LAUSR

OBJECTIVE To explore the effect of SARS CoV-2 pandemic on preterm birth at different gestational ages and fetal death in the state of Michigan. METHODS Data on live births and fetal deaths in the state of Michigan from March- November in the years 2017 through 2020 were obtained from Michigan Department of Health and Human Services (MDHHS). Preterm birth rate, fetal death rate (per 1,000 live births) overall and stratified by race and maternal comorbidities during the period of pandemic (March-November 2020) were compared with the same period (March- November) in the pre-pandemic years (2017-2019). RESULTS Of 328,879 live births and 1,470 fetal deaths during the study period, 77,983 live births and 242 fetal deaths were reported in 2020. Compared with pre-pandemic years, fetal death rate per 1,000 live births was significantly lower in 2020 [3.1 vs.4.7 (2017), 5.2(2018), 4.4(2019), p-value <0.001]. The adjusted risk for fetal death in 2020 was decreased [OR 0.64 (95% CI 0.56-0.74), p<0.0001], compared to pre-pandemic years. Fetal death was significantly associated with African American race, pregnancy hypertension and pre-pregnancy diabetes. No significant difference in the proportion of preterm births (< 37 weeks gestation) was noted between pandemic and pre-pandemic years (9.9% vs. 10.0%, p=0.50). There was no significant difference in the risk of preterm birth across gestational age strata (<28 weeks, 28 - 31 6/7 weeks, 32-36 6/7 weeks, 37-41 6/7 weeks and >42 weeks) between pandemic and pre-pandemic years on multinomial analysis. Significant associations with preterm birth across all years included African American race, lower level of maternal education, pregnancy induced hypertension, chronic hypertension, pre-pregnancy diabetes, congenital anomalies, previous preterm birth and prolonged rupture of membranes > 12 hours. CONCLUSION Fetal death rate was significantly lower whereas preterm births remained unchanged during pandemic in comparison with pre-pandemic years in the state of Michigan.