Indirect effects of the Covid-19 pandemic on pregnancy
Primary sources
Ripe-tomato.org has been collecting primary scientific (click here) & newspaper reports (click here) of Covid-19 or SARS-CoV-2 infection in pregnancy since early in the pandemic (click here for our Covid-19 in pregnancy navigation page).
Here we (Jim Thornton, Keelin O’Donoghue and Kate Walker) collect primary scientific reports of the indirect effects of the pandemic on pregnancy. As usual facts but no comments. For convenience we list papers in roughly reverse order, newest first. We will update regularly.
Update 6 June – paper 75 added
Paper 75 – increased thromboembolism during lockdown in Israel
In 2020 the rate of pregnancy-related thromboembolic events was significantly higher than in 2018 and 2019 at the Mount Scopus and Ein Kerem campuses of Hadassah-Hebrew University Medical Center in jerusalem (click here or paper). Citation: Gabrieli D, Cahen-Peretz A, Shimonovitz T, Marks-Garber K, Amsalem H, Kalish Y, Lavy Y, Walfisch A. Thromboembolic events in pregnant and puerperal women after COVID-19 lockdowns: A retrospective cohort study. Int J Gynaecol Obstet. 2021 Jun 2. doi: 10.1002/ijgo.13777. Epub ahead of print. PMID: 34077561.
Update 3 June – paper 74 added
Paper 74 – Reduced prematurity in France
Preamature births fell in single but not in multiple pregnancies (click here or paper). There was no alteration in stillbirths. Citation: Simon E, Cottenet J, Mariet A-S, Bechraoui-Quantin S, Rozenberg P, Gouyon J-B, Quantin C, Impact of the COVID-19 pandemic on preterm birth and stillbirth: a nationwide, population-based retrospective cohort study, American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2021.05.015.
Update 29 May – paper 73 added
Paper 73 – emergency dept avoidance but no adverse effects in Canada
In Ontario, after an initial reduction, ED presentations for ectopic pregnancy quickly returned to expected levels. In contrast presentations for miscarriage showed sustained reductions but complications and mortality rates did not alter during the pandemic (click here or paper). Citation: Gomez D, Simpson AN, Sue-Chue-Lam C, de Mestral C, Dossa F, Nantais J, Wilton AS, Urbach D, Austin PC, Baxter NN. A population-based analysis of the impact of the COVID-19 pandemic on common abdominal and gynecological emergency department visits. CMAJ. 2021 May 25;193(21):E753-E760. doi: 10.1503/cmaj.202821. PMID: 34035055.
Update 27 May – paper 72 added
Paper 72 – the first wave in Ethiopia
Government health facilities in Bench Sheko, Sheka, Keffa, and West Omo zones in southern Ethiopia reported reduced antenatal, family planning and newborn immunization visits, and health facility births, and more teenage pregnancies, abortions, institutional stillbirths and neonatal deaths during March–June 2020 (click here or paper). Citation: Kassie A, Wale A, Yismaw W. Impact of Coronavirus Diseases-2019 (COVID-19) on Utilization and Outcome of Reproductive, Maternal, and Newborn Health Services at Governmental Health Facilities in South West Ethiopia, 2020: Comparative Cross-Sectional Study. Int J Womens Health. 2021 May 19;13:479-488. doi: 10.2147/IJWH.S309096. PMID: 34040456; PMCID: PMC8141395.
Update 17 May – papers 70 and 71 added
Paper 71 – more ruptured ectopic pregnancies in USA
From Newark, Delaware (click here or paper). Citation: Toma, Helen V. MD, MSPH; Bank, Tracy Caroline MD; Hoffman, Matthew K. MD, MPH Care for Women With Ectopic Pregnancies During the Coronavirus Disease 2019 (COVID-19) Pandemic, Obstetrics & Gynecology: May 06, 2021 – Volume Latest Articles – Issue – 10.1097/AOG.0000000000004392 doi: 10.1097/AOG.0000000000004392
Paper 70 – no change in preterm birth or stillbirth during first 6 months of pandemic
From Ontario, Canada (click here or paper). Citation: Simpson AN, Snelgrove JW, Sutradhar R, Everett K, Liu N, Baxter NN. Perinatal Outcomes During the COVID-19 Pandemic in Ontario, Canada. JAMA Netw Open. 2021;4(5):e2110104. doi:10.1001/jamanetworkopen.2021.10104
Update 16 May – paper 69 added
Paper 69 – More Caesareans in Brazil
From Dr. Miguel Riet Corrêa Jr., University Hospital of the Universidade Federal do Rio Grande (HU-FURG), in the state of Rio Grande do Sul (click here or paper). Citation: Manoela de Azevedo Bicho, Mayra Pacheco Fernandes, Luís Paulo Vidaletti, Juliana dos Santos Vaz. Cesarean section prevalence at a baby-friendly hospital in southern Brazil: current context in the face of COVID-19. medRxiv 2021.05.03.21256516; doi: https://doi.org/10.1101/2021.05.03.21256516
Update 15 May – paper 68 added
Paper 68 – fewer very preterm births during lockdown in Vienna
From the Viennese Danube Hospital (click here or study). Citation: Kirchengast S, Hartmann B. Pregnancy Outcome during the First COVID 19 Lockdown in Vienna, Austria. Int J Environ Res Public Health. 2021 Apr 5;18(7):3782. doi: 10.3390/ijerph18073782. PMID: 33916365; PMCID: PMC8038559.
