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The impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women have been of considerable concern. Uninfected pregnant women may be affected by generalized social panic, reduced number of prenatal examinations (NPE)①, and delayed medical treatment. During the COVID-19 pandemic in China, most pregnant women stayed at home unless an urgent prenatal examination or treatment was required. It was reported that COVID-19 pandemic resulted in approximately 1/3 of pregnant women having inadequate antenatal visits and 44.7% of pregnancies with complications due to their fear of contracting infections (1). This study examined the impact of the COVID-19 pandemic on the clinical characteristics of uninfected pregnant women and their neonates by using two ongoing programs conducted by the Maternal and Newborn Health Monitoring Program (MNHMP) and a birth cohort of the Haidian Maternal and Child Care Hospital (HMCCH) in Beijing, China. The results suggested that the rates of caesarean section (CS) and preterm birth② increased slightly in areas that were more affected by the pandemic. NPE were not significantly interrupted, and most maternal and neonatal clinical characteristics were within the normal ranges. The rate of the number of prenatal eligible examinations exceeding 5 times (PEE5) with blood pressure and blood routine examinations during the regulated prenatal care③ according to the National Standards for Basic Public Health Services in China was significantly reduced in Hubei. We concluded that the frequency of routine prenatal care had been well maintained in China during the pandemic period in 2020. However, special in-time prenatal examination should be provided to improve the quality of care for pregnant women, and screening and management of high-risk pregnancies should be strengthened when pandemic-like circumstances occur in the future.
This prospective cohort study was based on two ongoing multicenter programs including: 1) the MNHMP established in 2013 by the National Center for Women and Children’s Health (NCWCH) of China CDC, of which the detailed information had been described previously (2); and 2) a birth cohort in HMCCH in Beijing in China. For all areas, pregnant women were recruited with delivery or termination from January 1, 2019 to May 31, 2019 (pre-pandemic period: P-2019) and from January 1, 2020 to May 31, 2020 (pandemic period: P-2020). Finally, 32,277 pregnant women were included from 6 Provincial Administration Level Divisions(PLADs), including 6,449 in Hubei Province, 5,878 in Guangdong Province, 3,641 in Hebei Province, 6,328 in Shandong Province, 2,920 in Yunnan Province, and 7,061 in Beijing Municipality. The main outcomes, including the NPE, PEE5, preterm birth, stillbirth④, large for gestational age (LGA)⑤, small for gestational age (SGA)⑥, macrosomia⑦, and low birth weight (LBW)⑧ status were recorded or calculated. Means ± standard deviations (SDs) or medians (25%–75% percentile ranges) were used to describe distributions. SGA and LGA status were assessed from gestational week 24–42. COVID-19 pandemic status served as a categorical variable. Three regression models were used to estimate the effects of the pandemic depending on the data distribution, i.e., Poisson, linear, and log-binomial regressions. The confounders included body mass index (BMI, categorical), age (categorical), parity, gravidity, ethnicity, and educational level. The study protocol was approved by the institutional review board of Peking University.
The demographic characteristics of all women were listed in Table 1. The mean ages differed between the two periods (P-2019 vs. P-2020) for Hubei (29.1 vs. 28.7), Guangdong (28.4 vs. 27.9), Beijing (31.6 vs. 31.4), and Hebei (29.8 vs. 29.4). However, the differences were negligible (maximum 1.7% in Guangdong). Parity distribution varied by location but did not differ between the two periods. The average BMI (kg/m2) ranged from 22.2 (Hubei) to 23.2 (Hebei). For Hebei alone, the average BMI increased slightly from 23.1 (P-2019) to 23.5 (P-2020). Educational levels differed greatly; although significant differences between the two periods were evident in Hubei and Guangdong, the overall pattern remained similar.
