Pandemic May Have Left Lessons on C-Section ‘Preemie’ Births

There was a 6.5% drop in premature births from cesarean sections and induced deliveries in the United States during the pandemic, likely because pregnant women made fewer visits to their doctors, researchers report.

They said their findings raise questions about whether some decisions made by doctors during pregnancy may lead to unnecessary preterm births, defined as babies born before 37 weeks of pregnancy.

“It’s really about, how does this affect fetal health?” said study author Daniel Dench, an assistant professor in Georgia Institute of Technology’s School of Economics. “Did doctors miss some false positives — did they just not deliver the babies that would have survived anyway? Or did they miss some babies that would die in the womb without intervention?”

In the study, Dench’s team determined the number of premature births from 2010 to 2020 and compared that with U.S. National Center for Health Statistics data to forecast expected premature births from March to December 2020.

In March 2020 — when the World Health Organization declared COVID-19 a pandemic — preterm births from C-sections or induced deliveries were 0.4 percentage points below the predicted number.

From March 2020 to December 2020, the average number of preterm births from C-sections or induced deliveries remained 0.35 percentage points below predicted figures.

That works out to 350 fewer preterm C-sections and induced deliveries per 100,000 live births, or 10,000 fewer overall, according to the study published April 6 in the journal Pediatrics.

The number of preterm C-sections and induced deliveries had been on the rise before the pandemic, the researchers noted.

They also found a slight decrease in spontaneous preterm births — those not induced or from C-section — in the first months of the pandemic, but the decline was much less than preterm births from C-sections or induced deliveries.

The causes of preterm births are not always known, said Dench.

“However, we know for certain that doctors’ interventions cause preterm delivery, and for good reason most of the time,” Dench said in a Georgia Tech news release. “So, when I saw the change in preterm births, I thought, if anything changed preterm delivery, it probably had to be some change in how doctors were treating patients.”

The findings raise important questions about pre-pandemic levels of doctors’ interventions during pregnancy.

Dench said that while “much more research needs to be done, including understanding how these changes affected fetal deaths and how doctors triaged patient care by risk category during the pandemic, these are significant findings that should spark discussion in the medical community.”

Next, he plans to analyze fetal death records from March 2020 to December 2020. If there was no change in fetal deaths at the same time as the drop in preterm births, that could point to “false positives” in doctor intervention that can be avoided in the future, according to Dench.

Identifying which pregnancies required care during the pandemic and which ones didn’t could help doctors avoid unnecessary interventions in the future, he explained.

More information

For more on preterm birth, go to the U.S. National Institute of Child Health and Human Development.

SOURCE: Georgia Institute of Technology, news release, April 6, 2022

Source: HealthDay