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Changes in Preterm Birth and Stillbirth During Covid-19 Lockdowns in 26 Countries Publisher Pubmed



Calvert C1 ; Brockway MM2 ; Zoega H3, 4 ; Miller JE5, 6 ; Been JV7 ; Amegah AK11 ; Racinepoon A12 ; Oskoui SE1 ; Abok II13 ; Aghaeepour N14 ; Akwaowo CD15, 16 ; Alshaikh BN17 ; Ayede AI18 ; Bacchini F19 Show All Authors
Authors
  1. Calvert C1
  2. Brockway MM2
  3. Zoega H3, 4
  4. Miller JE5, 6
  5. Been JV7
  6. Amegah AK11
  7. Racinepoon A12
  8. Oskoui SE1
  9. Abok II13
  10. Aghaeepour N14
  11. Akwaowo CD15, 16
  12. Alshaikh BN17
  13. Ayede AI18
  14. Bacchini F19
  15. Barekatain B20
  16. Barnes R21
  17. Bebak K22
  18. Berard A23, 24, 25
  19. Bhutta ZA26, 27
  20. Brook JR28
  21. Bryan LR29
  22. Cajachaguatorres KN30, 31, 32
  23. Campbellyeo M33
  24. Chu DT34
  25. Connor KL35
  26. Cornette L36
  27. Cortes S37
  28. Daly M38
  29. Debauche C39, 40
  30. Dedeke IOF41
  31. Einarsdottir K4, 42
  32. Engjom H43
  33. Estradagutierrez G44
  34. Fantasia I45
  35. Fiorentino NM2
  36. Franklin M46
  37. Fraser A47
  38. Gachuno OW48
  39. Gallo LA49
  40. Gissler M50, 51, 52
  41. Haberg SE53
  42. Habibelahi A54
  43. Haggstrom J55
  44. Hookham L56
  45. Hui L57
  46. Huicho L58
  47. Hunter KJ1
  48. Huq S59
  49. Kc A60
  50. Kadambari S61
  51. Kelishadi R62
  52. Khalili N63
  53. Kippen J22
  54. Le Doare K64, 65
  55. Llorca J66, 67
  56. Magee LA68
  57. Magnus MC53
  58. Man KKC69, 70, 71
  59. Mburugu PM72
  60. Mediratta RP73
  61. Morris AD74
  62. Muhajarine N75
  63. Mulholland RH1
  64. Bonnard LN76
  65. Nakibuuka V77
  66. Nassar N78
  67. Nyadanu SD42, 79
  68. Oakley L53, 80
  69. Oladokun A81
  70. Olayemi OO81
  71. Olutekunbi OA82
  72. Oluwafemi RO83
  73. Ogunkunle TO84
  74. Orton C85
  75. Ortqvist AK86, 87
  76. Ouma J88
  77. Oyapero O89
  78. Palmer KR90
  79. Pedersen LH91
  80. Pereira G53, 92
  81. Pereyra I93
  82. Philip RK94
  83. Pruski D22
  84. Przybylski M22
  85. Quezadapinedo HG30, 31, 32
  86. Regan AK95
  87. Rhoda NR96, 97
  88. Rihs TA98
  89. Riley T99
  90. Rocha TAH100
  91. Rolnik DL90
  92. Saner C5, 101, 102
  93. Schneuer FJ103
  94. Souter VL104
  95. Stephansson O86
  96. Sun S105
  97. Swift EM106
  98. Szabo M107
  99. Temmerman M108
  100. Tooke L109
  101. Urquia ML110
  102. Von Dadelszen P68
  103. Wellenius GA105
  104. Whitehead C111
  105. Wong ICK69, 70, 71
  106. Wood R1, 112
  107. Wroblewskaseniuk K113
  108. Yeboahantwi K114
  109. Yilgwan CS115
  110. Zawiejska A116
  111. Sheikh A1
  112. Rodriguez N2
  113. Burgner D5, 6
  114. Stock SJ1
  115. Azad MB2, 117
Show Affiliations
Authors Affiliations
  1. 1. Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
  2. 2. Children’s Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
  3. 3. School of Population Health, Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, NSW, Australia
  4. 4. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  5. 5. Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia
  6. 6. Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
  7. 7. Division of Neonatology, Department of Paediatrics
  8. 8. Department of Obstetrics and Gynaecology
  9. 9. Department of Public Health
  10. 10. Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
  11. 11. Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
  12. 12. Novartis, Basel, Switzerland
  13. 13. Department of Pediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
  14. 14. Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, United States
  15. 15. Institute of Health Research and Development, University of Uyo Teaching Hospital, Uyo, Nigeria
  16. 16. College of Health Sciences, University of Uyo, Uyo, Nigeria
  17. 17. Department of Pediatrics, University of Calgary, Calgary, AB, Canada
  18. 18. Department of Pediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
  19. 19. Canadian Premature Babies Foundation, Toronto, ON, Canada
  20. 20. Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  21. 21. Aridhia Informatics, Glasgow, United Kingdom
  22. 22. Obstetrics and Gynaecology Ward, District Public Hospital in Poznan, Poznan, Poland
