Abstract
Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s). Lockdowns have dramatically impacted maternal workload, access to healthcare, hygiene practices, and air pollution - all of which could impact perinatal outcomes and might affect pregnant women differently in different regions of the world. In the international Perinatal Outcomes in the Pandemic (iPOP) Study, we will seize the unique opportunity offered by the COVID-19 pandemic to answer urgent questions about perinatal health. In the first two study phases, we will use population-based aggregate data and standardized outcome definitions to: 1) Determine rates of preterm birth, low birth weight, and stillbirth and describe changes during lockdowns; and assess if these changes are consistent globally, or differ by region and income setting, 2) Determine if the magnitude of changes in adverse perinatal outcomes during lockdown are modified by regional differences in COVID-19 infection rates, lockdown stringency, adherence to lockdown measures, air quality, or other social and economic markers, obtained from publicly available datasets. We will undertake an interrupted time series analysis covering births from January 2015 through July 2020. The iPOP Study will involve at least 121 researchers in 37 countries, including obstetricians, neonatologists, epidemiologists, public health researchers, environmental scientists, and policymakers. We will leverage the most disruptive and widespread "natural experiment" of our lifetime to make rapid discoveries about preterm birth. Whether the COVID-19 pandemic is worsening or unexpectedly improving perinatal outcomes, our research will provide critical new information to shape prenatal care strategies throughout (and well beyond) the pandemic.
Highlights
The COVID-19 pandemic and response measures taken to mitigate the spread of infection have dramatically impacted health and health systems across the globe
The iPOP Study will leverage the natural experiment arising from the COVID-19 pandemic, to understand possible mechanisms of adverse perinatal outcomes and inform interventions and policy
IPOP will investigate the effects of pandemic lockdowns by country income setting, incorporating data from low-income countries (LICs) to high-income countries (HICs) across the globe on key perinatal outcomes
Summary
The COVID-19 pandemic and response measures taken to mitigate the spread of infection have dramatically impacted health and health systems across the globe. The pandemic mitigation measures have substantially impacted maternal workload[11], access to healthcare[12], hygiene practices[13], air pollution[14], nutrition[15,16,17], and non-SARS-CoV-2 infection[18], each of which may have affected maternal and perinatal outcomes disproportionately in different socio-economic and regional settings. To address the impact of the pandemic response measures on perinatal health, the international Perinatal Outcomes in the Pandemic (iPOP) study, is working in partnership with the International COVID-19 Data Alliance (ICODA, supported by the COVID-19 Therapeutics Accelerator) to establish an inclusive international research programme that will collaborate to focus on key questions relevant to countries across the globe of all income levels. The initial focus of iPOP will be on the impact of COVID‐19 pandemic lockdowns on perinatal outcomes, including preterm birth, low birth weight, and stillbirth
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