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Small blessings: Pre-term births drop during lockdowns

New research from Australia and around the world suggests that the premature birth rate declined during COVID-19 lockdowns. The findings have surprised experts and have provoked discussion around the lessons for managing pregnancies as lives return to pre-pandemic pace. Greg Hall reports.

Small blessings: Pre-term births drop during lockdowns

Baby Douglas at six months with sister, Obelia. Photo provided by Cara Skeen.

Words by Greg Hall
 

Eight-month-old Douglas Irvin is a bouncing, blue-eyed picture of health. But he came into the world in dramatic fashion – ten weeks early and in the middle of a pandemic.

Cara Skeen, who gave birth by emergency caesarean, vividly recalls the shock of her son’s sudden arrival: “He was in distress and he needed to come out … I had reduced foetal movements at 3 am, I got to the hospital at 4 am and I was in theatre at 6 am.”

Giving birth to a premature baby can be a frightening experience and scientists are yet to understand why some babies arrive prematurely. But a curious thing happened during Australia’s lockdowns. Cases like that of Cara Skeen’s were noticeably fewer. And researchers have now documented a marked decline in premature birth rates during COVID-19 lockdowns.

The findings reflect a number of international studies from other high income countries – the Netherlands, Ireland and Denmark – that came to the same conclusion.

“When the pandemic started in 2020, within a few months we started to notice a drop in our bed occupancy in the neonatal units,” says Associate Professor and neonatologist Dr Atul Malhotra. When reports started to emerge from Europe about a drop in pre-term births, Dr Malhotra and his team at Monash Health thought: “Okay, we probably need to look at this from our own perspective.” He points out that his team’s findings, published in the Australian and New Zealand Journal of Gynaecology, are indicative of a high income country with good medical facilities and low COVID-19 transmission rates.

In Brisbane, too, special care nursery wards were unusually quiet at the start of the pandemic. Dr Linda Gallo, a medical researcher and lecturer based at the University of the Sunshine Coast also studied the association: “We found pretty much what was being reported … that there was a profound reduction in pre-term births.”

In addition, both the Brisbane and the Melbourne studies found that there was no corresponding increase in adverse birth outcomes such as still birth, which suggests that something about lockdown lifestyle was very good for babies.

While the question of what that something is remains unclear, the findings are nonetheless exciting, says Dr Gallo. “The longer the baby can stay up until the maximum of 41 – 42 weeks the better.” Prematurity can be associated with a number of neurological and physical conditions later in life, and – as Skeen discovered – it can also make for a very difficult birthing experience.

Almost immediately after his arrival, baby Douglas was rushed to the NCIU (Neonatal Intensive Care Unit) where he remained for a month. Because Skeen and her partner were in the middle of an isolation period following exposure to COVID-19 from their three-year-old daughter’s day care, they were treated as suspected COVID patients: “We weren’t allowed to see him [Douglas] for the remaining five days of our isolation.”

Baby Douglas was born 10 weeks premature. Photo provided by Cara Skeen.

Baby Douglas was born 10 weeks premature. Photo provided by Cara Skeen.

While the long separation due to COVID protocols is unusual, premature babies are commonly separated from their mothers immediately for treatment and taken to a different ward.

Douglas, who weighed just over 1.5 kilograms, did not have many major health complications. But he spent his first few days alone in an incubator swaddled in bubble wrap, wearing a CPAP (continuous positive airway pressure) device and being fed through a tube as he was too young to feed.

“When we finally got to see him … he was in the isolette” [incubator] says Skeen. “You’re just presented with your baby in a weird little isolette fish bowl and the only thing that you can do when you first walk in is just open a little window and put your hand on them.”

“When he was born he was so little we were discouraged from holding him too much … It meant only one person could have one cuddle of him per day … We had to kind of ask permission to hold our baby.”

For the next month, Skeen spent between 4 and 5 hours at the hospital every day to be with her tiny son and pump breast milk.

First cuddle with baby Douglas. Photo provided by Cara Skeen.

First cuddle with baby Douglas. Photo provided by Cara Skeen.

The exact reason for the reduction in pre-term births occurring during lockdowns remains the subject of further study.

Researchers have hypothesized that the reduced pre-term birth rate may have something to do with working from home, reduced exposure to air pollution, decreased health-seeking behaviour resulting in fewer planned pre-term births, or better hygiene and social distancing resulting in fewer infections from common pathogens.

“We think perhaps it could be related to reductions in work and social-related stress” says Dr Gallo. “That is the main theory or hypothesis at the moment” says Gallo, but further interrogation is required.

The discovery raises interesting and potentially controversial questions about whether age-old advice that pregnant women should stay home and rest was correct after all.

However, both Gallo and Malhotra state that not enough is understood at this point to change the advice given to pregnant women. Dr Malhotra is also quick to point out that “physical activity and exercise actually decreases some of the complications for pregnancy so it’s definitely not a good idea to be sedentary and stay at home.”

A new global consortium of researchers is now examining the connection between COVID lockdowns, pre-term births and regional trends. For now, at least, researchers are one baby step closer to working out the mysteries of premature birth which is good news for families like Skene’s.

When Skene and her partner reflect on what it is like to raise a premmie, they say that Douglas had an extended baby phase. “We had an extra 10 weeks of him just being this tiny little baby that feeds every three hours.” They also reflect that the early arrival of Douglas brought out a lot of support from family and friends.

But the hardest thing, says Skene, was that first month in hospital. “Walking out of a hospital without your baby and having to do that every day for a month … It’s so unnatural.”

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