A decline in planned, but not spontaneous, preterm birth rates in a large Australian tertiary maternity centre during COVID‐19 mitigation measures

  1. Linda A. Gallo
  2. Tania F. Gallo
  3. Danielle J. Borg
  4. Karen M. Moritz
  5. Vicki L. Clifton
  6. Sailesh Kumar

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Abstract

Reports from around the world suggest that rates of preterm birth decreased during COVID‐19 lockdown measures.

Aims

To compare the prevalence of preterm birth and stillbirth rates during COVID‐19 restriction measures with infants born at the same maternity centre during the same weeks in 2013–2019.

Materials and Methods

Deidentified data were extracted from the Mater Mothers’ healthcare records database. This is a supra‐regional tertiary perinatal centre. Logistic regressions were used to examine singleton live preterm birth rates during the beginning of COVID‐19 restrictions (16 March‐17 April; ‘early’; 6955 births) and during the strictest part of COVID‐19 restrictions (30 March‐1 May; ‘late’; 6953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Singleton stillbirth rates were also examined between 16 March–1 May.

Results

Planned moderate/late preterm births declined by more than half during early COVID‐19 restrictions compared with the previous seven years (29 vs an average of 64 per 1000 births; adjusted odds ratio 0.39, 95% CI 0.22–0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two‐week non‐significant spike in spontaneous preterm births from late April to early May, 2020.

Conclusions

Together with evidence from other nations, the pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth.

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  1. Version published to 10.1111/ajo.13406
  2. ScreenIT

    SciScore for 10.1101/2020.11.24.20237529: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical and governance approvals were obtained from the institution’s Human Research Ethics Committee and Governance and Privacy office respectively (Ref No: HREC/MML/61799).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableWomen with singleton pregnancies who birthed between 16th March to 1st May in years 2013-2020 were included in the main analyses.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: This was a retrospective data collection approach using a hospital database that had some missing data. We included all livebirths ≥23 completed weeks’ gestation, as active resuscitation and support is usually offered from this gestation depending on parental wishes. While our statistical analyses also included some babies who later died in hospital during March 16-May 1, 2013-2020 (N=21/9,986 singleton livebirths), we feel this is a better representation of the birthing population, especially of those born preterm. While there were no neonatal deaths during the spike in spontaneous preterm births, we did not examine other variables related to neonatal health (e.g. Apgar scores). It is also possible that we received fewer referrals from other local perinatal centres during the restriction period, due to patient avoidance of the tertiary setting.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.11.24.20237529v1 on medRxiv