Effects of the COVID-19 Pandemic on Maternal and Fetal Outcomes
The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken.
The adverse effects of the COVID-19 pandemic on maternal and perinatal health are not limited to the morbidity and mortality caused directly by the disease itself. Nationwide lockdowns, disruption of health-care services, and fear of attending health-care facilities might also have affected the wellbeing of pregnant people and their babies.
Emerging evidence suggests that rates of stillbirth and preterm birth might have changed substantially during the pandemic. A reduction in health-care-seeking behaviour, as well as reduced provision of maternity services, has been suggested as a possible cause.
Wider societal changes are also echoed in observed changes in maternal health. Intimate-partner violence, already a leading cause of maternal death, has increased during the pandemic and has already been highlighted as a contributor to increased maternal mortality.
Women have been disproportionately more likely to both become unemployed and take on more childcare because of nursery and school closures. The resultant financial and time constraints are likely to have far-reaching consequences for mothers’ physical, emotional, and financial health during pregnancy and in the future.
Global maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. There is an urgent need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises.
Health-care providers planning for service delivery in the ongoing pandemic must consider how to establish robust antenatal care pathways that explicitly reach out to vulnerable individuals and communities. Public health messaging must emphasise the importance of antenatal care, and provide avenues of support for those at risk of intimate-partner violence.
National governments must consider how to support financially vulnerable and socially isolated individuals, considering that each intersecting vulnerability magnifies risk across all contexts.
It is clear that pregnant individuals and babies have been subjected to harm during the pandemic, and the onus is on the academic community, health-care providers, and policy-makers to learn from it. Women’s health-care is often adversely affected in humanitarian disasters and the central importance of planning for robust maternity services in any emergency response.
There remain opportunities to be seized as well as challenges to be faced as we work to end the grip of the pandemic on our global community. Rapid restructuring of maternity care has shown that high-quality remote care can be facilitated, reductions in hospital stay can be achieved, and apparently intractable and entrenched problems can be transformed by the concerted application of funding, scientific enquiry, and political will.
We can prioritise safe and accessible maternity care during the pandemic and the aftermath, while planning for a future of radically inclusive and equitable maternity care that will draw on the lessons of this pandemic to reduce preterm birth, stillbirth, and maternal mortality worldwide.
The Author is a Consumer Rights Advocate at Consumer Grassroots Association, Kenya.