Maternal-Newborn Health System Changes and Outcomes in Ontario Canada during Wave 1 of the COVID-19 Pandemic - A Retrospective Study

Changes associated with the COVID-19 pandemic on postpartum screening results in Ontario, Canada: The healthy babies healthy children screening tool

BACKGROUND

Research on the impact of the COVID-19 pandemic on mothers/childbearing parents has mainly been cross-sectional and focused on psychological symptoms. This study examined the impact on function using ongoing, systematic screening of a representative Ontario sample.

METHODS

An interrupted time series analysis of repeated cross-sectional data from a province-wide screening program using the Healthy Babies Healthy Children (HBHC) tool assessed changes associated with the pandemic at the time of postpartum discharge from hospital. Postal codes were used to link to neighborhood-level data. The ability to parent or care for the baby/child and other psychosocial and behavioral outcomes were assessed.

RESULTS

The co-primary outcomes of inability to parent or care for the baby/child were infrequently observed in the pre-pandemic (March 9, 2019-March 15, 2020) and initial pandemic periods (March 16, 2020-March 23, 2021) (parent 209/63,006 (0.33%)-177/56,117 (0.32%), care 537/62,955 (0.85%)-324/56,086 (0.58%)). Changes after pandemic onset were not observed for either outcome although a significant (p = 0.02) increase in slope was observed for inability to parent (with questionable clinical significance). For secondary outcomes, worsening was only seen for reported complications during labor/delivery. Significant improvements were observed in the likelihood of being unable to identify a support person to assist with care, need of newcomer support, and concerns about money over time.

CONCLUSIONS

There were no substantive changes in concerns about ability to parent or care for children. Adverse impacts of the pandemic may have been mitigated by accommodations for remote work and social safety net policies.

Retrospective Cohort Study on the Impact of the COVID-19 Pandemic on Pregnancy Outcomes for Women Living With HIV in British Columbia

BACKGROUND

For pregnant women living with HIV (WLWH), engagement in care is crucial to maternal health and reducing the risk of perinatal transmission. To date, there have been no studies in Canada examining the impact of the COVID-19 pandemic on pregnant WLWH.

METHODS

This was a retrospective cohort study assessing the impact of the pandemic on perinatal outcomes for pregnant WLWH using data from the Perinatal HIV Surveillance Program in British Columbia, Canada. We compared maternal characteristics, pregnancy outcomes, and clinical indicators related to engagement with care between a prepandemic (January 2017-March 2020) and pandemic cohort (March 2020-December 2022). We investigated preterm birth rates with explanatory variables using logistic regression analysis.

RESULTS

The prepandemic cohort (n = 87) had a significantly (P < 0.05) lower gestational age at the first antenatal encounter (9.0 vs 11.8) and lower rates of preterm births compared with the pandemic cohort (n = 56; 15% vs 37%). Adjusted odds of preterm birth increased with the presence of substance use in pregnancy (aOR = 10.45, 95% confidence interval: 2.19 to 49.94) in WLWH. There were 2 cases of perinatal transmission of HIV in the pandemic cohort, whereas the prepandemic cohort had none.

CONCLUSIONS

The pandemic had pronounced effects on pregnant WLWH and their infants in British Columbia including higher rates of preterm birth and higher gestational age at the first antenatal encounter. The nonstatistically significant increase in perinatal transmission rates is of high clinical importance.

Increasing Preterm Delivery and Small for Gestational Age Trends in South Carolina during the COVID-19 Pandemic

Preterm delivery (PTD) complications are a major cause of childhood morbidity and mortality. We aimed to assess trends in PTD and small for gestational age (SGA) and whether trends varied between race-ethnic groups in South Carolina (SC). We utilized 2015-2021 SC vital records linked to hospitalization and emergency department records. PTD was defined as clinically estimated gestation less than (<) 37 weeks (wks.) with subgroup analyses of PTD < 34 wks. and < 28 wks. SGA was defined as infants weighing below the 10th percentile for gestational age. This retrospective study included 338,532 (243,010 before the COVID-19 pandemic and 95,522 during the pandemic) live singleton births of gestational age ≥ 20 wks. born to 260,276 mothers in SC. Generalized estimating equations and a change-point during the first quarter of 2020 helped to assess trends. In unadjusted analyses, pre-pandemic PTD showed an increasing trend that continued during the pandemic (relative risk (RR) = 1.04, 95% CI: 1.02-1.06). PTD < 34 wks. rose during the pandemic (RR = 1.07, 95% CI: 1.02-1.12) with a significant change in the slope. Trends in SGA varied by race and ethnicity, increasing only in Hispanics (RR = 1.02, 95% CI: 1.00-1.04) before the pandemic. Our study reveals an increasing prevalence of PTD and a rise in PTD < 34 wks. during the pandemic, as well as an increasing prevalence of SGA in Hispanics during the study period.