Demographic characteristic Hubei Guangdong Beijing County or district Huangmei, Luotian Longchuan, Zijin Haidian Year P-2019 P-2020 P-2019 P-2020 P-2019 P-2020 No. of subjects 3,300 3,149 3,328 2,550 3,902 3,159 Age (years) 28.7 ± 4.2** 29.1 ± 4.3§, §§ 27.9 ± 5.0 28.4 ± 5.0§, §§ 31.4 ± 4.0 31.6 ± 4.0*, §§ 28.0 (26.0, 31.0)†† 29.0 (27.0, 32.0)§, ¶¶ 27.0 (24.0, 31.0) 28.0 (25.0, 31.0)§, ¶¶ 31.0 (29.0, 34.0) 31.0 (29.0, 34.0)†, ¶¶ Missing 0 (0) 2 (0) 0 (0) 2 (0) 0 (0) 0 (0) Gravidity 1 time 1,276 (39) 1,220 (39) 884 (27) 698 (27) 1,785 (46) 1,422 (45) ≥2 times 2,024 (61) 1,929 (61) 2,444 (73) 1,852 (73) 2,117 (54) 1,737 (55) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Parity Nulliparous − ††† − 1,255 (38) 960 (38) 2,517 (65) 2,058 (65) Multiparous − − 2,073 (62) 1,590 (62) 1,385 (35) 1,101 (35) Missing − − 0 (0) 0 (0) 0 (0) 0 (0) BMI (kg/m2) 22.2 ± 3.1** 22.3 ± 3.2 22.0 ± 3.3 22.1 ± 3.5 − − 21.7 (20.1, 23.8)†† 21.9 (20, 24) 21.6 (19.6, 24.1) 21.7 (19.5, 24.1) − − Missing 116 (4) 167 (5) 84 (3) 87 (3) − − Education Primary or lower 26 (1) 15 (0) §, *** 58 (2) 53 (2)†, *** − − Junior high 558 (17) 424 (14) 1,865 (56) 1,351 (53) − − Senior high 2,295 (72) 2,377 (78) 760 (23) 566 (22) − − College or higher 316 (10) 242 (8) 645 (19) 580 (23) − − Missing 105 (3) 91 (3) 0 (0) 0 (0) − − Ethnicity Han 3,248 (100) 3,086 (100) 3,233 (98) 2,483 (98) − − Others 10 (0) 12 (0) 51 (2) 47 (2) − − Missing 42 (1) 51 (2) 44 (1) 20 (1) − − Demographic characteristic Shandong Hebei Yunnan County or district Shizhong, Huaiyin Zhengding, Xingtai Huaning, Tonghai Year P-2019 P-2020 P-2019 P-2020 P-2019 P-2020 No. of subjects 3,879 2,449 2,280 1,361 1,952 968 Age (years) 31.3 ± 4.3 31.3 ± 4.2 29.4 ± 3.9 29.8 ± 3.9†, §§ 27.9 ± 4.8 28.0 ± 4.6 31.0 (29.0, 34.0) 31.0 (29.0, 34.0) 29.0 (27.0, 32.0) 30.0 (27.0, 32.0)†, ¶¶ 28.0 (24.0, 31.0) 28.0 (25.0, 31.0) Missing 0 (0) 0 (0) 0 (0) 1 (0) 0 (0) 0 (0) Gravidity 1 time 1,353 (35) 832 (34) 562 (25) 317 (23) 537 (28) 227 (23)*, *** ≥2 times 2,526 (65) 1,617 (66) 1,718 (75) 1,044 (77) 1,415 (72) 741 (77) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Parity Nulliparous 1,968 (51) 1,182 (48) 764 (34) 465 (34) 772 (40) 390 (40) Multiparous 1,911 (49) 1,267 (52) 1,516 (66) 896 (66) 1,180 (60) 578 (60) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) BMI (kg/m2) 22.9 ± 3.6 22.8 ± 3.6 23.1 ± 4.0 23.5 ± 4.2 22.1 ± 3.7 22.1 ± 3.8 22.3 (20.2, 24.8) 22.3 (20.3, 24.6) 22.4 (20.2, 25.3) 22.8 (20.4, 26.1)†, ¶¶ 21.4 (19.4, 24.1) 21.4 (19.2, 24.2) Missing 36 (1) 9 (0) 1 (0) 0 (0) 0 (0) 0 (0) Education Primary or lower 9 (0) 9 (0) 19 (1) 4 (0) 199 (10) 86 (9) Junior high 237 (7) 138 (7) 457 (25) 277 (24) 700 (36) 372 (39) Senior high 477 (14) 240 (12) 479 (26) 310 (27) 564 (29) 289 (30) College or higher 2,687 (79) 1,675 (81) 895 (48) 551 (48) 475 (25) 211 (22) Missing 469 (12) 387 (16) 430 (19) 219 (16) 14 (1) 10 (1) Ethnicity Han 3,740 (98) 2,375 (98) 1,819 (98) 1,124 (99) 1,514 (78) 744 (78) Others 79 (2) 54 (2) 31 (2) 17 (1) 419 (22) 216 (22) Missing 60 (2) 20 (1) 430 (19) 220 (16) 19 (1) 8 (1) Notes: The COVID-19 pandemic level of the 6 PLADs are: Hubei, level IV; Guangdong, level III; Beijing, level II; Shandong, level II; Hebei, level I; and Yunnan, level I.
