Changes in live births, preterm birth, low birth weight, and cesarean deliveries in the United States during the SARS-CoV-2 pandemic

Background: The SARS-CoV-2 pandemic and associated social, economic, and clinical disruption have been widely speculated to affect pregnancy decision-making and outcomes. While a few US-based studies have examined subnational changes in fertility, preterm birth, and stillbirth, there remains limited knowledge of how the pandemic impacted childbearing and a broader set of perinatal health indicators at the national-level throughout 2020. Here, we use recently released national-level data to fill this gap. Importantly, we, unlike earlier work, use time-series methods to account for strong temporal patterning (e.g., seasonality, trend) that could otherwise lead to spurious findings. Methods: For the years 2015 to 2020, we obtained national monthly counts of births and rates (per 100 births) for six perinatal indicators: preterm birth (<37 weeks gestation), early preterm birth (<34 weeks gestation), late preterm birth (34-36 weeks gestation), low birth weight birth (<2500 g), very low birth weight birth (<1500 g), and cesarean delivery. We use an interrupted time-series approach to compare the outcomes observed after the pandemic began (March 2020) to those expected had the pandemic not occurred. Results: For total births as well as five of the six indicators (i.e., all but the rate of cesarean delivery), observed values fall well below expected levels (p<.0001 for each test) during the entire pandemic period. Declines in preterm birth and low birth weight were largest in magnitude in both early and later stages of the 2020 pandemic, while those for live births occurred at the end of the year. Discussion: Our findings provide some of the first national evidence of substantial reductions in live births and adverse perinatal outcomes during the SARS-CoV-2 pandemic. Only cesarean delivery appeared unaffected. These declines were not uniform across the pandemic, suggesting that several mechanisms, which require further study, may explain these patterns.

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Pregnancy Outcome during the First COVID 19 Lockdown in Vienna, Austria

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073782 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3782

Author(s):

Sylvia Kirchengast ◽

Beda Hartmann

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Pregnancy Outcome ◽

Gestational Age ◽

Very Low Birth Weight ◽

Extremely Low Birth Weight ◽

Negative Effects ◽

Gestational Length ◽

Live Births

The COVID 19 pandemic represents a major stress factor for non-infected pregnant women. Although maternal stress during pregnancy increases the risk of preterm birth and intrauterine growth restriction, an increasing number of studies yielded no negative effects of COVID 19 lockdowns on pregnancy outcome. The present study focused on pregnancy outcome during the first COVID 19 lockdown phase in Austria. In particular, it was hypothesized that the national lockdown had no negative effects on birth weight, low birth weight rate and preterm birth rate. In a retrospective medical record-based single center study, the outcome of 669 singleton live births in Vienna Austria during the lockdown phase between March and July 2020 was compared with the pregnancy outcome of 277 live births at the same hospital during the pre-lockdown months of January and February 2020 and, in addition, with the outcome of 28,807 live births between 2005 and 2019. The rate of very low gestational age was significantly lower during the lockdown phase than during the pre-lockdown phase. The rate of low gestational age, however, was slightly higher during the lockdown phase. Mean birth weight was significantly higher during the lockdown phase; the rates of low birth weight, very low birth weight and extremely low birth weight were significantly lower during the lockdown phase. In contrast, maternal gestational weight gain was significantly higher during the lockdown phase. The stressful lockdown phase in Austria seems to have no negative affect on gestational length and newborn weight among non-infected mothers.

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Low Birth Weight, Vital Records, and Infant Mortality

PEDIATRICS ◽

10.1542/peds.78.6.1143 ◽

1986 ◽

Vol 78 (6) ◽

pp. 1143-1145

Author(s):

MYRON E. WEGMAN

Keyword(s):

Birth Weight ◽

Infant Mortality ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

The United States ◽

Low Birth Weight Infants ◽

Neonatal Deaths ◽

Live Births ◽

Order Of Magnitude ◽

Almost All

About one tenth of all infant deaths occur in babies weighing less than 500 g at birth, almost all of whom die very shortly thereafter. In 1983, when the United States reported 3,638,933 live births, 4,368 of them were less than 500 g; that year there were 26,507 neonatal deaths. This means that slightly more than 0.1% of all live births contributed to 17% of neonatal mortality. Given this order of magnitude, any change in the numbers relating to these tiny babies can have a disproportionate influence on reported infant mortality and on interstate comparisons. Two questions promptly arise. How accurate and meaningful are the data regarding babies born weighing less than 500 g? What can be done to decrease the deaths in this category? Wilson et al1 call attention to how the number of very low birth weight infants reported by a state may be affected by the state's definition of a live birth.

