# The association of COVID-19 lockdowns with adverse birth and pregnancy outcomes in 28 high-income countries: a systematic review and meta-analysis

## TL;DR

This study finds that lockdowns during the pandemic were linked to fewer preterm births but more signs of depression in pregnant people across 28 high-income countries.

## Contribution

The study is the first large-scale meta-analysis examining the impact of lockdowns on pregnancy outcomes and mental health in high-income countries.

## Key findings

- Lockdowns were associated with reduced preterm birth rates, with the effect remaining after adjusting for long-term trends.
- Lockdowns were linked to increased rates of positive depression screening among pregnant individuals.
- No significant associations were found for other adverse birth or pregnancy outcomes.

## Abstract

We conducted a systematic review and meta-analysis to review the association of lockdowns with adverse birth and pregnancy outcomes (ABPOs) and related inequalities, in high-income countries (HICs). Databases (EMBASE, MEDLINE/PubMed and Web of Science) were searched from 1 January 2019 to 22 June 2023 for original observational studies based in HICs that compared the rates of ABPOs, before and during lockdowns. The risk of bias was assessed using the Newcastle–Ottawa tool for cohort studies. We ran random-effects meta-analyses and subgroup analyses per region, lockdown period, ethnicity group and deprivation level and adjusted for underlying temporal trends. A total of 132 studies were meta-analysed from 28 HICs. Reduced rates of preterm birth (reported by 26 studies) were associated with the first lockdown (relative risk 0.96, 95% confidence interval 0.93–0.99), 11 studies adjusted for long-term trends and the association remained (0.97, 0.95–0.99), and subgroup analysis found that this association varied by continental region. Ten studies reported positive screening rates for possible depression antenatally, and lockdown was associated with increases in positive screening rates (1.37, 1.06–1.78). No other ABPOs were associated with lockdowns. Investigation of inequalities was limited due to data availability and heterogeneity; further research is warranted on the effect of lockdowns on health inequalities. This study was funded by the National Institute of Health Research, School of Primary Care Research and registered on PROSPERO (CRD42022327448).

In this systematic review and meta-analysis of 132 studies, Hindes et al. examine evidence for adverse birth and pregnancy outcomes. They find that reduced rates of preterm birth and increased positive screening rates for possible antenatal depression are associated with the first lockdowns.