Update 1 May – paper 67 added
Paper 67 – fewer antenatal attendances in Uganda
The authors of this MedRxiv preprint report many changes in maternity care and outcomes during the first wave at Kawempe National Referral Hospital in Kamapala (click here or paper). Citation: Jessica Burt, Joseph Ouma, Alexander Amone, Lorna Aol, Musa Sekikubo, Annettee Nakimuli, Eve Nakabembe, Robert Mboizi, Philippa Musoke, Mary Kyohere, Emily Namara, Asma Khalil, Kirsty Le Doare. Indirect Effects of COVID-19 on Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda medRxiv 2021.04.23.21255940; doi: https://doi.org/10.1101/2021.04.23.21255940
Update 21 April – Paper 66 added
Paper 66 – increase in molar pregnancy in Israel
A doubling in the incidence of molar pregnancies at Galilee Medical Center, Nahariya, in January–October, 2020 (click here or paper). Citation: Aiob A, Naskovica K, Sharon A, Bornstein J. A possible association between hydatidiform mole and the COVID-19 pandemic: A retrospective cohort study. Gynecol Oncol. 2021 Mar 5:S0090-8258(21)00192-X. doi: 10.1016/j.ygyno.2021.02.035. Epub ahead of print. PMID: 33712273; PMCID: PMC7934616.
Update 11 April – papers 64 and 65 added
Paper 65 – fewer births and terminations in Italy
From the Institute for Maternal and Child Health, Trieste (click here or paper). Citation: Trombetta A, Travan L, Elefante P, Canton M, Rispoli F, Maso G, Barbi E, Risso FM. The first Italian COVID-19 lockdown reduced births and voluntary terminations by just under a fifth. Acta Paediatr. 2021 Mar 29. doi: 10.1111/apa.15862. Epub ahead of print. PMID: 33780031.
Paper 64 – reduced preterm birth rate in Saudi Arabia
From King Saud Medical City, Riyadh (click here or paper). Citation: Huseynova R, Bin Mahmoud L, Abdelrahim A, Al Hemaid M, Almuhaini MS, Jaganathan PP, Career H, Huseynov O. Prevalence of Preterm Birth Rate During COVID-19 Lockdown in a Tertiary Care Hospital, Riyadh. Cureus. 2021 Mar 1;13(3):e13634. doi: 10.7759/cureus.13634. PMID: 33816033; PMCID: PMC8011548.
Update 30 March – paper 63 added
Paper 63 – national changes in US
This MedRxiv preprint reports a fall in live births, preterm births and low birth weight babies in the United States during the pandemic (click here or paper). Citation: Alison Gemmill, Joan A. Casey, Ralph Catalano, Deborah Karasek, Tim Bruckner. Changes in live births, preterm birth, low birth weight, and cesarean deliveries in the United States during the SARS-CoV-2 pandemic. medRxiv 2021.03.20.21253990; doi: https://doi.org/10.1101/2021.03.20.21253990
Update 21 March – papers 61 and 62 added
Paper 62 – fewer OBGYN emergency hospital visits during first wave
Data from Kaiser Permanente Northern California, Oakland (click here or ). Citation: Abel, Mary Kathryn AB; Alavi, Mubarika X. MS; Tierney, Cassidy MD; Weintraub, Miranda Ritterman PhD, MPH; Avins, Andrew MD, MPH; Zaritsky, Eve MD Coronavirus Disease 2019 (COVID-19) and the Incidence of Obstetric and Gynecologic Emergency Department Visits in an Integrated Health Care System, Obstetrics & Gynecology: March 10, 2021 – Volume Latest Articles – Issue – 10.1097/AOG.0000000000004331 doi: 10.1097/AOG.0000000000004331
Paper 61 – more abortion referrals and procedures during first wave.
From author affiliations the unnamed Northern California tertiary referral center may have been Dept. OBGYN, University of California, Davis, in Sacramento (click here or PgwZqt-PIIS0002937821001587). Citation: Creinin MD, Tougas H, Wilson M, Matulich MC, COVID-19 impact on abortion care at a Northern California tertiary family planning program American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2021.03.007.
Update 20 March – paper 60 added
Paper 60 – no change in ethnic disparities in preterm birth in New York
Women who delivered from March 28 to July 31, 2020, in New York City, were compared with women who delivered from March 28 to July 31, 2019 (click here or janevic_2021_oi_210084_1615398911.43761). Citation: Janevic T, Glazer KB, Vieira L, Weber E, Stone J, Stern T, Bianco A, Wagner B, Dolan SM, Howell EA. Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic. JAMA Netw Open. 2021 Mar 1;4(3):e211816. doi: 10.1001/jamanetworkopen.2021.1816. PMID: 33729505.
Update 3rd March – papers 58 and 59 added. Additional data & citation paper 10. Paper 15 (abstract) and paper 22 (full paper) noted to report the same data.
Paper 59 – no change in preterm births in Massachussetts
Preterm birth rates, defined in various ways, did not alter significantyl in four Boston hospitals during the pandemic, compared with the previous year (click here or Preterm_Birth_During_the_Coronavirus_Disease_2019.2). Citation: Wood, Rachel MD; Sinnott, Colleen MD; Goldfarb, Ilona MD; Clapp, Mark MD, MPH; McElrath, Thomas MD, PhD; Little, Sarah MD, MPH Preterm Birth During the Coronavirus Disease 2019 (COVID-19) Pandemic in a Large Hospital System in the United States, Obstetrics & Gynecology: March 2021 – Volume 137 – Issue 3 – p 403-404. doi: 10.1097/AOG.0000000000004237
Paper 58 – Increased stillbirths in India
Stillbirths were significantly increased during the pandemic in a large New Delhi hospital compared with the previous year (click here or ijgo.13564). Citation: Kumar, M., Puri, M., Yadav, R., Biswas, R., Singh, M., Chaudhary, V., Jaiswal, N. and Meena, D. (2021), Stillbirths and the COVID‐19 pandemic: Looking beyond SARS‐CoV‐2 infection. Int J Gynecol Obstet. https://doi.org/10.1002/ijgo.13564
Update 27 February – Papers 56 and 57 added
Paper 57 – Slightly fewer preterm births in Pittsburg
At University of Pittsburgh Medical Centres, Magee-Womens Hospital, births <37 weeks fell from 11.1% (1 Jan 2018 to 31 Jan 2020 pre-pandemic) to 10.1% (1 April 2020 to 27 October 2020 pandemic) (click here or 1-s2.0-S2589933321000252-main). Citation: Lara Lemon, Robert P. Edwards, Hyagriv N. Simhan. What is driving the decreased incidence of preterm birth during the COVID-19 pandemic? American Journal of Obstetrics & Gynecology MFM (2021), doi: https://doi.org/10.1016/j.ajogmf.2021.100330
Paper 56 – Effect of lockdown in Beijing, China
No major effects seen (click here or e047900.full). Citation: Du M, Yang J, Han N, et alAssociation between the COVID-19 pandemic and the risk for adverse pregnancy outcomes: a cohort studyBMJ Open 2021;11:e047900. doi: 10.1136/bmjopen-2020-047900
Update 25 February – paper 55 added
Paper 55 – HSIB first wave maternal death report
The UK Healthcare Safety Investigation Branch (HSIB) reviewed 20 maternal deaths (19 included in review) that occurred between 1 March and and 31 May 2020 (the first peak of the COVID-19 pandemic in England) (click here or HSIB_Maternal_Death_Report_V13). Citation: National Learning Report. Maternal death: learning from maternal death investigations during the first wave of the COVID-19 pandemic. Independent report by the Healthcare Safety Investigation Branch I2020/017. February 2021.
