A major review of global health data has found that COVID-19 lockdowns were associated with fewer spontaneous preterm births and reduced neonatal mortality in high-income countries, but also linked to worsening maternal mental health.
The findings, published in Nature Human Behaviour, stem from a systematic review and meta-analysis of 132 studies examining how pandemic-era restrictions affected adverse birth and pregnancy outcomes (ABPOs) between January 2019 and June 2023. Researchers focused on data from high-income countries (HICs), where access to healthcare and pandemic policies were broadly comparable.
Key Findings: Fewer Preterm Births, Higher Depression Risk
The analysis found a 4% reduction in preterm births—specifically spontaneous preterm births—during the first wave of COVID-19 lockdowns in Europe and Australia. This trend remained statistically significant even after accounting for long-term fluctuations in birth outcomes. However, the effect was largely absent in subsequent lockdowns and in regions outside Europe and Australia, including North America, Asia, South America, and the Middle East.
Neonatal mortality also appeared to drop by 18% during lockdown periods. Yet researchers urged caution in interpreting this result, noting it was heavily influenced by a single large study and requires additional time-adjusted analysis to confirm.
In contrast, antenatal depression screening rates rose sharply—by 37%—suggesting increased psychological strain among expectant mothers during lockdowns. Despite this, researchers could not draw firm conclusions about how socioeconomic inequalities or ethnic backgrounds may have influenced outcomes, due to a lack of consistent data.
Study Background and Methodology
COVID-19 lockdowns were introduced globally as a non-pharmaceutical intervention to limit virus transmission. While effective in curbing infection rates, these measures inadvertently reshaped healthcare delivery and daily life—factors that could influence pregnancy outcomes.
Previous research had shown contrasting trends: stillbirths increased in low- to middle-income countries (LMICs), while some high-income nations reported declines in preterm births. This new review sought to resolve inconsistencies in earlier studies by systematically analyzing available data from HICs.
To do so, researchers scoured databases including EMBASE, Web of Science, MEDLINE/PubMed, and preprint archives. After screening over 14,000 records and removing duplicates or overlapping studies, 132 publications were included in the final meta-analysis. Most were cohort studies (86%), with the majority of participants from Europe (45%) and North America (41%).
Additional Outcomes: Mixed Results and Regional Differences
Beyond preterm births and mental health, the study found no consistent evidence linking lockdowns to stillbirths, low birth weight, caesarean section rates, or neonatal sepsis.
Some regional differences did emerge in other areas:
- Neonatal admissions decreased in the Middle East but increased in Asia.
- Maternal readmission rates dropped in parts of Europe, particularly the United Kingdom.
However, the researchers emphasized that these regional trends lacked sufficient data for broader conclusions. High variability between studies also made subgroup analysis difficult, especially in understanding how socioeconomic or ethnic disparities may have shaped outcomes.
A Natural Experiment with Uneven Effects
The researchers described the pandemic lockdowns as a “natural experiment” with complex, uneven effects on maternal and neonatal health. While the restrictions appeared to reduce some adverse birth outcomes, they also intensified mental health challenges among pregnant women.
The study’s authors argue that broad, one-size-fits-all lockdown policies can produce unequal health impacts. Instead, they advocate for more targeted public health interventions and support systems that address the specific needs of different populations.
“Understanding these differences is vital,” the researchers concluded, “to inform future responses that better balance infection control with maternal and infant well-being.”
Call for Further Research
The authors called for future studies to explore the underlying causes of these trends, especially through mixed-methods approaches that combine statistical data with qualitative insights. They also highlighted a pressing need for more research into how healthcare access and social inequalities influenced outcomes during the pandemic.
As the world reflects on the far-reaching effects of COVID-19, this study offers a nuanced perspective: while lockdowns may have offered unexpected health benefits for some, they also underscored existing vulnerabilities in maternal care systems.
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