Pregnancy outcomes during the Jordanian COVID-19 national lockdown

There have been numerous outbreaks associated with coronaviruses throughout the years that have had the potential to cause serious problems to global health, including the Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV).

Currently, the world's health is being threatened by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) following its rapid spread worldwide since emerging in late December 2019 in Wuhan, China.

Globally, the spread of the SARS-CoV-2 has caused significant disruptions and lockdowns. In addition, as a result of everyday lifestyle changes and the inaccessibility of antenatal care during the coronavirus disease 2019 (COVID-19) epidemic, pregnancy outcomes are affected in various ways.

A Jordanian study was conducted to investigate the effects of the COVID-19 national lockdown on stillbirth, neonatal-perinatal mortality, preterm birth, and birth weight.

The neonatal mortality rate could be affected by the pandemic due to an anticipated decline in healthcare services and through fear of visiting healthcare facilities. Prematurity is a leading cause of death among children under five years of age and is associated with high morbidity and mortality. The reported preterm birth rate in Jordan, 2020 was 11%.

In this study, a team of researchers from the University of Jordan analyzed neonatal mortality, preterm birth, and low birth weight rates, which could lead to future studies on the underlying causes, since low birth weight and preterm birth result in different health outcomes when classified in different birth weight and gestation age strata. This study aimed to evaluate alterations in birth weight, stillbirth, preterm birth, and neonatal-perinatal mortality rates during the COVID-19 national lockdown in Jordan.

This study is published in the BMC Pregnancy and Childbirth journal.

The study

Between May 2019 and December 2020, there was a total of 29,592 women admitted for delivery to the five pilot hospitals, with 31,106 babies being born, 15,311 born before the lockdown and 15,795 during the lockdown.

Within the study period, there was a total of 14,989 vaginal births, of which 7,228 occurred before the lockdown and 7,761 occurred during the lockdown.

Additionally, 14,603 births required a cesarean section (C-section), of which 7,088 occurred before the lockdown and 7,515 occurred during the lockdown.

The proportion of women delivering babies with an income of less than 500 Jordanian dinars (JD) was significantly lower during the lockdown than before the lockdown. No significant difference was displayed between-period variation in the proportion of preterm babies. In contrast, there was a significant between-period difference in the birth weight distribution.

Compared to before the pandemic, the proportion of babies born at a low or very low birth weight was significantly lower during the COVID-19 pandemic. During the lockdown period, the percentage of babies with an appropriate weight for gestational age was significantly higher when compared to before the lockdown. Between both during and after the lockdown, there were no significant differences in the rates of perinatal mortality, neonatal mortality, and stillbirths.

The multinominal regression analysis utilized for nominal pregnancy outcomes for before and during the lockdown was adjusted for the mother's age, occupation, income, education, health sector, nationality, and multiplicity revealed no significant difference in the chance of extremely preterm, very preterm, and moderate to late preterm between before and during the lockdown. However, when compared to babies born before the lockdown, those born during were significantly less likely to be born with extremely low birth weight. Also, there were no significant between-period differences in neonatal mortality, stillbirth, and perinatal mortality rates.

Implications

After the authors adjusted for sociodemographic factors, the study results showed significant differences in the populations between before and during the lockdown regarding extremely low birth weights.

Still, there was no difference observed in neonatal death rates, perinatal death, preterm birth, and stillbirth. To determine if these changes persist into the future, the birth outcomes should be tracked throughout the following years of the COVID-19 pandemic.

Future research, both experimental- and epidemiological-based, is required to gain a better understanding of the effects of socioeconomic, maternal behavior, and nutritional factors on the variable reported birth outcomes that have occurred globally during the COVID-19 pandemic, to develop effective preventative mechanisms.

Written by

Colin Lightfoot

Colin graduated from the University of Chester with a B.Sc. in Biomedical Science in 2020. Since completing his undergraduate degree, he worked for NHS England as an Associate Practitioner, responsible for testing inpatients for COVID-19 on admission.