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Indirect effects of the Covid-19 pandemic on pregnancy

October 8, 2020

Primary sources updated 24th October

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 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

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 

This preprint consists only of results tables (click here or PIIS0002937820311881 (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 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: Philip RKPurtill HReidy E, 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

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