Volume 130, Issue 3 p. 276-284
RESEARCH ARTICLE

Pregnancy outcomes in Italy during COVID-19 pandemic: A population-based cohort study

Franca Rusconi

Corresponding Author

Franca Rusconi

Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy

Correspondence

Franca Rusconi, Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Via Cocchi 7/9, 56121 Pisa, Italy.

Email: [email protected]

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Monia Puglia

Monia Puglia

Unit of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy

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Martina Pacifici

Martina Pacifici

Unit of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy

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Sonia Brescianini

Sonia Brescianini

Centre for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy

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Luigi Gagliardi

Luigi Gagliardi

Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy

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Anna Maria Nannavecchia

Anna Maria Nannavecchia

Department of Epidemiology and Care Intelligence, Regional Agency for Health and Social Affair of Puglia, Bari, Italy

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Pietro Buono

Pietro Buono

Department of Maternal and Child Health, General Directorate for Health, Naples, Italy

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Sara Cantoira

Sara Cantoira

Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy

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Sara Farchi

Sara Farchi

Area Rete Ospedaliera, Lazio Regional Authority, Rome, Italy

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Michele Gobbato

Michele Gobbato

Pianificazione, Programmazione e Controllo Direzionale, Azienda Regionale di Coordinamento della Salute, Udine, Italy

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Edda Pellegrini

Edda Pellegrini

Welfare General Directorate, Milan, Italy

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Enrica Perrone

Enrica Perrone

Unit of Primary Care, Regional Health Authority of Emilia-Romagna, Bologna, Italy

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Riccardo Pertile

Riccardo Pertile

Department of Clinical and Evaluative Epidemiology, Health Service of Trento, Trento, Italy

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Elisa Eleonora Tavormina

Elisa Eleonora Tavormina

Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy

Department of Health Activities and Epidemiological Observatory, Regional Health Authority, Palermo, Italy

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Laura Visonà Dalla Pozza

Laura Visonà Dalla Pozza

Birth Registry, Coordinating Centre for Rare Diseases, Padua, Italy

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Francesca Zambri

Francesca Zambri

National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy

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the AIE Perinatal Health Working Group

the AIE Perinatal Health Working Group

The AIE (Associazione Italiana di Epidemiologia) Perinatal Health Working Group members are listed in Appendix  A.

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First published: 09 October 2022
Citations: 5

Abstract

Objective

To compare the estimates of preterm birth (PTB; 22–36 weeks' gestational age, GA) and stillbirth rates during COVID-19 pandemic in Italy with those recorded in the three previous years.

Design

A population-based cohort study of live- and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (1 March 2020–31 March 2021, n = 362 129) to an historical period (January 2017–February 2020, n = 1 117 172). The cohort covered 84.3% of the births in Italy.

Methods

Poisson regressions were run in each Region and meta-analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021.

Main outcome measures

The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32–36 weeks' GA), very PTB (<32 weeks' GA), and extremely PTB (<28 weeks' GA), overall and stratified into singleton and multiples.

Results

The pandemic period compared with the historical one was associated with a reduced risk for PTB (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.88–0.93), late PTB (RR 0.91, 95% CI 0.88–0.94), very PTB (RR 0.88, 95% CI 0.84–0.91) and extremely PTB (RR 0.88, 95% CI 0.82–0.95). In multiples, point estimates were not very different, but had wider CIs. No association was found for stillbirths (RR 1.01, 95% CI 0.90–1.13). A linear decreasing trend in PTB rate was present in the historical period, with a further reduction after the lockdown.

Conclusions

We demonstrated a decrease in PTB rate after the introduction of COVID-19 restriction measures, without an increase in stillbirths.

CONFLICT OF INTERESTS

None declared. Completed disclosure of interest forms are available to view online as supporting information.

DATA AVAILABILITY STATEMENT

Data available on request due to privacy/ethical restrictions.