Temporal trends in pregnancy outcomes during a health system shock

To better understand reported COVID-19 pandemic effects on pregnancy, we examined temporal trends in pregnancy outcomes in a diverse population from South London, United Kingdom.

We included 31,411 singleton pregnancies with complete registration and birth outcomes across pre-pandemic (May 1, 2019-March 22, 2020, 24.5%), pandemic lockdowns (March 23, 2020-July 17, 2021, 32.3%), and pandemic without lockdown epochs (July 18, 2021-April 22, 2023, 43.2%). Multivariable regression was employed to evaluate outcomes by study epoch, adjusting for potential confounders (e.g., ethnicity, deprivation, site), followed by generalized additive modelling to visualise monthly trends.

Here we show that of 17 outcomes: six have stable trends (e.g., preterm birth, stillbirth); eight show linear trends, either decreasing (e.g., gestational age at birth, vaginal tears) or increasing (e.g., Caesareans, postpartum haemorrhage); and three show quadratic (complex) trends (e.g., secondary mental health services, labour induction).

Overall, most outcomes during the pandemic mirror pre-pandemic trends, with fluctuations observed likely due to site-specific responses. Our findings highlight the need for temporal analysis of pregnancy outcomes.