Abbreviations: P-2019, January 1–May 31, 2019 as the pre-pandemic period; P-2020, January 1–May 31, 2020 as the pandemic period.
* P<0.05;
† P<0.01;
§ P<0.001;
¶ The COVID-19 pandemic levels were classified according to the provincial overall prevalence rate compared to Hubei Province;;
** Mean value ± standard deviation;
†† Median value (25%–75% percentile);
§§ Compared by t test;
¶¶ Compared by Mann-Whitney U test;
*** Compared by Chi-square test;
††† Data was unavailable.Table 1. Demographic characteristics of the participants in the 2 periods of 2019 and 2020 in 6 provincial-level administrative divisions (PLADs) of China.
The maternal and neonatal clinical characteristics were listed in Table 2. The NPE varied by locations. The average NPE in Hubei and Beijing decreased slightly from P-2019 to P-2020 but increased in Guangdong and Hebei. Comparatively speaking, the ratio of PEE5 significantly decreased from 5.4% (P2019) to 2.6% (P2020) in Hubei. No between-period changes in maternal death, stillbirth, neonatal gender, or normal weight or LBW status were evident. The maternal death and stillbirth rates rarely occurred. Guangdong (28%) and Yunnan (27%) exhibited lower CS rates than the other regions. The CS rates increased significantly between the two periods for Hubei and Guangdong only. Most Apgar scores ranged from 9 to 10 except for Hubei monitored at 1 min, but the differences were negligible. The preterm birth rate increased between the two periods for Hubei and Guangdong only. The macrosomia rate in Beijing only increased by about 2%. The SGA rates decreased for Hubei and Guangdong only. The LGA rate in Hubei only increased from 8% to 10%.
Characteristic Hubei Guangdong Beijing P-2019 P-2020 P-2019 P-2020 P-2019 P-2020 N1 ¶ 3,300 3,149 3,328 2,550 3,902 3,159 No. of prenatal examinations Mean (SD) 5.3 ± 2.5** 5.0 ± 2.0§, §§ 5.2 ± 2.5 5.4 ± 2.5§, §§ 15.0 ± 2.8 14.0 ± 3.1§, §§ Median (IQR) 5 (4, 6.8)†† 5 (4, 6)§, ¶¶ 5 (3, 7) 5 (3, 7)§, ¶¶ 15 (13, 17) 14 (13, 16)§, ¶¶ Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Prenatal eligible examinations (> 5 times) No 3,123 (94.6) 3,067 (97.4)§, *** 3,270 (98.3) 2,494 (97.8) − − Yes 177 (5.4) 82 (2.6) 58 (1.7) 56 (2.2) − − Missing 0 (0) 0 (0) 0 (0) 0 (0) − − Delivery gestational weeks Mean±SD 39.0 ± 1.3** 38.9 ± 1.3§, §§ 39.2 ± 1.4 ** 39.0 ± 1.4§, §§ 39.11 ± 1.3 39.10 ± 1.4 Median (IQR) 39.0 (38.0, 40.0)†† 39.0 (38.0, 