Changes in preterm birth and caesarean deliveries in the United States during the SARS‐CoV‐2 pandemic
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Abstract
Background
Preliminary studies suggest that the SARS‐CoV‐2 pandemic and associated social, economic and clinical disruptions have affected pregnancy decision‐making and outcomes. Whilst a few US‐based studies have examined regional changes in birth outcomes during the pandemic's first months, much remains unknown of how the pandemic impacted perinatal health indicators at the national‐level throughout 2020, including during the ‘second wave’ of infections that occurred later in the year.
Objectives
To describe changes in monthly rates of perinatal health indicators during the 2020 pandemic for the entire US.
Methods
For the years 2015 to 2020, we obtained national monthly rates (per 100 births) for four perinatal indicators: preterm (<37 weeks’ gestation), early preterm (<34 weeks’ gestation), late preterm (34–36 weeks’ gestation) and caesarean delivery. We used an interrupted time‐series approach to compare the outcomes observed after the pandemic began (March 2020) to those expected had the pandemic not occurred for March through December of 2020.
Results
Observed rates of preterm birth fell below expectation across several months of the 2020 pandemic. These declines were largest in magnitude in early and late 2020, with a 5%–6% relative difference between observed and expected occurring in March and November. For example, in March 2020, the observed preterm birth rate of 9.8 per 100 live births fell below the 95% prediction interval (PI) of the rate predicted from history, which was 10.5 preterm births per 100 live births (95% PI 10.2, 10.7). We detected no changes from expectation in the rate of caesarean deliveries.
Conclusions
Our findings provide nationwide evidence of unexpected reductions in preterm delivery during the 2020 SARS‐CoV‐2 pandemic in the US. Observed declines below expectation were differed by both timing of delivery and birth month, suggesting that several mechanisms, which require further study, may explain these patterns.
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SciScore for 10.1101/2021.03.20.21253990: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Institutional review board approval was not required because the deidentified data are publicly available. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. 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:A key limitation of this study is that the released provisional data from 2020 did not allow us to examine other outcomes, …
SciScore for 10.1101/2021.03.20.21253990: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Institutional review board approval was not required because the deidentified data are publicly available. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. 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:A key limitation of this study is that the released provisional data from 2020 did not allow us to examine other outcomes, particular subgroups, or severely affected geographies. Future detailed data will allow researchers to study the patterns we identify here in greater detail, including changes in fertility decisions and other proposed mechanisms (e.g., elevated selection in utero, reduced air pollution, and changes in clinical practice) that may have caused the observed outcomes.
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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