Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries
Year: 2023
Type: article
Abstract: Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
Source: Nature Human Behaviour
Authors: Clara Calvert, Meredith Brockway, Helga Zoega, Jessica E. Miller, Jasper V. Been, Adeladza Kofi Amegah, Amy Racine-Poon, Solmaz Eradat Oskoui, Ishaya I. Abok, Nima Aghaeepour, Christie D. Akwaowo, Belal N. Alshaikh, Adejumoke I. Ayede, Fabiana Bacchini, Behzad Barekatain, Rodrigo Barnes, Karolina Bebak, Anick Berard, Zulfiqar A. Bhutta, Jeffrey R. Brook, Lenroy R. Bryan, Kim N. Cajachagua-Torres, Marsha Campbell-Yeo, Dinh-Toi Chu, Kristin L. Connor, Luc Cornette, Sandra Cortés, Mandy Daly, Christian Debauche, Iyabode Olabisi F. Dedeke, Kristjana Einarsdóttir, Hilde Engjom, Guadalupe Estrada-Gutierrez, Ilaria Fantasia, Nicole M. Fiorentino, Meredith Franklin, Abigail Fraser, Onesmus W. Gachuno, Linda A. Gallo, Mika Gissler, Siri E. Håberg, Abbas Habibelahi, Jonas Häggström, Lauren Hookham, Lisa Hui, Luis Huicho, Karen J. Hunter, Sayeeda Huq, Ashish KC, Seilesh Kadambari, Roya Kelishadi, Narjes Khalili, Joanna Kippen, Kirsty Le Doare, Javier Llorca, Laura A. Magee, Maria C. Magnus, Kenneth K. C. Man, Patrick M. Mburugu, Rishi P. Mediratta, Andrew D. Morris, Nazeem Muhajarine, Rachel H. Mulholland, Livia Nagy Bonnard, Victoria Nakibuuka, Natasha Nassar, Sylvester D. Nyadanu, Laura Oakley, Adesina Oladokun, Oladapo O. Olayemi, Olanike A. Olutekunbi, Rosena O. Oluwafemi, Taofik O. Ogunkunle, Chris Orton, Anne K. Örtqvist, Joseph Ouma, Oyejoke Oyapero, Kirsten R. Palmer, Lars H. Pedersen, Gavin Pereira, Isabel Pereyra, Roy K. Philip, Dominik Pruski, Marcin Przybylski, Hugo G. Quezada-Pinedo, Annette K. Regan, Natasha R. Rhoda, Tonia A. Rihs, Taylor Riley, Thiago Augusto Hernandes Rocha, Daniel L. Rolnik, Christoph Saner, Francisco J. Schneuer, Vivienne L. Souter, Olof Stephansson, Shengzhi Sun, Emma M. Swift, Miklós Szabó, Marleen Temmerman, Lloyd Tooke, Marcelo L. Urquia, Peter von Dadelszen, Gregory A. Wellenius, Clare Whitehead, Ian C. K. Wong, Rachael Wood, Katarzyna Wróblewska-Seniuk, Kojo Yeboah-Antwi, Christopher S. Yilgwan, Agnieszka Zawiejska, Aziz Sheikh, Natalie Rodriguez, David Burgner, Sarah J. Stock, Meghan B. Azad
Institutions: University of Edinburgh, University of Toronto, Children's Hospital Research Institute of Manitoba, University of Manitoba, University of Iceland, UNSW Sydney, Royal Children's Hospital, The University of Melbourne, Murdoch Children's Research Institute, Erasmus MC, Erasmus MC - Sophia Children’s Hospital, University of Cape Coast, Novartis (Switzerland), University of Jos, Jos University Teaching Hospital, Stanford Medicine, Stanford University, University of Uyo, University of Uyo Teaching Hospital, University of Calgary, University of Ibadan, University College Hospital, Ibadan, Isfahan University of Medical Sciences, Aridhia (United Kingdom), Lyon 1 Université, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Aga Khan University, Hospital for Sick Children, Universidad Peruana Cayetano Heredia, Dalhousie University, Vietnam National University, Hanoi, VNU International School, Carleton University, AZ Sint-Jan, Advanced Center for Chronic Diseases, Cliniques Universitaires Saint-Luc, UCLouvain, Federal Medical Centre, Curtin University, Norwegian Institute of Public Health, Instituto Nacional de Perinatología, IRCCS Materno Infantile Burlo Garofolo, University of Bristol, University of Nairobi, The University of Queensland, Region Stockholm, Karolinska Institutet, Finnish Institute for Health and Welfare, Stockholm Health Care Services, Ministry of Health and Medical Education, Cytel (United States), MUJHU Research Collaboration, International Centre for Diarrhoeal Disease Research, Uppsala University, University of Oxford, NIHR Oxford Biomedical Research Centre, Iran University of Medical Sciences, St George's, University of London, MRC/UVRI & LSHTM Uganda Research Unit, Medical Research Council, Uganda Virus Research Institute, Universidad de Cantabria, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, King's College London, Laboratory of Data Discovery for Health, UCL School of Pharmacy, University College London, University of Hong Kong, Jomo Kenyatta University of Agriculture and Technology, Health Data Research UK, University of Saskatchewan, Nsambya Hospital, The University of Sydney, Children's Hospital at Westmead, London School of Hygiene & Tropical Medicine, Swansea University, Visby lasarett, Region Gotland, Monash University, Aarhus University, Aarhus University Hospital, Catholic University of the Maule, University of Limerick, University Maternity Hospital Limerick, University of San Francisco, Western Cape Department of Health, University of Cape Town, Federal Statistical Office, University of Washington, World Health Organization Regional Office for the Americas, University of Bern, University Hospital of Bern, Foundation for Health Care Quality, Boston University, Semmelweis University, Aga Khan University Nairobi, Royal Women's Hospital, Public Health Scotland, Poznan University of Medical Sciences
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $11,690
Funders: Bill and Melinda Gates Foundation, World Health Organization, Canadian Institute for Advanced Research, Wellcome Trust, Public Health Agency of Canada, Scottish Government, Government of the United Kingdom, Natera, British Heart Foundation, Department of Health and Social Care, European Commission, Public Health Agency, University of New South Wales, Semmelweis Egyetem, Innovation and Technology Commission, Karolinska Institutet, NordForsk, Pontificia Universidad Católica de Chile, National Institutes of Health, Chief Scientist Office, Scottish Government Health and Social Care Directorate, Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, National Health and Medical Research Council, Health and Social Care Research and Development Division, National Institute of General Medical Sciences, European and Developing Countries Clinical Trials Partnership
Awards: G1007510808, G2975900969, G339059223, G434337789, G4899798142, G5002805933, Scandinavian studies of COVID-19 in Pregnancy (SCOPE), G5514976981, Studies of COvid-19 in PrEgnancy - A framework to secure reproductive, maternal and child health during societal crises (SCOPE 2), Administrative Data Research Centres 2018, G6122222817, Administrative Data Research Centre Wales (Part of ADR UK), Medicines in pregnancy: predicting harms and benefits of antenatal corticosteroids, Medicines in pregnancy: predicting harms and benefits of antenatal corticosteroids, G8415457339, G885813400, G9000023826, G9000040228, G9000116783
OpenAlex ID: W4322492440