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Impact of Lockdown Measures during COVID-19 Pandemic on Pregnancy and Preterm Birth

American Journal of Perinatology ◽

10.1055/s-0041-1739357 ◽

2021 ◽

Author(s):

Belal Alshaikh ◽

Po-Yin Cheung ◽

Nancy Soliman ◽

Marie-Anne Brundler ◽

Kamran Yusuf

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Pregnancy Outcomes ◽

Very Low Birth Weight ◽

Gestational Hypertension ◽

Cohort Analysis ◽

Preterm Births ◽

Live Births ◽

Very Preterm

Objective The objective of this study is to assess the effect of the lockdown measures during the coronavirus disease 2019 (COVID-19) pandemic on pregnancy outcomes of women who were not affected by severe acute respiratory syndrome coronavirus 2 infection. Study Design We used data from the perinatal health program and neonatal databases to conduct a cohort analysis of pregnancy outcomes during the COVID-19 lockdown in the Calgary region, Canada. Rates of preterm birth were compared between the lockdown period (March 16 to June 15, 2020) and the corresponding pre-COVID period of 2015 to 2019. We also compared maternal and neonatal characteristics of preterm infants admitted to neonatal intensive care units (NICUs) in Calgary between the two periods. Findings A total of 4,357 and 24,160 live births occurred in the lockdown and corresponding pre-COVID period, respectively. There were 366 (84.0 per 1,000 live births) and 2,240 (92.7 per 1,000 live births) preterm births in the lockdown and corresponding pre-COVID period, respectively (p = 0.07). Rates of very preterm and very-low-birth-weight births were lower in the lockdown period compared with the corresponding pre-COVID period (11.0 vs. 15.6 and 9.0 vs. 14.4 per 1,000 live births, p = 0.02 and p = 0.005, respectively). There was no difference in spontaneous stillbirth between the two periods (3.7 vs. 4.1 per 1,000 live birth, p = 0.71). During the lockdown period, the likelihood of multiple births was lower (risk ratio [RR] 0.73, 95% confidence interval [CI]: 0.60–0.88), while gestational hypertension and clinical chorioamnionitis increased (RR 1.24, 95%CI: 1.10–1.40; RR 1.33, 95%CI 1.10–1.61, respectively). Conclusion Observed rates of very preterm and very-low-birth-weight births decreased during the COVID-19 lockdown. Pregnant women who delivered during the lockdown period were diagnosed with gestational hypertension and chorioamnionitis more frequently than mothers in the corresponding pre-COVID period. Key Points

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Reduction in preterm births during the COVID-19 lockdown in Ireland: a natural experiment allowing analysis of data from the prior two decades

10.1101/2020.06.03.20121442 ◽

2020 ◽

Cited By ~ 2

Author(s):

RK Philip ◽

H Purtill ◽

E Reidy ◽

M Daly ◽

M Imcha ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Rate Ratio ◽

Birth Rate ◽

Very Low Birth Weight ◽

Preterm Births ◽

List Type ◽

Live Births ◽

New Findings

AbstractBackgroundAetiology of preterm birth (PTB) is heterogeneous and preventive strategies remain elusive. Socio-environmental measures implemented as Ireland’s prudent response to the SARS-CoV-2 virus (COVID-19) pandemic represented, in effect, a national lockdown and have possibly influenced the health and wellbeing of pregnant women and unborn infants. Cumulative impact of such socio-environmental factors operating contemporaneously on PTB has never been assessed before.MethodsRegional PTB trends of very low birth weight (VLBW) infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Observed regional data from January – April 2020 were compared to historical regional and national data and forecasted national figures for 2020.ResultsPoisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI: 7.21, 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed. The rate ratio of 3.77 (95% CI: 1.21, 11.75), p = 0.022, estimates that for the last two decades there was, on average, 3.77 times the rate of VLBW, compared to the period January to April 2020 during which there is a 73% reduction. National Irish VLBW rate for 2020 is forecasted to be reduced to 400 per 60,000 births compared to the historical 500-600 range.ConclusionAn unprecedented reduction in PTB of VLBW infants was observed in one health region of Ireland during the COVID-19 lockdown. Potential determinants of this unique temporal trend reside in the summative socio-environmental impact of the COVID-19 dictated lockdown. Our findings, if mirrored in other regions that have adopted similar measures to combat the pandemic, demonstrate the potential to evaluate these implicated interdependent behavioural and socio-environmental modifiers to positively influence PTB rates globally.Key QuestionsWhat is already known?Premature birth is an important contributor for under-five mortality globally.Currently there is no broadly accepted and effective strategy to prevent the birth of premature very low birth weight infants.Impact of socio-environmental and maternal behavioural modifications on the incidence of preterm birth has not been assessed.What are the new findings?COVID-19-triggered national lockdown in Ireland created an opportunity to study the cumulative influence of socio-environmental modifications on pregnant mothers.An unprecedented 73% reduction in the rate of very low birth weight deliveries was noted in one designated health region of Ireland during January to April of 2020 in comparison to the preceding 20 year timeframe.Our observations, if nationally mirrored, indicate that birth rate of very low birth weight premature infants in Ireland is forecasted to decrease considerably in 2020.What do the new findings imply?Socially rooted modifiers such as family support, work related stress and commuting, environmental pollution, infection avoidance, sleep and nutritional support, adequate exercise, reduced exposure to tobacco and illicit drugs, avoidance of financial strain, all cumulatively could contribute to reduce preterm birth rate.Our observations, if reflected in other countries that adopted COVID-19-prompted lockdown measures, would redefine the antecedents that trigger the yet poorly understood pathways leading to preterm births.Prematurity rate would be the most important ‘curve to bend’ in the context of reducing infant mortality globally and thus promote the achievement of sustainable development goals for children.

