Are COVID-19 Mitigation Measures Associated with a Reduction in Preterm Births?
BACKGROUND AND PURPOSE:
Been et al. (The Lancet, 2020) examined the impact of the COVID-19 mitigation measures on the incidence of preterm birth
Assessed response to mitigations implemented in Netherlands in a stepwise fashion (March 9, March 15, and March 23, 2020)
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
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
School closures and childcare facilities | Closures of hospitality industry and of non-essential services involving physical contact | Physical distancing introduced (1.5 meter rule)
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
Neonatal dried blood spot screening program (2010 to 2020)
National perinatal registry data
Stratified analyses based on gestational age subgroups
Researchers assessed potential modifiers
Neighborhood socioeconomic status
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
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
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