Perinatal Health and Healthcare Utilisation During the COVID-19 Pandemic: A Nationwide Interrupted Time Series Analysis.

BACKGROUND

Perinatal health was profoundly affected as a result of the socioeconomic hardships and public health measures during the COVID-19 pandemic. Few studies have evaluated changes and disparities in perinatal health using population-based data and rigorous methods.

OBJECTIVE

To examine changes related to the COVID-19 pandemic in perinatal health and healthcare utilisation.

METHODS

Using population-based data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (N = 116,170), we employed a Bayesian structural time-series approach to examine deviations in perinatal health and healthcare utilisation outcomes from predicted trends following the onset of the COVID-19 pandemic in March 2020, adjusting for covariates.

RESULTS

The onset of the COVID-19 pandemic was associated with delayed prenatal care initiation (1.1%, 95% confidence interval [CI] 0.2, 2.0), reduced prenatal care (-2.8%, 95% CI -3.6, -1.7), reduced postpartum visits (-1.0%, 95% CI -1.5, -0.4), and increased gestational hypertension (11.1%, 95% CI 5.4, 16.7), gestational diabetes mellitus (GDM), (17.6%, 95% CI 10.1, 26.2), and prenatal depression (7.3%, 95% CI 1.9, 13.0). Stratified models showed that Black participants experienced earlier prenatal care initiation; Native American participants experienced lower prenatal care visits and greater increases in gestational hypertension and GDM; Asian/Pacific Islander participants experienced delayed prenatal care initiation and heightened prenatal depression and postnatal depressive symptoms; and Hispanic participants experienced higher GWG and reduced postpartum visits.

CONCLUSIONS

As perinatal health imparts enduring impacts for pregnant people and infants, this study provides insight into the pandemic's potentially long-lasting population health effects. Future work should examine longer-term trends and how pandemic-related policies contributed to disparate impacts.