40.0)§, ¶¶ 39.3 (38.4, 40.1)†† 39.1 (38.4, 40.0)§, ¶¶ 39.3 (38.6, 39.9) 39.1 (38.6, 40.0) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Caesarean section (CS) No 1,738 (53) 1,449 (46)§, *** 2,483 (75) 1,761 (69)§, *** 2,273 (58) 1,804 (57) Yes 1,562 (47) 1,700 (54) 845 (25) 789 (31) 1,629 (42) 1,355 (43) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Maternal death No −††† − 3,328 (100) 2,550 (100) 3,902 (100) 3,159 (100) Yes − − 0 (0) 0 (0) 0 (0) 0 (0) Missing − − 0 (0) 0 (0) 0 (0) 0 (0) Stillbirth (%) No 3,293 (100) 3,143 (100) 3,326 (100) 2,549 (100) 3,900 (100) 3,155 (100) Yes 7 (0) 6 (0) 2 (0) 1 (0) 2 (0) 4 (0) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) N2 ¶ 3,293 3,143 3,326 2,549 3,900 3,155 Neonatal gender Female 1,548 (47) 1,434 (46) 1,561 (47) 1,192 (47) 1,886 (48) 1,547 (49) Male 1,745 (53) 1,709 (54) 1,765 (53) 1,356 (53) 2,014 (52) 1,608 (51) Unknown 0 (0) 0 (0) 0 (0) 1 (0) 0 (0) 0 (0) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Neonatal weight (kg) Mean±SD 3.32 ± 0.4 3.33 ± 0.4 3.16 ± 0.4 3.17 ± 0.4 3.33 ± 0.4 3.32 ± 0.4 Median (IQR) 3.30 (3.00, 3.60) 3.30 (3.00, 3.60) 3.10 (2.90, 3.40) 3.20 (2.90, 3.50) 3.35 (3.08, 3.60) 3.32 (3.08 3.60) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Apgar score 1 min (SD) 8.7 ± 0.8 8.9 ± 0.6§, §§ 9.4 ± 0.6 9.4 ± 0.6*, §§ 10 ± 0.4 9.9 ± 0.5 Missing 454 (14) 586 (19) 0 (0) 0 (0) 2 (0) 2 (0) 5 min (SD) 9.5 ± 0.6 9.4 ± 0.6§, §§ 10 ± 0.2 10 ± 0.2 10 ± 0.3 10 ± 0.3 Missing 447 (14) 583 (19) 0 (0) 0 (0) 2 (0) 2 (0) 10 min (SD) 9.5 ± 0.5 9.9 ± 0.4§, §§ 10 ± 0.1 10 ± 0.1 10 ± 0.4 10 ± 0.4 Missing 992 (30) 672 (21) 0 (0) 0 (0) 13 (0) 15 (1) Preterm birth No 3,212 (98) 3,036 (97)*,*** 3,180 (96) 2,399 (94)†,*** 3,729 (96) 3,011 (95) Yes 81 (2) 107 (3) 146 (4) 150 (6) 171 (4) 144 (5) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Low birth weight No 3,235 (98) 3,083 (98) 3,194 (96) 2,434 (96) 3,788 (97) 3,049 (97) Yes 58 (2) 60 (2) 132 (4) 115 (4) 112 (3) 106 (3) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Macrosomia No 3,093 (94) 2,923 (93) 3,239 (97) 2,467 (97) 3,728 (96) 2,977 (94)*, *** Yes 200 (6) 220 (7) 87 (3) 82 (3) 172 (4) 178 (6) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) N3¶ 3,269 3,118 3,322 2,529 3,857 3,105 Small for gestational age No 3,029 (93) 2,929 (94)*,*** 2,898 (87) 2,310 (91)§,*** 3,688 (96) 2,967 (96) Yes 240 (7) 189 (6) 424 (13) 219 (9) 169 (4) 138 (4) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Large for gestational age No 3,007 (92) 2,817 (90)*,*** 3,179 (96) 2,404 (95) 3,531 (919) 2,811 (91) Yes 262 (8) 301 (10) 143 (4) 125 (5) 326 (9) 294 (9) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Characteristic Shandong Hebei Yunnan P-2019 P-2020 P-20 19 P-2020 P-2019 P-2020 N1¶ 3,879 2,449 2,280 1,361 1,952 968 Number of prenatal examinations Mean±SD − − 5.5 ± 3.0** 6.3 ± 2.8§, §§ 11.5 ± 2.6 11.6 ± 2.4 Median (IQR) − − 6 (2, 8)†† 7 (4, 8)§, ¶¶ 11 (10, 13) 12 (10, 13) Missing − − 0 (0) 0 (0) 0 (0) 0 (0) Prenatal eligible examinations (>5 times) No − − 1,606 (70.4) 960 (70.5) 779 (39.9) 249 (25.7)§, *** Yes − − 674 (29.6) 401 (29.5) 1,173 (60.1) 719 (74.3) Missing − − 0 (0) 0 (0) 0 (0) 0 (0) Delivery gestational weeks Mean±SD 39.2 ± 1.3 39.2 ± 1.3 39.1 ± 1.4 39.2 ± 1.5 39.0 ± 1.4 38.9 ± 1.4 Median (IQR) 39.3 (38.6, 40.1) 39.3 (38.6, 40.1) 39.3 (38.6, 40.0) 39.3 (38.6, 40.0) 39.0 (38.3, 40.0) 39.0 (38.0, 40.0) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Caesarean section No 1,947 (50) 1,256 (51) 1,381 (60) 808 (60) 1,439 (74) 693 (72) Yes 1,932 (50) 1,193 (49) 899 (40) 552 (40) 512 (26) 274 (28) Missing 0 (0) 0 (0) 0 (0) 1 (0) 1 (0) 1 (0) Maternal death No 3,879 (100) 2,449 (100) 2,280 (100) 1,359 (100) 1,748 (100) 909 (100) Yes 0 (0) 0 (0) 0 (0) 2 (0) 1 (0) 1 (0) Missing 0 (0) 0 (0) 0 (0) 0 (0) 203 (10) 58 (6) Stillbirth (%) No 3,879 (100) 2,449 (100) 2,277 (100) 1,360 (100) 1,946 (100) 965 (100) Yes 0 (0) 0 (0) 3 (0) 1 (0) 6 (0) 3 (0) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) N2¶ 3879 2449 2277 1360 1946 965 Neonatal gender Female 1,889 (49) 1,166 (48) 1,096 (48) 658 (48) 930 (48) 450 (47) Male 1,988 (51) 1,282 (52) 1,181 (52) 702 (52) 1,016 (52) 515 (53) Unknown 2 (0) 1 (0) 0 (0) 0 (0) 0 (0) 0 (0) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Neonatal weight (kg) Mean±SD 3.40 ± 0.4 3.40 ± 0.4 3.33 ± 0.5 3.32 ± 0.5 3.23 ± 0.5 3.22 ± 0.4 Median (IQR) 3.40 (3.10, 3.70) 3.40 (3.10, 3.70) 3.30 (3.00, 3.60) 3.30 (3.00, 3.60) 3.20 (3.00, 3.50) 3.20 (3.00, 3.50) Missing 0 (0) 1 (0) 8 (0) 12 (1) 0 (0) 0 (0) Apgar score 1 min − − 9.9 ± 0.4 9.9 ± 0.4 9.3 ± 1.4 9.5 ± 1†, §§ Missing − − 110 (5) 17 (1) 1 (0) 0 (0) 5 min − − 10 ± 0.3 10 ± 0.3 9.8 ± 1.2 9.9 ± 0.7†, §§ Missing − − 110 (5) 17 (1) 1 (0) 0 (0) 10 min − − 10 ± 0.3 10 ± 0.1 9.8 ± 1.2 9.9 ± 0.8*, §§ Missing − − 110 (5) 17 (1) 1 (0) 0 (0) Preterm