Update 21 February – paper 54 added
Paper 54 – Delayed diagnosis of ectopic pregnancy in Israel
From Shaare Zedek Medical Center, Jerusalem (click here or ijgo.13647). Citation: Barg M, Rotem R, Mor P, Rottenstreich M, Fayez K, Grisaru-Granovsky S, Armon S. Delayed presentation of ectopic pregnancy during the COVID-19 pandemic: A retrospective study of a collateral effect. Int J Gynaecol Obstet. 2021 Feb 18. doi: 10.1002/ijgo.13647. Epub ahead of print. PMID: 33599285.
Update 13 February – paper 53 added
Paper 53 – no effect of pandemic on assisted reproduction outcomes in Italy
From Lombardy (click here or LeviSetti preprint 2021). Citation: Paolo Emanuele Levi-Setti, Federico Cirillo, Valentina Immediata et al. First Trimester Pregnancy Outcomes in a Large ART Center From the Lombardy County (Italy) During the Peak COVID-19 Pandemic., 08 February 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-152522/v1]
Update 1 February – paper 52 added
Paper 52 – first wave hospital births in Israel
Poster presented at the Society of Materno-Fetal Medicine 2021 conference (SMFM 2021) 
. Fewer hospital births, and higher induction and Caesarean rates during the first wave at Shaare Zedek Medical Center in Jerusalem. Citation to follow.
Update 13 January – paper 51 added
Paper 51 – no association with preterm birth or stillbirth in Sweden
In this national registry study there was no increase in preterm births, or in stillbirths, over the period 1 April through 31 May 2020, compared with the same period over the previous five years (click here or m20-6367). Citation: Pasternak B, Neovius M, Söderling J, Ahlberg M, Norman M, Ludvigsson JF, Stephansson O. Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study. Ann Intern Med. 2021 Jan 12. doi: 10.7326/M20-6367. Epub ahead of print. PMID: 33428442.
Update 9 January – paper 50 added
Paper 50 – fewer & later pregnancy terminations in Texas
The effect of an executive order between March 22 and April 21, to postpone surgery that was not medically necessary, and which was interpreted by some as including abortion, is described (click here or jama_white_2021_ld_200123_1609269106.91809). Citation: White K, Kumar B, Goyal V, Wallace R, Roberts SCM, Grossman D. Changes in Abortion in Texas Following an Executive Order Ban During the Coronavirus Pandemic. JAMA. Published online January 04, 2021. doi:10.1001/jama.2020.24096
Update 2 January – paper 49 added
Paper 49 – more ruptured ectopics during first wave
The ratio of ruptured to unruptured ectopic pregnancies rose between March 15th and May 17th 2020 at Lenox Hill Hospital, New York (click here or ijcp.13925). Citation: Werner, S, Katz, A. Change in ectopic pregnancy presentations during the covid‐19 pandemic. Int J Clin Pract. 2020; 00:e13925. https://doi.org/10.1111/ijcp.13925
Update 23 December – Paper 48 added
Paper 48 – No major adverse effect of lockdown in Botswana
No increase in adverse perinatal outcomes during or after lockdown in Botswana. Rather, a modest reduction, driven primarily by reduced preterm birth and growth restriction (click here or caniglia AJOG 2020 (002)). Time period of lockdown validated against Facebook geolocation data. Citation: CANIGLIA EC, MAGOSI LE, ZASH R, DISEKO M, MAYONDI G, MABUTA J, POWIS K, DRYDEN-PETERSON S, MOSEPELE M, LUCKETT R, MAKHEMA J, MMALANE M, LOCKMAN S, SHAPIRO R, Modest reduction in adverse birth outcomes following the COVID-19 lockdown, American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2020.12.1198.
