Overwhelmed health systems and less access to care during the coronavirus pandemic worsened birth outcomes for expectant mothers and newborns around the world, an analysis of dozens of studies suggests.
Researchers from St. George’s University Hospitals NHS Foundation Trust in the U.K. published findings in The Lancet Global Health on Wednesday, with results drawing from 40 studies conducted from January 2020 through January 2021 on over 6 million pregnancies and rates of outcomes like complications and deaths. The team drew reports from Medline and Embase research databases.
Findings indicated "significant increases" in stillbirths and maternal deaths by about one-third during the pandemic, though the rate of overall preterm births remained about the same compared to pre-pandemic life. More specifically, researchers cited a 28% uptick in stillbirths, noting 1,099 stillbirths per 168,295 pregnancies during the pandemic, compared to pre-pandemic rates at 1,325 stillbirths per 198,993 pregnancies. Maternal deaths occurred at reported rates of 530 per 1,237,018 pregnancies during the pandemic, compared to 698 per 2,224,859 pregnancies pre-pandemic.
The team also reported a decline in mothers’ mental health like heightened depression and anxiety, and additional findings indicated a six-fold uptick in surgeries relating to ectopic pregnancies (occurring outside of the uterus), suggesting women delayed medical care.
"This finding suggests that the increased rate of adverse outcomes might be driven mainly by the inefficiency of health-care systems and their inability to cope with the pandemic, rather than by the stringency of pandemic mitigation measures," study authors wrote.
"It is clear from our study and others that the disruption caused by the pandemic has led to the avoidable deaths of both mothers and babies, especially in low- and middle-income countries," said Asma Khalil, lead study author and professor at St George's University of London, in part in a release. "We urge policymakers and health care leaders to prioritise safe, accessible, and equitable maternity care within the strategic response to the pandemic and aftermath, to reduce adverse pregnancy outcomes worldwide."
The team noted limitations in the findings, such as fewer studies conducted in lower-income countries, which was "concerning" due to considerable differences in outcomes among these countries. For instance, while high-income countries saw a notable decline in preterm births, lower-income countries did not.
Several other factors could have contributed to the worsened outcomes, such as maternity staff redirected to treat critical patients during the pandemic, and also an increase in "intimate-partner violence," study authors suggested.
"We can prioritise safe and accessible maternity care during the pandemic and the aftermath, while planning for a future of radically inclusive and equitable maternity care that will draw on the lessons of this pandemic to reduce preterm birth, stillbirth, and maternal mortality worldwide," study authors concluded.