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Am J Perinatol 2023; 40(04): 445-452
DOI: 10.1055/a-1877-5973
Original Article

Pregnancy during a Pandemic: A Cohort Study Comparing Adverse Outcomes during and before the COVID-19 Pandemic

Manasa G. Rao 
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Lorraine E. Toner
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Joanne Stone
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Chioma A. Iwelumo
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Cody Goldberger
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Brittany J. Roser
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Ruhee Shah
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Paige Rattner
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Keisha S. Paul
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Guillaume Stoffels
2   Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
,
Angela Bianco
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract

Objective This study was aimed to evaluate how the novel coronavirus disease 2019 (COVID-19) pandemic may have negatively impacted birth outcomes in patients who tested negative for the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus.

Study Design We conducted a retrospective cohort study using electronic health records of pregnant women admitted to a tertiary medical center in New York City, an epicenter of the pandemic. Women with a singleton gestation admitted for delivery from March 27 to May 31, 2019, and March 27 to May 31, 2020, were included. Women less than 18 years of age, those with a positive SARS-CoV-2 polymerize chain reaction (PCR) test on admission, fetal anomaly, or multiple gestation were excluded. Adverse pregnancy outcomes were compared between groups. Univariable and multivariable logistic regression analyses were used to assess outcomes. The primary outcome was preterm birth.

Results Women who delivered during the 2020 study interval had a significantly higher rate of hypertensive disorders of pregnancy (gestational hypertension [GHTN] or preeclampsia; odds ratio [OR] = 1.40, 95% confidence interval [CI]: 1.05–1.85; p = 0.02), postpartum hemorrhage (PPH; OR = 1.77, 95% CI: 1.14–2.73; p = 0.01), and preterm birth (OR = 1.49, 95% CI: 1.10–2.02; p = 0.01). Gestational age at delivery was significantly lower in the 2020 cohort compared with the 2019 cohort (39.3 versus 39.4 weeks, p = 0.03). After adjusting for confounding variables, multivariate analysis confirmed a persistent increase in hypertensive disorders of pregnancy (OR = 1.56, 95% CI: 1.10–2.20, p = 0.01), PPH (OR = 1.74, 95% CI: 1.06–2.86, p = 0.03), and preterm birth (OR = 1.72, 95% CI: 1.20–2.47, p = 0.003) in patients who delivered in 2020 compared with the same period in 2019. Specifically, medically indicated preterm births increased during the pandemic (OR = 3.17, 95% CI: 1.77–5.67, p < 0.0001).

Conclusion Those who delivered during the COVID-19 pandemic study interval were more likely to experience hypertensive disorders of pregnancy, medically indicated preterm birth, and PPH even in the absence of SARS-CoV2 infection.

Key Points

  • Stressful life events can lead to adverse pregnancy outcomes.

  • Even patients negative for COVID-19 experienced GHTN, preeclampsia, PPH and preterm birth during the pandemic.

  • Pandemic-related stress may adversely affect perinatal outcomes.

Keywords

pregnancy - COVID-19 - preterm birth - pandemic stress - postpartum hemorrhage - gestational hypertension - preeclampsia - hypertensive disorders of pregnancy


Publication History

Received: 09 October 2021

Accepted: 03 June 2022

Accepted Manuscript online:
16 June 2022

Article published online:
22 August 2022

© 2022. Thieme. All rights reserved.

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