Modest reduction in adverse birth outcomes following the COVID-19 lockdown.
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Author list: Caniglia EC, Magosi LE, Zash R, Diseko M, Mayondi G, Mabuta J, Powis K, Dryden-Peterson S, Mosepele M, Luckett R, Makhema J, Mmalane M, Lockman S, Shapiro R
Publisher: Elsevier: 12 months
Publication year: 2020
Journal: American Journal of Obstetrics & Gynecology (0002-9378)
Journal acronym: Am J Obstet Gynecol
ISSN: 0002-9378
Languages: English-Great Britain (EN-GB)
Abstract
BACKGROUND\nOBJECTIVE\nSTUDY DESIGN\nRESULTS\nCONCLUSIONS\nWidespread lockdowns imposed during the COVID-19 crisis may impact birth outcomes.\nTo evaluate the association between the COVID-19 lockdown and the risk of adverse birth outcomes in Botswana.\nIn response to COVID-19, Botswana enforced a lockdown that restricted movement within the country. We used data from an ongoing nationwide birth outcomes surveillance study to evaluate adverse outcomes (stillbirth, preterm birth, small-for-gestational-age [SGA], and neonatal death) and severe adverse outcomes (stillbirth, very preterm birth, very SGA, and neonatal death) recorded pre-lockdown (January 1 - April 2), during lockdown (April 3 - May 7), and post-lockdown (May 8 - July 20). Using difference-in-differences analyses, we compared the net change in each outcome from the pre-lockdown to lockdown periods in 2020 relative to the same two periods in 2017-2019, and the net change in each outcome from the pre-lockdown to post-lockdown periods in 2020 relative to the same two periods in 2017-2019.\n68,448 women delivered a singleton infant in 2017-2020 between January 1 and July 20 and were included in our analysis (mean [interquartile range] age of mothers, 26 [22,32] years). Across the included calendar years and periods, the risk of any adverse outcome ranged from 27.92% to 31.70% and the risk of any severe adverse outcome ranged from 8.40% to 11.38%. The lockdown period was associated with a 0.81 percentage point reduction (95% CI, -2.95%, 1.30%) in the risk of any adverse outcome (3% relative reduction) and a 0.02 percentage point reduction (95% CI, -0.79%, 0.75%) in the risk of any severe adverse outcome (0% relative reduction). The post-lockdown period was associated with a 1.72 percentage point reduction (95% CI, -3.42%, -0.02%) in the risk of any adverse outcome (5% relative reduction) and a 1.62 percentage point reduction (95% CI, -2.69%, -0.55%) in the risk of any severe adverse outcome (14% relative reduction). Reductions in adverse outcomes were largest among women with HIV and among women delivering at urban delivery sites, driven primarily by reductions in preterm birth and SGA.\nAdverse birth outcomes decreased from the pre-lockdown to post-lockdown periods in 2020, relative to the change during the same periods in 2017-2019. Our findings may provide insights into associations between mobility and birth outcomes in Botswana and other low- and middle-income countries.
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