How has COVID-19 affected the outcome of pregnancies?

Bottom Line:

Stillbirth rates were shown to have increased over the course of the COVID-19 pandemic. Although it is possible this is a direct consequence of SARS-CoV-2 infection, other reasons for this trend should also be taken into consideration.

Reference:

Khalil, A. et al. Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic. JAMA (2020). https://doi.org/10.1001/jama.2020.12746

Date Published:

10 July 2020

Synopsis:

Stillbirth is defined as the death of a fetus when a woman is at, or beyond, 24 weeks of pregnancy, and preterm delivery is defined as going into labour earlier than 37 weeks of pregnancy. A study was done in London to determine how rates of stillbirth and preterm delivery have changed during the pandemic, compared to a pre-pandemic period in the UK. The only significant differences in the characteristics of women included in the study were a lower number of nulliparous women (i.e. women who have never given birth before) and women with high blood pressure in the pandemic period. The study showed that the incidence of stillbirth was higher during the pandemic period, however there were no differences seen in preterm births, C-sections, or hospital admissions of the newborn. The lower number of nulliparous women and women with high blood pressure during the pandemic period theoretically should have led to a lower risk of stillbirth, contrary to the results that were observed. However, it is possible that high blood pressure and other health conditions may have been missed during the pandemic period, since there were less face-to-face visits between the pregnant woman and her healthcare workers. None of the women who had a stillbirth had any symptoms of COVID-19, although asymptomatic infection may have been possible, and therefore SARS-CoV-2 infection may be directly linked to this increase rate of stillbirth. Other possible reasons for this increase in stillbirth rate are also important to consider, such as a hesitancy to seek medical care even if there was a cause for concern, fear of contracting COVID-19 from the hospital, obstetric staff shortages and a lower number of check-ups throughout the pregnancy.

Summary by: Caroline Gregory