article · Nature Human Behaviour
This study analysed 52 million births across 26 countries to investigate changes in preterm birth (PTB) and stillbirth rates during COVID-19 lockdowns. It found small but statistically significant reductions in PTB during the first three months of lockdown, which could lead to a large number of averted cases globally. For high-income countries, an increased risk of stillbirth was observed in the first month of lockdown, but not in subsequent months. In contrast, Brazil showed an increased risk of stillbirth across the second, third, and fourth months of lockdown. The research highlights the need for further investigation into the causal factors behind these observed changes.
Preterm birth is the leading cause of infant mortality worldwide. Understanding how major societal events, such as lockdowns, affect birth outcomes can inform public health policies and interventions to improve maternal and infant health globally, potentially saving many lives.
The abstract does not indicate an immediate application pathway or commercialisation potential. It primarily calls for further research into the causal pathways behind the observed changes in preterm birth and stillbirth rates during lockdowns. This is early-stage research aimed at understanding public health impacts rather than developing a product or service.
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Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
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DOI: 10.1038/s41562-023-01522-y
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