Download PDF
Am J Perinatol 2024; 41(S 01): e236-e248
DOI: 10.1055/a-1878-0503
Original Article

Population-Level Study on Fetal Deaths and Preterm Births during SARS-CoV-2 Pandemic in the State of Michigan

Monika Bajaj
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
,
Roberto Romero
2   Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland
3   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
4   Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
5   Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
8   Detroit Medical Center, Detroit, Michigan
,
Lindsey Myers
6   Division for Vital Records and Health Statistics, Department of Health and Human Services, Lansing, Michigan
,
Jeffrey Duncan
6   Division for Vital Records and Health Statistics, Department of Health and Human Services, Lansing, Michigan
,
Lami Yeo
2   Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland
7   Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
,
Sanket Jani 
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
,
Girija Natarajan
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Central Michigan University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, Michigan
› Author Affiliations Funding This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. Dr. Romero has contributed to this work as part of his official duties as an employee of the United States Federal Government.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective The aim of the study is to explore the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on preterm birth at different gestational ages and fetal death in the state of Michigan.

Study Design Data on live births and fetal deaths in the state of Michigan from March to November in the years 2017 through 2020 were obtained from Michigan Department of Health and Human Services (MDHHS). Preterm birth rate, fetal death rate (per 1,000 live births) overall and stratified by race and maternal comorbidities during the period of pandemic (March–November 2020) were compared with the same period (March–November) in the prepandemic years (2017–2019).

Results Of 328,879 live births and 1,470 fetal deaths during the study period, 77,983 live births and 242 fetal deaths were reported in 2020. Compared with prepandemic years, fetal death rate per 1,000 live births was significantly lower in 2020 (3.1 vs. 4.7 [2017], 5.2 [2018], 4.4 [2019], p-value <0.001). The adjusted risk for fetal death in 2020 was decreased (odds ratio [OR] = 0.64 [95% confidence interval (CI): 0.56–0.74], p <0.0001), compared with prepandemic years. Fetal death was significantly associated with African-American race, pregnancy hypertension and prepregnancy diabetes. No significant difference in the proportion of preterm births (<37 weeks' gestation) was noted between pandemic and prepandemic years (9.9 vs. 10.0%, p = 0.50). There was no significant difference in the risk of preterm birth across gestational age strata (<28, 28–316/7, 32–366/7, 37–416/7, and >42 weeks) between pandemic and prepandemic years on multinomial analysis. Significant associations with preterm birth across all years included African American race, lower level of maternal education, pregnancy-induced hypertension, chronic hypertension, prepregnancy diabetes, congenital anomalies, previous preterm birth, and prolonged rupture of membranes >12 hours.

Conclusion Fetal death rate was significantly lower whereas preterm births remained unchanged during pandemic in comparison with prepandemic years in the state of Michigan.

Key Points

  • A decrease in fetal death rate was noted during SARS CoV-2 pandemic in the State of Michigan.

  • Overall state-wide rates of preterm birth did not change in 2020, compared to previous years.

  • Significant risk factors associated with preterm birth and fetal deaths did not differ between prepandemic and pandemic years.

