Preterm Birth and Stillbirth During the COVID-19 Pandemic in Sweden: A Nationwide Cohort Study
Abstract
Background: A recent Danish study reported that the rate of extremely preterm birth was reduced during the lockdown period of the coronavirus disease 2019 (COVID-19) pandemic; the odds ratio (OR) was 0.09 (95% CI, 0.01 to 0.40) compared with previous years (1). Given the lockdownmeasures, potential mechanisms might include reduced exposure to various infectious agents, physical work strain, or stress; another explanation might be an increase of stillbirth, as the Danish study was based on live births. A study from the United Kingdom reported that stillbirth was more common during the pandemic; the difference was 6.93 (CI, 1.83 to 12.0) cases per 1000 births, corresponding to a 4-fold risk increase (2). Objective: To investigate associations between being born during a period when many public health interventions aimed at mitigating the spread of COVID-19 were enforced and the risk for preterm birth and stillbirth. Methods and Findings:We conducted a nationwide cohort study of singleton births using the Swedish Pregnancy Register. This register covers 92% of all births in Sweden and includes many variables describing the mother and newborn. The study was approved by the Swedish Ethical Review Authority. We compared the risk for preterm birth and stillbirth among births from 1 April through 31May 2020, a period when Swedish authorities had enforced a range of pandemic mitigation interventions, with births from all April through May periods in the years 2015 to 2019 combined.…
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