Background: Preterm birth rates may have been affected during the COVID- 19 pandemic but the impact of this on perinatal morbidity is unknown. Aim: To review the impact of the COVID- 19 pandemic on rates of preterm birth and perinatal mortality. Methods: Medline, Embase, and online pre- prints were searched from Jan 2020 to Oct 2022. Case–control, cohort studies and reports comparing rates of preterm birth, stillbirth and neonatal death before and during the COVID- 19 pandemic period were included. The pooled odds ratio (OR) for preterm birth, stillbirth and neonatal death was calculated using a random effects model. The primary outcome was the rate of preterm birth, stillbirth and neonatal death in the pre- pandemic and pandemic periods. Results: 100 studies were included. Compared with pre- pandemic periods, there was a decrease in preterm births during the pandemic period: OR 0.95 (95% CI 0.94–0.97) I2 = 0.93, with the greatest reduction for births < 28 weeks' gestation in high- income countries: OR 0.92 (95% CI 0.88–0.96), I2 = 0.46. There was a reduction in neonatal deaths in high- income countries: OR 0.78 (95% CI 0.64–0.95), I2 = 0.4. In low- and middle- income countries the stillbirth rate increased during the pandemic compared with the pre- pandemic period: OR 1.18 (95% CI 1.02–1.36), I2 = 0.86. Conclusion: The COVID- 19 pandemic was associated with a reduction in preterm births and neonatal deaths. Further research is needed to investigate the mechanisms underlying these findings. Stillbirth rates increased in low- and middleincome countries where access to healthcare may have been restricted and strategies to address this in future pandemics are warranted.
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