Fellow, PGY6 UPMC Pittsburgh, Pennsylvania, United States
Background: American healthcare delivery changed rapidly during the COVID-19 pandemic and markers of psychosocial stress rose. Access to healthcare and maternal stress are both known to impact fetal and newborn health. High-risk birthing persons with chronic conditions monitored closely during pregnancy, diabetes (DM) and hypertension (HTN), and their offspring are particularly vulnerable.
Objective: This study aims to evaluate the impact of pandemic-era obstetric care and obstetric patient behaviors on adverse neonatal outcomes in the newborn population at Magee-Womens Hospital (MWH), a tertiary care center serving Western Pennsylvania.
Design/Methods: This retrospective, descriptive study compares infant data over a year-long, pandemic-era period (PE: May 2020-April 2021, n=9503) to a pre-pandemic, control period (C: January 2019-February 2020, n=9465). Incidence rates of adverse neonatal outcomes 1) associated with DM and HTN and 2) resulting from acute perinatal stress were extracted from MWH’s own maternal and neonatal databases. Control and study groups were compared using chi-square tests, Fisher’s exact test, independent t-tests and Mann-Whitney U tests where appropriate.
Results:
PE obstetric patients presented at an earlier average gestational age (GA) for their first prenatal visit (p < 0.001) but had significantly fewer visits overall (p < 0.001) than C patients. They had a higher proportion of depression (p < 0.001) as well as THC use (p=0.002) compared to the C group. There was a decrease in preterm births (p=0.009), an increase in induced deliveries (p < 0.05) and a decrease in newborn length of stay (p < 0.001, LOS) with no change in average GA or birthweight (BW). There was an increase (p < 0.001) in the incidence of fetal distress at delivery but no associated change in neonatal diagnoses associated with acute perinatal stress (Table 1).
There was a significant increase in DM (p=0.017) and HTN (p=0.019) in the PE group. Infants born to diabetics (IDMs) in the C group had smaller BW (p=0.03). There was no change in the proportion of IDMs admitted to the NICU; those that were had significantly lower GA (p < 0.001) and BW (p = 0.003) and significantly longer LOS (p < 0.001) than those born during the control period (Table 2). There were no differences in outcomes of infants born to hypertensives.
Conclusion(s): Despite PE increases in DM, HTN and fetal distress at delivery, there were few differences in neonatal outcomes. These findings demonstrate the general population’s resilience to PE care and stress and highlight a unique impact on infants born to diabetics. APRandall CVAlice Randall CV Oct 2021.pdf Tables 2 and 3Selected IDM Outcomes
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Selected IDM Outcomes