Effect of the COVID-19 Pandemic on Stillbirths in Canada and the United States

OBJECTIVE

There is uncertainty regarding the effect of the COVID-19 pandemic on population rates of stillbirth. We quantified pandemic-associated changes in stillbirth rates in Canada and the United States.

METHODS

We carried out a retrospective study that included all live births and stillbirths in Canada and the United States from 2015 to 2020. The primary analysis was based on all stillbirths and live births at ≥20 weeks gestation. Stillbirth rates were analyzed by month, with March 2020 considered to be the month of pandemic onset. Interrupted time series analyses were used to determine pandemic effects.

RESULTS

The study population included 18 475 stillbirths and 2 244 240 live births in Canada and 134 883 stillbirths and 22 963 356 live births in the United States (8.2 and 5.8 stillbirths per 1000 total births, respectively). In Canada, pandemic onset was associated with an increase in stillbirths at ≥20 weeks gestation of 1.01 (95% confidence interval [CI] 0.56-1.46) per 1000 total births and an increase in stillbirths at ≥28 weeks gestation of 0.35 (95% CI 0.16-0.54) per 1000 total births. In the United States, pandemic onset was associated with an increase in stillbirths at ≥20 weeks gestation of 0.48 (95% CI 0.22-0.75) per 1000 total births and an increase in stillbirths at ≥28 weeks gestation of 0.22 (95% CI 0.12-0.32) per 1000 total births. The increase in stillbirths at pandemic onset returned to pre-pandemic levels in subsequent months.

CONCLUSION

The COVID-19 pandemic's onset was associated with a transitory increase in stillbirth rates in Canada and the United States.

Strategies to support maternal and early childhood wellness: insight from parent and provider qualitative interviews during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic resulted in rapid changes to the delivery of maternal and newborn care. Our aim was to gain an understanding from parents and healthcare professionals (HCPs) of how the pandemic and associated public health restrictions impacted the peripartum and postpartum experience, as well as longer-term health and well-being of families.

DESIGN

Qualitative study through focus groups.

SETTING

Ontario, Canada.

PARTICIPANTS

HCPs and parents who had a child born during the COVID-19 pandemic.

INTERVENTIONS

Semistructured interview guide, with questions focused on how the pandemic impacted their care/their ability to provide care, and strategies to improve care and support now or in future situations with similar healthcare restrictions.

OUTCOME MEASURES

Thematic analysis was used to describe participant experiences and recommendations.

RESULTS

We included 11 HCPs and 15 parents in 6 focus groups. Participants described their experiences as 'traumatic', with difficulties in accessing prenatal and postpartum services, and feelings of distress and isolation. They also noted delays in speech and development in children born during the pandemic. Key recommendations included the provision of partner accompaniment throughout the course of care, expansion of available services for young families (particularly postpartum), and special considerations for marginalised groups, including access to technology for virtual care or the option of in-person visits.

CONCLUSIONS

Our findings may inform the development of healthcare system and organisational policies to ensure the provision of maternal and newborn care in the event of future public health emergencies. Of primary importance to the participants was the accommodation of antenatal, intrapartum and postpartum partner accompaniment, and the provision of postpartum services.

The pandemic experiences of Ontario perinatal providers: a qualitative study

BACKGROUND

The COVID-19 pandemic has produced widespread disruptions for healthcare systems across Canada. Perinatal care in Ontario, Canada was subject to province-wide public health restrictions, reallocation of hospital beds and human health resources. To better understand the impacts of the pandemic on Ontario perinatal care, this study explored the perspectives of perinatal care providers about their clinical COVID-19 pandemic experiences.

METHODS

Semi-structured key informant virtual interviews were conducted between August 2021 and January 2022 with 15 Ontario-based perinatal care providers. Recorded interviews were transcribed, and thematic content analysis used to identify major themes and subthemes.

