ABSTRACT
Background: Conflicting evidence exists on the impact of the COVID-19 pandemic restrictions on stillbirth rates in developed countries. We aimed to examine and compare the incidence rates of stillbirth before and after the implementation of COVID-19 measures in Canada and Japan. Method(s): We conducted two populationbased studies using mother-infant linked data from JMDC hospitalizations database (JMDC Inc.) in Japan and administrative health databases in Manitoba, Canada, from October 2016 to March 2021. We used interrupted time series analysis (generalized linear models) to investigate the immediate change in level and rebound change in quarterly rates of stillbirth (fetal death > 20 weeks of gestation). We modeled the forecasted trends based on prepandemic data via autoregressive moving average models. Result(s): We included 70,931 and 169,883 pregnancies in Manitoba and Japan during the study period, respectively. On average, stillbirth rates were 0.66% in Manitoba and 0.31% in Japan. The pandemic restrictions were associated with an immediate relative increase in stillbirths in Japan by 19.19% (beta2=0.05;p=0.5693) and in Manitoba by 18.6% (beta2=0.12;p=0.4434). However, the quarterly stillbirth rates decreased (beta3=0.1625, p=0.5066) in Japan and Manitoba (beta3=0.011, p=0.8296) during the pandemic period. During the first quarter of 2021, the absolute differences in the observed and forecasted rates in Manitoba and Japan were 0.04% and -0.05%, respectively. Conclusion(s): Although various approaches were implemented to address the pandemic in Manitoba (Canada) and Japan, we found no evidence of a significant increase in the incidence of stillbirth rates during the first year of the pandemic. Healthcare services in Canada and Japan have experienced substantial changes since the start of the COVID-19 pandemic, with little influence on stillbirth rates at population level. This study will further examine the effect of the pandemic measures on other adverse pregnancy outcomes in both countries.
ABSTRACT
Background: Limited evidence exists on the pandemic's role in limiting access and use of prenatal care services and the quality of care for pregnant women. We aimed to investigate the impact of the pandemic restrictions on in-person prenatal care visits (PNCV) and the quality of prenatal care. Method(s): Using the mother-infant-linked administrative health databases in Manitoba, Canada, we conducted a province-wide population-based cohort study among independent pregnancies. We examined the quarterly rates of PNCV before (October 2016-March 2020) and during (April 2020-March 2021) the pandemic. Quality of prenatal care was categorized using the Revised Graduated Prenatal Care Utilization Index (R-GINDEX) into inadequate (<50% visits), intermediate (50%-80% visits), adequate (>80% visits), intensive (high-risk), and no care. Interrupted time series analyses were conducted to assess the immediate and lagged changes in PNCV and quality of care after the implementation of pandemic restrictions. Result(s): Amongst 70,931 pregnancies, we observed no significant mean difference in the overall numbers of PNCV during the pandemic compared to prepandemic (8.2 vs. 8.6,p=0.0837). Prenatal care utilization was 3.4% inadequate and 34.7% adequate before the pandemic and 4.8% and 26.6% during the pandemic, respectively. Restrictions were associated with an abrupt decline in adequate and intermediate care during the first trimester by 11.3% (p<0.001) and 11.98%, respectively, followed by non-significant change throughout the pandemic (beta3=-0.25,p=0.694 and beta3=-0.96,p=0.192, respectively). Moreover, restrictions were associated with an increased rate of inadequate care during the first (beta2=1.52,p=0.007) and second trimesters (beta2=0.78,p=0.208), and not among third trimesters (beta2=-0.44,p=0.094). During the pandemic, we found no significant differences in the rates of intensive prenatal care during the first (p=0.478), second (p=0.614), and third (p=0.608) trimesters compared to pre-pandemic. Conclusion(s): Our findings suggest a decline in adequacy levels of prenatal care services after COVID-19 restrictions were enacted, with a higher impact on pregnancies during their first and second trimesters. Although the overall adequacy of care decreased, there were no changes to the rates of intensive visits. This study will further investigate the impact of the pandemic on virtual PNCV and assess the association between the quality of prenatal care and adverse maternal and neonatal outcomes.