Health Care System Burden During the COVID-19 Pandemic and Pregnancy Outcomes: A Population-Based Study

We aimed to explore how the COVID-19 pandemic impacted the incidence of preterm birth (PTB) and other perinatal outcomes.

This is a population-based cohort study using provincial-level population data. The study population consisted of persons who gave birth in a setting of a single-payer insurer during the period from January 2020 to December 2020. The comparator group included persons who delivered in the same setting between January 2017 and December 2019. The main outcome measured was PTB before 37 weeks gestation. In addition, we analyzed several secondary outcomes, including PTB at different gestational ages, hypertensive disorders in pregnancy, and composite neonatal morbidity (5-minute Apgar score <5, respiratory distress syndrome, or need for mechanical ventilation).

Between January 2020 and December 2020, 116 244 births were documented (study group) and were compared with 363 650 births that occurred between January 2017 and December 2019 (control group). There was no difference in the rate of PTB before 37 weeks (7.57% vs. 7.57%, adjusted relative risk [aRR] 1.00, 95% CI 0.98-1.02), nor were there differences in the rate of PTB before 34, 32, 28, or 26 weeks gestation. The risk for gestational diabetes was slightly higher (9.54% vs. 8.67%, aRR 1.07, 95% CI 1.05-1.10), as was the risk of composite neonatal morbidity (11.65% vs. 10.85%, aRR 1.06, 95% CI 1.04-1.08).

During the first year of the COVID-19 pandemic, the rate of PTB was not higher than in previous years. However, a higher risk of gestational diabetes and composite neonatal morbidity was noted.