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Analysis of selected perinatological indicators in the Slovak Republic in the years 2007–2018

Česká gynekologie ◽

10.48095/cccg2021102 ◽

2021 ◽

Vol 86 (2) ◽

pp. 102-109

Author(s):

Miroslav Korbeľ ◽

◽

Pavel Kaščák ◽

zuzana Nižňanská

Keyword(s):

Birth Weight ◽

Mortality Rate ◽

Low Birth Weight ◽

Perinatal Mortality ◽

Total Fertility Rate ◽

Very Low Birth Weight ◽

Slovak Republic ◽

In Utero ◽

Fertility Rate ◽

Live Births

Overview Objective: Analysis of perinatal mortality in the Slovak Republic during the years 2007–2018. Methods: Analysis of prospectively collected selected perinatal data in the years 2007–2018. Results: In the year 2007, there were 63 obstetrics units, 51,146 deliveries and that of live births 51,650 in the Slovak Republic. The number of obstetrics units decreased to 51 in the years 2018, the total number of deliveries increased to 57,085 and that of live births increased to 57,773. The total fertility rate in the years 2007–2018 increased from 1.27 to 1.54. The preterm deliveries rate increased from 7.3% in the year 2007 to 8.5% in the year 2010 and decreased to 7% in the year 2018. The perinatal mortality rate decreased from 6.2 in the year 2007 to 4.4 in the year 2017, increased again in the years 2018 to 5.0 and according to the criteria of WHO (World Health Organization) to 6.6 per 1,000 still- and live-births. During the years 2007–2018 at perinatal mortality stillbirth participate with 65%, low birth weight with 63% and severe congenital anomalies with 19%. Transport in utero to perinatological centers in the years 2007–2018 has decreased from 57 to 56% for infants 1,000–1,499 g and from 75 to 73% for infants below 1,000 g. Conclusion: In the year 2017, perinatology in the Slovak Republic reached the best result in the perinatal mortality rate – 4.4‰ (0.44%), but has increased to over 5‰ next year. To further reduce perinatal mortality in the Slovak Republic, it is necessary to improve the prenatal diagnosis of severe congenital abnormalities, transport in utero of very low birth weight fetuses, centralization of high-risk pregnancies, obstetric personnel and material-technical equipment of obstetricians and neonatal intensive care units. Keywords: perinatal mortality – preterm delivery – multiple pregnancy – low birth weight – very low birth weight – total fertility rate

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Will Neonatology Vanish in 1995?

PEDIATRICS ◽

10.1542/peds.77.5.792 ◽

1986 ◽

Vol 77 (5) ◽

pp. 792-793

Author(s):

EMILE PAPIERNIK

Keyword(s):

United States ◽

Birth Weight ◽

Low Birth Weight ◽

Prevention Program ◽

Very Low Birth Weight ◽

The United States ◽

Low Birth Weight Infants

In Reply.— The interest of neonatologists in preventing preterm deliveries is remarkable in the United States. In France, where a policy of prevention was developed nationally in 1971, the first impulse also came from the neonatologists and specifically Alex Minkowski, who challenged the obstetricians to propose a real prevention program. The results of this program have now been published.1 incidence of very low birth weight infants in France in 1972 was 0.8 and in 1981 0.4.2

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IS BEING A PREMATURE OR HAVING ABNORMAL BIRTH WEIGHT ASSOCIATED WITH DEPRESSION AMONG 6 - 17 YEARS OLD U.S. CHILDREN?

