Exposure to the early COVID-19 pandemic and early, moderate and overall preterm births in the United States: A conception cohort approach

Abstract

Background: The United States (US) data suggest fewer-than-expected preterm births in 2020, but no study has examined the impact of exposure to the early COVID-19 pandemic at different points in gestation on preterm birth. Objective: Our objective was to determine—among cohorts exposed to the early COVID-19 pandemic—whether observed counts of overall, early and moderately preterm birth fell outside the expected range. Methods: We used de-identified, cross-sectional, national birth certificate data from 2014 to 2020. We used month and year of birth and gestational age to estimate month of conception for birth. We calculated the count of overall (<37 weeks gestation), early (<33 weeks gestation) and moderately (33 to <37 weeks gestation) preterm birth by month of conception. We employed time series methods to estimate expected counts of preterm birth for exposed conception cohorts and identified cohorts for whom the observed counts of preterm birth fell outside the 95% detection interval of the expected value. Results: Among the 23,731,146 births in our study, the mean prevalence of preterm birth among monthly conception cohorts was 9.7 per 100 live births. Gestations conceived in July, August or December of 2019—that is exposed to the early COVID-19 pandemic in the first or third trimester—yielded approximately 3245 fewer moderately preterm and 3627 fewer overall preterm births than the expected values for moderate and overall preterm. Gestations conceived in August and October of 2019—that is exposed to the early COVID-19 pandemic in the late second to third trimester—produced approximately 498 fewer early preterm births than the expected count for early preterm. Conclusions: Exposure to the early COVID-19 pandemic may have promoted longer gestation among close-to-term pregnancies, reduced risk of later preterm delivery among gestations exposed in the first trimester or induced selective loss of gestations.