'Alarming' Uptick In Stillbirths During COVID Pandemic, But Jury Still Out

A study from the U.K. shows an increase in stillbirths during the COVID-19 pandemic and the study team says a direct consequence of SARS-CoV-2 infection is possible.

They compared pregnancy outcomes at St. George's University Hospital in London in the pre-COVID-19 period of October 1, 2019, to January 31, 2020 and the pandemic period of February 1, 2020, to June 14, 2020.

The incidence of stillbirth was significantly higher during the pandemic period (16 of 1,718 births; 9.31 per 1,000 births) than the prepandemic period (four of 1,681 births; 2.38 per 1,000), a difference of 6.93 stillbirths per 1,000 births.

"The observed increase in stillbirth during the COVID-19 pandemic is alarming, but it confirms the anecdotal reports of excess cases of unexplained stillbirth by a number of clinicians," Dr. Asma Khalil of St. George's University Hospitals told Reuters Health by email.

There were no significant differences between the two time periods for preterm births, admission to the neonatal unit or cesarean delivery.

None of the stillbirths in the pandemic period were in women diagnosed with COVID-19, but surveillance studies in pregnant women have shown that the vast majority of SARS-CoV-2-positive cases were asymptomatic. And until recently, testing in the U.K. was limited to symptomatic people requiring hospital admission, Dr. Khalil and colleagues note in JAMA.

Alternatively, they say the uptick in stillbirths may be due to indirect effects such as a reluctance to go to the hospital when needed (such as in the case of reduced fetal movements), fear of contracting COVID-19, or not wanting to further burden the National Health Service. Changes in obstetric services may also have played a role.

"Pregnant women should seek medical advice if they have any concerns, including reduced fetal movements. Healthcare professionals should ensure that pregnant women know whom to contact and what to do if they have any worries in any future pandemics," Dr. Khalil told Reuters Health.

Limitations of the analysis include its retrospective design, single-center setting, small numbers, short time frame and lack of information on the causes of stillbirths.

Commenting on the study in a joint email to Reuters Health, Dr. Joanne Stone and Dr. Angela Bianco, OBGYNs at the Icahn School of Medicine at Mount Sinai in New York, said, "It is difficult to draw conclusions based on a single study with a small study population. If there is truly an increased rate of stillbirth it is unclear what the underlying etiology is given the SARS-CoV-2 status may not have been known and other risk factors/co-morbidities were not assessed."

"Additionally this was not a matched cohort of women pre- and post-pandemic; therefore comparisons may not be valid. We await publication of additional data to more effectively counsel our patients but of course encourage mitigation techniques including physical distancing, mask wearing and proper hand hygiene," said Dr. Stone, director of Maternal Fetal Medicine for the Mount Sinai Health System, and Dr. Bianco, associate professor of obstetrics, gynecology, and reproductive science.

—Megan Brooks

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