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COVID-19 and Women’s Health

Evidence from a Diverse Cohort Suggests No Increase in Preterm Births or Stillbirth During the COVID-19 Pandemic

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BACKGROUND AND PURPOSE:

  • Handley et al. (JAMA, 2020) examined a diverse cohort in the US to assess whether preterm birth and stillbirth rates have changed during the COVID-19 pandemic

METHODS:

  • Cohort study
  • Setting
    • Philadelphia, PA during the pandemic (March-June 2020) and pre-pandemic (same months in 2018 and 2019)
  • Data source
    • GeoBirth – curated pregnancy cohort of all births in Penn Medicine Hospitals since 2008
  • Study design

Preterm birth: <37 weeks

  • Spontaneous preterm birth
    • Preterm labor | Spontaneous rupture of membranes
  • Medically indicated preterm birth
    • Clinician-initiated due to a maternal or fetal health condition, such as preeclampsia or FGR

Stillbirth:  Intrauterine fetal demise at ≥20 weeks

  • Absolute risk differences calculated comparing pandemic and pre-pandemic outcomes
    • Risk Factor adjustments: Birth month | Age | Parity | BMI | Race/ethnicity | Marital status | Smoking | Insurance status
    • Stratification: Race/ethnicity to account for persistent preterm birth disparities

RESULTS:

  • 8,867 total singleton live births (2018, 2019, 2020)
    • Maternal race/ethnicity: 42% non-Hispanic Black | 37% non-Hispanic White | 21% other race/ethnicity
  • During the pandemic period there were 2992 deliveries
    • Preterm births: 283
      • Spontaneous: 135
      • Medically indicated: 148
    • Stillbirths: 15
  • Birth outcomes pre-pandemic vs pandemic
    • Preterm births: 10.5% vs 9.5% of total deliveries
      • Adjusted difference −1.1% (95% CI, −2.4% to 0.2%)
    • Spontaneous preterm births: 5.7% vs 4.7% of total deliveries
      • Adjusted difference −0.8% (95% CI, −1.8% to 0.2%)
    • Medically indicated preterm births: 5.7% vs 4.7% of total deliveries
      • Adjusted difference −0.3% (95% CI, −1.4% to 0.6%)
    • Stillbirths: 5.4 per 1000 births vs 5.0 per 1000 births
      • Adjusted difference −0.03 per 1000 births (95% CI, −0.34 to 0.29)
  • Spontaneous preterm birth among non-Hispanic White patients declined during the pandemic
    • 4.5% vs 2.9%: adjusted difference −1.4% (95% CI, −2.8% to −0.1%)
  • There were no significant changes pre-pandemic vs pandemic for other racial/ethnic groups
    • No significant interaction was detected between race/ethnicity and epoch with spontaneous preterm birth (P = 0.09 for interaction)
  • Among the 86 patients who tested positive for SARS-CoV-2 (following initiation of universal testing)
    • Preterm birth rate: 11.6%
      • Spontaneous: 6 births | Medically indicated: 4 births
    • 1 Stillbirth was reported

CONCLUSION:

  • In this racial diverse cohort of pregnant women in Philadelphia, there was no evidence of increased risk for preterm births or stillbirths during the COVID-19 pandemic

Learn More – Primary Sources:

Changes in Preterm Birth Phenotypes and Stillbirth at 2 Philadelphia Hospitals During the SARS-CoV-2 Pandemic, March-June 2020

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Related ObG Topics:

118 Pregnant Women with COVID-19: Treatments and Outcomes
COVID-19 and Risk for Stillbirth and Preterm Birth
Pregnant Women with COVID-19 and ICU Admissions

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