RESULTS

Participants were mainly women, practicing in Eastern and Central Ontario as health providers (obstetricians, nurses, midwives), allied regulated health professionals (social worker, massage therapist), and perinatal support workers (doula, lactation consultant). Major themes and subthemes were identified inductively as follows: (1) Impacts of COVID-19 on providers (psychosocial stress, healthcare system barriers, healthcare system opportunities); (2) Perceived impacts of COVID-19 on pregnant people (psychosocial stress, amplification of existing healthcare barriers, influences on reproductive decision making; minor theme- social and emotional support roles); (3) Vaccine discourse (provider empathy, vaccines and patient family dynamics, minor themes- patient vaccine hesitancy, COVID-19 misinformation); and (4) Virtual pregnancy care (benefits, disadvantages, adaptation of standard care practices).

CONCLUSIONS

Perinatal care providers reported significant stress and uncertainty caused by the COVID-19 pandemic and evolving hospital protocols. Providers perceived that their patients were distressed by both the pandemic and related reductions in pregnancy healthcare services including hospital limits to support companion(s). Although virtual pregnancy care impaired patient-provider rapport, most providers believed that the workflow efficiencies and patient convenience of virtual care is beneficial to perinatal healthcare.

The Temporal Relationship Between the Coronavirus Disease 2019 (COVID-19) Pandemic and Preterm Birth

OBJECTIVE

To evaluate whether preterm birth rates changed in relation to the onset of the coronavirus disease 2019 (COVID-19) pandemic and whether any change depended on socioeconomic status.

METHODS

This is an observational cohort study of pregnant individuals with a singleton gestation who delivered in the years 2019 and 2020 at 1 of 16 U.S. hospitals of the Maternal-Fetal Medicine Units Network. The frequency of preterm birth for those who delivered before the onset of the COVID-19 pandemic (ie, in 2019) was compared with that of those who delivered after its onset (ie, in 2020). Interaction analyses were performed for people of different individual- and community-level socioeconomic characteristics (ie, race and ethnicity, insurance status, Social Vulnerability Index (SVI) of a person's residence).

RESULTS

During 2019 and 2020, 18,526 individuals met inclusion criteria. The chance of preterm birth before the COVID-19 pandemic was similar to that after the onset of the pandemic (11.7% vs 12.5%, adjusted relative risk 0.94, 95% CI 0.86-1.03). In interaction analyses, race and ethnicity, insurance status, and the SVI did not modify the association between the epoch and the chance of preterm birth before 37 weeks of gestation (all interaction P >.05).

CONCLUSION

There was no statistically significant difference in preterm birth rates in relation to the COVID-19 pandemic onset. This lack of association was largely independent of socioeconomic indicators such as race and ethnicity, insurance status, or SVI of the residential community in which an individual lived.

Preterm birth and stillbirth rates associated with socioeconomic disparities during COVID-19 pandemic: a population-based cross-sectional study

BACKGROUND

Conflicting evidence exists on the impact of the COVID-19 pandemic restrictions on preterm birth (PTB) and stillbirth rates. We aimed to evaluate changes in PTB and stillbirth rates before and during the pandemic period and assess the potential effect modification of socioeconomic status (SES).

METHODS

Using the linked administrative health databases from Manitoba, Canada, we conducted a cross-sectional study among all pregnant women, comparing 3.5 years pre-pandemic (1 October 2016 to 29 February 2020) to the first year of the pandemic (1 March 2020 to 31 March 2021). We used generalised linear models to assess the quarterly rates of PTB (<37 weeks) and stillbirths. We calculated the predicted trends based on pre-pandemic period data. Finally, we evaluated the PTB and stillbirth rates among lower and higher SES pregnant women (average annual household income) using subgroup analysis and interaction models.

RESULTS

We examined 70 931 pregnancies in Manitoba during the study period. The risk of PTB increased by 7.7% (95%CI 1.01 to 1.13) and stillbirths by 33% (95% CI 1.08 to 1.64) during the pandemic period. Following COVID-19 restrictions implemented in March 2020, there were increases in the quarterly rates of both PTB (immediate increase (β₂)=1.37; p=0.0247) and stillbirths (immediate increase (β₂)=0.12; p=0.4434). Among the lower income groups, the pandemic restrictions resulted in an immediate relative increase in PTB and stillbirth rates by 20.12% (immediate increase (β₂)=3.17; p=0.0057) and 27.19% (immediate increase (β₂)=0.48; p=0.0852). However, over the pandemic, the overall PTB rate significantly decreased as a rebound effect by 0.85% per quarter (p=0.0004), whereas the overall stillbirth rate did not decrease significantly (slope decrease (β₃) =-0.01; p=0.8296) compared with the pre-pandemic period. The quarterly rates during the pandemic among the higher income group decreased by 0.39% (p=0.1296) for PTB and increased by 0.07% (p=0.1565) for stillbirth. We observed an effect modification by SES for PTB rates (p=0.047).