Update 19 December – papers 46 and 47 added
Paper 47 – Antenatal care during lockdown in Ethiopia
Pregnant women attending ANC services at public hospitals in Northeast Ethiopia between February 2 & August 30, 2020 (click here or ijwh-287534-antenatal-care-service-utilization-of-pregnant-women-attendi). No control group. Citation: Tadesse E. Antenatal Care Service Utilization of Pregnant Women Attending Antenatal Care in Public Hospitals During the COVID-19 Pandemic Period. Int J Womens Health. 2020;12:1181-1188. Published 2020 Dec 8. doi:10.2147/IJWH.S287534
Paper 46 – Fewer planned moderately preterm births in an Australian hospital
During the 2020 lockdown, rates of planned (iatrogenic) moderately preterm birth fell in the Mater Mothers’ Hospital, South Brisbane, Queensland (click here or 2020.11.24.20237529.full). Outcomes not reported. Citation: Linda A. Gallo, Tania F. Gallo, Danielle J. Borg, Karen M. Moritz, Vicki L. Clifton, Sailesh KumarPreterm birth rates in a large tertiary Australian maternity centre during COVID-19 mitigation measures medRxiv 2020.11.24.20237529; doi: https://doi.org/10.1101/2020.11.24.20237529
Update 15 December – paper 45 added
Paper 45 – fewer visits during lockdown in Nanjing, China
Hospital visits for pregnancy care fell during lockdown in Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China grid.452290.8 (click here or 10.1177_0300060520939337). There were no reported harms. Citation: Gu XX, Chen K, Yu H, Liang GY, Chen H, Shen Y. How to prevent in-hospital COVID-19 infection and reassure women about the safety of pregnancy: Experience from an obstetric center in China. J Int Med Res. 2020;48(7):300060520939337. doi:10.1177/0300060520939337
Update 14 December – paper 44 added
Paper 44 – increased stillbirths during 1st wave in Israel
Stillbirth were increased in the period February 21 to April 30 2020, compared with the corresponding periods for 2017 to 2019 in Shamir Medical Center, Zerifin, Israel (click here or s-0040-1721515). Citation: Matan Mor, Nadav Kugler, Eric Jauniaux, Moshe Betser, Yifat Wiener, Howard Cuckle, Ron Maymon. Impact of the COVID-19 Pandemic on Excess Perinatal Mortality and Morbidity in Israel. Am J Perinatol DOI: 10.1055/s-0040-1721515
Update 10th December – paper 43 added
Paper 43 – rise in the rate of ruptured ectopic pregnancies
In Sant’Orsola-Malpighi University Hospital in Bologna, Italy, the rate of ruptured ectopic pregnancies normally 52/201 (26%) rose to 6/9 (66%) during the first lockdown period (click here or uog.22126). Citation: Casadio, P., Youssef, A., Arena, A., Gamal, N., Pilu, G. and Seracchioli, R. (2020), Increased rate of ruptured ectopic pregnancy in COVID‐19 pandemic: analysis from the North of Italy. Ultrasound Obstet Gynecol, 56: 289-289. https://doi.org/10.1002/uog.22126
Update 8th December – papers 41 and 42 added
Paper 42 – no significant alteration in stillbirths during first wave in England
There was no significant alteration in stillbirths overall, or in any region of the UK during the first wave (click here or jama_stowe_2020_ld_200113_1607178377.6775) Citation: Stowe J, Smith H, Thurland K, Ramsay ME, Andrews N, Ladhani SN. Stillbirths During the COVID-19 Pandemic in England, April-June 2020. JAMA. Published online December 07, 2020. doi:10.1001/jama.2020.21369
Paper 41- no significant alteration in preterm births or in stillbirths during first wave in Philadelphia
There were no significant alterations in the patterns, or overall rates, of preterm births or stillbirths during the first wave, in two Philadelphia hospitals (click here or jama_handley_2020_ld_200111_1607178374.44311 (1)). Citation: Handley SC, Mullin AM, Elovitz MA, et al. Changes in Preterm Birth Phenotypes and Stillbirth at 2 Philadelphia Hospitals During the SARS-CoV-2 Pandemic, March-June 2020. JAMA. Published online December 07, 2020. doi:10.1001/jama.2020.20991
Update 7th December – paper 40 added
Paper 40 – 16 maternal deaths in Indonesia
From March to May 2020, 16 pregnant or postnatal women died in West Sumatra (click here or 10.1080@0167482X.2020.1779216). It is not reported whether these were caused by Covid-19 or other diseases. Citation: Mijke Lambregtse-van den Berg, Julie Quinlivan. (2020) Identifying pregnant women at risk of developing COVID-19 related mental health problems – a call for enhanced psychoeducation and social support. Journal of Psychosomatic Obstetrics & Gynecology 41:4, pages 249-250.
Update 5th December – papers 38 and 39 added
Paper 39 – no major obstetric effects of lockdown in Wuhan, China
The Maternal and Child Hospital of Hubei Province (which I believe is part of Huazhong University of Science and Technology Hospital grid.488485.d) observed no major effects of lockdown compared with the previous year (click here or journal.pone.0237420). The Caesarean rate, for example, rose from 47% to 48%. Citation: Li M, Yin H, Jin Z, Zhang H, Leng B, Luo Y, Zhao Y. Impact of Wuhan lockdown on the indications of cesarean delivery and newborn weights during the epidemic period of COVID-19. PLoS One. 2020 Aug 13;15(8):e0237420. doi: 10.1371/journal.pone.0237420. PMID: 32790709; PMCID: PMC7425855.
Paper 38 – reduced prenatal diagnosis procedures Trabzon, Turkey
Between 11 March and 30 June 2020 prenatal dignosis procedures reduced by about one third at Karadeniz Perinatology Clinic, compared with the same period in the previous year (click here or Effect of COVID 19 pandemic process on prenatal diagnostic procedures (1)). Citation: Mirac Ozalp, Omer Demir, Hümeyra Akbas, Ecem Kaya, Cemre Celik & Mehmet Armagan Osmanagaoglu (2020) Effect of COVID-19 pandemic process on prenatal diagnostic procedures, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1815190
Update 3rd December – paper 37 added
Paper 37 – Reduced hospitalisation & increased maternal & perinatal mortality in Jodhpur, India
Reduced hospitlisation and emergency referrals after lockdown, coincided with increased in-hospital maternal mortality, and late intrauterine fetal death and stillbirth in a group of four hospitals associated with Dr S N Medical College, Jodhpur, India (click here or PIIS2214109X20303193). Citation: Kumari V, Mehta K, Choudhary R. COVID-19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Glob Health. 2020 Sep;8(9):e1116-e1117. doi: 10.1016/S2214-109X(20)30319-3. Epub 2020 Jul 14. PMID: 32679037.
