An alarming upward trend in stillbirths has prompted a warning from doctors that the coronavirus has made both patients and global health-care systems more vulnerable than previously thought — and with far-reaching impact.
A new batch of gynecologic studies has revealed that babies are dying in the womb at an increasing rate since the COVID-19 outbreak in March. Researchers believe that the deterrence or lack of clinical access among pregnant mothers due to pandemic restrictions may have given rise to prenatal complications, sometimes leading to stillbirth.
“What we’ve done is cause an unintended spike in stillbirth while trying to protect [pregnant women] from COVID-19,” Jane Warland, a midwife at the University of South Australia in Adelaide, told Nature.
The assertion is based on a review of findings from a number of recent international reports from countries including India, Nepal, England and Scotland.
In August, global health journal The Lancet published a study with data from more than 20,000 expectant mothers across nine hospitals in Nepal. Physicians there noted a 50% increase in stillbirths: from 14 per 1,000 births, before the pandemic, to 21 per 1,000 by the end of May. They found that the rate spiked especially during the first month of the pandemic, while residents were almost completely quarantined in their homes.
“Nepal has made significant progress in the last 20 years in health outcomes for women and their babies, but the last few months have deaccelerated that progress,” said study leader Ashish KC, a perinatal epidemiologist at Sweden’s Uppsala University.
On paper, the overall number of stillbirths had, in fact, not changed. However, KC and his colleagues explained the rate increase by pointing out that the number of births actually occurring in hospitals fell by half during the pandemic, from an average 1,261 births each week prior to lockdown to just 651.
Nepal’s larger neighbor, India, fared no better, according to another study in The Lancet. Doctors there reported an increase in stillbirth rates as well as a drop in emergency pregnancy care by two-thirds — indicating that more births were taking place outside the hospital, at home or other non-hospital facilities.
The same trend was observed in UK hospitals, too. At St George’s, a University of London hospital, health-care workers discovered their rate of stillbirths had quadrupled between October 2019 and June 2020, from 2.38 to 9.31 per 1,000 births. Their report appeared in JAMA online in July. Nearby Scotland has unfortunately joined the trend as well, according to a Nature analysis of that country’s birth records.
Coronavirus restrictions and fears are putting the squeeze in other areas of health, too, with a marked rise in deaths due to heart disease and diabetes, according to Nature.
Maimuna Majumder, a computational epidemiologist at Harvard Medical School, described the bleak situation for the science journal: “You died from something else, but the reason you died from something else is because the systems that were initially in place to take care of you are no longer strong enough.”