Calvert, Clara, Brockway, Meredith (Merilee), Zoega, Helga, Miller, Jessica E., Been, Jasper V., Amegah, Adeladza Kofi, Racine-Poon, Amy, Oskoui, Solmaz Eradat, Abok, Ishaya I., Aghaeepour, Nima, Akwaowo, Christie D., Alshaikh, Belal N., Ayede, Adejumoke I., Bacchini, Fabiana, Barekatain, Behzad, Barnes, Rodrigo, Bebak, Karolina, Berard, Anick, Bhutta, Zulfiqar A., Brook, Jeffrey R., Bryan, Lenroy R., Cajachagua-Torres, Kim N., Campbell-Yeo, Marsha, Chu, Dinh Toi, Connor, Kristin L., Cornette, Luc, Cortés, Sandra, Daly, Mandy, Debauche, Christian, Dedeke, Iyabode Olabisi F., Einarsdóttir, Kristjana, Engjom, Hilde, Estrada-Gutierrez, Guadalupe, Fantasia, Ilaria, Fiorentino, Nicole M., Franklin, Meredith, Fraser, Abigail, Gachuno, Onesmus W., Gallo, Linda A., Gissler, Mika, Håberg, Siri E., Habibelahi, Abbas, Häggström, Jonas, Hookham, Lauren, Hui, Lisa, Huicho, Luis, Hunter, Karen J., Huq, Sayeeda, Kc, Ashish, Kadambari, Seilesh, Kelishadi, Roya, Khalili, Narjes, Kippen, Joanna, Le Doare, Kirsty, Llorca, Javier, Magee, Laura A., Magnus, Maria C., Man, Kenneth K.C., Mburugu, Patrick M., Mediratta, Rishi P., Morris, Andrew D., Muhajarine, Nazeem, Mulholland, Rachel H., Bonnard, Livia Nagy, Nakibuuka, Victoria, Nassar, Natasha, Nyadanu, Sylvester D., Oakley, Laura, Oladokun, Adesina, Olayemi, Oladapo O., Olutekunbi, Olanike A., Oluwafemi, Rosena O., Ogunkunle, Taofik O., Orton, Chris, Örtqvist, Anne K., Ouma, Joseph, Oyapero, Oyejoke, Palmer, Kirsten R., Pedersen, Lars H., Pereira, Gavin, Pereyra, Isabel, Philip, Roy K., Pruski, Dominik, Przybylski, Marcin, Quezada-Pinedo, Hugo G., Regan, Annette K., Rhoda, Natasha R., Rihs, Tonia A., Riley, Taylor, Rocha, Thiago Augusto Hernandes, Rolnik, Daniel L., Saner, Christoph, Schneuer, Francisco J., Souter, Vivienne L., Stephansson, Olof, Sun, Shengzhi, Swift, Emma M., Szabó, Miklós, Temmerman, Marleen and Wong, Ian C.K. (2023). Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries. Nature Human Behaviour, 7 (4), pp. 529-544.
Abstract
Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value <0.0001), second (0.96, 0.92–0.99, 0.03) and third (0.97, 0.94–1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96–1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88–1.14, 0.98), third (0.99, 0.88–1.12, 0.89) and fourth (1.01, 0.87–1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02–1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03–1.15, 0.002), third (1.10, 1.03–1.17, 0.003) and fourth (1.12, 1.05–1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
| Publication DOI: | https://doi.org/10.1038/s41562-023-01522-y |
|---|---|
| Divisions: | College of Health & Life Sciences > Aston Pharmacy School Aston University (General) |
| Funding Information: | Funding and in-kind support: This work was supported by the International COVID-19 Data Alliance (ICODA), an initiative funded by the Bill and Melinda Gates Foundation and Minderoo as part of the COVID-19 Therapeutics Accelerator and convened by Health Da |
| Additional Information: | Copyright © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/. |
| Uncontrolled Keywords: | Social Psychology,Experimental and Cognitive Psychology,Behavioral Neuroscience |
| Publication ISSN: | 2397-3374 |
| Data Access Statement: | Extended data is available for this paper at https://doi.org/10.1038/s41562-023-01522-y. |
| Last Modified: | 15 Jul 2025 07:14 |
| Date Deposited: | 14 Jul 2025 11:25 |
| Full Text Link: | |
| Related URLs: |
http://www.scop ... tnerID=8YFLogxK
(Scopus URL) https://www.nat ... 562-023-01522-y (Publisher URL) |
PURE Output Type: | Article |
| Published Date: | 2023-04 |
| Published Online Date: | 2023-02-27 |
| Accepted Date: | 2023-01-06 |
| Authors: |
Calvert, Clara
Brockway, Meredith (Merilee) Zoega, Helga Miller, Jessica E. Been, Jasper V. Amegah, Adeladza Kofi Racine-Poon, Amy Oskoui, Solmaz Eradat Abok, Ishaya I. Aghaeepour, Nima Akwaowo, Christie D. Alshaikh, Belal N. Ayede, Adejumoke I. Bacchini, Fabiana Barekatain, Behzad Barnes, Rodrigo Bebak, Karolina Berard, Anick Bhutta, Zulfiqar A. Brook, Jeffrey R. Bryan, Lenroy R. Cajachagua-Torres, Kim N. Campbell-Yeo, Marsha Chu, Dinh Toi Connor, Kristin L. Cornette, Luc Cortés, Sandra Daly, Mandy Debauche, Christian Dedeke, Iyabode Olabisi F. Einarsdóttir, Kristjana Engjom, Hilde Estrada-Gutierrez, Guadalupe Fantasia, Ilaria Fiorentino, Nicole M. Franklin, Meredith Fraser, Abigail Gachuno, Onesmus W. Gallo, Linda A. Gissler, Mika Håberg, Siri E. Habibelahi, Abbas Häggström, Jonas Hookham, Lauren Hui, Lisa Huicho, Luis Hunter, Karen J. Huq, Sayeeda Kc, Ashish Kadambari, Seilesh Kelishadi, Roya Khalili, Narjes Kippen, Joanna Le Doare, Kirsty Llorca, Javier Magee, Laura A. Magnus, Maria C. Man, Kenneth K.C. Mburugu, Patrick M. Mediratta, Rishi P. Morris, Andrew D. Muhajarine, Nazeem Mulholland, Rachel H. Bonnard, Livia Nagy Nakibuuka, Victoria Nassar, Natasha Nyadanu, Sylvester D. Oakley, Laura Oladokun, Adesina Olayemi, Oladapo O. Olutekunbi, Olanike A. Oluwafemi, Rosena O. Ogunkunle, Taofik O. Orton, Chris Örtqvist, Anne K. Ouma, Joseph Oyapero, Oyejoke Palmer, Kirsten R. Pedersen, Lars H. Pereira, Gavin Pereyra, Isabel Philip, Roy K. Pruski, Dominik Przybylski, Marcin Quezada-Pinedo, Hugo G. Regan, Annette K. Rhoda, Natasha R. Rihs, Tonia A. Riley, Taylor Rocha, Thiago Augusto Hernandes Rolnik, Daniel L. Saner, Christoph Schneuer, Francisco J. Souter, Vivienne L. Stephansson, Olof Sun, Shengzhi Swift, Emma M. Szabó, Miklós Temmerman, Marleen Wong, Ian C.K. ( 
0000-0001-8242-0014)
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