Impact of COVID-19 Lockdown on Preterm Births, Low Birthweights and Stillbirths: A Retrospective Cohort Study

Charles Garabedian; Ninon Dupuis; Christophe Vayssière; Laurence Bussières; Yves Ville; Benoît Renaudin; Louise Dugave; Norbert Winer; Nathalie Banaszkiewicz; Patrick Rozenberg; Manon Defrance; Marie-Laure Legris; Thibaud Quibel; Philippe Deruelle

doi:10.3390/jcm10235649

Impact of COVID-19 Lockdown on Preterm Births, Low Birthweights and Stillbirths: A Retrospective Cohort Study

J Clin Med. 2021 Nov 30;10(23):5649. doi: 10.3390/jcm10235649.

Authors

Charles Garabedian^{1

2}, Ninon Dupuis³, Christophe Vayssière^{3

4}, Laurence Bussières^{5

6}, Yves Ville^{5

6}, Benoît Renaudin⁵, Louise Dugave¹, Norbert Winer^{7

8}, Nathalie Banaszkiewicz⁷, Patrick Rozenberg^{9

10}, Manon Defrance⁹, Marie-Laure Legris¹¹, Thibaud Quibel^{9

10}, Philippe Deruelle¹¹

Affiliations

¹ CHU Lille, Department of Obstetrics, F 59000 Lille, France.
² University Lille, ULR 2694 METRICS, F 59000 Lille, France.
³ Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 31059 Toulouse, France.
⁴ UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation), Toulouse III University, 31062 Toulouse, France.
⁵ Obstetrics, Fetal Surgery, Medicine and Imaging Department, AP-HP, Hôpital Necker-Enfants Malades, 75007 Paris, France.
⁶ EHU 7328 PACT, Université de Paris, 75006 Paris, France.
⁷ Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Nantes, University Nantes, 44035 Nantes, France.
⁸ UMR PhAN 1280 NUN INRAE, F-44000, University Nantes, 44035 Nantes, France.
⁹ Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300 Poissy, France.
¹⁰ UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESP, Paris Saclay University, 78180 Montigny-le-Bretonneux, France.
¹¹ Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Avenue Moliere, 67000 Strasbourg, France.

Abstract

Objective: The effect of lockdowns during the coronavirus (COVID-19) pandemic on pregnancy outcomes remains uncertain. We aimed to evaluate the association between the COVID-19-related lockdown and pregnancy outcomes in maternity hospitals in France.

Study design: This was a retrospective cohort study from six tertiary referral hospitals in different regions of France. Three 55-day periods were compared: pre-lockdown from 22 January 2020, lockdown from 17 March 2020, and post-lockdown from 11 May 2020 to 4 July 2020. We included all women who delivered singleton or multiple pregnancies, who delivered at ≥24 weeks of gestation and with birthweights ≥500 g. We documented gestational ages at the delivery of liveborn and stillborn infants ('stillbirths'). These were categorized as having a very low birthweight (VLBW, <1500 g), or a low birthweight (LBW, <2500 g). Adjustments were made for place of birth, maternal age, parity and diabetes, and hypertensive disorders, as well as for multiple pregnancies.

Results: In total, 11,929 women delivered in the six selected centers. This figure is constituted of 4093, 3829, and 4007 deliveries in the pre-lockdown (1), peri-lockdown (2), and post-lockdown (3) periods, respectively. There were no differences in pregnancy outcomes between these three periods. Overall, birth rates <27⁺⁶ weeks, between weeks 28⁺⁰ and 31⁺⁶, and between 32⁺⁰ and weeks 36⁺⁶ were 1.0%, 1.9%, and 4.4%, respectively. After adjustment, these rates were stable between periods 1 and 2 (adjusted odds ratio, aOR 0.90; 95% confidence interval, CI 0.69-1.19) and between periods 2 and 3 (aOR 1.04; 95% CI 0.80-1.36). Although more VLBW neonates were born during lockdown (3.5% vs. 2.6%, p = 0.03), this difference did not persist after adjustment (aOR 0.84, CI 95% 0.64-1.10). The LBW rates were similar during the three periods at 12.5% overall. The stillbirth rate was unaffected by the lockdown.

Conclusion: The pregnancy outcomes (preterm birth, LBW, VLBW, and stillbirth rates) were not modified by the COVID-19 lockdown in our cohort study in France. Considering the discrepancies in results and methodological issues in previous published studies, there is not sufficient evidence to conclude that such lockdowns have any impact on perinatal outcomes.

Keywords: COVID-19 pandemic; low birthweight; pregnancy; preterm birth; stillbirth.