Keywords

SARS CoV-2 - COVID-19 - fetal deaths - preterm birth - pandemic


Publication History

Received: 06 July 2021

Accepted: 26 May 2022

Accepted Manuscript online:
16 June 2022

Article published online:
01 October 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Chi J, Gong W, Gao Q. Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review. Arch Gynecol Obstet 2021; 303 (02) 337-345
    CrossrefPubMedSearch in Google Scholar
  • 2 Kyle MH, Glassman ME, Khan A. et al. A review of newborn outcomes during the COVID-19 pandemic. Semin Perinatol 2020; 44 (07) 151286
    CrossrefPubMedSearch in Google Scholar
  • 3 Wang CL, Liu YY, Wu CH, Wang CY, Wang CH, Long CY. Impact of COVID-19 on pregnancy. Int J Med Sci 2021; 18 (03) 763-767
    CrossrefPubMedSearch in Google Scholar
  • 4 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
    CrossrefPubMedSearch in Google Scholar
  • 5 Papapanou M, Papaioannou M, Petta A. et al. Maternal and neonatal characteristics and outcomes of COVID-19 in pregnancy: an overview of systematic reviews. Int J Environ Res Public Health 2021; 18 (02) E596
    CrossrefPubMedSearch in Google Scholar
  • 6 Khoury R, Bernstein PS, Debolt C. et al. Characteristics and outcomes of 241 births to women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at five New York City medical centers. Obstet Gynecol 2020; 136 (02) 273-282
    CrossrefPubMedSearch in Google Scholar
  • 7 Woodworth KR, O'Malley Olsen E, Neelam V. et al. Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy—SET-NET, 16 Jurisdictions, March 29 to October 14, 2020. Center for Disease Control. Morb Mortal Wkly Rep 2020; 69: 1635
    CrossrefPubMedSearch in Google Scholar
  • 8 Huntley BJF, Mulder IA, Di Mascio D. et al. Adverse pregnancy outcomes among individuals with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a systematic review and meta-analysis. Obstet Gynecol 2021; 137 (04) 585-596
    CrossrefPubMedSearch in Google Scholar
  • 9 Di Mascio D, Buca D, Berghella V. et al. Counseling in maternal-fetal medicine: SARS-CoV-2 infection in pregnancy. Ultrasound Obstet Gynecol 2021; 57 (05) 687-697
    CrossrefPubMedSearch in Google Scholar
  • 10 D'Antonio F, Sen C, Mascio DD. et al. On the behalf of the World Association of Perinatal Medicine working group on coronavirus disease 2019. Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019. Am J Obstet Gynecol MFM 2021; 3 (04) 100329
    CrossrefPubMedSearch in Google Scholar
  • 11 Mullins E, Hudak ML, Banerjee J. et al; PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021; 57 (04) 573-581
    CrossrefPubMedSearch in Google Scholar
  • 12 Been JV, Burgos Ochoa L, Bertens LCM, Schoenmakers S, Steegers EAP, Reiss IKM. Impact of COVID-19 mitigation measures on the incidence of preterm birth: a national quasi-experimental study. Lancet Public Health 2020; 5 (11) e604-e611
    CrossrefPubMedSearch in Google Scholar
  • 13 Cheung PY, Alshaikh B, Yang C. COVID-19 pandemic: different associative relationships of city lockdown with preterm births in three cities—an ecological study. Front Pediatr 2021; 9: 644771
    CrossrefPubMedSearch in Google Scholar
  • 14 De Curtis M, Villani L, Polo A. Increase of stillbirth and decrease of late preterm infants during the COVID-19 pandemic lockdown. Arch Dis Child Fetal Neonatal Ed 2021; 106 (04) 456
    CrossrefPubMedSearch in Google Scholar
  • 15 Kasuga Y, Tanaka M, Ochiai D. Preterm delivery and hypertensive disorder of pregnancy were reduced during the COVID-19 pandemic: a single hospital-based study. J Obstet Gynaecol Res 2020; 46 (12) 2703-2704
    CrossrefPubMedSearch in Google Scholar
  • 16 Justman N, Shahak G, Gutzeit O. et al. Lockdown with a price: the impact of the COVID-19 pandemic on prenatal care and perinatal outcomes in a tertiary care center. Isr Med Assoc J 2020; 22 (09) 533-537
    PubMedSearch in Google Scholar
  • 17 Arnaez J, Ochoa-Sangrador C, Caserio S. et al. Lack of changes in preterm delivery and stillbirths during COVID-19 lockdown in a European region. Eur J Pediatr 2021; 180 (06) 1997-2002
    CrossrefPubMedSearch in Google Scholar
  • 18 Michigan.gov. Coronavirus/Michigan Data. Published 2021. Accessed March 22, 2021 at: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html. Updated 3/22/2021.
    PubMed
  • 19 Mor M, Kugler N, Jauniaux E. et al. Impact of the COVID-19 pandemic on excess perinatal mortality and morbidity in Israel. Am J Perinatol 2021; 38 (04) 398-403
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Kumar M, Puri M, Yadav R. et al. Stillbirths and the COVID-19 pandemic: looking beyond SARS-CoV-2 infection. Int J Gynaecol Obstet 2021; 153 (01) 76-82
    CrossrefPubMedSearch in Google Scholar
  • 21 Kumari V, Mehta K, Choudhary R. COVID-19 outbreak and decreased hospitalisation of pregnant women in labour. Lancet Glob Health 2020; 8 (09) e1116-e1117
    CrossrefPubMedSearch in Google Scholar
  • 22 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; 324 (07) 705-706
    CrossrefPubMedSearch in Google Scholar
  • 23 Kc A, Gurung R, Kinney MV. et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. Lancet Glob Health 2020; 8 (10) e1273-e1281
    CrossrefPubMedSearch in Google Scholar
