COVID-19 and preterm birth
Authors: Laura A Magee, Peter von Dadelszen, Asma Khalil
Journal: The Lancet Global Health (2020)

In their Comment (September, 2020), Vimla Kumari and colleagues1Kumari V Mehta K Choudhary R COVID-19 outbreak and decreased hospitalisation of pregnant women in labour.Lancet Glob Health. 2020; 8: e1116-e1117Summary Full Text Full Text PDF PubMed Scopus (74) Google Scholar analyse the impact of the COVID-19 pandemic in four tertiary teaching hospitals in western India. The authors report that, compared with before the pandemic, the demographics of pregnant women delivering in their facilities has changed (ie, there are more educated and nulliparous women), and there is an increased number of in-hospital maternal deaths, and an increased number of late pregnancy fetal losses. During the lockdown period there was a 43·2% reduction in hospital admissions when compared with the control period (ie, 10 weeks before lockdown; 6209 vs 3527), and a 66·4% reduction in referred obstetric emergencies compared with the same calendar period in the previous year (905 vs 304).1Kumari V Mehta K Choudhary R COVID-19 outbreak and decreased hospitalisation of pregnant women in labour.Lancet Glob Health. 2020; 8: e1116-e1117Summary Full Text Full Text PDF PubMed Scopus (74) Google Scholar These results are interesting, as the increase in maternal deaths combined with the observed reduction in the number of emergency referrals during lockdown compared with before lockdown suggest that, not only are fewer women seeking care, the local maternity health system is also failing to seek care for these women. This observation continues to illustrate the indirect effects of COVID-19 on maternal and perinatal health, which we had previously warned about,2von Dadelszen P Khalil A Wolfe I Kametas NA O'Brien P Magee LA "Women and children last"- effects of the covid-19 pandemic on reproductive, perinatal, and paediatric health.BMJ. 2020; 369m2287Crossref PubMed Scopus (7) Google Scholar and that there is an urgent need to comprehensively report all important obstetric and neonatal outcomes to highlight both predictable and understandable outcomes (eg, an increase in the incidence of stillbirth3Khalil 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: 705-706Crossref PubMed Scopus (309) Google Scholar) and unexpected patterns of outcomes (eg, the contradictory global evidence about preterm birth rates3Khalil 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: 705-706Crossref PubMed Scopus (309) Google Scholar, 4Hedermann G Hedley PL Baekvad-Hansen M et al.Danish premature birth rates during the COVID-19 lockdown.Arch Dis Child Fetal Neonatal Ed. 2020; (published online Aug 9.)https://doi.org/10.1136/archdischild-2020-319990Crossref PubMed Scopus (176) Google Scholar, 5KC A Gurung R Kinney MV et al.Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study.Lancet Glob Health. 2020; 8: e1273-e1281Summary Full Text Full Text PDF PubMed Scopus (263) Google Scholar). Lower preterm birth rates during the COVID-19 pandemic compared with before the pandemic would not be explained by reduced care-seeking behaviour, but could reflect countervailing reductions in maternal activity (high amounts of which could potentially be associated with an increased risk of preterm birth), changes in clinical decision making that might reduce iatrogenic prematurity, or both. Do Kumari and colleagues1Kumari V Mehta K Choudhary R COVID-19 outbreak and decreased hospitalisation of pregnant women in labour.Lancet Glob Health. 2020; 8: e1116-e1117Summary Full Text Full Text PDF PubMed Scopus (74) Google Scholar have information about changes in the number of preterm births during lockdown to help present a more complete picture? We declare no competing interests. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational studyInstitutional childbirth reduced by more than half during lockdown, with increases in institutional stillbirth rate and neonatal mortality, and decreases in quality of care. Some behaviours improved, notably hand hygiene and keeping the baby skin-to-skin with their mother. An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period. Full-Text PDF Open AccessCOVID-19 and preterm birth – Authors' replyWe thank Laura Magee and colleagues for providing their feedback on our Comment.1 Indeed, the reduction in the number of referrals to emergency obstetric care was more alarming than the overall decrease in the number of hospital admissions for management of pregnancy. This reduction in emergency referrals could be due to reluctance by the patient or their caregiver for timely referral to tertiary care in non-urgent cases when suggested by the treating doctor at primary and secondary health-care centres. Full-Text PDF Open Access