Covid-19 pandemic linked to worsened pregnancy outcomes for women and babies worldwide
Published: 01 April 2021
Pregnancy outcomes for mothers and babies have worsened during the Covid-19 pandemic, according to a review of data from 40 studies representing 17 countries, led by St George’s Professor Asma Khalil.
Published in The Lancet Global Health journal, the 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.
Mental health outcomes also worsened during the pandemic. Of the 10 studies included in the analysis that reported on maternal mental health, six reported an increase in postnatal depression, maternal anxiety, or both.
Overall, outcomes were worse in low- and middle-income countries as compared to high-income countries and the researchers say immediate action is required to preserve safe maternity care worldwide, especially during the global emergency.
Although the study did not analyse the direct impact of Covid-19 infection during pregnancy, it provides the first global assessment of the collateral impact of the pandemic on antenatal, birth, and postnatal outcomes.
Professor Asma Khalil, lead author of the study from St George’s, said: “The Covid-19 pandemic has had a profound impact on healthcare systems around the world. Disruption to services, nationwide lockdowns, and fear of attending health care facilities mean that the adverse effects of Covid-19 are expected to have health consequences that extend beyond the deaths and disease caused by the virus itself.
“It is clear from our study and others 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 prioritise safe, accessible, and equitable maternity care within the strategic response to the pandemic and aftermath, to reduce adverse pregnancy outcomes worldwide.”
Studies from individual countries have suggested that the pandemic has affected rates of stillbirth and pre-term birth, potentially as a result in a reduction of healthcare-seeking behaviour for fear of infection, as well as reduced provision of maternity services.
In this latest study, the researchers reviewed data from 40 studies that were published between 1st January 2020 and 8th January 2021, representing 17 countries and with data from more than 6 million pregnancies. All of the studies compared pregnancy outcomes during and before the pandemic.
The review did not find any difference in overall rates of pre-term birth before and during the pandemic. However, pooled data from studies from high-income countries suggest that, in this setting, the odds 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, rather than those requiring medically indicated early induction of labour or caesarean section, which may be increased. They say this means it is more likely that changes in health care delivery and population behaviours are contributing factors, which may bring valuable lessons for understanding the mechanisms underlying preterm birth.
The researchers found the variation in outcomes reported between different studies included in the paper may be partially explained by inefficiencies in health care systems in the countries studied. However, differences in pandemic mitigation responses between countries did not seem to affect the findings. The researchers say this suggests the increase in adverse pregnancy outcomes may be driven by pressures on health care systems caused by Covid-19 itself, rather than measures aimed at limiting the spread of the virus, such as lockdowns.
Dr Erkan Kalafat, a co-author of the study from Koc University, Turkey, said: “We have an unprecedented opportunity to learn from the experiences of the Covid-19 pandemic to plan for a future of inclusive and equitable maternity care worldwide. One such learning opportunity will be to investigate the mechanisms underlying the apparent reduction in pre-term births observed in high-income settings during the pandemic, with a view to identifying new preventative interventions that could potentially benefit all women worldwide.”
The authors note several limitations to their findings. Notably, the studies included in their analysis varied in the way pregnancy outcomes were defined and measured, which makes it difficult to compare results between studies. There were fewer studies from low- and middle-income settings, which may be concerning as the analysis shows substantial variation in outcomes between high- and low-income settings. The authors also note that they cannot exclude the risk of publication bias against studies reporting negative findings, although they did not find any evidence of bias when they tested for this.
This work extends a portfolio of research at St George’s to understand the impacts of the coronavirus pandemic. The University has launched a Coronavirus Action Fund to raise money for vital research into the pandemic and is actively seeking support for a broad research programme involving all parts of the University.