  23. 23. Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
  24. 24. CHU Ste-Justine, Montreal, QC, Canada
  25. 25. Faculty of Medicine, Universite Claude Bernard Lyon 1, Lyon, France
  26. 26. Center of Excellence in Women Child Health, The Aga Khan University, Karachi, Pakistan
  27. 27. Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
  28. 28. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  29. 29. Department of Obstetrics & Gynaecology and Child Health, University of The West MonaIndies, Mona, Jamaica
  30. 30. The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  31. 31. The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  32. 32. Centro de Investigacion en Salud Materna e Infantil and Centro de Investigacion para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
  33. 33. School of Nursing, Dalhousie University and IWK Health, Halifax, NS, Canada
  34. 34. Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Viet Nam
  35. 35. Department of Health Sciences, Carleton University, Ottawa, ON, Canada
  36. 36. AZ St-Jan Bruges-Ostend AV Hospital, Bruges, Belgium
  37. 37. Department of Public Health, School of Medicine, Advanced Center for Chronic Diseases Diagonal (ACCDIS), Santiago, Chile
  38. 38. Irish Neonatal Health Alliance, Wicklow, Ireland
  39. 39. Department of Neonatology, Cliniques Universitaires Saint-Luc, IREC, UCLouvain, Brussels, Belgium
  40. 40. CEpiP (Centre d’Epidemiologie Perinatale), Brussels, Belgium
  41. 41. Department of Paediatrics, Federal Medical Centre, Abeokuta, Nigeria
  42. 42. Curtin School of Population Health, Curtin University, Perth, WA, Australia
  43. 43. Department of Health Registry Research and Development, Norwegian Institute of Public Health, Oslo, Norway
  44. 44. National Institute of Perinatology, Mexico City, Mexico
  45. 45. Institute for Maternal and Child Health, IRCCS Burlo Garofolo Children’s Hospital, Trieste, Italy
  46. 46. Department of Statistical Sciences and School of the Environment, University of Toronto, Toronto, ON, Canada
  47. 47. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
  48. 48. Obstetrics and Gynecology, Medicine, University of Nairobi, Nairobi, Kenya
  49. 49. School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
  50. 50. Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
  51. 51. Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
  52. 52. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  53. 53. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
  54. 54. Neonatology, Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Iran
  55. 55. Cytel, Waltham, MA, United States
  56. 56. St. George’s University, Makerere University - Johns Hopkins University Research Collaboration, London, United Kingdom
  57. 57. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
  58. 58. Centro de Investigacion en Salud Materna e Infantil, Centro de Investigacion para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  59. 59. Nutrition and Clinical Services Division, ICDDR, B (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
  60. 60. Uppsala University, Uppsala, Sweden
  61. 61. Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
  62. 62. Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
  63. 63. Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  64. 64. International Centre for Neonatal and Paediatric Infection, St. George’s, University of London, London, United Kingdom
  65. 65. Medical Research Council/Uganda Virus Research Institute and London School of Medical Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
  66. 66. Universidad de Cantabria, Santander, Spain
  67. 67. CIBERESP (Consortium for Biomedical Research in Epidemiology & Public Health, en Epidemiologia y Salud Publica), Madrid, Spain
  68. 68. Institute of Women and Children’s Health, School of Life Course and Population Sciences, King’s College London, London, United Kingdom
  69. 69. Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
  70. 70. Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
