Effects of the COVID‐19 early pandemic on delivery outcomes among women with and without COVID‐19 at birth

Abstract

AbstractBackgroundThe COVID‐19 pandemic may influence delivery outcomes through direct effects of infection or indirect effects of disruptions in prenatal care. We examined early pandemic‐related changes in birth outcomes for pregnant women with and without a COVID‐19 diagnosis at delivery.MethodsWe compared four delivery outcomes—preterm delivery (PTD), severe maternal morbidity (SMM), stillbirth, and cesarean birth—between 2017 and 2019 (prepandemic) and between April and December 2020 (early‐pandemic) using interrupted time series models on 11.8 million deliveries, stratified by COVID‐19 infection status at birth with entropy weighting for historical controls, from the Healthcare Cost and Utilization Project across 43 states and the District of Columbia.ResultsRelative to 2017–2019, women without COVID‐19 at delivery in 2020 had lower odds of PTD (OR = 0.93; 95% CI = 0.92–0.94) and SMM (OR = 0.88; 95% CI = 0.85–0.91) but increased odds of stillbirth (OR = 1.04; 95% CI = 1.01–1.08). Absolute effects were small across race/ethnicity groups. Deliveries with COVID‐19 had an excess of each outcome, by factors of 1.07–1.46 for outcomes except SMM at 4.21. The effect for SMM was more pronounced for Asian/Pacific Islander non‐Hispanic (API; OR = 10.51; 95% CI = 5.49–20.14) and Hispanic (OR = 5.09; 95% CI = 4.29–6.03) pregnant women than for White non‐Hispanic (OR = 3.28; 95% CI = 2.65–4.06) women.DiscussionDecreasing rates of PTD and SMM and increasing rates of stillbirth among deliveries without COVID‐19 were small but suggest indirect effects of the pandemic on maternal outcomes. Among pregnant women with COVID‐19 at delivery, adverse effects, particularly SMM for API and Hispanic women, underscore the importance of addressing health disparities.