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Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

2023; Nature Portfolio; Volume: 7; Issue: 4 Linguagem: Inglês

10.1038/s41562-023-01522-y

2397-3374

Clara Calvert, Meredith Brockway, Helga Zoëga, Jessica E. Miller, Jasper V. Been, A. Kofi Amegah, Amy Racine-Poon, Solmaz Eradat Oskoui, Ishaya I. Abok, Nima Aghaeepour, Christie Akwaowo, Belal Alshaikh, Adejumoke Idowu Ayede, Fabiana Bacchini, Behzad Barekatain, Rodrigo Barnes, Karolina Bebak, Anick Bérard, Zulfiqar A Bhutta, Jeffrey R. Brook, Lenroy Bryan, Kim N. Cajachagua‐Torres, Marsha Campbell‐Yeo, Dinh‐Toi Chu, Kristin L. Connor, Luc Cornette, Sandra Cortés, Mandy Daly, Christian Debauche, Iyabode Olabisi Florence Dedeke, Kristjana Einarsdóttir, Hilde Engjom, Guadalupe Estrada‐Gutiérrez, Ilaria Fantasia, Nicole Fiorentino, Meredith Franklin, Abigail Fraser, Onesmus 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 Doaré, Javier Llorca, Laura A. Magee, Maria C. Magnus, Kenneth K. C. Man, Patrick Mburugu, Rishi P. Mediratta, Andrew D. Morris, Nazeem Muhajarine, Rachel Mulholland, Livia Nagy Bonnard, Victoria Nakibuuka, Natasha Nassar, Sylvester Dodzi Nyadanu, Laura Oakley, Adesina Oladokun, Oladapo Olayemi, Olanike Abosede Olutekunbi, Rosena Olubanke Oluwafemi, Taofik Oluwaseun Ogunkunle, Chris Orton, Anne K. Örtqvist, Joseph Ouma, Oyejoke Oyapero, Kirsten R. Palmer, Lars Henning Pedersen, Gavin Pereira, Isabel Pereyra, Roy K. Philip, Dominik Pruski, Marcin Przybylski, Hugo G. Quezada‐Pinedo, Annette K. Regan, Natasha Rhoda, Tonia Rihs, Taylor Riley, Thiago Augusto Hernandes Rocha, Daniel L. Rolnik, Christoph Saner, Francisco J. Schneuer, Vivienne Souter, Olof Stephansson, Shengzhi Sun, Emma Swift, Miklós Szabó, Marleen Temmerman, Lloyd Tooke, Marcelo L. Urquía, Peter von Dadelszen, Gregory A. Wellenius, Clare Whitehead, Ian C. K. Wong, Rachael Wood, Katarzyna Wróblewska‐Seniuk, Kojo Yeboah‐Antwi, Christopher Sabo Yilgwan, Agnieszka Zawiejska, Aziz Sheikh, Natalie Rodriguez, David Burgner, Sarah J. Stock, Meghan B. Azad,

COVID-19 and healthcare impacts

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.