Silverstein Hannah, Jennings Mayo-Wilson Larissa, Austin Anna
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Reprod Health. 2025 Jul 29;22(1):136. doi: 10.1186/s12978-025-02084-0.
Starting in March 2020, the COVID-19 pandemic strained the healthcare system in the United States, directly and indirectly changing the provision of many types of care, including maternity care. This paper describes longer-term changes in maternal health services utilization in the U.S. during the COVID-19 pandemic.
Using United States monthly aggregated birth record data from 2016 to 2023, we examined changes in the average number of prenatal visits (overall and by delivery pay type) and total births (overall, by pay type, and by birthplace) before, during, and after the pandemic. We estimated monthly time series models replicating pre-pandemic patterns from January 2016 to February 2020. We then extended those models to predict monthly levels of each outcome had COVID-19 not occurred from March 2020 through December 2023. We compared observed and predicted levels from March 2020 onward, assessing differences associated with COVID-19.
There were persistent and significantly lower-than-expected levels of average number of prenatal care visit across all COVID-19 months. There was also a temporary significant drop in total births during 2020 that recovered to expected levels in 2021, except for an increase in the total self-pay births in 2023. Patterns by pay type were similar to the overall patterns observed. Total non-hospital births were significantly higher than expected for the entirety of the pandemic, with large increases in intentional home births.
Most initial changes to maternity care persisted throughout and continued after the pandemic, resulting in lower levels of prenatal care visits and higher numbers of home births. These findings show sustained changes to maternity care provision and access prompted by COVID-19, which highlight how vulnerable maternity services are to healthcare disruptions and suggest prolonged effects on equitable access to safe care.
自2020年3月起，新冠疫情给美国的医疗系统带来了压力，直接或间接地改变了包括孕产妇护理在内的多种医疗服务的提供方式。本文描述了新冠疫情期间美国孕产妇健康服务利用情况的长期变化。
利用2016年至2023年美国每月汇总的出生记录数据，我们研究了疫情前、疫情期间和疫情后产前检查的平均次数（总体及按分娩支付类型）以及总出生数（总体、按支付类型和出生地）的变化。我们估计了月度时间序列模型，以复制2016年1月至2020年2月的疫情前模式。然后，我们扩展这些模型，以预测如果2020年3月至2023年12月没有发生新冠疫情，每个结果的月度水平。我们比较了2020年3月起的观察水平和预测水平，评估与新冠疫情相关的差异。
在整个新冠疫情期间，产前护理就诊的平均次数持续低于预期水平，且差异显著。2020年总出生数也出现了暂时的显著下降，到2021年恢复到预期水平，但2023年自费分娩总数有所增加。按支付类型划分的模式与观察到的总体模式相似。在整个疫情期间，非医院分娩总数显著高于预期，其中有意在家分娩的数量大幅增加。
孕产妇护理的大多数初始变化在疫情期间持续存在，并在疫情后继续存在，导致产前检查次数减少和在家分娩数量增加。这些发现表明，新冠疫情促使孕产妇护理的提供和获取发生了持续变化，凸显了孕产妇服务在面对医疗中断时的脆弱性，并暗示了对安全护理公平获取的长期影响。
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