COVID-19 and Global Perinatal Health: Lessons Learned on Maternal-Neonatal Outcomes, Infant Feeding Practices, and Health Care Economics across Income Settings.

The coronavirus disease 2019 (COVID-19) pandemic fundamentally disrupted health care systems worldwide, with disproportionate consequences for maternal and newborn health. Pregnant individuals and neonates faced both direct clinical consequences of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and indirect effects of health system disruption. This narrative review synthesizes global evidence on the pandemic's impact on perinatal outcomes, neonatal care, breastfeeding practices, and financial burden on health care institutions, contrasting high-income countries (HICs) and low- and middle-income countries (LMICs). PubMed, the World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the Centers for Disease Control and Prevention (CDC) databases were searched for peer-reviewed publications through early 2026. The pandemic increased maternal mortality, stillbirth, and neonatal morbidity, particularly in LMICs, alongside paradoxical preterm birth reductions in some HICs. Vertical SARS-CoV-2 transmission remained infrequent. Neonatal admissions fell while acuity and length of stay increased. Breastfeeding was profoundly disrupted by inconsistent separation policies and infection control measures. Health care institutions absorbed substantial additional costs from screening programs and care pathway reorganization. COVID-19 exposed and exacerbated existing global health inequities in maternal and neonatal care. Evidence-based, context-sensitive policies from the WHO, AAP, and CDC are essential to preserve perinatal care quality during future health emergencies. · COVID-19 worsened maternal and neonatal outcomes, with LMICs bearing the greatest burden.. · Separation policies disrupted breastfeeding; breast milk was confirmed safe and protective.. · Vaccination in pregnancy reduced hospitalization by 62% and stillbirth risk by up to 45%..