Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile Application: Retrospective Cohort Study.

Noddin, Katie; Bradley, Dani; Wolfberg, Adam

BACKGROUND The COVID-19 pandemic has presented obstacles for providers and patients in the maternal healthcare setting, causing changes to many pregnant women's birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal healthcare landscape at the national level in the United States. OBJECTIVE To assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, home births, and length of hospital stay) during the COVID-19 pandemic as compared to the six months prior. METHODS We conducted a retrospective cohort study of women ages 18-44 in the US who delivered between October 1, 2019 and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile application. Women were assigned to the pre-pandemic cohort if they delivered between October and March, and the during-pandemic cohort if they delivered between April and September. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. RESULTS A total of 304,023 birth reports were collected with 152,832 (50.26%) in the pre-pandemic cohort and 151,191 (49.73%) in the during-pandemic cohort. Compared to the pre-pandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the during-pandemic cohort (P<.001; OR = 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR = 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay post-delivery (mean 2.48 days (SD 1.35)). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age and race and ethnicity subgroups. CONCLUSIONS Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses, and the important role of digital data collection, particularly during the pandemic. CLINICALTRIAL