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.

Details

Title
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
Author
Zeitlin, Jennifer 1   VIAFID ORCID Logo  ; Philibert, Marianne 1 ; Barros, Henrique 2   VIAFID ORCID Logo  ; Broeders, Lisa 3 ; Cap, Jan 4 ; Draušnik, Željka 5   VIAFID ORCID Logo  ; Engjom, Hilde 6 ; Farr, Alex 7 ; Fresson, Jeanne 8 ; Gatt, Miriam 9 ; Gissler, Mika 10   VIAFID ORCID Logo  ; Heller, Günther 11 ; Isakova, Jelena 12 ; Källén, Karin 13 ; Kyprianou, Theopisti 14 ; Loghi, Marzia 15 ; Monteath, Kirsten 16 ; Mortensen, Laust 17 ; Rihs, Tonia 18 ; Sakkeus, Luule 19 ; Sikora, Izabela 20 ; Szamotulska, Katarzyna 21 ; Velebil, Petr 22 ; Verdenik, Ivan 23 ; Weber, Guy 24 ; Zile, Irisa 25 ; Zurriaga, Oscar 26 ; Smith, Lucy 27 ; Klimont, Jeannette; Alexander, Sophie; Delnord, Marie; Racapé, Judith; Vandervelpen, Gisèle; Wei-Hong, Zhang; Kolarova, Rumyana; Jordanova, Evelin; Dimnjakovic, Jelena; Rodin, Urelija; Scoutellas, Vasos; Jirova, Jitka; Hansen, Anne Vinkel; Laust Hvas Mortensen; Abuladze, Liili; Heino, Anna; Amyx, Melissa; Blondel, Béatrice; Chantry, Anne; Catherine Deneux Tharaux; Durox, Mélanie; Hocquette, Alice; Vilain, Annick; Bon, Dimitra; Misselwitz, Björn; Antsaklis, Aris; Sziller, István; Védís, Helga Eiríksdóttir; Gunnarsdóttir, Jóhanna; Ólafsdóttir, Helga Sól; Kearns, Karen; Boldrini, Rosaria; Cuttini, Marina; Donati, Serena; Pappagallo, Marilena; Misins, Janis; Zile-Velika, Irisa; Gaidelyte, Rita; Billy, Audrey; Lecomte, Aline; Pastore, Jessica; Achterberg, Peter; Hindori-Mohangoo, Ashna; Nijhuis, Jan; Akerkar, Rupali; Klungsøyr, Kari; Mierzejewska, Ewa; Rodrigues, Carina; Mihaela-Alexandra Budianu; Cucu, Alexandra; Horga, Mihai; Puscasiu, Lucian; Sandu, Petru; Tica, Vlad; Cáp, Ján; Lucovnik, Miha; Adela Recio Alcaide; Fernández-Elorriaga, María; Jané, Mireia; Vidal, Maria José; Zurriaga, Óscar; Nyman, Anastasia; Anderson, Diane; Clarke, Samantha; McConnell, Hannah; Macfarlane, Alison; Magill, Sinead; Morgan, Siobhán; Murphy, Joanne; Piper, Mark; Scott, Sonya; Craig, Thomas; Williams, Martin; Habl, Claudia; Pries, Cara; Pentz, Richard; Mathis-Edenhofer, Stefan; Schmidt, Andrea; Alexander Grabenhofer-Eggerth; Weiss, Johannes; Sagerschnig, Sophie; Gottlob, Anita; Lorenz Dolanski; Degelsegger-Marquez, Alexander; Gruber, Beate; Habimana, Katharana; Bogaert, Petronille; Schutte, Nienke; Vyncke, Kim; Krzywania, Tadek; Abboud, Linda; Saso, Miriam; Brecht Devleesschauwer; Barthélémy Moreau de Lizoreux; Derycke, Pascal; Daubresse, Pierre; Milbeck, Sasha; De Ridder, Karin; Charles-Andrew Van de Catsyne; Lagarija, Sejla Cilovic; Chileva, Anina; Vukovic, Jakov; Dankova, Sarka; Májek, Ondrej; Vorobjov, Sigrid; Idavain, Jane; Rätsep, Merika; Tolonen, Hanna; Mäkinen, Mari; Carcaillon-Bentata, Laure; Haneef, Romana; Makovski, Tatjana; Thißen, Martin; Seeling, Stefanie; Fehr, Angela; Ziese, Thomas; Georgakopoulou, Christina; Petelos, Elena; Lionis, Christog; Lingri, Dimitra; Tóth Kornél; Töll, Ágnes; Bezzegh, Peter; Csizmadia, István; Láng, Róbert; Kiss Csaba; Cahill, Alan; Courtney, Michael; White, Pauline; Kelly, Ailish; Clarke, Patricia; Kappala, Sharon; Smyth, Breda; Palmieri, Luigi; Unim, Brigid; Faragalli, Andrea; Zelviene, Ausra; Astrauskiené, Audronè; Buttigieg, Dorita; Calleja, Neville; Lozan, Oleg; Gramme, Rodica; Tijhuis, Mariken; Daniela Moye Holz; Hilderink, Henk; Berger-Symons, Linda; de Vries, Marit; Haaheim, Håkon; Forland, Frode; Nordeng, Zuzana; Larose, Tricia; Strozyk, Malgorzata; Maryniak, Pawel; Drogon, Krystyna; Węgrzyn, Karolina; Wisniewski, Tomasz; Paciorek, Kinga; Nogueira, Paulo; Bacelar-Nicolau, Leonor; Rodrigo Feteira Santos; Lapão, Luís; Peyroteo, Mariana; Marília Silva Paulo; Montez, Teresa; Dias, Carlos; Gomez, Veronica; Lucinda Oliveira das Neves; Peralta-Santos, Andre; Gaftonie, Elena Gabriela; Fekete, Edit; Brinduse, Lacramioara; Radulescu, Silviu; Krstic, Maja; Medaveric, Aleksandar; Zaletel, Metka; Vinko, Matej; Bric, Tatjana Kofol; Inmaculada León Gómez; Rodriguez-Blazquez, Carmen; M João Forjaz; Marin, Marta; Larrauri, Amparo; Ramis, Rebeca; Diaz, Asuncion; Angulo-Pueyo, Ester; Garriga, Cesar; Valero, Teresa; Estupiñán, Francisco; Garcia-Armesto, Sandra; Bernal-Delgado, Enrique; Juan González García; Javier Gómez-Arrue Azpiazu; Ramon Launa Garces; López-Cuadrado, Teresa; Launag, Ramón; Telleria, Carlos; Seral, Meriam; Syden, Lovisa; Akbari, Ashley; Lyons, Ronan; Aldridge, Sarag