  71. 71. Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong
  72. 72. Department of Child Health and Paediatrics, School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
  73. 73. Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
  74. 74. Health Data Research UK, London, United Kingdom
  75. 75. Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
  76. 76. Melletted a helyem Egyesulet, Right(s) Beside You Association, Budapest, Hungary
  77. 77. Department of Paediatrics, St. Francis Nsambya Hospital, Kampala, Uganda
  78. 78. Child Population and Translational Health Research, Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  79. 79. Education, Culture, and Health Opportunities (ECHO) Research Group International, Aflao, Ghana
  80. 80. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  81. 81. Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
  82. 82. Lagos Island Maternity Hospital, Lagos, Nigeria
  83. 83. Department of Paediatrics and Child Health, Mother and Child Hospital, Akure, Nigeria
  84. 84. Department of Paediatrics, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
  85. 85. Swansea University, Swansea, United Kingdom
  86. 86. Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
  87. 87. Department of Obstetrics and Gynecology, Visby County Hospital, Visby, Sweden
  88. 88. Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
  89. 89. Paediatrics Department, Ikorodu General Hospital, Ikorodu, Nigeria
  90. 90. Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
  91. 91. Department of Obstetrics and Gynecology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
  92. 92. Curtin School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
  93. 93. School of Nutrition, Catholic University del Maule, Region del Maule, Chile
  94. 94. Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick and University of Limerick School of Medicine, Limerick, Ireland
  95. 95. School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States
  96. 96. Paediatric Department, School of Adolescent and Child Health, University of Cape Town, Cape Town, South Africa
  97. 97. Mowbray Maternity Hospital, Western Cape Department of Health, Cape Town, South Africa
  98. 98. Federal Statistical Office (FSO), Neuchatel, Switzerland
  99. 99. Department of Epidemiology, University of Washington, Seattle, WA, United States
  100. 100. Evidence and Intelligence for Action in Health Department, Pan-American Health Organization - World Health Organization, Washington, DC, United States
  101. 101. Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  102. 102. Department of Biomedical Research, University of Bern, Bern, Switzerland
  103. 103. The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  104. 104. Foundation for Health Care Quality, Seattle, WA, United States
  105. 105. Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
  106. 106. Faculty of Nursing, Department of Midwifery, University of Iceland, Reykjavik, Iceland
  107. 107. Division of Neonatology, 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
  108. 108. Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
  109. 109. Department of Paediatrics, University of Cape Town, Cape Town, South Africa
  110. 110. Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
  111. 111. The Royal Women’s Hospital, University of Melbourne, Melbourne, VIC, Australia
  112. 112. Public Health Scotland, Edinburgh, United Kingdom
  113. 113. II Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
  114. 114. Public Health Unit, Father Thomas Alan Rooney Memorial Hospital, Asankrangwa, Western Region, Ghana
  115. 115. Department of Paediatrics, University of Jos, Jos, Nigeria
  116. 116. Department of Medical Simulation, Chair of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
  117. 117. Departments of Pediatrics and Child Health, Community Health Sciences, and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada, Winnipeg, MB, Canada

Source: Nature Human Behaviour Published:2023


Abstract

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. © 2023, The Author(s).
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