COVID-19 pandemic worsened pregnancy outcomes for women and babies worldwide
Pregnancy outcomes for mothers and babies have worsened during the COVID-19 pandemic, a review of knowledge from 40 studies representing 17 countries published today within the Lancet Global Health journal has revealed.
Findings varied by country but analysis of pooled data showed stillbirth and maternal mortality rates increased by approximately one-third during the pandemic compared to life before COVID-19 took hold (stillbirth rates: during pandemic 1099/168,295 pregnancies vs before pandemic 1325/198,993 pregnancies; maternal mortality rates: during pandemic 530/1,237,018 pregnancies vs pre-pandemic 698/2,224,859 pregnancies).
Mental health outcomes also worsened during the pandemic. Of the ten studies included within the analysis that reported on maternal psychological state, six reported a rise in postnatal depression, maternal anxiety, or both.
Overall, outcomes were worse in low- and middle-income countries as compared to high-income countries and therefore the researchers say immediate action is required to preserve safe maternity care worldwide, especially during the worldwide emergency.
Although the study didn't analyze the impact of COVID-19 infection during pregnancy, it provides the primary global assessment of the collateral impact of the pandemic on antenatal, birth, and postnatal outcomes.
Professor Asma Khalil, the lead author of the study, of the St George's University of London, said: "The COVID-19 pandemic has had a profound impact on health care systems around the world. Disruption to services, nationwide lockdowns, and fear of attending health care facilities means the adverse effects of COVID-19 are expected to possess health consequences that reach beyond the deaths and diseases caused by the virus itself. it's clear from our study et al. that the disruption caused by the pandemic has led to the avoidable deaths of both mothers and babies, especially in low- and middle-income countries. We urge policymakers and health care leaders to prioritize safe, accessible, and equitable maternity care within the strategic response to the pandemic and aftermath, to scale back adverse pregnancy outcomes worldwide."
Studies from individual countries have suggested that the pandemic has affected rates of stillbirth and pre-term birth, potentially as an end in a discount of healthcare-seeking behavior for fear of infection, also like the reduced provision of maternity services.
In this latest study, researchers reviewed data from 40 studies that were published between 1 January 2020 and eight January 2021, representing 17 countries and with data from quite 6 million pregnancies. All of the studies compared pregnancy outcomes during and before the pandemic, but studies that focused solely on SARS-CoV-2 infected women were excluded.
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Of the studies included within the review, 12 reported on the incidence of stillbirth. Analysis of the pooled data found the probabilities of getting a stillbirth were increased by quite 1 / 4 compared with pre-pandemic instances (odds of stillbirth increased 28%; stillbirth rate during a pandemic: 1,099/168,295 pregnancies, stillbirth rate before pandemic: 1,325/198,993 pregnancies).
The review included two studies that investigated the impact of the pandemic on maternal death rates, both from middle-income countries (one from India and one from Mexico). Pooled analysis of knowledge from both studies found that the danger of mothers dying during pregnancy or childbirth was increased by quite a 3rd compared with before the pandemic (maternal death rate: during an epidemic, 530/1,237,018 pregnancies vs pre-pandemic: 698/2,224,859 pregnancies). This finding was dominated by the study from Mexico, which represented the bulk of pregnancies included within the analysis (Mexico study 3,452,141/ 3,468,086 pregnancies [99.7%], India study 9,736 / 3,468,086 pregnancies [0.3%]).
The review didn't find any difference in overall rates of pre-term birth before and through the pandemic. However, pooled data from studies from high-income countries suggests that, during this setting, the chances of preterm birth were reduced by almost 10% during the pandemic. The authors say the reduction appears to be driven by a drop in spontaneous pre-term birth, instead of those requiring medically indicated early induction of labor or cesarean delivery, which can be increased. they assert this suggests it's more likely that changes in health healthcare delivery and population behaviors are contributing factors, which can bring valuable lessons for understanding the mechanisms underlying preterm birth. the chances of getting a pre-term birth in low- and middle-income countries were unchanged.
From the three studies that reported on the utilization of surgery for treatment of ectopic pregnancies, analysis of pooled data revealed that surgery rates were almost sixfold higher during the pandemic compared with before, after accounting for the dimensions of the included studies (surgery rate for ectopic pregnancies across all studies during pandemic 27/37, pre-pandemic 73/272). If discovered early, ectopic pregnancies can typically be treated with medication, meaning this increase in surgeries could also be a sign that more women delayed seeking care.
The variation in outcomes reported between different studies could also be partially explained by inefficiencies in health care systems within the countries studied, the researchers found. Differences in pandemic mitigation responses between countries didn't seem to affect the findings, however. The researchers say this means the rise in adverse pregnancy outcomes could also be driven by pressures on health care systems caused by COVID-19 itself, instead of measures aimed toward limiting the spread of the virus, like lockdowns.
The review didn't identify any changes in reporting of other pregnancy complications during the pandemic, including gestational diabetes or pregnancy disorders linked to high vital signs. there have been no observed changes in delivery outcomes during the pandemic either, like cesarean delivery or spontaneous vaginal delivery or the speed of pregnancies requiring induction of labor. Despite these numbers remaining steady, the researchers nonetheless say their findings provide a transparent indication that ladies and babies have experienced worse health outcomes during the pandemic. They highlight the necessity to prioritize safe, accessible, and equitable maternity care within the strategic response to the present pandemic and in future health crises.
Dr. Erkan Kalafat, a co-author of the study from Koc University, Turkey, said: "We have an unprecedented opportunity to find out from the experiences of the COVID-19 pandemic to plan for a way forward for inclusive and equitable maternity care worldwide. One such learning opportunity is going to be to research the mechanisms underlying the apparent reduction in pre-term births observed in high-income settings during the pandemic, to spot new preventative interventions that would potentially benefit all women worldwide."
The authors note several limitations to their findings. Notably, the studies included within their analysis varied in the way pregnancy outcomes were defined and measured, which makes it difficult to match results between studies. there have been fewer studies from low- and middle-income settings and this is often concerning because the analysis shows substantial variation in outcomes between high- and low-income settings. The authors also note that they can't exclude the danger of publication bias against studies reporting negative findings, although they didn't find any evidence of bias once they tested for this.
Writing during a linked Comment article, Dr. Jogender Kumar, of the Postgraduate Institute of Medical Education and Research, India, who wasn't involved within the study, said: "There was significant heterogeneity in outcomes between HICs and LMICs, and therefore the rates of the adverse outcomes were much higher in LMICs. These findings highlight disparities in health care within and across countries."
He added: "In resource-poor countries, even under normal circumstances, it's a challenge to supply adequate coverage for antenatal checkups, obstetric emergencies, universal institutional deliveries, and respectful maternity care. The COVID-19 pandemic has widened this gap and exposed several lacunae of health-care systems worldwide, but more so in LMICs."
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