@article{4f4a8bd8191d4b749441862e08ba2eeb,
title = "Reduction in spontaneous and iatrogenic preterm births in twin pregnancies during COVID-19 lockdown in Melbourne, Australia: a multicenter cohort study",
abstract = "Background: Melbourne, Australia, recorded one of the longest and most stringent pandemic lockdowns in 2020, which was associated with an increase in preterm stillbirths among singleton pregnancies. Twin pregnancies may be particularly susceptible to the impacts of pandemic disruptions to maternity care due to their higher background risk of adverse perinatal outcomes. Methods: Multicenter retrospective cohort study of all twin pregnancies birthing in public maternity hospitals in Melbourne. Multivariable log-binomial regression models were used to compare perinatal outcomes between a pre-pandemic group to women in whom weeks 20+0 to 40+0 of gestation occurred entirely during one of two lockdown-exposure periods: exposure 1 from 22 March 2020 to 21 March 2021 and exposure 2 from 22 March 2021 to 27 March 2022. Results: Total preterm births < 37 weeks were significantly lower in exposure 1 compared with the pre-pandemic period (63.1% vs 68.3%; adjusted risk ratio 0.92 95% CI 0.87–0.98, p = 0.01). This was mainly driven by fewer spontaneous preterm births (18.9% vs 20.3%; adjusted risk ratio 0.95 95% CI 0.90–0.99, p = 0.04). There were also lower rates of preterm birth < 34 weeks (19.9% vs 23.0%, adjusted risk ratio 0.93 95% CI 0.89–0.98 p = 0.01) and total iatrogenic births for fetal compromise (13.4% vs 20.4%; adjusted risk ratio 0.94 95% CI 0.89–0.98, p = 0.01). There were fewer special care nursery admissions (38.5% vs 43.4%; adjusted risk ratio 0.91 95% CI 0.87–0.95, p < 0.001) but no significant changes in stillbirth (1.5% vs 1.6%; adjusted risk ratio 1.00 95% CI 0.99–1.01, p = 0.82). Compared with the pre-pandemic period, there were more preterm births < 28 weeks and neonatal intensive care unit admissions in exposure 2. Conclusions: Melbourne{\textquoteright}s first lockdown-exposure period was associated with lower preterm births in twins without significant differences in adverse newborn outcomes. Our findings provide insights into the influences on preterm birth and the optimal timing of delivery for twins.",
keywords = "Coronavirus, COVID-19, Pandemic, Prematurity, Preterm birth, Stillbirth, Twins",
author = "Manno, {Juliana M.} and Marzan, {Melvin B.} and Rolnik, {Daniel L.} and Stephanie Potenza and Natasha Pritchard and Said, {Joanne M.} and Palmer, {Kirsten R.} and Whitehead, {Clare L.} and Sheehan, {Penelope M.} and Jolyon Ford and Mol, {Ben W.} and Walker, {Susan P.} and Lisa Hui",
note = "Funding Information: LH has received research funding from Ferring Pharmaceuticals outside the scope of this work. BWM is a consultant for Guerbet,and has received research grants from Guerbet and Merck. KRP has received consultancy fees from Janssen. DLR has received fees from General Electric, the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and Alexion for lectures and participation in advisory boards, all unrelated to this work. All other authors declare no competing interests. Funding Information: The health services and individual hospitals contributing to the Collaborative Maternity and Newborn Dashboard for the COVID-19 Pandemic are: ∙ Mercy Health (Mercy Hospital for Women, Werribee Mercy Hospital) ∙ The Royal Women{\textquoteright}s Hospital, The Women{\textquoteright}s at Sandringham ∙ Monash Health (Monash Medical Centre, Casey Hospital, Dandenong Hospital) ∙ Northern Health (The Northern Hospital) ∙ Western Health (Joan Kirner Women{\textquoteright}s and Children{\textquoteright}s Hospital) ∙ Eastern Health (Box Hill Hospital, The Angliss Hospital) ∙ Peninsula Health (Frankston Hospital) We thank the health service data managers and research midwives (Tania Fletcher, Lynn Rigg, Michelle Knight, Eleanor Johnson, Abby Monaghan, Pauline Hamilton, Roshanee Perera) for their assistance with primary data collection and Dr Andrew Goldsack for his assistance with coding of the indications for iatrogenic births. The findings of our study were presented at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Scientific Symposium February–March 2022 Melbourne, Australia and at the Perinatal Society of Australia and New Zealand (PSANZ) Annual Congress March 2023 Melbourne, Australia as poster presentations. Funding Information: The Collaborative Maternity and Newborn Dashboard (CoMaND) for the COVID-19 pandemic was funded by the Norman Beischer Medical Research Foundation, and the University of Melbourne Department of Obstetrics and Gynaecology. LH, KRP and BWM are supported by National Health and Medical Research Council investigator grants (GNT1196010, GNT2009765 and GNT11766437). The funding bodies had no role in any aspects of the design or conduct of this study. Publisher Copyright: {\textcopyright} 2023, The Author(s).",
year = "2023",
month = dec,
doi = "10.1186/s12884-023-06137-9",
language = "English",
volume = "23",
journal = "BMC Pregnancy and Childbirth",
issn = "1471-2393",
publisher = "BioMed Central",
number = "1",
}