Abstract
The influence of the COVID-19 pandemic on fertility rates has been suggested in the lay press and anticipated based on documented decreases in fertility and pregnancy rates during previous major societal and economic shifts. Anticipatory planning for birth rates is important for health care systems and government agencies to accurately estimate size of economy and model working and/or aging populations. To use projection modeling based on electronic health care records in a large US university medical center to estimate changes in pregnancy and birth rates prior to and after the COVID-19 pandemic societal lockdowns. This cohort study included all pregnancy episodes within a single US academic health care system retrospectively from 2017 and modeled prospectively to 2021. Data were analyzed September 2021. Pre- and post-COVID-19 pandemic societal shutdown measures. The primary outcome was number of new pregnancy episodes initiated within the health care system and use of those episodes to project birth volumes. Interrupted time series analysis was used to assess the degree to which COVID-19 societal changes may have factored into pregnancy episode volume. Potential reasons for the changes in volumes were compared with historical pregnancy volumes, including delays in starting prenatal care, interruptions in reproductive endocrinology and infertility services, and preterm birth rates. This cohort study documented a steadily increasing number of pregnancy episodes over the study period, from 4100 pregnancies in 2017 to 4620 in 2020 (28 284 total pregnancies; median maternal [interquartile range] age, 30 [27-34] years; 18 728 [66.2%] White women, 3794 [13.4%] Black women; 2177 [7.7%] Asian women). A 14% reduction in pregnancy episode initiation was observed after the societal shutdown of the COVID-19 pandemic (risk ratio, 0.86; 95% CI, 0.79-0.92; P < .001). This decrease appeared to be due to a decrease in conceptions that followed the March 15 mandated COVID-19 pandemic societal shutdown. Prospective modeling of pregnancies currently suggests that a birth volume surge can be anticipated in summer 2021. This cohort study using electronic medical record surveillance found an initial decline in births associated with the COVID-19 pandemic societal changes and an anticipated increase in birth volume. Future studies can further explore how pregnancy episode volume changes can be monitored and birth rates projected in real-time during major societal events.
Highlights
The COVID-19 pandemic and associated societal measures to control the spread of the virus have brought about significant changes in almost every aspect of life in the US and globally
This cohort study using electronic medical record surveillance found an initial decline in births associated with the COVID-19 pandemic societal changes and an anticipated increase in birth volume
In this cohort study of pregnancies within a large US university health care system, a model using electronic medical records projected an initial decline in births associated with the COVID-19 pandemic societal shutdown, predominantly related to fewer conceptions following the societal changes instituted to control COVID-19 spread. This decline was followed by a projected birth volume surge anticipated to occur in summer 2021. Meaning These findings suggest that electronic medical records can be used to model and project birth volume changes and demonstrate that the COVID-19 pandemic societal changes are associated with reproductive choices
Summary
The COVID-19 pandemic and associated societal measures to control the spread of the virus have brought about significant changes in almost every aspect of life in the US and globally. The economic and societal effects of the pandemic are vast, with consequences for large systems such as health care and education, and for individuals and families. Previous large societal disruptions in the US, such as the 1918 H1N1 Influenza pandemic, Great Depression (1929), and Great Recession (2008) have influenced population growth and fertility rates, but the exact effects of COVID-19 on fertility and birth rates are speculative to date. A 2020 Guttmacher Institute study demonstrated that 40% of women reported changes in plans for childbearing due to the COVID-19 pandemic, 41% of women with children reported worry about being able to take care of their children, and 33% of women had to delay or cancel an appointment for reproductive health or contraception care. The COVID-19 pandemic has highlighted longstanding economic and health disparities in the US, yet how such disparities will influence fertility rates and obstetric complications are unknown at this time
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