Update 2nd December – papers 35 and 36 added
Paper 36 – freebirth due to fear of Covid in Iran
A woman from Dezful, Khuzestan province in Iran had a normal birth alone at home because she was fearful of contracting Covid-19 in hospital (click here or IJPS-15-366). Both mother and baby were fine. Citation: Nosratabadi M, Sarabi N, Masoudiyekta L. A Case Report of Vaginal Delivery at Home due to Fear of Covid-19. Iran J Psychiatry. 2020;15(4):366-369. doi:10.18502/ijps.v15i4.4306
Paper 35 – delayed presentation in labour in Sao Paolo, Brazil
In São Paulo Hospital betwee March 11 and June 11, more women presented in advanced labour (click here or ijgo.13357). Citation: Sun, S.Y., Guazzelli, C.A.F., de Morais, L.R., Dittmer, F.P., Augusto, M.N., Soares, A.C., Coutinho da Silva, P.M., Abuchaim, E.d.S.V. and Mattar, R. (2020), Effect of delayed obstetric labor care during the COVID‐19 pandemic on perinatal outcomes. Int J Gynecol Obstet, 151: 287-289. https://doi.org/10.1002/ijgo.13357
Update 1st December – papers 32 to 34 added
Paper 34 – reduced risk of post partum depression during lockdown
Rates of raised EPDS scores were reduced during lockdown among women cared for at Soroka University Medical Center, Negev, Israel (click here or Pariente2020_Article_RiskForProbablePost-partumDepr). Citation: Pariente, G., Wissotzky Broder, O., Sheiner, E. et al. Risk for probable post-partum depression among women during the COVID-19 pandemic. Arch Womens Ment Health (2020). https://doi.org/10.1007/s00737-020-01075-3
Paper 33 – breast feeding during lockdown in Belgium
Reported behaviour of a self-selected sample (click here or ijerph-17-06766). Most women reported continuing breast feeding for longer during lockdown. Citation: Ceulemans, M.; Verbakel, J.Y.; Van Calsteren, K.; Eerdekens, A.; Allegaert, K.; Foulon, V. SARS-CoV-2 Infections and Impact of the COVID-19 Pandemic in Pregnancy and Breastfeeding: Results from an Observational Study in Primary Care in Belgium. Int. J. Environ. Res. Public Health 2020, 17, 6766.
Paper 32 – sexual behaviour during lockdown in China
Reported behaviour of a self-selected sample (click here or pdf (1)). Citation. Li G, Tang D, Song B, Wang C, Qunshan S, Xu C, Geng H, Wu H, He X, Cao Y. Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study. J Med Internet Res. 2020 Aug 6;22(8):e20961. doi: 10.2196/20961. PMID: 32716895; PMCID: PMC7419154.
Update 27 November – paper 31 added
Paper 31 – effect of lockdown in Karnataka, India
The self-reported effects of lockdown of 290/315 pregnant women attending Shri B.M. Patil Medical College, Hospital and Research Center, Vijayapura, Karnataka, India, between 21/05/2020 & 08/06/2020 (click here or pmr-12-03-3). Citation: Dr. Rajasri G. Yaliwal, Dr. Aruna M.Biradar, Dr. Shreedevi S. Kori, Dr. Subhashchandra, R. Mudanur, Dr. Shivakumar U. Pujeri, Dr. Shailaja R. Bidri, Dr. Neelamma G. Patil. CHALLENGES OF PREGNANCY DURING THE COVID19 PANDEMIC AND LOCKDOWN –A CROSS-SECTIONAL STUDY. Pravara Med Rev; September 2020, 12(03) , 23-30 DOI: 10.36848/PMR/2020/13100.51291
Update 26 November – papers 29 and 30 added
Paper 30 – more women not receiving antenatal care in Jordan
The self-reported rate of women not receiving antenatal care in this online survey of self-selected members of women’s and motherhood groups in Jordan, rose from a recalled 38/944 (4%) before lockdown to 562 (60%) during lockdown (click here or ijwh-280342-pregnancy-during-covid-19-outbreak-the-impact-of-lockdown-i). Citation: Muhaidat N, Fram K, Thekrallah F, Qatawneh A, Al-Btoush A. Pregnancy During COVID-19 Outbreak: The Impact of Lockdown in a Middle-Income Country on Antenatal Healthcare and Wellbeing. Int J Womens Health. 2020;12:1065-1073 https://doi.org/10.2147/IJWH.S280342
Paper 29 – couples delaying conception in Shanghai, China
Of 447 couples who had been recorded before the pandemic as planning to conceive a pregnancy, 151 (34%) stated that they had altered their plans, presumably in the direction of cancelling or delaying trying for a baby (click here or ijgo.13366). Citation: Zhu, C., Wu, J., Liang, Y., Yan, L., He, C., Chen, L. and Zhang, J. (2020), Fertility intentions among couples in Shanghai under COVID‐19: A cross‐sectional study. Int. J. Gynecol. Obstet., 151: 399-406. https://doi.org/10.1002/ijgo.13366
Update 24th November – paper 28 added
Paper 28 – fewer & later attendances in pregnancy during first wave in Israel
Fewer pregnant women attended the emergency department during the first wave compared with the same period in the previous year, and those that did attended at later gestations or at more advanaced stages of labour. Hower, no differences were seen in outcomes (click here or Changes in the obstetrical emergency department profile during the COVID 19 pandemic). From author affiliations this was probably Carmel Medical Center, Haifa, Israel. Citation: (2020) Changes in the obstetrical emergency department profile during the COVID-19 pandemic, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1847072
Update 23rd November – paper 27 added
Paper 27 – cancelled clinic appointments in Iran
57/103 pregnant or post-partum women reported cancelling clinic appointments for themselves or their child during lockdown (click here or ijerph-17-08272). Participants were patients in the Department of Gynecology and Midwifery of the Arak University of Medical Sciences, Arak, Iran. Citation: Shayganfard, M.; Mahdavi, F.; Haghighi, M.; Sadeghi Bahmani, D.; Brand, S. Health Anxiety Predicts Postponing or Cancelling Routine Medical Health Care Appointments among Women in Perinatal Stage during the Covid-19 Lockdown. Int. J. Environ. Res. Public Health 2020, 17, 8272.
