Modest reduction in adverse birth outcomes following the COVID-19 lockdown

Abstract

Background: Widespread lockdowns imposed during the coronavirus disease 2019 crisis may impact birth outcomes.

Objective: This study aimed to evaluate the association between the COVID-19 lockdown and the risk of adverse birth outcomes in Botswana.

Study design: In response to the coronavirus disease 2019 crisis, Botswana enforced a lockdown that restricted movement within the country. We used data from an ongoing nationwide birth outcomes surveillance study to evaluate adverse outcomes (stillbirth, preterm birth, small-for-gestational-age fetuses, and neonatal death) and severe adverse outcomes (stillbirth, very preterm birth, very-small-for-gestational-age fetuses, and neonatal death) recorded prelockdown (January 1, 2020-April 2, 2020), during lockdown (April 3, 2020-May 7, 2020), and postlockdown (May 8, 2020-July 20, 2020). Using difference-in-differences analyses, we compared the net change in each outcome from the prelockdown to lockdown periods in 2020 relative to the same 2 periods in 2017-2019 with the net change in each outcome from the prelockdown to postlockdown periods in 2020 relative to the same 2 periods in 2017-2019.

Results: In this study, 68,448 women delivered a singleton infant in 2017-2020 between January 1 and July 20 and were included in our analysis (mean [interquartile range] age of mothers, 26 [22-32] years). Across the included calendar years and periods, the risk of any adverse outcome ranged from 27.92% to 31.70%, and the risk of any severe adverse outcome ranged from 8.40% to 11.38%. The lockdown period was associated with a 0.81 percentage point reduction (95% confidence interval, -2.95% to 1.30%) in the risk of any adverse outcome (3% relative reduction) and a 0.02 percentage point reduction (95% confidence interval, -0.79% to 0.75%) in the risk of any severe adverse outcome (0% relative reduction). The postlockdown period was associated with a 1.72 percentage point reduction (95% confidence, -3.42% to 0.02%) in the risk of any adverse outcome (5% relative reduction) and a 1.62 percentage point reduction (95% confidence interval, -2.69% to -0.55%) in the risk of any severe adverse outcome (14% relative reduction). Reductions in adverse outcomes were largest among women with human immunodeficiency virus and among women delivering at urban delivery sites, driven primarily by reductions in preterm birth and small-for-gestational-age fetuses.

Conclusion: Adverse birth outcomes decreased from the prelockdown to postlockdown periods in 2020, relative to the change during the same periods in 2017-2019. Our findings may provide insights into associations between mobility and birth outcomes in Botswana and other low- and middle-income countries.

Keywords: human immunodeficiency virus; mobility; neonatal death; pregnancy outcomes; preterm birth; small-for-gestational-age fetuses; stillbirth.

Figure 1

Staying-put percentage by region in Botswana, February 28, 2020 to July 24, 2020 Data are the average number of Facebook users with location services turned on that were present in the same 600×600-m grid location over a 24-hour period. Presence in the same location considered as global positioning system ping in at least 3 different time blocks of the day. Threshold: at least 300 unique users present. Baseline: average number of people staying put during the month of February 2020. Caniglia et al. Coronavirus disease 2019 lockdown and adverse birth outcomes in Botswana. Am J Obstet Gynecol 2021.

Figure 2

Weekly risk of any adverse and any severe adverse outcome Weekly risk of any adverse outcome (A) and any severe adverse outcome (B) over a 28-week period (January 3, 2020–July 16, 2020) compared with the same period (January 2 to July 16) in 2017–2019. The yellow vertical lines show the lockdown period. Caniglia et al. Coronavirus disease 2019 lockdown and adverse birth outcomes in Botswana. Am J Obstet Gynecol 2021.