Preterm Birth Rates and Racial Disparities during the COVID-19 Pandemic at a Single Institution in the Southeastern United States

 

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Abstract

Objective The COVID pandemic has been associated with varied effects on preterm birth (PTB). We sought to compare rates of PTB during the pre- and post vaccination COVID periods with pre-pandemic PTB rates, stratified by race and ethnicity.

Study Design Retrospective cohort comparing all deliveries over 20 weeks at a single tertiary center during “early” (March 2020–June 2020) versus “late” COVID (March 2021–June 2021), and “late” COVID versus pre-COVID (March to June 2014–2019). PTBs <37, <34, and <28 weeks were compared and stratified by race/ethnicity.

Results A total of 16,483 deliveries occurred including 2,068 “early” COVID, 2,115 “late” COVID, and 12,300 pre-COVID. The PTB rate during “late” COVID was lower compared to “early” COVID (12.1 vs. 14.6%, p = 0.02). Rate of PTB <34 was also lower during “late” COVID (4.4 vs. 5.7%, p = 0.05). PTB <28 did not differ. When controlling for prior PTB, “late” COVID remained associated with a decreased risk of PTB compared to “early” COVID, adjusted odds ratio (aOR) of 0.82 (95% confidence interval [CI]: 0.68, 0.98). Although there was no difference in PTB among Hispanic individuals when comparing “late” COVID versus pre-COVID, when further subdivided, a small number of Hispanic Puerto Rican individuals had higher odds of PTB < 37 during “late” COVID versus pre-COVID (aOR = 4.29 [95% CI: 1.12, 16.4]). Additionally, White individuals had reduced odds of PTB <37 (aOR = 0.80 [95% CI: 0.65, 0.98]) during “late” COVID versus pre-COVID while the PTB rate was unchanged when comparing “late” COVID versus pre-COVID in all other racial and ethnic groups.

Conclusion During 2021, PTB rates decreased from rates observed in 2020 at the height of COVID restrictions. Among White birthing individuals, PTB decreased in 2021 compared to pre-COVID rates. This decrease was not observed in Black and Hispanic birthing individuals. These data highlight the continued racially disparate impact of the COVID-19 pandemic on PTB rates.

Key Points

• The COVID-19 pandemic has been associated with varied effects on the preterm birth (PTB) rate.

• PTB rates decreased in “late” COVID compared to “early” COVID.

• When stratified, PTB decreased among white individuals, but not in Black or Hispanic individuals.

Note

This article was presented at the Society Maternal Fetal Medicine's 42nd Annual Pregnancy Meeting, virtual conference, January 31–February 5, 2022.

Publication History

Received: 12 September 2022

Accepted: 16 December 2022

Accepted Manuscript online:
06 January 2023

Article published online:
21 February 2023

© 2023. Thieme. All rights reserved.

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