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. 2022 Aug 1;5(8):e2226531.
doi: 10.1001/jamanetworkopen.2022.26531.

Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-19 Pandemic

Rose L Molina  1   2 , Thomas C Tsai  3   4   5 , Dannie Dai  5 , Mark Soto  5 , Ning Rosenthal  6 , E John Orav  7 , Jose F Figueroa  5   7
Affiliations

Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-19 Pandemic

Rose L Molina et al. JAMA Netw Open. .

Erratum in

Abstract

Importance: Little is known about changes in obstetric outcomes during the COVID-19 pandemic.

Objective: To assess whether obstetric outcomes and pregnancy-related complications changed during the COVID-19 pandemic.

Design, setting, and participants: This retrospective cohort study included pregnant patients receiving care at 463 US hospitals whose information appeared in the PINC AI Healthcare Database. The relative differences in birth outcomes, pregnancy-related complications, and length of stay (LOS) during the pandemic period (March 1, 2020, to April 31, 2021) were compared with the prepandemic period (January 1, 2019, to February 28, 2020) using logistic and Poisson models, adjusting for patients' characteristics, and comorbidities and with month and hospital fixed effects.

Exposures: COVID-19 pandemic period.

Main outcomes and measures: The 3 primary outcomes were the relative change in preterm vs term births, mortality outcomes, and mode of delivery. Secondary outcomes included the relative change in pregnancy-related complications and LOS.

Results: There were 849 544 and 805 324 pregnant patients in the prepandemic and COVID-19 pandemic periods, respectively, and there were no significant differences in patient characteristics between periods, including age (≥35 years: 153 606 [18.1%] vs 148 274 [18.4%]), race and ethnicity (eg, Hispanic patients: 145 475 [47.1%] vs 143 905 [17.9%]; White patients: 456 014 [53.7%] vs 433 668 [53.9%]), insurance type (Medicaid: 366 233 [43.1%] vs 346 331 [43.0%]), and comorbidities (all standardized mean differences <0.10). There was a 5.2% decrease in live births during the pandemic. Maternal death during delivery hospitalization increased from 5.17 to 8.69 deaths per 100 000 pregnant patients (odds ratio [OR], 1.75; 95% CI, 1.19-2.58). There were minimal changes in mode of delivery (vaginal: OR, 1.01; 95% CI, 0.996-1.02; primary cesarean: OR, 1.02; 95% CI, 1.01-1.04; vaginal birth after cesarean: OR, 0.98; 95% CI, 0.95-1.00; repeated cesarean: OR, 0.96; 95% CI, 0.95-0.97). LOS during delivery hospitalization decreased by 7% (rate ratio, 0.931; 95% CI, 0.928-0.933). Lastly, the adjusted odds of gestational hypertension (OR, 1.08; 95% CI, 1.06-1.11), obstetric hemorrhage (OR, 1.07; 95% CI, 1.04-1.10), preeclampsia (OR, 1.04; 95% CI, 1.02-1.06), and preexisting chronic hypertension (OR, 1.06; 95% CI, 1.03-1.09) increased. No significant changes in preexisting racial and ethnic disparities were observed.

Conclusions and relevance: During the COVID-19 pandemic, there were increased odds of maternal death during delivery hospitalization, cardiovascular disorders, and obstetric hemorrhage. Further efforts are needed to ensure risks potentially associated with the COVID-19 pandemic do not persist beyond the current state of the pandemic.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Tsai reported receiving grants from Massachusetts Consortium on Pathogen Readiness underwritten by the Massachusetts Life Sciences Center during the conduct of the study and grants from the Commonwealth Fund, the William F. Milton Fund of Harvard University, and Arnold Ventures outside the submitted work. Dr Figueroa reported receiving grants from Arnold Ventures, and The Commonwealth Fund and Robert Wood Johnson Foundation during the conduct of the study as well as grants the Robert Wood Johnson Foundation, Arnold Ventures, the National Institute of Aging, the Episcopal Health Foundation, the Commonwealth Fund, and the Harvard Center for AIDS Research and personal fees from Humana outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Rates of Mortality Outcomes, January 2019 to April 2021
Vertical dotted line indicates the start of the COVID-19 pandemic.
Figure 2.
Figure 2.. Rates of Live Birth Outcomes and Mode of Delivery, January 2019 to April 2021
Vertical dotted line indicates the start of the COVID-19 pandemic.
Figure 3.
Figure 3.. Rates of Complications During Pregnancy and Birth, January 2019 to April 2021
Vertical dotted line indicates the start of the COVID-19 pandemic.
See this image and copyright information in PMC

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