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

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