Coronaios: What did the lockdowns have to do with reducing preterm births?



Some public health researchers have long observed evidence that the coronavirus pandemic could solve a major mystery: What causes preterm birth? Studies in Ireland and Denmark this summer showed that preterm births declined during the spring lockdown. Anecdotally, doctors around the world reported corresponding reductions. It has been suggested that reducing maternal stress, a cleaner atmosphere or better hygiene may have played a role. A large study conducted in the Netherlands was published on Tuesday in the Lancet Public Health, bringing to light even stronger links between lockdowns and lower preterm births. Extensive study The authors used data from the National Newborn Screening Program. In the Netherlands, small blood samples are taken from almost all babies a few days after birth to test them for various diseases. The information includes the number of weeks of pregnancy on the day of delivery. Dutch researchers looked at the data of newborn examinations for the period 2010 to 2020, which concern more than 1.5 million babies. More than 56,000 of these babies were born after the Dutch lockdown. With their large data set, the researchers compared preterm births between one and four months before and after the lockdown. Looking at the same intervals in previous years, they were able to take into account other trends, such as the role of seasons in premature births. Regardless of the intervals they compared, the researchers found that preterm births had declined since March 9, the day the Dutch government began issuing warnings about stricter hygiene rules and keeping people with symptoms at home. Within the next week, schools and workplaces began to close. Significant reduction in preterm births “We could see that there was indeed a correlation,” explains Dr. Jasper Bean, a neonatologist at Erasmus Medical Center in Rotterdam and lead author of the study. The reduction ranged from 15% to 23%. Roy Philip, a neonatologist at the University of Limerick Obstetrics Clinic in Ireland and author of an earlier study that reported a reduction in preterm births in his country in the spring, said he was “excited” by the new research. As he says, it shows that lockdown was indeed the cause of the decrease in premature births. In contrast to the Irish and Danish surveys, the new Dutch survey showed a reduction in all premature births, and not just premature births. Bean notes that “the questions are more than we had at the beginning.” The role of stillbirthOne of these unanswered questions is stillbirth. In the best case scenario, premature babies who disappeared from hospitals were born as healthy babies at the completion of normal birth weeks. However, it is possible that some of them ended up dead. Mortality “may indeed be the dark side of this development”, notes Dr. Bin. The researchers could not estimate the death rate in the Dutch data, as only live infants are being tested. But if almost all the premature babies missing from the measurements had died, the stillbirth would have increased dramatically – by conservative estimates, it would have tripled. No country has recorded such a big change so far. In a London hospital, a study showed an increase in stillbirth after the onset of the pandemic (not the lockdown). This increase may be due to unknown coronavirus infections, the authors write, or to women seeking medical attention during a pandemic. Studies in Nepal and India have shown that mothers were less likely to give birth in hospital during the spring and that stillbirths increased in those countries. To further complicate the picture, the coronavirus itself may increase the likelihood of preterm birth. Income issue? To find out how lockdowns affected preterm birth in different countries, Dutch researchers are participating in an international consortium of almost 40 countries exchange data. “Lockdowns may have been good for the health of mothers and babies in some places and not in others,” he said. Bean, adding: “In general we see that the pandemic greatly increases inequalities.” The Dutch study even suggested that the decline in preterm births was limited to the wealthier neighborhoods, although the result was not statistically significant. of Yale Dr. Kalein says the new study confirmed what she learned from colleagues in the United States. “Anecdotally, this is what we heard and this is what we believed,” he notes. In the absence of strong evidence for the US, she and her colleagues are working with an insurance company to begin an extensive study of how lockdowns have affected preterm birth in her country. She speculates that the effects of lockdowns depend on economic conditions. For mothers who had the resources to work from home, “this situation could reduce stress,” she explains. “For the needy workers or those who were experiencing financial difficulties, things may have been completely different.” We see huge inequalities in this country, “she said. Calein. “I guess women who did not experience some relief from their normal daily routine may have had increased levels of stress.” “We have not managed in any way to reduce the rates of premature births,” says Dr. Calein. Future studies may be able to finally find a solution that will end premature births – without the need for a pandemic. Source: www.nytimes.com



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