Preterm Birth and Perinatal Mortality During the COVID-19 Pandemic Period: A Systematic Review and Meta-Analysis

Preterm birth rates may have been affected during the COVID-19 pandemic but the impact of this on perinatal morbidity is unknown.

To review the impact of the COVID-19 pandemic on rates of preterm birth and perinatal mortality.

Medline, Embase, and online pre-prints were searched from Jan 2020 to Oct 2022. Case-control, cohort studies and reports comparing rates of preterm birth, stillbirth and neonatal death before and during the COVID-19 pandemic period were included. The pooled odds ratio (OR) for preterm birth, stillbirth and neonatal death was calculated using a random effects model. The primary outcome was the rate of preterm birth, stillbirth and neonatal death in the pre-pandemic and pandemic periods.

100 studies were included. Compared with pre-pandemic periods, there was a decrease in preterm births during the pandemic period: OR 0.95 (95% CI 0.94-0.97) I ²  = 0.93, with the greatest reduction for births < 28 weeks' gestation in high-income countries: OR 0.92 (95% CI 0.88-0.96), I ²  = 0.46. There was a reduction in neonatal deaths in high-income countries: OR 0.78 (95% CI 0.64-0.95), I ²  = 0.4. In low- and middle-income countries the stillbirth rate increased during the pandemic compared with the pre-pandemic period: OR 1.18 (95% CI 1.02-1.36), I ²  = 0.86.

The COVID-19 pandemic was associated with a reduction in preterm births and neonatal deaths. Further research is needed to investigate the mechanisms underlying these findings. Stillbirth rates increased in low- and middle-income countries where access to healthcare may have been restricted and strategies to address this in future pandemics are warranted.