Paediatrics & Child Health ◽

10.1093/pch/pxy054.130 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e51-e51

Author(s):

Abdulaziz Bahassan ◽

Colin Depp

Keyword(s):

Mental Health ◽

United States ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

The United States ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Health ◽

History Of

Abstract BACKGROUND Reports in 2015 showed that premature birth rate in the United States increased when compared to 2014 data, and this was the first increment since 2007. Major complications of prematurity and birth weight abnormalities are well known, but other complications including mental health abnormalities require more investigation to understand their association well. OBJECTIVES We aimed in this study to determine if prematurity and birth weight abnormalities including very low birth weight (VLBW) and low birth weight (LBW) are associated with depression among United States children aged between six and seventeen years old. DESIGN/METHODS This is a cross sectional study using data from the National Survey of Children’s Health (NSCH) 2011–2012. When we applied our selection criteria, 84,182 children out of the total 95,677 NSCH population were selected. Our exclusion criteria were: age less than six years, child’s history of cerebral palsy, and mental retardation. Multivariable logistic regression was done to control for confounding effects when studying the association of prematurity, birth weight abnormalities and depression. RESULTS Our results reveal that 3.6% of our population had history of depression, 11% were born prematurely, 7.4% had low birth weight, and 1.5% had very low birth weight. Depression was more frequent in children who were born prematurely (prevalence 4.3%) when compared to children born at term. Different models were built to analyze the association between prematurity, birth weight abnormalities and depression. There was no detectable statistically significant association when controlling for demographic data (age, gender, race, family structure) and mental health risk factors (parental poor mental health, chronic health conditions) as well as other factors. Results reveal that children who had chronic health conditions or had adverse family experiences have greater odds of having depression. On the other hand, African-American, male, and younger (6–11 years old) children have lower odds of depression. CONCLUSION Further longitudinal studies are required to establish a causal relationship of behavioral and psychological complications, and to determine the biological mechanisms of brain development that could be associated with depression among premature infants or those who have birth weight abnormalities.

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Polymorphisms of haemostasis genes as risk factors for preterm delivery

Thrombosis and Haemostasis ◽

10.1160/th04-10-0653 ◽

2005 ◽

Vol 94 (07) ◽

pp. 88-92 ◽

Cited By ~ 19

Author(s):

Christoph Härtel ◽

Sören von Otte ◽

Julia Koch ◽

Peter Ahrens ◽

Evelyn Kattner ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Preterm Delivery ◽

Factor Xiii ◽

Very Low Birth Weight ◽

Factor V Leiden ◽

Factor Vii ◽

Factor V

SummaryClinical trials evaluating the potential benefit of anticoagulant treatment in pregnant women with inherited thrombophilia are based on the observation that a genetic predisposition to thrombosis is associated with frequent abortions and preterm birth. It was the aim of our study to delineate the impact of genetic polymorphisms with prothrombotic and antithrombotic effects on the occurrence of preterm birth in a large cohort of very-low-birth-weight (VLBW)-infants and their mothers. We examined the factor V Leiden and the prothrombin G20210A mutation, the factor VII 121del/ins and the factor XIII Val34Leu polymorphism in preterm very-low-birth-weight (VLBW, n=593) and term-born-infants (n=278) and their mothers (n=785).The primary outcome was preterm vs. term birth. From all polymorphisms tested, the maternal factor VII-121del/ins polymorphism (26.2 vs. 17.6 %; p=0.009) and the infant’s factor VII-121del/ins polymorphism (29.0 vs. 20.0 %; p=0.009) were more frequent in singletonVLBW and their mothers compared to term infants and their mothers. Furthermore, the frequency of the factor XIII-Val34Leu polymorphism was significantly lower in singleton VLBW than in term infant controls (5.1 vs. 9.6%, p=0.025). In a multivariate regression analysis, previous preterm delivery (OR=3.8, 95% CI: 1.7–8.4), the maternal carrier status of the factor-VII-121del/ins polymorphism (OR=1.7, 95% CI: 1.12–2.5, p=0.007) and the lower frequency of infant’s factor-XIII-Val34Leu polymorphism (OR=0.53; 95% CI: 0.29–0.96; p=0.038) were found to be independently associated with preterm delivery. InVLBW mothers with pathological CTG as cause of preterm delivery, the frequency of factor V Leiden mutation was significantly increased compared to VLBW mothers without pathological CTG (14.1 vs. 6.1%, p=0.01).The investigated haemostasis gene polymorphisms have a much lower impact on subsequent preterm delivery than known risk factors such as previous preterm birth. The reported association of the factor-VII-121del/ins polymorphism on preterm delivery and its clinical relevance needs to be further elucidated.

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