Kristjana Einarsdóttir1, Emma Marie Swift2,3, Helga Zoega1,4. 1. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 2. Faculty of Nursing/Department of Midwifery, University of Iceland, Reykjavík, Iceland. 3. Women's Clinic, Landspitali National University Hospital of Iceland, Reykjavik, Iceland. 4. Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia.
Abstract
INTRODUCTION: Previous evidence has been conflicting regarding the effect of Covid-19 pandemic lockdowns on obstetric intervention and preterm birth rates. The literature to date suggests potentially differential underlying mechanisms based on country economic setting. We aimed to study these outcomes in an Icelandic population where uniform lockdown measures were implemented across the country. MATERIAL AND METHODS: The study included all singleton births (n=20,680) during 2016-2020 identified from the population-based Icelandic Medical Birth Register. We defined two lockdown periods during March-May and October-December in 2020 according to government implemented nationwide lockdown. We compared monthly rates of cesarean section, induction of labor and preterm birth during lockdown with the same time periods in the four years prior (2016-2019) using logit binomial regression adjusted for confounders. RESULTS: Our results indicated a reduction in the overall cesarean section rate, which was mainly evident for elective cesarean section, both during the first (adjusted odd ratio (AOR) 0.71, 95% CI 0.51-0.99) and second (AOR 0.72, 95% CI 0.52-0.99) lockdown periods, and not for emergency cesarean section. No change during lockdown was observed in induction of labor. Our results also suggested a reduction in the overall preterm birth rate during the first lockdown (AOR 0.69, 95% CI 0.49-0.97) and in the months immediately following the lockdown (June-September) (AOR 0.67, 95% CI 0.49-0.89). The reduction during the first lockdown was mainly evident for medically indicated preterm birth (although not statistically significant) and the reduction during June-September was mainly evident for spontaneous preterm birth. CONCLUSIONS: This study suggested a reduction in elective cesarean section during Covid-19 lockdown, possibly reflecting changes in prioritization of nonurgent health care during lockdown. We also found a reduction in overall preterm birth during the first lockdown and spontaneous preterm birth following the first lockdown, but further research is needed to shed light on the underlying mechanisms for these findings. This article is protected by copyright. All rights reserved.
INTRODUCTION: Previous evidence has been conflicting regarding the effect of Covid-19 pandemic lockdowns on obstetric intervention and preterm birth rates. The literature to date suggests potentially differential underlying mechanisms based on country economic setting. We aimed to study these outcomes in an Icelandic population where uniform lockdown measures were implemented across the country. MATERIAL AND METHODS: The study included all singleton births (n=20,680) during 2016-2020 identified from the population-based Icelandic Medical Birth Register. We defined two lockdown periods during March-May and October-December in 2020 according to government implemented nationwide lockdown. We compared monthly rates of cesarean section, induction of labor and preterm birth during lockdown with the same time periods in the four years prior (2016-2019) using logit binomial regression adjusted for confounders. RESULTS: Our results indicated a reduction in the overall cesarean section rate, which was mainly evident for elective cesarean section, both during the first (adjusted odd ratio (AOR) 0.71, 95% CI 0.51-0.99) and second (AOR 0.72, 95% CI 0.52-0.99) lockdown periods, and not for emergency cesarean section. No change during lockdown was observed in induction of labor. Our results also suggested a reduction in the overall preterm birth rate during the first lockdown (AOR 0.69, 95% CI 0.49-0.97) and in the months immediately following the lockdown (June-September) (AOR 0.67, 95% CI 0.49-0.89). The reduction during the first lockdown was mainly evident for medically indicated preterm birth (although not statistically significant) and the reduction during June-September was mainly evident for spontaneous preterm birth. CONCLUSIONS: This study suggested a reduction in elective cesarean section during Covid-19 lockdown, possibly reflecting changes in prioritization of nonurgent health care during lockdown. We also found a reduction in overall preterm birth during the first lockdown and spontaneous preterm birth following the first lockdown, but further research is needed to shed light on the underlying mechanisms for these findings. This article is protected by copyright. All rights reserved.
Entities:
Keywords:
Covid-19; cesarean section; induction of labor; lockdown; preterm birth
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