  • 24 Dell'Utri C, Manzoni E, Cipriani S. et al. Effects of SARS Cov-2 epidemic on the obstetrical and gynecological emergency service accesses. What happened and what shall we expect now?. Eur J Obstet Gynecol Reprod Biol 2020; 254: 64-68
    CrossrefPubMedSearch in Google Scholar
  • 25 Handley SC, Mullin AM, Elovitz MA. et al. Changes in preterm birth phenotypes and stillbirth at 2 Philadelphia hospitals during the SARS-CoV-2 pandemic, March-June 2020. JAMA 2021; 325 (01) 87-89
    CrossrefPubMedSearch in Google Scholar
  • 26 Pasternak B, Neovius M, Söderling J. et al. Preterm birth and stillbirth during the COVID-19 pandemic in Sweden: a nationwide cohort study. Ann Intern Med 2021; 174 (06) 873-875
    CrossrefPubMedSearch in Google Scholar
  • 27 Philip RK, Purtill H, Reidy E. et al. Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a ‘natural experiment’ allowing analysis of data from the prior two decades. BMJ Glob Health 2020; 5 (09) e003075
    CrossrefPubMedSearch in Google Scholar
  • 28 Caniglia EC, Magosi LE, Zash R. et al. Modest reduction in adverse birth outcomes following the COVID-19 lockdown. Am J Obstet Gynecol 2021; 224 (06) 615.e1-615.e12
    CrossrefPubMedSearch in Google Scholar
  • 29 Matheson A, McGannon CJ, Malhotra A. et al. Prematurity rates during the coronavirus disease 2019 (COVID-19) pandemic lockdown in Melbourne, Australia. Obstet Gynecol 2021; 137 (03) 405-407
    CrossrefPubMedSearch in Google Scholar
  • 30 Metz TD, Clifton RG, Hughes BL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2021; 137 (04) 571-580
    CrossrefPubMedSearch in Google Scholar
  • 31 Pruitt SM, Hoyert DL, Anderson KN. et al. Racial and ethnic disparities in fetal deaths - United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2020; 69 (37) 1277-1282
    CrossrefPubMedSearch in Google Scholar
  • 32 Rowland Hogue CJ, Silver RM. Racial and ethnic disparities in United States: stillbirth rates: trends, risk factors, and research needs. Semin Perinatol 2011; 35 (04) 221-233
    CrossrefPubMedSearch in Google Scholar
  • 33 Hedermann G, Hedley PL, Bækvad-Hansen M. et al. Danish premature birth rates during the COVID-19 lockdown. Arch Dis Child Fetal Neonatal Ed 2021; 106 (01) 93-95
    CrossrefPubMedSearch in Google Scholar
  • 34 Berghella V, Boelig R, Roman A, Burd J, Anderson K. Decreased incidence of preterm birth during coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2020; 2 (04) 100258
    CrossrefPubMedSearch in Google Scholar
  • 35 Harvey EM, McNeer E, McDonald MF. et al. Association of preterm birth rate with COVID-19 statewide stay-at-home orders in Tennessee. JAMA Pediatr 2021; 175 (06) 635-637
    CrossrefPubMedSearch in Google Scholar
  • 36 McDonnell S, McNamee E, Lindow SW, O'Connell MP. The impact of the Covid-19 pandemic on maternity services: a review of maternal and neonatal outcomes before, during and after the pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 255: 172-176
    CrossrefPubMedSearch in Google Scholar
  • 37 Meyer R, Bart Y, Tsur A. et al. A marked decrease in preterm deliveries during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol 2021; 224 (02) 234-237
    CrossrefPubMedSearch in Google Scholar
  • 38 Huseynova R, Bin Mahmoud L, Abdelrahim A. et al. Prevalence of preterm birth rate during COVID-19 lockdown in a tertiary care hospital, Riyadh. Cureus 2021; 13 (03) e13634
    PubMedSearch in Google Scholar
  • 39 Kirchengast S, Hartmann B. Pregnancy outcome during the first COVID 19 lockdown in Vienna, Austria. Int J Environ Res Public Health 2021; 18 (07) 3782
    CrossrefPubMedSearch in Google Scholar
  • 40 Gu XX, Chen K, Yu H, Liang GY, Chen H, Shen Y. How to prevent in-hospital COVID-19 infection and reassure women about the safety of pregnancy: experience from an obstetric center in China. J Int Med Res 2020; 48 (07) 300060520939337
    CrossrefPubMedSearch in Google Scholar
  • 41 Wood R, Sinnott C, Goldfarb I, Clapp M, McElrath T, Little S. Preterm birth during the coronavirus disease 2019 (COVID-19) pandemic in a large hospital system in the United States. Obstet Gynecol 2021; 137 (03) 403-404
    CrossrefPubMedSearch in Google Scholar
  • 42 Main EK, Chang SC, Carpenter AM. et al. Singleton preterm birth rates for racial and ethnic groups during the coronavirus disease 2019 pandemic in California. Am J Obstet Gynecol 2021; 224 (02) 239-241
    CrossrefPubMedSearch in Google Scholar
  • 43 Li M, Yin H, Jin Z. et al. Impact of Wuhan lockdown on the indications of cesarean delivery and newborn weights during the epidemic period of COVID-19. PLoS One 2020; 15 (08) e0237420
    CrossrefPubMedSearch in Google Scholar
  • 44 Manuck TA. Racial and ethnic differences in preterm birth: a complex, multifactorial problem. Semin Perinatol 2017; 41 (08) 511-518
    CrossrefPubMedSearch in Google Scholar
  • 45 Purisch SE, Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol 2017; 41 (07) 387-391
    CrossrefPubMedSearch in Google Scholar
  • 46 Chopra T, Sobel J. Detroit under siege, the enemy within: the impact of the COVID-19 collision. Infect Control Hosp Epidemiol 2020; 41 (09) 1122
    CrossrefPubMedSearch in Google Scholar
  • 47 Stowe J, Smith H, Thurland K, Ramsay ME, Andrews N, Ladhani SN. Stillbirths during the COVID-19 pandemic in England, April-June 2020. JAMA 2021; 325 (01) 86-87
    CrossrefPubMedSearch in Google Scholar