Socioeconomic disparities in changes to preterm birth and stillbirth rates during the first year of the COVID-19 pandemic: a study of 21 European countries
Jennifer Zeitlin, Marianne Philibert, Henrique Barros, Lisa Broeders, Ján Cáp, Željka Draušnik, Hilde Engjom, Alex Farr, J. Fresson, Miriam Gatt, Mika Gissler, Günther Heller, Jelena Isakova, Karin Källén, Theopisti Kyprianou, Marzia Loghi, Kirsten Monteath, Laust Hvas Mortensen, Tonia Rihs, Luule Sakkeus, Izabela Sikora, Katarzyna Szamotulska, P Velebil, Ivan Verdenik, Guy Weber, Irisa Zīle, Óscar Zurriaga, Lucy Smith, Jeannette Klimont, Alex Farr, Sophie Alexander, Marie Delnord, Judith Racapé, Gisèle Vandervelpen, Wei‐Hong Zhang, Rumyana Kolarova, Evelin Jordanova, Jelena Dimnjaković, Željka Draušnik, Urelija Rodin, Theopisti Kyprianou, Vasos Scoutellas, Jitka Jírová, P Velebil, Anne Vinkel Hansen, Laust Hvas Mortensen, Liili Abuladze, Luule Sakkeus, Mika Gissler, Anna Heino, Melissa Amyx, Béatrice Blondel, Anne Alice Chantry, Catherine Deneux‐Tharaux, Mélanie Durox, J. Fresson, Alice Hocquette, Marianne Philibert, Annick Vilain, Jennifer Zeitlin, Dimitra Bon, Günther Heller, Björn Misselwitz, Aris Antsaklis, István Sziller, Védís Helga Eiríksdóttir, Jóhanna Gunnarsdóttir, Helga Sól Ólafsdóttir, Karen Kearns, Izabela Sikora, Rosaria Boldrini, Marina Cuttini, Serena Donati, Marzia Loghi, Marilena Pappagallo, Jānis Misiņš, Irisa Zīle, Rita Gaidelyte, Jelena Isakova, Audrey Billy, Aline Lecomte, Jessica Pastore, Guy Weber, Miriam Gatt, Peter Achterberg, Lisa Broeders, Ashna D. Hindori‐Mohangoo, Jan G. Nijhuis, Rupali Akerkar, Hilde Engjom, Kari Klungsøyr, Ewa Mierzejewska, Katarzyna Szamotulska, Henrique Barros, Carina Rodrigues, Mihaela-Alexandra Budianu, Alexandra Cucu, Mihai Horga, Lucian Pușcașiu, Petru Sandu
Abstract
BACKGROUND: Despite concerns about worsening pregnancy outcomes resulting from healthcare restrictions, economic difficulties and increased stress during the COVID-19 pandemic, preterm birth (PTB) rates declined in some countries in 2020, while stillbirth rates appeared stable. Like other shocks, the pandemic may have exacerbated existing socioeconomic disparities in pregnancy, but this remains to be established. Our objective was to investigate changes in PTB and stillbirth by socioeconomic status (SES) in European countries. METHODS: The Euro-Peristat network implemented this study within the Population Health Information Research Infrastructure (PHIRI) project. A common data model was developed to collect aggregated tables from routine birth data for 2015-2020. SES was based on mother's educational level or area-level deprivation/maternal occupation if education was unavailable and harmonized into low, medium and high SES. Country-specific relative risks (RRs) of PTB and stillbirth for March to December 2020, adjusted for linear trends from 2015 to 2019, by SES group were pooled using random effects meta-analysis. RESULTS: Twenty-one countries provided data on perinatal outcomes by SES. PTB declined by an average 4% in 2020 {pooled RR: 0.96 [95% confidence intervals (CIs): 0.94-0.97]} with similar estimates across all SES groups. Stillbirths rose by 5% [RR: 1.05 (95% CI: 0.99-1.10)], with increases of between 3 and 6% across the three SES groups, with overlapping confidence limits. CONCLUSIONS: PTB decreases were similar regardless of SES group, while stillbirth rates rose without marked differences between groups.