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Perinatal Health and Healthcare Utilisation During the COVID-19 Pandemic: A Nationwide Interrupted Time Series
Deborah Karasek1, Daniel F Collin2, Rita Hamad2
1School of Public Health at Oregon Health & Science University and Portland State University, Portland, Oregon, USA.
Insights
The COVID-19 pandemic negatively impacted perinatal health, leading to delayed prenatal care and increased gestational diabetes. Disparities in care and outcomes were observed across racial and ethnic groups, highlighting long-term public health concerns.
Area of Science:
- Perinatal Health
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly affected perinatal health due to socioeconomic factors and public health measures.
- Limited research has explored pandemic-related changes and disparities in perinatal health using robust, population-based data.
Purpose of the Study:
- To investigate changes in perinatal health and healthcare utilization during the COVID-19 pandemic.
- To identify potential disparities in these changes among different demographic groups.
Main Methods:
- Utilized population-based data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (N=116,170).
- Employed a Bayesian structural time-series analysis to detect deviations from predicted trends post-March 2020.
- Adjusted for relevant covariates in the analysis.
Main Results:
- Pandemic onset correlated with delayed prenatal care initiation, reduced overall prenatal care, and fewer postpartum visits.
- Significant increases observed in gestational hypertension, gestational diabetes mellitus (GDM), and prenatal depression.
- Racial and ethnic disparities emerged, with Black participants showing earlier initiation, Native American participants experiencing worse outcomes, Asian/Pacific Islander participants facing delayed care and increased depression, and Hispanic participants showing higher gestational weight gain and reduced postpartum visits.
Conclusions:
- The COVID-19 pandemic has had a substantial impact on perinatal health, with potential long-term consequences for maternal and infant well-being.
- Observed disparities underscore the need for targeted interventions and further research into pandemic-related policy impacts on diverse populations.
Background:
Perinatal health was profoundly affected as a result of the socioeconomic hardships and public health measures during the COVID-19 pandemic. Few studies have evaluated changes and disparities in perinatal health using population-based data and rigorous methods.
Objective:
To examine changes related to the COVID-19 pandemic in perinatal health and healthcare utilisation.
Methods:
Using population-based data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (N = 116,170), we employed a Bayesian structural time-series approach to examine deviations in perinatal health and healthcare utilisation outcomes from predicted trends following the onset of the COVID-19 pandemic in March 2020, adjusting for covariates.
Results:
The onset of the COVID-19 pandemic was associated with delayed prenatal care initiation (1.1%, 95% confidence interval [CI] 0.2, 2.0), reduced prenatal care (-2.8%, 95% CI -3.6, -1.7), reduced postpartum visits (-1.0%, 95% CI -1.5, -0.4), and increased gestational hypertension (11.1%, 95% CI 5.4, 16.7), gestational diabetes mellitus (GDM), (17.6%, 95% CI 10.1, 26.2), and prenatal depression (7.3%, 95% CI 1.9, 13.0). Stratified models showed that Black participants experienced earlier prenatal care initiation; Native American participants experienced lower prenatal care visits and greater increases in gestational hypertension and GDM; Asian/Pacific Islander participants experienced delayed prenatal care initiation and heightened prenatal depression and postnatal depressive symptoms; and Hispanic participants experienced higher GWG and reduced postpartum visits.
Conclusions:
As perinatal health imparts enduring impacts for pregnant people and infants, this study provides insight into the pandemic's potentially long-lasting population health effects. Future work should examine longer-term trends and how pandemic-related policies contributed to disparate impacts.
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