CONCLUSION

While the onset of COVID-19 pandemic restrictions was not associated with significant effects on stillbirth rates, we observed an immediate and rebound effect on PTB rates. The impact of COVID-19 on preterm birth was dependent on SES, with higher influence on families with lower SES. Further studies are needed to detect future trend changes during pandemic waves after 2021 and assess potential underlying mechanisms.

The impacts of the COVID-19 pandemic on birth satisfaction and birth experiences in Russian women

Background

Women's satisfaction with their childbirth experiences has significant impacts on their health and the health of their children. Recently, childbirth and maternity care systems have been disrupted by the COVID-19 pandemic. This study aimed to investigate the association of birth satisfaction with mode of birth, medical interventions, support during labour, type of childbirth healthcare plan and antenatal education in the context of the COVID-19 pandemic in Russia.

Methods

1,645 Russian women who gave birth during the first year of the COVID-19 pandemic and 611 matched controls who gave birth in the previous year participated in an anonymous Internet survey about their childbirth experience. The survey included questions regarding women's demographic and obstetric characteristics as well as their childbirth experiences. Birth satisfaction was measured using the Birth Satisfaction Scale Revised Indicator (BSS-RI).

Results

Birth satisfaction scores did not show notable changes before and during the pandemic (Pearson Chi-square = 19.7, p = 0.22). Women had lower BSS-RI scores if they tested positive for COVID-19 during labour (F = 9.18, p = 0.002), but not during pregnancy or postpartum (p > 0.32). In both cohorts women who had vaginal births rated birth satisfaction higher than those who had caesarean births. The more medical interventions there were, the lower were the BSS-RI scores (B = -0.234, 95% CI: -0.760; -0.506, p < 0.001), but only during the pandemic. Birth satisfaction was higher if women had a support person present during labour (F > 7.44, p < 0.001), which was not possible for over 70% of participants during the pandemic. In both cohorts birth satisfaction was associated with the childbirth healthcare plan (F > 5.27, p < 0.001), but not with antenatal education (F < 0.15, p > 0.43).

Conclusions

Our study highlights the significant impacts of the COVID-19 pandemic on the birth experiences of Russian women. Sustaining the rights of women to informed decisions during labour, respect for their preferred childbirth healthcare plan, presence of the birth team of choice and professional support for home birth are essential for higher birth satisfaction and better health outcomes for mothers and their infants.

Impacts of COVID-19 pandemic on preterm birth: a systematic review and meta-analysis

OBJECTIVES

The COVID-19 pandemic has significantly affected healthcare systems and daily well-being. However, the reports of the indirect impacts of the pandemic on preterm birth remain conflicting. We performed a meta-analysis to examine whether the pandemic altered the risk of preterm birth.

STUDY DESIGN

This was a systematic review and meta-analysis of the previous literature.

METHODS

We searched MEDLINE and Embase databases until March 2022 using appropriate keywords and extracted 63 eligible studies that compared preterm between the COVID-19 pandemic period and the prepandemic period. A random effects model was used to obtain the pooled odds of each outcome. The study protocol was registered with PROSPERO (No. CRD42022326717).

RESULTS

The search identified 3827 studies, of which 63 reports were included. A total of 3,220,370 pregnancies during the COVID-19 pandemic period and 6,122,615 pregnancies during the prepandemic period were studied. Compared with the prepandemic period, we identified a significant decreased odds of preterm birth (PTB; <37 weeks' gestation; pooled odds ratio [OR; 95% confidence interval (CI)] = 0.96 [0.94, 0.98]; I² = 78.7%; 62 studies) and extremely PTB (<28 weeks' gestation; pooled OR [95% CI] = 0.92 [0.87, 0.97]; I² = 26.4%; 25 studies) during the pandemic, whereas there was only a borderline significant reduction in the odds of very PTB (<32 weeks' gestation; pooled OR [95% CI] = 0.93 [0.86, 1.01]; I² = 90.1%; 33 studies) between the two periods. There was significant publication bias for PTB.

CONCLUSION

Pooled results suggested the COVID-19 pandemic was associated with preterm birth, although there was only a borderline significant reduction for very PTB during the pandemic compared with the prepandemic period. Large studies showed conflicting results, and further research on whether the change is related to pandemic mitigation measures was warranted.