Abstract
Objective The COVID pandemic has been associated with varied effects on preterm birth (PTB).
We sought to compare rates of PTB during the pre- and post vaccination COVID periods
with pre-pandemic PTB rates, stratified by race and ethnicity.
Study Design Retrospective cohort comparing all deliveries over 20 weeks at a single tertiary
center during “early” (March 2020–June 2020) versus “late” COVID (March 2021–June
2021), and “late” COVID versus pre-COVID (March to June 2014–2019). PTBs <37, <34,
and <28 weeks were compared and stratified by race/ethnicity.
Results A total of 16,483 deliveries occurred including 2,068 “early” COVID, 2,115 “late”
COVID, and 12,300 pre-COVID. The PTB rate during “late” COVID was lower compared to
“early” COVID (12.1 vs. 14.6%, p = 0.02). Rate of PTB <34 was also lower during “late” COVID (4.4 vs. 5.7%, p = 0.05). PTB <28 did not differ. When controlling for prior PTB, “late” COVID remained
associated with a decreased risk of PTB compared to “early” COVID, adjusted odds ratio
(aOR) of 0.82 (95% confidence interval [CI]: 0.68, 0.98). Although there was no difference
in PTB among Hispanic individuals when comparing “late” COVID versus pre-COVID, when
further subdivided, a small number of Hispanic Puerto Rican individuals had higher
odds of PTB < 37 during “late” COVID versus pre-COVID (aOR = 4.29 [95% CI: 1.12, 16.4]).
Additionally, White individuals had reduced odds of PTB <37 (aOR = 0.80 [95% CI: 0.65,
0.98]) during “late” COVID versus pre-COVID while the PTB rate was unchanged when
comparing “late” COVID versus pre-COVID in all other racial and ethnic groups.
Conclusion During 2021, PTB rates decreased from rates observed in 2020 at the height of COVID
restrictions. Among White birthing individuals, PTB decreased in 2021 compared to
pre-COVID rates. This decrease was not observed in Black and Hispanic birthing individuals.
These data highlight the continued racially disparate impact of the COVID-19 pandemic
on PTB rates.
Key Points
-
The COVID-19 pandemic has been associated with varied effects on the preterm birth
(PTB) rate.
-
PTB rates decreased in “late” COVID compared to “early” COVID.
-
When stratified, PTB decreased among white individuals, but not in Black or Hispanic
individuals.
Keywords
COVID-19 pandemic - preterm birth - racial disparities - racial disparities in preterm
birth