Update 20 November – paper 26 added
Paper 26 – no alteration in miscarriage rate after embryo transfer in New York
The authors of this conference abstract report that early pregnancy loss rates did not alter during the first wave of the SARS-CoV-2 pandemic (click here or PIIS0015028220323165). Citation: Flisser, Eric et al. PREGNANCY LOSS RATES AFTER SINGLE, EUPLOID FROZEN-THAWED EMBRYO TRANSFER IN THE COVID-19 ERA. Fertility and Sterility, Volume 114, Issue 3, e561 – e562
Update 14 November – paper 25 added
Paper 25 – more stillbirths & fewer late preterm births in Rome, Italy
Using the Lazio region hospital discharge database, the authors report fewer 32-36w births, & more stillbirths in March to May 2020, compared with the same period 2019 (click here or archdischild-2020-320682.full). Citation: De Curtis M, Villani L, Polo A. Arch Dis Child Fetal Neonatal Ed Epub ahead of print: doi:10.1136/archdischild-2020-320682 Accepted 21 October 2020 Arch Dis Child Fetal Neonatal Ed 2020;0:F1. doi:10.1136/fetalneonatal-2020-320682
Update 12 November – papers 22 to 24 added
Paper 24 – hospital births and postnatal depression scores in Hong Kong
Queen Mary Hospital, Pokfulam, Hong Kong observed a fall in hospital births and raised rates of Edinburgh postnatal depression scores over 10 during lockdown (click here or hkmj208774). Citation: PW Hui, Grace Ma, Mimi TY Seto, KW Cheung. Effect of COVID-19 on delivery plans and postnatal depression scores of pregnant women. Hong Kong Med J 2020;26:Epub 5 Nov 2020 https://doi.org/10.12809/hkmj208774
Paper 23 – stress during lockdown in Cork, Ireland
This survey reported no major differences in a range of self-reported psychological or behavioural outcomes during lockdown (click here or 1-s2.0-S187151922030367X-main). Citation: Karen Matvienko-Sikar, Johanna Pope, Avril Cremin, Hayley Carr, Sara Leitao, Ellinor K. Olander, Sarah Meaney. Differences in levels of stress, social support, health behaviours, and stress-reduction strategies for women pregnant before and during the COVID-19 pandemic, and based on phases of pandemic restrictions, in Ireland. Women and Birth. 2020,ISSN 1871-5192, https://doi.org/10.1016/j.wombi.2020.10.010. (http://www.sciencedirect.com/science/article/pii/S187151922030367X)
Paper 22 – lockdown did not affect miscarriage rates in Montreal, Canada
There was no difference in miscarriage/non-viable pregnancy rates in this Montreal fertility unit, between the period of the first wave, and an equivalent period in 2019 (click here or Rotshenker-Olshinka2020_Article_COVID-19PandemicEffectOnEarlyP). Citation: Rotshenker-Olshinka, K., Volodarsky-Perel, A., Steiner, N. et al. COVID-19 pandemic effect on early pregnancy: are miscarriage rates altered, in asymptomatic women?. Arch Gynecol Obstet (2020). https://doi.org/10.1007/s00404-020-05848-0 3 March update. This is the full report of paper 15 (abstract)
Update 10th November – paper 21 added
Paper 21 – shorter postnatal stay during pandemic in Los Angles
Women and babies who delivered in March and April 2020 at Cedars-Sinai Medical Center, Los Angeles, California, USA, had significantly reduced postpartum stays than those in prepandemic periods (click here or Greene AJOG MFM-main). No adverse effects were reported. Citation: Greene NH, Kilpatrick SJ, Wong MS, et al. Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2020;2:100234. https://doi.org/10.1016/j.ajogmf.2020.100234
Update 9th November – papers 19 and 20 added
Paper 20 – halving of emergency admissions during the pandemic in Bologna, Italy
In March 2020, the middle of the COVID-19 pandemic, emegency room attendances halved compared with March 2019 in S.Orsola-Malpighi University Hospital of Bologna (click here or Salsi AJOG MFM). Citation: Ginevra Salsi, Anna Seidenari, Josefina Diglio, Federica Bellussi, Gianluigi Pilu, Federica Bellussi. Obstetrics and gynecology emergency services during the coronavirus disease 2019 pandemic. American Journal of Obstetrics & Gynecology MFM, Volume 2, Issue 4, Supplement, 2020, 100214, ISSN 2589-9333, https://doi.org/10.1016/j.ajogmf.2020.100214. (http://www.sciencedirect.com/science/article/pii/S2589933320301828)
Paper 19 – halving of admissions & births during the pandemic in Jodhpur, India
Over the period of the pandemic, hospital admissions in pregnancy, and hospital births halved in the All India Institute of Medical Sciences, Jodhpur, a tertiary referral hospital (click here or ijgo.13457). 32 pregnant women with Covid-19 were included, so this paper is also included as study 343 here. Citation: Goyal, M., Singh, P., Singh, K., Shekhar, S., Agrawal, N. and Misra, S. (2020), The effect of the COVID‐19 pandemic on maternal health due to delay in seeking health care: Experience from a tertiary center. International Journal of Gynecology & Obstetrics. Accepted Author Manuscript. https://doi.org/10.1002/ijgo.13457
Update 31st October – paper 18 added
Paper 18 – no effect on preterm births in California
No effect on preterm births over the pandemic first wave in California, apart from a small “increase” in births between 28 and 32 weeks (click here or Main AJOG 21 oct 2020 (1)). Citation: Main EK, Chang S-C, Carpenter AM, Wise PH, Stevenson DK, Shaw GM, Gould JB, Preterm birth rates for racial and ethnic groups during the COVID-19 pandemic in California, American Journal of Obstetrics and Gynecology (2020), doi: https://doi.org/10.1016/j.ajog.2020.10.033.
