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COVID-19 and Women’s Health

COVID-19 and Risk for Stillbirth and Preterm Birth

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PURPOSE:

  • Khalil et al. (JAMA, 2020) analyzed the association between COVID-19 and risk for stillbirth and preterm delivery        

METHODS:

  • Retrospective cohort study
    • St George’s University Hospital, London (UK)
  • Compared 2 time periods
    • Prepandemic: October 1, 2019, to January 31, 2020
    • Pandemic (following first reported cases in UK of COVID-19): February 1, 2020, to June 14, 2020
  • Outcomes
    • Stillbirth | Preterm birth | Cesarean delivery | NICU admission
    • Repeat analysis performed with exclusion of terminations for fetal anomalies (IN UK, stillbirth includes late termination ≥24 weeks)

RESULTS:

  • Prepandemic
    • 1681 births | 1631 singletons | 22 twins | 2 triplets
  • Pandemic period
    • 1718 births: 1666 singleton | 26 twins
  • Nulliparity was less common during the pandemic period (P < .001)
    • Prepandemic: 52.2%
    • Pandemic: 45.6%
  • Fewer pregnancies were complicated by hypertension during the pandemic period (P = .005)
    • Prepandemic: 5.7%
    • Pandemic period: 3.7%
  • Stillbirth incidence was increased during the pandemic period
    • Prepandemic: 2.38 per 1000 births (n=4)
    • Pandemic: 9.31 per 1000 births (n=16)
    • Difference: 6.93 per 1000 births (95% CI, 1.83-12.0; P = .01)
  • Stillbirth incidence remained elevated after exclusion of terminations for anomalies
    • Prepandemic: 1.19 per 1000 births
    • Pandemic: 6.98 per 1000 births
    • Difference: 5.79 (95% CI, 1.54-10.1; P = .01)
  • There were no significant differences identified for the following outcomes
    • Preterm deliveries (<37 weeks)
    • NICU admission
  • No cases of stillbirth were associated with COVID-19
    • None of the mothers had symptoms associated with COVID-19
    • No placental or postmortem exams suggested of COVID-19
    • Note: Universal testing for SARS-CoV-2 only began May 28, 2020

CONCLUSION:

  • Stillbirth rates were increased during the pandemic vs prepandemic period
    • One important limitation noted by authors is lack of data on cause of the stillbirth
  • Possible reasons for increase in stillbirth rate
    • Increase may still be due to SARS-CoV-2 infection in asymptomatic women (who would not have been tested)
    • Women may have deferred care due to COVID-19 concerns (e.g. delaying care to avoid infection)
    • Possible change in practice resulting in fewer antenatal visits or ultrasound assessments
    • Chance: Study time frame was short | If study was longer, difference perhaps would resolve
    • Hospital may have received more referrals 

Learn More – Primary Sources:

Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic

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Related ObG Topics:

Coronavirus and Pregnancy: CDC Guidance and Professional Recommendations
Vertical Transmission in Pregnancies with Confirmed COVID-19
The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital
CDC Reports on Pregnancy and COVID-19 Outcomes

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