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#Grand Rounds

Are COVID-19 Mitigation Measures Associated with a Reduction in Preterm Births?

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BACKGROUND AND PURPOSE:

  • Been et al. (The Lancet, 2020) examined the impact of the COVID-19 mitigation measures on the incidence of preterm birth

METHODS:

  • Assessed response to mitigations implemented in Netherlands in a stepwise fashion (March 9, March 15, and March 23, 2020)
  • March 9
    • Using paper handkerchiefs | Sneezing or coughing in one’s elbow | Regular handwashing | Advice against handshaking
    • Stay at home when experiencing cold symptoms or fever or in contact with COVID-19-positive person or having visited a high-risk area
  • March 12
    • Events of more than 100 individuals cancelled | Work from home when possible | Stay home if symptomatic (fever, respiratory complaints) | Advice against social interaction and visiting older people
  • March 15
    • School closures and childcare facilities | Closures of hospitality industry and of non-essential services involving physical contact | Physical distancing introduced (1.5 meter rule)
  • March 23
    • All events and gatherings cancelled | No groups of >3 people allowed in public areas (except households and children) | Fines for not complying with physical distancing | Municipalities can close busy places and shops
  • Data sources
    • Neonatal dried blood spot screening program (2010 to 2020)
    • National perinatal registry data
  • Study design
    • Stratified analyses based on gestational age subgroups
    • Researchers assessed potential modifiers
      • Neighborhood socioeconomic status
      • Sex
      • Small-for-gestational-age status

RESULTS:

  • 1,599,547 neonatal records analyzed
    • 56,720 births occurring after implementation of COVID-19 mitigation measures (March 9)
  • There were consistent reductions in the incidence of preterm birth across various time windows surrounding March 9
    • ± 2 months: Odds ratio (OR) 0.77 (95% CI, 0.66 to 0.91); p = 0.0026; n=531,823
    • ± 3 months: OR 0.85 (95% CI, 0.73 to 0.98); p = 0.028; n = 796,531
    • ± 4 months: OR 0.84 (95% CI, 0.73 to 0.97); p = 0.023; n = 1,066,872
  • Incidence of preterm birth experienced a decrease of smaller magnitude following the March 15 measures, but these were not statistically significant
  • No changes were observed after March 23
  • Reductions in the incidence of preterm births after March 9 were
    • Consistent across gestational age strata
    • Confined to neighborhoods of high socioeconomic status, but effect modification was not statistically significant

CONCLUSION:

  • Implementation of initial measures to stop the spread of COVID-19 on March 9 in the Netherlands was associated with a reduction in preterm births in the following months
  • The authors hypothesize the following factors that may account for this reduction
    • Hygiene measures and behavioral changes on the part of pregnant women
    • Less physically demanding work and less shift work and work-related stress due to business closures
    • Reduction in air pollution
    • Changes in obstetric practice or care-seeking behavior

Learn More – Primary Sources:

Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study

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Related ObG Topics:

COVID-19 and Risk for Stillbirth and Preterm Birth
What is the SARS-CoV-2 Transmission Risk Associated with Prenatal Visits?
Can COVID-19 Patients be Co-Infected with Other Respiratory Pathogens?

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