Socioeconomic disparities in changes to preterm birth and stillbirth rates during the first year of the COVID-19 pandemic: a study of 21 European countries
Authors: Zeitlin Jennifer , Philibert Marianne , Barros Henrique , Broeders Lisa , Cap Jan , Draušnik Željka , Engjom Hilde , Farr Alex , Fresson Jeanne , Gatt Miriam , Gissler Mika , Heller Günther , Isakova Jelena , Källén Karin , Kyprianou Theopisti , Loghi Marzia , Monteath Kirsten , Mortensen Laust , Rihs Tonia , Sakkeus Luule , Sikora Izabela , Szamotulska Katarzyna , Velebil Petr , Verdenik Ivan , Weber Guy , Zile Irisa , Zurriaga Oscar , Smith Lucy ,   Euro-Peristat Research Group and the Population Health Information Research Infrastructure, Klimont Jeannette , Farr Alex , Alexander Sophie , Delnord Marie , Racapé Judith , Vandervelpen Gisèle , Zhang Wei-Hong , Kolarova Rumyana , Jordanova Evelin , Dimnjakovic Jelena , Draušnik Željka , Rodin Urelija , Kyprianou Theopisti , Scoutellas Vasos , Jirova Jitka , Velebil Petr , Hansen Anne Vinkel , Mortensen Laust Hvas , Abuladze Liili , Sakkeus Luule , Gissler Mika , Heino Anna , Amyx Melissa , Blondel Béatrice , Chantry Anne , Tharaux Catherine Deneux , Durox Mélanie , Fresson Jeanne , Hocquette Alice , Philibert Marianne , Vilain Annick , Zeitlin Jennifer , Bon Dimitra , Heller Günther , Misselwitz Björn , Antsaklis Aris , Sziller István , Eiríksdóttir Védís Helga , Gunnarsdóttir Jóhanna , Ólafsdóttir Helga Sól , Kearns Karen , Sikora Izabela , Boldrini Rosaria , Cuttini Marina , Donati Serena , Loghi Marzia , Pappagallo Marilena , Misins Janis , Zile-Velika Irisa , Gaidelyte Rita , Isakova Jelena , Billy Audrey , Lecomte Aline , Pastore Jessica , Weber Guy , Gatt Miriam , Achterberg Peter , Broeders Lisa , Hindori-Mohangoo Ashna , Nijhuis Jan , Akerkar Rupali , Engjom Hilde , Klungsøyr Kari , Mierzejewska Ewa , Szamotulska Katarzyna , Barros Henrique , Rodrigues Carina , Budianu Mihaela-Alexandra , Cucu Alexandra , Horga Mihai , Puscasiu Lucian , Sandu Petru , Tica Vlad , Cáp Ján , Lucovnik Miha , Verdenik Ivan , Alcaide Adela Recio , Fernández-Elorriaga María , Jané Mireia , Vidal Maria José , Zurriaga Óscar , Källén Karin , Nyman Anastasia , Rihs Tonia , Anderson Diane , Clarke Samantha , McConnell Hannah , Macfarlane Alison , Magill Sinead , Monteath Kirsten , Morgan Siobhán , Murphy Joanne , Piper Mark , Scott Sonya , Smith Lucy , Thomas Craig , Williams Martin , Habl Claudia , Pries Cara , Pentz Richard , Mathis-Edenhofer Stefan , Schmidt Andrea , Grabenhofer-Eggerth Alexander , Weiss Johannes , Sagerschnig Sophie , Gottlob Anita , Dolanski Lorenz , Degelsegger-Marquez Alexander , Gruber Beate , Habimana Katharana , Bogaert Petronille , Delnord Marie , Schutte Nienke , Vyncke Kim , Krzywania Tadek , Abboud Linda , Saso Miriam , Devleesschauwer Brecht , de Lizoreux Barthélémy Moreau , Derycke Pascal , Daubresse Pierre , Milbeck Sasha , De Ridder Karin , Van de Catsyne Charles-Andrew , Lagarija Sejla Cilovic , Chileva Anina , Dimnjakovic Jelena , Vukovic Jakov , Dankova Sarka , Májek Ondrej , Vorobjov Sigrid , Idavain Jane , Rätsep Merika , Tolonen Hanna , Mäkinen Mari , Gissler Mika , Zeitlin Jennifer , Philibert Marianne , Carcaillon-Bentata Laure , Haneef Romana , Makovski Tatjana , Thißen Martin , Seeling Stefanie , Fehr Angela , Ziese Thomas , Georgakopoulou Christina , Petelos Elena , Lionis Christog , Lingri Dimitra , Kornél Tóth , Töll Ágnes , Bezzegh Peter , Csizmadia István , Láng Róbert , Csaba Kiss , Cahill Alan , Courtney Michael , White Pauline , Ailish Kelly , Clarke Patricia , Kappala Sharon , Smyth Breda , Palmieri Luigi , Unim Brigid , Faragalli Andrea , Misins Janis , Zile Irisa , Zelviene Ausra , Astrauskiené Audronè , Weber Guy , Buttigieg Dorita , Calleja Neville , Lozan Oleg , Gramme Rodica , Tijhuis Mariken , Holz Daniela Moye , Hilderink Henk , Berger-Symons Linda , de Vries Marit , Haaheim Håkon , Forland Frode , Nordeng Zuzana , Larose Tricia , Strozyk Malgorzata , Maryniak Pawel , Drogon Krystyna , Węgrzyn Karolina , Wisniewski Tomasz , Paciorek Kinga , Nogueira Paulo , Bacelar-Nicolau Leonor , Santos Rodrigo Feteira , Lapão Luís , Peyroteo Mariana , Paulo Marília Silva , Montez Teresa , Dias Carlos , Gomez Veronica , Neves Lucinda Oliveira das , Peralta-Santos Andre , Sandu Petru , Gaftonie Elena Gabriela , Fekete Edit , Brinduse Lacramioara , Radulescu Silviu , Krstic Maja , Medaveric Aleksandar , Cap Jan , Zaletel Metka , Vinko Matej , Bric Tatjana Kofol , Gómez Inmaculada León , Rodriguez-Blazquez Carmen , Forjaz M João , Marin Marta , Larrauri Amparo , Ramis Rebeca , Diaz Asuncion , Angulo-Pueyo Ester , Garriga Cesar , Valero Teresa , Estupiñán Francisco , Garcia-Armesto Sandra , Bernal-Delgado Enrique , García Juan González , Azpiazu Javier Gómez-Arrue , Garces Ramon Launa , López-Cuadrado Teresa , Launag Ramón , Telleria Carlos , Seral Meriam , Angulo-Pueyo Ester , Syden Lovisa , Akbari Ashley , Lyons Ronan , Aldridge Sarag 
Published: July 2024