1  Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOpé), Centre for Research in Epidemiology and Statistics (CRESS), INSERM, INRAE, Paris Cité University , Paris, France 
2  EPIUnit, University of Porto , Porto, Portugal 
3  The Netherlands Perinatal Registry (Perined) , Utrecht, Netherlands 
4  National Health Information Center , Bratislava, Slovakia 
5  Division of Public Health, Croatian Institute of Public Health , Zagreb, Croatia 
6  Division of Mental and Physical Health, Norwegian Institute of Public Health , Bergen, Norway 
7  Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna , Vienna, Austria 
8  Department for Research, Studies, Assessment and Statistics (DREES), French Ministry of Health , Paris, France 
9  National Obstetric Information System, Directorate for Health Information and Research , Pieta, Malta 
10  Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare , Helsinki, Finland 
11  Social Data Department, Institute for Quality Assurance and Transparency in Healthcare (IQTIG) , Berlin, Germany 
12  Health Statistics Department, Health Information Centre, Institute of Hygiene , Vilnius, Lithuania 
13  Department of Evaluation and Analysis, Epidemiology and Methodological Support Unit, Karolinska Institute , Stockholm, Sweden 
14  Health Monitoring Unit, Ministry of Health , Nicosia, Cyprus 
15  Directorate for Social Statistics and Welfare, Italian Statistical Institute (ISTAT) , Rome, Italy 
16  Information Services Division, Public Health Scotland , Edinburgh, UK 
17  Department of Public Health, University of Copenhagen , Copenhagen, Denmark 
18  Federal Statistical Office (FSO) , Neuchâtel, Switzerland 
19  Estonian Institute for Population Studies, Tallinn University , Tallinn, Estonia 
20  The National Perinatal Reporting System, Health Pricing Office , Dublin, Ireland 
21  Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child , Warsaw, Poland 
22  Institute for the Care of Mother and Child , Prague, Czechia 
23  Department of Obstetrics & Gynecology—Research Unit, University Medical Centre , Ljubljana, Slovenia 
24  Department of Epidemiology and Statistics, Directorate of Health , Luxembourg, Luxembourg 
25  The Centre for Disease Prevention and Control of Latvia , Riga, Latvia 
26  Public Health General Directorate, Valencia Regional Public Health Authority , Valencia, Spain 
27  Department of Health Sciences, College of Life Sciences, University of Leicester , Leicester, UK 
Pages
i58-i66
Publication year
2024
Publication date
Jul 2024
Publisher
Oxford University Press
ISSN
11011262
e-ISSN
1464-360X
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/eurpub/ckad186
ProQuest document ID
3192327378
Copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.