Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Calvert, ClaraORCID logo; Brockway, Meredith Merilee; Zoega, HelgaORCID logo; Miller, Jessica EORCID logo; Been, Jasper VORCID logo; Amegah, Adeladza KofiORCID logo; Racine-Poon, Amy; Oskoui, Solmaz Eradat; Abok, Ishaya IORCID logo; Aghaeepour, NimaORCID logo; +105 more...Akwaowo, Christie DORCID logo; Alshaikh, Belal NORCID logo; Ayede, Adejumoke IORCID logo; Bacchini, FabianaORCID logo; Barekatain, BehzadORCID logo; Barnes, RodrigoORCID logo; Bebak, Karolina; Berard, Anick; Bhutta, Zulfiqar A; Brook, Jeffrey R; Bryan, Lenroy RORCID logo; Cajachagua-Torres, Kim NORCID logo; Campbell-Yeo, Marsha; Chu, Dinh-Toi; Connor, Kristin LORCID logo; Cornette, Luc; Cortés, SandraORCID logo; Daly, Mandy; Debauche, Christian; Dedeke, Iyabode Olabisi F; Einarsdóttir, KristjanaORCID logo; Engjom, HildeORCID logo; Estrada-Gutierrez, GuadalupeORCID logo; Fantasia, IlariaORCID logo; Fiorentino, Nicole M; Franklin, MeredithORCID logo; Fraser, Abigail; Gachuno, Onesmus W; Gallo, Linda A; Gissler, Mika; Håberg, Siri E; Habibelahi, Abbas; Häggström, Jonas; Hookham, LaurenORCID logo; Hui, Lisa; Huicho, LuisORCID logo; Hunter, Karen JORCID logo; Huq, Sayeeda; Kc, AshishORCID logo; Kadambari, Seilesh; Kelishadi, Roya; Khalili, Narjes; Kippen, Joanna; Le Doare, Kirsty; Llorca, Javier; Magee, Laura AORCID logo; Magnus, Maria C; Man, Kenneth KCORCID logo; Mburugu, Patrick MORCID logo; Mediratta, Rishi PORCID logo; Morris, Andrew D; Muhajarine, Nazeem; Mulholland, Rachel H; Bonnard, Livia Nagy; Nakibuuka, Victoria; Nassar, Natasha; Nyadanu, Sylvester DORCID logo; Oakley, LauraORCID logo; Oladokun, AdesinaORCID logo; Olayemi, Oladapo O; Olutekunbi, Olanike AORCID logo; Oluwafemi, Rosena OORCID logo; Ogunkunle, Taofik OORCID logo; Orton, Chris; Örtqvist, Anne K; Ouma, JosephORCID logo; Oyapero, Oyejoke; Palmer, Kirsten RORCID logo; Pedersen, Lars HORCID logo; Pereira, GavinORCID logo; Pereyra, IsabelORCID logo; Philip, Roy KORCID logo; Pruski, Dominik; Przybylski, Marcin; Quezada-Pinedo, Hugo G; Regan, Annette K; Rhoda, Natasha R; Rihs, Tonia A; Riley, Taylor; Rocha, Thiago Augusto Hernandes; Rolnik, Daniel LORCID logo; Saner, ChristophORCID logo; Schneuer, Francisco JORCID logo; Souter, Vivienne L; Stephansson, OlofORCID logo; Sun, Shengzhi; Swift, Emma M; Szabó, Miklós; Temmerman, MarleenORCID logo; Tooke, LloydORCID logo; Urquia, Marcelo L; von Dadelszen, PeterORCID logo; Wellenius, Gregory AORCID logo; Whitehead, Clare; Wong, Ian CKORCID logo; Wood, RachaelORCID logo; Wróblewska-Seniuk, KatarzynaORCID logo; Yeboah-Antwi, KojoORCID logo; Yilgwan, Christopher S; Zawiejska, AgnieszkaORCID logo; Sheikh, AzizORCID logo; Rodriguez, Natalie; Burgner, DavidORCID logo; Stock, Sarah JORCID logo; and Azad, Meghan BORCID logo (2023) Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries. Nature human behaviour, 7 (4). pp. 529-544. ISSN 2397-3374 DOI: 10.1038/s41562-023-01522-y
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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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