activity, less shift work, less work-related stress, optimization of sleep durations, substantial reductions in air pollution, social distancing resulting in fewer infections by common pathogens, and an increased focus on hygiene
It could be associated with a reduction in visits to hospitals or a reluctance to visit the hospital due to the fear of contracting COVID-19. This could result in delayed or deferred interventions in pregnancy. This increase in the incidence of stillbirths remains controversial because other studies in England, Australia and Ireland reported no increased stillbirth rates associated with lockdown [2,5,10]
Summary
Lockdowns have been used by several health authorities to mitigate the effects of the COVID-19 pandemic on public health, which was caused by strains of the SARS-CoV-2 virus [1]. Several publications from Australia, the United States, Italy, Denmark, the Netherlands, Ireland, and England have reported substantial reductions in the preterm birth and/or low birthweight (LBW) rates following national COVID-19 lockdown measures [2,3,4,5,6]. One serious concern possibly associated with lockdown is the significant increase in the incidence of stillborn infants (‘stillbirths’) and neonatal mortality observed by several authors in England, Italy and Nepal [3,8,9] This increase in the stillbirth rate does not seem to be a direct consequence of COVID-19 infection. This increase in the incidence of stillbirths remains controversial because other studies in England, Australia and Ireland reported no increased stillbirth rates associated with lockdown [2,5,10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
