Maternal Health against the Backdrop of COVID-19
January 21, 2021
The COVID-19 pandemic has affected many aspects of patients’ health and the healthcare system writ large, including maternal health. Pregnant women have been found to be at increased risk for severe illness from COVID-19 compared to people who are not pregnant. In addition, among pregnant women with COVID-19, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth. During the COVID-19 pandemic, pregnant women have experienced heightened stress and anxiety.
To study the impact of the pandemic on maternity services and maternal and neonatal health in the United States, FAIR Health analyzed data from its database of over 32 billion private healthcare claim records, the nation’s largest such repository. The analysis focused on month-by-month changes from January to September 2019 compared to the same months in 2020. Key findings are presented in an infographic and described below.
The share of deliveries performed by obstetricians/gynecologists (OB/GYNs) increased 14.7 percent from January to September 2020. This is in contrast to the corresponding months in 2019, which saw a decrease of 1.4 percent. The month in 2020 in which deliveries by OB/GYNs first outpaced the corresponding month in 2019 was April, at the height of the spring wave of the pandemic. In April 2020, 61.7 percent of all deliveries were by OB/GYNs, compared to 60.3 percent in April 2019.
OB/GYNs may have been more sought after during the pandemic than some other specialties that participate in deliveries, such as nurse practitioners and physician assistants—both of whom had their percentage of deliveries decline—because pregnant women wanted to plan their deliveries, by induced labor or elective C-sections. That way, they and their partners could be tested for COVID-19 and found negative before delivery. C-sections increased 6.09 percent from January to September 2020.
A birthing center is a facility that is not a hospital or in a hospital and where births are planned to take place away from the mother’s home following a normal, uncomplicated (low-risk) pregnancy. From April 2019 to April 2020, deliveries in birthing centers increased 172.22 percent.
The rise in use of birthing centers during the COVID-19 pandemic may be due in part to pregnant women seeking an alternative to hospitals, both to avoid contracting the disease and to be able, potentially, to have more visitors.
Gestational diabetes, diabetes that occurs only during pregnancy, increased 24.09 percent from January to September 2020. By comparison, diagnoses of the condition grew 6.38 percent during the same months in 2019.
The greater increase in gestational diabetes in 2020 than the year before may be related to conditions during the pandemic. Risk factors for gestational diabetes include overweight and obesity, as well as a lack of physical activity. Because many people, pregnant and otherwise, have been sheltering in place in response to the pandemic, many have been exercising less and eating more (partly in reaction to stress), resulting in weight gain.
Neonatal Withdrawal Syndrome
Diagnoses of neonatal withdrawal syndrome, or neonatal abstinence syndrome, a group of problems that occur in newborns exposed to opioids in the uterus, increased 17.82 percent in the single month from April to May 2020. By comparison, diagnoses of the syndrome decreased 19.74 percent in the same month in 2019.
From May to July 2020, diagnoses of neonatal withdrawal syndrome stayed above the levels reached in the corresponding months of 2019. This may be due to increases in substance use, which have been documented internationally during the COVID-19 pandemic. For example, CDC surveys in the United States in June 2020 found that 13.3 percent of respondents had initiated or increased substance use to cope with COVID-19-associated stress.
Newborns Affected by Other Maternal Medications
Diagnoses of newborns affected by other maternal medications, which include prescribed drugs such as antidepressants and antianxiety medications, increased 31.37 percent in the single month from February to March 2020. From March to September 2020, such diagnoses stayed above the levels reached in the corresponding months of 2019.
Antidepressants and antianxiety drugs may have been prescribed more in 2020 because both depression and anxiety increased during the pandemic. A CDC study found that the prevalence of depression reported in June 2020 was approximately four times that reported in the second quarter of 2019, and the prevalence of anxiety in June 2020 was about three times that in the second quarter of 2019.
For an infographic on some of these findings, click here.
If you are interested in more detailed information regarding the impact of COVID-19 on maternal health, contact FAIR Health by email at email@example.com or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.