Changes in obstetric interventions and preterm birth during COVID-19: A nationwide study from Iceland.

• Published in: Acta Obstetricia et Gynecologica Scandinavica
• Main Authors: Einarsdóttir, Kristjana, Swift, Emma Marie, Zoega, Helga
• Other Authors: 1Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 2Faculty of Nursing/Department of Midwifery, University of Iceland, Reykjavík, Iceland. 3Women's Clinic, Landspitali National University Hospital of Iceland, Reykjavik, Iceland. 4Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2021
• Subjects: COVID-19; cesarean section; induction of labor; lockdown; preterm birth; Fæðingarhjálp; Fyrirburar; Delivery; Obstetric; Premature Birth; Iceland
• Online Access: http://hdl.handle.net/2336/621908; https://doi.org/10.1111/aogs.14231

To access publisher's full text version of this article click on the hyperlink below Introduction: Previous evidence has been conflicting regarding the effect of coronavirus disease 2019 (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 4 previous years (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 non-urgent health care during lockdown. ...