Update 24 October – papers 16 and 17 added
Paper 17 – reduced general anaesthesia for Caesarean during lockdown, UK
Six hospitals observed a fall in Caesarean general anaesthesia rates from 7.7 to 3.7% during the pandemic (click here or ). Citation; Bhatia K, Columb M, Bewlay A, Eccles J, Hulgur M, Jayan N, Lie J, Verma D, Parikh R. The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross sectional analysis of six hospitals in the north-west of England. Anaesthesia. 2020 Oct 18. doi: 10.1111/anae.15313. Epub ahead of print. PMID: 33073371.
Paper 16 – reduced preterm birth in a Philadelphia hospital
In Thomas Jefferson University Hospital preterm birth fell from 13% in March 1-July 31 2019, to 10% in March 1-July 31 2020 (click here or berghella AJOGMFM). Citation: Berghella V, Burd J, Anderson K, Boelig R, Roman A, Decreased incidence of preterm birth during COVID-19 pandemic, American Journal of Obstetrics & Gynecology MFM (2020), doi: https://doi.org/10.1016/j.ajogmf.2020.100258.
Update 20 October – papers 13 to 15 added
Paper 15 – miscarriage before and during lockdown in Montreal, Canada
No change (click here or main (4)) Citation: Olshinka KR, Volodarsky-Perel A, Steiner N, Rubenfeld ES, Dahan MH. COVID-19 PANDEMIC EFFECT ON EARLY PREGNANCY – ARE MISCARRIAGE RATES ALTERED, IN ASYMPTOMATIC WOMEN?. Fertil Steril. 2020;114(3):e525-e526. doi:10.1016/j.fertnstert.2020.09.036 March 3rd update. The full version of this abstract is reported in paper 22.
Paper 14 – diabetes control during lockdown in Lille, France
It deteriorated (click here or main (3)). Citation: Ghesquière L, Garabedian C, Drumez E, et al. Effects of COVID-19 pandemic lockdown on gestational diabetes mellitus: A retrospective study [published online ahead of print, 2020 Oct 15]. Diabetes Metab. 2020;doi:10.1016/j.diabet.2020.09.008
Paper 13 – the Covid-19 New Mum survey
Self-selected and self-reported UK maternal birth experiences before and after lockdown (click here or main (2)). Citation: A. Vazquez-Vazquez, Appetite, https://doi.org/10.1016/j.appet.2020.104985
Update 18 October – papers 10 to 12 added
Paper 12 – reduced preterm birth in The Netherlands
National study based on dried blood spot screening programme (click here or PIIS2468266720302231). Citation: Been, Jasper V et al. Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study. The Lancet Public Health, Volume 0, Issue 0. https://doi.org/10.1016/S2468-2667(20)30223-1
Paper 11 – reduced preterm births in Dublin, Ireland
There was a small reduction in preterm birth, but no other effects, between 1st January & 31st July 2020 compared to the same period in 2019 in the Coombe Women & Infants University Hospital (click here or PIIS0301211520306539). Citation: McDonnell S, McNamee E, Lindow SW, O’Connell MP, The impact of the Covid-19 pandemic on maternity services: a review of maternal and neonatal outcomes before, during and after the pandemic, European Journal of Obstetrics and amp; Gynecology and Reproductive Biology (2020), doi: https://doi.org/10.1016/j.ejogrb.2020.10.023
Paper 10 – reduced preterm births in Israel (update 3 March)
This preprint consists only of results tables (click here or PIIS0002937820311911 (1)). The corresponding author is from Chaim Sheba Medical Center, Israel. Citation: Meyer R, Friedrich L, Maixner N, Bart Y, Tsur A, Yinon Y, Levin G, A marked decrease in Preterm Deliveries during the COVID-19 Pandemic, American Journal of Obstetrics and Gynecology (2020), doi: https://doi.org/10.1016/j.ajog.2020.10.017. Update 3 March. This paper (click here or 244117) with overlapping authorship, also reports the effect of lockdown in the same hospital. Citation: Meyer R, Levin G, Hendin N, Katorza E. Impact of the COVID-19 Outbreak on Routine Obstetrical Management. Isr Med Assoc J. 2020 Aug;22(8):483-488. PMID: 33236580.
Update 12 October – papers 8 and 9 added
Paper 9 – effect of lockdown in one hospital in Israel
Various pregnancy complications over March–April 2020 (the peak COVID-19 outbreak) in one large hospital, were compared with March–April 2019 in the same hospital (click here or 231152 (002)). From author affiliations the hospital was probably Rambam Health Care Campus in Haifa. Citation: Justman N, Shahak G, Gutzeit O, Ben Zvi D, Ginsberg Y, Solt I, Vitner D, Beloosesky R, Weiner Z, Zipori Y. Lockdown with a Price: The impact of the COVID-19 Pandemic on Prenatal Care and Perinatal Outcomes in a Tertiary Care Center. Isr Med Assoc J. 2020 Sep;9(22):467-471. PMID: 32954690.
