Increased adverse pregnancy outcomes among decreased assisted reproductions during the COVID-19 pandemic: insights from a birth cohort study in Southwest China

Abstract

Objectives: We elucidate the impact of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproductive technology (ART) services and birth outcomes and establish an evidence-based framework to maintain the high quality of ART healthcare services and ensure continuous improvement of birth outcomes.

Methods: A total of 19,170 pregnant women from Sichuan, Guizhou and Chongqing in Southwest China between 2018 and 2021 were included in this study. The log-binomial regression model was employed to analyse the changes in the probability of adverse birth outcomes, such as low birth weight (LBW), preterm birth (PTB), Apgar score < 7 at 1 min and congenital anomalies (CAs) and their relationship with ART before and after the pandemic. In this analysis, confounding factors such as family annual income, maternal ethnicity, delivery age, subjective prenatal health status, vitamin or mineral supplementation during pregnancy and level of prenatal care provided by the hospital were controlled.

Results: ART mothers had the highest probability of giving birth to LBW babies (relative risk (RR): 2.82, 95% confidence interval (CI): 2.32-3.41), experiencing PTB (RR: 2.72, 95% CI: 2.78-3.22) and delivering babies with an Apgar score < 7 at 1 min (RR: 1.73, 95% CI: 1.05-2.69). Before the pandemic, the ART rate increased from 4.42% in 2018 to 6.71% in 2019 (rate difference of 2.29%, P < 0.001). After the pandemic, the ART rate decreased from 6.71% in 2019 to 6.55% in 2020 (rate difference of - 0.16%, P = 0.752). Compared with the pre-pandemic period, the rate difference for LBW decreased from - 0.21% (P = 0.646) in 2018-2019 to an increase of + 0.89% (P = 0.030) in 2019-2020. Similarly, PTB showed an increase in rate difference from + 0.20% (P = 0.623) before the pandemic to + 0.53% (P = 0.256) afterwards. Apgar score < 7 at 1 min had a negative rate difference of - 0.50% (P = 0.012), which changed to a positive value of + 0.20% (P = 0.340). For CAs, the rate difference increased from + 0.34% (P = 0.089) prior to the outbreak to + 0.59% (P = 0.102) at post-outbreak. In 2018 (pre-pandemic), ART was the most significant predictor of LBW, exhibiting an RR of 3.45 (95% CI: 2.57-4.53). Furthermore, in 2020, its RR was 2.49 (95% CI: 1.78-3.42). Prior to the onset of the pandemic (2018), ART (RR: 3.17, 95% CI: 2.42-4.08) was the most robust predictor of PTB. In 2020, its RR was 2.23 (95% CI: 1.65-2.97).

Conclusion: ART services have been significantly impacted by the COVID-19 pandemic, and the resulting delays in ART services have had notable implications for maternal birth outcomes.

Keywords: Apgar; CA; COVID-19; LBW; PTB.

Fig. 1

Association between assisted reproductive technology and birth outcomes before (left) and during (right) the pandemic. *SES: Sociodemographic and Economic Status Factors

Fig. 2

Flow chart of data collection in this study

Fig. 3

Incidence of assisted reproductive technology and adverse birth outcomes from 2018 to 2020

Fig. 4

Strength of the association between assisted reproductive technology and birth outcomes from 2018 to 2020. *The adjusted variables considered in this study encompass annual household income, ethnicity, maternal age at delivery, educational attainment, self-reported health status prior to pregnancy, vitamin or mineral supplementation status, hospital classification, pre-pregnancy body mass index (BMI) and parity

Fig. 5

Predictive power of influencing factors on low birth weight from 2018 to 2020. *The adjusted variables encompass all other factors listed in the variable column

Fig. 6

Predictive power of influencing factors on preterm birth from 2018 to 2020. *The adjusted variables encompass all other factors listed in the variable column