Neonatal-Perinatal Medicine Fellow University of Alabama at Birmingham University of Alabama at Birmingham Birmingham, Alabama, United States
Background: Identification of changes in the pregnancy and perinatal outcomes in relation to the COVID-19 pandemic is important to inform strategies to mitigate the impact of the pandemic on adverse fetal-neonatal outcomes.
Objective: Hypothesis: The COVID-19 pandemic is associated with a higher rate of stillbirth and lower neonatal mortality.
Design/Methods: This cohort study compares two epochs: calendar weeks 9-35 (defined as week 1 starting on the first Sunday of the year) of the years 2014-2019 (baseline period), and 2020 (pandemic period). The study period was selected from the start of the pandemic period (March 2020, week 9) to the availability of provisional data (August 2020, week 35) and corresponding calendar weeks in the baseline period. The study included all stillbirths >20 weeks and livebirths >22 weeks gestational age in Alabama state residents who delivered in Alabama from the Alabama Department of Public Health database. The primary outcome was the stillbirth rate during the early COVID-19 pandemic and its change from the baseline period. Analysis of stillbirths and livebirths stratified by gestational age groups and social distancing index (based on location data, for the state of Alabama, https://data.covid.umd.edu) was done.
Results: 143,935 pregnancies were included in the study (28,139 from the pandemic period and 115,796 from the baseline period). There was a transient decrease in stillbirth following the period of increased social distancing index and a persistent decrease in neonatal deaths, which consistently remained lower during the pandemic period (Figure). Overall, the stillbirth rate did not decrease significantly (p=0.19), but neonatal death rate was lower during the pandemic period (p=0.02). There was a higher NICU admission rate in the pandemic period (p<0.0001). The gestational age at delivery showed a shift towards higher gestations in the pandemic period for only livebirths (p=0.0075, Table). Conclusion(s): This population-based study showed that there was a persistent decrease in neonatal deaths and a moderate shift to higher gestation of livebirths with a transient decrease in stillbirths during the COVID-19 pandemic. The increase in the NICU admission rate may result from later detection of complications. However, higher gestational age at delivery may have mitigated the risk of neonatal death. The ongoing analysis of sociodemographic characteristics and factors associated with adverse fetal/neonatal outcomes may inform health policy for this vulnerable patient population.
Table: Group Comparison
Figure: Weekly Change in Social Distancing Index and Percent Change in Stillbirth and Neonatal Death in the Pandemic Period from the Baseline Period.
Authors/Institutions: Vivek V. Shukla, University of Alabama at Birmingham, Birmingham, Alabama, United States; AKM F. Rahman, University of Alabama at Birmingham, Birmingham, Alabama, United States; Xuejun Shen, The Center for Health Statistics, Montgomery, Alabama, United States; Allison Black, University of Alabama at Birmingham, Birmingham, Alabama, United States; Nitin Arora, University of Alabama at Birmingham, Birmingham, Alabama, United States; Charitharth V. Lal, University of Alabama at Birmingham, Birmingham, Alabama, United States; Namasivayam Ambalavanan, University of Alabama at Birmingham, Birmingham, Alabama, United States; Waldemar Carlo, University of Alabama at Birmingham, Birmingham, Alabama, United States