birth No 3,710 (96) 2,359 (96) 2,174 (95) 1,293 (95) 1,845 (95) 929 (96) Yes 169 (4) 90 (4) 103 (5) 67 (5) 101 (5) 36 (4) Missing 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Low birth weight No 3,790 (98) 2,397 (98) 2,199 (97) 1,312 (97) 1,863 (96) 934 (97) Yes 89 (2) 51 (2) 70 (3) 36 (3) 83 (4) 31 (3) Missing 0 (0) 1 (0) 8 (0) 12 (1) 0 (0) 0 (0) Macrosomia No 3,540 (91) 2,252 (92) 2,117 (93) 1,266 (94) 1,864 (96) 932 (97) Yes 339 (9) 196 (8) 152 (7) 82 (6) 82 (4) 33 (3) Missing 0 (0) 1 (0) 8 (0) 12 (1) 0 (0) 0 (0) N3¶ 3877 2448 1844 1138 1900 953 Small for gestational age No 3,720 (96) 2,351 (96) 1,759 (95) 1,078 (95) 1,717 (90) 875 (92) Yes 155 (4) 95 (4) 85 (5) 60 (5) 183 (10) 78 (8) Missing 2 (0) 2 (0) 0 (0) 0 (0) 0 (0) 0 (0) Large for gestational age No 3,358 (87) 2,137 (87) 1,648 (89) 1,038 (91) 1,783 (94) 900 (94) Yes 517 (13) 309 (13) 196 (11) 100 (9) 117 (6) 53 (6) Missing 2 (0) 2 (0) 0 (0) 0 (0) 0 (0) 0 (0) Abbreviations: P-2019, January 1–May 31, 2019 as the pre-pandemic period; P-2020, January 1–May 31, 2020 as the pandemic period.
* P<0.05;
† P<0.01;
§ P<0.001;
¶ N1: number of the total subjects, N2: those N1 without delivering stillbirths; and N3: those N2 delivering fetuses at gestational weeks 24–42 and without major birth defects;
** Mean value ± standard deviation (SD);
†† Median value (25%–75% percentile);
§§ Compared by t test;
¶¶ Compared by Mann-Whitney U test;
*** Compared by Chi-square test;
††† Data are unavailable.Table 2. Maternal and neonatal clinical characteristics in the two periods of 2019 and 2020 in 6 provincial-level administrative divisions (PLADs) of China.
The adjusted regression parameters of the clinical manifestations of the two periods are listed in Table 3, which were consistent with those without adjustment for confounders. For Hubei, the NPE, delivery gestational weeks(DGW)⑨, and SGA were negatively associated with the pandemic, and the CS and preterm birth rates were positively associated. Guangdong was similar, but the NPE change lacked significance. The PEE5 in Hubei were negatively associated with the pandemic, while not for others. The effect of the pandemic on preterm birth in Hubei and Guangdong did not change substantially with additional adjustment for CS. In contrast, we only found the positive associations for the macrosomia risk in Beijing and the NPE in Hebei, and a negative association for the DGW in Yunnan.
