Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

Rosemary Townsend; Barbara Chmielewska; Imogen Barratt; Erkan Kalafat; Jan van der Meulen; Ipek Gurol-Urganci; Pat O'Brien; Edward Morris; Tim Draycott; Shakila Thangaratinam; Kirsty Le Doare; Shamez Ladhani; Peter von Dadelszen; Laura A Magee; Asma Khalil

doi:10.1016/j.eclinm.2021.100947

Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

EClinicalMedicine. 2021 Jun 19:37:100947. doi: 10.1016/j.eclinm.2021.100947. eCollection 2021 Jul.

Authors

Rosemary Townsend^{1

2}, Barbara Chmielewska³, Imogen Barratt³, Erkan Kalafat^{4

5}, Jan van der Meulen⁶, Ipek Gurol-Urganci⁶, Pat O'Brien^{6

7

8}, Edward Morris^{7

9}, Tim Draycott^{7

10}, Shakila Thangaratinam¹¹, Kirsty Le Doare¹², Shamez Ladhani^{12

13

14}, Peter von Dadelszen¹⁵, Laura A Magee¹⁵, Asma Khalil^{2

3}

Affiliations

¹ Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
² Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom.
³ Fetal Medicine Unit, St George's Hospital, St George's University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom.
⁴ Middle East Technical University, Faculty of Arts and Sciences, Department of Statistics, Ankara, Turkey.
⁵ Koc University, School of Medicine, Department of Obstetrics and Gynaecology, Istanbul, Turkey.
⁶ Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom.
⁷ The Royal College of Obstetricians and Gynaecologists, London, United Kingdom.
⁸ University College London Hospitals NHS Foundation Trust, London, United Kingdom.
⁹ Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, United Kingdom.
¹⁰ North Bristol NHS Trust Department of Women's Health, Westbury on Trym, United Kingdom.
¹¹ Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, United Kingdom.
¹² Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, United Kingdom.
¹³ Immunisation and Countermeasures Division, Public Health England, United Kingdom.
¹⁴ British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, United Kingdom.
¹⁵ Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.

Abstract

Background: The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic.

Methods: We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI).

Findings: Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486-0776, P<00001, I²=54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602-0911, P = 00046, I²=00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762-2794, P<00001, I²=90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118-1319, P<00001, I²=00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407-0690, P<00001, I²=00%). There was no significant change in intrapartum epidural use (P = 00896) or the use of GA for elective CS (P = 079).

Interpretation: Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.