IMPACT OF COVID-19 ON PREGNANCY AND PREGNANCY CARE

Evidence is accumulating to suggest that preoccupation with Covid-19 is resulting in collateral damage to persons with other health conditions. What has been the impact of Covid-19 on pregnancy? This question was examined by Khalil et al (2020) at St George’s University Hospital, London, UK.

These authors extracted data for pregnancy outcomes during 2 periods: between October 2019 and January 2020 (prepandemic period) and between February 2020 and June 2020 (pandemic period). There were 1681 vs 1718 births during these 2 periods, respectively.

Important findings were:

1. The incidence of stillbirth was significantly higher during the pandemic than during the control period (n=16 vs 4; 0.9% vs 0.2%, respectively). This was true even when late terminations of pregnancy for fetal abnormality were excluded (0.7% vs 0.1%, respectively). SARS-CoV-2 infection did not appear to be implicated in any case.

2. Pandemic and control periods did not differ significantly in the rates of birth before 37 weeks of gestation, births after 34 weeks of gestation, cesarean section, or neonatal unit admission.

Summary

This small obstetric study from a single hospital in London, UK, found that the risk of stillbirth more than quadrupled during pandemic relative to prepandemic months. However, the risks did not differ for premature births, cesarean section, or neonatal unit admission.

Comments

The study was based on small numbers and on a brief study period in a single hospital. There were no adjustments for potential confounds nor correction for multiple hypothesis testing. Nevertheless, it does suggest that antenatal care may have be compromised in some regards, resulting in at least one adverse outcome: an increased risk of stillbirth. Readers may note that this finding was observed despite the rates of nulliparity and hypertension being lower during the pandemic period (though the latter may have been underdiagnosed).

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