Characteristics Hubei Guangdong Beijing NPE¶, §§ 0.95 (0.92, 0.99)† 1.03 (1.00, 1.07) 0.99 (0.96, 1.02) PEE5**, §§ 0.49 (0.37, 0.64)§ 1.22 (0.84, 1.76) − DGW††, §§ −0.15 (−0.22, −0.08)§ −0.16 (−0.23, −0.08)§ 0 (−0.02, 0.02) CS**, §§ 1.11 (1.06, 1.17)§ 1.17 (1.08, 1.27)§ 1.02 (0.97, 1.08) NW††, §§ 0 (−0.02, 0.02) 0.01 (−0.01, 0.03) −0.01 (−0.07, 0.05) Stillbirth**, §§ 0.88 (0.30, 2.63) 1.5 (0.09, 24.47) 2.43 (0.44, 13.28) Preterm birth**, §§ 1.37 (1.02, 1.84)* 1.34 (1.07, 1.67)* 1.03 (0.83, 1.28) LBW**, §§ 1.08 (0.75, 1.58) 1.18 (0.92, 1.51) 1.16 (0.89, 1.50) Macrosomia**, §§ 1.10 (0.91, 1.34) 1.18 (0.87, 1.59) 1.26 (1.03, 1.55)* SGA**, §§ 0.81 (0.67, 0.98)* 0.71 (0.60, 0.83)§ 1.01 (0.81, 1.25) LGA**, §§ 1.17 (0.99, 1.38) 1.10 (0.87, 1.39) 1.11 (0.96, 1.29) Characteristics Shandong Hebei Yunnan NPE¶, §§ − 1.08 (1.03, 1.13)§ 1.0 (0.96, 1.05) PEE5**, §§ − 0.96 (0.82, 1.12) 1.97 (1.65, 2.34)§ DGW††, §§ −0.02 (−0.09, 0.05) 0 (−0.11, 0.1) −0.13 (−0.23, −0.02)* CS**, §§ 0.99 (0.94, 1.04) 0.99 (0.92, 1.07) 1.05 (0.93, 1.19) NW††, §§ −0.01 (−0.03, 0.02) −0.02 (−0.06, 0.01) −0.01 (−0.04, 0.03) Stillbirth**, §§ − 0.58 (0.06, 5.55) 0.66 (0.13, 3.31) Preterm birth**, §§ 0.85 (0.64, 1.11) 1.01 (0.72, 1.42) 0.73 (0.50, 1.06) LBW**, §§ 0.98 (0.67, 1.43) 0.75 (0.48, 1.18) 0.77 (0.51, 1.16) Macrosomia**, §§ 0.88 (0.73, 1.06) 0.86 (0.65, 1.14) 0.83 (0.56, 1.24) SGA**, §§ 0.98 (0.74, 1.30) 1.13 (0.82, 1.55) 0.87 (0.67, 1.12) LGA**, §§ 0.93 (0.81, 1.08) 0.82 (0.65, 1.03) 0.87 (0.63, 1.19) Abbreviations: NPE, No. of prenatal examinations; PEE5, Prenatal eligible examinations of ≥5 times; DGW, delivery gestational weeks; CS, Caesarean section; NW, Neonatal weight; LBW, low birth weight; SGA, small for gestational age; LGA, large for gestational age.
* P<0.05;
† P<0.01;
§ P<0.001;
¶ Relative risk calculated by Poisson regression model;
** Relative risk calculated by log-binomial regression model;
†† Regression coefficient (β value) calculated by linear regression model;
§§ Adjusted for BMI (categorical), age (categorical), parity, gravidity, ethnicity, and education. For Hubei Province, parity information is unavailable. For Beijing, the information of BMI, ethnicity, and education is unavailable.Table 3. Adjusted relative risk associated with the occurrence of the COVID-19 between 2019 and 2020 in 6 provincial-level administrative divisions (PLADs) of China.
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FootNote
① | The times of examinations which women took from their first antenatal care examination to childbirth. |
② | Live infants born before 37 gestational weeks. |
③ |
The regulated prenatal care in standards for the management and service of maternal health is issued in the National Standards for Basic Public Health Services (Third Edition) by National Health Commission in China. There are routine prenatal cares for five times at <13rd, 16th–20th, 21st–24th, 28th–36th, and 37st–40th. The details can be found on the website: |
④ | Late fetal deaths weighing more than 1,000 g or occurring after 28 weeks gestation. |
⑤ | Live infants born at gestational weeks 24–42 without major birth defects and with birthweight above the 90th percentile for gestational age of the reference population mean for birthweight and gestational age. |
⑥ | Live infants born at gestational weeks 24–42 without major birth defects and with birthweight below the 10th percentile for gestational age of the reference population mean for birthweight and gestational age. |
⑦ | Live infants with weight at birth not less than 4,000 g. |
⑧ | Live infants with weight at birth less than 2,500 g. |
⑨ | Duration from the last menstrual period reported by the women and the time of delivery. |
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