Population Health Office - Directorate of Research, Study, Evaluation and Statistics (DREES) - Health Ministry, Paris, France; Department of Medical Information - University Hospital (CHRU), Nancy, France; Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.
Program in Public Health & Center for Population, Inequality and Policy, University of California, Irvine, Irvine, CA.
Ann Epidemiol. 2022 Aug;72:74-81. doi: 10.1016/j.annepidem.2022.05.004. Epub 2022 May 25.
Given contradictory evidence about preterm birth (PTB) decreases during COVID-19 lockdowns, we investigate PTB rates during France's strict nationwide lockdown (March 17, 2020 to May 10, 2020).
This is an interrupted time series analysis using data on maternal delivery hospitalizations in France from January 01, 2016 to July 31, 2020 (3,448,286 singleton births ≥22 weeks' gestational age (GA)). Outcomes were weekly PTB rates (overall and by GA sub-group: <28, 28-31, 32-34, 35-36 weeks), stillbirth and cesarean birth. We estimate odds ratios (OR) using the lockdown period as exposed and other weeks as unexposed, nationally and for districts grouped by COVID-19 incidence.
Of 96,076 singleton live births during the lockdown, 4,799 were preterm. PTB rates were 6% (OR: 0.94, 95% CI: 0.90-0.98) lower than expected over this period. This decrease occurred among births 35-36 weeks' GA (OR: 0.92, 95% CI: 0.87-0.98), with no detectable reductions for other GA groups. Cesarean and stillbirth rates were stable. Larger differences were observed in districts with low (OR: 0.92, 95% CI 0.87-0.98) versus moderate/high COVID-19 incidence (OR: 0.97, 95% CI 0.92-1.03).
Late preterm births decreased during France's first lockdown without concurrent change in cesareans and stillbirths. Effects were not more pronounced in moderate/high-COVID-19 districts, contradicting expectations if healthcare disruption were a principal cause.
鉴于关于 COVID-19 封锁期间早产 (PTB) 减少的证据相互矛盾，我们调查了法国严格的全国性封锁期间的 PTB 率（2020 年 3 月 17 日至 2020 年 5 月 10 日）。
这是一项使用法国 2016 年 1 月 1 日至 2020 年 7 月 31 日（3448286 例 22 周以上妊娠龄（GA）的单胎分娩住院数据）的中断时间序列分析。结局为每周 PTB 率（总体和按 GA 亚组：<28、28-31、32-34、35-36 周）、死产和剖宫产。我们使用封锁期作为暴露期，其他周作为非暴露期，在全国范围内和按 COVID-19 发病率分组的地区估计比值比（OR）。
在封锁期间的 96076 例单胎活产中，有 4799 例早产。在此期间，PTB 率低 6%（OR：0.94，95%CI：0.90-0.98）。这种下降发生在 35-36 周 GA 的分娩中（OR：0.92，95%CI：0.87-0.98），其他 GA 组未检测到减少。剖宫产和死产率保持稳定。在 COVID-19 发病率较低（OR：0.92，95%CI 0.87-0.98）和中度/高（OR：0.97，95%CI 0.92-1.03）的地区观察到更大的差异。
在法国第一次封锁期间，晚期早产减少，同时剖宫产和死产没有变化。如果医疗保健中断是主要原因，那么在中度/高 COVID-19 地区，效果不会更加明显，这与预期相反。
