Impact of the COVID-19 Pandemic on Excess Perinatal Mortality and Morbidity in Israel

Abstract

Objective The 2020 COVID-19 pandemic has been associated with excess mortality and morbidity in adults and teenagers over 14 years of age, but there is still limited evidence on the direct and indirect impact of the pandemic on pregnancy. We aimed to evaluate the effect of the first wave of the COVID-19 pandemic on obstetrical emergency attendance in a low-risk population and the corresponding perinatal outcomes.

Study Design This is a single center retrospective cohort study of all singleton births between February 21 and April 30. Prenatal emergency labor ward admission numbers and obstetric outcomes during the peak of the first COVID-19 pandemic of 2020 in Israel were compared with the combined corresponding periods for the years 2017 to 2019.

Results During the 2020 COVID-19 pandemic, the mean number of prenatal emergency labor ward admissions was lower, both by daily count and per woman, in comparison to the combined matching periods in 2017, 2018, and 2019 (48.6 ± 12.2 vs. 57.8 ± 14.4, p < 0.0001 and 1.74 ± 1.1 vs. 1.92 ± 1.2, p < 0.0001, respectively). A significantly (p = 0.0370) higher rate of stillbirth was noted in the study group (0.4%) compared with the control group (0.1%). All study group patients were negative for COVID-19. Gestational age at delivery, rates of premature delivery at <28, 34, and 37 weeks, pregnancy complications, postdate delivery at >40 and 41 weeks, mode of delivery, and numbers of emergency cesarean deliveries were similar in both groups. There was no difference in the intrapartum fetal death rate between the groups.

Conclusion The COVID-19 pandemic stay-at-home policy combined with patient fear of contracting the disease in hospital could explain the associated higher rate of stillbirth. This collateral perinatal damage follows a decreased in prenatal emergency labor ward admissions during the first wave of COVID-19 in Israel.

Key Points

• Less obstetrical ER attendance is observed during the pandemic.

• There is a parallel increase in stillbirth rate.

• Stillbirth cases tested negative for COVID-19.

• Lockdown and pandemic panic are possible causes.

Keywords

COVID-19 - pandemic - IUFD - SARS-COV-2 - stillbirth

Publication History

Received: 11 August 2020

Accepted: 04 November 2020

Article published online:
10 December 2020

• References

• 1 Vestergaard LS, Nielsen J, Richter L. et al; ECDC Public Health Emergency Team for COVID-19. Excess all-cause mortality during the COVID-19 pandemic in Europe - preliminary pooled estimates from the EuroMOMO network, March to April 2020. Euro Surveill 2020; 25 (26) 2001214
• 2 WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. WHO Director General's speeches. Accessed August 2, 2020 at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020
• 3 Otero D, Singam NSV, Barry N, Raheja P, Solankhi A, Solankhi N. Complication of late presenting STEMI due to avoidance of medical care during COVID-19 pandemic. JACC Case Rep 2020;
• 4 De Filippo O, D'Ascenzo F, Angelini F. et al. Reduced rate of hospital admissions for ACS during COVID-19 outbreak in Northern Italy. N Engl J Med 2020; 383 (01) 88-89
• 5 Tam CF, Cheung KS, Lam S. et al. Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment-elevation myocardial infarction care in Hong Kong, China. Circ Cardiovasc Qual Outcomes 2020; 13 (04) e006631
• 6 Moroni F, Gramegna M, Ajello S. et al. Collateral damage: medical care avoidance behavior among patients with acute coronary syndrome during the COVID-19 pandemic. JACC Case Reports 2020;
• 7 Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020; 55 (05) 586-592
• 8 Breslin N, Baptiste C, Gyamfi-Bannerman C. et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2 (02) 100118
• 9 Chang HJ, Huang N, Lee CH, Hsu YJ, Hsieh CJ, Chou YJ. The impact of the SARS epidemic on the utilization of medical services: SARS and the fear of SARS. Am J Public Health 2004; 94 (04) 562-564
• 10 Chen L, Zheng D. Clinical characteristics of pregnant women with covid-19 in Wuhan, China. N Engl J Med 2020; 100: 1-3
• 11 Zhang L, Jiang Y, Wei M. et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi 2020; 55 (03) 166-171
• 12 Pierce-Williams RAM, Burd J, Felder L. et al. Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol MFM May 2020; 100134
• 13 Li Y, Zhao R, Zheng S. et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis 2020; 26 (06) 1335-1336
• 14 Richtmann R, Torloni MR, Oyamada Otani AR. et al. Fetal deaths in pregnancies with SARS-CoV-2 infection in Brazil: a case series. Case Rep Womens Health 2020; 27: e00243
• 15 Knight M, Bunch K, Vousden N. et al; UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ 2020; 369: m2107
• 16 Khalil A, von Dadelszen P, Draycott T, Ugwumadu A, O'Brien P, Magee L. Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic. JAMA 2020;
• 17 Eriksson AW, Fellman J. Seasonal variation of livebirths, stillbirths, extramarital births and twin maternities in Switzerland. Twin Res 2000; 3 (04) 189-201
• 18 Strand LB, Barnett AG, Tong S. The influence of season and ambient temperature on birth outcomes: a review of the epidemiological literature. Environ Res 2011; 111 (03) 451-462
• 19 Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birth weight standards in the live-born population in Israel. Isr Med Assoc J 2005; 7 (05) 311-314
• 20 Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 2020; 4 (05) e10-e11
• 21 COVID-19 statistics in Israel. Accessed August 28, 2020 at: https://datadashboard.health.gov.il/COVID-19/?utm_source=go.gov.il&utm_medium=referral
• 22 Smith GC, Fretts RC. Stillbirth. Lancet 2007; 370 (9600): 1715-1725
• 23 Altijani N, Carson C, Choudhury SS. et al. Stillbirth among women in nine states in India: rate and risk factors in study of 886,505 women from the annual health survey. BMJ Open 2018; 8 (11) e022583
• 24 Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. Disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clinical Infectious Diseases. Oxford Academic. Clin Infect Dis 2020; ciaa815 . Accessed August 2, 2020 at: https://academic-oup-com.assafh-ez.medlcp.tau.ac.il/cid/article/doi/10.1093/cid/ciaa815/5860249
• 25 Goldenberg RL, Kirby R, Culhane JF. Stillbirth: a review. J Matern Fetal Neonatal Med 2004; 16 (02) 79-94