{
  "abstract": "Background The COVID-19 pandemic disrupted healthcare service utilisation, but evidence on its impact on perinatal outcomes is conflicting. We investigated the impact of the pandemic public health measures (eg, lockdowns, reduced healthcare access, altered health-seeking behaviour) on preterm birth (PTB), stillbirth, low birth weight (LBW), small for gestational age, caesarean delivery, breastfeeding initiation (BFI) and neonatal intensive care unit (NICU) admissions.Methods Using linked administrative health databases, we conducted a population-based study of pregnancies before (January 2008–February 2020) or during (March 2020–March 2022) the pandemic; for the latter period, they were categorised by exposure duration. We conducted interrupted time series analyses using season-adjusted generalised linear models, and analyses were stratified by income.Results Among 222 636 pregnancies (190 694 prepandemic and 31 942 during pandemic), PTB rates increased from 8% prepandemic to 9.1% during the pandemic, with a 19.0% relative increase overall (p<0.01). In stratified analyses, PTB rose by 27.1% in the lower-income group (8.8% to 10.1%, p=0.01) and by 19.7% in the higher income group (7.3% to 8.2%, p=0.02); however, effect modification by income was statistically non-significant. Pregnancies 100% exposed during the first and second year of the pandemic experienced higher rates of PTB by 15.0% (p=0.01) and 11.6% (p<0.01) compared with the prepandemic period, respectively. The pandemic measures were associated with no changes in stillbirth (0.7‰ vs 0.61%; p=0.37) or NICU admission rates (8.3% vs 8.2%; p=0.69). LBW rates increased from 5.5% to 6.3% (13.9% relative increase, p=0.05). Pregnancies spanning the entire first year of the pandemic experienced higher rates of caesarean deliveries (24.6% relative increase, p<0.01). BFI rates decreased from 82.5% to 81.8% (3.9% relative decrease, p=0.01) compared with prepandemic, followed by a slight increase (p=0.02) during the pandemic period.Conclusions The COVID-19 pandemic measures were associated with increased PTB and caesarean delivery rates, particularly among pregnancies fully exposed to pandemic measures. Over the 2-year pandemic period, stillbirth, NICU admissions and BFI rates were stable.",
  "authors": [
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Laila Aboulatta"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada",
        "Department of Biochemistry & Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada",
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Kaarina Kowalec"
    },
    {
      "affiliations": [
        "College of Community and Global Health, University of Manitoba, Winnipeg, Manitoba"
      ],
      "name": "Lisa M Lix"
    },
    {
      "affiliations": [
        "Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Mina Tadrous"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada",
        "Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Joseph A Delaney"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada",
        "Department of Psychiatry, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Christine Leong"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Jamie Falk"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada",
        "Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada"
      ],
      "name": "Silvia Alessi-Severini"
    },
    {
      "affiliations": [
        "College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Christina Raimondi"
    },
    {
      "affiliations": [
        "Department of Family Medicine, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada",
        "Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Katherine Kearns"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Lara Haidar"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Payam Peymani"
    },
    {
      "affiliations": [
        "Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada"
      ],
      "name": "Qier Tan"
    },
    {
      "affiliations": [
        "College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada",
        "The Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Sherif Eltonsy"
    }
  ],
  "title": "Disruptions in perinatal outcomes across Manitoba, Canada: before and over 2 years of the COVID-19 pandemic",
  "uid": "7ec324d0-ecb7-5884-9592-f71d22289892"
}