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The association of COVID-19 lockdowns with adverse birth and pregnancy outcomes in 28 high-income countries: a systematic review and meta-analysis

Author

Listed:
  • Iona Hindes

    (Queen Mary University London)

  • Hawa Nuralhuda Sarwar

    (Queen Mary University London)

  • Benjamin Y. Gravesteijn

    (Amsterdam University Medical Centre)

  • Jennifer Jardine

    (Queen Mary University London)

  • Lizbeth Burgos-Ochoa

    (University Medical Centre Rotterdam
    Tilburg University)

  • Jasper V. Been

    (University Medical Centre Rotterdam
    University Medical Centre Rotterdam
    University Medical Centre Rotterdam)

  • Dominik Zenner

    (Queen Mary University London)

  • Stamatina Iliodromiti

    (Queen Mary University London)

Abstract

We conducted a systematic review and meta-analysis to review the association of lockdowns with adverse birth and pregnancy outcomes (ABPOs) and related inequalities, in high-income countries (HICs). Databases (EMBASE, MEDLINE/PubMed and Web of Science) were searched from 1 January 2019 to 22 June 2023 for original observational studies based in HICs that compared the rates of ABPOs, before and during lockdowns. The risk of bias was assessed using the Newcastle–Ottawa tool for cohort studies. We ran random-effects meta-analyses and subgroup analyses per region, lockdown period, ethnicity group and deprivation level and adjusted for underlying temporal trends. A total of 132 studies were meta-analysed from 28 HICs. Reduced rates of preterm birth (reported by 26 studies) were associated with the first lockdown (relative risk 0.96, 95% confidence interval 0.93–0.99), 11 studies adjusted for long-term trends and the association remained (0.97, 0.95–0.99), and subgroup analysis found that this association varied by continental region. Ten studies reported positive screening rates for possible depression antenatally, and lockdown was associated with increases in positive screening rates (1.37, 1.06–1.78). No other ABPOs were associated with lockdowns. Investigation of inequalities was limited due to data availability and heterogeneity; further research is warranted on the effect of lockdowns on health inequalities. This study was funded by the National Institute of Health Research, School of Primary Care Research and registered on PROSPERO (CRD42022327448).

Suggested Citation

  • Iona Hindes & Hawa Nuralhuda Sarwar & Benjamin Y. Gravesteijn & Jennifer Jardine & Lizbeth Burgos-Ochoa & Jasper V. Been & Dominik Zenner & Stamatina Iliodromiti, 2025. "The association of COVID-19 lockdowns with adverse birth and pregnancy outcomes in 28 high-income countries: a systematic review and meta-analysis," Nature Human Behaviour, Nature, vol. 9(7), pages 1420-1430, July.
    • Handle: RePEc:nat:nathum:v:9:y:2025:i:7:d:10.1038_s41562-025-02139-z
    DOI: 10.1038/s41562-025-02139-z
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    References listed on IDEAS

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    1. Daniela Pereira & Brigite Wildenberg & Andreia Gaspar & Carolina Cabaços & Nuno Madeira & António Macedo & Ana Telma Pereira, 2022. "The Impact of COVID-19 on Anxious and Depressive Symptomatology in the Postpartum Period," IJERPH, MDPI, vol. 19(13), pages 1-13, June.
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