25 - The impact of COVID-19 on perinatal outcomes and delivery locations in U.S. metropolitan area

Poster Number: 25

Esther Lee, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Alejandra B. B Perez, Rush Medical College of Rush University Medical Center, Chicicago, IL, United States; ARTH PATEL, Rush University, Chicago, IL, United States; Aloka L. Patel, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Kousiki Patra, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Thaddeus Waters, Rush Medical College of Rush University Medical Center, Chicago, IL, United States; Tricia J. Johnson, Rush University, Chicago, IL, United States

Background: Preterm birth is a leading cause of morbidity and mortality worldwide. Reductions in preterm birth rates in Europe and the US have been reported during the COVID-19 pandemic, and no study has evaluated the impact of COVID-19 on preterm births based on delivery hospital type and insurance payers.

Objective:
To investigate 1) rates of preterm births preceding and during the COVID-19 pandemic in the Chicago metropolitan area; 2) shifts in delivery location between academic medical centers (AMC) and community hospitals during COVID-19; and 3) impact of insurance and socioeconomic status (SES) on outcomes.

Design/Methods: We examined 93,762 birth records from the Illinois COMPdata for 8 Chicago metropolitan counties. We compared births from April to Sept 2020 during the COVID-19 stay-at-home mandate and Phase 3 opening to births from April to Sept 2019 as the pre-COVID-19 cohort. We compared preterm birth rates ( < 37 weeks), hospital designation (AMC versus community) and primary payer (private, Medicaid, uninsured, other). We preformed binary logistic regression analyses, adjusting for infant demographic characteristics and SES using Stata version 17.

Results: There were no differences in the preterm birth rate (9.4% pre-COVID-19 vs. 9.1% during COVID-19) or gestational age categories after adjusting for infant demographics and SES. There was a statistically significant difference in birth location with 21.9% (pre-COVID-19) vs. 22.9% (during COVID-19) of deliveries occurring at AMCs. Term infants were 3.4 percentage points (95% CI: 2.9, 4.2) and preterm infants were 5.1 percentage points (95% CI: 2.8, 7.5) more likely to be born in an AMC during COVID-19 versus pre-COVID-19, after adjusting for infant demographics and SES. Term infants with Medicaid were 1.6 percentage points less likely (95% CI: -2.4, -0.8) and preterm infants with Medicaid were 3.1 percentage points less likely (95% CI: -5.8, -4.0) to be born in an AMC during COVID-19.
 Conclusion(s): COVID-19 was not associated with a change in preterm birth rates in the Chicago metropolitan area. There was an overall shift in both term and preterm deliveries towards AMCs, which was primarily accounted for by infants with private insurance. Further research is needed to determine whether other factors including distance to hospital, indication for delivery and obstetric referral patterns may explain these disparate outcomes.
Preterm Births by Month as a Percent of Total Births Pre and During COVID-19
Figure 2. Average Marginal Effect of COVID-19: Difference in Probability of AMC Birth (During to Pre- COVID-19)*Models adjust for preterm birth, infant race/ethnicity, infant sex, infant primary payer, and neighborhood socioeconomic status (% of population working, percent of households living below the federal poverty level, percent of households receiving SNAP or food stamps, % of housing units that are crowded, percent of population uninsured, percent of adults age 25 and older with at least a high school degree, percent of households without a computer, percent of households without a smart phone).