Peer-reviewed article

Preterm Birth and Perinatal Mortality During the COVID-19 Pandemic Period: A Systematic Review and Meta-Analysis.

Peart SR, Haj-Yahya R, Nugent M, Ganbold O, Harbinson L et al. · 2 May 2026

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This systematic review and meta-analysis examined how COVID-19 affected preterm birth rates and perinatal mortality across 100 studies published between 2020 and 2022. The study found that preterm births and neonatal deaths decreased during the pandemic in high-income countries, but stillbirth rates increased in low- and middle-income countries. The findings suggest that healthcare disruptions during the pandemic had different impacts depending on country income level and severity of prematurity.

Key points

Preterm birth rates decreased during COVID-19 compared to pre-pandemic periods (OR 0.95, 95% CI 0.94-0.97)
The greatest reduction in preterm births occurred for births before 28 weeks in high-income countries (OR 0.92)
Neonatal deaths decreased in high-income countries during the pandemic (OR 0.78, 95% CI 0.64-0.95)
Stillbirth rates increased in low- and middle-income countries during the pandemic (OR 1.18, 95% CI 1.02-1.36)
The mechanisms underlying reduced preterm births and increased stillbirths in different settings remain unclear

Limitations

The review does not explain why preterm births decreased or why stillbirths increased in different country settings, and the underlying mechanisms require further investigation. The included studies may have varied in quality, methodology, and data collection during a period of healthcare disruption.

Abstract

Background Preterm birth rates may have been affected during the COVID-19 pandemic but the impact of this on perinatal morbidity is unknown. Aim To review the impact of the COVID-19 pandemic on rates of preterm birth and perinatal mortality. Methods Medline, Embase, and online pre-prints were searched from Jan 2020 to Oct 2022. Case-control, cohort studies and reports comparing rates of preterm birth, stillbirth and neonatal death before and during the COVID-19 pandemic period were included. The pooled odds ratio (OR) for preterm birth, stillbirth and neonatal death was calculated using a random effects model. The primary outcome was the rate of preterm birth, stillbirth and neonatal death in the pre-pandemic and pandemic periods. Results 100 studies were included. Compared with pre-pandemic periods, there was a decrease in preterm births during the pandemic period: OR 0.95 (95% CI 0.94-0.97) I 2 = 0.93, with the greatest reduction for births < 28 weeks' gestation in high-income countries: OR 0.92 (95% CI 0.88-0.96), I 2 = 0.46. There was a reduction in neonatal deaths in high-income countries: OR 0.78 (95% CI 0.64-0.95), I 2 = 0.4. In low- and middle-income countries the stillbirth rate increased during the pandemic compared with the pre-pandemic period: OR 1.18 (95% CI 1.02-1.36), I 2 = 0.86. Conclusion The COVID-19 pandemic was associated with a reduction in preterm births and neonatal deaths. Further research is needed to investigate the mechanisms underlying these findings. Stillbirth rates increased in low- and middle-income countries where access to healthcare may have been restricted and strategies to address this in future pandemics are warranted.