Policy Responses to the COVID-19 Pandemic in High-Income Countries and the Associated Maternal-Infant Health...

Foreseeing how policy impacts pregnant women and infants is limited by ethical challenges of experimental research within these groups. The COVID-19 pandemic generated natural experiments, offering rare opportunities to explore associations between specific policy responses and maternal-infant health outcomes. These insights are useful for informing policy design aligned with the 2030 Sustainable Development Goals.

To systematically review evidence of associations between COVID-19 policies, OxCGRT Stringency Index (a University of Oxford tool for comparing the stringency of policies) and maternal-infant health outcomes during pregnancy, birth, and the first 12 months postpartum from 2020-2022 in high-income countries.

Following PRISMA guidelines, Embase, MEDLINE, PubMed, and Web of Science were searched (January 1 2020-July 9 2022) using subject headings, keywords, and variants for "COVID-19", "policies", "perinatal", and "randomized", and "non-randomized" study designs. Eligible studies were from high-income countries, published in English, and used comparison groups. Two reviewers independently extracted and analyzed data. Heterogeneity and risk of bias made meta-analysis inappropriate. Outcomes were instead reported using tables and visuals of effect sizes, ratio estimates, and 95% confidence intervals.

Of 3143 citations, 35 studies met inclusion criteria. All reported high OxCGRT Stringency Index during exposure, validating the fidelity of adhering to defined policy exposure periods. Lockdown was associated with reductions in preterm and low birthweight births, infant emergency admissions, and breast feeding women, and increases in hypertensive disorders of pregnancy and gestational diabetes mellitus. Telehealth was associated with earlier gestational age at antenatal visits and less breast feeding women. Maternal mental health and stillbirth results were mixed.

High stringency policies, including lockdowns and telehealth, were associated with both favorable and adverse maternal-infant outcomes. Findings inform avenues for future causal inference research and areas for mitigation planning should high stringency policies be reintroduced, supporting progress towards the 2030 Sustainable Development Goals.