Impact of COVID-19 Lockdown on the Incidence of Common Pregnancy Complications—Is the Diagnosis of IUGR Generally Made Too Generously?

Purpose In 2020 a lockdown due to COVID-19 was ordered by the German government resulting in population-wide restrictions in daily behaviour. In this retrospective study, we questioned whether the lockdown had an impact on the incidence of relevant pregnancy complications. Methods The incidence of relevant pregnancy complications was evaluated during all trimesters of pregnancy in a 6 month pre-pandemic period (April-September 2019) compared to the same period in the pandemic year 2020 including mothers and newborns who presented at the University Hospital St. Hedwig, Regensburg, Germany. Finally the incidence of preeclampsia and suspected IUGR (intrauterine growth retardation) as relevant obstetrical diseases was compared with a post-pandemic period (April-September 2023). Group comparisons were performed using Mann-Whitney-U-test, t-test, Fisher’s exact test and Chi-Square-test. Results 5137 newborn were included with 1709 born during the 6 month pre-pandemic, 1806 during the 6 month lockdown period and 1622 during the 6 month post-pandemic period. During the pandemic period, significantly less patients were hospitalized due to hyperemesis gravidarum (1.8% vs 0.9%, p=0.04). No differences were observed concerning the incidence of miscarriages before and after 14 weeks of gestation (WG), preterm deliveries (< 37 WG), gestational age at preterm birth and birth weight. Likewise, within preterm born babies no difference was observed in preeclampsia among the two periods. However, in the pandemic period, the frequency of preterm born babies with suspected IUGR was significantly lower than in the pre-pandemic period (1.5 % and 0.6 %, p=0.01). Regarding this point, we analyzed data of all newborns in the comparative post-pandemic period in 2023 (n=1622) resulting in a significantly increased IUGR incidence compared to the pandemic level and therefore returning to pre-pandemic level (1.5% and 1.4%, p=0.145). Conclusion Lockdown associated changes in the health and social behavior of physicians and patients led to modest but partially significant variation in the incidence of pregnancy complications. Less preterm delivered babies due to antepartum diagnosed IUGR indicate that the diagnosis was made much more restrictively during the pandemic than before. After all COVID-19-specific restrictions on elective and outpatient services were passed, the incidence of antepartum suspected IUGR returned to its initial level. This suggests that the diagnosis of IUGR – a solely machine-dependent and not symptom based diagnosis- was partly exaggerated before and after the pandemic.