Abstract

Background
Despite concerns about worsening pregnancy outcomes resulting from healthcare restrictions, economic difficulties and increased stress during the COVID-19 pandemic, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth rates appeared stable. Like other shocks, the pandemic may have exacerbated existing socioeconomic disparities in pregnancy, but this remains to be established. Our objective was to investigate changes in PTB and stillbirth by socioeconomic status (SES) in European countries.

Methods
The Euro-Peristat network implemented this study within the Population Health Information Research Infrastructure (PHIRI) project. A common data model was developed to collect aggregated tables from routine birth data for 2015–2020. SES was based on mother’s educational level or area-level deprivation/maternal occupation if education was unavailable and harmonized into low, medium and high SES. Country-specific relative risks (RRs) of PTB and stillbirth for March to December 2020, adjusted for linear trends from 2015 to 2019, by SES group were pooled using random effects meta-analysis.

Results
Twenty-one countries provided data on perinatal outcomes by SES. PTB declined by an average 4% in 2020 {pooled RR: 0.96 [95% confidence intervals (CIs): 0.94–0.97]} with similar estimates across all SES groups. Stillbirths rose by 5% [RR: 1.05 (95% CI: 0.99–1.10)], with increases of between 3 and 6% across the three SES groups, with overlapping confidence limits.

Conclusions
PTB decreases were similar regardless of SES group, while stillbirth rates rose without marked differences between groups.