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Caniglia EC, Magosi LE, Zash R, Diseko M, Mayondi G, Mabuta J, Powis K, Dryden-Peterson S, Mosepele M, Luckett R, Makhema J, Mmalane M, Lockman S, Shapiro R. Modest reduction in adverse birth outcomes following the COVID-19 lockdown. Am J Obstet Gynecol. 2020 Dec 18:S0002-9378(20)32574-6. doi: 10.1016/j.ajog.2020.12.1198. Epub ahead of print. PMID: 33347842.

Background: Widespread lockdowns imposed during the COVID-19 crisis may impact birth outcomes.

Objective: To evaluate the association between the COVID-19 lockdown and the risk of adverse birth outcomes in Botswana.

Study design: In response to COVID-19, Botswana enforced a lockdown that restricted movement within the country. We used data from an ongoing nationwide birth outcomes surveillance study to evaluate adverse outcomes (stillbirth, preterm birth, small-for-gestational-age [SGA], and neonatal death) and severe adverse outcomes (stillbirth, very preterm birth, very SGA, and neonatal death) recorded pre-lockdown (January 1 – April 2), during lockdown (April 3 – May 7), and post-lockdown (May 8 – July 20). Using difference-in-differences analyses, we compared the net change in each outcome from the pre-lockdown to lockdown periods in 2020 relative to the same two periods in 2017-2019, and the net change in each outcome from the pre-lockdown to post-lockdown periods in 2020 relative to the same two periods in 2017-2019.

Results: 68,448 women delivered a singleton infant in 2017-2020 between January 1 and July 20 and were included in our analysis (mean [interquartile range] age of mothers, 26 [22,32] years). Across the included calendar years and periods, the risk of any adverse outcome ranged from 27.92% to 31.70% and the risk of any severe adverse outcome ranged from 8.40% to 11.38%. The lockdown period was associated with a 0.81 percentage point reduction (95% CI, -2.95%, 1.30%) in the risk of any adverse outcome (3% relative reduction) and a 0.02 percentage point reduction (95% CI, -0.79%, 0.75%) in the risk of any severe adverse outcome (0% relative reduction). The post-lockdown period was associated with a 1.72 percentage point reduction (95% CI, -3.42%, -0.02%) in the risk of any adverse outcome (5% relative reduction) and a 1.62 percentage point reduction (95% CI, -2.69%, -0.55%) in the risk of any severe adverse outcome (14% relative reduction). Reductions in adverse outcomes were largest among women with HIV and among women delivering at urban delivery sites, driven primarily by reductions in preterm birth and SGA.

Conclusions: Adverse birth outcomes decreased from the pre-lockdown to post-lockdown periods in 2020, relative to the change during the same periods in 2017-2019. Our findings may provide insights into associations between mobility and birth outcomes in Botswana and other low- and middle-income countries.

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