Paper 8 – effect of lockdown in one hospital in Japan
The rates of women hospitalised for some pregnancy complications in Keio University Hospital between April 1st and June 30th, 2020, were compared with the same period 2017-19 (click here or jog.14518). No substantive outcomes reported. Citation: Kasuga, Y., Tanaka, M. and Ochiai, D. (2020), Preterm delivery and hypertensive disorder of pregnancy were reduced during the COVID‐19 pandemic: A single hospital‐based study. J. Obstet. Gynaecol. Res.. doi:10.1111/jog.14518
Update 9 October – papers 6 and 7 added
Paper 7 – reduced admission to emergency OBGYN during first wave in Milan, Italy
Between February 24th & May 31st 2020 emergency OBGYN admissions decreased by 35% at Clinica Mangiagalli, the largest maternity clinic in Milan, compared with the corresponding period in 2019 (click here or 1-s2.0-S0301211520305777-main). Five fetal deaths were seen in the emergency clinic in the pandemic period compared with one in the earlier period. Total perinatal deaths were not reported for either period. Citation: Chiara Dell’Utri, Elisabetta Manzoni, Sonia Cipriani, Claudio Spizzico, Andrea Dell’Acqua, Giussy Barbara, Fabio Parazzini, Alessandra Kustermann. Effects of SARS Cov-2 epidemic on the obstetrical and gynecological emergency service accesses. What happened and what shall we expect now? European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 254, 2020, Pages 64-68, ISSN 0301-2115, https://doi.org/10.1016/j.ejogrb.2020.09.006.
Paper 6 – four maternal deaths from suicide & two women murdered during UK lockdown
Four women died from suicide during pregnancy or soon after birth and two recently pregnant women died from domestic violence in the UK, between 01/03/2020 and 31/05/2020,causes (click here or ref.-201-mbrrace-uk-maternal-covid-19-report-final-002)). Citation: Knight M, Bunch K, Cairns A, Cantwell R, Cox P, Kenyon S, Kotnis R, Lucas DN, Lucas S, Marshall L, Nelson-Piercy C, Page L, Rodger A, Shakespeare J, Tuffnell D, Kurinczuk JJ on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Rapid Report: Learning from SARS-CoV-2-related and associated maternal deaths in the UK March – May 2020 Oxford: National Perinatal Epidemiology Unit, University of Oxford 2020.
Paper 5 – no change in extremely preterm births during lockdown in the SafeBoosC-III consortium trial centres
In this Medxiv preprint the rate of extremely preterm births (<28 weeks) in 46 neonatal intensive care units participating in the SafeBoosC-III trial, did not alter during the three months of most rigorous lockdown, compared with the corresponding three months of 2019 (click here or 2020.10.02.20204578v1.full). Citation: Marie Isabel Rasmussen, Mathias Luehr Hansen, Gerhard Pichler, Eugene Dempsey, Adelina Pellicer, Afif EL-Khuffash, Shashidhar A, Salvador Piris-Borregas, Miguel Alsina, Merih Cetinkaya, Lina Chalak, Hilal Ozkan, Mariana Baserga, Jan Sirc, Hans Fuchs, Ebru Ergenekon, Luis Arruza, Amit Mathur, Martin Stocker, Olalla Otero-Vaccarello, Tomasz Szczapa, Kosmas Sarafidis, Barbara Krolak-Olejnik, Asli Memisoglu, Hallvard Reigstad, Elzbieta Rafinska-Wazny, Eleftheria Hatzidaki, Zhang Peng, Despoina Gkentzi, Renaud Viellevoye, Julie De Buyst, Emmanuele Mastretta, Ping Wang, Gitte Hahn, Lars Bender, Luc Cornette, Jakub Tkaczyk, Ruth del Rio, Monica Fumagalli, Evangelina Papathoma, Maria Wilinska, Gunnar Naulers, Iwona Sadowska-Kakrawczenko, Chantal Lecart, Maria Luz Couce, Siv Fredly, Anne Marie Heuchan, Tanja Karen, Gorm Greisen Extremely preterm infant admissions within the SafeBoosC-III consortium during the COVID-19 lockdown medRxiv 2020.10.02.20204578; doi: https://doi.org/10.1101/2020.10.02.20204578
Paper 4 – fall in very & extremely low birthweight infants during lockdown in Limerick, Ireland
The rate of birth of both very low birthweight and extremely low birth weight infants reduced significantly in Jan-April 2020 compared witht the same period over the preceding 10 years (click here or e003075.full). Citation: , et al Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a ‘natural experiment’ allowing analysis of data from the prior two decades.
Paper 3 – halving of hospital births & increased perinatal mortality during lockdown in Nepal
Between Jan 1 and May 30, 2020, births in nine hospitals in Nepal halved during the latter 5 lockdown weeks, and stillbirths and neonatal mortality rose significantly (click here or PIIS2214109X20303454 (1)). Citation: KC, Ashish et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. The Lancet Global Health, Volume 8, Issue 10, e1273 – e1281
Paper 2 – fall in extreme prematurity during lockdown in Denmark
Using a national database the numbers of extremely premature singleton births was significantly lower between 12 March and 14 April 2020 than the previous five years (click here or fetalneonatal-2020-319990). There was no significant difference in other gestational age categories. Citation: Hedermann G, Hedley PL, Bækvad-Hansen M, Hjalgrim H, Rostgaard K, Poorisrisak P, Breindahl M, Melbye M, Hougaard DM, Christiansen M, Lausten-Thomsen U. Danish premature birth rates during the COVID-19 lockdown. Arch Dis Child Fetal Neonatal Ed. 2020 Aug 11:fetalneonatal-2020-319990. doi: 10.1136/archdischild-2020-319990. Epub ahead of print. PMID: 32788391; PMCID: PMC7421710.
Paper 1 – rise in stillbirths at a London hospital
St George’s hospital in South London noted a rise in stillbirths between February 1 & June 14, 2020 compared with the previous four months (click here or jama_khalil_2020_ld_200076). Neonatal deaths were not reported. There were no significant differences in preterm birth rates. Citation: Khalil A, von Dadelszen P, Draycott T, Ugwumadu A, O’Brien P, Magee L. Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic. JAMA. 2020;324(7):705–706. doi:10.1001/jama.2020.12746
Jim Thornton, Keelin O’Donoghue & Kate Walker
