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Health Care System Burden During the COVID-19 Pandemic and Pregnancy Outcomes: A Population-Based Study
Atar Ben Shmuel1, Nikola Rasevic2, Howard Berger3
1Division of Maternal-Fetal Medicine, Dan Women and Babies Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON.
Insights
The COVID-19 pandemic did not increase preterm birth (PTB) rates. However, the first year of the pandemic saw higher risks of gestational diabetes and neonatal complications.
Area of Science:
- Perinatal epidemiology
- Public health
- Infectious disease epidemiology
Background:
- The COVID-19 pandemic presented unprecedented public health challenges.
- Understanding its impact on maternal and infant health is crucial for future preparedness.
- Preterm birth (PTB) and other perinatal outcomes are key indicators of maternal and neonatal well-being.
Purpose of the Study:
- To investigate the association between the COVID-19 pandemic and the incidence of preterm birth (PTB).
- To analyze the pandemic's impact on other significant perinatal outcomes.
- To compare outcomes in the first year of the pandemic with pre-pandemic data.
Main Methods:
- Population-based cohort study utilizing provincial-level data.
- Comparison of births between January 2020-December 2020 (pandemic group) and January 2017-December 2019 (control group).
- Primary outcome: PTB before 37 weeks gestation; Secondary outcomes: Hypertensive disorders, composite neonatal morbidity.
Main Results:
- No significant difference in PTB rates before 37 weeks (7.57% vs. 7.57%) was observed.
- Rates of PTB at earlier gestational ages (34, 32, 28, 26 weeks) also showed no significant differences.
- Increased risks were noted for gestational diabetes (aRR 1.07) and composite neonatal morbidity (aRR 1.06).
Conclusions:
- The initial year of the COVID-19 pandemic was not associated with an increased incidence of preterm birth.
- A higher risk of gestational diabetes and composite neonatal morbidity was identified during the pandemic.
- These findings highlight specific areas of concern for perinatal care during public health crises.
Objectives:
We aimed to explore how the COVID-19 pandemic impacted the incidence of preterm birth (PTB) and other perinatal outcomes.
Methods:
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).
Results:
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).
Conclusions:
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.
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