Obstetric interventions and pregnancy outcomes during the Covid-19 pandemic in England: a nationwide cohort study

Title Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: a nationwide cohort study 300 words excluding title and headings No references Background The COVID-19 pandemic has disrupted maternity services worldwide and imposed restrictions on societal behaviours. The ‘indirect’ effects of these changes on maternal and neonatal outcomes are likely to be larger than the direct effects of COVID-19 infection.

Aims and objective/s Comparing obstetric intervention rates and pregnancy outcomes in England during the pandemic/prepandemic periods

To assess if the differences in rates varied according to ethnic and socioeconomic background.

Method (must include research design, sample, analysis and ethical approval)

National study of singleton births in English NHS hospitals.

Births during the COVID-19 pandemic period (23/03/20-22/2/21) compared with births during the corresponding calendar period one year earlier. Hospital Episode Statistics provided data about maternal characteristics, obstetric inventions and maternal and neonatal outcomes.

Multi-level logistic regression models were used with all models adjusted for maternal characteristics and COVID-19 status at birth.

This study was exempt from ethical review as we used routinely collected data; personal data used without individual consent was approved by the NHS Health Research Authority.

Findings: Of 948,020 singleton births 451,727 occurred during the defined pandemic period. Maternal characteristics were similar in the pre-pandemic and pandemic periods. Compared to the pre-pandemic period, stillbirth rates remained similar (0.36% versus 0.37% p-value 0.16),preterm birth and SGA birth rates were slightly lower (6.0% versus 6.1% and 6% versus 5.8% respectively, both p<0.001), and obstetric interventions were slightly higher (40.4% versus 39.1% IOL; 13.9% versus 12.9% for EL CS; 18.4% versus 17.0% for EM CS; all p<0.001). There were lower rates of prolonged maternal length of stay (16.7% versus 20.2%, p<0.001) and maternal readmission (3.0% versus 3.3%, p<0.001). There was some evidence that differences in outcomes varied according to women’s ethnic background but not according to their socioeconomic background.

Conclusions Changes in obstetric intervention rates and pregnancy outcomes during the pandemic period may be linked to women’s behaviour, environmental exposure, changes in maternity practice, or reduced staffing levels.